Infections Of The CNS Flashcards

1
Q

List the possible route of infection for meningitis

A

Blood-borne
Parameningeal suppuration e.g. otitis media, sinusitis
Direct spread through defect in the duration e.g. trauma
Direct spread through cribriform plate (rare)

CSF stile, immune system can’t cope

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2
Q

List the complications alongside meningitis

A
death
subdural collection
cerebral vein thrombosis
hydrocephalus 
9-15% deafness (Hib)
convulsions
visual/motor/sensory deficit
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3
Q

Below are the common organisms that cause meningitis, what group are they commonly found in?

Neisseria meningitidis
Streptococcus pneumoniae
Hib
Escherichia coli
Listeria monocytogenes
A

neisseria meningitidis - children/young adults

strep pneumoniae - elderly and children <2 yrs
Hib - children <5yrs
e.coli - neonates
listeria - neonates/immunocompromised

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4
Q

What are the levels of protein
IgG
lymphatics in cerebrospinal fluid?

A

LOW

and no lymphatics

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5
Q

Describe the inflammatory process in meningitis

A

Release inflammatory mediators - TNF, IL-1&8, PAF and NO

neutrophils migrate to the CSF, release proteolytic products and toxic O radicals

vascular endothelium is damages, BBB is reduced = alteration of CSF and blood supply dynamics

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6
Q

What symptoms arise in meningitis

where else can these symptoms occur?

A

global headache
neck and back stiffness
nausea and vomiting
photophobia

infections, SAH, malignancy, NSAIDs

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7
Q

What symptoms are found in infants with meningitis (typical signs aren’t present in <18/12)

A
flaccid- later opisthotonus (muscle spasms)
bulging fontanelle due to increased ICP 
fever and vomiting 
strange cry
convulsions
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8
Q

List the physical symptoms of meningitis

A

fever
rash - petechial/purpuric (meningococcal usually)
irritation - photophobia, Kernig’s positive, neck stiffness, Brudzinski’s sign

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9
Q

Why have a lumbar puncture in meningitis?

A

most rapid diagnostic test
distinguish between bacterial and viral

risk of herniation

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10
Q

How does the CSF change in meningitis for bacterial, tuberculous and viral?

leucocytes
neutrophiles
lymphocytes
protein
glucose
A

increase in leucocytes and lymphocytes and neutrophiles

decrease in glucose

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11
Q

What organisms are common in community acquired meningitis?

A

51% s.pneumoniae
37%n.meningitidis
4% l.monocytogenes

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12
Q

What complications are associated with meningococcal disease

A
death 
necrotic lesions
reactive arthritis (young adults)
serositis 
neurological sequelae (rare)
abscess formation (rare)
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13
Q

List the risk factors of a poor outcome with meningococcal disease

A
advanced age
presence of otitis media or sinusitis 
absence of rash
tachycardia
low GCS
positive blood culture 
thrombocytopenia 
low CSF fluid - white cell count
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14
Q

Give the general management of meningitis

A
antibiotics
adequate oxygenation
prevention of hypoglycaemia and hypotraemia 
anticonvulsants 
decrease intracranial hypertension
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15
Q

What makes a good antibiotic for meningitis

A

bactericidal
sufficient penetration into CSF at non-toxic doses

low levels of endotoxin release when organisms killed?

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16
Q

What are the differences between the BBB and the B-CSF barrier

A

BBB - no fenestrations in the endothelium, thick basement membrane, has astrocytes

B-CSF - fenestrated, thin basement membrane, has choroid plexus

17
Q

Penetration of antibiotics into CSF is enhanced by…?

A
high lipid solubility 
low molecular weight 
low degree of ionisation 
high serum concentration 
low degree of protein binding 
meningeal inflammation
18
Q

There are three groups of CSF penetration:
1 penetrate inflamed and non-inflamed at standard dose
2 penetrate inflamed/high dose
3 penetrate poorly

give an example of each

A

1 metronidazole, trimethoprim, sulphonamides

2 benzylpenicillin, cephalosporins, rifampicin, vancomycin, amB

3 gentamicin, cephalosporins, erythromycin, tetracycline

19
Q

What is chloramphenicol used for

A

reserve agen for allergic patients with meningitis

resistance in Hib and pneumococci

20
Q

What is cefotaxime/ceftriaxone used for

A

first line treatment for meningitis in adults and children, NOT for listeria

can be used if someone has a penicillin allergy

21
Q

What is benzylpenicillin used for

A

Best for pneumococcal meningitis
high levels can lower threshold for epileptic fits
not for haemophilus influenze

22
Q

What are the penetration of antibiotics into the brain/blood ratio for

chloramphenicol
cefotaxime/ceftriaxone
benzylpenicillin G

A

9: 1
1: 10
1: 23

23
Q

Roughly how to treat meningitis with antibiotics

A

meningococcus 7
pneumococcus 14
haemophilus 7
listeria 21

if organism is not isolated this should be IV 7-14 days

24
Q

what is the link between meningitis and steroids

A

give steroids prior to antibiotics for beneficial effect

25
What antibiotics are used in phrophylatic for meningitis
rifampicin (liver effect) or ciprofloxacin (for pregnant women)
26
What vaccines are there for meningitis
MenB and MenC
27
What are the presentations for a brain abscess
``` focal neurological signs raised intracranial pressure headache fever CRP and ESR raised (CSF pleocytosis) ```
28
Name the three ways brain abscess can occur
direct spread via venous connections haematogenous spread direct implantation
29
Name the three ways a brain abscess can form
cerebritis with central inflammation ring of cerebritis with necrotic centre capsule formation
30
List some of the bacterial aetiology of a brain abscess
``` strep. milleri anaerobes enterobacteriaceae staph.aureus polymicrobial ```
31
Describe the general treatment options for a brain abscess
drainage (crainiotomy) excision via craniotomy antibiotics
32
List the antibiotic treatments by source: likely dental, sinus, haematogenous source likely otogenic source post-operative/ traumatic
1 ceftriaxone and metronidazole (narrow down to benzylpenicillin and met.azole is anaerobic) 2 ceftazidime, benzylpenicillin and metronidazole or meropenem 3 vancomycin and meropenem
33
How long should brain abscess antibiotic treatment last?
high dose 6-8 weeks IV first then oral