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Medicine Phase 2a Neuro > Infection > Flashcards

Infection Flashcards

1
Q

Infective causes of meningitis

A

Bacterial
Viral
Fungal
Parasitic

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2
Q

Non-infective causes of meningitis

A

Paraneoplastic
Drug side effects
Autoimmune e.g. vasculitis/SLE

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3
Q

How does infection enter body

A

Via bloodstream i.e. bacteraemic
Neurosurgical complications (Post op, Infected shunts, Trauma)
Extracranial infection e.g. nesopharynx, ear, sinuses (nasal carriage, otitis media, sinusitis etc)

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4
Q

Pathophysiology of infection

A

Bacteria enter CSF and can be isolated from immune cells due to BBB, replication
Blood vessels become leaky
Therefore WBCs can enter the CSF, meninges and brain
Meningeal inflammation with or without brain swelling

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5
Q

Key symptoms of patient with infection

A

Fever
Headache
Neck stiffness (Meningism)

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6
Q

What % of people infected with bacterial meningitis die and what % have permanent effects as result of infection

A

5% mortality (when treated)

20% permanent effects

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7
Q

Permanent effect of bacterial meningitis

A 
Skin scars
Amputation
Hearing loss
Seizures
Brain damage
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8
Q

**Immediate management of bacterial meningitis

A
  1. Assess GCS (Glasgow Coma Scale)
  2. Blood cultures
  3. Broad spectrum antibiotics
  4. Steroids (IV dexamethasone)
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9
Q

Medial management of bacterial meningitis

A

First line antibiotics – either ceftriaxone or cefotaxime

Steroids to reduce neurological sequelae and therefore reduce morbidity (particularly with strep. Pneumoniae)

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10
Q

Examples of first line (broad spectrum) antibiotics for bacterial meningitis

A

Cephalosporins such as:
Ceftriaxone
OR
Cefotaxime

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11
Q

What can GCS help us determine

A

How sick the patient is, the lower the GCS, the sicker the patient!
If they can maintain their own airway (if <8 then no -> intubate!)
If there is any raised intracranial pressure

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12
Q

3 examples of what GCS tests

A

Best eye response
Best verbal response
Best motor response

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13
Q

What type of antibiotic is cephalosporins

A

Beta-lactam family

need a bactericidal antibiotic to eliminate infection quickly

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14
Q

What special considerations need to be taken for those to use antibiotics

A

Are they penicillin allergic?
Immunocomprimised?
Recent travel (<6 months)?

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15
Q

If someone has a reaction with penicillin, what is the chance of a reaction with cephalosporin

A

10%

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16
Q

If penicillin allergic patient develops a rash reaction, what is give

A

Cephalosporin

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17
Q

If penicillin allergic patient has an anaphylactic reaction, what is given

A

Chloramphenicol

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18
Q

If patient with bacterial meningitis is immunocomprimised, what can they be at risk of?

A

Listeria

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19
Q

If bacterial meningitis patient is immunocompromised, what is added to cephalosporin and why

A

Amoxicillin

Risk fo listeria

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20
Q

Why is it important to ask about any recent travel in bacterial meningitis

A

Some countries have higher incidence of penicillin resistant strep pneumoniae

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21
Q

What is added to cephalosporin if patient suspected to have penicillin resistant infection from recent travel?

A

Vancomycin

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22
Q

*Once immediate management of bacterial meningitis is done, what is done after to DIAGNOSE MENINGITIS

A

Lumbar puncture

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23
Q

What is done with the lumbar puncture sample

A

Microscopy, Gram stain, Culture, Protein, Glucose, viral PCR

Viral or bacterial?

