infections of CNS - other types of meningitis Flashcards
general difference in presentation of chronic meningitis
- less signs of inflammation and more signs of neurologic damage
- “cranial nerves, focal sensorimotor deficit, cognitive deterioration, etc”
two types of chronic meningitis
- infectious and non-infectious
types of infectious chronic meningitis
- tuberculosis
- cryptococcal
- atypical bacteria and spirochetes (syphilis and Lyme)
types of noninfectious chronic meningitis
- sarcoid
- carinoma
tuberculosis meningitis occurs mostly in…
- children
- immunocompromised
how does tuberculosis meningitis start?
- seeding of tuberculoma in brain or meninges, usually traveled in blood from a central lesion like the lung
tuberculosis meningitis possible findings
- headache, fever, malaise
- nuchal rigidity
- weight loss
- hydrocephalus, cranial nerve palsy, arteritis
WBCs in CSF in tuberculosis meningitis
- pleocytosis but usually fewer than 300/cu mm
protein and sugar in tuberculosis meningitis
protein high
sugar low
tuberculosis meningitis treatment if suspected
- Isoniazide (INH), streptomycin, rifampin and pyrazinamide are used in combination
- Ethambutol may be useful if given in high doses
- treat 6-9 months
labs for tuberculosis meningitis
- acid fast bacilli - not always accurate and can take a long time
- chest x-ray and skin test - but not always accurate
- PCR generally accurate
cryptococcal meningitis caused by
cryptococcus neoformans
presentation of crypt meningitis
- indolent, symptoms can go back years
- headache most common
- mental deterioration
- cranial nerve palsies and focal brainstem dysfunction
cryptococcus may grow on…
- india pink preparation
- but not uncommon for it to not show at all
treatment of crypt meningitis
- “systemic and intrathecal amphotericin B and 5-fluorcytosine”
CSF in crypt meningitis
- same as tuberculosis meningitis
- protein high, sugar low
- WBC count high but under 300/ cu mm
CSF in sarcoid meningitis
same as tuberculosis and cryptococcus
treatment of sarcoid meningitis
- immune suppressing drugs
- corticosteroids
CSF in carcinomatous meningitis
- very high protein
- possible cancer cells
carcinomatous meningitis presentation
- hydrocephaly and CN damage typical
possible tests to confirm carcinomatous meningitis
- biopsy
- flow cytometry for lymphoma looking for monoclonality
drugs that can cause meningitis
- NSAIDs
- sulfa drugs
- chemotherapy and antiviral drugs in CSF
