Infectious Diseases Flashcards
1
Q
Routes of Transmission
HEP B
A
Vertical
Horizontal
–> Sexual (very common- more infectious than HIV or HCV)
–> Blood transfusion and procedures (dialysis/ operations)
–> Needles or sharps- re-use or injury
–> Household transmission - use of shared razors or toothbrushes
2
Q
Etiological agent of Hep B
A
enveloped DNA virus of hepadnaviridae family
3
Q
Antigens of Hep B
A
- surface antigen (HBsAg)
- envelope antigen (HBeAg)
- core antigen
4
Q
HBsAG (hep b surface antigen)
A
protein found in blood or serum of patients with current infection
- used as diagnostic confirmation of infection
- genetically producable –> used a vaccine
5
Q
HBeAg (Envelope antigen)
A
allows for assessment of phase of infection
6
Q
HBsAb (surface antibody)
A
indicates immunity to hep B following immunisation or infection
7
Q
HBeAB (envelope antibody)
A
appears in the later phase of the disease in acute and chronic infection
evidence of immune response
8
Q
HBcAb (core antibody)
A
found in most people exposed to HBV
- tested as total (IgG and IgM)
- doesn’t discriminate between acute/chronic/past infections
- not found after immunisation
IgM routine test on new diagnosis - identifies acute infection
9
Q
HBV DNA
A
measured and quantified by nucleic acid testing like PCR
- determines grade of replication and activity of the virus
10
Q
Acute or Chronic?
Hep B
A
host characteristics determines if the virus is cleared within 6 months - age, immune status
11
Q
Acute hep B management
A
usually self limiting
no indication for treatment
occasionally fulminant hepatitis can cause liver failure (indicated by rising INR) –> requires a liver transplant
12
Q
Chronic Hep B
A
- lasting longer than 6 months
- if acquired at birth may last decades (90% of cases chronic)
- 5% of adults with Hep B have chronic disease
13
Q
Chronic Hep B
Prevention
A
immunisation
immunoglobulin post exposure administration
- both used in highly infectious mothers at the end of pregnancy
14
Q
Hep B diagnosis
A
usually asymptomatic
serological testing
15
Q
Chronic Hep B complications
A
cirrhosis
hepatocellular carcinoma
considered an oncogenic virus
16
Q
Chronic Hep B management
A
- identifying phase of the infection
- control viral replication
- reduce inflammation
- pegylated interferon alpha (weekly injections 48/52)
- ## Tenofovir or Entecavir daily (long term)
17
Q
Hep C
A
hepacivirus from Flaviviridae family
160,000 chronically infected in the UK
3rd largest cause of end stage liver disease
18
Q
Hep C modes of transmission
A
- parenteral
- common in former IVDUs
- small number of pts from infected transfusions
- needle stick injuries and tattooing
- low risk of household transmission unless sharing razors or toothbrushes
- sexual transmission is rare
- vertical transmission in 6% of positive mothers
19
Q
Response to infection
Hep C
A
- most asymptomatic or symptoms that require medical attention
- 15% - malaise, nausea, RUQ pain and jaundice
- if symptomatic more likely to clear the disease
20
Q
Symptoms of Chronic Hep C
A
non-specific usually asymptomatic but may have: - malaise - fatigue - intermittent RUQpain
21
Q
Extra-hepatic manifestations of Hep C
common associations
A
- essential mixed cryoglobulinaemia (abnormal proteins in blood that clump together in cold temps)
- membranoproliferative glomerulonephritis
- porphyria cutanea tarda (photosensitivity)
- autoimmune thyroid disease (women)
22
Q
Extra-hepatic manifestations of Hep C
rare associations
A
- lichen planus
- Sjogren’s syndrome
- B-cell lymphoma
- interstitial lung disease
23
Q
Diagnosis of Hep C
A
primarily serological
enzyme immunoassay followed by confirmatory testing with an immunoblot assay
positive serology –> HCV RNA testing with PCR to confirm current infection
24
Q
HCV genotypes
A
6 with different geological distributions
most common in the UK are genotypes 1 & 2/3
Genotype 4 common in Africa/ Middle East
Genotype 5 common in South Africa
Genotype 6 common in SE Asia
25
Hep C and ESLD
chronic infection --> 1/3 chance of ESLD in 25 years
further 1/3 will develop ESLD after 25 years
- risk increased/ accelarated by :
HIV
African- Americans
26
Clinical Assessment of Hep C
Fibro-scan for fibrosis baseline
Potentially need a liver biopsy
advanced fibrosis (Metavir F3) or cirrhosis (Metavir F4) --> screening for HCC 6/12 AFP (alpha fetoprotein) and liver USS
27
Treatment of Hep C
Aim is curative (undetectable HCV RNA 12/52 after finishing treatment)
- direct acting anti-retroviral drugs
- higher cure rates, shorter treatment durations and less side affects than pegylated interferon alpha and ribavarin dual therapy
28
Direct Acting Anti-Retrovirals
- act on specific HCV enzymes, analogous to ART for HIV
- NS3/4A protease inhibitors (-previr) (CI in decompensated cirrhosis)
- NS5A inhibitors (-asvir)
- NS5B inhibitors (buvir)
combination of 2 agents
29
Re-Treatment regime for Hep C
```
3 agents (CI in decompensated cirrhosis)
Sofosbuvir/ Velpatasvir and ribavirin (funded for pts with decompensated cirrhosis)
```
30
What causes infectious mononucleosis?
