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Year 2 Clinical Pathology > CNS infections > Flashcards

CNS infections Flashcards

1
Q

Other than inflammation of the meninges, how else can meningitis be defined?

A

Infection of the cerebrospinal fluid

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2
Q

What is the main difference in symptoms between encephalitis and meningitis?

A

In meningitis there is not altered conscious level or focal neurological signs

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3
Q

What is the usual cause of brain abscesses?

A

Normally bacterial but can be parasitic

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4
Q

In which 2 ways may invasion of microorganisms into the brain occur?

A

Blood borne invasion

Invasion via peripheral nerves

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5
Q

In viral, TB and cryptococcal infection of the brain, the white cell count in CSF is raised, what is the predominant type of white cell?

A

Lymphocytes

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6
Q

How does CSF glucose differ in viral, TB and cryptococcal brain infection?

A

Normal or reduced

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7
Q

How does CSF protein differ in viral, TB and cryptococcal brain infection?

A

Normal or increased

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8
Q

How does CSF glucose and protein change in bacterial infection?

A

Glucose is reduced

Protein is increased

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9
Q

Neisseria meningitidis is one of the main causes of bacterial meningitis, what kind of bacteria is it?

A

Gram negative diplococci

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10
Q

How many capsular types of Neisseria meningitidis, what are the 5 most common types?

A

13 capsular types

A, B, C, W135 and Y are most common

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11
Q

Other than by culturing how else can Neisseria meningitis be identified?

A

By nucleic acid amplification - PCR

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12
Q

What is the natural habitat of Neisseria meningitidis?

A

Nasopharynx

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13
Q

What 2 factors affect the survival ability of Neisseria meningitidis in the bloodstream?

A

1) Presence of a capsule - protects against complement-mediated bacteriolysis and phagocytosis
2) Ability to modify host cell inflammatory processes ie. host cell cytokine production

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14
Q

Once Neisseria meningitidis has crossed the BBB where does it multiply?

A

In the subarachnoid space

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15
Q

Meningococcal meningitis is caused by which organism?

A

Neisseria meningitidis

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16
Q

Meningoccal meningitis is more common in which age groups?

A

Children below 9 months

Another small peak at ~18 years

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17
Q

What 4 infections can Neisseria meningitidis commonly cause?

A

1) Fulminant (severe and sudden onset) septicaemia
2) Septicaemia with purpuric rash
3) Septicaemia with meningitis
4) Pyogenic (purulent) meningitis with no rash

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18
Q

Other than the 4 most common, what 4 other infections can Neisseria meningitidis cause?

A

1) Chronic meningococcal bacteraemia with arthralgia
2) Focal sepsis
3) Conjunctivitis
4) Endophthalmitis (inflammation of the internal coats of the eye)

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19
Q

What is septicaemia?

A

Bloodstream infection

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20
Q

What is the treatment for Neisseria meningitidis infection?

A

Ceftriaxone, cefotaxime - culture bacteria in the lab and if sensitive to penicillin then step down to penicillin
Early treatment, intensive care

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21
Q

Chemoprophylaxis is used in contacts of people with invasive Neisseria meningitidis infection, what 2 anti-microbials are used?

A

(Used for close or ‘kissing’ contacts)
Rifampicin
Ciprofloxacin

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22
Q

Is there an available vaccine against Neisseria meningitidis?

A

Yes for groups A, C and W135 but none against group B

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23
Q

The ‘African meningitis belt’ refers to massive epidemics across Africa caused by which group of Neisseria meningitidis?

A

Group A

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24
Q

Haemophilus influenza bacteria is unable to grow in the absence of what?

A

Blood or certain constituents of blood

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25
Q

What kind of bacteria is haemophilus influenza?

A

Small, pleomorphic, gram negative cocci-bacilli or bacilli

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26
Q

Does haemophilus influenza have a capsule?

A

Some strains produce a polysaccharide capsule

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27
Q

Which type of haemophilus influenza causes the most invasive disease?

A

Type B

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28
Q

In which part of the body is haemophilus influenza commonly carried in humans?

A

Throat carriage

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29
Q

How does haemophilus influenza commonly invade the bloodstream?

A

1) Carried in the throat
2) Invasion of submucosa
3) Invasion into blood stream

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30
Q

Haemophilus influenza can cause meningitis most commonly in which group?

A

Infants - > 2months - 2 years

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31
Q

Which type of haemophilus influenza has a capsule?

A

Type B

32
Q

What is the treatment for haemophilus influenza?

A

Ceftriaxone, cefotaxime
Ampicillin
B-lactamase producing strains are common

33
Q

Which antimicrobial is used in chemoprophylaxis of contacts of invasive haemophilus influenza infection?

A

Rifampicin

34
Q

Is there a vaccine available against haemophilus influenza?

A

Type B conjugate vaccine available

Led to a dramatic reduction in the incidence of invasive disease

35
Q

What kind of bacteria is streptococcus pneumoniae?

A

Gram positive cocci, cells in pairs

36
Q

What does streptococcus pneumoniae require for growth?

A

Requires blood or serum for growth

37
Q

What is the normal habitat of streptococcus pneumoniae and how is it transmitted?

A

Normal habitat is human respiratory tract - transmission is via droplet spread

38
Q

Streptococcus pneumoniae causes meningitis more commonly in which groups?

