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RB Y3 1.2 Neurology > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

normal values of WCC, red cells, protein and glucose in CSF

A

White cells: <5/mm3

Red cells: <5mm

Protein: 150-450 mg/L

Glucose: 60-70% of blood glucose

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2
Q

what are most aspectic meningitis cases caused by

A

viruses

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3
Q

pathology of bacterial meningitis

A
  • subarachnoid space is congest with polymorphs, layer of pus forms over the brain
  • can form adhesions - CN palsies and hydrocephalus
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4
Q

what is the most common cause of spread for bacterial meningitis

A

nasopharyngeal colonisation

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5
Q

aetiology of brain infection

A
  • Nasopharyngeal colonisation
    • Most common
  • Direct extension of bacteria
    • Parameningeal foci (sinusitis, mastoiditis, brain abscess)
    • Across skull defects or fracture
  • Post-trauma, post-surgery
  • From remote foci of infection
    • Endocarditis, pneumonia, UTI
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6
Q

what is the classic triad of meningitis

A

headache, neck stifness and feve

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7
Q

other CF

A
  • photophobia
  • vomiting
  • altered mental state - GCS
  • fever, rigors
  • rash
  • seizures
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8
Q

describe the classical meningococcal rash and its signifance

A

non blanching on tumbler test, may be only 1 or 2 spots

Neisseria meningitidis infection

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9
Q

Kernig’s sign

A

inability to extend the knee with the hip fuly flexed

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10
Q

what is a risk factor for infection with encapsulated bacteria

A

Hyposplenism is a risk factor for encapsulated bacteria: H influenzae, Strep pneumoniae

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11
Q

most common organism in children

A

H influenzae - uncommon now due to vaccination

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12
Q

vaccination schedule for HiB

A

in the 6 in 1 at 2,3,4 months

wtih MenC at 12-13 months

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13
Q

gram stain for HiB

A

aerobic gram negative bacilli

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14
Q

2 most common organisms for bacterial meningitis

A

Neisseria meningitidis and S pneumoniae

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15
Q

in which age groups are s pneumoniae and n meningitidis most common

A

NM from 1-0-21, SP > 21

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16
Q

neisseria meningitidis classification

A

gram negative encapsulated diplococci aerobic, is intracellular

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17
Q

strep pneumoniae classification

A

gram positive, alpha haemolytic streptococci

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18
Q

in which conditions does listeria multiply

A

poorly refridgerated temperatures

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19
Q

which pt are more liekly to be infected with listeria, and what precuation is taken for these individuals

A

IS, elderly, alcoholics, chemo, neonatal

amoxicillin is given until culture results returned in those >60 and IS as a precaution

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20
Q

how does Neisseria usually spread to the brain

A

found in the throats of health people, bacteria probs gain access through blood stream

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21
Q

what type of vaccine is the HiB vaccine

A

conjugated

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22
Q

which pt are more susceptible to strep p infection

A

patients with skull fractures, hospitalized pt, diabetics, alcohlics, youn children

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23
Q

which surgical procedure particularly increases the risk of s pneumoniae

A

cochlear implant

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24
Q

which other group of organisms are implicated eg in head trauma/surgery

A

skin commensals (Staph (epidermidis), gram neg bacilli)

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25
Q

how does TB meningitis present

A
  • Develops over 1-3 weeks: fever, headache, vomiting, abdominal pain, drowsiness, meningism, delirium ± seizures
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26
Q

what is a typical feature of TB meningitis

A

cranial nerve palsies

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27
Q

management of TB meningitis

A

isoniazid and rifampicin are key for 12m (add pyrazinamide and ethambutol)

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28
Q

what is cryptococcus

A

a fungus that is found in soil and bird droppings

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29
Q

who tends to egt cryptococcal meningitis

A

seen mainly in HIV, those with a low CD4 count (<100)

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30
Q

presentation of crytopcoccal

A

subtle neurological presentation, aseptic picture on CSF

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31
Q

what are the likely organisms in neonatal meningitis

A

Group B Strep and Listeria

32
Q

how does Group B strep get passed on to neonate

A

acquired from mother (vaginal colonisation), occurs within the first few days after birth

subtle presentation

33
Q

management and prevention of Group B Strep for neonatal meningitis

A
  • Management: benzylpenicillin and gentamicin
  • Prevention: intrapartum ABx given if pre-term labour, prolonged rupture of membranes, fever, known past infection/colonisation
34
Q

how does Listeria infect neonate in neonatal meningitis

A
  • Found in various foods (poorly refrigerated temperatures)
  • Transplacental infection, causes stillbirth as well as neonatal sepsis/meningitis
35
Q

management of Listeria causing neonatal meningitis

A

amoxicillin and gentamicin

36
Q

sequelae of meningitis

A

Fatal disease. 25% of those who survive suffer from limb loss deafness, blindness, cerebral palsy, quadriplegia and severe mental impairment.

