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Neurology > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

important microbes to know about?

A

pneumococci

meningococci

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2
Q

untreated CNS infection has what risks?

A

brain herniation and death

cord compression and necrosis and subsequent permanent paralysis

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3
Q

classification of meningitis?

A

acute pyogenic (bacterial)
acute aseptic (e.g viral) meningitis
acute focal suppurative infection (abscess, subdural and extradural empyema)
chronic bacterial infection (tuberculosis)
acute encephalitis (infection in brain parenchyma)

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4
Q

aseptic meningitis?

A

no bacteria involved but same symptoms as meningitis

can be viral

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5
Q

pyogenic meningitis shows what?

A

“pus forming”
shows thick layer of suppurative exudate over leptomeninges on surface of brain
exudate in basal and convexity surface

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6
Q

microscopic features of pyogenic meningitis?

A

lots of neutrophils in subarachnoid space

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7
Q

general rule for meningitis antibiotics?

A

always very high doses IV (never oral)
ceftriaxone 2g IV (or chloramphenicol if penicillin allergic)
- add vancomycin in places where it is known there are resistant meningococcus

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8
Q

when does viral meningitis usually occur during the year?

A

late summer/autumn

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9
Q

what causes viral meningitis?

A

enteroviruses (e.g ECHO virus)

other microbes and other non-infectious causes as well

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10
Q

how is viral meningitis diagnosed?

A

viral stool culture
throat swab
CSF PCR

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11
Q

how is viral meningitis managed?

A

supportive (self limiting)

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12
Q

encephalitis features?

A 
cerebral cortex is diffusely involved
mental status change
confusion
obtundation, stupor or coma
behavioural, memory and speech disturbance
focal or diffuse
insidious onset
meningismus (neck stiffness)
seizures, partial paralysis
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13
Q

important differential for encephalitis?

A

herpes simplex virus

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14
Q

look at flow charts for meningitis management

A

…

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15
Q

encephalitis findings on MRI?

A

shows as diffuse white areas

- HSV encephalitis usually in temporal lobe

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16
Q

main features of bacterial meningitis?

A 
fever
rash
photophobia
change in mental state
nausea and vomiting
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17
Q

main causes of bacterial meningitis depending on age?

A 
neonates = listeria group B strep, E.coli
children = H influenzae
10-21 = Neisseria meningitidis
21+ = strep pneumoniae > Neisseria meningitidis
65+ = strep pneumoniae
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18
Q

risk factors for bacterial meningitis?

A

immunocompromised
basilar skull fracture or fracture or cribiform plate
head trauma or post neurosurgery
CSF shunt

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19
Q

impact of meningitis after infection/

A

can cause death

25% of people have life changing after-affects (limb loss, blindness, paralysis, cerebral palsy etc)

20
Q

complications?

A

purulence (pus collects at base of brain and around nerves and in sulci)
invasion
cerebral oedema
ventriculitis/hydrocephalus

21
Q

3 main routes of infection in bacterial meningitis?

A

nasopharyngeal colonization
direct extension of bacteria (brain abscess, across skull fracture etc)
from remote foci of infection (endocarditis, pneumonia etc)

22
Q

principles of lumbar puncture?

A 
only perform in clinically feasible
be cautious if increased ICP possible
use sitting position if needed
measure opening pressure if fast flow
be careful in delirium
treat with antibiotics first
CSF pleocytosis not bacterial meningitis
23
Q

what tests are performed on lumbar puncture sample?

A

haematology (cell count etc)
microbiology (gram stain, culture)
chemistry (glucose, protein)

24
Q

microbiological diagnosis of meningitis?

A 
microscopy
biochemistry
culture
antigen detection
PCR
25
Q

bacterial meningitis can be culture negative, true or false?

A

true

10-15% are negative due to pre-lumbar puncture antibiotics

26
Q

acute bacterial meningitis findings?

