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CNS & Meningitis Flashcards

1
Q

What are the causative agents for meningitis?

A 
NM
Strep pneumo
H influenzae 
TB 
Various viruses 
Cryptococcus neoformans
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2
Q

What are the causative agents of encephalitis?

A 
Rabies virus
Arbovirus
Trypanosoma species 
Prions 
Amoeba
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3
Q

What are the causative agents of myelitis?

A

Poliovirus

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4
Q

What are the causative agents of neurotoxin?

A

Clostridium tetani

Clostridium botulinum

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5
Q

What is meningitis?

A

Inflammatory process of meninges and CSF

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6
Q

What is meningoencephalitis?

A

Inflammation of meninges and brain parenchyma

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7
Q

What is the neurological sequlae of meningitis?

A

Direct bacterial toxicity (endotoxins from gram neg, E. coli, NM, pos produce exotoxinss in ecellular space, s aureus
Indirect inflammatory process and cytokines release and oedema
Shock, seizures, and cerebral hypoperfusion

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8
Q

What is the mortality rate of meningitis?

A

10%, 5% survivors have neurological sequlae, sensineural deafness

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9
Q

What is the classification of meningitis?

A

Acute- bacterial
Chronic- TB, spirochetes (syphilus), Cryptococcus
Aseptic- acute viral

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10
Q

What are the causes of acute meningitis?

A

NM
Strep pneumo
H influenzae type B

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11
Q

What are the less common causes of acute meningitis?

A

Listeria - alcoholics with diabetes, soft cheese
Group B strep neonates, vaginal colonisation
E. coli neonates

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12
Q

What about NM?

A

Infectious cause of childhood death in all countries
Person to person, symptomatic carriers
Pathogenic strains found in 1% of carriers
Nasopharyngeal mucosa in susceptible individual
Infections in less than 10 days

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13
Q

What ins the dermatological presentation of meningococcal meningitis?

A

Nonblanching purpuric rash 80%
Maculopapular rash 13%
No rash 7%

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14
Q

Vaccines re: NM?

A

Present- type C

Absent- A, Y, W135, and B which is common in UK (antigenic shift)

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15
Q

What are the clinical outcomes of NM?

A

Meningitis- 50%
Septicaemia- 7-10%
Both- 40%
Tx is different for hypotension and raised ICP

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16
Q

What happens if you give steroids in septicaemia?

A

You suppress their immunogenicity which is keeping them alive
If meningitis- oedema, vasodilation is harmful, steroids help.

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17
Q

What CT signs can be seen with chronic meningitis?

A

Enhancement in the basal cistern and meninges with dilation of ventricles

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18
Q

What about TB chronic meningitis?

A

Incidence 544 per 100000
Immunosuppressed
Meninges, basal cisterns.
Granulomas, absecces, cerebritis

19
Q

How do you manage chronic meningitis?

A

DO NOT manage chronic meningitis- refer to specialist
Supportive neurosurgeons
Radiologists
Pharmacists

20
Q

What about aseptic meningitis?

A

Most common infection of CNS
Non specific rash can accompany symptoms
Coxsackie group B and echovirus 80-90 % cases in which a causative organism is identified

21
Q

What are the viral causes of CNS infections in children, infants, young adults?

A 
Mumps
Measles 
Varicella zoster
Epstein Barr, cytomegalovirus 
Other- myxovirus, paramyxovirus, adenovirus
22
Q

What are the viral causes of CNS infections in adults?

A

Enterovirus- coxsackie, echo, polio. All ages.
Herpes simplex 1-2 high dose IV acyclovir won’t alter course. Crystallises renal tract.
Summer autumn.

23
Q

What is the presentation of encephalitis?

A

Headache, neck stiffness, confusion

24
Q

What is the transmission for encephalitis?

A 
Person to person, or vectors 
Mosquitoes 
Lice
Ticks 
Various viridae from Togavirus, Flavivirus, Bunyavirus
25
What should you do for herpes simplex encephalitis?
High dose IV acyclovir
26
Which virus is becoming leading cause of viral encephalitis?
West Nile virus Birds migrate to New York and bring mosquitoes Italy
27
What are the other infectious causes of encephalitis?
Bacterial- listeria Amoebic- naegleria fowleri, habitat warm water acanthamoeba species, balamuthia mandrillaris- brain abcess, aseptic or chronic meningitis. South west England, Bath.
28
What is a non bacterial, non viral cause of encephalitis?
Toxoplasmosis, obligate intracellular protozoal parasite Oral, transplacental, organ transplantation Immunocompromised Grey and white matter of brain, retina, alveolar, heart, skeletal muscle
29
Brain abcess pathophysiology?
Otitis media,mastoiditis, parasinuses, endocarditis, haematology
30
What is the microbiology of brain abcess?
Streptococci, staph, gram neg, TB, fungi, parasite, actinomycetes, nocardia species
31
What is the common form of vertebral infection?
(Htlv1- transverse myelitis, polio) Pyogenic vertebral osteomyelitis, IVDU Direct open spinal trauma, infections in adjacent structure, haematogenous spread Left untreated, neurological deficits, spinal deformity, death.
32
What are the risk factors for spinal infections?
``` Advanced age IVDU Long term systemic steroids DM Organ transplantation Malnutrition Cancer ```
33
What imaging is the best?
Contrast MRI - detecting parenchymal abnormalities such as abcess and infections CSF sample, brain tissue.
34
What other samples can you get for meningitis case?
Blood culture Blood for PCR Throat swab
35
What is the microscopy for purulent meningitis?
Turbid, 100-200 polymorphs, high protein, low glucose
36
What is the microscopy for aseptic meningitis?
Slightly turbid, lymphocytes, high protein, normal glucose | Partially treated bacterial meningitis
37
What is the microscopy for TB meningitis?
Slightly turbid, lymphocytes, high protein, low glucose
38
What is the link with HIV and cryptococcus meningitis?
Immunocompromised, opportunitistic infection | Indian ink stain
39
What are the limitations of diagnostics?
``` MRI oedema pattern cannot be differentiated from tumour/stroke/vasculitis Early infection and serological tests Amount of CSF PCR techniques Methods to detect amoebic infections Availability of good lab technique ```
40
What is the management approach?
Hx, empirical abx, LP CSF analysis CSF culture
41
What is the therapy for meningitis?
Ceftriaxone 2g IV bd | If >50 years or immunocompromised add amoxicillin 2g IV 4 hourly
42
What is the therapy for meningitis- encephalitis?
Aciclovir 10mg/kg IV tds Ceftriaxone 2g IV bd If more than 50 years or immunocompromised add amoxicillin 2g IV 4 hourly, covers listeria
43
What are the 4 routes of entry?
Haematogenous spread Direct implantation via instrumentation Local extension secondary to established infections PNS to CNS- viruses

Microbiology (15 decks)

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