| glandular fever
Epstein- Barr
spread by saliva or droplets
31
EBV- demographics
- early childhood few symptoms
- adolescents/ young adults - infectious mononucleosis
- associated with cancers - stomach/nasal/lymphoma
32
EBV facts
- DNA herpesvirus
- predilection for B-lymphocytes and causes
- causes proliferation of T-cells which are cytotoxic to EBV, can proliferate like immunoblastic lymphoma
33
Signs and Symptoms of EBV
- sore throat, temp, anorexia, malaise, lymphadenopathy, palatal petechiae, splenomegaly, fatigue, low mood
34
severe chronic active EBV infection
- anaemia
- low platelets
- hepatosplenomegaly
- fatigue
35
Severe complications of EBV
```
meningoencephalitis
cerebellitis
Guillan- Barré
myeloradiculitis
cranial nerve lesions
fulminant hepatitis
RDS (respiratory distress syndrome)
severe thrombocytopeania/ aplastic anaemia
acute renal failure
Myocarditis
```
36
EBV Blood Film
lymphocytosis
| atypical lymphocytes - large irregular nuclei
37
Differential Diagnosis for EBV
```
Streptococci
CMV
Viral hepatitis
HIV seroconversion
Toxoplasmosis
Leukaemia
DIptheria
```
38
Management of EBV
none
manage chronic fatigue- avoid vigorous sports - splenic rupture
Steroids +/- aciclovir for severe symptoms
39
EBV oncogenicity
Lymphoma
Nasopharyngeal cancer
Leiomyosarcoma
Oral hairy leucoplakia
40
CMV
Direct transmission
Becomes latent after acute infection but may reactivate at times of stress or immunocompromise
may be indistinguishable from glandular fever or acute hepatitis
41
CMV post transplant
fever> pneumonitis> colitis> hepatitis> retinitis
42
CMV &HIV
retinitis> colitis >CNS disease
43
CMV diagnosis
IgM acute infection (unreliable if HIV +ve)
| CMV PCR of blood/CSF/ bronchoalveolar lavage
44
CMV treatment
only if serious infection
| - ganciclovir IV or valganciclovir, foscarnet, cidofovir
45
Post-transplant prevention for CMV
- weekly PCR 14/52
| - treat if positive
46
Congenital CMV
jaundice
hepatosplenomegaly
purpura
Chronic defects --> low IQ, cerebral palsy, epilepsy, deafness and eye problems
47
Tetanus
Tetanospasmin - exotoxin of Clostridium tetani
| Causes muscle spasm, rigidity, cardinal features of tetanus
48
Pathogenesis of Tetanus
C. tetani spores live in soil, faeces, dust and on instruments
Diabetics at increased risk
Exotoxin travels up peripheral nerves and interferes with inhibitory synapses
49
Signs of Tetanus
Prodrome --> fever, malaise, headache
Classic features --> trismus (lock jaw), risus sardonicus (grin), opisthonus (neck hyperextension), spasm, autonomic dysfunction
50
Differential diagnosis for tetanus
dental abscess
rabies
phenothiazine toxicity
strychnine poisoning
51
Poor prognosis in tetanus
```
incubation <1 week
trismus --> spasm in < 48hrs
Neonates/elderly
Post-infective
Post-partum
```
52
Tetanus treatment
ITU
- may need tracheostomy and ventilation
- Human tetanus immunoglobulin
- sedation but rousable
53
Tetanus prevention
Neonatal/ maternal vaccination
Vaccinate if uncertain vaccination history,
Severe wound - give vaccine and tetanus immunoglobulin
54
Necrotising Fascitis
Rapidly progressing infection of the deep fascia causing necrosis of subcutaneous tissues
- intense pain over affected skin and underlying muscle
Group A Beta-Haemolytic Streptococci, but often polymicrobial
55
Fournier's gangrene
necrotising fascitis localised to the scrotum and the pernieum
56
Management of nec fasc
radical debridement +/- amputation
| IV abx - benzylpenicillin and clincamycin
57
Herpes zoster
varicella = chicken pox
| contagious febrile illness with crops of blisters
58
Comlications of of h.zoster
purpura fulminans/ DIC (may need heparin)
pneumonitis
ataxia
--> commoner in pregnancy and adults than children
59
H. zoster incubation
11-21 days
60
H. zoster infectivity
4 days before rash until all lesions are scabbed (~1 week)
61
Shingles
reactivation of h. zoster
