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Block G -- Infection > Dr. Loo -- CNS Infections > Flashcards

Dr. Loo -- CNS Infections Flashcards

1
Q

Define meningitis

A

Inflammatory disease of the leptomeninges, the tissues surrounding the brain and the spinal cord

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2
Q

5 categories of meningitis

A
  • Bacterial
  • Viral
  • Fungal
  • Mycobacteria
  • Parasitic
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3
Q

2 sub-categories of bacterial meningitis

A
  • Community-acquired
  • Healthcare-associated Post neurosurgical
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4
Q

4 pathogens associated with community-acquired meningitis in infants less than 1 month old

A
  • *Streptococcus agalactiae *(Group B)
  • E. coli
  • Listeria monocytogenes
  • *Klebsielle *spp.
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5
Q

5 pathogens associated with community-acquired meningitis from ages 1 - 23 months

A
  • Strep. pneumoniae
  • N. meningitidis
  • S. agalactiae
  • H. influenzae
  • E. coli
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6
Q

2 pathogens associated with community-acquired meningitis from 2 - 50 years old

A
  • N. meningitidis
  • S. pneumoniae
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7
Q

4 pathogens associated with community-acquired meningitis >50 years of age

A
  • S. pneumoniae
  • N. meningitidis
  • L. monocytogenes
  • Aerobic Gram negative bacilli
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8
Q

2 most common pathogens for meningitis

A
  • Streptococcus pneumoniae
  • Neisseria meningitidis
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9
Q

Most common serogroup of N. meningitidis

A

Serogroup B (out of 12)

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10
Q

Age group with highest rates of meningitis

A

<20 years old

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11
Q

3 risk factors for *N. meningitidis *meningitis

A
  • Complement deficiencies
  • Functional or anatomic asplenia
  • Household exposure to an infected person
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12
Q

Bacterial meningitis due to *N. meningitidis *transmission

A

Droplets; respiratory secretions

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13
Q

Bacterial meningitis due to *N. meningitidis *carriage

A

Nasal

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14
Q

Reason for decreased incidence of meningitis due to *S. pneumoniae * in 2005 and 2011

A

Introduction of conjugated pneumococcal vaccine PCV7 (2005) and PCV13 (2011)

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15
Q

*N. meningitidis *meningitis mortality

A

10 - 20%

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16
Q

*S. pneumoniae *meningitis mortality

A

20 - 25%

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17
Q

9 risk factors for *S. pneumoniae *meningitis

A
  • Splenectomy or asplenic states
  • Mulitple myeloma
  • Hypogammaglobulinemia
  • Alcoholism, chronic liver
  • Renal disease
  • Malignancy
  • DM
  • Children with cochlear implants with positioners beyond 24 months after implantation
  • CSF leak
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18
Q

Reason that meningitis due to *H. influenzae *is rare

A

Vaccination since 1998

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19
Q

Group affected by H. influenzae meningitis (2)

A
  • Unimmunized children
  • Partially immunized children
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20
Q

*H. influenzae *meningitis transmission

A

Droplet

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21
Q

Acquisition of menigitis due to Listeria monocytogenes

A

Contaminated foods

  • Coleslaw
  • Raw vegetables
  • Milk and cheese
  • Processed meats
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22
Q

Mortality of *Listeria monocytogenes *meningitis

A

15 - 30%

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23
Q

Most common cause of bacterial meningitis in neonates

A

*Streptococcus agalactiae *(GBS)

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24
Q

Mortality of GBS meningitis

A

7 - 27%

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25
Q

Method of transmission of GBS meningitis

A

Through birth canal

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26
Q

3 pathogens of healthcare-associated bacterial meningitis

A
  • Aerobic gram negative bacilli including P. aeruginosa
  • Staphylococcus
    • Coagulase negative
    • S. aureus
  • Propionibacterium acnes
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27
Q