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24
Q

Complications of lumbar puncture

A 
Abnormal clotting (platelets/coagulation)
Petechial rash
Raised intracranial pressure
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25
Q

Causative organisms of meningitis

A

Neisseria meningitidis

Streptococcus pneumoniae

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26
Q

How would you tell causative organism of meningitis between Neisseria and strep pneumoniae

A

Gram stain:
gram Negative cocci = Neisseria
gram Positive cocci = Pneumococcus (strep.pneumoniae)

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27
Q

What % of adults and teenagers carry Neisseria meningitidis

A

5-11% adult carriage

25% teenagers

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28
Q

Causes of acute bacterial infection

A

Neisseria meningitidis (gram negative diplococci)
Strep. pneumoniae (gram positive diplococci)
Listeria spp. (gram positive rod)
Group B Strep (gram positive cocci)
Haemophilus influenzae B (gram negative rod)
E.coli (gram negative rod)

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29
Q

Causes of acute viral infection

A

Enterovirus
Herpes Simplex Virus (HSV)
Varicella Zoster Virus (VZV)

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30
Q

Causes of chronic bacterial infection

A 
Mycobacterium tuberculosis (TB)
Syphilis
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31
Q

Causes of chronic fungal infection

A

Cryptococcal

32
Q

Bacterial infection causes in neonates

A

Listeria monocytogenes
Group B streptococcus
Escherichia coli

33
Q

Bacterial infection causes in children

A

Neisseria meningitidis
Streptococcus pneumoniae
Haemophilus influenzae

34
Q

Bacterial infection causes in adults

A

Neisseria meningitidis

Streptococcus pneumoniae

35
Q

Bacterial infection causes in elderly

A

Neisseria meningitidis
Streptococcus pneumoniae
Listeria

36
Q

Once condition of patient with Neisseria meningitidis (or meningitis in general) is more stable, what would you do after

A

Inform Public Health England
For Neisseria, identify ‘close contacts’ who have a 1/300 risk of developing meningitis (particularly first 7 days)
Antibiotic prophylaxis reduces risk and prevents onward transmission

37
Q

Examples of antibiotic prophylaxis to reduce risk and prevent onward transmission

A

Ciprofloxacin

Rifampicin

38
Q

What is Encephalitis

Causes of Encephalitis

A

Infection (and inflammation) of the brain parenchyma
Usually viral:
*Herpes Simplex
Varicella Zoster

39
Q

Other causes of encephalitis (not herpes simplex or varicella zoster)

A 
ASK ABOUT TRAVEL
Japanese encephalitis virus
Tick-borne encephalitis
Rabies
West Nile etc

Non-infective - autoimmune, paraneoplastic

40
Q

Clinical presentation of encephalitis

A

Hours to days: preceding “flu-like” illness
Then:
Altered GCS - confusion, drowsiness, coma
Fever, Seizures, Memory loss
Also: headache, altered behaviour and altered mental status.
Less commonly; hemiparesis, dysphagia, seizure and coma.

41
Q

Investigations of encephalitis

A 
Viral serology (LP and CSF studies) 
CT: Check for space occupying lesions
MRI head with or without EEG
Lumbar puncture after
Lymphocytic CSF
Viral PCR
HIV test
42
Q

Treatment of encephalitis

A

Mostly supportive
Aciclovir if HSV or VZV

(2-3 weeks of antivirals providing end of treatment CSF is –ve on PCR; extend course if ongoing viral presence)

43
Q

Infection process of tetanus

A

Inoculation through skin with Clostridium tetani spores (found globally in soil)
e.g. stepping on a nail, dirty wounds
Bacteria produce toxins

44
Q

What toxins are produced in tetanus infection

A

Tetanolysin (tissue destruction)

Tetanospasmin (clinical tetanus)

45
Q

What bacteria causes tetanus and what type of bacteria is it

A

Clostridium tetani

Gram +ve anaerobe with spores

46
Q

Pathophysiology of tetanus

A

Tetanospasmin toxin in tetanus can travel retrogradely along axons
Interferes with neurotransmitter release -> increased neurone firing -> unopposed muscle contraction and spasm

47
Q

Incubation time for tetanus

A

8 days

48
Q

Generalised tetanus signs and symptoms

A 
Opisthotonos (generalised spasms)
Lock jaw and possibly risus sardonicus
Also:
Respiratory compromise
Pain
Hypertension, tachycardia, arrhythmias
Fever
49
Q

Localised tetanus signs and symptoms

A

Injury to right head

2 days later unopposed flexion of fingers and spasm of forearm

50
Q

Management of tetanus

A

Vaccination to prevent
Supportive - muscle relaxants and paracetamol/cooling
Immunoglobulin to mop up toxin
Metronidazole to clear any residual bacteria

