CNS Infections - Kozel Flashcards
1
Q
Glucose concentrations in the CSF are what percent of the serum level?
A
60%
2
Q
What are some specific tests you can order based on clinical suspicion?
A
Nucleic acid amplification Stain and culture for AFB VDRL test India ink negative stain Cryptococcal polysaccharide antigen Fungal culture Viral culture
3
Q
What are the following CSF findings for viral infections? WBC count WBC cell type Glucose Protein
A
WBC: 50-1000
Mononuclear
Glucose >45
Protein <200
4
Q
What are the following CSF findings for bacterial infections? WBC count WBC cell type Glucose Protein
A
WBC: 1000-5000
Neutrophilic
Glucose <40
Protein 100-500
5
Q
What are the following CSF findings for tuberculous infections? WBC count WBC cell type Glucose Protein
A
WBC: 50-300
Mononuclear
Glucose <45
Protein 50-300
6
Q
What are the following CSF findings for cryptococcal infections? WBC count WBC cell type Glucose Protein
A
WBC: 20-500
Mononuclear
Glucose 45
7
Q
Basically what is the only type of CNS infection that will raise glucose above 45?
A
viral
8
Q
What is the only type of CNS infection that will have a neutrophilic infiltrate?
A
bacterial
9
Q
What is the normal range of glucose in the CSF?
A
50-80
10
Q
What is the normal WBC count in the CSF
A
0-5
11
Q
what is the effect of blood in the CSF on the WBC count?
A
need to adjust the count
12
Q
What are the reasons for decrased glucose in the CSF?
A
- Increased glycolysis by leukocytes and bacteria
- Increased metabolic rate of brain and spinal cord
- Altered glucose transport between blood and CSF
13
Q
What are the reasons for increased protein in the CSF?
A
disruption of BBB; must also be adjusted if there is blood in the CSF
14
Q
what are the contraindications for LP?
A
papilledema; increased ICP
neurological suggestion of intracranial mass
15
Q
What are the three things you need to do in the initial management of acute meningitis?
A
- Lumbar puncture and CSF analysis
- Empiric antimicrobial therapy based on patient age
- Adjunctive dexamethasone if appropriate
16
Q
What is the most common cause of viral meningitis?
A
enterovirus
17
Q
What is the most common cause of bacterial meningitis?
A
Strep pneumo
18
Q
What are the two causes of spirchetal meningitis
A
Treponema pallidum
Borrelia burgdorferii
19
Q
T/F: you can get helminths in the brain
A
true
20
Q
what is the invasion process of bacterial meningitis?
A
Mucosal/nasopharyngeal colonization
Local invasion
Intravascular survival
Meningeal invasion – Moxon experiment
Induction of subarachnoid space inflammation
Alterations of blood-brain barrier
Cerebral edema and increased intracranial pressure
21
Q
what are the three types of cerebral edema?
A
- vasogenic from increased BBB permeability
- cytotoxic from swelling of cellular elements of the brain
- interstitial from obstruction of normal flow of CSF
22
Q
what are the common bacterial pathogens for meningitis of the neonate?
A
Strep agalactiae
E. coli
Listeria monocytogenes
Klebsiella spp.
23
Q
What are the common bacterial pathogens for meningitis of the 1-23 month old?
A
S. agalactiae E. coli H. flu Strep pneumo N. meningitidis
24
Q
What are the common bacterial pathogens for meningitis of the 2-50 year old?
A
S. pneumo
N. meningitidis
25
What are the common bacterial pathogens for meningitis of the >50 year old?
S. pneumo
N. meningitidis
Listeria monocytogenes
Aerobic gram-negative bacilli
26
What allows disruption of the BBB that allows Abx to reach the brain?
inflammation
27
what effect do corticosteroids have on abx penetration of the brain?
they reduce inflamm so they also reduce abx penetration of the bbb
28
What are the features of abx with good CNS penetration in the absence of meningeal inflammation?