Virus responsible for 85 - 95% of viral meningitis

A

Enterovirus

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28
Q

Enterovirus transmission

A

Person-person

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29
Q

Enterovirus seasonality

A

Summer and fall

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30
Q

2 less common causes of viral meningitis

A
  • Arboviruses – mosquitoes or ticks (can also cause encephalitis)
  • Herpes simplex
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31
Q

6 non-specific clinical manifestations of viral meningitis in infants

A
  • Fever
  • Poor feeding
  • Vomiting
  • Lethargy
  • Irritability
  • Bulging Fontanelle
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32
Q

4 clinical manifestations of viral meningitis in older children

A
  • Vomiting
  • Photophobia
  • Headache
  • Neck stiffness
33
Q

10 clinical manifestations of viral meningitis in adults

A
  • Fever
  • Headache
  • Meningismus
  • Altered mental status and sensorium
  • Vomtiing
  • Seizures
  • Papilledema
  • Neck stiffness
  • Brudzinski’s sign
  • Kernig’s sign
34
Q

Define Brudzinski’s sign

A
  • “Nape of the neck sign”
  • Passive flexion of the neck results in flexion of the hips and knees
35
Q

Define Kernig’s sign

A
  • Patient supine with thigh flexed on the abdomen and the knee flexed
  • Leg is passively extended
  • In the presence of meningeal inflammation, patient resists leg extension
36
Q

2 things rash may suggest

A
  • N. meningitidis (75%)
  • Enterovirus meningitis
37
Q

What might cranial nerve findings suggest?

A

L. monocytogenes

38
Q

7 ways to manage meningitis

A
  • ABCs
  • Level of consciousness; possible intubation
  • Circulatory – BP
  • Blood cultures
  • Lumbar puncture
  • Empiric antibiotics
  • CT scan in certain cases
39
Q

5 situations where you should do CT scan in even of meningitis

A
  • Immunocompromised
  • Focal neurologic signs
  • Seizure
  • Papilledema
  • Decreased level of consciousness
40
Q

Difference between bacterial vs. viral meningitis: Cell count (cells/mm3)

A
  • Bacterial = 1000 - 5000
  • Viral = 100 - 1000
41
Q

Difference between bacterial vs. viral meningitis: protein lab findings

A
  • Bacterial = 1.0 - 5.0
  • Viral = 1.0 (moderate increase)
42
Q

Difference between bacterial vs. viral meningitis: glucose

A

Bacterial = low

Viral = normal

43
Q

Difference between bacterial vs. viral meningitis: gram stain vs. blood culture

A

Bacterial = positive 60 - 90%

Viral = pasitive 10 - 90%

44
Q

Appearance of N. meningitis

A

Gram negative cocci in pairs

45
Q

Appearance of H. influenzae

A

Gram negative coccobacilli

46
Q

Appearance of *s. pnuemoniae *and GBS

A

Gram positive coccin in pairs

47
Q

Appearance of listeria monocytogenes

A

Gram positive rods

48
Q

Empiric antibiotics for neonatal bacterial meningitis patients

A

Ampicillin IV + Cefotaxime IV

49
Q

Empiric antibiotics for infants 1 - 3 months old with bacterial meningitis

A

Ampicilliln IV + Vancomycin IV + Cefotaxime or Ceftriaxone IV

50
Q

EMpiric antibiotics for bacterial meningitis patients that are pediatrics and adult up to 50 years old

A

Cefotaxime or Ceftriaxone IV + Vancomycin IV

51
Q

Empiric antibiotics for adult (>50 years) and immunocompromised patients with bacterial meningitis

A

Ampicillin IV + Vancomycin IV + Cefotaxime or Ceftriaxone IV

52
Q

Antibiotic regimen for empiric therapy of healthcare associated bacterial meningitis (2)

