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CNS infections Flashcards

1
Q

what is meningitis inflammation of

A

all the meninges

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2
Q

why is time important in CNS infections

A

to save neural tissue
untreated infection may cause:
-brain herniation and death
-cord compression and necrosis (paralysis)

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3
Q

what is encephalitis

A

global infection of the brain parenchyma often caused by viruses

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4
Q

what is meningoencephalitis

A

inflammatory process (most often caused by viral infection), involving both the brain and meninges

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5
Q

what is encephalomyelitis

A

inflammation of the brain and spinal cord

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6
Q

what is neuritis

A

inflammation of one or more nerves

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7
Q

what are the types of menigitis

A

acute pyogenic (bacterial)
acute aseptic (viral)
acute focal suppurative infection (brain abscess, subdural and extradural empyema)
chronic bacterial infection (TB)

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8
Q

what is encephalopathy

A

any disease or disoder that affects the brain

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9
Q

what are the features of pyogenic meningitis

A

have a thich layer of suppurative exudate covering the leptomeninges over the surface of the brain
exudate in basal and convexity surface

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10
Q

what is seen microscopically in pyogenic meningitis

A

neutrophils in the subarachnoid space- lots of neutrophils in lumbar puncture= bacterial meningitis

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11
Q

do you get lots of neutrophils in CSF in a viral meningitis

A

no

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12
Q

what bacteria commonly cause bacterial meningitis

A

pneumococcus (strep pneumoniae)
meningococcus
haemophilus influenzae

listeria if >60 or immunocompressed

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13
Q

what is the treatment for bacterial meningitis

A

ceftriaxone IV
(if penicillin allergy chloramphenicol)
+
dexamethasone (IV) start with or just before abx

if listeria cover required add in amoxicillin IV (or co-trimoxazole if p allergic)

if recent travel ass in vancomycin IV for pneumococcal resistance

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14
Q

why should you make sure someone is allergic to penicillin before giving chloramphenicol

A

as v nasty drug - grey baby

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15
Q

what type of bacteria is strep pneumoniae

A

gram +ve cocci

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16
Q

what type of bacteria is listeria monocytogenes

A

gram +ve rod

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17
Q

what type of bacteria is haemophilis influenza

A

gram -ve bacillus

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18
Q

what causes viral meningitis

A 
enteroviruses (echo virus) 
herpes simplex (will have coldsores)
varicellar zoster virus

(in immunosuppressed EBV and CMV)

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19
Q

how is viral menigitis diagnosed

A

viral stool culture
throat swab
CSF PCR (will have only a few lymphocytes)

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20
Q

what is the treatment for viral meningitis

A

initially same as bacterial

supportive- e.g. vomiting give anti emetic

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21
Q

what should you not delay in suspected encephalitis

A

lumbar puncture (unless they have had seizures)

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22
Q

what Tx for viral encephalitis

A

IV aciclovir

LP after 14 days, HSV PCR weekly until negative

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23
Q

what are the clinical features of encephalitis

A

insidious onset
meningismus (features of meningitis without inflammation of the meninges)

cerebral cortex is diffusely involved:
mental changes
confusion
stupor 
coma 
seizures 
partial paralysis 
speech and memory symptoms 
pychosis 
focal or diffuse neurological changes
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24
Q

what are the clinical features of meningoencephalitis

A

features of encephalitis but with alos:

  • headache
  • fever
  • neck stiffness
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25
what viruses commonly causes viral encephalitis
herpes simplex
26
what investigations for encephalitis
LP, EEG, MRI
27
what are the symptoms of meningitis
``` headache vomiting pyrexia neck stiffness photophobia lethargy confusion rash (non blanching) muscle pain ```
28
what causes bacterial meningitis in neonates
listerior, group B strep, e coli
29
what causes bacterial meningitis in children
h influenza (vaccinate against this)
30
what causes bacterial meningitis in ages 10-21
neisseria meningitidis
31
what causes bacterial meningitis in ages over 21
strep pneumoniae , neisseria meningitidis
32
what causes bacterial meningitis in overs 65s
streptococcus pneumoniae, listeria
33
what causes bacterial meningitis in the immunocompromised
S. pneumoniae, N. meningitidis, listeria, aerobic GNR
34
what causes bacterial meningitis in basilar skull fractures
s. pneumoniae, h. influenzae, beta hemolytic strep group A
35
what causes bacterial meningitis in head trauma/ post op
s. aureus, s epidermis, aerobic GNR
36
what causes bacterial meningitis in a CSF shunt
s. epidermis, S aureus, aerobic GNR, p. acnes
37
what are the possible complications of meningitis
as limb loss, deafness, blindness, cerebral palsy, quadriplegia and severe mental impairment Purulence Exudate around nerves (III, VI cranial nerves particularly vulnerable) invasion and abscesses cerebral oedema ventriculitis/ hydrocephalus
38
what are the pathogeneses of bacterial meningitis
- nasopharyngeal colonisation (most common) - direct (sinusitis, mastoiditis, brain abscess, skull defects/ fracture - from remote foci of infection (endocarditis, pneumonia, UTI)
39
what do you analyse in CSF from a lumbar puncture
Tube 1. Hematology: cell count, differential Tube 2. Microbiology: gram stain, cultures Tube 3. Chemistry: glucose (will be low in meningitis as bacteria eating it), protein Tube 4. Hematology: cell count, differential opening pressure lactate
40
what precautions must be made in lumbar punctures
be careful of raised ICP (dont do) | treat with antibiotics first in suspected bacterial infection
41
what CSF results are 99% predictive of bacterial meningitis
``` high WBC count higher neutrophils high protien low glucose low glucose (CSF/serum) ```
42
what are the typical CSF findings in viral meningitis
lymphocytes protein normal/ slightly high glucose usually normal gram stain will be negative
43
what will the gram stain be in TB CSF analysis
may be pos or negative
44
what causes the symptoms in neisseria meningitis
endotoxin
45
who usually gets neisseria meningitis
young children
46
what does the rash look like in meningococcal infection
non blanching purpura that look like coalesced bruises
47
what does H influenza require for growth
blood factors
48
what is the most common cause of meningitis in children under 4
h influenzae
49
where is strep pneumoniae usually found- why is this important
nasopharynx Hospitalized patients, patients with CSF skull fractures, diabetics/ alcoholics and young children are most susceptible to S. pneumoniae meningitis.
50
what tx for cryptococcus meningitis
will have very high ICP so give serial LPs and anti fungals (IV amphotericin A/ flucytosine, fluconazole)
51
who gets cryptococcus
HIV patients
52
what is the most common meningitis in immunocompromised
listeria
53
what are the features of cryptococcal meningitis
``` fungal mainly in HIV disease low CD4 disseminated infection aseptic CSF ```
54
who gets listeria meningitis infections
neonates >55s immunosuprpessed (esp malignancy)
55
what antibiotic for listeria
IV amoxicillin (or ampicillin)
56
what are the features of tuberculous meningitis
reactivation, elderly often non specific illness previous TB on CXR hard to diagnose- poor yield on culture
57
tx for TB meningitis
Isoniazid + rifampicin key (add pyrazinamide + ethambutol)
58
why can bacterial meningitis be culture negative
10-15% are anyway | pre LB use of oral antibiotics can lower culture
59
what other than bacterial meningitis can a neutrophilic & low glucose CSF mena
early viral leakage of abscess into ventricle TB chemical meningitis behcet syndrome drug induced
60
what is aspetic meningitis
``` non pyogenic bacterial meningitis: spinal fluid that contains -low WBC -minimally elevated protein -normal glucose ``` can be lots of things other than viral meningitis
61
what are the (treatable) causes of aseptic meningitis/ encephalitis
``` Infectious: HSV 1 and 2 Syphilis Listeria (occasionally) Tuberculosis Cryptococcus Leptospirosis Cerebral malaria African tick typhus Lyme disease ``` ``` Non-Infectious: Carcinomatous Sarcoidosis Vasculitis Dural venous sinus thrombosis Migraine Drug Co-trimoxazole IVIG NSAIDS ```
62
what are the contact prophylaxis regimes for meningitis
500 mg ciprofloxacin orally as a single dose for adults and children aged more than 12 years 600 mg rifampicin orally 12-hourly for four doses (adults and children over 12 years)
63
should you involve public health about meningitis
yes- all suspected cases
64
what vaccines protect against meningitis
travel vaccinations (neisseria) HiB vaccine pneumococcal vaccines
65
which space are samples obtained from in an LP
subarachnoid space
66
what are normal CSF WBC and RBC counts
white 0-5 | red 0
67
what are the expected ratios for protein and glucose in CSF
glucose 0.6 (should be 2/3rds of blood glucose) | protein 150-450:1
68
proportionally more neutrophils (aka polymorphs) in CSF= ?
bacterial infection
69
proportionally more lymphocytes in CSF= ?
viral/ fungal infection
70
what is petechea
non blanching rash, meningitis
71
what are the rules for CTs and LPs
NEVER DO LP WITHOUT DOING CT AS MIGHT HAVE RAISED ICP- cause brain to herniate = coning (when cerebellum goes through foramen magnum) unless in suspected meningitis if patient has no focal deficit, is not immunocompromised, no skull #, has had no seizures,no Hx of CNS disease, no papilloedema, normal conscious level then do LP ASAP and start antibiotics
72
gram -ve cocci meningitis= ?
meningococcus meningitis (caused by neisseria)
73
what drug for chemoprophylaxis for bacterial meningitis
ciprofloxacin
74
what is the abx treatment for a brain abscess
IV ceftriaxone IV metronidazole add flucloxacillin in staph suspected IV vancomycin if pen allergic/ MRSA suspected for 4 weeks minimum
75
what other tests should be done in viral meningitisi
throat swap stool sample HIV test
76
what CNS infection causes oedema in the temporal loves
herpes simplex encephalitis
77
what test to confirm herpes simplex encephalitis
PCR from LP
78
what 3 tests do you prioritise in meningitis
LP CT blood culture
79
gram +ve diplococci meningitis= ?
pneumococcus
80
where can an brain abscess originate from
mastoiditis sinusitis orbital cellulitis
81
what organisms can cause brain abscesses
streptococci, bacteriodes, staphylococci, anaerobes, colliforms
82
why do you give ceftriaxone and not penicillin for meninigitis
as lasts longer in CSF
83
when do you delay an LP in meningitis
``` signs of severe sepsis cardiac/ resp compromise rapidly evolving rash significant bleeding risk signs suggesting shift of brain compartments (do CT) - focal neuro signs - papilloedema - seizures that are continuous/ uncontrolled - GCS = 12 ```
84
buzzworrds: summer/ autumn time, GI symptoms
enterovirus viral meningitis
85
what is the key symptom in encephalitis
confusion

Neurology (35 decks)

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