A

Elderly and immunocompromised

39
Q

What 2 antimicrobials are used in the treatment of streptococcal meningitis?

A

Ceftriaxone and cefotaxime

Penicillin resistant strains common in some parts of the world

40
Q

Is there chemoprophylaxis for contacts of invasive streptococcal meningitis?

A

No

41
Q

Is there a vaccine available against streptococcus pneumoniae?

A

Conjugate vaccine available against common serotypes

42
Q

What are the 3 common bacteria causing meningitis?

A

1) Neisseria meningitidis
2) Haemophilus influenza
3) Streptococcus pneumoniae

43
Q

Other than antimicrobials what other drugs can be used in meningitis, particularly in streptococcus pneumoniae?

A

Steroids

44
Q

Neonatal meningitis is commonly caused by which 3 organisms?

A

1) Group B haemolytic streptococci
2) Escherichia coli
3) Listeria monocytogenes

45
Q

What is the course of infection leading to meningitis in n neonates?

A

1) Early (5 days) - usually meningitis

46
Q

What 3 antimicrobials are used to treat neonatal meningitis?

A

1) Cefotaxime
2) Ampicillin
3) Gentamicin

47
Q

What are 8 possible complications of meningitis?

A

1) Death
2) Overwhelming sepsis
3) Raised intracranial pressure
Longer term problems
4) Deafness
5) Delayed development
6) Seizures
7) Stroke
8) Hydrocephalus

48
Q

What 3 types of organisms can lymphocytic meningitis be caused by?

A

1) Most commonly viral meningitis
2) Spirochete (spiral shaped bacteria) - treponemal, borrelia
3) TB

49
Q

What virus can cause meningitis that may lead to paralysis but can be prevented with vaccination?

A

Polio virus

50
Q

What are the 3 epidemiological risk factors for TB meningitis?

A

1) Immunocompromised
2) Alcoholic
3) Comes from an endemic area

51
Q

What is the treatment for TB meningitis?

A

1) 12 month standard TB treatment

2) Steroids beneficial

52
Q

What is meant by acid fast bacilli stain used for TB?

A

Add stain and try and wash away with acid and alcohol but the cell walls of the TB retains the stain

53
Q

By what 2 methods can TB be detected?

A

1) Ziehl Neelsen stain

2) Fluorescent Ab stain

54
Q

Brain abscesses caused by bacteria which has spread from the middle ear or sinuses will commonly be caused by what bacteria?

A

Streptococci anaerobes

55
Q

Brain abscesses caused by bacteria which has spread from the blood stream are commonly caused by what bacteria?

A

Staphylococcus aureus

56
Q

What investigation is needed to confirm a diagnosis of brain abscess?

A

Brain imaging

57
Q

Cryptococcal meningitis is a common problem in which group of patients, is it lymphocytic or polymorphic?

A

Those with late stage HIV - lymphocytic

58
Q

What is the treatment for cryptococcal meningitis?

A

Prolonged course of treatment with amphotericin, flucytosine or fluconazole

59
Q

Is encephalitis more commonly caused by bacteria or viruses?

A

usually viral

60
Q

What is the most common cause of encephalitis worldwide?

A

Japanese encephalitis

61
Q

Which group does Japanese encephalitis commonly affect?

A

Children

62
Q

What is the prognosis for Japanese encephalitis?

A

1/3 die in acute illness
1/3 left with severe long term neurological disability
1/3 recover

63
Q

Is Japanese encephalitis preventable?

A

Yes by vaccine

64
Q

What is the prognosis for rabies encephalitis and how is it spread?

A

100% mortality

Spread by dog, fox and bat bites

65
Q

Is rabies encephalitis preventable?

A

Yes by vaccination

66
Q

Clostridium tetani causes what condition?

A

Tetanus (lock jaw)

67
Q

What are the 5 main symptoms of tetanus?

A

1) Tonic muscle spasms
2) Trismus (spasm of the jaw muscles)
3) Opsithotonus (spasm of muscles causing backward arching of the head)
4) Respiratory difficulties
5) Cardiovascular instability

68
Q

What kind of bacteria is clostridium tetani?

A

gram positive spore forming bacillus - strict anaerobe

69
Q

How is clostridium tetani spread?

A

Organism which is widespread in the soil - implantation of contaminated soil into wound which may be major or minor

70
Q

How does clostridium tetani cause the symptoms of tetanus?

A

1) Organism is non invasive but produces tetanospasmin
2) Toxin genes plasmid encoded
3) Toxin spreads via blood stream and retrograde transport
4) Toxin binds to ganglioside receptors and blocks release of inhibitory interneurons
5) Get convulsive contraction of voluntary muscles

71
Q

What is the most common entry site of clostridium tetani to the body?

A

Foot

72
Q

Name a toxin mediated CNS infection?

A

Tetanus

73
Q

What is the treatment for tetanus?

A 
Antitoxin - horse or human
Penicillin or metronidazole
Drugs for spasms
Muscle relaxants
Respiratory support
74
Q

What can be used in the prevention of tetanus?

A

Toxoid (chemically modified toxin which is no longer toxic but is still antigenic and can be used as a vaccine)

75
Q

What type of cell culture is used to identify streptococcus pneumonia?

A

Optochin test

Year 2 Clinical Pathology (64 decks)

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