CNS infections

Question 1

what is Meningtitis?

Answer 1

inflamamtion of the leptomeninges and underlying subarchnoid cerebrospinal fluid

Leptomenignes= pai mater, archnoid mater, dura matter

Question 2

what are the most common caustiave organism in Meningitis ?

Answer 2

Neisseria Meningitidis (meningococcal disease)- most common

Streptococcus pneumonia (pneumococccal disease)

Haemophilis influenza type b (hib)

Question 3

what are the symtpoms of Meningitis

Answer 3

• fever
• headahce
• stiff neck
• back rigiity
• bulgin fontanelle (infnats)
• photophobia
• altered mental stae
• unconsiocu, toxic/moribund state
• seizures
• non-blanching rash

Question 4

why is Meningococcal disease difficult to diagnose?

Answer 4

rare- GPs may only see 1 or 2 cases in enite career

clinical feautres vague and non-specific- simialr to other non-bacterial cases of meningitis

diseas progress Very rapdily (cna quickly lead to death)

can only be diagnosed in secondary care- Lumbar punction with laboratory examination ofn CNS

Question 5

what are the most common casues of Meningitis in neonates?

Answer 5

Streptococcus agalactiae (group B strep)

Escherichia coli

S. pneumoniae

Listeria monocytogenes

Question 6

what are the symptoms of meningococcal disease

Answer 6

• Neisseria Meningitidis
• symptoms
  
  • invasive meingococcal disase- presents with meningitis and sepsis
  1. petchial rash highly suggrest of invasive meningooccal disease (non blanching all over body inclduing conjuctiva

Question 7

which serotypes of Meningococal meningitis are most common in the uk

Answer 7

Men B and men W

vaccine agaisnt men B, Men C

different capsular seotypes-

Question 8

describe the symptoms of Men W

Answer 8

different symptoms to other kinds og Meningococcal disease

• septic arthritis or sevre RTI
• may have Mainly gastrointestinal symptoms
• wihtout characterisitic non-blanching rash and progress rapidly to death
• case fertality rate 12%
• hyper virulent

Question 9

what is Penumoccoal meningitis- what gorups is it common in

Answer 9

S. Pneumoniae

second biggest cause of meningititis - newborns and more senior age groups

Question 10

is petechial rash expected with Pneumococcal disease?

Answer 10

Not common

Question 11

why have the rates for Penumococcal disease fallen in the UK?

Answer 11

vaccination for <2 and over 65

Prevnar 13- 13 polysacchairde capuslar serotypes

Question 12

Management of Bacterial Meningitis

Answer 12

call 999 with blanching rash or NOT

give Parenteral nezylpeniccilin at earleast as long as this does NOT delay Transfer to hospital

Meningooccal - benzylpenicclin/cefotazime)

invasive Pneumooccal disease - Cefotazime

hib (cefotazime , rare now)

Question 13

Group B streptocci GBS as a cause of Meningitis- who is it most associated with

Answer 13

neonates

occurs in first week of life (infection at birth) or occurs between 7 and 90th day of life (late onset , infeciton after birth)

part of normal gut flora

Question 14

what is the cause of Lyme disease and hwo is it spread?

Answer 14

sheep carry ticsk- lyme disease causaitve agent (borelia Burgdorferi)

need to remove ticks properly- dont leave any reaming

Question 15

what is this? and how would we treat

Answer 15

characteristic erythema migran (lyme disease sstage 1)

ciruclar rash at the site of infecitous tick atathcment within 3-36 days

doxycycline

Question 16

what is stage 2 lyme disease

Answer 16

Flu like illnes

Neurological disorder or neuroborreliosis 10% of untreated cases

Unilateral or bilateral facial nerve palsies

Meningism and meningitis

Mild encephalitis producing malaise and fatigue