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Clinical Pathology > CNS Infections - Bacterial and Fungal Meningitis (27) > Flashcards

CNS Infections - Bacterial and Fungal Meningitis (27) Flashcards

1
Q

CNS infections

A

Meningitis (bacterial, viral, TB, cryptococcus), brain abscess, encephalitis, toxin mediated

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2
Q

What is meningitis?

A

Infection of CSF/meninges

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3
Q

How does meningitis present?

A

Acute fever, headache, neck stiffness, +/- rash, fully conscious, usually viral

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4
Q

What is encephalitis?

A

Infection of brain tissue

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5
Q

How does encephalitis present?

A

Acute fever, headache, neck stiffness, altered conscious level, seizures, focal neurological signs, usually viral

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6
Q

What is a brain abscess?

A

Abscess within brain tissue

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7
Q

How does brain abscess present?

A

Insidious onset of fever, headache, +/- neck stiffness, +/- altered conscious level, seizures, focal neurological signs, usually bacterial (parasitic?)

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8
Q

How does invasion via micro-organisms occur?

A

Blood-borne invasion (blood-brain barrier/blood CSF barrier), peripheral nerves

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9
Q

What does normal CSF look like?

A

Clear

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10
Q

Polymorphic nucleoles likely to be

A

Bacterial

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11
Q

Neisseria meningitidis

A

Gram negative diplococci, require blood for growth, 13 capsular types (A, B, C, W135, Y most common), detected by nucleic acid amplification (PCR)

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12
Q

Natural habit of N. meningitidis

A

Nasopharynx, 5-20% carriers (increased smokers), half strains non-capsulate, increase in Gp A carriage rates before epidemics

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13
Q

Factors affecting intravascular survival (N. meningitidis)

A

Capsule - protects against complement-mediated bacteriolysis and phagocytosis

Acquisition of iron from transferrin

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14
Q

N. meningitidis BBB

A

Cross BBB and multiply in subarachnoid space, can remain in blood stream/not cross BBB

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15
Q

N. meningitidis can cause

A

Fulminant septicaemia, septicaemia with purpuric rash, septicaemia with meningitis, pyogenic/purulent meningitis with no rash, chronic meningococcal bacteraemia with arthralgia, focal sepsis, conjunctivitis, endophthalmitis

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16
Q

Is rash blanching or non-blanching?

A

Can be blanching early in disease and progress to be non-blanching

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17
Q

Treatment of N. meningitidis

A

Ceftriaxone, cefotaxime (Penicillin)

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18
Q

Chemoprophylaxis of contacts on invasive disease (N. meningitidis)

A

Close/kissing contacts, Rifampicin/Ciprofloxacin

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19
Q

Vaccination for N. meningitidis

A

Active against Group A and C and W135 (not against Group B)

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20
Q

When is peak of N. meningitidis?

A

Winter

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21
Q

Local outbreaks of N. meningitidis

A

Population of susceptible individuals, high transmission rate, virulent, capsulate strain

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22
Q

Haemophilus influenzae

A

Unable to grow in the absence of blood/constituents of blood, small, pleomorphic gram negative cocco-bacilli/bacilli, some strains produce a polysaccharide capsule (6 antigenic types a-f, type b causes most invasive disease)

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23
Q

Normal carriage of H.influenzae

A

Restricted to humans, 25-80% carry non-capsulate strains, 5-10% carry capsulate strains

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24
Q

Throat carriage of H.influenzae

A

Invasion of submucosa > blood stream > (invasive infections if meningitis, infants, >2 months - 2 years)

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25
Q

Virulence factors of H.influenzae

A

Type b capsule, Fimbriae, IgA proteases, outer membrane proteins/lipolysaccharide (intercurrent viral infection)

26
Q

Treatment of H.influenzae

A

Ceftriaxone, cefotaxime (ampicillin, B-lactamase producing strains common)

27
Q

Chemoprophylaxis of H.influenzae

A

Rifampicin

28
Q

Vaccines for H.influenzae

A

Type b conjugates vaccines (dramatic reduction in incidence of invasive disease)

29
Q

Streptococcus pneumoniae

A

Gram positive cocci, cells in pairs, requires blood/serum for growth, a-haemolytic activity on blood agar (green)

30
Q

What test can be done to see if Step pneumoniae is present?

