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Conditions + definitions > Infection - meningitis > Flashcards

Infection - meningitis Flashcards

1
Q

What is meningitis?

A

Inflammation of the meninges

Usually due to infection

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2
Q

What is the pathogenesis of meningitis?

A 
Attachment  to mucosal epithelial cells
Transgression of mucosal barrier
Survival in blood stream
Entry into CSF
Production of overt infection in meninges (with or without brain infection - encephalitis)
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3
Q

What are the common bacterial causes of meningitis>

A

Neiseria meningitidis (mengiococcus)
Strepococcus pneumonia
Neonates - E. Coli + Group B streptococci

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4
Q

What are the common viral causes of meningitis>

A 
Enteroviruses
-Echoviruses
-Parechoviruses
-coxsackie viruses
-polio(not in UK)
Mumps (rarely)
Herpes simplex
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5
Q

What are the less common causes of meningitis ?

A 
Haem influ B
Listeria monocyotgenes
Mycobacterium TB
Leptosporosis
Borelia burgdorferi
Crytococcus neoformans
HIV
Varicella virus
Epstein-barr virus
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6
Q

What are the non-infective causes of meningitis?

A

Tumours

Causes aseptic meningitis

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7
Q

What is aseptic meningitis?

A

High protein + lymphocytes

No organism detected

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8
Q

How does meningitis present?

A 
Heaache
Photophobia
Neck stiffness
Vomiting
Lethargy
Clouding conciousness
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9
Q

When should you expect bacterial meningitis?

A

Clouded conciousness

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10
Q

How long are symptoms present in acute presentation of meningitis?

A

Less than 24 but rapidly progressive

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11
Q

What causes sub acute presentation of meningitis? What is the time period?

A

1-7 days

All viral and 65% bacterial. Fungal also possible

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12
Q

What are the side effects for late treatment of bacterial meningitis?

A

Long term deafness
Fits
Mental impairment

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13
Q

What are the key points in a general exmaination in suspected meningitis?

A

Pyrexial?
Level of conciousness?
Rashes - skin + conjunctival petechia in 60% with mengiococcal

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14
Q

What are the key points in a cardiovascular exmaination in suspected meningitis?

A 
Pulse - brady/tachy?
Blood pressure (septic shock?)
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15
Q

What are the key points in a neurological exmaination in suspected meningitis?

A

Focal neurological signs (TB/cryoticiccal meninigits)

Papilloedema (unusual - consider space occupying lesion)

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16
Q

What are the traditional physical signs in meningitis?

A 
Kernig sign (hip flexed, patients leg cannont be straightened due to hamstring spasm)
Flex neck in attempt to touch chin - difficult with neck stiffness
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17
Q

What specimines should you collect in suspected meningism?

A

Blood cultures (before antibiotics if possible, but take anyway even if antibiotics taken). Then treat with best guess
Lumber puncture
CT if papillodema to rule out lesion

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18
Q

What are the CSF findings in bacterial mengitis?

A

Looks turbid (nroamlly clear)
Cells - greatly increased (normally small unmbers)
Predominant cell type - neutrophils (normally phymphocytes)
Glucose reduced (normally 60% of blood level)
Protein greatly increased

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19
Q

What are the CSF findings in viral mengitis?

A

Looks clear- turbid (normally clear)
Cells - moderate increased (normally small unmbers)
Predominant cell type - lymphocytes (normally lymphocytes)
Glucose normal
Protein moderate increased

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20
Q

What are the CSF findings in TB mengitis?

A

Looks turbid (nroamlly clear)
Cells - moderate increased (normally small unmbers)
Predominant cell type - lymphocyte or mixed (normally phymphocytes)
Glucose reduced (normally 60% of blood level)
Protein greatly increased

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21
Q

How do you treat acute bacterial meningitis?

A

Use antibiotic that penetrates the CSF
Benzylpenicillin - if CSF inflamed + 4hrly doses
Ceftrizone in bacterial menigitis

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22
Q

What is the epidemiology of menigococcal meningitis?

A

Primarily young children
Sporadic disease
University student outbreaks in recent years

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23
Q

What is fulminant mengiococcal speticaemia?

A

Startling suddens of symptoms causing rapid deterionation in consciousness, fever, septicaemic shock with renal failure _ disseminated intravascular coagulation
Not techincally meningitis as CSF sterile

Purplish rash charecteristic

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24
Q

What is the management for fulminant mengiococcal septicamia?

A

Antiobiotics by GP immediately - penicillin

Modified after blood tests

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25
Q

What is the rash assciated with mengioccoal disease?

