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infections Flashcards

1
Q

commonest cause of meningitis in neonates

A

Group B Streptococcus

(then E.coli, listeria moncytogenes)

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2
Q

commonest cause of meningitis in kids and adults

A

neisseria meningitidis
strep pneumoniae

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3
Q

commonest cause of meningitis in immunosuppressed

A

listeria monocytogenes

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4
Q

meningococcal septicaemia

A

= when meningococcus is in bloodstream
o cause of non-blanching rash -> indicates disseminated intravascular coagulopathy (DIC) + subcutaneous haemorrhages

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5
Q

presentation of bacterial meningitis

A

headache, fever
photophobia, neck stiffness
drowsiness
non-blanching rash (meningococcal septicaemia)

Neonates + babies -> Non-specific
 Hypotonia
 Poor feeding
 Lethargy
 Hypothermia
 Bulging fontanelle

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6
Q

which test are used in suspected meningitis

A

Kernig’s test
o Lying on back, flexing one hip + knee to 90 then slowly straightening knee whilst keeping hip flexed at 90
 Creates stretch in meninges -> will produce pain or resistance to this movement

Brudzinski’s test
o Lying on back lift their head + neck off bed + flex chin to chest
 Positive – involuntary flex of hips + knees

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7
Q

meningitis investigations

A

lumbar puncture
CT
MRI

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8
Q

when to delay lumbar puncture

A

raised ICP
continous or uncontrolled seizure
GCS <=12

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9
Q

appearance of bacterial CSF

A

cloudy
high protein
low glucose
high WCC (neutrophils)

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10
Q

appearance of viral CSF

A

clear
protein normal/mildy raised
normal glucose
high WCC - lymphocytes

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11
Q

management of kids in community with suspected meningitis AND non-blanching rash

A

IM benzylpenicillin

<1yr - 300mg
1-9yr - 600mg
>10yrs - 1200mg

then immediate transfer to hospital (watch for pen allergy)

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12
Q

Management of meningitis

A

IV antibiotics
- <3months = amoxicillin + ceftriaxone
- 3month-50yrs = ceftriaxone
- >60yrs = ceftriaxone + amoxicillin

IV dexamethosome
- esp if strep pneumoniae
- start before or with 1st dose of Abx - no later than 12hrs after
- NOT in shock, septicaemia, *following surgery

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13
Q

prophylaxis for meningitis contacts

A

ciprofloxacin

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14
Q

complications of meningitis

A

sensorineural hearing loss
seizures, epilepsy
cognitive impairment, learning disability
memory loss

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15
Q

where do multiple abscesses tend to occur in the brain

A

at grey + white matter border

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16
Q

pyogenic meningitis

A

thick layer of supparative exudate cover leptomennges over the surface of brain

exudate in basal + convexity surface

neutrophils in subarachnoid space

17
Q

listeria meningidis

A

gram pos
over 60s, alcoholic

Q will sound like meningitis but mention risk factor

18
Q

steroids in meningococcal management

A

Give to all patients suspected of bacterial meningitis
o 10mg IV 15-20min before or with the first dose of antibiotic + then every 6hrs for 4d

Pneumococcal meningitis benefits the most from this

  • DO NOT give in post surgical meningitis, severe immunocompromised, meningococcal, septic shock or hypersensitive to steroids
19
Q

causes of viral meningitis

A

enteroviruses - coxsackie, echovirus
mups
herpes simplex virus, CMV, herpes zoster
HIV
measles

20
Q

management of viral meningitis

A

CSF PCR to diagnose

self limiting, supportive treatment

aciclovir if secondary to HSV

21
Q

encephalitis commonest cause

A

HSV-1 (cold sore)
- (HSV-2 in neonates)

(encephalitis = brain parenchyma inflamed)

22
Q

presentation of encephalitis

A

fever, headache, psychiatric symptoms, seizures
focal features - aphasia
personality/behavioural change

(typically affect temporal + inferior lobes)

23
Q

encephalitis MRI findings

A

medial temporal + inferior frontal changes (petechia haemorrhages)

24
Q

management of encephalitis

A

pre-emptive aciclovir

25
Q

cribiform plate fracture causing meningitis causative organism

A

strep pneumoniae

also hospitalised patients, diabetics, cochlear implants

26
Q

who should undergo CT prior to lumbar puncture?

A

immunocompromised
history of CNS infection
new onset seizure
papillodema
abnormal level of consciousness
focal neurologic deficit

27
Q

cryptococcal meningitis

A

fungal
subtle neurological presentation
aseptic picture on CSF
mainly in HIV - CD4<100

IV amphotericin B/flucytosine fluconazole

28
Q

antibiotics for bacterial meningitis in penicillin allergy

A

chloramphenicol + dexamethosone

add co-trimoxazole if over 60

neuro (26 decks)

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