CNS Infections

Question 1

Classic meningitis triad

Answer 1

Fever
Headache
Neck stiffness
(photophobia …?)

Question 2

What is encephalomyelitis

Answer 2

Inflammation of the brain and the spinal cord

Question 3

Diagnosis of viral meningitis

Answer 3

Viral stool culture
Throat swab
CSF PCR

Question 4

Treatment for herpes simplex encephalitis

Answer 4

Aciclovir (IV high dose !!)

Question 5

How quickly do you need to diagnose herpes simplex encephalitis?

Answer 5

RAPIDLY within 6 hours !!

Question 6

Diagnosis of encephalitis:

Answer 6

Lumbar puncture
EEG
MRI

If delay, start pre-emptive treatment with aciclovir!!!!! prevents death

Question 7

Bacteria most likely to cause meningitis in children?

Answer 7

H. influenza

Question 8

Bacteria most likely to cause meningitis in ppl aged 10-21

Answer 8

Meningococcal

above 21 = pneumococcal

Question 9

Listeria, group B strep and E. coli are most likely to cause meningitis in which age group?

Answer 9

Neonates

Question 10

Bacteria most likely to cause meningitis in immunocompromised?

Answer 10

LISTERIA !!!

Question 11

Satphylococcus / gram negative rods most likely to cause meningitis in which group of people?

Answer 11

Ppl who have had neurosurgery / open head trauma

Question 12

WHAT ORGANISM CAUSES MENINGITIS IN PEOPLE WITH CRIBRIFORM FRACTURE ?!

Answer 12

Pneumococcal

Question 13

Organism causing meningitis in patient with CSF shunt?

Answer 13

Staph epidermidis

Question 14

Which bacteria causes meningococcal meningitis?

Answer 14

Neisseria meningitidis

-this occurs most often in young children

Question 15

Where is neisseria meningitidis found?

Answer 15

Throats of healthy carriers

-H. influenza also found in the throat

Step. pneumonia is found in the nose !!!

Question 16

Which meningitis causing bacteria can be found in leukocytes in the CNS? and what are the symptoms due to?

Answer 16

N. meningitidis

-symptoms are due to endotoxin

Question 17

Vaccination with purified capsular polysaccharide prevents against which meningitis?

Answer 17

Meningococcal meningitis

N. meningitidis

Question 18

What does H. influenzae require for growth?

Answer 18

Blood factors

Question 19

Most common type of H. influenzae in children under 4?

Answer 19

H. influenza type b

Question 20

What type of vaccine is available against haemophilus influenza?

Answer 20

A coonjugate vaccine against the polysaccharide antigen

Question 21

Which bacteria is found in the nose?

Answer 21

Strep

Question 22

Some evidence that this bacteria is related to CNS implants like cochlear implants

Answer 22

Strep

Question 23

Hospitalized patients, patients with CSF skull fractures, diabetics/ alcoholics and young children are most susceptible to which bacteria meningitis?

Answer 23

Penumococcal!!! (caused by strep. pneumoniae)

Question 24

This type of meningitis is caused by gram positive bacilli?

Answer 24

Listeria

Question 25

Bacteria most likely to cause meningitis in malignancy? (a.k.a immunocompromised)

Answer 25

Listeria

Question 26

Antibiotics for listeria

Answer 26

IV ampicillin/amoxicillin | ceftriaxone no value as intrinsically resistant

Question 27

GRAM POSITIVE ROD

Answer 27

Listeria (LEARN THIS)

Question 28

Treatment for tb meningitis?

Answer 28

Rifampicine and isoniazid (add pyrazinamide and ethambutol)

Question 29

Organism seen in HIV meningitis

Answer 29

Cryptotoccus | this is a FUNGUS !!

Question 30

Treatment for cryptococcus meningitis?

Answer 30

- IV amphotericin b / flucytosine | - fluconazole

Question 31

This organism gives an aseptic picture on CSF

Answer 31

Cryptococcal meningitis

Question 32

Other causes of raised neutrophils and low CSF glucose (i.e. causes which aren't bacterial meningitis)

Answer 32

- viral meningitis in early phase - leakage of brain abscess - chemical-meningitis (contrast) - Behcet syndrom - Drug induced (NASIDS etc)

Question 33

What is aseptic meningitis?

Answer 33

Non-pyogenic meningitis | low WBC, protein minimally elevated, normal glucose

Question 34

Admission to hospital: what type of swab should you take?

Answer 34

Throat swab and swab from any petechial/purpuric lesions

Question 35

Antibiotics for meningitis (acute admission)

Answer 35

CEFOTAXIME/ CEFTRIAXONE add ampicillin/amoxicillin if listeria suspected Penicillin allergy = chloramphenicol with vancomycin If listeria suspected and penicillin allergy, co-trimoxazole

Question 36

WHAT DO YOU GIVE WITH ABX FOR SUSPECTED BACTERIAL MENINGITIS?

Answer 36

STEROIDS !!!! | -before or with first dose

Question 37

When would you not give steroids in meningitis?

Answer 37

- post-surgical meningitis - severe immunocompromised - meningococcal or septic shock

Question 38

Abx used for contact prophylaxis for meningitis

Answer 38

Rifampicin (over 12) Ciprofloxacin (not licensed but widely used) Ceftriaxone Rifampicin - warn of reduced efficacy of OCP, red coloration of urine, staining of contact lenses

Question 39

Neisseria meningitidis vaccine: - which serogroups does it vaccinate against? - who commonly receives it?

Answer 39

- Serogroups A and C | - Commonly used in travel vaccination