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CSF Flashcards

1
Q

A lumbar puncture procedure consists of:

A

a needle being inserted through a patient’s back
between two lower vertebrae and moved into the space surrounding the spinal cord.

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2
Q

the space
surrounding the spinal cord is filled with:

A

cerebrospinal fluid (CSF) that will drip from the needle
once properly inserted. Fluid will then be collected into sterile containers for laboratory testing

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3
Q

CSF collection from a ventricular shunt is accomplished through:

A

the placement of a catheter
behind the ear that will drain excess spinal fluid from the brain

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4
Q

A shunt is inserted into:

A

ventricles of the brain to relieve pressure caused by an accumulation of CSF

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5
Q

Catheter tubing is
placed to:

A

divert excess CSF either outside of the body for sterile collection or to other parts of the
body, such as the pleural or peritoneal cavities, to be absorbed by blood vessels

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6
Q

A catheter may be placed into a lateral ventricle that is attached to:

A

a reservoir implanted under the
scalp for external access to a shunt system

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7
Q

The reservoir is often used to

A

deliver drugs directly to
the CSF and CNS or to aspirate CSF for testing with a syringe in a minimally invasive manner

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8
Q

Haemophilus influenzae react and present in the following ways:

A

Catalase +
Oxidase +
X factor (hemin) +
V factor (NAD) +
Beta-hemolytic on sheep blood agar −
Lactose fermentation −
Mannose fermentation −

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9
Q

Gram stain: Haemophilus influenzae

A

GNRs

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10
Q

Growth requirements: Haemophilus influenzae

A

aerobic and facultative anaerobe, grow best on chocolate agar in 5–
10% CO2 at 35–37 °C

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11
Q

Colony morphology: Haemophilus influenzae

A

o Unencapsulated strains — small, smooth, and translucent on chocolate agar
o Encapsulated strains — larger, mucoid, with a mouse nest odor on chocolate agar.

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12
Q

Neisseria meningitidis react and present in the following ways

A

Catalase +
Oxidase +
Nitrate reduction −
Maltose fermentation +
Glucose fermentation +
Lactose fermentation −

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13
Q

Gram stain: Neisseria meningitidis

A

GND

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14
Q

Growth requirements: Neisseria meningitidis

A

aerobic and facultative anaerobe, grow best in a humid, 5–10% CO2
environment at 35–37 °C

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15
Q

Colony morphology: Neisseria meningitidis

A

a green hue may be present on agar underneath colonies
o Unencapsulated strains — medium, round, smooth, gray to white, moist on chocolate
and sheep blood agar
o Encapsulated strains — more mucoid appearing.

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16
Q

Escherichia coli react and present in the following ways:

A

Indole +
Citrate −
Hydrogen sulfide (H2S) −
Lysine decarboxylase (LDC) +
Lysine deaminase (LDA) −
Urease −
Motility +
Voges–Proskauer +
Triple sugar iron (TSI) agar A/A
Gas production +

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17
Q

Gram stain: E. coli

A

GNRs

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18
Q

growth requirements of e. coli

A

aerobic and facultative anaerobe, grow best at 37 °C

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19
Q

colony morphology: e coli

A

circular, convex colonies, dull gray, smooth on sheep blood agar, pink
to red, surrounded by dark-pink precipitate on MacConkey agar, and yellow on Hektoen and
xylose lysine deoxycholate agar (XLD) agars.

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20
Q

Listeria monocytogenes react and present in the following ways:

A

Catalase +
Motility at 20–25 °C +
Esculin +
Nitrate reduction −
Christie–Atkins–Munch–Petersen (CAMP) test +
Hippurate +
Glucose fermentation +

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21
Q

gram stain: Listeria monocytogenes

A

GNRs or CB

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22
Q

growth requirements; Listeria monocytogenes

A

aerobic and facultative anaerobe, grow best at 35–37 °C in ambient
air or 5–10% CO2

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23
Q

colony morphology; Listeria monocytogenes

A

white, translucent, smooth, moist, with a narrow zone of beta-
hemolysis on sheep blood agar

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24
Q

Corynebacterium species react and present in the following ways:

