Fever & Headache Flashcards

1
Q

Cardinal meningitis symptoms

A
Headache 
Photophobia
Neck stiffness
Drowsiness
-usually present late though
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2
Q

What precedes bacterial meningitis

A

Colonisation of nasopharynx, 10-20% adults colonised by N. meningiditis

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3
Q

How does bacteria propogate

A

Through sub arachnoid space - contains wbc’s, cellular debris etc.

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4
Q

Diagnoses of meningitis>

A

Clinical suspicion, need tests done as signs and symptoms appear late.

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5
Q

Tests done for diagnoses of meningitis

A

CSF sample
Blood culture
Throat swab
PCR blood tests

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6
Q

What is a manoeuvre used to test for subarachnoid haemorrhage?

A

Kernigs sign: When leg and knee flexed at 90 degrees, subsequent flexion causes hamstring pain being a positives kernigs sign indicating SA haemorrhage/meningitis.

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7
Q

Steps in Lumbar puncture (CSF sampling):

A

Foetal position on side. Enter around L2 (below the spinal cord where cauda equina is).
Enter needle between spinous processes in subarachnoid space.

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8
Q

CSF component levels:

A

Glucose: High in bact. Low in viral - bacteria and neutrophils using up glucose

Protein: High in bact. High/normal in viral - Debris from immune response

WBC’s: High in bact. High in viral

Cells: Neutrophils in bact. Lymphocytes in viral

Gram stain: +/- in bacteria

Culture: ++/- in bacteria

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9
Q

What warrants further molecular investigation?

A

Serious illnesses or sequelae

Pathogens unable to be cultivated

Improve diagnostic measure

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10
Q

When is further molecular investigation not necessary/useful?

A

When diagnoses is known

When bacteria can be cultivated

When there is only a small number of pathogens that cause an illness.

When other means are more appropriate.

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11
Q

Classic sign of meningitis?

A

Pinprick rash!

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12
Q

If no characteristic rash, what next?

A

ALL EFFORTS TO FIND AETIOLOGY TO EXCLUDE MENINGOCOCCAL DISEASE!

If CSF comes back gram negative - 
Strep. Pneumoniae antigen test
CSF PCR - Pneumoniae vs. Meningiditis 
Blood PCR -
Throat swab - commensal Neisseria Meningiditis
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13
Q

When did the meningococcal epidemic occur in NZ?

A

1990’s

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14
Q

Implications of influenzae and meningitis both having peak incidence in winter?

A

Important to tell difference early as meningitis is more serious.

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15
Q

Neisseria Meningiditis virulence factors?

A

Polysaccharide capsule - Prevents opsinisation

Binds factor H - Down regulates complement cascade

Expresses human LPS on surface - Masks itself from immune system

Secretes LPS - Decoy, keeps complement busy .

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16
Q

Parthenogenesis of N. meningiditis

A

Vasodilation/leaky vessels from complement activation via LPS plebs (more systemic).

Immune system become overwhelmed, neutrophils lyse and release their DNA in to blood vessels.

DNA is sticky so debris and RBC’s etc. stick together and block bllod vessels.

This causes hypotension, tachycardia, septic shock, reduced organ perfusion.

17
Q

Signs and symptoms:

A

Fever, tachycardia, drowsy/confusion, clammy skin, reduced urine output (AKI) aches and pains, tachypnoea, hypotension.

18
Q

Management for bacterial meningitis

A

IV antibiotics (Penicillin)

Resuscitate

Blood cultures when IV line sited

Pain relief, fluids

Droplet isolation

Prophylaxis for family members

19
Q

Management for viral

A

Reassurance
Analgesia (headache)
Home recovery

20
Q

How could a cephalosporin be used to treat meningitis

A

It is structurally similar to penicillin (contains Beta lactam ring)

21
Q

Pattern of cephalosporin generations

A

Early generations:
-Are more effective with Gram positive bacteria, though function restored at generation 4.
- For skin infections, pneumonia
CEFAZOLIN

Later generations:
- Are more effective with Gram negative bacteria
- UTI, pneumonia,
CEFTRIAXONE

5 generations

22
Q

Why do we use penicillin over cephalosporins in NZ?

A

Penicillin has a more narrow range
- Flucloxacillin kills off only Staph infection on skin, while giving cefazolin works well but kill of commensal bacteria as well.