| pain in dermatological distribution preceding malaise and fever
62
Shingles treatment
aciclovir (SE decreased GFR, vomiting, encephalopathy, urticaria)
63
post-herpetic neuralgia
affected dermatomes can last years- try amitriptyline, topical lidocaine
64
Genital Herpes
flu-like prodrome
grouped vesicles/papules develop around genitals, anus or throat
pupules burst and form shallow ulcers
--> give anti-virals (aciclovir)
65
herpes simplex encephalitis
spreads from cranial nerve ganglia to frontal and temporal lobes
- Fever
- Fits
66
Osteomyelitis
| - causative organisms
staphylococcus aureus
psuedomonas
e. coli
streptococci
others: salmonella (sickle cell)
mycobacteria
funghi
67
osteomyelitis categorisation
acute haematogenous
secondary to contiguous local infection (+/- vascular disease)
direct inoculation from trauma/ surgery
68
Clinical features of osteomyelitis
cancellous bone - vertebrae (IVDU) and feet (DM)
in children - vascular bones (long bone metaphyses- distal femur/ upper tibia)
Infection leads to cortex erosion (cloacae)
exudation of pus lifts up periosteum and disrupts blood supply to underlying bone --> necrosis
69
Signs and symptoms of osteomyelitits
pain of gradual onset
unwillingness to move
tenderness, warmth, erythema and slight effusion in neighbouring joints
70
HIV facts
retrovrius
- binds via gp120 to CD4 receptors on t-lymphocytes, monocytes, macrophages and neural cells
- CD4 +ve cells migrate to the lymphoid tissue where the virus replicates
- infection progresses --> depletion or impaired function of CD4 +ve cells and decreasing immune function
71
HIV virology
9 subtypes (clades)
viral reverse transcriptase makes a DNA copy of the RNA genome
-viral integrase integrates this into the host DNA
- viral protease cuts up polypeptide blocks
- completed virions are released by budding
72
HIV seroconversion
primary infection
- accompanied by transient illness 2-6 weeks after infection
- fever, malaise, myalgia, pharyngitis, maculopapular rash or meningoencephalitis
- followed by asymptomatic infection (30% have persistent generalised lymphadenopathy)
73
Persistent generalised lymphadenopathy
nodes >1cm diameter at >/ extra-inguinal sites for 3+ months
74
Later constitutional symptoms of HIV
AIDS-related Complex
Prodrome to AIDS
```
Temp
Night sweats
Diarrhoea
Weight loss
+/- minor opportunistic infections - oral candida, oral hairy leukoplakia, herpes zoster, seborrhoeic dermatitis, tinea
```
75
AIDS
HIV + indicator disease
e.g. TB, pnuemocystis jiroveci, aspergillosis, cryptococcus, histoplasma
Kaposi's sarcoma, lymphoma, lymphoid interstitial pneuomonitis
CMV- retinitis/pneunomitis
Toxoplasmosis
Candida
Chronic HIV-associated neurocognitive diseorder
76
HIV diagnosis
- serum/salivary HIV-Ab by ELISA (may be -ve 1-3 weeks post exposure)
- HIV RNA or core p24 antigen in plasma
77
HIV prevention
blood screening
disposable equipment
antenatal anti-retrovirals if HIV +ve +/- C-section +/- bottle feeding
78
Anti-retrovirals
Protease inhibitors
slow cell-to-cell spread
and lengthen the time to the first clinical event
often given with low-dose ritonavir
metabolised by cytochrome p450 so increases concentrations of certain drugs by competitive inhibition of their metabolism
can cause dyslipidaemia, hyperglycaemia/ insulin resistance
79
Non-nucleoside reverse transcriptase inhibitors
may also interact with drugs metabolised
80
Non-nucleoside reverse transcriptase inhibitors
may also interact with drugs metabolised by cytochrome p450
81
Integrase strand transfer inhibitors
| InSTIs
SE: GI upset, insomnia
| maybe combined with tenofovir lamivudine
82
CCR% antagonists
CC-chemokine recepotr 5
83
Egs of HAART regime
efavirenz (NNRTI) + 2 NRTIs
Monitor U&Es
use at least 3 agents to reduce resistance
84
TB Diagnosis (latent)
Mantoux test
| Interferon- gamma testing (Quantiferon or T-spot TB)
85
TB Diagnosis (active) (pulmonary)
