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Infectious Disease > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

This is the term for the inflammation of the meninges and the CSF

A

Meningitis

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2
Q

This is the term for the inflammation of the brain parenchyma

A

Encephalitis

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3
Q

T/F: The distinction between meningitis and encephalitis is clear.

A

False, It is “blurry.”

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4
Q

Risk Factors for Meningitis

A
  • Age < 2, >50 yo
  • URI, including otitis media, sinusitis
  • Mastoiditis
  • Head trauma
  • Recent neurosurgery
  • Immunosuppression
  • Crowded living conditions
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5
Q

Common Bacteria Causing Meningitis in Neonates:

A
  • Gram (-) Bacteria
  • Streptococci, mostly GBS
  • Listeria Monocytogenes
  • H. influenza
  • E. coli
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6
Q

Common Bacteria Causing Meningitis in Children:

A
  • H. influenza
  • Neisseria meningitidis
  • Streptococcus pneumoniae
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7
Q

Common Bacteria Causing Meningitis in Adult (<50 yo):

A
  • Streptococcus pneumoniae

- Neisseria meningitidis

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8
Q

Sources of Infection for Meningitis:

A
  1. Contiguous Spread
  2. Hematogenous
  3. Direct Inoculation
  4. Reactivation
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9
Q

Examples of Contiguous Spread as a Source of Infection for Meningitis:

A
  • Sinusitis
  • Otitis Media
  • Birth Defects
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10
Q

Examples of Hematogenous Spread as a Source of Infection for Meningitis:

A
  • Bacteremia
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11
Q

Examples of Direct Inoculation as a Source of Infection for Meningitis:

A
  • Trauma

- Neurosurgical complications

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12
Q

Examples of Reactivation as a Source of Infection for Meningitis:

A
  • HSV

- TB

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13
Q

What causes the BBB to get damaged causing the infection to spread in the CNS?

A

*Response to Infection

  • Contact with bacterial cell wall causes cytokine release (TNF-alpha, IL-1, PAF)
  • PAF triggers clotting cascade
  • Cytokine cascade stimulates vasodilation and vascular permeability
  • Compromised BBB allows entry of neutrophils and other blood components
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14
Q

After the infection has crossed into the CNS, what continues to happen?

A
  • Increased ICP (Cerebral Edema may be present)
  • Decreased cerebral blood flow (s/s start to show up)
  • Ischemic and Direct Tissue Damage
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15
Q

Cardinal Signs and Symptoms of Meningitis

A
  1. Altered mental status
  2. Stiff neck
  3. Fever
  4. Headache
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16
Q

T/F: All four cardinal signs/symptoms must be present for diagnosing Meningitis.

A

False, any one of these may be presents. The more signs, the more likely it may be meningitis.

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17
Q

Other signs and symptoms of Meningitis:

A
  • Nausea
  • Focal Neurological Signs
  • Seizure
  • Papilledema
  • Neck stiffness, Kernig/Brudzinski Signs
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18
Q

T/F: As age increases, signs and symptoms of meningitis become less obvious.

A

True. You still want to have a high index of suspicion of meningitis.

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19
Q

What does the diagnosis of Meningitis depend on?

A

CSF.

You want to do an LP (but not right away, think about it)

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20
Q

Contraindications to a Lumbar Puncture

A
  1. Space Occupying Lesion
    - High ICP
  2. Coagulopathy
    - Platelets less than 20k
    - INR > 1.5
    - Heparin in less than 24 hours
  3. Spinal Deformities (Relative)
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21
Q

What happens if you can’t do an LP but still suspect meningitis?

A

Labs

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22
Q

Purpose of 4 Tubes in CSF Collection:

Tube 1

A

Bacteriology

  • Gram Stain
  • Routine C&S
  • AFB
  • Fungal Stain & Culture
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23
Q

Purpose of 4 Tubes in CSF Collection:

Tube 2

A
  • Glucose & Protein

- Electrophoresis for oligoclonal banding and myelin basic protein if MS is suspected

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24
Q

Purpose of 4 Tubes in CSF Collection:

Tube 3

A

Cell count

- CBC with differential

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25
Q

Purpose of 4 Tubes in CSF Collection:

Tube 4

A

Special Studies

  • VDRL
  • Counterimmunoelectrophoresis (H. flu, Strept pneumonia, N. meningitidis)
  • TB PCR
  • HSV PCR
  • India Ink Stain & Antigen Testing for Cryptococcus
26
Q

What would CSF from LP look like in a normal patient?

A
  • Clear
  • < 5 WBC
  • Glucose: 50-70% serum
  • Protein: 15-50 mg
  • Pressure: 50-180 mmH2O
27
Q

What would CSF from LP look like in a patient with bacterial infection?

A
  • Cloudy
  • Markedly increased WBC 100-5000
  • Glucose: < 40% serum
  • Protein: Increased
  • Pressure: Increased
28
Q

What would CSF from LP look like in a patient with viral infection?

A
  • Clear
  • Increased WBC 10-500
  • Glucose: Normal (or low)
  • Protein: Increased
  • Pressure: Normal to Slightly Increased
29
Q

What would CSF from LP look like in a patient with fungal or TB infection?

A
  • Clear to Cloudy
  • > 5-1000 WBC
  • Glucose: < 40% serum (but may be normal)
  • Protein: Increased
  • Pressure: Increased
30
Q

When comparing Gram Stains of CSF showing pneumococcus and meningococcemia, what is the difference?