1. Low molecular weight
2. Low degree of ionization at 3. physiological pH
4. High lipid solubility
5. Low degree of protein binding
6. Absence of active efflux systems
29
What is the Tx for meningitis in the 1 month old?
ampicillin plus ceftoxamine
or
ampicillin plus an aminoglycoside
30
What is the Tx for meningitis in the 1-23 month old?
Vancomycin plus a third gen cephalosporin
31
What is the Tx for meningitis in the 2-50 year old?
Vancomycin plus a third gen cephalosporin
32
What is the Tx for meningitis in the >50 year old?
vancomycin plus ampicillin plus third gen cephalosporin
33
What is the recommended drug for strep pneumo meningitis?
vancomycin plus third gen cephalosporin
34
What is the alternative tx for strep pneumo?
Meropenem
| Fluoroquinolone
35
What is the tx for N. meningitidis?
Third gen cephalosporin
36
what is the alt. tx for N. meningitidis?
PCN G
Ampicillin
fluoroquinolone
37
What is the tx for listeria monocytogenes?
ampicillin
| PCN G
38
What is the alt. tx for listeria monocytogenes?
TMP-SMX
| Meropenem
39
What is the tx for strep. agalactiae?
Ampicillin
| PCN G
40
What is the alternative tx for strep agalactiae?
third gen cephalosporin
41
What is the tx for h flu?
third gen cephalosporin
42
what is the alt. tx for h flu?
cefepime
meropenem
fluoroquinolone
43
What is the tx for E. coli?
third gen cephalosporin
44
what is the alt. tx for E. coli?
```
Cefepime
meropenem
aztreonam
fluoroquinolone
TMP-SMX
```
45
what are the two things that define chronic meningitis?
indolent onset of greater than four weeks
| signs of chronic inflamm in CSF
46
What are the early symptoms of chronic meningitis?
HA
nausea
decreased memory and comprehension
47
What are the differences you see in chronic meningitis vs. acute?
onset is more gradual
fever is lower
assc'd with lethargy and disability
pt is often immunocompromised
48
What are the mycoses that can cause chronic meningitis?
Cryptococcosis
Coccidioidomycosis
Histoplasmosis
Candidiasis
49
what are the bacteria that can cause chronic meningitis?
Mycobacterium tuberculosis
Treponema pallidum
Borrelia burgdorferii
50
what are the parasites that can cause chronic meningitis?
Acanthamebiasis
Cysticerosis
Angiostrngylus cantonensis
51
what are the two defining features of encephalitis?
inflamm in the brain parenchyma
| clinical or lab evidence of neuro dysfunction
52
What are the symptoms of encephalitis?
fever and HA
| altered mental status--EARLIER than meningitis
53
Describe the CSF profile in enceph?
normal glucose
elevated protein
Lymphocytic pleocytosis (elevated lymphs)--magnitude changes with etiology
54
What are the most common viral etiologies of enceph?
```
HSV-1 and HSV-2
Varicella-Zoster virus
CMV
HHV-6
Arboviruses
HIV
enterovirus ---polio
rabies virus
```
55
(Vira/bacterial) sources are most common for enceph
viral
56
What are the possible bacterial causes of enceph?
```
Listeria monocytogenes
Rickettsia spp.
Ehrlichia spp.
Bartonella spp.
Mycoplasma pneumoniae
```
57
Is the capsule of a brain abscess well or poorly vascularized?
well vascularized
58
What are the three sources of a brain abscess?
1. Contiguous spread from sinusitis, otitis media, or mastoiditis
2. hematogenous spread
3. trauma
59
What are the symptoms of a brain abscess?
HA, N/V, FOCAL NUERO FINDINGS BASED ON SIDE OF ABSCESS
60
Are brain abscesses singular or mixed in their etiology?
MIxed
61
What are the two most common sources of brain abscesses?