A 
\+ve gram stain
\+ve antigen detection
high protein
low glucose
raised WBC and neutrophils
27
Q

features of Neisseria meningitidis (meningococcal meningitis)?

A 
found in throat
gains access to meninges via blood stream
may be found in leukocytes in CSF
symptoms arise due to endotoxin
most common in young kids
28
Q

describe haemophilus influenzae meningitis?

A

part of normal throat microbiota
requires blood factors for growth
type B = most common cause of meningitis in kids <4
has a vaccine

29
Q

strep pneumoniae meningitis?

A

found in nasopharynx
common in hospitalized, skull fractures, diabetics/alcoholics and young children
can be 2ndary to pneumococcal pneumonia in some cases

30
Q

common causes of meningitis in immunocompromised?

A

listeria monocytogenes
mycobacterium tuberculosis
nocardia asteroids
Cryptococcus neoformans (HIV with CD4<100)

31
Q

listeria is resistant to what antibiotic? how is it managed instead?

A

ceftriaxone

management = IV ampicillin/amoxicillin

32
Q

describe listeria monocytogenes?

A

gram +ve bacillus
sporadic but becoming more common
neonatal, over 55s or immunosuppressed

33
Q

describe tuberous meningitis?

A 
often due to reactivation in the elderly
non-specific ill health
previous TB on CXR
poor yield from CSF
high morbidity if untreated
34
Q

how is tuberous meningitis managed?

A

Isoniazid + rifampicin key

add pyrazinamide + ethambutol

35
Q

cryptococcal meningitis features and management?

A

fungal
mainly in HIV
CD4 < 100
subtle presentation and aseptic CSF picture
management = IV amphotericin B/flucytosine, fluconazole

36
Q

what is aseptic meningitis?

A 
term used to describe non-pyogenic meningitis
spinal fluid formula typically has
- low WBC
- minimally elevated protein
- normal glucose
37
Q

infectious causes of aseptic meningitis/encephalitis syndrome?

A 
HSV 1 and 2
syphilis
listeria
tuberculosis
Cryptococcus
38
Q

non-infectious causes of aseptic meningitis?

A 
carcinomatous
sarcoidosis
vasculitis
dural venous sinus thrombosis
migraine
drugs
39
Q

contact prophylaxis regimes to prevent meningitis if you’ve come into contact with someone?

A

600mg rifampicin orally every 12 hours for 4 doses (age 12+)
10mg/kg rifampicin every 12 hrs for 4 doses (3-11 months)
or
500mg ciprofloxacin orally as single dose
or
250mg ceftriaxone intramuscularly as single dose

40
Q

how are secondary cases of meningitis prevented?

A

phone public health

keep GP records of all close contact to people with meningitis

41
Q

indications for hospital admission?

A 
signs of meningeal irritation
impaired conscious level
petechial rash
febrile/unwell and has a recent fit
illness after contact with someone with meningitis
42
Q

what action should be taken on admission to hospital?

A

blood cultures
give treatment
take a throat swab
disrupt and swab or aspirate any petechial or purpuric skin lesions for microscopy and culture

43
Q

who should receive a lumbar puncture?

A

all adult patients with suspected meningitis except when there is a clear contraindication or if there is a clear clinical diagnosis

44
Q

are antibiotics given before or after lumbar puncture?

A

before

45
Q

empirical antibiotic therapy?

A

2g IV ceftriaxone bd

  • add IV ampicillin/amoxicillin 2g if listeria suspected
  • penicillin allergy = chloramphenicol IV + vancomycin IV
  • listeria + penicillin allergy = co-trimoxazole
46
Q

how are steroids used in meningitis?

A

give to all patients with suspected bacterial meningitis before or with first dose of antibiotics
- don’t give in post-surgical, immunocompromised or septic shock

47
Q

which causes of meningitis have vaccines?

A

Neisseria meningitidis (YWCA)
haemophilus influenzae
strep pneumoniae

Neurology (53 decks)

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