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CNS Infections Flashcards

1
Q

Define Meningitis

A

Swelling and inflammation of the membranes covering the brain and spinal cord

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2
Q

Define Encephalitis

A

Inflammation of the brain

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3
Q

Define Nosocomial Infections

A

Hospital acquired

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4
Q

Define Abscess

A

Confined pocket of pus that collects in tissues, organs, or spaces inside the body

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5
Q

Community Bacterial Meningitis Bugs (Newborn-1 month)

A

Group B Strep- 70%

H. influenzae, Listeria, S. pneumoniae- 30%

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6
Q

Community Bacterial Meningitis Bugs (1-23 months)

A

S. pneumoniae- 50%
N. meningitidis- 30%
Group B. Strep- 15%

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7
Q

Community Bacterial Meningitis Bugs (2-18 years)

A

N. meningitidis- 60%
S. pneumoniae- 25%
H. influenzae- 8%

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8
Q

Community Bacterial Meningitis Bugs (19-50 years)

A

S. pneumoniae- 60%
N. meningitidis- 20%
H. influenzae- 10%
Listeria- 6%

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9
Q

Community Bacterial Meningitis Bugs (50+)

A

S. pneumoniae- 70%
Listeria- 20%
N. meningitidis, group B strep, H. influenza- 10%

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10
Q

Nosocomial Bacterial Meningitis Epidemiology

A

Disease of neurosurgical patients, trauma, etc

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11
Q

Nosocomial Bacterial Meningitis Bugs

A 
E. coli, K. pneumoniae, P. auruginosa- 33%
Strep-9%
S. aureus- 9%
Coagulase negative staph- 9%
Listeria- 8%
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12
Q

Changes in Epidemiology for Bacterial Meningitis

A

Decline in H. influenza
Increased incidence of S. pneumo
Shift from pediatrics to adults
Increase incidence of antibiotic-resistant organisms (PCN & Cephalosporin)

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13
Q

Predisposing Factors of Bacterial Meningitis

A

Colonization of the nasopharynx (N. meningitides, S pneumonia, H. influenza)
Direct entry of organisms into the CNS from contiguous infection, trauma, neurosurgery, a CSF leak, or medical device

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14
Q

Host Risk Factors for Bacterial Meningitis

A

Asplenia
Corticosteroid use
immune-compromised/HIV infection
Exposure to someone with menigitis

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15
Q

Pathogenesis of Bacterial Meningitis

A

Virulence factors of pathogen
CSF has inadequate humoral immunity
Bacteria produce inflammatory response
Leads to vasogenic brain edema, increase ICP, brain ischemia, cytotoxic injury & neuronal apoptosis

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16
Q

Presentation of Bacterial Meningitis

A

Symptoms of 2-3 days
FEVER >38 C
NUCHAL RIGIDITY
CHANGE IN MENTAL STATUS

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17
Q

Other Symptoms of Bacterial Meningitis

A 
Headache
Photophobia
Characteristic rash
N/V
Seizures
Focal neurological deficits
Papilledema
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18
Q

Exanthem

A

Small hemorrhages under the skin

Rash doesn’t fade under pressure

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19
Q

Exanthem Pathogenesis

A 
Septicemia
Wide spread endothelial damage
Activation of coagulation
Thrombosis
Platelet aggregation
Reduction of platelets
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20
Q

Physical Exam Tests

A

Kerning Sign

Brudzinski Sign

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21
Q

Kerning Sign

A

Supine position, flex hip 90 degressm inability or reluctance to allow full extension of the knee when the hip is flexed

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22
Q

Brudzinski sign

A

Spontaneous flexion of hips during attempted passive flexion of the neck

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23
Q

Meningitis Workup

A 
CBC with differential
CMP
UA
Blood cultures
Lumbar Puncture
Possible CT
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24
Q