Strep spp. 70%
| Staph aureus 10-20%
62
What are the most common fungal brain abscesses?
```
Aspergillus
Candida
Cryptococcus
Mucorales
Coccidioides
```
63
What is the most common protozoal/helminthic brain abscess?
toxoplasma gondii
64
Neurocysticercosis is caused by the larval form of (blank)
Taenia solium
65
What are some other notable causes of helminthic brain abscesses?
Trypanosoma cruzi, Entamoeba histolytica, Shistosoma spp.
66
What are isolates from a brain abscess caused by sinus and dental infection?
```
Aerobic and aneorbic streptococci
Bacteroides
Prevotella spp.
Enterobacterieriae
Staph aurues
```
67
What are isolates from a brain abscess caused by penetrating trauma?
Staph aureus
Aerobic streptococci
Enterobacteriae
Clostridium
68
What are isolates from a brain abscess caused by pulmonary infection?
```
Fusobacterium
Actinomyces
Bacterioides
Prevotella
Nocardia
Streptococci
```
69
What are isolates from a brain abscess caused by congenital heart disease?
Streptococci
| Staph aureus
70
What are isolates from a brain abscess caused by HIV infection?
```
TOXOPLASMA GONDII
Nocardia
Mycobacterium
Listeria monocytogenes
Cryptococcus neoformans
```
71
What are isolates from a brain abscess caused by transplantation?
```
Aspergillus
Candida
Mucorales
Nocardia
Toxoplasma Gondii
```
72
What are isolates from a brain abscess caused by neutropenia?
Aerobic gram-neg bacilli
Aspergillus
Candida
Mucorales
73
```
Which bug is this?
Gram negative cocci
Fastidious pathogen;
A) grows on blood, chocolate, and Thayer-Martin Medium
B) can only culture on Thayer-Martin
```
Neisseria
74
Neisseria produces (blank) oxidase which can be used to ID it
indphenol oxidase
75
T/F: Neisseria is easily killed by sunlight, heat, and chemicals
true
76
Neisseria has a (blank)-specific CPS
group specific
77
Which group of neisseria is the epidemic strain?
group A
78
Groups B, C, Y, and W-135 are which type of Neisseria strains?
endemic
79
Which group of Neisseria is a polymer of sialic acid?
Group B
80
Group B Neisseria is (poorly/stronlgy) immunogenic
poorly; seen as self
81
Group B Neisseria ag is expressed in what specific tissue?
neonatal!
82
Which group of the endemic Neisseria strains can occasionally become epidemic?
group C
83
Neisseria has (group/type) specific outer membrane protiens and lipooligosacchardies
type specific
84
T/F: Meningococcemia can occur with or without meningitis
true
85
What are the general findings in a meningococcal infection?
Meningococcemia
Meningitis
Petechial lesions
86
Petechiae correlate with the degree of (blank) due to DIC
thrombocytopenia
87
T/F: patients with fulminant sepsis and meningitis show purpura, petechia, and echymoses
true
88
what part of neiserria makes it antiphagocytic?
the capsule
89
What part of neiserria is extremely toxic and produces inflamm?
LOS
90
LOS contains lipid (A/C) and the core oligosaccharaide
lipid A
91
T/F: LOS has the O antigen
false; lacks the O ag
92
How is LOS released from neisseria?
from the bacterial surface as the membrane blebs
93
Neisseria has (pili/flagella)
pili
94
Neiserria first gains access to the body where?
nasopharynx
95
Neiserria uses its (blank) to adhere to the epi cells of the nasopharynx
pili
96
besides prevent phagocytosis, what else does the capsule of neiserria do?
prevents complement mediated lysis
97
Which part of Neisseria causes tissue damage?
LOS
98
DIC from Neisseria is caused by what toxic part of the bacteria?
LOS
99
Multiple attacks of Neisseria is associated with depletion of which complement factors?
