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Neurology SB > CNS Infections and Microbiology > Flashcards

CNS Infections and Microbiology Flashcards

1
Q

what are the classifications of CNS infections

A
  • acute pyogenic (bacterial) meningitis
  • aseptic (viral) meningitis
  • focal infection (e.g. brain abscess, subdural and extradural empyema)
  • chronic bacterial infection (TB)
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2
Q

what is acute encephalitis an infection of

A

brain parenchyma

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3
Q

what should your Ddx be in a patient with fever and altered mental status

A 
Encephalitis 
Meningitis
Meningoencephalitis
Encephalomyelitis
Severe sepsis syndrome due to infection elsewhere
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4
Q

viral meningitis is very rare - true or false

A

false

- it is very common, particularly in the late summer/autumn

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5
Q

who most commonly gets viral meningitis

A

children

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6
Q

what causes viral meningitis

A

enteroviruses e.g. ECHO virus, coxsackie virus

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7
Q

Ix for viral meningitis

A

Viral Stool culture
Throat Swab
CSF PCR

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8
Q

Tx for viral meningitis

A

Supportive

self-limiting

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9
Q

what is the expected CSF results of someone with viral meningitis

A

CSF WCC raised, predominantly lymphocytes
CSF protein normal or slightly raised
CSF glucose normal

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10
Q

what is the most common cause of viral encephalitis

A

Herpes simplex

but also varicella zoster, CMV, HIV, measles

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11
Q

what are the symptoms of encephalitis

A 
Insidous onset; sometimes sudden 
Meningismus
Stupor, coma
Seizures, partial paralysis
Confusion, psychosis
Speech, memory symptoms
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12
Q

what is Meningismus

A

a set of symptoms similar to those of meningitis but not caused by meningitis
e.g. neck stiffness, headache, photophobia

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13
Q

in children older than 3 months and in adults, what form of HSV causes encephalitis and where does it affect

A

HSV-1

localised to the temporal and frontal lobes

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14
Q

in neonates, what HSV causes encephalitis and where does it affect

A

HSV-2
(acquired at time of delivery)
generalised brain involvement

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15
Q

what virus should be considered in the immunodeficient

A

CMV

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16
Q

what must be considered in patients when identifying the bacterial cause of meningitis

A

age and risk factors

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17
Q

what bacteria commonly cause bacterial meningitis in neonates

A

listeria
group B streptococci
E. coli

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18
Q

what bacteria commonly cause bacterial meningitis in children

A

H. influenza

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19
Q

what bacteria commonly cause bacterial meningitis in 10 to 21 y/o

A

meningococcal

20
Q

what bacteria commonly cause bacterial meningitis in > 21y/o and elderly

A

pneumococcal

21
Q

what bacteria is suspect in immunocompromised patients

A

listeria
S.pneumoniae
N.meningitidis

22
Q

what bacteria is suspect in patients who have had neurosurgery or opened head trauma

A

staph aureus

staph epidermidis

23
Q

if the patient has a fracture of the cribriform plate, what bacteria is suspected

A

pneumococcal

H. influenzae

24
Q

what is the 3 ways that bacteria can enter the brain

A

1 - nasopharyngeal colonisation (of pneumococcus commonly)
2 - direct extension of bacteria (e.g. brain abscess, skull fracture)
3 - from remote foci of infection (e.g. pneumonia, UTI, endocarditis)

25
Q

what does Neisseria Meningitis cause in immunocompromised patients

A

meningococcal meningitis

26
Q

what causes the symptoms in meningococcal meningitis and what would you expect to find in the CSF

A

endotoxin

leukocytes

27
Q

what is the appearance of listeria and who is commonly affected by it

A

gram positive bacilli

neonatal and elderly
immunocompromised

28
Q

what is suggestive of Tuberculous meningitis

A
  • elderly patient with Hx of TB
  • non specific ill health
  • poor yield from CSF
29
Q

Tx for Tuberculous meningitis

A

Isoniazid + rifampicin

add pyrazinamide + ethambutol

30
Q

triad of bacterial meningitis

A

fever
stiff neck
altered consciousness

31
Q

who are signs of bacterial meningitis often absent or atypical in

A

The very young
The very old
The immunocompromised

32
Q

when should a LP never be done

A

if confirmed or suspected raised ICP

33
Q

what is important to note in a LP result in bacterial meningitis

A

false negative around 10-15%. Pre-LP use of antibiotics may low the positivity of culture.

34
Q

what are CSF results predictive of bacterial meningitis

A 
WBC Count >2,000
Neutrophils > 1180
Protein > 220 mg/dl
Glucose < 34 mg/dl
Glu (CSF/serum) <0.23
cloudy appearance
35
Q

what is aseptic meningitis

A

non-pyogenic bacterial meningitis

36
Q

what is the features of CSF in aseptic meningitis

A

low number of WBC
minimally elevated protein
normal glucose

37
Q

who should undergo a CT BEFORE a lumbar puncture

A 
Immunocompromised
Hx of CNS disease
New Onset seizure
Papilloedema
Abnormal level of consciousness
Focal neurologic deficit
38
Q

what are signs of a focal neurological deficit

A

non reactive pupils, abnormal visual fields, arm or leg drift

39
Q

what are warning signs in bacterial meningitis

A 
Marked depressive conscious level (GCS <12) or a  
 fluctuating conscious level (fall in GCS >2)
Focal neurology
Seizure before or at presentation
shock
Bradycardia and hypertension
Papilloedema
40
Q

what is the empirical antibiotic therapy in bacterial meningitis

A

IV Ceftriaxone 2g bd

If penicillin allergic:
IV Chloramephenicol 25mg/kg 6-hourly with Vancomycin IV 500mg 6-hourly

41
Q

what is added is listeria is suspected in bacterial meningitis treatment

A

IV Ampicillin/Amoxicillin

If penicillin allergic:
IV Co-trimoxazole (alone)

42
Q

what should be Given to all patients suspected of bacterial meningitis before or with first dose of antibiotics

A

IV Dexamethasone

43
Q

what bacterias which cause bacterial meningitis have vaccines

A

Neisseria meningitidis
Haemophilus influenzae
Streptococcus pneumoniae

44
Q

how is Group B strep meningitis is neonates treated

A

benzylpenicillin and gentamicin

45
Q

what can be given as prophylaxis to family members with patients with meningococcal meningitis

A

Rifampicin/Ciprofloxacin

Neurology SB (23 decks)

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