Head CT prior to LP for Meningitis

A

Immunocompromised

Hx of seizure

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25
Reasons for CT in Bacterial Meningitis
Identify contraindications to LP Evidence of head trauma, sinus/mastoid infection, skull fracture, & congenital anomalies May identify cerebral edema, effusion, hydrocephalus, abscess Reveal cause of infection
26
Normal LP values
``` Pressure: 70-180 Appearance: clear, colorless CSF protein: 15-45 mg/dL Gamma globulin: 3-12% of protein CSF glucose 45-85 mg/100mL (OR >2/3 serum) CSF WBC: ```
27
Bacterial Meningitis LP
``` Elevated opening pressure Cloudy, purulent Leukocytosis (1000 to 5000) Protein 100-500 mg/dL Glucose ```
28
Gram Positive Diplococci in Bacterial Meningitis
S. pneumoniae
29
Gram Negative Diplococci in Bacterial Meningitis
N. meningitidis
30
Small Pleomorphic Gram Negative Coccobacilli in Bacterial Meningitis
H. influenzae
31
Gram Positive rods and coccobaccila
Listeria
32
Empiric Treatment of S. pneumonia and Meningococcal Bacterial Meningitis
Cefotaxime (Claforan) Ceftriaxone (Rochephin) Either of above + Vancomycin
33
Empiric Treatment of L. monocytogenes Bacterial Meningitis
Ampicilling + gentamycin | PCN allergy: TMP-SMX or meropenem
34
Nosocomial Bacterial Meningitis
Ceftazidime + Vacomycin
35
Risk Factors for Drug-Resistant S. pneumoniae
``` Extremes of age Recent antibiotic treatment Significant comorbid disease HIV infection Immunodeficiency Day care parent/sib Recent hospitalization Congregate settings ```
36
Neurologic Complications
``` Increased ICP Cerebral edema Seizures Cranial nerve palsies Hemiparesis ```
37
Cerebrovascular Complications
``` Vessel wall irregularities Focal dilatations Arterial occlusions Focal arterial bleeding Venous thrombosis ```
38
Sensorineural Hearing Loss
Greater with S. pneumoniae
39
Role of Steroids
Attempt to diminish the rate of hearing loss, cerebral edema, other neurologic complications Reduces mortality and neurologic disability in patients with GCS scores of 8-11 Continue if S. pneumoniae
40
Prevention of Bacterial Meningitis
Avoid sharing saliva, cups, utensils Good hand washing Vaccines: H. flu, pneumococcal conjugate, pneumococcal polysaccharide, meningococcal conjugate, Serogroup B meningococcal
41
Adults Should Get Quadrivalent Meningococcal Conjugate Vaccine if:
Complement deficiency Asplenia Microbiologist frequently exposed to N. meningitidis Traveling to countries where disease common Population at risk due to outbreak College students Military recruits
42
Aseptic Meningitis
Clinical and lab evidence for meningeal inflammation with negative bacterial cultures
43
Cause of Aseptic Meningitis
``` Enterovirus Mycobacteria Fungi Spirochetes Parameningeal infections Medications Malignancy ```
44
Aseptic Meningitis Presentation
Fever HA Stiff neck Photophobia
45
Aseptic Meningitis Approach
Comprehensive hx CSF clear- observe Treatment supportive
46
Define Encephalitis
Inflammation of the brain parenchyma, manifested by neurologic dysfunction
47
Causes of Encephalitis
``` Viral Postinfectious Autoimmune Paraneoplastic Medication induced ```
48
Clinical Presentation of Encephalitis
``` Altered mental status Seizures common Focal neurologic abnormalities Exaggerated DTRs Pathologic reflexes Motor/senosry deficits Altered behavior Personality changes Speech or movement disorders Hemiparesis ```
49
Imaging fo Encephalitis
CT- lesion, abscess MRI- demyelination EEG-abnormal
50
Complications of Encephalitis
``` Status epilepticus Cerebral edema SIADH Cardiorespiratory failure DIC Death ```
51
Difference between Meningitis and Encephalitis
Meningitis- cerebral function remains intact Encephalitis- abnormalities in brain function; meningeal irritation absent Meningoencephalitis is used to describe both
52
Viral Etiologies of Encephalitis
HSV1 3 alpha- western, easter, and venezualan equine encephalitis 5 flaviviruses- west nile, yellow fever Bunyviruses- Cali
53
Non-viral/Post-infectious Etiologies of Encephalitis
``` Lyme disease Rocky Mountain spotted fever Rabies encephalitis Syphilis Tuberculosis ```
54
Viral Encephalitis Findings
Elevated CSF WBCs | Elevated protein but
55
West Nile Virus Signs and Symptoms
``` Fever Malaise Stiff Neck Sore Throat N/V Stupor-Convulsions-Coma ```
56
Signs of Upper Motor Neuron Lesion in West Nile Virus
Exaggerated DTRs Absent superficial reflexes pathologic reflexes Spastic paralysis
57
West Nile Virus CSF
Increase protein Increased opening pressure Lymphocytic leukocytosis
58
Rocky Mountain Spotted Fever Signs & Symptoms
``` Fever Headache Nausea Rash Hyponatremia Thrombocytopenia Mild increase in LFTs ```
59
Rocky Mountain Spotted Fever CSF
Increased Lymphocytes/PMNs Increased Protein Negative gram stain
60
Rocky Mountain Spotted Fever Diagnosis
Clinical Suspicion
61
Treatment for Rocky Mountain Spotted Fever
Doxycycline
62
Rocky Mountain Spotted Fever Big Points
``` Empiric treatment Hyponatremia Low platelets Elevated LFTs DON'T WAIT FOR RASH ```
63
Lyme Disease Stages
Erythema migrans rash Multiple EM lesions Late/chronic: persistent arthritis, subtle encephalopathy/polyneuropathy
64
Treatment of Early Lyme Disease
Doxycycline Amoxicillin Cefuroxime
65
Treatment of Late Lyme Disease
Cefotaxime | Penicillin G
66
Define Brain Abscess
Pus filled cavity ringed by granulation tissue and outer fibrous capsule surrounded by edematous brain tissue
67
Pathophysiology of Brain Abscess
``` Chronic pulmonary infections Skin infections Pelvic infections Intra-abdominal infections Esophageal dilation Bacterial endocarditis Cyanotic congenital heart disease ```
68
Clinical Features of Brain Abscess
Triad- HA, FEVER, FOCAL DEFICIT Toxic appearance Seizure, vomiting, confusion, obtundation Frontal lobe- hemiparesis Temporal lobe- hemonymous superior quadrant visual field defect or aphasia Cerebellum- limb incoordination or nystagmus
69
Diagnostics of Brain Abscess
CT with Contrast MRI Needle guided biopsy

Neurology (10 decks)

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