C5,6,7,8
100
What types of specimens do you need to collect to Dx Neisseria?
blood
CSF
NP secretions in the carriers
101
How do you visualize Neisseria?
Direct exam with gram stain of the CSF
102
What type of culture and special conditions are needed to culture Neisseria?
Culture IMMEDIATELY
incubate in CO2
Use Thayer-martin agar
103
What is the gram stain and general appearance of Neisseria?
gram negative diplococci
104
What is the oxidase status of Neisseria?
oxidase positive
105
Neisseria oxidatively produces acid from what?
sugars, eg glucose and maltose
106
How is Neisseria spread man to man?
airborne transmission via respiratory droplets
107
Which populations are most susceptible to Neisseria?
```
young kids (no Abs)
college students and military recruits (crowding and fatigue)
```
108
What is the carrier rate of Neisseria?
1-40%; few carriers develop disease
109
T/F: Neisseria only happens in outbreaks
false; may occur sporadically or in epidemics, hence the multiple strains
110
immunity to meningococcus is due to what?
anticapsular AB
111
what are the MOA's of immunity to Neisseria?
complement mediated lysis and opsonization
112
Anticapsular Ab is the major factor that determines (blank vs. blank)
resistance vs. susceptibility
113
What explains the risk of Neisseria in kids between 6-24 months?
lack of anticapsular Ab
114
Naturally ocurring Abs to Neisseria are probably due to the carrier state and to cross reacting with what other bacteria?
E. coli
115
The tetravalent meninogcoccal vaccine has which four Neisseria strains?
A
C
Y
W-135
116
What part of the bacteria does the meningococcal vaccine contain?
purified polysaccharide only
117
T/F: The tetravalent vaccine is one of two vaccines used for adults older than 56
false; the only one
118
The (polysacc/polysacc-protein) vaccine is used to vaccinate adolescents against meningitis
polysacc-protein conjugate
119
Which four strains does the polysacc-protein conjugate vaccine against meningitis have?
A
C
Y
W-135
120
When do kids get the meningitis vaccine?
11-12
121
when do you get a meningitis booster?
16-18
122
What are the special populations that should receive the meningococcal vaccine besides adolescents?
```
College freshmen living in dormitories
Microbiologists with potential exposure
Military recruits
Travelers to endemic regions
Terminal complement deficiencies
Anatomic or functional asplenia
```
123
Why is group B neisseria not included in any vaccine?
poorly immunogenic
124
The vaccine for group B neisseria targets (blank)
factor H protein
125
what is the vaccine for cholera?
inactivated v. cholera
126
what is the vaccine for diphtheria?
toxoid
127
what is the vaccine for h. flu?
CPS-protein conjugate
128
What is the vaccine for meningococcus?
Multivalent CPS or CPS-protein conjugate
129
What is the vaccine for pertussis?
Inactivated or disrupted B. pertussis
| Acellular vaccine of purified proteins
130
What is the vaccine for pneumococcus?
Multivalent CPS or 13-valent CPS-protein conjugate
131
What is the vaccine for tetanus?
toxoid
132
What is the vaccine for TB?
live attenuated BCG
133
what is the vaccine for typhoid?
heat killed S. typhi
| live attenuated oral vaccine
134
What is the std. Tx. if N. meningitidis is ID'd?
```
1. Third gen cephalosporin
or
PCN G or Ampicillin
2. extensive supportive care
3. chemoprophylaxis for family contacts using rifampin
```
135
Why is a third gen cephalosporin or PCN G/Amp used to Tx N. meningitidis?
readily penetrates inflamed meninges
136
what are some of the clinical signs of H flu in the newborn?
fever
refusal to eat
grunting respirations
hypertonicity
137
what causes Brazilian purpuric fever?
H. flu biogropu aegyptius
138
What causes acute purulent conjunctivitis?
H. aegyptius
139
What causes soft chancre veneral disease?
