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MD1 Neuroscience > CNS Infections - Cellular Pathogens > Flashcards

CNS Infections - Cellular Pathogens Flashcards

1
Q

What is meningitis?

A

Inflammation of meninges

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2
Q

What is encephalitis?

A

Inflammation of brain

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3
Q

What is myelitis?

A

Inflammation of spinal cord

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4
Q

What is neuritis?

A

Inflammation of nerves

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5
Q

What is a brain abscess?

A

Pus in brain

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6
Q

What is a subdural empyema?

A

Pus in subdural space

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7
Q

What is an epidural abscess?

A

Pus in epidural space

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8
Q

Where are most cases of bacterial meningitis found?

A

96% in less developed countries

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9
Q

What is the mortality rate of bacterial meningitis globally?

A

50%

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10
Q

How many people have neurological sequalae after bacterial meningitis?

A

Half of survivors

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11
Q

Who is meningococcal disease most common in?

A

Children under age of 5

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12
Q

How does the likelihood of death from bacterial meningitis change over different age groups?

A

More likely as you get older

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13
Q

What are the causes of meningitis?

A 
Culture positive
- Bacteria
Culture negative
- Bacteria
- Viruses
- Other
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14
Q

What is aseptic meningitis?

A

Culture negative

  • Didn’t grow bacteria
  • Caused by something else
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15
Q

What is the most common cause of meningitis?

A

Viruses

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16
Q

What are the most common viral causes of meningitis?

A

Enteroviruses

  • Coxsackie
  • Echo
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17
Q

What are other infectious causes of meningitis?

A 
TB
Fungus
Parasites
Syphilis
Lyme
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18
Q

What are some non-infectious causes of meningitis?

A 
Malignancy
Drugs
- NSAIDs
- Antibiotics
- IV Ig
Inflammatory conditions
- Sarcoidosis
- Connective tissue disorders
- Lupus
- Vasculitis
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19
Q

Does viral meningitis usually need treatment? Why?

A

Doesn’t usually need treatment because

  • Self-limiting
  • Don’t get neurological sequelae
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20
Q

What are the most common causes of bacterial meningitis?

A

Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae

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21
Q

Who gets infected with the three most common causes of bacterial meningitis?

A

Infants
Children
Adults

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22
Q

What are the most common types of N meningitidis in Australia?

A

B and C

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23
Q

Which type of N meningitidis is the most common killer of people and especially children worldwide?

A

A

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24
Q

Which type of H influenzae is most common in Australia?

A

Type b

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25
Q

Where are the three most common causes of bacterial meningitis usually found?

A

In nasopharynx

26
Q

Which bacteria additionally cause bacterial meningitis in neonates and infants under the age of three months?

A

E coli and other Gram negative rods
Group B Streptococcus
Listeria monocytogenes

27
Q

Where are the bacteria that especially infect neonates and young infants found?

A

In birth canal of mother

28
Q

Which bacteria don’t usually cause bacterial meningitis?

A 
Streptococcus pyogenes (group A)
Staphylococcus aureus
29
Q

What are the host factors that predispose a person to bacterial meningitis?

A 
Genetics
Young age
Recent respiratory infection
Neuroanatomical defects
Immunodeficiency
30
Q

What are the pathogen factors that predispose a person to bacterial meningitis?

A

Polysaccharide capsule
Infecting dose
Competing commensals

31
Q

What are the environmental factors that predispose a person to bacterial meningitis?

A 
Overcrowding
Smoke exposure
Season
Attendance at daycare
Sharing food, drink, and dummies
32
Q

What are the steps in the development of bacterial meningitis?

A
  1. Colonisation of nasopharyngeal mucosa
  2. Invasion of bloodstream > bacteraemia
  3. Survival and multiplication > septicaemia
  4. Crossing of BBB
  5. Invasion of meninges and CNS
  6. Increased permeability of BBB
  7. Pleocytosis
  8. Increased intracranial pressure
  9. Release of pro-inflammatory cytokines
  10. Neuronal injury
33
Q

What causes neuronal injury in bacterial meningitis?

A

Immune response

34
Q

What are the non-specific symptoms and signs of meningitis?

A

Fever
Vomiting/nausea
Headache

35
Q

What are more specific signs of meningitis?

A

Stiff neck
Altered mental state
Photophobia
Seizures

36
Q

What is meningococcal disease often associated with?

A

Petechial or purpuric rash

37
Q

How do you test if a rash is purpuric?

A

Put glass against rash > doesn’t blanch

38
Q

What are the normal values of CSF?

A

Pressure: 60% blood

39
Q

Do normal CSF values change with age?

40
Q

What does the CSF look like with viral meningitis?

A

Increased WCC
Negative Gram stain
Increased protein
Normal glucose

41
Q

What does the CSF look like with bacterial meningitis?

A 
Raised pressure
Cloudy
Hugely increased WCC
Positive Gram stain
Increased protein
Decreased glucose
42
Q

What does the CSF look like with TB meningitis?

A 
Raised pressure
Cloudy
Increased WCC
ZN positive stain
Increased protein
Decreased glucose
43
Q

When don’t you perform a lumbar puncture?

A 
Raised ICP
Shock
Spreading purpura
After convulsions
Coagulationk abnormalities
Infection at site of lumbar puncture
44
Q

What happens to the CSF sample if it isn’t sent off to the lab immediately?

A

Cells start to lyse > WCC and glucose rapidly decrease

45
Q

Can normal CSF results exclude meningitis?

46
Q

Does pre-treatment with antibiotics change the WCC in CSF?

47
Q

What is the treatment for bacterial meningitis?

A 
Resuscitation/life support
Fluids
Antibiotics
Steroids
Contact prophylaxis
48
Q

What are the antibiotics used for the treatment of bacterial meningitis?

A 
IV 3rd generation cephalosporin
- Eg: cefotaxime/ceftriaxone
For neonates and infants under 3 months, add
- IV penicillin
- IV gentamicin
49
Q

Why is the family of the patient also treated?

A

Because family at increased risk of infection, especially if bacteria N meningitidis

50
Q

What antibiotic is given to contacts for prophylaxis?

A

Rifampicin

51
Q

Which bacteria is associated with the worst complications?

A

Streptococcus pneumoniae

52
Q

What is the most common neurological sequelae of bacterial meningitis?

A

Hearing loss

53
Q

Why are steroids used in the treatment of bacterial meningitis?

A

Suppress immune response that causes damage

54
Q

What is the state of consciousness in a person with meningitis?

55
Q

What are the causes of encephalitis?

A

Almost always viral

56
Q

What is the most common cause of viral encephalitis?

57
Q

What are the symptoms of encephalitis?

A

Fever
Headache
Altered conscious state
+/- convulsions

58
Q

What is added to the treatment if encephalitis is suspected?

59
Q

Why is acyclovir added to treatment of bacterial meningitis if encephalitis is suspected?

A

People can have meningoencephalitis

60
Q

Which types of bacteria that cause meningitis are we vaccinated against?

A

H influenzae type b
S pneumoniae
N meningitidis A - given to travellers only
N meningitidis B - not on schedule, but available - very expensive
N meningitidis C

MD1 Neuroscience (55 decks)

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