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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 3 predominant causative pathogens of bacterial meningitis in adults

A
  • Strep pneumoniae
  • Neisseria meningitidis
  • H. influenzae type b
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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 3 causative pathogens of viral meningitis

A
  • Enterovirus, e.g. coxsackievirus
  • Herpes simple virus (HSV-2)
  • Varicella zoster virus
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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
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10
Q

Give 2 clinical signs that are highly specific for meningitis

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 4 ways meningitis is investigated

A
  • Lumbar puncture within 1h of arrival
  • Blood culture within 1h of arrival or PCR
  • CT head - underlying pathology eg raised ICP
  • Blood glucose
  • FBC, LFTs and U+Es
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14
Q

Describe a CSF analysis that would indicate bacterial meningitis

A
  • Cloudy appearance
  • High protein
  • Low glucose - <2.5mmol/L or <40% of measured 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
  • Typically normal or >50% of plasma glucose
  • High lymphocytes
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16
Q

When is lumbar puncture contraindicated

A
  • Raised ICP
  • Coagulopathy
  • Cardio/ resp instability
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/IM cefotaxime/ ceftriaxone
18
Q

What is the treatment for bacterial meningitis caused by: H. influenzae, S. pneumoniae or N. meningitidis

A
  • IV ceftriaxone/ cefotaxime for 10 days
  • OR chloramphenicol (penicllin allergy)
  • IV dexamethasone for 4 days
19
Q

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

A
  • IV amoxicillin for 21 days
  • OR IV trimethoprim/sulfamethoxazole (penicillin allergy)
20
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)

21
Q

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

A
  • Close prolonged contact within 7 days before onset
  • Single dose of ciprofloxacin guided by local health protection team
22
Q

How is viral meningitis treated

A

Aciclovir (HSV-2)

23
Q

Give 4 complications of meningitis

A
  • Hearing loss
  • Seizures
  • Raised ICP
  • Cognitive and behavioural issues
24
Q

What type of bacteria is N. meningitidis

A

Gram negative diplococcus

25
Q

What type of bacteria is L. monocytogenes

A

Gram positive bacillus

26
Q

What type of bacteria is strep. pneumoniae

A

Gram positive diplococci

27
Q

What is encephalitis

A

Inflammation of the brain parenchyma associated with neuro dysfunction

28
Q

Give 3 causes of encephalitis

A
  • HSV-1 (mc)
  • West Nile virus
  • EBV
29
Q

Give 3 RFs of encephalitis

A
  • Age <1 or >65
  • Immunodeficiency
  • Animal/ insect bites
30
Q

Give 5 typical symptoms of encephalitis

A
  • Fever
  • Rash
  • Altered mental state
  • Focal neuro deficits: aphasia
  • meningismus: neck stiffness, photophobia + headache
31
Q

How is encephalitis investigated

A
  • FBC - raised WCC
  • LP - findings vary depending on cause
  • MRI brain - hyperintense lesions, oedema
  • Electroencephalogram
32
Q

What is the treatment for encephalitis

A

IV Aciclovir for 14-21 days

33
Q
A

3a neurology (13 decks)

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