H. ducreyi
140
What is the morphology of H. flu?
very small gram neg. rods
141
What are the special nutritional requirements of H. flu?
X factor aka hematin
V. factor aka NAD
Chocolate agar
142
Why must chocolate agar be heated for H. flu?
lyses RBCs to release X and V factors
| inactivates inhibitor of V factor
143
(blank) can causes satelliting on plates of H. flu as it also releases X and V factors
S. aureus
144
T/F: H. ducreyi also requires X and V factors
false; only needs X factor
145
WHat part of H. flu prevents phagocytosis?
CPS
146
how many types of H flu capsule are there?
a-f
147
WHat type of H flu causes almost all systemic disease>?
H flu B
148
H flu B secretes what unique chemical?
polyribitol phosphate
149
T/f; there are many common non-typable strains of H flu that lack a capsule
true
150
H flu begins where?
as nasopharyngitis
151
Which strains of H flu most commonly migrate to the sinuses or middle ear? What else can do this?
non-typeable strain
| can also be strep pneumo or Moraxella catarrhalis
152
H flu that extends to the blood and meninges is what type?
B
153
(blank) strains of H flu cause epiglotitis
encapsulated strains
154
H flu pneumonia is secondary to (blank) virus infection
influenza
155
H flu B capsule is able to block (blank) mediated lysis
complement
156
H flu b is releases what that causes meningeal inflamm?
endotoxin
157
WHat types of samples do you need to collect to ID Hib?
NP swab, blood, CSF
158
Gram stain of (blood/CSF) can give a provisional Dx of H flu
VSF
159
What must be done to culture H flu?
culture immediately; does not survive well
160
The ID of H flu is made on the need for what nutritional supplements?
X and V factor
161
Latex agglutination is an assay to detect (blank) in the CSF
H flu B capsular antigen
162
What percent of pts with H flu meningitis have neuro sequelae?
30-50%
163
What is URT carrier rate of H. flu in kids?
30-50%
164
most carrier strains of H flu are (typeable/non-typeable)
non-typeable causing otitis media
165
There are (many/few) asymptomatic carriers of H flu B
few
166
What is the primary risk factor for H flu meningitis?
lack of anticapsular Ab
167
What is the MOA of protection of the anticapsular Ab to H flu?
opsonization and complement mediated lysis
168
H flu meningitis is most common in what age group?
6 months and 3 years
169
Maternal Abs protect against H flu until what age?
6 months
170
Exposure to Hib carriers and cross reactive ags protect kids until what age?
3
171
What was in the old vaccine for Hib?
polyribitol phosphate aka the CPS
172
What was the issue with the old vaccine?
poorly immunogenic in kids younger than 18 months
173
What is in the current vaccine for H flu?
protein conjugate;
174
What is in the connaught vaccine for H flu?
PRP coupled to diptheria toxoid
175
what is in the Praxis Biologics vaccine for H flu?
PRP coupled to nontoxic mutant of diphtheria toxin
176
What is in the Merck, Sharp, and Dohme vaccines for H flu?
PRP coupled to the N meningitidis OMP
177
When is the H flu vaccine given?
2 months
178
T/F: the vaccine for Hib reduces the carrier rate
true; goal is elimination of Hib
179
Should you wait for pos cultures before treating for H flu?
NO; NEEDS IMMEDIATE TX
180
What is the firstline Tx for H flu?
broad spectrum cephalosporin with CNS penetration; aka cefotaxime or ceftriaxone
181
What is used to cleanse carriers of H flu?
rifampin
182
What causes this?
Following conjunctivitis-- Acute onset of fever, vomiting and abdominal pain, followed by purpura, vascular collapse and death
Brazilian purpuric fever
aka
H flu biogroup aegyptius
183
Where is H. ducreyi common?
Afrika
184
What is a probable co-factor in transmission of AIDS in Afrika?
H. ducreyi
185
What is the morphology of Strep pneumo?