A

Purplish rash that does not blanche under pressure

However, earlier signs exist (cold extremities, leg pains)

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26
Q

What factors indicated a bad prognosis of meningitis?

A

Delay of antibiotics
Extremes of age
Purpuric leasions
Shock with absence of signs of meningitis

Lab:
Metabolic acidosis
Abscence of polymorph leucotosis

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27
Q

Who should meningitis be reported to?

A

Local consultant in health protection

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28
Q

What is the epidemoiology of pneumococcal meningitis?

A 
Most frequent cause of bacterial meningitis
Predisposing factors:
Pneumonia
Sinusitis
Endocarditis
Head trauma
Alcoholism
Splenocetpmy
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29
Q

What is the microbiology of penumoccoci?

A

Gram positive

a haemolytic on agar jelly

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30
Q

What are the clinical features of pneumococcal meningitis?

A

Often acute within 1-2 days
Focal neurological signs or altered conciousness more common in haemphilus or mengiococcal
Concurrent infection in sinuses

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31
Q

What is the treatment for pneumoccoal meningitis?

A

Early administration of high dose ceftrixone

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32
Q

What are the complications of pneumococcal menginitis?

A 
Death
Loss of hearing
Cranial nerve deficits
Hydrocephalus
Seizures
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33
Q

Who are immunised against pneumococcal meningitis?

A 
Patients with
Splenectomy
Diabetes mellitus
Chronic renal disease
Cardio-respiratory disease
HIV
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34
Q

What is the epidemiology of haemophilus inflenzae B meningitis?

A

Young children affected

Mild URTI followed by rapid deterioation

35
Q

What is the treatment of choice in haemophilus influenzae meningitis?

A

Dexamethasone

36
Q

What is the clinical picture in TB meningitis?

A

Meningitis follows rupture of subependymal tubercle
Low grade fever + extrameningeal TB

Lethargy
Chronic headache
Change in mentation

37
Q

How do you investigate suspected TB meningitis?

A

Culture most sensitive
Repeated LP
CT head

38
Q

What is the epidemiology of viral meningitis?

A

Young adults or children
Enteroviruses most common
Late summer/early autumn

39
Q

What are the clinical features of viral meningitis?

A 
No specific prodrome
Rapid onset headache
Photophobia
Low grade fever
Stiff neck

Patients normally altert and lucid
Rash may be present

40
Q

What are the investigations into suspected viral meningitis?

A

PCR of CSF

Shows lymphocytosis with normal glucose

41
Q

How do you treat viral meningitis?

A

Enteroviruses
Normally none needed as recover within 72 hours
If immunocomprimised/chronic infection - IV immunoglobulin may be used

For herpes - aciclovier IV, then oral

42
Q

What yeast is most likely to cause meningitis?

A

Crytococcus neoformans
Occurs in HIV
Sometimes in diabetes + immunosupression

43
Q

What is the clinical presentation of fungal meningitis?

A 
Most commonly subacute onset of symptoms
Low grade fever
Headache
Nausea
Lethargy
Confusion
Abdominal pain
44
Q

How do you treat fungal meningitis?

A

Amphotericin IV

Sometimes with fluconazole

45
Q

How does neonate meningitis differ from adult meningitis?

A

Symptoms usually non specific or not well localised
Bacteria involved often E coli, L monocytogenes, group B streptococci
Enteroviruses
Parechoviruses

46
Q

What are the clinical signs of early onset neonatal meningitis?

A

Early onset - within 3 days of birth
Marked respiratory disrtress
Bacteraemia
High mortality

Associated with premature or difficult/prolonged birth

47
Q

What are the clinical signs of late onset meningitis?

A

More than one week after birth

Bacteraemia + meningitis
Pulmonary involvment rare
Moraltity 10-20%

48
Q

How do you diagnose neonatal meningitis?

A

Bacterial - neonate CSF + blood cultures

Viral - neonate CSF, EDTA blood, faeces + nasopharyngeal secretions

49
Q

What is the prognosis of neonate meningitis?

A

High mortality - up to 50%

Neurological + development difficulties in around 33%

50
Q

How do you prevent neonatal meningitis?

A

High risk mothers given chemoprophylaxis during labour

51
Q

What are the clinical features for Hep A?

A 
Usually mild + subclinical
Often children under 5
Fever
Malaise
Anorexia
Nausea
Vomiting
Upper abdominal pain
Jaundice
Self limiting
52
Q

How is hep A spread?

A

Faecal oral route

MSM
IV drug users

53
Q

What is the treatment ofr hep A?

A

Supportive - no specific treatment as usually self limiting

54
Q

What are the clinical features of hep B?