A

Pneumococcus:

  • Gram + diplococci
  • Bacilli scattered

Meningococcemia:

  • Gram - Diplococci
  • Grouping/ Clusters
31
Q

What type of person could get cryptococcus meningitis (This is very rare)?

A

Immunocompromised

32
Q

How do you determine if there is a traumatic tap?

A

True WBC in CSF = Actual WBC in CSF - [(WBC in blood x RBC in CSF) / (RBC in Blood)]

33
Q

Newer tests for Diagnosis of Meningitis

A
  • Latex agglutination to detect antigens
  • PCR
  • Microarray
  • CSF Lactate
34
Q

Treatment of Patient with Meningitis < 1 month old.

  • Common Bacterial Pathogens for this age group:
  • Strept
  • E. coli
  • Listeria monocytogenes
  • Klebsiella
A

Ampicillin + Cefotaxime

OR

Ampicillin + Aminoglycoside

35
Q

Treatment of Patient with Meningitis 1-23 months old.

  • Common Bacterial Pathogens for this age group:
  • Pneumococcus
  • Meningococcus
  • H. flu
  • E. coli
A

Vancomycin + Cefotaxime

36
Q

Treatment of Patient with Meningitis 2-50 years old.

  • Common Bacterial Pathogens for this age group:
  • Meningococcus
  • Pneumococcus
A

Vancomycin + Cefotaxime

37
Q

Treatment of Patient with Meningitis > 50 years old.

  • Common Bacterial Pathogens for this age group:
  • Meningococcus
  • Pneumococcus
  • L. monocytogenes
A

Vancomycin + Cefotaxime + Ampicillin

38
Q

Timing of Antibiotics

A

Do not delay!

39
Q

Do you use steroids (immunosuppressants) on a patient with suspected meningitis? If so, why?

A

Yes, to suppress inflammation and the cytokine chain reactions

40
Q

Do steroids work in achieving the goal of suppressing inflammation and the cytokine chain reactions?

A

Controversial, but still accepted as a method of care

41
Q

What happens if a patient has increased ICP?

A

CT!!!

42
Q

Prognosis of Meningitis

A

Good if given abx in a timely fashion

43
Q

Sequelae of Meningitis

A
  • Hearing Loss
  • Cognitive Defects
  • Paraplegia
44
Q

Chemoprophylaxis of Meningitis

A
  • Rifampin
  • Ciprofloxacin
  • IM Ceftriaxone
45
Q

Viral Causes of Aseptic Meningitis

A
  • Enterovirus
  • HSV
  • Varicella zoster
  • CMV
  • EBV
  • HIV
  • Poliovirus
46
Q

Fungal Causes of Aseptic Meningitis

A
  • Cryptococcus neoformans

- Blastomyces dermatidis

47
Q

Parasites Causing Aseptic Meningitis

A
  • Toxoplasma gondii
48
Q

Bacterial Causes of Aseptic Meningitis

A
  • Partially treated meningitis
  • TB
  • Borrelia burgdorferi
  • Treponema pallidum
  • Brucella
49
Q

Pharmacological Causes of Aseptic Meningitis

A
  • NSAIDs
  • Amoxicillin
  • TMP-SMX
  • Isoniazid
  • IV IG
  • Azothioprine
  • Allopurinol
50
Q

Systemic Dzs Causing Aseptic Meningitis

A
  • Sarcoidosis
  • SLE
  • Wegener Granulomatosis
  • MS
  • Guillain-Barre syndrome
  • Leukemia
  • Lymphoma
51
Q

Most common cause of Encephalitis

A

Virus

52
Q

Clinical Manifestations of Encephalitis

A
  • Typically, insidious onset but may be rapid onset
  • Altered LOC or an abnormal mental state
  • Focal or diffuse neurological signs/sxs
53
Q

Diagnosis of Encephalitis

A
  • LP shows a lymphocytic pleocystosis, mildly elevated protein, normal glucose
  • LP may have abundance of RBC in the absence of a traumatic tap
54
Q

Management of Encephalitis

A
  • Antibacterial agents
  • Acyclovir if viral etiology
  • Corticosteroids?
55
Q

This is the term for a focal suppurative process in the brain parenchyma.

A

Brain Abscess

56
Q

Complications of Brain Abscess

A

Can spread from a contiguous focus (mastoiditis, sinusitis, tooth/gum infection) or can be hematogenous

57
Q

Age risk factors for Brain Abscess

A
  • Median age is 30-45 yo

- ~25%in Children less than 15 yo

58
Q

Signs and Symptoms of a Brain Abscess

A
  • Nonspecific and vary according to location
  • Severity of the primary infection
  • Virulence of the infecting organism
  • Size and location of the abscess
  • The person’s ability to mount an immune response
59
Q

Classic Triad of Brain Abscess

A
  • Headache
  • Fever
  • Focal Neurologic Deficits
60
Q

Diagnosis of Brain Abscess

A

CT

  • has ~95% sensitivity
  • CT with Contrast, abscess will appear hypodense and surrounded by uniformly enhancing ring
61
Q

T/F: LPs are a useful tool in diagnosis of a brain abscess.

A

False, the findings could be abnormal, but they are nonspecific.

62
Q

Treatment of Brain Abscess

A
  • Abx and Sx Intervention

Primary:
—3rd Gen. Cephalosporin (Cefotaxime) AND Metronidazole

Post-Sx, Post-traumatic:
— Nafacillin OR Oxacillin AND 3rd Gen. Cephalosporin (Cefotaxime)

Infectious Disease (6 decks)

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