Gram pos
ovoid or lancet shaped in pairs
aerobic
186
Is strep pneumo neked or encapsulated?
ENCAPSULATED
187
Older cultures of strep pneumo undergo (blank), which is activated by surfactants such as bile and detergents
autolysis
188
Strep pneumo can undergo a rough-to-smooth conversion via.....
transformation
189
what agar must be used to grow strep pneumo?
blood agar
190
What is the major ag in strep pneumo?
CPS
191
the CPS of strep pneumo is (T/B) independent
T independent
192
incubation of encapsulated bacteria with antibody makes the capsule refractile is known as the (blank) reaction
Quellung
193
Strep pneumo C polysaccharaide is aka....
teichoic acid
194
teichoic acid is a cell wall CHO that reacts with which acute phase protein?
CRP
195
strep pneumo pneumonia is (lobar/hilar) in 80-90% of cases
lobar
196
Strep pneumo is the most common cause of (blank() in children older than three months
otitis media
197
Strep pneumo is the most common cause of (blank) among the young and the elderly
meningitis
198
What are some other complications of a strep pneumo infection?
peritonitis, endocarditis, arthritis
199
What are the characteristics of meningitis from strep pneumo?
by abrupt onset, toxicity, fulminant course and DIC
200
What is the actual dz state due to with infx of strep pneumo?
inflammatory response to both the bacteria and its products
201
T/F: the CPS of strep pneumo is essential for its virulence
true
202
What part of strep pneumo is antiphagocytic?
the CPS
203
What type of Ab protects against strep pneumo via opsonization only?
anticapsular ab
204
What does the the anticapsular Ab against N. meningitidis and Hib do that the one for strep pneumo can't?
activate complement mediated lysis
205
(blank) is a porin similar to Streptolysin O found in strep pneumo
Pneumolysin
206
What is the effect of pneumolysin?
contributes to inflammation
207
PDG and lipoteichoic acid are components of the....
cell wall
208
PDG and lipoteichoic acid activate the (classical/alternative) complement pathway
alternative
209
PDG and lipoteichoic acid elicit which two cytokines?
IL1
| TNFa
210
What two components of strep pneumo are largely responsible for the inflammatory response?
PDG
| lipoteichoic acid
211
t/F: natural resistance to strep pneumo is very high
true; 40-70% of people carry strep pneumo in the NP
212
WHat are the natural defensive barriers against strep pneumo?
Cough and epiglottal reflex
Mucus and cilia
Phagocytosis by alveolar macrophages
Splenic clearance from blood
213
What are some of the conditions that lower resistance to strep pneumo?
```
depressed action of cilia
depressed epiglottal reflex
hyposplenia or asplenia
SICKLE CELL DISEASE
malnutrition
```
214
What are some causes of depressed epiglottal reflex?
EtOH, morphine, anesthesia
215
What are some causes of depressed action of cilia?
viral infx aka flu
216
What are the characteristics of pneumococcal pneumonia?
1. sudden onset with shaking chill, fever, and sharp pleural pain
217
What does the sputum look like in pneumococcal pneumonia?
bloody and rusty
218
Where in the lungs does pneumococcal pneumonia localize in the lung?
lower lobes
219
What types of samples do you need to Dx pneumococcal meningitis?
sputum and body fluids:
CSF
pus
etc
220
What two things must you do to do a direct examination of strep pneumo?
gram stain
| DNA PROBE
221
what type of agar do you need to use to isolate strep pneumo?
blood agar
222
What are the three things that differentiates strep pneumo from strep viridans?
alpha hemolytic
Optochin sensitive
Bile soluble
223
What types of serologic tests can you do to test for strep pneumo?
free ag in body fluids
| pneumococcal C polysacc
224
T/F: most infections with strep pneumo are endogenous
true
225
Despite most infections with strep pneumo being endogenous, most healthy adults lack the (blank), unlike N. meningitidis and Hib
anticapsular ab
226
What are the steps to prevent and control strep pneumo infx?
prevent primary damage
immunization as needed
isolation to prevent transmission to pts at risk
227
Strep pneumo enters and exits the body via the...