```
sputum sample (3+) for MC&S for acid fast bacilli Zeihl Neelsen
May need bronchoscopy and lavage
```
86
TB diagnosis (active) (non-pulmonary)
sputum/ pleura/ pleural fluid/ urine/ pus /ascites/ peritoneal/ bone marrow or CSF samples for culture
CXR
Incubate samples for 12 weeks on Lowenstein-Jensen medium
87
TB diagnosis (further tests
PCR- look for rifampicin resistance
Histology - caseating granuloma
CXR - consolidation, cavitation, fibrosis and calcification
88
Immunological evidence of TB
Tuberculin skin test - indicates immunity- previous exposure, BCG. False negatives in immunospupression
89
Treating pulmonary TB
- test colour vision (Ishihara test) (ethanbutmbutol may cause reversible ocular toxicity)
- inital phase 8 weeks: Rifampicin, Isoniazid, Pryazinamide, ethambutol
- Continuation phase 16 weeks: rifampicin and isoniazid. Continue pyridoxine
- Consider steroids if meningeal or pericardial TB
90
TB treatment SE
Rifampicin
```
- raised LFTs, stop if bilirubin increases,
decreased platelets,
orange discolouration,
inactivation of the Pill,
flu symptoms.
```
91
TB treatment SE
Isoniazid
- raised LFTs
- low WCC
- stop if neuropathy and give pyridoxine
92
TB treatment SE
Ethambutaol
Optic neuritis (colour vision first to deteriorate)
93
TB treatment SE
| Pyrazinamide
heptatitis
| arthralgia (CI acute gout or porphyria)
94
Chemoprophylaxis for asymptomatic TB
one or two anti-TB drugs for 3 or 6 months
adults with documented recent tuberculin convrsion and some young immigrants with t-spot TB /mantoux +ve
95
Clinical features TB
Pulmonary
- silent
- cough
- sputum
- malaise
- weight loss
- night sweats
- pleurisy
- haemoptysis
- pleural effusion
- super-imposed pulmonary infection
96
Clinical features TB
Miliary
```
haematogenous dissemination
may be non-specific or overwhelming
-CXR
- may be retinal TB
Biopsy - lung/liver/lymph nodes or marrow
```
97
Clinical features TB
Genitourinary
-dysuria
- frequency
- loin/ back pain
- haematuria
- sterile pyuria
Renal TB may spread to bladder, seminal vesicles, epididymis or fallopian tubes
98
Clinical features TB
Peritoneal
Abdominal pain
GI upset
Ascites
may need laparotomy
99
Clinical features TB
Bone
vertebral collapse
Potts vertebrae
100
Clinical features TB
Skin
lupus vulgaris
| jelly like nodules
101
Clinical features TB
| Acute TB pericarditis
exudative allergy lesion
102
Clinical features TB
Chronic pericardial effusion and constrictive pericarditis
- fibrosis/ calcification
- may spread to myocardium
- steroids for 11 weeksk
103
Clinical features TB
Meningitis
Prodrome
```
30% mortality
- fever
- headache
- vomiting
- abdo pain
- drowsiness
meningism
- delirium
worsening over weeks +/- seizures
```
104
Clinical features TB
Meningitis
CNS signs
tremor
papilloedema
cranial nerve palsies
105
Clinical features TB
Meningitis
Diagnosis
LP
TB PCR
MRI + enhancement
106
Cholera
| cause
vibrio cholerae gram negative curved flagellated motile vibrating rod
107
Cholera
INcubation
hours to days
108
Cholera
Spread
faecal-oral
109
Cholera
| Signs
Profuse, watery 'Rice-water' Stools
fever
vomiting
rapid dehydration --> cause of death with associated metabolic acidosis
110
Cholera
| Diagnosis
stool microscopy and culture
111
Cholera
| Treatment
strict barrier nursing
- prompt oral rehydration
- IVI of 0.9% saline +KCl
112
Cholera
Prevention
Education
| Good hygiene & waste disposal
113
Diptheria
Corynebacterium diphtheriae toxin
Signs: tonsillitis +/- pseudomembrane over the fauces +/- lymphadenopathy
Rx- erthyromycin
114
Thrush (candida albicans)
discharge described as white curds
Vulva & vagina - red, fissuredand sore
RF: pregnancy, immunodeficency, DM, the Pill and abx
Rx: imidazole vaginal pessary - clotrimzaole
115
Malaria biology
Plasmodium protozoa injected by female anopheles mosquitos multiply in RBCs --> haemolysis, RBC sequestration and cytokine release
