CNS Infections Flashcards
1
Q
tumbling motility at room temp (37)
A
Listeria
2
Q
grows at 4 degrees C
A
listeria
3
Q
high risk patients for listeria
A
neonates
pregnant women (20 fold increase)
patients with defective or cell mediated immunity
4
Q
refrigeration is not sufficient to kill
A
listeria
5
Q
how is early onset listeria acquired in neonates?
A
transplacentally
**80 mortality
6
Q
disseminated abscesses and granulomas in multiple organs
A
granulomatosis infanticeptica
7
Q
how is late onset listeria acquired?
A
at birth or soon after
8
Q
late onset listeria presents 2-3 weeks after birth with
A
meningoencephalitis septicemia
**70% mortality
9
Q
in immunocompromised adults, listeria can present as
A
meningitis
bacteremia
**50% mortality in immunocompromised
10
Q
facultative intracellular, replicates in macrophages
A
listeria
11
Q
listeria’s internalins help mediate
A
forced phagocytosis
12
Q
listeriolysin
A
pore forming hemolysin
activated by acidic pH
13
Q
how is listeria motile?
A
actin polymerization (ActA protein)
14
Q
listerias phospholipases do what?
A
destabilize vacuolar membrane
15
Q
not sensitive for CSF
A
listeria
16
Q
umbrella like growth in mobility agar
A
listeria
17
Q
how has listeria acquired antibiotic resistance
A
conjugated plasmids from enterococci
18
Q
DOC listeria
A
ampicillin or TMP-SMX
**IV for meningitis
19
Q
listeria prevention
A
avoid eating at risk foods
20
Q
is GBS encapsulated
A
yes
21
Q
colonizes GI and GU tracts
A
GBS
22
Q
pregnant women are at high risk of transmission of GBS, what is done to screen these patients?
A
culture at 35-37 weeks
23
Q
GBS is part of normal vaginal flora in
A
25% of women
24
Q
in non-pregnant adults, GBS can cause
A
endocarditis
25
in neonates, GBS can cause
pneumonia
meningitis
sepsis
26
risk factors for neonatal GBS infection
maternal colonization
PROM
27
diagnostic factor for GBS
CAMP factor
28
DOC for GBS meningitis/bacteremia in adults
pen G
29
DOC for GBS endocarditis
Pen G and gent
30
DOC for GBS infections in neonates
ampicillin + gent
31
prevention of GBS
prenatal screen cultures
32
two major causes of neonatal meningitis
E coli
GBS
33
portal of entry for E coli in neonates
nasopharynx and GI tracts
34
Hib is covered by what vaccine
2nd gen PRP conjugate
35
what age is the Hib vaccine given?
2-15 months
36
non-encapulated strains of Hib cause
otitis media, sinusitis, geriatric pneumonia
37
DOC invasive H. flu
cephalosporin
38
common cause of community acquired meningitis
N. meningitidis
39
what capsule serogroups of N. meningitidis are relevant to the US
B, C, Y
40
is N. meningitidis considered normal flora
no
41
transmitted through exchange of respiratory and throat secretions
N. meningitidis
42
diagnostic triad: N. meningitidis
nuchal rigidity
sudden high fever
altered mental status
43
3-7 days after exposure
starts with severe headache
N. meningitidis
44
20% of N. meningitidis cases develop
meningococcemia
45
progression of meningococcemia
petechial lesions --> hemorrhagic bullae --> gangrene
46
DOC N. meningitidis
ceftriaxone, cefotaxime
47
N. meningitidis prophylaxis
rifampin
ceftriaxone
48
diagnosis N. meningitidis
lumbar puncture and gram/stain culture of CSF
49
what age group is the Hib-MenCY vaccine for
[N. meningitidis]
6-18 months
50
what age group is the MenACWY vaccine for
[N. meningitidis]
2-55 years
quadrivalent
51
infection of the leptomeninges-including arachnoid mater and the CSF in both the subarachnoid space and cerebral ventricles
meningitis
52
infection of brain parenchyma; AMS >24 hrs, focal neuro deficit, seizure, CSF pleocytosis, abnormal imaging
encephalitis
53
cross over between infection of the arachnoid CSF and brain parenchyma with combine clinical features
meningoencephalitis
54
rare inflammatory demyelinating disease of the CNS though to be an autoimmune process triggered by an environmental stimulus in susceptible individuals
acute disseminated encephalomyelitis
55
HA
stiff neck
retained cerebral function
meningitis
56
no stiff neck
AMS
encephalitis
57
no fever
normal CSF
MRI unremarkable
encephalopathy
58
ADEM occurs
post infection/vaccination
59
MRI focal hyperinstensity in gray matter
viral encephalitis
60
MRI focal hyperintensity in white matter
ADEM
61
most common fatal sporadi viral encephalitis worldwide
HSV
62
treatment HSV/VZV meningitis
IV acyclovir
63
temporal lobe changes
HSV meningitis
64
Diagnosis HSV meningitis
HSV PCR of CSF
65
diagnosis VZV meningitis
CSF VZV PCR
maybe IgM
66
leading recognizable cause of aseptic meningitis accounting for 85-95% of all cases
enterovirus
67
summer/fall seasonality
enterovirus
68
fecal oral spread, houseflies, wastewater [virus]
enterovirus
69
diagnosis EV meningitis
CSF EV PCR
70
treatment EV meningitis
supportive care
71
treatment CMV meningitis
ganciclovir, foscarnet
72
is EBV meningitis common?
