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Neurology > Infections of central nervous system > Flashcards

Infections of central nervous system Flashcards

1
Q

What are the source of infectious agents in meningitis

A

Typically colonize nasopharynx and respiratory tract, then enter CNS

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2
Q

What are three routes through which meningitis organisms enter the CNS

A

1.) Blood2.) Retrograde transport along cranial/peripheral nerves3.) Contiguous spread from sinusitis, otitis media, surgery, or trauma

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3
Q

Two major classes of meningitis based on onset

A

Acute - hours to days onsetChronic - weeks to months onset

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4
Q

What is chronic meningitis typically caused by

A

Mycobacteria, fungi, lyme disease, parasites

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5
Q

Two major classifications of meningitis based on species involved

A

Bacterial and aseptic

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6
Q

Bacterial: Causes of meningitis in neonates

A

Group B strep, E. coli, Listeria monocytogenes

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7
Q

Bacterial: Causes of meningitis in children > 3 months

A

N. meningitis, strep pneumoniae, H. influenzae

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8
Q

Bacterial: Causes of meningitis in adults ages 18 to 50

A

strep pneumoniae, N. meningitis, H. influenzae

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9
Q

Bacterial: Causes of meningitis in elderly > 50 years

A

strep pneumo, N. meningitis, L. monocytogenes

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10
Q

Bacterial: Complications of meningitis

A

Seizures, coma, brain abscess, DIC, respiratory arrest, subdural empyema

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11
Q

Bacterial: Permanant damage of meningitis

A

Deafness, brain damage, hydrocephalus

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12
Q

Aseptic: Viruses involved

A

HSV and enterovirus

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13
Q

What do you do if you are uncertain it is aseptic meningitis

A

Treat like its bacterial meningitis

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14
Q

What is the classic triad of acute bacterial meningitis

A

Fever, nuchal rigidity, and alteration in mental status

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15
Q

What other symptoms, aside from the triad, occurs in bacterial meningitis

A

Headache (worse with lying down), nausea/vomiting, photophobia, rashes, increased ICP (papilledema), cranial nerve palsies

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16
Q

What are two kinds of rashes you can see in meningitis and what species are they associated with

A

1.) Maculopapular rash with petechiae - N. meningitis2.) Vesicular lesions - HSV or varicella

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17
Q

In how many patients is kernig’s sign and brudzinkksi’s sign present in meningitis

A

50%

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18
Q

What is the first thing you must do if you suspect meningitis, and when is that contraindicated and replaced by something else first

A

LP for CSF examination and noting opening pressure, unless space occupying lesion or focal neurological signs, in which case do CT scan first

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19
Q

What can be seen initially to naked eye of CSF examination before sending it

A

Cloudy = pyogenic leukocytosis

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20
Q

What should CSF be examined for

A

WBC count, protein, glucose, gram stain, culture, cryptococcal antigen (or india ink)

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21
Q

What should you see in CSF analysis of bacterial meningitis

A

Elevated WBC’s with high PMNs, low glucose, high protein, and positive gram stain in 75 to 80%

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22
Q

What should you see in CSF analysis of aseptic meningitis

A

lymphocytic pleocytosis, protein normal, glucose normal, CSF normal looking

23
Q

What should you obtain before beginning any antibiotics in meningitis

A

Blood cultures

24
Q

Memorize CSF analysis

A

Page 370

25
Q

When should you initiate antibiotics in meningitis

A

Immediately after LP

26
Q

How do you decide what antibiotics to give to someone with meningitis

A

By their age

27
Q

What antibiotics should you give in meningitis:

A

Cefotaxime + ampicillin + vancomycin(aminoglycoside if less than 4 weeks old)

28
Q

What antibiotics should you give in meningitis: 3mo to 50 years

A

Ceftriaxone + vancomycin

29
Q

What antibiotics should you give in meningitis: >50 years

A

Ceftriaxone + vancomycin + ampicillin

30
Q

What antibiotics should you give in meningitis: impaired cellular immunity (HIV)

A

Ceftazidime + ampicillin + vancomycin

31
Q

What is the vaccination criteria for meningitis

A

> 65 years = S. pneumoAsplenic = S. pneumo, N meningitis, H influenzaeImmunocompromised = meningococcus

32
Q

What should you do for all close contacts of meningitis patients

A

Prophylax - IM ceftriaxone of patients with meningococcus

33
Q

What is the care for aseptic meningitis

A

Supportive care - disease self-limitedMay reduce fever and analgesia

34
Q

What is the most common organism for encephalitis

A

Viral - herpes, arbovirus (West nile and eastern equine), enterovirus (polio) and others

35
Q

What are nonviral causes of encephalitis

A

Aspergillosis, toxoplasmosis, T cell lymphoma

36
Q

What specific kind of encephalitis are you at risk for with a CD4 count of less than 200

A

Toxoplasmosis

37
Q

What are some common risk factors for encephalitis

A

1.) AIDS2.) Immunosuppression3.) Underdeveloped countries4.) Mosquito exposure in endemic area5.) Rabies exposure in endemic area

38
Q

How does encephalitis progress

A

Starts off with headache, malaise, myalgiaThen in hours to days becomes more acutely ill

39
Q

What are signs and symptoms of encephalitis

A

Meningitis symptoms + altered sensorium (like delerium) + focal neurological signs

40
Q

How do you rule out nonviral causes of encephalitis

A

CXR, urine and blood culture, urine toxicology, serum chemistry

41
Q

What should be done in the first step in diagnosing viral causes of encephalitis

A

LP to examine CSF showing lymphocytosis with normal glucose, but cultures would be negative. CSF PCR is test of choice!

42
Q

What else can be done besides LP to see causes of encephalitis

A

MRI: Rules out neurological causes such as abscessIncreased signal in T2 in frontotemporal area = HSV encephalitis

43
Q

When is brain biopsy indicated in suspected encephalitis

A

Last resort - acutely ill patient with focal, enhancing lesion on MRI without clear diagnosis

44
Q

What is the main treatment for encephalitis

A

Supportive care, maybe intubate

45
Q

For what two viruses can you give antiviral therapy for in encephalitis

A

1.) HSV - acyclovir 2 to 3 weeks2.) CMV - ganciclovir/foscarnet

46
Q

What do you do if cerebral edema in encephalitis

A

Hyperventilation, osmotic diuresis, and steroids

47
Q

What species do you think of in AIDS and neutropenic patients

A

AIDS = toxoplasmosis, fungiNeutropenic = candida, aspergillus, zygomycosis

48
Q

What are normal levels for WBC count (cells/mm3), WBC differential, glucose, and protein

A

WBC count:

49
Q

What do you usually see in viral meningitis in CSF findings

A

Glucose greater than 45, protein less than 200, negative gram stain

50
Q

What do you usually see in bacterial meningitis in CSF findings

A

Glucose less than 34, protein greater than 220, leukocytes greater than 2000/uL, CSF neutrophils greater than 1180/uL (99% certainty)

51
Q

What should be used as empiric therapy for acute bacterial meningitis

A

Third generation cephalosporin (ceftriaxone), vancomycin, and ampicillin

52
Q

What is ampicillin used for empiric therapy of acute meningitis

A

Listeria monocytogenes

53
Q

Why is ceftriaxone used for empiric therapy of acute meningitis

A

Penicillin-resistant strep pneumo

Neurology (9 decks)

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