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Neuro_week3 > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

Meningitis less than 3 month clinical presentation

A

1) slow or inactive
2) vomiting
3) poor feeding
4) irritable

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2
Q

Meningitis 3month - 50 yr

clinical presentation

A

1) high fever
2) nuchal rigidity
3) atered mental status
4) HA

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3
Q

meningitis > 50 yr

clinical presentation

A

1) high fever
2) nuchal rigidity
3) atered mental status
4) HA

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4
Q

Meningitis less than 2 month

most common organisms

A 
group b strep
gram neg rod (e coli, enterobacter)
strep pneumo
n meningitidis
listeria (only 1st 30 days)

amp + cefotaxime OR ampicillin + aminoglycoside

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5
Q

Meningitis 2month - 23 mo
most common orgnaism

treatment

A

1) strep pnumo
2) neisseria meningitis
3) group b strep
4) GNR (e coli)
5) h influenzae

ceftriaxone AND vancomycin

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6
Q

meningitis 2-35

more than 35yrs
most common organism

treatment

A

1) neisseria meningitidis
2) strep pneumo

1) strep pneumo
2) neisseria meningitidis
3) listeria monocytogenes (more immunocompromised and older patients esp 65+)

ceftriaxone + vanco + ampicillin (for listeria)

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7
Q

Meningitis less than 3 month

CSF profile

A

low WBC
low protein
2/3 serum glucose

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8
Q

lMeningitis 3month - 50 yr

CSF profile

A

low wbc
18-50 protein
2/3 serum glucose

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9
Q

meningitis > 50 yr

CSF profile

A

same as 3month-50 yr

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10
Q

meningitis > 60
most common organisms
treatment

A

1) strep pneumo
2) n meningitidis
3) listeria

ceftraixone OR cefotaxime + vanco + ampicillin

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11
Q

when do you give steroids for meningitis

A

if immunocompetnet prior to and with first dose of antibiotics to decr inflamm

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12
Q

how soon do u start antibiotics in ER for meningitis

A

within 60 min

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13
Q

what drug specific for listeria

A

ampicillin

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14
Q

meropenem has activity against

A

pseudomonas

resistant gram negative rods

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15
Q

vanco for

A

penicillin and cephalosporin resistant pneumococci and coag neg MRSA
and enterococcus

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16
Q

define meningitis

has decr since

A

infection of subarach space

decr since creation of encapsul organism vaccines (HiB, pneumo, meningo)

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17
Q

cellular effects of bact meningitis after enter blood

A

enters blood

or adjacent intracranial infection (otitis, sinusitis) = kids

or spinal/skull defect (congenital/trauma)
______
incr BBB permeability (vasogenic edemia, incr ICP)

infarction from vasculitis

hydrocephalus and incr IL-1, TNFa causing further BBB perm and worsening vasogenic/cytotoxic edema

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18
Q

classic triad of bact meningitis

CN effects and other signs

A

stiff neck
fever
decr consciousness

CN 3, 6, 7, 8
seizure, vomiting
myalgia,
hemiparesis, gaze pref

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19
Q

complications of bact meningitis

A

1) infarcts due to septic arteritis or endarteritis obliterans (MRI)
2) meningoencephalitis (effaced sulci) (CT or MRII)
3) CN palsy esp 8, seizures (EEG)
4) subdural empyema esp s. aureus (LP or ventriculostomy)
5) acute hydrocephalus

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20
Q

CSF of bact meningitis shows

A

1) CSF pleocytosis (WBC in fluid)

2) mainly PMNs
3) high protein, low glucose, low CSF to glucose ratio

4) gram stain and culture

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21
Q

do not do LP on bact meningitis if

A

1) focal deficits/altered conscious/new seziures
2) incr ICP/papilledema
3) focal CNS abscess, empyema
4) immunocompromise

get ct and cultures and empiric therapy first (never delay antibiotics)

