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Neuro Histology & Pathology > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

What are the commonest causes of viral meningitis?

A

Enteroviruses: coxsackie and echo

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2
Q

What is the epidemiology of meningitis?

A

It is a global disease

It is a disease of developing countries

It mainly affects young children

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3
Q

Which 3 bacteria are the commonest causes of meningitis in children and adults?

A

Neisseria meningitidis

Strep pneumoniae

H influenzae type B

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4
Q

Which are the most common strains of Neisseria meningitidis in Australia? Africa?

A

B & C; A

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5
Q

What is common to the bacteria that cause meningitis?

A

LPS capsule that helps them evade the immune system (complement and phagocytosis)

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6
Q

What are the commonest causes of bacterial meningitis in neonates (<3mo)?

A

Group B strep algalacticae

E. coli

Listeria monocytogenes

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7
Q

What is the origin of bacterial meningitis agents in neonates?

A

Birth canal

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8
Q

What is the pathogenesis of meningitis?

A

Colonization of nasopharyngeal mucosa

Bacteria then invade the bloodstream

99% are killed by the immune response

Rare surviving bacteria multiply in the blood

They then cross the BBB and invade the meninges and CNS

This increases the permeability of the BBB

WBCs are now able to escape the blood stream and enter CSF, increasing ICP

WBCs release cytokines and pro-inflammatory compounds that result in cytotoxic neuronal damage

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9
Q

What are the commonest clinical features of meningitis?

A

Fever, vomiting, headache, and photophobia (also neck stiffness, altered mental state, and seizures)

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10
Q

What are the commonest clinical features of meningitis in babies?

A

fever, vomiting, irritability, refusal of food/drink, altered mental state, bulging fontanelles

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11
Q

What is indicative of meningococcemia?

A

Petechial rash

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12
Q

What does petechial rash indicate in the context of other meningitis symptoms?

A

Possible meningococcal meningitis (Neisseria meningitides)

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13
Q

CSF is analysed for

A

pressure, biochem (protein, glucose), microscopy (WBC, RBC, Gram stain), culture, PCR (viruses - entero, HSV, bacteria - meningo, pneumo for 16s rDNA)

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14
Q

T/F Meningitis can be dx without abnormal CSF

A

False

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15
Q

Normal pressure for CSF is

A

< 150mm H20

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16
Q

Normal colour of CSF is

A

Clear

17
Q

Normal WBC count in CSF is

A

none (cutoff is <5x10^6/L)

18
Q

Normal RBC count in CSF is

A

0

19
Q

Normal Gram stain of CSF is

A

negative

20
Q

Normal protien in CSF is

A

<0.4g/L

21
Q

Normal glucose for CSF is

A

>60% of blood glucose (>2.5mmol/L)

22
Q

How do cells end up in CSF in meningitis?

A

The BBB becomes permeable

23
Q

Viral meningitis CSF shows

A

normal pressure and clear

100s of lymphocytes

RBC 0

Gram stain negative

increased protein (<0.4-1.0)

glucose more than 60% blood glucose

24
Q

Bacterial meningitis CSF shows

A

raised pressure and cloudy

WBC 100s of neutrophils

RBC 0

Gram stain: positive

Protein >1.0

glucose <40% blood glucose (lower)

25
Q

TB meningitis CSF shows

A

+raised pressure and cloudy

100s of lymphocytes

RBC 0

ZN positive

protein 1.0-5.0

glucose <30% of blood

26
Q

T/F you can predict from CSF whether meningitis is viral or bacterial

A

False

27
Q

How do antibiotics affect CSF values?

A

lower glucose and higher protein

cell count should be normal because inflammatory response continues

28
Q

What is the initial treatment of meningitis?

A

resuscitation and fluids

then ABs and possibly steroids

29
Q

What is the AB tx for meningitis?

A

IV 3rd generation cephalosporin (cefotaxime)

30
Q

What is the AB treatment of neonatal meningitis?

A

IV 3rd gen cephalosporin (cefotaxime) + penicillin and gentamicin

31
Q

What viruses commonly cause encephalitis?

A

HSV, mycoplasma

32
Q

What symptoms differentiate encephalitis from meningitis?

A

changes in consciousness: confusion, disorientation, altered behaviour

33
Q

What is the treatment for encephalitis (and meningoencephalitis)?

A

aciclovir for HSV

Neuro Histology & Pathology (6 decks)

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