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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
Purpose of 4 Tubes in CSF Collection: Tube 4
Special Studies - VDRL - Counterimmunoelectrophoresis (H. flu, Strept pneumonia, N. meningitidis) - TB PCR - HSV PCR - India Ink Stain & Antigen Testing for Cryptococcus
26
What would CSF from LP look like in a normal patient?
- Clear - < 5 WBC - Glucose: 50-70% serum - Protein: 15-50 mg - Pressure: 50-180 mmH2O
27
What would CSF from LP look like in a patient with bacterial infection?
- Cloudy - Markedly increased WBC 100-5000 - Glucose: < 40% serum - Protein: Increased - Pressure: Increased
28
What would CSF from LP look like in a patient with viral infection?
- Clear - Increased WBC 10-500 - Glucose: Normal (or low) - Protein: Increased - Pressure: Normal to Slightly Increased
29
What would CSF from LP look like in a patient with fungal or TB infection?
- Clear to Cloudy - >5-1000 WBC - Glucose: < 40% serum (but may be normal) - Protein: Increased - Pressure: Increased
30
When comparing Gram Stains of CSF showing pneumococcus and meningococcemia, what is the difference?
Pneumococcus: - Gram + diplococci - Bacilli scattered Meningococcemia: - Gram - Diplococci - Grouping/ Clusters
31
What type of person could get cryptococcus meningitis (This is very rare)?
Immunocompromised
32
How do you determine if there is a traumatic tap?
True WBC in CSF = Actual WBC in CSF - [(WBC in blood x RBC in CSF) / (RBC in Blood)]
33
Newer tests for Diagnosis of Meningitis
- Latex agglutination to detect antigens - PCR - Microarray - CSF Lactate
34
Treatment of Patient with Meningitis < 1 month old. * Common Bacterial Pathogens for this age group: - Strept - E. coli - Listeria monocytogenes - Klebsiella
Ampicillin + Cefotaxime OR Ampicillin + Aminoglycoside
35
Treatment of Patient with Meningitis 1-23 months old. * Common Bacterial Pathogens for this age group: - Pneumococcus - Meningococcus - H. flu - E. coli
Vancomycin + Cefotaxime
36
Treatment of Patient with Meningitis 2-50 years old. * Common Bacterial Pathogens for this age group: - Meningococcus - Pneumococcus
Vancomycin + Cefotaxime
37
Treatment of Patient with Meningitis > 50 years old. * Common Bacterial Pathogens for this age group: - Meningococcus - Pneumococcus - L. monocytogenes
Vancomycin + Cefotaxime + Ampicillin
38
Timing of Antibiotics
Do not delay!
39
Do you use steroids (immunosuppressants) on a patient with suspected meningitis? If so, why?
Yes, to suppress inflammation and the cytokine chain reactions
40
Do steroids work in achieving the goal of suppressing inflammation and the cytokine chain reactions?
Controversial, but still accepted as a method of care
41
What happens if a patient has increased ICP?
CT!!!
42
Prognosis of Meningitis
Good if given abx in a timely fashion
43
Sequelae of Meningitis
- Hearing Loss - Cognitive Defects - Paraplegia
44
Chemoprophylaxis of Meningitis
- Rifampin - Ciprofloxacin - IM Ceftriaxone
45
Viral Causes of Aseptic Meningitis
- Enterovirus - HSV - Varicella zoster - CMV - EBV - HIV - Poliovirus
46
Fungal Causes of Aseptic Meningitis
- Cryptococcus neoformans | - Blastomyces dermatidis
47
Parasites Causing Aseptic Meningitis
- Toxoplasma gondii
48
Bacterial Causes of Aseptic Meningitis
- Partially treated meningitis - TB - Borrelia burgdorferi - Treponema pallidum - Brucella
49
Pharmacological Causes of Aseptic Meningitis
- NSAIDs - Amoxicillin - TMP-SMX - Isoniazid - IV IG - Azothioprine - Allopurinol
50
Systemic Dzs Causing Aseptic Meningitis
- Sarcoidosis - SLE - Wegener Granulomatosis - MS - Guillain-Barre syndrome - Leukemia - Lymphoma
51
Most common cause of Encephalitis
Virus
52
Clinical Manifestations of Encephalitis
- Typically, insidious onset but may be rapid onset - Altered LOC or an abnormal mental state - Focal or diffuse neurological signs/sxs
53
Diagnosis of Encephalitis
- LP shows a lymphocytic pleocystosis, mildly elevated protein, normal glucose - LP may have abundance of RBC in the absence of a traumatic tap
54
Management of Encephalitis
- Antibacterial agents - Acyclovir if viral etiology - Corticosteroids?
55
This is the term for a focal suppurative process in the brain parenchyma.
Brain Abscess
56
Complications of Brain Abscess
Can spread from a contiguous focus (mastoiditis, sinusitis, tooth/gum infection) or can be hematogenous
57
Age risk factors for Brain Abscess
- Median age is 30-45 yo | - ~25%in Children less than 15 yo
58
Signs and Symptoms of a Brain Abscess
- 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
Classic Triad of Brain Abscess
- Headache - Fever - Focal Neurologic Deficits
60
Diagnosis of Brain Abscess
CT - has ~95% sensitivity - CT with Contrast, abscess will appear hypodense and surrounded by uniformly enhancing ring
61
T/F: LPs are a useful tool in diagnosis of a brain abscess.
False, the findings could be abnormal, but they are nonspecific.
62
Treatment of Brain Abscess
* 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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