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3.2 Neurology > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

What are some clinical consequences of untreated infections of the CNS?

A

Brain herniation and death Cord compression and necrosis with subsequent permanent paralysis

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2
Q

List infections of the CNS

A

Encephalitis Meningitis Meningoencephalitis Encephalomyelitis Epidural abscess Neuritis Sepsis syndrome due to infection elsewhere

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3
Q

Name different classifications of meningitis

A

Acute pyogenic (bacterial) meningitis Acute aseptic (viral) meningitis Acute focal suppurative infection (brain abscess, subdural and extradural empyema) Chronic bacterial infection (tuberculosis) Acute encephalitis

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4
Q

What is acute encephalitis?

A

An infection of the brain parenchyma

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5
Q

What does the brain look like when infected by pyogenic meningitis?

A

Thick layer of suppurative exudate covering the leptomeninges

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6
Q

What is seen microscopically in pyogenic meningitis?

A

Neutrophils in the subarachnoid space

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7
Q

What pathogens cause bacterial meningitis?

A

Pneumococcus Meningococcus Haemophilus influenza

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8
Q

What other pathogen can cause bacterial meningitis in patients >60 or immunocompromised?

A

Listeria spp

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9
Q

What antibiotics are used to treat bacterial meningitis?

A

Ceftriazone IV + Dexamethasone IV If P allergy: chloramphenicol IV

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10
Q

What antibiotic can be added to cover listeria infection?

A

Amoxicillin IV P allergy: co-trimoxazole

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11
Q

Why does H. influenza rarely cause meningitis?

A

Vaccination

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12
Q

Which bacteria is diplococcus, gram positive and stains purple?

A

Strep pneumonia

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13
Q

Which bacteria is gram-negative (stains pink) and is intracellular?

A

Neisseria meningitidis

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14
Q

Which bacteria is gram positive, bacillus (rod-shaped) and occurs in over 60s and alcoholics?

A

Listeria monocytogenes

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15
Q

Which bacteria is gram negative and bacillus?

A

H. influenzae

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16
Q

Which pathogen causes viral meningitis?

A

Enteroviruses e.g. ECHO virus

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17
Q

How is viral meningitis diagnosed?

A

Viral stool culture Throat swab CSF PCR

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18
Q

What is the treatment for viral meningitis?

A

Supportive Self-limiting

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19
Q

What questions should you ask when taking a history from a patient with suspected encephalitis?

A

Current or recent febrile, flu-like illness? Altered behaviour, personality change or altered consciousness? New onset seizures? Focal neurological symptoms? Rash? Family/neighbours affected? Travel history? Recent vaccinations? Animals (rabies)? Fresh water (leptospirosis)? Mosquito/tick bites? Immunocompromised? HIV?

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20
Q

What are the clinical features of encephalitis?

A

Insidious onset Stiffness in head/neck Stupor, coma Seizures, partial paralysis Confusion, psychosis Speech, memory symptoms

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21
Q

Which disease is coma more likely to present in, encephalitis or meningitis?

A

Encephalitis

22
Q

What are the investigations for encephalitis?

A

Lumbar puncture EEG MRI

23
Q

Should acyclovir be given pre-emptively if there is a delay in treating encephalitis?

A

Yes- prompt therapy improves outcomes

24
Q

What are the common signs and symptoms of meningitis?

A

Fever, cold hands + feet Drowsy Severe muscle pain Severe headache Dislike bright lights Vomiting Confusion + irritability Pale, blotchy skin Spots/rash Stiff neck Convulsions/seizures

25
Q

Which bacteria commonly infects neonates with community acquired bacterial meningitis?

A

Listeria Group B Streptococci E.coli

26
Q

Which bacteria commonly infects children with community acquired bacterial meningitis?

A

H. influenza

27
Q

Which bacteria commonly infects children aged 10-21yrs with community acquired bacterial meningitis?

A

Neisseria menigitidis

28
Q

Which bacteria commonly infects >21yrs with community acquired bacterial meningitis?

A

Streptococcus pneumonias > Neisseria meningitidis

29
Q

Which bacteria commonly infects >65yrs with community acquired bacterial meningitis?

A

Streptococcus pneumonia > Listeria

30
Q

Which bacteria commonly infects patients with decreased cell mediated immunity with community acquired bacterial meningitis?

A

Listeria monocytogenes

31
Q

Which bacteria commonly infects neurosurgery/head trauma patients with community acquired bacterial meningitis?

A

Staph aureus Staph epidermis Aerobic GNR

32
Q

Which bacteria commonly infects fracture of cribriform patients with community acquired bacterial meningitis?

A

Streptococcus pneumoniae

33
Q

Which bacteria commonly infects CSF shunt patients with community acquired bacterial meningitis?

A

Staph epidermidis Staph aureus Aerobic GNR Propionibacterium acnes

34
Q

What percentage of those who survive meningitis with have life-altering after effects. Give examples

A

25% Limb loss Blindness Deadness Cerebral palsy Quadriplegia Severe mental impairement

35
Q

What is the pathogenesis of bacterial meningitis?

A

Nasopharyngeal colonisation Direct extension of bacteria- parameningeal foci (sinusitis, mastoiditis or brain abscess) or across skull defects/fractures From remote foci of infection (endocarditis, pneumonia, UTI)

36
Q

Which bacteria causes meningococcal meningitis?

A

Neisseria meningitidis Found in throats of healthy carriers

37
Q

What indicates the presence of n. meningitidis in CSF?

A

Bacteria found in leukocytes

38
Q

Which type of H. influenza meningitis is most common in children under 4?

A

Type B

39
Q

How does the vaccine for H. influenza work?

A

Conjugated vaccine directed against capsular polysaccharide antigen

40
Q

Which groups of people are most susceptible to s. pneumoniae meningitis?

A

Hospitalised patients Patients with CSF skull fractures Diabetics Alcoholics Young children

41
Q

Which vaccine is given to children to protect against pneumococcal meningitis?

A

Pneumococcal pneumonia vaccine

42
Q

What is a gram positive bacilli (+blood cultures)?

A

Listeria monocytogenes

43
Q

What is the antibiotic of choice for listeria monocytogenes?

A

IV ampicillin/amoxicillin Ceftriaxone has no value

44
Q

Who is affected most by TB meningitis?

A

Reactivation Elderly

45
Q

How is TB meningitis treated?

A

Isoniazid + rifampicin (add pyrazinamide + ethambutol)

46
Q

What are features of cryptococcal meningitis?

A

Fungal Mainly in HIV disease CD4 <100 Disseminated infection

47
Q

What is found on investigation of a patient with cryptococcal meningitis?

A

Subtle neurological presentation Aseptic on CSF Serum and CSF cryptococcal antigen

48
Q

Which antibiotics should be given for cryptococcal meningitis?

A

IV amphotericin B/ Flucytosine Fluconazole

49
Q

What should be measured when taking a CSF sample?

A

Opening pressure Microscopy, culture +sensitivity Meningococcal and pneumococcal PCR Protein Glucose Lactate

50
Q

What further tests should be performed in suspected meningitis?

A

Bacterial- PCR on CSF Viral- PCR on CSF for: HSV1/2, VSZ, enterovirus Stool Throat swab

51
Q

What is the algorithm for meningitis?

A
52
Q
A

3.2 Neurology (9 decks)

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