Layer of pus can form adhesions - CN palsies (III and IV) and hydrocephalus

37
Q

should you admit someone to hospita with just eg a headache if they have had contact with meningococcal infection

A

yes

even if they have received prophylactic ABx

38
Q

pt presents with suspicion of bacterial meningitis

A
  • bloods and LP
  • treatment
  • throat swab, swab any lesions
39
Q

contra indications/reasons to delay lumbar puncture

A
  • ANY sign of raised ICP
  • IC
  • history of CNS disease
  • new onset seizure
  • altered consciousness
  • focal neurological deficit
  • GCS ≤12
  • signs of severe sepsis or rapidly evolving rash
  • bleeding risk
  • severe resp/cardio compromise
40
Q

suspected meningitis, w/ raised ICP, w/ severe sepsis/rapidly evolving rash:

A

perform CT first

41
Q
A
42
Q

what would happen if you did a LP in someone with inc ICP

A

forms a low pressure shunt - CSF and brain mass shift towards low pressure outlet - herniation

43
Q

why is LP normally performed before ABx given

A

use of ABx first would lower gram stain and culture positivity

44
Q

ABx

A

ceftriaxone and dexamethasone IV

45
Q

ABx penicillin allergy

A

chloramphenicol and vancomycin

46
Q

Listeria coverage

A

Amoxicillin (Co-t if penicillin allergic)

47
Q

when should Listeria coverage be given first instance

A

if there is a risk eg old age, IS, alcoholic, chemo

48
Q

which organism do steroids have the best benefit for

A

pneumococcal meningitis

49
Q

who should not receive steroid therapy

A

post surgical, severe IC, septic shock, hypersenitive to steroids

50
Q

LP results for viral, bacterial and TB infection

A
51
Q

contact prophylaxis

A

rifampicin, ciprofloxacin, ceftriaxone

52
Q

women on rifampicin

A

reduces the effiacy of oral contraceptive

53
Q

must you inform public health about meningitis ?

A

yes

54
Q

vaccination schedule: meningitis

A

Men C at 3 months

Men B at 2m, 4m, 12-13m

MenC/HiB 12-13 m

Men ACWY at 13-14y

55
Q

what is a brain abscess

A

inflammation and collection of infected material

56
Q

how do brain abscesses arise

A

either local spread of infection or 2y to remote infective process

57
Q

clinical features of brain abscess

A

classic triad of fever, headache and focal neurological signs

seizures

58
Q

microbiology of brain abscess

A

Streptococci (S milleri), coliforms (e.g. Proteus), anaerobes, S aureus, Actinomyces

59
Q

diagnosis of brain abscess

A

ring enhancing lesion on CT

60
Q
A

strep pneumoniae

61
Q

management of brain abscess

A

drainage, ceftriaxone (gram neg and pos) and metronidazole (anaerobes) for 6 weeks

modify in light of culture

62
Q

when is viral meningitis more common

A

late summer/autumn (freshers)

63
Q

describe the course of viral meningitis

A

bengin and self limiting (4-10 days)

headache may follow on for some months after, no serious sequelae normally

64
Q

is there pus, polymorphs, adhesions etc in viral meningitis?

A

no it is a predominantly lymphocytic inflammatory reaction

  • no adhesions etc form
  • little or no cerebral oedema
65
Q

key features of viral meningitis history

A

GI symptoms and travel history

66
Q

what is the main cause of viral meningitis

A

enteroviruses

67
Q

diagnosis of viral meningitis

A

LP - lymphocytes

viral stool culture, throat PCR and CSF PCR

68
Q

treatment of viral meningitis

A

supportive as it is self limiting

69
Q

clinical features of encephalitis

A
  • personality and behavioural change - reduced level of consciousness - coma
  • seizures
  • focal neurological deficits
70
Q

what is the onset of encephalitis like

A

insidious

71
Q

what is encephalitis caued by, and treatment

A

HSV, IV acyclovir

72
Q

investigations of encephalitis

A

LP

EEG

CT

MRI

viral PCR

73
Q

what is a CT/MRI of encephalitis likely to show

A

focal oedema in temporal lobes

inflammation and swelling

74
Q

which lobe does HSV encephalitis tend to affect

A

temporal

75
Q

management of encephalitis

A

As shown below: ABCDE and glucose - LP (if ok) - MRI/CT - ACYCLOVIR - PCR Results

(pre-emptive acyclovir is beneficial)

76
Q

what are 2 positive movement signs in bacterial meningitis

A

RB Y3 1.2 Neurology (23 decks)

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