51
Q

How many people die of rabies per year

A

35-50,000

Once symptomatic, invariably fatal

52
Q

Transmission of rabies

A

Inoculation through skin with saliva of rabid animal (dogs, cats, foxes etc) e.g. lick, lite, splash
Travels retrogradely along nerves

53
Q

Incubation time of rabies

A

2 weeks to years depending on site and size on inoculation

54
Q

Pathophysiology of rabies

A

Travels retrogradely along nerves
Reaches CNS
Furious or paralytic presentation

55
Q

Management of rabies

A

Sedatives
Prophylaxis:
Pre-exposure prophylaxis (vaccination)
Post-exposure prophylaxis (vaccination and immunoglobulin)

56
Q

What is meningitis

A

Inflammation of the meninges

57
Q

What is Shingles

A

Varicella zoster virus reactivation

Herpes zoster

58
Q

Aetiology of Shingles

A

Varicella-zoster. Usually occurs in childhood, but lies dormant for years/decades.

59
Q

Pathophysiology of Shingles

A

After infection, the virus lies dormant in the sensory nervous system in the geniculate, trigeminal or dorsal root ganglia.
Eventually flares up -> Virus travels down the affected nerve over 3-4 days, causing perineural and intraneural inflammation.

60
Q

Clinical presentation of Shingles: pre-eruptive

A

Pre-eruptive: No skin lesions, but burning itching in one dermatome. Usually a day or two before eruption.

Rash does not cross dermatomes.

61
Q

Clinical presentation of Shingles: eruptive

A

Eruptive phase: Skin lesions appear (infectious until dried). Erythmatous, swollen plaques.
Rash does not cross dermatomes

62
Q

Diagnosis of Shingles

A

Clinical

Based on rash within a dermatome

63
Q

Treatment of Shingles

A

Oral aciclovir

64
Q 
Protein levels in infection that is:
Bacterial
Viral
TB
Cryptococcal
A

Bacterial - low
Viral - normal
TB - low
Cryptococcal - low

65
Q 
Cells found in microscopy in infection that is:
Bacterial
Viral
TB
Cryptococcal
A

Bacterial - neutrophil polymorphs
Viral - lymphocytes
TB - lymphocytes
Cryptococcal - lymphocytes

66
Q 
Appearance of CSF in infection that is:
Bacterial
Viral
TB
Cryptococcal
A

Bacterial - cloudy
Viral - clear
TB - ‘fibrin web’
Cryptococcal - ‘fibrin web’

67
Q

Viral causes of meningitis

A 
Mumps virus
Echo virus
Coxsackie virus
Other enteroviruses
Herpes simplex virus
Lymphocytic chorio meningitis virus
Poliovirus
68
Q

Diagnosis of meningitis

A 
Lumbar puncture - CSF
Blood culture
Nose and throat swabs - put on chocolate agar and examined for virus
Stool
Blood is taken for serology (antibodies)
69
Q

What tests are done with CSF in diagnosis of meningitis

A

Cell count, gram film, protein assay, glucose assay, culture on blood agar/chocolate

70
Q

Appearance of CSF

A

Gin-clear normally

71
Q

Clinical presentation of meningitis

A

Stiffness of neck
Photophobia
Severe headache
Bacterial or viral meningitis: Fever, unwell and may have a rash (characteristically haemorrhagic)

72
Q

What is meningitis

A

Inflammation of the pia and arachnoid mater

Micro-organisms infect the cerebrospinal fluid

73
Q

What is encephalitis

A

Inflammation of the cerebral cortex

74
Q

Clinical symptoms of encephalitis

A

Lethargy and fatigue

Decreased levels of consciousness and fever

75
Q

Cause of encephalitis

A 
Generally viral infection and viral causes are:
Herpes simplex virus
Varicella zoster virus
Paroviruses
HIV
Mumps virus
Measles virus
76
Q

Diagnosis of encephalitis

A

CSF - cultured on cell monolayers to detect viral growth. HSV can be detected by polymerase chain reaction

Serology of blood - acute and convalescent blood is taken to detect a rise in antibody to HSV, VZV, mycoplasma, mumps virus and measles

Medicine Phase 2a Neuro (28 decks)

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