A

Catalase +
Motility −
Esculin −
Mycolic acids +

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25
gram stain: Corynebacterium species
Gram-positive bacilli, slightly curved, with rounded ends — some species are pleomorphic, presenting a Chinese letter formation appearance
26
Growth requirements: Corynebacterium species
aerobic and facultative anaerobe, grow best at 35–37 °C in ambient air or 5–10% CO2
27
Colony morphology: Corynebacterium diphtheriae:
varying morphology from small, gray, and translucent to medium, white, and opaque; black or gray colonies on cystine-tellurite blood agar
28
Colony morphology: Less virulent Corynebacterium species:
small to medium, gray, white, or yellow, nonhemolytic colonies
29
Propionibacterium species react and present in the following ways:
* Gram stain: Gram-positive bacilli, pleomorphic, diphtheroid-like, may be club shaped or in palisade arrangements * Growth requirements: anaerobic, grow best at 35–37 °C for 48 hours * Colony morphology: small white to gray on anaerobic blood agar. More mature colonies will be larger and yellow colored
30
Correlating the appearance, microbiology, cell count, and chemistry testing of a CSF sample will provide evidence for:
determining the presence of a meningitis infection, as well as differentiate the causative agent.
31
The expected results of a normal CSF sample free of infection are as follows:
Appearance: clear and colorless * Protein: 15–45 mg/dL * Glucose: 60–70% plasma glucose levels * Cell count: 0–5 WBC/µL * Differential: 70% lymphocytes, 30% monocytes
32
Abnormalities in the color and clarity of a CSF sample can be indicative of the following
a traumatic tap; current, recent, or previous subarachnoid hemorrhage; and infection.
33
Evidence of a traumatic tap will show
blood in collection tubes, with a successive clearing in each tube, a clear supernatant when spun, and clots from the presence of fibrinogen.
34
Samples will contain blood in every collection tube during
a current subarachnoid hemorrhage, appear pale-pink to pale-orange in a recent hemorrhage, and appear yellow in a past hemorrhage. A cloudy sample, maybe due to increased WBCs, can be indicative of an infection
35
Bacterial infections can be detected and a presumptive causative organism can be
seen on a Gram stain of CSF and correlated with the cell count and chemistry results.
36
Bacterial CSF lab values
CSF protein = greatly increased CSF glucose= decreased CSF WBC pop= Neutrophils Lactate = increased
37
Viral CSF lab values
CSF protein = increased CSF glucose = normal CSF WBCs = lymphs
38
Fungal CSF lab values
CSF protein = increased CSF glucose = normal - decreased CSF WBCs = lymphs or monos CSF lactate = increased
39
Direct detection methods for the evaluation and diagnosis of CSF infections includes
stains, rapid latex antigen testing, and serological testing
40
Bacterial meningitis can be detected by the presence of
bacteria found on a Gram stain.
41
India ink and acid-fast stain preparations allow for
the direct detection of Cryptococcus and tuberculosis pathogens, respectively.
42
Rapid latex antigen tests are useful in the immediate detection of
classic meningitis causing bacteria such as S. pneumoniae, H. influenzae, group B strep, E. coli, Neisseria meningitides, and Cryptococcus neoformans.
43
Latex beads coated with
ensitized monoclonal IgG antibodies for each bacterium are added to a test card with a CSF sample, mixed, and mechanically rotated for 5 minutes
44
Agglutination of the latex determines
the presence of bacterial antigens, thus indicating a bacterial infection
45
Serological methods are also used in
determining syphilis infections of the CNS
46
The fluorescent treponemal antibody absorption test
very sensitive but less specific in CSF samples than serum
47
Molecular methods aid in
detecting pathogens that do not grow on routine media or in patients who have already had antibiotic treatments.
48
PCR testing is available for the detection and amplification of
nucleic acids in the RNA or DNA of various CSF pathogens including bacteria, virus, fungi, and parasites.
49
COMMON MENINGITIS-CAUSING PATHOGENS
S. pneumoniae, H. influenzae, and N. meningitidis, E. coli and L. monocytogenes, Streptococcus agalactiae
50
Bacterial meningitis is caused by
opportunistic bacteria that enter the bloodstream, are carried across the blood–brain barrier to the meninges, and spread throughout the spinal fluid
51
S. pneumoniae, H. influenzae, and N. meningitidis are
normal flora of the upper respiratory tract and are spread from person to person by respiratory droplets.
52
The most susceptible population of meningitis are
children younger than 5 years of age, and pneumonia or bacteremia are commonly the initial infection in a host prior to meningitis.
53
S. pneumoniae in meningitis
Pneumolysin: antiphagocytic capsular protein o Several adhesion factors and immunogenic cell wall membrane
54
H. influenzae and N. meningitidis in meningitis
Encapsulated strains: resistant to phagocytosis and complement-mediated lysis
55
H. influenzae: in meningitis
B strain, most likely to cause meningitis
56
N. meningitidis: in meningitis
most common meningitis causing strains: A, B, C, Y, W.
57
E. coli and L. monocytogenes are transmitted via the: in meningitis
ingestion of contaminated food.
58
E. coli and L. monocytogenes, Streptococcus agalactiae: in meningitis
are common pathogens of neonatal meningitis due to transmission from mother to baby at birth
59
S. agalactiae (group B strep): in meningitis
Polysaccharide capsule: prevents phagocytosis Pore-forming toxins: promote entry into host cells and facilitate organism survival
60
E. coli: in meningitis
K1 strain: inhibits phagocytosis and resists bactericidal activity of serum antibodies
61
L. monocytogenes: in meningitis
Escape phagocytic vacuoles due to listeriolysin O, phospholipase A, and phospholipase B.
62
COMMON PATHOGENS OF CSF SHUNT INFECTIONS
Coagulase-negative Staphylococcus Corynebacterium Propionibacterium
63
Contamination of the shunt can occur
during surgery to implant the device or during the aftercare and maintenance of the shunt.
64
Coagulase-negative Staphylococcus in CSF shunt infections
Encapsulated serotypes: resistant to phagocytosis Several adhesion factors and biofilm producing the cell wall membrane
65
Corynebacterium in CSF shunt infections
Toxigenic strains are lysogenic due to exotoxin production
66
Propionibacterium in CSF shunt infections
Acquired resistance to the following antibiotic classes: ❖ Macrolides: erythromycin and azithromycin ❖ Lincosamides: clindamycin ❖ Tetracyclines: doxycycline and minocycline
67

ASCP M Mometrix (18 decks)

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