116
Malaria fever paroxysms
synchronous release of flocks merozoites from mature schizonts
1. Shivering
2. Hot stage- T =41, flushed, dry skin, N&V, headache
3. Sweats. T falls.
117
malaria protective factors
- GDP6 deficiency
- sickle cell trait
- melanesian ovalocytosis (oval shaped erythrocytes)
- HLA B53
118
Falciparum malaria
Mortality = 20% (higher in < 3/ pregnancy)
present within 1/12 of infection
plasmodium falciparum
119
Falciparum Malaria symptoms
prodromal headache
Malaise
myalgia
anorexia before first fever paroxysm (+/- faints)
120
Falciparum Malaria signa
anaemia
jaundice
hepatosplenomegaly - no rash or lymphadenopathy
121
Falciparum Malaria complications
anaemia
| thrombocytopenia
122
Falciparum Malaria
5 grim signs
1. decreased conciousness/ coma (cerebral malaria)
2. convulsions
3. co-exisiting chronic illness
4. Acidosis (esp. HCO3 <15)
5. Renal failure (acute tubular necrosis)
123
Falciparum Malaria
Diagnosis
serial thick and thin blood films
% parasitaemia
Rapid stick testss
FBC (anaemia/ TCP), clotting, ABG, U&E, urinalysis, blood cultures
124
Falciparum Malaria
Treatment (medicines)
use different drugs to prophylaxis
- most resistent to chloroquine
- uncomplicated:
- -> Artemether-lumefantrine
- -> artesunate-amodiaaquine
- -> Dihydroartemisinin-napthoquine
- -> cholorquinine + doxycycline + clindamycin
125
Falciparum Malaria
Treatment (other)
- tepid sponging
- paracetamol
- transfusion if anaemic
126
Malaria travel prophylaxis
- proguanil (low chloroquine resisitance)
| - chloroquine resistance --> mefloquine, doxycyline or atovaquone + proguanil (Malarone)
127
Chloroquine SE
Headache
psychosis
Retinopathy (chronic use)
128
Malarone SE
Abdo pain
nausea
Headache
Dizzinessxx
129
Rabies
rhabdovirus spread by infected animal bites
| - slight risk from scratches, licks to cuts/mouth/eyes
130
Rabies patients
present 9-90 days incubation
| Prodrome: headache, malaise, odd behaviour, agitation, fever and itch around bite site.