A

Optochin test (ethyldydrohupreine)

31
Q

Who does Step pneumoniae effect?

A

All ages, more severe in elderly and immunocompromised

32
Q

Treatment of Step pneumoniae

A

Ceftriaxone, cefotraxime (Penicillin resistance)

33
Q

Vaccine for Step pneumoniae

A

Conjugate vaccine available against serotypes

34
Q

Steroids for meningitis in adults

A

Must be given shortly before/with first dose of antibiotics, should be given if Step pneumoniae suspected

35
Q

Neonatal meningitis usually caused by

A

Group B beta-haemolytic streptococci, E.coli, Listeria monocytogenes (rare)

36
Q

Neonatal extent of infection (variable onset)

A

Early 5 days - meningitis

37
Q

Treatment of neonatal meningitis

A

Cefotaxime (ampicillin and gentamicin)

38
Q

Acute complications of meningitis

A

Death, overwhelming sepsis, raised ICP

39
Q

Chronic complications of meningitis

A

Deafness, delayed development, seizures, stroke, hydrocephalus

40
Q

Lymphocytic meningitis

A

Viral (Enterovirus/HSV 2/polio), benign outcome

41
Q

Consequence of polio meningitis

A

Paralysis

42
Q

Bacteria causing lymphocytic meningitis

A

Spirochete - treponemal/borrelia

43
Q

Lymphocytic meningitis - TB

A

Insidious onset

44
Q

Risk factor for TB

A

Immunocompromised, alcoholic, endemic area

45
Q

Detection of TB

A

Ziehl Neelsen/Fluorescent antibody stain

46
Q

Toxoplasma gondii encephalitis

A

Protozoan, contracted by eating contaminated meat, resembles glandular fever, immunocompromised

47
Q

Cryptococcal meningitis

A

Lymphocytic meningitis, yeast, common with late HIV, insidious onset

48
Q

Where are yeast forms of Cryptococcal meningitis seen?

A

In CSF in Indian Ink stain

49
Q

Cryptococcal meningitis treatment

A

Prolonged course - amphotericin, flucytosine, fluconazole

50
Q

Encephalitis

A

Altered conscious level, HSV 1 most common, affects temporal lobes, 50% over 50s

51
Q

Diagnosis of encephalitis

A

Detecting viral nuclei acid in CSF (PCR)

52
Q

Rabies encephalitis

A

Common, dog, fox, bat bites, 100% mortality, preventable by vaccination

53
Q

Clostridium tetani

A

Gram positive spore forming bacillus, terminal round spore (drumstick), strict anaerobe

54
Q

How is Clostridium tetani spread?

A

Contaminated soil > wound (major/minor)

55
Q

Clostridium tetani’s toxin

A

Non-invasive, produces tetanospasmin, toxin genes plasmid encoded, spreads via bloodstream and retrograde transport, binds to ganglioside receptors and blocks release of inhibitory interneurones convulsive contractor of voluntary muscles

56
Q

Tetanus/lock jaw

A

Tonic muscle spasms, trismus (jaw), opisthotonus (spine bent), respiratory difficulties, cardiovascular instability (sympathetic nervous system), increased muscle tone

57
Q

Most common entry site of Clostridium tetani

A

Via feet

58
Q

Clostridium tetani treatment

A

Antitoxin (horse/human), Penicillin/metronidazole, drugs for spasms, muscle relaxants, respiratory support

59
Q

Prevention of Clostridium tetani

A

Toxoid

60
Q

Epidemiology of Clostridium tetani

A

1 millon required hospital treatment each year

Clinical Pathology (60 decks)

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