A

Vancomycin and Ceftazidime

OR

Vancomycin and Meropenem

53
Q

Antibiotics for *S. pneumonia *bacterial meningitis and duration

A
  • Penicillins
  • Cefotaxime or Ceftriaxone IV

10 - 14 days

54
Q

Antibiotics for N. meningitidis bacterial meningitis and duration

A

Penicillins IV or Cefotaxime/Ceftriaxone IV

5 - 7 days

55
Q

Antibiotics for H. influenzae type B bacterial meningitis and duration

A

Cefotaxime or Ceftriaxone IV

10 - 14 days

56
Q

Antibiotics for GBS bacterial meningitis and duration

A

Beta lactam IV + aminoglycoside IV

10 - 14 days

57
Q

Antibiotics for L. monocytogenes bacterial meningitis and duration

A

Beta lactam IV + aminoglycoside IV

21 days

58
Q

2 causes of meningitis where IV dexamethsone is recommended as an adjunct

A
  • H. influenzae at any age
  • *S. pneumoniae *in adults
59
Q

Rationale for using adjunctive steriods in the treatment of bacterial meningitis

A

Prevent neurological damage (esp. to hearing) due to an inflammatory and cytokine influx after antiobitics cause lysis of bacteria and release of pro-inflammatory factor into the closed brain space

60
Q

3 prophylactic antibiotics for *N. meningitidis *and H. influenzae meningitis

A
  • Rifampin
  • Ceftriaxone
  • Ciprofloxacin
61
Q

Define encephalitis

A

Inflammatory process of the brain parenchyma

62
Q

7 associated clinical findings of encephalitis

A

Findings of brain dysfunction:

  • Altered mental status (range = subtle deficits to complete unresponsiveness)
  • Motor and sensory deficits
  • Altered behavior and personality changes
  • Speech or movement disorders
  • Meningeal irritation (i.e. nuchal rigidity usually absent)
  • Seizures
  • Hemiparesis, craniael nerve palsies

NOTE: Meningitis = usually NORMAL brain function

63
Q

2 most frequent age groups affected by encephalitis

A
  • Infants <1 year
  • Elderly > 65 years
64
Q

3 possible etiologies of encephalitis

A
  • Usually infectious
    • Predominantly viral
  • Non-infectious unusual
    • Autoimmune disorders (i.e. collagen vascular diseases)
    • Paraneoplastic syndromes
65
Q

Virus that can cause encephalitis from animal bites

A

Rabies

66
Q

Virus that can cause encephalitis from bats or pigs

A

Nipah virus

67
Q

Virus that can cause encephalitis from rodents

A

Lymphocytic choriomeningitis

68
Q

Seasonality of encephalitis

A

Summer (mosquitoes)

69
Q

5 diagnostic lab tools for encephalitis

A
  • CSF analysis
    • Gram stain and culture
    • Mycobacteria, funal, viral culture
    • PCR
  • Serology
  • West Nile serology
70
Q

5 viruses for which PCR could be used to diagnose encephalitis

A
  • HSV
  • Enterovirus
  • Immunocompromised:
    • VZV
    • EBV
    • CMV
71
Q

4 findings from CSF analysis for encephalitis

A
  • Increased WBC (but usually <250/mm3)
    • Predomniance of lymphocytes
  • Increased protein (usually <1.5 g/l)
  • Normal glucose usually
    • Decreased in HSV and mumps
  • Red cells suggest necotizing encephalitides (i.e. HSV)
72
Q

3 imaging techniques to diagnose encephalitis

A
  • MRI
  • CT
  • EEG
73
Q

MRI or CT scan findings that suggests HSV as cause of encephalitis

A

Temporal lobe involvement

74
Q

MRI or CT scan finding to suggest arbovirus as cause of encephalitis

A

Thalamus or basal ganglia

75
Q

EEG finding for encephalitis that suggests HSV as cause

A

Focality in the temporal lobe

76
Q

Therapy for HSV encephalitis

A

Acyclovir 10 mg/kg IV q 8h (adjust for creatinine clearance)

77
Q

Potential sequelae of encephalitis (4)

A
  • Difficulty concentrating
  • Behavioral
  • Speech
  • Memory
78
Q

Bacterial meningitis triad

A
  • Fever
  • Headache
  • Nuchal rigidity

NOTE: Not all patients have

Block G -- Infection (23 decks)

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