CNS Infections and Lab yayayayayayayayyaa

Question 1

Bacterial Meningitis signs

Answer 1

Headache
Neck Stiffness
Photophobia

Non-blanching rash - NM
can have altered mental state

Question 2

What to do in suspected bacterial meningitis

What ABs

Answer 2

Blood Culture
AB start

• LP after CT if no RICP

Vancomycin (Strep. Pneumonia)
Ceftriaxone (Strep. Pneumonia, HiB, NM)
Ampicillin (L. MCG)

• LMCG is resistant to cephalosporin tgt w Enterococci
• HiB is resistant to ampicillin due to beta lactamase

Question 3

Whats the CSF profiles between

- Bac, Viral, TB

Answer 3

CSF WCC, Glucose, Protein

Glucose decrease for both bacteria
Protein increase for ALL

WCC:

• Neutrophils, polynuclear polymorphs: bacteria
• Lymphocytes: TB + Viral

Question 4

Name the top bacterias for

• normal population
• neonates

Describe their structure and AB susceptibilities

Answer 4

Strep P - G+ Diplococci
- ‘decrease susceptibility to Pencillin’ cos of PBP changes

Hib - GNR

• has beta lactamases similar to MSSA
• • should be against ampicillin for now;; ceftriaxone ok

Neisseria Meningitidis - Gram Neg Diplococci
- ok w Penicillin but does not clear throat carriage

Neonates:

• E. Coli (note coliforms no materal AB) - GNR
• • R to Cephalosporin
• LMCG (fecal) - GPR
• • R to Cephalosporin hence Ampicillin
• GBS Strep Agalacticae - beta hemolytic hence ok to penicillin

Question 5

How to prevent against the top 3 meningitis?

Answer 5

Vaccines

• ONLY 2 vaccines are in national childhood immunization program
• Strep P, HiB,

Meningoccocal conjugate is not in SG;

Question 6

HIV meningitis how?
structure
from where
first line?

Answer 6

suspect cryptococcal neoformans

• this is a capsulated yeast
• from soil, birds

First line
- AmP + 5FC

Question 7

TB how?

Answer 7

Miliary

PCR CSF; AFB just start

Question 8

Viral Meningitis how?

Answer 8

Self-limiting
PCR

• if suspect HSV give Acyclovir to prevent mortality

Question 9

Pulmonary infection + Meningitis think what?

Presentations and other CAPs?

Answer 9

Strep Pneumonia most common
Hib less likely cos vaccine

• both are CAP
• • Strep Pneumonia and ATYPICALS
• think lobar pneumonia

Question 10

Blood route think what?

Answer 10

S. Aureus

Question 11

How to check HIV meningitis?

Answer 11

Cryptococcus Neoformans

• CSF India ink
• CSF antigen

Question 12

Note oral Strep; blood staph; gram neg think e coli but uncommon; Hib IS NEGATIVE LMAO

• immunocompromised think Cryptococcus neoformans, candida; TOXOPLASMOSIS

Answer 12

okie

Question 13

Encephalitis think what 2 causes

Answer 13

Viral: HSV
Prions

Virus is human to human
Prions is animal to humans

Question 14

Presentations of

Rubella
CMV
Syphilis
Toxoplasmosis

Answer 14

Rubella

• Cataracts // or other Ocular Defects;
• CVS
• CN 8

CMV

• CN8
• Chorioretinitis
• HSM

Syphilis - Hutchinson’s Triad

• Notched teeth
• CN8
• Keratitis

Toxoplasmosis

• Hydrocephalus
• ICC
• Chorioretinitis

Question 15

Rinne and Weber for kids w diseases?

Answer 15

all but toxoplasmosis have CN8

• Rinne: air still louder;
• Weber: localize to normal ear