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MD4001 Pathology > Infections of the CNS > Flashcards

Infections of the CNS Flashcards

1
Q

What is more seroius meningitis or sepsis?

A

Sepsis

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2
Q

What are the clinical features of meningitis?

A
  • Headache, sore throat, drowsiness
  • Rapid onset fever, photophobia, neck stiffness
  • Level of consciousness progressively falls
  • Petechial or purpuric rash
  • Intravascular coagulation, endotoxaemia, shock, multi-organ fever, raised intracranial pressure
  • Life-threatening emergency
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3
Q

What is a petechial rash?

A
  • Red/brown/purple pinpoint spots on the skin that are a result of bleeding
  • Do not lose colour when touched
  • Clinical sign of meningitis
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4
Q

How do you check whether an individual has meningococcal meningitis?

A

Glass test - skin does not blanch

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5
Q

What is purpura fulminans?

A

Blood spots, bruising and discolouration of the skin resulting from coagulation in small blood vessels within the skin and rapidly leads to skin necrosis and disseminated intravascular coagulation
- Sign of acute meningitis

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6
Q

What are some clinical signs of meningitis in babies?

A
  • Tense or bulging soft spot on their head
  • Refusing to feed
  • Irritable when picked up, with a high pitched or moaning cry
  • A stiff body with jerky movements, or else floppy and lifeless
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7
Q

What are some clinical signs that are more specific to meningitis than septicaemia?

A
  • Severe headache
  • Stiff neck (viral)
  • Dislike of bright lights (viral)
  • Seizures (viral)
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8
Q

What is sepsis?

A

Whole body inflammation

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9
Q

How can infectious agents reach the CNS?

A
  • Breach by infectious agents of BBB at arachnoid membrane in ventricles -> meningitis
  • Breach of blood brain barrier (tight junctions) -> encephalitis
  • Direct spread;
    Sinuses
    Otitis media
    Skull fracture
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10
Q

What laboratory tests should be carried out if patient is suspected of meningitis?

A 
Blood
- FBC 
- Coagulation screen 
- Blood culture 
- PCR or NAAT
- Blood glucose 
- UandEs
CSF
- White cell count 
- Gram stain 
- Ziehl-Neelsen stain (TB)
- India ink (negative stain - shows whether microbe has capsule)
- NAAT
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11
Q

What stain/test is used to find out whether a microbe has a capsule?

A

India ink

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12
Q

When would a lumbar puncture not be performed?

A
  • GCS <9

- Intracranial pressure

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13
Q

What are the 4 most common bacterial causes of meningitis?

A
  • Neisseria meningitidis
  • Haemophilus influenzae
  • Streptococcus pneumoniae
  • Mycobacterium tuberculosis
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14
Q

What are the most common viral causes of meningitis?

A 
Enteroviruses 
- Echovirus
- Coxsackie viruses AandB
Hepres simplex 1 and 2
Paramyxovirus
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15
Q

What is paramyxovirus a compliacation of?

A

Mumps

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16
Q

What fungi can cause meningitis?

A

Cryptococcus neoformans (HIV+)

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17
Q

What are the protozoa which cause meningitis?

A

Sub-saharan Africa

  • Amoebea
  • Naegleria
  • Acanthamoeba
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18
Q

What are the features of neisseria meningitidis?

A
  • Meningicoccal
  • Gram negative
  • Intracellular diplococus
  • Only infects humans
  • Exists as normal microbiota in nasopharynx
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19
Q

How is neisseria meningitidis spread?

A

Droplet spread or direct contact from carriers

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20
Q

What are the 5 strains of neisseria meningitidis?

A

A, B, C W135, Y

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21
Q

What are the features of Haemophilus influenzae?

A
  • Gram negative

- Cocobacilli

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22
Q

What are the different serotypes of haemophilus influenzae able to cause disease?

A

A-F

- Most virulent strain is type B (Hib)

23
Q

What are the features of streptococcus pneumoniae?

A
  • Pneumococcal disease
  • Chains of cocci
  • Gram positive
  • Exists as normal microbiota in nasopharynx
  • Also causes pneumonia, otitis media
24
Q

What are some virulence factors bacteria can have in bacterial meningitis?

A
  • ANti-phagocytic polysaccharide capsule
  • Endotoxin
  • IgA protease
  • Outer membrane proteins (OMPs)
  • Pili (fimbriae)
    All play an important role in pathogenesis
25
Q

What will CSF look like in bacterial meningitis vs viral and TB?

