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Nervous System: Unit II > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Clinical presentation of bacterial meningitis

A
  • Headache, stiff neck (nuchal rigidity),
  • Fever
  • Depressed consciousness
  • Hydrocephalus from obstruction
  • Inflammatory response into parenchyma → seizures
  • Hyperemia → infarction of cranial nerve palsies
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2
Q

Diagnosis of bacterial meningitis

A
  • Need an LP to diagnose
    • evaluate CSF profile
    • blood cultures + neuroimaging
  • Some patients need CT/MRI before LP:
    • focal neuro deficits
    • decreased level of consciousness
    • papilloedema
    • suspected focal CNS infection (empyema, abscess)
    • immunocompromised
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3
Q

Common organisms for bacterial meningitis < 2 mo.

A
  • Streptococcus agalactiae (Group B) = 86%
  • Gram Negative Rods = < 5%
  • Listeria Monocytogenes = < 5%
  • Streptococcus Pneumoniae (Pneumococcus) = 2-5%
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4
Q

Common organisms for bacterial meningitis 2-24 mo.

A
  • Strep pneumo = 50%
  • Neisseria Meningitides = 10-15%
  • Strep Agalactiae (Group B) = 10-15%
  • Hemophilus influenzae = 5-10%
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5
Q

Common organisms for bacterial meningitis 2-34 yrs.

A
  • Neisseria meningitis = 40%
  • Strep pneumo = 40%
  • Hemophilus influenzae = 5-10%
  • Strep agalactiae (Group B strep) = <5%
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6
Q

Common organisms for bacterial meningitis >34 yrs.

A
  • Strep pneumo = 50-70%
  • Neisseria menigitidis = 10-25%
  • Hemophilus influenzae = 1-10%
  • Listeria monocytogenes = 5-10%
    • >25% @ > 60 yrs. or immunocompromised
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7
Q

CSF profile in bacterial meningitis

A
  • WBC = 100-10,000
  • cell type = PMNs
  • Glucose = low
  • Protein = elevated
  • cultures = + for bacteria
    • gram stain
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8
Q

CSF profile in viral meningitis

A
  • WBCs = 10 - 2,000
  • Cell type = mononuclear (lymphocyte)
  • Glucose = normal
  • protein = normal/slightly elevated
  • cultures
    • +/- for viral
      • for bacteria
    • PCR test useful
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9
Q

Management of bacterial meningitis: Neonates/Infants

A
  • Ampicillin AND
  • Cefotaxime
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10
Q

Management of bacterial meningitis: Children & Adults (3 mo. - 50 yrs)

A
  • Ceftriaxone OR
  • Cefotaxime AND Vancomycin
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11
Q

Management of bacterial meningitis: Adults > 50 yrs.

A
  • Ceftriaxone OR Cefotaxime AND
  • Vancomycin AND
  • Ampicillin
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12
Q

Management of bacterial meningitis: Hospital acquired, recent head trauma/neurosurg, immunocomprom, alcoholics

A
  • Vancomycin AND
  • Meropenem
  • +/- Ampicillin
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13
Q

General management guidelines for bacterial meningtitis

A
  • start antibiotics according to age-group/infection-type
  • start corticosteroids before or concurrent w/first dose of antibiotics (prevent complications)
  • If LP is delayed for CT/MRI
    • STAT blood cultures AND
    • start empiric antibiotics
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14
Q

Clinical features of viral meningitis

A
  • headache
  • fever
  • meningeal irritation
  • milder sx than bacterial
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15
Q

Diagnostic tests in viral meningitis

A
  • LP ==> CSF profile
    • CSF IgM diagnostic of many aroboviruses
  • PCR amplification of viral genomic material
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16
Q

Viral causes of meningitis

A
  • Common
    • Enteroviruses
    • HSV-2
    • Arboviruses (West Nile Virus - WNV)
  • Intermediate/Uncommon
    • HSV 1
    • EBV
    • VZV
    • HIV
    • HHV-6
17
Q

CSF profile in viral encephalitis

A
  • WBC = 10 - 2,000
  • Cell type = mononuclear (lymphocyte)
  • Glucose = normal
  • Protein = elevated
  • Culture
    • +/- viral
      • bacterial
  • useful tests: PCR, MRI
18
Q

Viral encephalitis definition

A
  • viral infection of brain tissue (vs. only subarachnoid)
  • characterized by signs/symptoms more extensive than meningitis
19
Q

Clinical features of viral encephalitis

A
  • Common: Altered consciousness, fever, and headache.
  • Seizures and focal neurological signs/symptoms are common:
    • personality change, alteration in mental status/level of consciousness (75-95%)
    • aphasia (65-75%)
    • hemiparesis (30-40%)
    • ataxia (40%)
    • cranial nerve palsies (30-35%)
    • visual field loss (10-15%).
    • Tremors, myoclonus, Parkinsonism seen in WNV.
20
Q

Seasonal prevalences of viral encephalitis

A
  • Summer/Early Fall =
    • Arboviruses
  • Fall/Winter =
    • Lymphocytic Choriomeningitis Virus
  • Winter/Spring =
    • Mumps
  • Any season:
    • Herpes Simplex
21
Q

Diagnosis of viral encephalitis

A
  • CSF profile
  • EEG abnormalities (60-90%)
  • CT & MRI can help identify focal encephalitis
  • PCR amplification of viral nucleic acid from CSF is the diagnostic procedure of choice for HSV, VZV, CMV, EBV, and enteroviruses.
  • Detection of WNV IgM in CSF is diagnostic of WNV encephalitis and more sensitive than PCR

Nervous System: Unit II (19 decks)

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