131
Furious rabies
e.g. water provoked muscle spasms accompanied by hydrophobia
132
Dumb rabies
flaccid paralysis in the bitten limb
133
UTI classification
Uncomplicated
NOrmla renal tract adn function
134
UTI classification
Complicated
Abnormal renal/GU tract
decreased host defence (immunosuppression/ DM)
urinary tract obstruction - stones/catheter/malformation
135
UTI organism
E. Coli
Proteus mirabilis and klebsiella pneumoniae
Staphylococcus saprophyticus
136
Acute pyelonephritis symptoms
```
high fever,
rigors,
vomiting
loin pain
tenderness
oliguria (AKI)
```
137
Cystits
```
frequency
Dysuria
Urgency
Haematuria
Suprapubic pain
```
138
Prostatitis symptoms
flu-like symptoms
low back ache
few urinary symptoms
swollen or tender prostate
139
Signs of UTI
```
fever
abdominal or loin tenderness
foul smelling urine
occasionally
--> distended bladder or enlarged prostate
```
140
Causes of sterile pyuria
```
Treated UTI <2 weeks ago
Inadequately treated UTI
Appendicitis
Calculi, prostatitis
Bladder tumour
UTI with fastidious culture requirements
Papillary necrosis
Tubulinterstitial nephritis
Polycystic kidneys
Chemical cystitis
```
141
Causes of CAP
- streptococcus pneumoniae
- haemophilus influenzae
-mycoplasma pneumoniae
(-staphylococcus aureus)
142
Causes of Hospital acquired pneumonia
commonly gram-negative enterobacteria or staph. aureus
| Pseudomonas, Klebsiella, Bacteroides and clostridia
143
Causes of aspiration pneumonia
```
stroke
myasthenia
bulbar palsies
decreased conciousness
oesphageal disease
poor dental hygiene
```
144
Causes of pneumonia in the immunocompromised patient
- strep pneumoniae
- H. influenzae
- staph. aureus
- M. catarrhalis
M. pneumoniae
Gram -ve bacilli and pneumocystis jiroveci
Fungi
Viruses - CMV, HSV
Mycobacteria
145
Symptoms of pneumonia
```
fever
Rigors
anorexia
Dyspnoea
cough
purulent sputum
Haemoptysis
Pleuritic pain
```
146
Signs of Pneumonia
```
Pyrexia
Cyanosis
Confusion
tachypnoea
Tachycardia
Hypotension
Signs of consolidation
Pleural Rub
```
147
Signs of consolidation
diminished expansion
Dull percussion note
Increased vocal femitus/resonance
Bronchial breathing
148
Pneumonia tests
ABG
CXR
FBC, U&Es, LFTs, CRP, Blood cultures
Sputum cultures
149
Pneumonia severity
CURB-65
- Confusion
- Urea >7mmol/L
- Resp rate >/ 30/min
- BP <90 systolic
- Age >65
0-1 --> Home
2--> hospital therapy
3> severe- mortality 15-40% consider ITU
150
Penumonia Management
```
Abx --> typically co-amoxiclav/ amoxicillian or clarythromycin or doxycyline
Oxygen --> keep PaO2 >8.0
IV fluids
VTE prophylaxis
Analgesia if pleurisy
```
151
Complications of pneumonia
```
pleural effusion
empyema
lung abscess
respiratory failure
septicaemia
brain abscess
pericarditis
myocarditis
cholestatic jaundice
```
152
Lung abscess
cavitating area of localised, suppurative infection within the lung
153
Lung abscess causes
- inadequately treated pneumonia
- aspiration
- bronchial obstruction
- pulmonary infarction
- septic emboli
- subphrenic or hepatic abscess
154
Clincial features of lung abscesses
```
swinging fever
cough
purulent, foul smelling sputum
pleuritic chest pain,
haemoptysis
malaise
weight loss
```
--> finger clubbing, anaemia, crepitations
155
Lung abscess tests
FBC- anaemia & neutrophilia, ESR, CRP, blood cultures
Sputum microscopy and cultures and cytology
CXR
156
Meningitis organisms
meningococcus or pneumococcus
| Less commonly haemophilus influenzea, listeria monocytogenes, CMV, cryptococcus or TB
157
Meningitis differentials
```
malaria
encephalitis
septicaemia
subarachnoid haemorrhage
dengue
tentanus
```
158
Early features of meningitis
headache
leg pains
cold hands and feet
abnormal skin colour
159
Later features of meningitis
Meningism - neck stiffness, photophobia, Kernig's sign (pain and resistance on passive knee extension with fully flexed hips)
- decreased conciousness, coma
- seizures +/- focal CNS +/- opisthotonus
-petechial rash
Galloping sepsis - slow cap refill, DIC, low BP, temp, high or normal pulse
160
Meningitis management
start abx asap --> cefotaxime
| rifampicin for close contacts or ciprofloxacin
161
Meningitis investigations
U&E, FBC, LFTs, glucose, coagulation screen
Blood cultures, throat swabs, rectal swab, serology (EBV)
LP- after CT or if GCS 15 with no focal neurology
162
LP results in Meningitis
Bacterial
- often turbid
- predominantly polymorphic cells
- cell count 90-1000
- glucose - low/normal (<1/2)
- protein - >1.5
- bacteria in smear and culture
163
LP results in Meningitis
TB
- fibrin web
- mononuclear cells
- cell count - 10-1000
- <1/2 plasma glucose
- protein high (1-5)
- no bacteria in smear
164
LP results in Meningitis
Viral
Usually clear appearance
- mononuclear cells
- cell count 50-1000
- glucose >1/2 plasma
- low protein
- no bacteria on culture