A 
Bacterial = Turbid 
Viral = Clear 
TB = Clear (may cobweb)
26
Q

What cells will be present in bacterial meningitis vs viral and TB?

A
  • Polymorphs in bacterial and TB

- Lymphocytes in viral

27
Q

How much protein will be in CSF in bacterial vs viral vs TB meningitis?

A
  • Increased in all but more in bacterial and especially TB
28
Q

What will the glucose levels be in CSF in bacterial vs viral vs TB meningitis?

A
  • Reduced (0-5) in bacterial and TB

- Normal in viral

29
Q

What gram stain will be performed in bacterial vs viral vs TB meningitis?

A
  • Bacterial - gram negative usually
  • Viral not applicable
  • TB - do Ziehl-Neelson stain
30
Q

What will the white cell count be in bacterial vs viral vs TB meningitis?

A
  • Bacterial = Neutrophilia

- Viral and TB = Normal

31
Q

Cobweb CSF present in what type of meningitis?

A

TB

32
Q

When is pneumococcal meningitis most common?

A

< 1 year old

33
Q

What are the most common causes of bacterial meningitis in neonates?

A
  • Escherichia coli
  • Group B streptococcus
  • Listeria monocytogenes
34
Q

What is the most common form of meningitis in young adults?

A

neisseria meningitidis

35
Q

What are the features of early onset neonatal meningitis?

A
  • Occurs <7 days
  • Infected by heavily colonised mother
  • Premature rupture of membranes
  • Preterm delivery
  • 60% fatality rate
36
Q

What are the features of late onset neonatal meningitis?

A
  • Occurs < 3 months
  • Lack of maternal antibody
  • Poor hygiene in nursery
  • 20% fatality rate
37
Q

What are the complications of bacterial meningitis?

A
  • Sepsis
  • Intellectual defecit
  • Deafness
  • Arthritis
  • Skin necrosis
38
Q

What treatment should be administered in a suspected meningococcal infection?

A
  • IV/IM penicillin (Pre-admission)

- IV Ceftriaxone (on admission)

39
Q

What treatment should be administered in a suspected meningococcal infection < 3 months old?

A

IV Cefotaxime + amoxicillin

40
Q

Are meningococal diseases notifiable?

A

Yes

41
Q

What is the main prevention for meningitis?

A

Vaccines

42
Q

What is the most common type of meningitis?

A

Viral

43
Q

What is a valuable diagnostic tool in meningitis?

A

NAAT

44
Q

Is encephalitis usually viral or bacterial in origin?

A

Viral

45
Q

How can viruses gain access to the CNS?

A

Via blood or neurons

46
Q

How can encephalitis be classified?

A

Primary encephalitis
- First exposure to virus results in virus directly affecting brain / spinal cord
Secondary encephalitis
- Virus first infects another part of body, then affects CNS when reactivated

47
Q

What are signs of cerebral dysfunction/encephalitis?

A
  • Seizures
  • Nausea and Vomiting
  • Fever
  • Altered consciousness
  • Abnormal behaviour
48
Q

What are brain abscesses?

A
  • Begin as diffuse inflammation of brain matter progressing to focal lesion
  • Arise from pia mater suppuration
  • Visualised by MRI or CT scans
  • Diagnosed by culture from aspirated pus
49
Q

What are the predisposing factors to brain abcesses?

A
  • Ottis media
  • Mastoiditis
  • Sinusitis
50
Q

What are the oral-nasopharyngeal microbiota which can cause brain abscesses?

A
  • Aerobic (S. aureus, strep milleri)

- Anaerobic (BActeroides sp., Fusobacterium sp.)

51
Q

What are the immunocompromised diseases which can cause brain abcesses?

A
  • Protozoa (toxoplasma gondii)

- Fungi (Candida sp, Nocardia sp, Aspergillus sp.)

52
Q

What are transmiffible spongiform Encephalopathies (TSEs) caused by?

A

Prions

53
Q

What are some prions that can affect humans?

A
  • Creutzfeldt-Jakob disease (CJD)
  • New variant Creutzfeldt-Jakob disease (nvCJD)

Animlas (Bovine Spongiform Encephalopathy)

MD4001 Pathology (18 decks)

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