no, exceedingly rare
**don't go looking for it
73
in AIDS and POTs, consider EBV causing _______ in the CNS
B cell lymphoma
74
seasonality July-September
West Nile
75
transmitted from Culex mosquito
West Nile
76
fever
rash
flaccid paralysis
West Nile
77
diagnosis WNV meningits
IgM in CSF
78
treatment WNV meningitis
supportive
79
encapulated yeast
cryptococcal meningoencephalitis
80
risk for cryptococcal meningoencephalitis increases in HIV patients when
CD4 is below 100
81
treatment cryptococcal meningoencephalitis
ampho B + flucytosine
82
diagnosis cryptococcal meningoencephalitis
CSF cryptococcal antigen
83
main protozoan causing primary amebic meningoencephalitis
N. fowleri
84
primarily children/young adults freshwater swimming
N. fowleri
85
July-Sept seasonality
N. fowleri
86
timing to onset is 5-8 days but could be as short as 24 hrs
N. fowleri
87
bifrontal or fitemporal headaches unresponsive to analgesics w/high fevers
N. fowleri
88
alteration in taste/smell
N. fowleri
89
treatment: N. fowleri
miltefosine
but most people die
90
illness script: encephalitis
fever, confusion, no meningismus, fluctuating level of consciousness
91
illness script: acute meningitis
acute onset headache with fever and meningismus
92
what two signs can be used to indicate meningismus?
Kernig's
Brudzinkski's
93
why would you get a head CT prior to lumbar puncture?
immunocompromised
altered consciousness
new seizure
known CNS disease
papilledema
focal neuro defect
94
neutrophils predominate CSF, think....
bacterial
95
monocytes predominate CSF, think....
TB, crypto
96
lymphocytes predominate CSF, think....
viral
97
eosinophils predominate CSF, think.....
parasite
98
WBC 1000-5000 in CSF
bacterial
99
WBC 50-300
TB
100
WBC 50-500
cryptococcal
101
WBC 50-1000
viral
102
WBC 150-200
parasite
103
glucose normal
viral, parasite
104
glucose >45
bacteria
105
glucose <40
bacterial
106
glucose <45
TB
107
clear CSF
viral
108
protein 100-500
bacterial
109
protein 50-300
TB
110
protein >45
cryptococcal
111
protein <200
viral
112
protein >45
parasitic
113
high risk for S. pneumo meningitis
non vaccinated
asplenic
114
treatment S. pneumo meningitis
ceftriaxone
115
high risk of N. meningitidis
complement deficiency
116
treatment N. meningitidis meningits
ceftriaxone
117
high risk of listeria meningitis
low cell-mediated immunity
extremes of age
118
treatment listeria meningitis
ampicillin
119
high risk of H. flu meningitis
asplenic
120
treatment H. flu meningitis
ceftriaxone
121
empiric antimicrobial therapy for bacterial meningitis
ceftriaxone and vanc
**add amp if concern for listeria
122
if S. pneumo is suspected, what should be added to chemotherapy
dexamethasone
**discontinue if cultures come back negative for S. pneumo
123
illness script brain abscess
subacute onset headache with fever and focal neurodefecit
124
brain abscesses are caused by what pathogens
bacterial (frequently anaerobes)
protozoan
fungal
125
brain abscess associated with cranial trauma, post neurosurgery, endocarditis
S. aureus
126
Toxoplasmosis can cause brain abscesses after
reactivation a long time after initial exposure in AIDS patients
127
gram positive diplococci
S. pneumo
128
gram positive rod
listeria
129
gram negative rod/coccobacilli
H. flu
130
gram negative cocci
N. meningitidis
131
otitis media + CNS infection
S. pneumo
132
pregnant + CNS infection
listeria
133
asplenia + CNS
encapsulated
134
encephalitis with orchitis or parotitis
mumps
135
subacute meningoencephalitis in HIV+
cryptococcus
136
asymmetric flaccid paralysis
west nile
137
MRI temporal lobe enhancement
HSV-1 encephalitis
