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Microbiology > CNS & Meningitis > Flashcards

CNS & Meningitis Flashcards

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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
Q

What should you do for herpes simplex encephalitis?

A

High dose IV acyclovir

26
Q

Which virus is becoming leading cause of viral encephalitis?

A

West Nile virus
Birds migrate to New York and bring mosquitoes
Italy

27
Q

What are the other infectious causes of encephalitis?

A

Bacterial- listeria
Amoebic- naegleria fowleri, habitat warm water
acanthamoeba species, balamuthia mandrillaris- brain abcess, aseptic or chronic meningitis. South west England, Bath.

28
Q

What is a non bacterial, non viral cause of encephalitis?

A

Toxoplasmosis, obligate intracellular protozoal parasite
Oral, transplacental, organ transplantation
Immunocompromised
Grey and white matter of brain, retina, alveolar, heart, skeletal muscle

29
Q

Brain abcess pathophysiology?

A

Otitis media,mastoiditis, parasinuses, endocarditis, haematology

30
Q

What is the microbiology of brain abcess?

A

Streptococci, staph, gram neg, TB, fungi, parasite, actinomycetes, nocardia species

31
Q

What is the common form of vertebral infection?

A

(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
Q

What are the risk factors for spinal infections?

A 
Advanced age
IVDU 
Long term systemic steroids
DM
Organ transplantation 
Malnutrition 
Cancer
33
Q

What imaging is the best?

A

Contrast MRI - detecting parenchymal abnormalities such as abcess and infections
CSF sample, brain tissue.

34
Q

What other samples can you get for meningitis case?

A

Blood culture
Blood for PCR
Throat swab

35
Q

What is the microscopy for purulent meningitis?

A

Turbid, 100-200 polymorphs, high protein, low glucose

36
Q

What is the microscopy for aseptic meningitis?

A

Slightly turbid, lymphocytes, high protein, normal glucose

Partially treated bacterial meningitis

37
Q

What is the microscopy for TB meningitis?

A

Slightly turbid, lymphocytes, high protein, low glucose

38
Q

What is the link with HIV and cryptococcus meningitis?

A

Immunocompromised, opportunitistic infection

Indian ink stain

39
Q

What are the limitations of diagnostics?

A 
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
Q

What is the management approach?

A

Hx, empirical abx, LP
CSF analysis
CSF culture

41
Q

What is the therapy for meningitis?

A

Ceftriaxone 2g IV bd

If >50 years or immunocompromised add amoxicillin 2g IV 4 hourly

42
Q

What is the therapy for meningitis- encephalitis?

A

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
Q

What are the 4 routes of entry?

A

Haematogenous spread
Direct implantation via instrumentation
Local extension secondary to established infections
PNS to CNS- viruses

Microbiology (15 decks)

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