URT
228
What do both of the pneumonia vaccines contain?
purified capsular polysacc
229
The pneumonia vaccine is (poly/monovalent)
polyvalent
230
What is the MOA of the pneumo vaccine?
induction of opsonic Ab
231
What is the efficacy of the pneumo vaccine?
60-80%
232
The titers for the pneumo-vax last for how long?
5 years
233
The Ag involved in the pneumo vax is (T/B) independent and therefore not suitable in kids younger than two
T independent
234
What are the populations that should be vaccinated with pnuemovax?
all adults older than 65 or in series with PCV 13
| anyone 6-18 with specific risk factors
235
What is different about the polysacc-protein conjugate pneumo vax?
also covers 65% of acute otitis media in kids younger than six
also T independent
Reccomended for ALL children
Reduces carriage and produces herd immunity
236
What is the firstline Tx for strep pneumo?
PCN or ceftriaxone IF SUSCEPTIBLE; increasing reports of resistance
237
Strep pneumo resistance means that the lab needs to do more (blank) to determine the right abx
sensitivity testing
238
What is the MOA of strep pneumo resistance?
acquisition of a PBP with reduced affinity for abx
239
What are the alt. abx used for strep pneumo?
vancomycin
macrolides
doxycycline
quinolone
240
What is the empiric treatment for pneumococcal meningitis?
ceftriaxone or PCN + vancomycin
241
What is the reason to use ceftriaxone for pneumo meningitis?
better CNS penetration
242
Why do we include vancomycin in the Tx for pneumo meningitis?
coverage if resistant to B lactam
243
PCN (does/does not) pass through the normal BBB
does not
244
What is the ironic part of giving PCN to treat pneumo meningitis?
kills bacteria, which releases more PDG and TA, resulting in more inflamm, which causes increased ICP and IRREVERSIBLE BRAIN DAMAGE
245
How can you reduced the inflamm when giving abx for pneumo meningitis?
corticosteroids
246
GBS is part of the normal flora of....
GI and GU tracts
247
What is the leading cause of neonatal sepsis and meningitis?
GBS
248
what are the risk factors in adults that lead to systemic GBS?
diabetes
cancer
HIV infx
249
What is the key virulence factor in GBS?
antiphagocytic capsular polysaccharide
250
t/F: the Ab to the CPS of GBS is protective even in the newborn
true
251
When does GBS onset in the newborn
within the first week
252
How is GBS in the newborn acquired?
in utero or during birth
253
What are the symptoms of infx with GBS in the newborn?
bacteremia
pneumonia
and/or meningitis
254
When does late onset neonatal infections happen?
1 week to 3 months
255
How is late onset neonatal infections acquired?
from mother or another infant
256
WHat are the symptoms of late onset neonatal infection?
bacteremia and meningitis
257
How does GBS infx present in older adults>?
bacteremia, pneumonia, bone/joint infection and skin and soft tissue infection
258
WHat are the risk factors for early onset neonatal disease?
1. Exposure to bacterium via mother carrier, prolonged membrane rupture, or intrapartum fever
2. Absence of anticapsular Ab from mom lacking it or delivery sooner than 37 weeks
259
How do you ID GBS in the lab?
Gram stain
BETA hemolytic
Agglutination test for Lancefield Group B AG
260
What are the methods of preventing early onset neonatal disease?
1. unverisal screening of all preg women at weeks 35-37 for rectal/vaginal colonization of GBS
2. intrapartum abx prophylaxis
261
When do you give intrapartum abx prophylaxis?
