CNS infections Flashcards by Molly Richard

Signs and symptoms of meningitis

Fever 
Stiff neck 
Altered consciousness 
Headache 
Vomiting 
Photophobia 
Rash 
Shock

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What would you expect to happen to glucose levels in CSF in a patient with meningitis?

Glucose levels in the CSF would be lower relative to blood glucose due to bacteria using up the glucose

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What is the antibiotic of choice for meningitis?

What other medication should also be given?

IV ceftriaxone

steroids

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Which antibiotic should be used if listeria meningitis is suspected?

IV amoxicillin

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Which antibiotics are used for meningitis in patients with penicillin allergy?

Chloramphenicol IV and vancomycin IV

Co-trimoxazole for listeria

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Which inflammatory cell type can be seen in the subarachnoid space in patients with pyogenic (bacterial) meningitis?

Neutrophils

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Which type of viruses most commonly cause viral meningitis (a subset of aseptic meningitis)?

Enteroviruses

*Because these live in the gut a stool culture is needed for detection

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Describe the appearance of streptococcus pneumoniae

Gram positive diplococcus

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Describe the appearance of neisseria meningitides

Gram negativ intracellular

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Describe the appearance of listeria monocytogenes

Gram positive rods

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Describe the appearance of haemophilia influenza

Gram negative bacillus

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Which age group are most at risk of neisseria meningitis?

Young children

*nasopharyngeal colonisation

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Who gets streptococcus pneumoniae meningitis?

Hospital patients
Patients with skull fractures 
Alcoholics 
Diabetics 
Immunocompromised

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Who gets listeria monocytogenes?

Neonates
Age 55+
Immunosuppressed

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What side effects should you warn a patient about when treating them for tuberculous meningitis?

Reduced efficacy of the oral contraceptives
Red urine
Staining of contact lenses

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Who gets cryptococcal meningitis?

HIV patients
(with a CD4 <100)

This is a FUNGAL infection so is aseptic

Treated with IV amphotericin B/ flucytosine/ fluconoazole

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What are some consequences of untreated meningitis?

Brain herniation

Cord compression

What is encephalitis and how is it managed?

Infection of the brain parenchyma

pre-emptive aciclovir

What are the normal CSF values for white cells and red blood cells?

White cells <5mm3

There should be no RBCs in CSF

What would RBCs in CSF indicate?

Subarachnoid haemorrhage

NB it is possible to contaminate CSF with RBCs when doing an LP

What would you expect to happen to protein levels in the CSF in a patient with viral meningitis or encephalitis?

Protein would be normal or slightly increased

What would you expect to happen to glucose levels in the CSF in a patient with viral meningitis or encephalitis

No change

What would you expect to happen to glucose levels in the CSF in a patient with bacterial meningitis

Glucose would be decreased, this is because the bacteria use up the glucose

Lymphocytes in the CSF would indicate a viral or bacterial infection?

VIRAL

Polymorphs in the CSF would indicate a viral or bacterial infection?

BACTERIAL

Which 3 structures make up the meninges?

Dura, arachnoid and pia

Describe the location of the needle in LP

Needle enters the subarachnoid space at L4/5

How would you describe the typical meningitis rash?

Non blanching purpuric rash NB - petechiae if small

When would you do a CT before an LP?

You should always really do this But especially in patients with; - V.rapidly progressing rash (this may be suggestive of DIC) - GCS <12 / reduced consciousness - Seizures - Papilloedema

What are some of the side-effects/ risks associated with dexamethasone IV?

Raised blood glucose Confusion/ delirium

What medication should be given to people who have been in close contact with someone who has meningitis?

Single dose of ciprofloxacin

A "ring enhancing lesion" on a brain scan is the buzzword for what?

Brain abscess

What is the most common cause of viral encephalitis?

Herpes simplex

If confusion is the main presentation, which diagnosis should you think of? If neck stiffness is the main presentation, which diagnosis should you think of?

Confusion = encephalitis Neck stiffness = meningitis Confusion+neck stiffness = meningoencephalitis

Which antibiotics are used to treat neonatal meningitis?

Benzylbenicillin and gentamicin

A brain abscess may arise from local spread of which infections?

Middle ear infections, sinusitis and dental infections

What are the classic triad of clinical features that a patient with a brain abscess may present with?

Fever, headache and focal neurological signs

Describe the typical LP results for viral meningitis

CSF clear Normal opening pressure Lymphocytes, increased protein and normal glucose

Describe the typical LP results for bacterial meningitis

CSF cloudy Increased opening pressure Neutrophils, increased protein and decreased glucose

Describe the typical LP results for TB meningitis

CSF opaque Increased opening pressure Lymphocytes, increased protein and decreased glucose

Why is there raised protein in encephalitis and meningitis?

Because the BBB is leaky

Which cell type is raised in encephalitis Vs bacterial meningitis?

Encephalitis is usually viral, so lymphocytes are raised In bacterial meningitis, neutrophils are raised