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Y4: Infectious Disease > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

Name some anatomical infections of the CNS?

A
  • Myelitis
  • Abscess
  • Meningitis
  • Encephalitis
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2
Q

What are the 3 most important bacterial causes of CNS infections?

A
  • Listeria
  • Pneumococcus
  • Meningococcus
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3
Q

What are the most common viral causes of CNS infections?

A
  • HSV
  • VZV
  • Enterovirus
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4
Q

What is the most common fungal cause of CNS infections?

A

Cryptococcosis

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5
Q

What is the most common protozoal cause of CNS infections?

A

Toxoplasmosis

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6
Q

What is meningitis?

What is diagnosis based on?

A

Inflammation of meninges +/- cerebrum (meningo-encephalitis)

Inflammation presence in the CSF

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7
Q

What are the types of meningitis and what causes them?

A
  • Acute
    • Bacterial/viral
  • Sub-acute
    • Bacterial (Listeria/TB)
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8
Q

What are the signs and symptoms of meningitis?

A
  • Most will have 2 of:
    • Fever
    • Headache
    • Neck stiffness
    • Reduced GCS
  • Rash
  • Kernigs sign
  • Brudzinskis sign
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9
Q

What meningitis symptom is indicative of cerebritis/encephalitis?

A

Confusion

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10
Q

What type of rash is present in meningitis?

A
  • Purpuric +/
  • Petechial
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11
Q
  • What are each of the following?
    • Gram positive diplococci
    • Gram negative diplococci
    • Gram positive rods
A
  • Streptococcus pneumoniae
  • Neisseria meningitidis
  • Listeria monocytogenes
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12
Q

What should be considered if someone who has meningitis has recently travelled?

A
  • May be resistant meningitis
    • South East Asia
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13
Q

What are the risk factors for a pneumococal meningitis?

A
  • Mostly caused by an underlying disorder
    • Alcohol
    • Head injury
    • Immunosuppression
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14
Q

What are the risk factors for a listeria meningitis?

A
  • Pregnancy
  • Immunosuppression
  • Eating cheese and pate
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15
Q

Name some signs which make meningitis more likely to have a pneumococcal cause?

A
  • Seizures
  • CN VIII palsy
  • Endocarditis
  • Focal neurological signs
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16
Q

What is pictured here?

A
  • Typical signs of meningococcal meningitis
    • Purpuric rashes
    • Digital vasculitis
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17
Q

Name 4 prognostic indicators of a adverse outcome in bacterial meningitis?

A
  • Reduced GCS
  • Pneumococcal cause
  • CN palsy (pneumococcal)
  • Bleeding (meningococcal)
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18
Q

Name some investigations for a suspected meningitis?

A
  • History/ exam
  • Throat culture
  • Blood cultures
  • Lumbar puncture
  • FBC, U&Es, LFTs, CRP
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19
Q

Describe the use of a lumbar puncture as an investigation for a suspected meningitis?

A
  • Gram stain, Culture, PCR
  • Protein and Glucose
  • Viral PCR
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20
Q

What might you examine if there is a suspected meningitis?

A
  • Throat
  • Cervical lymph nodes
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21
Q

When would you perform a CT scan for a suspected meningitis?

A
  • To exclude mass lesion and gross cerebral oedema
  • Give antibiotics pre-scan
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22
Q

What can a CT not exclude?

A

Raised intracranial pressure

23
Q

When would you perform a CT before a lumbar puncture?

A
  • GCS <= 12
  • CNS signs
  • Papilloedema
  • Sezisures
  • Immunocompromised
24
Q

When is a LP contraindicated?

A
  • Brin shift
  • Severe sepsis
  • Coagulopathy
  • GCS deterioration
  • Infection at LP site
  • Rapidly evolving rash
25
What would be the CSF findings from LP if there was a bacterial meningitis?
* Raised protein * Glucose reduced \<50% * Neutrophils / Lymphocytes
26
What would be the CSF findings from LP if there was a TB meningitis?
* Lymphocytes * Raised protein * Glucose reduced \<50%
27
What would be the CSF findings from LP if there was a viral meningitis?
* Lymphocytes (neutrophils early) * Raised protein * Normal glucose
28
What would be the CSF findings from LP if there was a fungal meningitis?
* Lymphocytes * Raised protein * Glucose reduced \<50%
29
What investigations could be used to differentiate between a TB and a fungal cause of meningitis post-LP?
* TB * Culture, PCR * Fungal * India ink, CrAG
30
Describe the treatment of a suspected bacterial meningitis?
* IV antibiotics * Treat for all possible causes * IF there is a high possibility of pneumo cause: * Add steroids
31
What drug does everyone with a suspected bacterial meningitis get?
* Ceftriaxone * Covers all possible causes * Add Amoxicillin if there is signs of Listeria cause
32
What is the definitive antibiotic therapy for meningococcal bacterial meningitis?
* IV Ceftriazone or Benzyl Penicillin * 5 days
33
What is the definitive antibiotic therapy for pneumococcal bacterial meningitis?
* IV Ceftriaxone or Benzyl Penicillin * 14 days
34
What is the definitive antibiotic therapy for listerial bacterial meningitis?
* IV Amoxicillin (stop Ceftriaxone) * 21 days
35
Describe the use of secondary bacterial meningitis prevention?
* Give close contacts of someone with BM prophylactic treatment * Ciprofloxacin or Rifampicin
36
Look at the meningococcal vaccine schedule
37
What are the special circumstances for bacterial meningitis vaccinations?
* Asplenic patients * Cochlear implants * Complement deficiency * Travelling to Sub-Saharan Africa
38
Describe Viral Meningitis?
* Diagnosed only after bacterial exclusion * No confusion * Supportive treatment * Consider Aciclovir ONLY if immunocompromised
39
When is Aciclovir only considered as a treatment of viral meningitis?
* Immunocompromised * ?HIV
40
Describe the signs of Viral Encephalitis and what causes it?
* Confusion, Fever +/- Seizures * HSV
41
What are the CSF signs of viral encephalitis?
* Lymphocytes * Normal glucose
42
What is the treatment of Viral Encephalitis?
IV Aciclovir for 3 weeks
43
Describe intra-cerebral TB?
* Sub-acute * Associated with TB in another site * CN lesions usual * CSF may be normal
44
Describe the treatment for intra-cerebral TB?
'RIPE' + steroids
45
Describe HIV brain disease?
Consequence of untreated infection and marked immunodeficiency
46
What does PMLE stand for?
Progressive multifocal leucoencephalopathy
47
Describe PMLE?
* Progressive motor dysfunction * Immunocompromised * No specific treatment
48
Describe Intra-cerebral toxoplasmosis?
* Caused by Toxoplasma gondii * Immunocompromised * Headache, seizures, focal CNS signs * Multiple enhancing lesions
49
Name a diagnostic sign of intra-cerebral toxoplasmosis?
IgG and IgM in the blood
50
What is the treatment for intra-cerebral toxoplasmosis?
* Sulphadiazine * Pyramethamime
51
Describe Cryptococcal meningitis?
* Caused by fungus cryptococcus neoformans * Immunodeficiency usually (HIV)
52
How do you treat cryptococcal meningitis?
* Amphotericin B + Flucytosine * Shunt if raised ICP
53

Y4: Infectious Disease (18 decks)

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