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3a neurology > Infections > Flashcards

Infections Flashcards

1
Q

What is meningitis

A

Inflammation of the meninges usually caused by infection

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2
Q

Who does meningitis mainly affect

A

Infants
Children
Elderly (>60)

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3
Q

Give 4 RFs of meningitis

A
  • Immunocompromised
  • Crowding
  • IVDU
  • Pregnancy
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4
Q

Give 2 causes of bacterial meningitis in adults

A
  • Strep pneumoniae
  • Neisseria meningitidis
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5
Q

Give 4 groups of patients that are more likely to be affected by bacterial meningitis that is caused by listeria monocytogenes

A
  • Elderly
  • Immunocompromised
  • Alcohol misuse
  • DM
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6
Q

Give 5 causative pathogens of viral meningitis

A
  • Enterovirus, e.g. coxsackievirus - mc
  • Herpes simple virus and herpes zoster virus
  • measles and mumps
  • HIV
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7
Q

Give 2 causative pathogens of fungal meningitis

A
  • Cryptococcus neoformans
  • Cryptococcus gattii
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8
Q

Give 2 non-infective causes of meningitis

A
  • Paraneoplastic syndromes
  • Autoimmune conditions
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9
Q

Give 5 typical symptoms of meningitis

A
  • Fever and vomiting
  • Neck stiffness
  • Photophobia
  • Headache
  • Altered mental state - drowsiness/ seizures
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10
Q

Give 2 clinical signs that are indicative of inflammation of the meninges

A
  • Kernig’s sign
  • Brudzinski
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11
Q

What is kernig’s sign

A
  • hip and knee of one leg flexed to 90
  • Knee is then slowly straightened
    +ve sign = pain on knee extension
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12
Q

What is Brudzinski’s sign

A

Forced flexion of the neck causes flexion of the hips and knees

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13
Q

Give 3 ways meningitis is investigated

A
  • Lumbar puncture - cultures, glucose, protein, PCR and microscopy
  • CT head - if signs of raised ICP
  • Bloods: FBC, lactate, CRP and U+Es
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14
Q

Describe a CSF analysis that would indicate bacterial meningitis

A
  • Cloudy appearance
  • High protein (>1g/l)
  • Low glucose - <2.5mmol/L or <50% of serum glucose)
  • High neutrophils
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15
Q

Describe a CSF analysis that would indicate viral meningitis

A
  • Clear appearance
  • Normal or mildly raised protein
  • Typically normal or >60% of plasma glucose
  • High lymphocytes
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16
Q

When is lumbar puncture contraindicated/ delayed in the invesigation of meningitis

A
  • signs of raised ICP
  • signs of severe sepsis or rapidly evolving rash
  • Coagulopathy - signficant bleeding risk
  • severe cardio/ resp compromise
17
Q

How is meningitis initially treated if the patient presents to primary care

A
  • 1.2g IM/ IV benzylpenicillin then immediate transfer to hospital
  • OR IV cefotaxime/ ceftriaxone
18
Q

How should suspected bacterial meningitis be managed

A
  • IV access - take bloods and cultures
  • Lumbar puncture within one hour
  • < 60y: IV cefotaxime or ceftriaxone for 10 days
  • > 60y: IV cefotaxime/ ceftriaxone + amoxicillin/ ampicillin
  • IV dexamethasone - reduce neuro sequelae
19
Q

What should be done if a lumbar puncture can’t be done within the first hour in the case of suspected bacterial meningitis

A

IV antibiotics should be given after blood cultures have been taken

20
Q

When is IV dexamethasone avoided in the management of bacterial meningitis

A
  • septic shock
  • meningococcal septicaemia
  • immunocompromised
21
Q

What is the treatment for bacterial meningitis caused by L. monocytogenes

A
  • IV amoxicillin for 21 days
  • OR IV trimethoprim/sulfamethoxazole (penicillin allergy)
22
Q

When would vancomycin be given in combination with the typical Abx for bacterial meningitis

A

If there is a risk of penicillin-resistant pneumococcal infection (e.g. recent foreign travel or prolonged Abx exposure)

23
Q

Describe contact tracing in bacterial meningitis and state what prophylaxis is given

A
  • Close prolonged contact within the 7 days before onset
  • Single dose of oral ciprofloxacin or rifampicin guided by local health protection team
24
Q

How is viral meningitis managed

A
  • whilst awaiting results of LP, if bacterial meningitis or encephalitis are suspected, patient should start broad-spectrum antibiotics (e.g. IV ceftriaxone and aciclovir)
  • typically self-limiting over 2 weeks
  • Aciclovir if meningitis secondary to HSV
25
Q

Give 5 complications of meningitis

A
  • sensorineural hearing loss (mc)
  • Seizures
  • pressure: brain herniation, hydrocephalus
  • focal neurological deficit
  • infective: sepsis, intracerebral abscess
26
Q

What type of bacteria is N. meningitidis

A

Gram negative diplococcus

27
Q

What type of bacteria is L. monocytogenes

A

Gram positive bacillus

28
Q

What type of bacteria is strep. pneumoniae

A

Gram positive diplococci

29
Q

What is encephalitis

A

Inflammation of the brain parenchyma associated with neuro dysfunction

30
Q

Give 3 causes of encephalitis

A
  • HSV-1 (mc)
  • HSV-2 (neonates from genital herpes)
  • West Nile virus
  • Enterovirus
31
Q

Give 3 RFs of encephalitis

A
  • Age <1 or >65
  • Immunodeficiency
  • Animal/ insect bites
32
Q

Give 5 typical symptoms of encephalitis

A
  • Fever
  • headache
  • Altered mental state - consciousness, cognition
  • Focal neuro deficits: aphasia
  • seizures
  • vomiting
33
Q

How is encephalitis investigated

A
  • FBC - raised WCC
  • CSF (LP): high WCC, raised proteins, PCR for HSV, VZV and enteroviruses
  • MRI brain - medial temporal and inferior frontal changes, may be normal
  • Electroencephalogram
34
Q

What is the treatment for encephalitis

A

IV Aciclovir for 14-21 days
* repeat LP before stopping antivirals

35
Q

What lobe of the brain does herpes simplex encephalitis typically affect

A

temporal lobes

36
Q

Which type of HSV is responsible for most cases of herpes simplex encephalitis in adults

A

HSV-1

3a neurology (16 decks)

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