1. at time of labor when membrane ruptures
2. all preg women who test pos for GBS
3. Give PCN G or Ampicillin
262
Is there a vaccine to prevent early onsent neonatal disease?
nope
263
What is the empiric treatment of early onset neonatal disease?
Ampicillin plus aminoglycoside
264
What is the specific Tx for ID'd GBS neonatal disease?
PCN G
265
What are the indications for intrapartum GBS abx prophylaxis?
1. previous bebe with GBS dz
2. GBS bacteriuria during current pregnancy
3. Positive GBS screen
4. GBS status unknown plus any:
a) delivery before 37 weeks
b) amniotic membrane rupture greater than 18 hours
c) intrapartum temp >100.4
266
Cryptococcus neoformans is a (naked/encapsulated) yeast
encapsulated
267
What is the foundation of Dx of cryptococcus?
Assay for CrAg (cryptococcal ag)
268
How many serotypes of cryptococcus are there?
four: A-D
269
WHat species are serotypes A and D?
C. neoformans
270
What species aer serotypes B and C of cryptococcus?
C. gatti
271
Globally, what is the most serious and life threatening of the pathogenic fungi?
Cryptococcus
272
Where is cryptococcus found?
Saprophyte found in pigeon droppings and associated with EUCALYPTUS TREES
273
Which species of cryptococcus is associated with eucalyptus trees?
C. gatti
274
T/F: Cryptococcus is likely present in all people
true; causes a subclinical infection that goes latent
275
Why does cryptococcus reactivate in HIV/AIDS?
drop in T cell function
276
Where do we see most cases of cryptococcus acutely?
Sub-Saharan Africka; think AIDS
277
Cryptococcal infections in AIDS is well controlled with the use of ....
HAART
278
Pulmonary cryptococcosis begins as what type of infx?
pulmonary, duh
279
Which strain is most commonly the cause of pulmonary cryptococcus?
C. gatti
280
Cryptococcal meningitis is highly neuro(blank)
neurotropic
281
What are the other manifestations of a cryptococcal infx?
Skin lesions
Ocular infection
Prostatic involvement – possible asymptomatic reservoir
282
Since cryptococcus is opportunistic, in what situations do we see active infx?
HIV/AIDs
| immunosuppresion aka organ transplant
283
What strain of cryptococcus do we see in NON-HIV and NON-transplant hosts?
C. gatti
284
What types of specimens do you need to collect in order to Dx cryptococcus?
Blood/serum AND CSF
285
What types of stains do you need to do to visualize cryptococcus?
india ink looking for an encapsulated yeast
286
Ag detection of cryptococcus can happen via what three fluids?
serum
plasma
CSF
287
What are the three methods of assaying for CrAg?
latex agglutination
enzyme immunoassay
LFI
288
What i the lowest reliability Dx for cryptococcus?
india ink stain in NON-AIDS pts; only 50% sensitivity
289
T/F: cryptococcal tx can be mono or combo
true
290
What are the antifungals you would use against cryptococcus?
Amphotericin B
Flucytosine
Fluconazole
291
T/F: Tx of cryptooccus is different for immunocompromised pts
true
292
What are the three phases of Tx of cryptococcus?
Induction
Consolidation
Maintenance
293
What is Immune reconstitution inflammatory syndrome (IRIS)?
Occurs at initiation of HAART
| Overwhelming inflammatory response to previously acquired OI
294
In symptomatic pts, how do you initially Dx cryptococcal infection?
CSF, or if access to LP limited, THEN do serum CrAg
| USE THE LFI
295
What drugs should be used in the induction phase of crypto tx?
Amphotericin B
Flucytosine
Fluconazole
TOGETHER
296
What drugs should be used in the consolidation phase of crypto tx?
Fluconazole
297
What drugs should be used in the maintenance phase of crypto tx?
Fluconazole
298
WHen should all AIDS pts be screened for CrAg?
prior to starting ART
299
T/F: all CrAg pos pts should be treated BEFORE starting ART
true