A 
Anorexia
Lethargy
Nausea
Fever
Abdominal discomfort
Arthralgia
Urticarial skin lesion
Dark coloured urine
Jaundice
55
Q

What antigens are seen in Hep B?

A

HBsAg (surface antigen)
HBcAg (hep B core antigen
HBeAg (chronically infected)

56
Q

What are the routes of transmission for Hep B?

A

Vertical (mother to child), sexual, bloods etc

57
Q

What are the predisposing factors to Hep B?

A 
Injecting drug users
Multiple secual partners
Immigration from areas of high endemncity
Learn disability in care
Haemodialysis
Tattoo
58
Q

How do you diagnose an acute HBV infection?

A

HBsAg in serum on presentation
However, in late disease may have disappeared
(In which case diagnose with anti-HBc IgM antibodies)

59
Q

What are teh clinical features of chronic HBV infection?

A 
Persistence of HBsAg for more than 6 months
5-10% become chronically infected
Risk to develop:
Chronic liver disease
Membranous glomerulonephritis

Jaundice unusual until late disease

60
Q

What is the prognosis of hep B?

A

25% to go on to cirrhosis

Hepatoma can cause cancer

61
Q

When do you treat hep B?

A

Asymptomatic with raised ALT consider antiviral therapy
So should anyone with liver damage or cirrhosis

Otherwise: 2+ of
HBV DNA >2000 IU/ml
Raised ALT
Significant liver inflammation

62
Q

How do you treat hep B?

A

Long acting a intergeron via subcut injection

Entecavir
Tenofovir
In specialist clinics!

63
Q

How are reccomended to get the HBV vaccine?

A 
Healthcare personnel
Travellers in endemic areas
Renal dialysis patients
People who change sexual partners frequently
Some Police/emergency worers
64
Q

How is passive immunisation for hepatitis given?

A

Through administration of hepatitis B specific immunoglobulin

65
Q

What are the clinical features of Hep C?

A

Usually subclinical
Malaise
Anorezia
Fatigue

Jaundice + sever hepatitis can occur
Symptoms rare in chronic HCV
Hoever, AST/ALT levels fluxuate in chronic disease

66
Q

What is the main mode of transmission for Hep C?

A

IV drug users
Transfusions
Needle-stick injuries
Sexual transmission

67
Q

How do you diagnose HCV?

A

IgG (although false positive)

HCV-RNA

68
Q

How do you manage Hep C?

A

Alcohol abstention help

Pegylated a-interferon + rivavirin

69
Q

How does one accquire Hep D?

A

Either co-infection (at the same time) as getting hep B

Or at a later date (superinfection)

70
Q

How do you diagnose Hep D?

A

IgG and IgM to serum HDV, HDV-RNA and HDAg

71
Q

How do you manage hep D?

A

Pegylated a-interferon

72
Q

What are the clinical features of Hep E?

A

Subclinical or mild ilness in women + young people
Severe in elderly men
Liver failure may develop
Persitant infection can be present in immunocompromised patients

73
Q

What is the epidemiology of hep C?

A

Enterically transmitted
Most common acute form of hepatitis in UK
Transmitted from pigs

74
Q

How do you diagnose Hep E?

A

IgG and IgM and HEV-RNA

75
Q

What is the treatment for Hep E?

A

Self limiting - no treatment

In immunocormprimised - ribavirin to achieve viral clearance

76
Q

What other infections can cause hepatitis (non viral)?

A

Leptospirosis
Q fever
Psittacosis/ornithosis

77
Q

What is Q fever?

A

Zoonosis
coxiella burnetii
Acquired occupationally

78
Q

What are the clinical features of Q fever?

A

Self-limiting hepatitis with Jaundice
Pneumonia
Meningoencephalitis

Acute rarely fatal

79
Q

How do you diagnose Q fever?

A

Serological

80
Q

What is psittacosis?

A

Zoonosis - chlamydophila dound in bird faeces/bodily fluids of infected animals
Human to human rare

81
Q

What is the presentation of psittacosis?

A 
Subclinical
Febrile like flu illness
Pnemonia
Typhoid like illness
Hepatitis (jaundice sometimes), 
cardiac (endocarditis/myocarditis)
Neurological (meningitis, encephalitis)
Can be fatal
82
Q

When are health care workers excluded from doing an exposure prone procedure?

A

Hep B e antigen positive
Hep B surface antigen positive with high levels of DNA
Hep C PCR positive

83
Q

What is the process after exposure to blood/bodily fluids?

A

Encourage bleeding
Washing injury thoroughly
Cover with waterproof plaster
Report immediately

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