22
Q

viral meningitis
most due to what organism

transmission

A

> 80% enterovirus (fecal, oral, resp)
HSV-2
arbovirus (WNV)

transmit oral/fecal

23
Q

viral meningitis
symptoms

compare severity to bact meningitis

A

1) HA
2) fever
3) nuchal rigidity

less severe

24
Q

viral meningitis

csf signs

A

1) lymphocytic pleocytosis
WBC 10-2000
of lymphocytes

2) normal glucose
3) normal or slight incr protein

PCR best except for WNV

25
Q

viral meningitis
treatment

empiric
HIV
CMV
flu
entero
WNV
A 
empiric IV acyclovir 
ART for HIV, 
foscarnet/ganciclo/cidofovir for CMV
rimantidine for flu
pleconaril for entero
supportive for WNV
26
Q

viral encephalitis

major causes organisms

A

HSV-1 (1/3 primary, 2/3 reactiv) (very young or very old)
WNV

most unknown and could be autoimm encepahlitis

27
Q

viral encephalitis
symptoms

HSV-1 vs WNV

A

more altered consciousness because of parenchyma affected (seizures, personality change, CN, aphasia, hemiparesis)

+ HA, fever, nuchal rigidity

wnv = tremors, myoclonus, parkinsonian

28
Q

viral encephalitis

HSV-1 dx

A

PCR diagnostic
MRI with temporal lobe involvement
EEG abnormal in 60-90%

29
Q

viral encephalitis

WNV dx

A

serology for IgM
LP may have PMNs up to 1 week before lymphocytes
incr protein
normal glucose

30
Q

viral encephalitis

treatment

A

empiric IV acyclovir

for wnv,
supportive

31
Q

define brain abscess

define subdural empyema

define epidural abscess

A

brain abscess = focal infection within brain tissue

subdural empyema = infection btwn arachnoid and dura

epidural abscess = infection btwn dura and bone

32
Q

where do suppurative CNS infections arise from

A

originate from blood, adjacent intracranial infection (otitis, sinusitis, mastoid, dental, cellulitis), from distant infection (MCA territory or primary pulm infection) or direct intro of micororg

33
Q

microbes causing
brain abscess

vs empidural abscess or subdural empyema

A

brain abscess = polymicrobial = anaerobic + s aureus, strep, GNR

SDE or EA = s aureus or strep

34
Q

symptoms of brain abscess

A

sx of primary infection (sinusitis)
sx of high ICP (HA, vomiting, obtunded)

classic triad with focal neuro sx

35
Q

symptoms of subdural empyema

A

acutely ill with fever, HA, altered consciousness, focal sx, also contralateral hemiparesis

36
Q

symptoms of epidural abscess

A

less ill than subdural with fever, HA, hemiparesis, seizures

37
Q

diagnostic tests for brain abscess, subdural, epidural abscess (all same)

A

MRI
also brain biopsy or aspiration

NO LP may cause herniation

38
Q

treatment for for brain abscess, subdural, epidural abscess (all same)

A

antibiotics + surgical aspiration/drain

metronidazole and cefotaxime OR ceftraixone IV for 4-6 weeks

39
Q

most common cause of brain abscess in HIV +

A

toxoplasma gondii

40
Q

kernig’s sign

A

supine patient, flex thigh to abd then passive extension of leg but PATIENT RESISTS DUE TO PAIN

41
Q

brudzinski’s sign

A

passive flexion of neck causes flexion of hip and knee (stretching meningeal)

42
Q

work up for bact meningitis

A

1) blood culture
2) lumbar puncture
3) empiric antibiotics
4) imaging CT vs mri

43
Q

lumbar puncture for acute bacterial meningitis

A

opening pressure = slight elev
CSF pleocytosis = WBC, PMNs
Low glucose
Protein slight elev

CSF to serum glucose less than 0.4 for diabetics

44
Q

drugs to use for immunocompromised/nosocomial/recent head trauma/surgery

A

meropenem or cefepime AND vanco +/- ampicillin

45
Q

when to give steroids for bact meningitis

A

must give PRIOR OR WITH dose of antibiotics

46
Q

repeat lumbar punctures for

A

no response in 48 hrs
penicillin resistant pneumococcus
meningitis due to GNR and listeria

47
Q

enterovirus clues

A

rash (echo = macular rash)
pharyngitis/herpangina (coxsackie A)
GI
myocarditis/pericarditis

48
Q

treatment of HSV meningitis

A

valacyclovir

acyclovir

49
Q

autoimmune encpehalitis
anti-NMDA receptor encephalitis

CSF profile

dx via

treatment

A

prominent psych
cognitive
seizures

CSF profile looks like viral encephalitis

dx via antibody

treatment = immune suppression

50
Q

procedure for viral encephalitis

A

1) start antibitoics
2) steroids
3) acyclovir for HSV encephalitis
4) neuroimaging
5) lumbar puncture

can delay LP for 1 week if necessary

Neuro_week3 (23 decks)

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