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Neurology Module > Infectious Diseases of the Brain > Flashcards

Infectious Diseases of the Brain Flashcards

0
Q

How does bacterial meningitis spread?

A

Typically hematogenous spread:

  • 25% Otitis media, sinusitis
  • 12% Pneumonia
  • 16% immunocompromised
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1
Q

What is most commonly affected in bacterial meningitis?

A

Subarachnoid space.

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2
Q

Causative Organisms of Bacterial Meningitis in Neonates

A

Group B beta-hemolytic strep and enteric gram neg bacilli

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3
Q

Causative Organism of Bacterial Meningitis in Children

A

Haemophilus influenzae (40-60%)
Neisseria meningitidis
Streptococcus pneumoniae

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4
Q

Most common causative organisms of bacterial meningitis in adults

A

S.pneumoniae (30-50%)
N. Meningitidis (10-35%)

Other: Staphylococcus, H.Influenzae, Gram neg bacilli, Listeria)

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5
Q

Bacterial Meningitis causative organisms in the elderly:

A

S pneumoniae
E coli
Klebsiella
Listeria

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6
Q

Bacterial Meningitis presentation:

A

Fulminant illness <24 hours
Respiratory illness may precede by 7 days (25%)

Classic:

- Headache
- Stiff Neck
- Fever
- Photophobia
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7
Q

What are less common presentations of bacterial meningitis?

A 
Mental status changes.
Nausea/Vomiting
Seizures
Lethargy
Confusion
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8
Q

Presentation of bacterial meningitis in infants:

A

High pitched crying
Refusal to eat
Bulging fontanelles

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9
Q

PE tests for bacterial meningitis:

A

Nucchal Rigidity
Kernig’s Sign
Brudzinski’s sign
Skin Rash - Neisseria Meningococcal (65%)

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10
Q

What is notable about PE for bacterial meningitis?

A

Poor sensitivity! Do not rely on negative exams!

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11
Q

How is bacterial meningitis diagnosed?

A

Lumbar puncture - cloudy

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12
Q

Other labs for bacterial meningitis:

A

Blood cultures

CBC - NL does not r/o bacterial meningitis

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13
Q

Imaging for bacterial meningitis

A

CT to rule out mass or abscess

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14
Q

Bacterial Meningitis Treatment 1 m - 50 y

A

Vancomycin 1 g IV q 6 hours
+
Ceftriaxone 2 g IV q 12 h OR Cefotaxine 2 g IV q 6h

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15
Q

Bacterial Meningitis Treatment over 50

A 
Vancomycin 1g IV q 8 h 
\+
Ceftriaxone (2 g IV q 12 h) OR Cefotaxine (2g IV q 6h)
\+
Ampicillin (Listeria)
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16
Q

How long do you treat Bacterial Meningitis?

A

S Peumoniae - 10-14 days

Neisseria - 7 days

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17
Q

Complications of Bacterial Meningitis

A 
Cerebral edema
Vasculitis (arteritis- stroke; venous sinus thrombosis)
Increased ICP
Hydrocephalus
Seizures
DIC
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18
Q

What is the prognosis for bacterial meningitis?

A

N meningitis
-meningoccemia 30% mortality rate
-meningitis alone 4-5%
Pneumococcal meningitis - 30% mortality rate

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19
Q

What vaccines are available for bacterial meningitis prevention?

A

Pneumococcal

Meningococcal

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20
Q

Post exposure prophylaxis for bacterial meningitis:

A

Contagious 7 days prior to illness - 24 hours after antibiotics.

Rifampin x 2 days
Cipro x one oral dose
Ceftriaxone IM x1

For anyone who has been in high contact with the infected persons or healthcare workers.

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21
Q

Who gets the pneumococcal vaccine?

A

> 65
Other: asthma, smokers >50, HIV, nursing home patients
Reduces risk by 50%

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22
Q

Who gets the meningococcal vaccine?

A

Ages 11-55 yo
Before age 16 - 2 doses
Reduces risk by 50%

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23
Q

Viral Meningitis AKA

A

Aseptic Meningitis

24
Q

Incidence of Viral Meningitis

A

7.6 cases / 100,000 adults vs 1.5 cases/ 100,00 adults (bacterial)

25
Q

Causative organisms of viral meningitis in children

A 
Enterovirus
Arbovirus
HSV
Borrelia Burgdoferi (Lyme)
Coxsackie Virus
26
Q

Causative Organisms of Viral Meningitis in adults:

A

Enterovirus
HSV
Varicella-Zoster

27
Q

Viral Meningitis Signs and Symptoms

A 
Flue like symptoms
Headache
Fever
Malaise
Photophobia
Meningeal irritation
28
Q

Can bacterial meningitis be easily differentiated from viral from an H&P?

A

NO!!! Must treat as bacterial until proven otherwise!! Bacterial more severe!

29
Q

Treatment of Viral Meningitis

A

Asymptomatic

30
Q

Prognosis of viral meningitis

A

good, very low mortality rate

31
Q

Who gets Tuberculous meningitis?

A

Debilitated

Immunocompetent patients

32
Q

How is tuberculous meningitis spread?

A

primary focus - lungs

33
Q

Symptoms of Tuberculous meningitis?

A 
Headache
Malaise
Fever
Weight loss
Nucchal rigidity
34
Q

What does a lumbar puncture show in Tuberculous meningitis?

A

AFP

35
Q

Treatment of Tuberculous meningitis?

A

INH
Streptomycin
Rifampin
Pyrazinamide x 6-9 months

36
Q

Who is at risk for cryptococcal meningitis?

A

Debilitated
Immunocompetent patients
DM

37
Q

What is encephalitis?

A

Inflammation of the brain
+/- meningeal involvement
Brain dysfunction predominant

38
Q

Signs and Symptoms of encephalitis

A

Headache
Fever
Mental status changes

39
Q

Most common cause of encephalitis:

A

Herpes Simplex Encephalitis

  • HSV1 often lies dormant in the trigeminal ganglian
    • Frontal/orbital
    • Anteromedial/temporal
40
Q

What symptoms does HSVI cause in encephalitis?

A

Presence of virus causes severe inflammation, edema, necrosis, hemorrhage.

If lymbic system is involved may cause personality changes, change in olfactory function/olfactory hallucinations.

If asymmetric involvement - may include hemiparesis and appear as stroke.

41
Q

How is HSV encephalitis diagnosed?

A

CSF PCR for HCV GOLD STANDARD - false negatives may occur in first 12 hours and after 10 days

42
Q

What will a lumbar puncture show with HSV encephalitis?

A

CSF leukocytes - 10-200 cells
CSF protein ~ 100 mg/dL
CSF glucose normal to low

43
Q

What imaging is used for HSV Encephalitis?

A 
MRI preferred (CT normal for first 5 days) - diffuse edema
T1 - hypointensity
T2 - hyperintensity
44
Q

Treatment of HSV Encephalitis

A

Acyclovir IV 12.5 mg/kg IV q 8 h x 14 days

+/- steroids

45
Q

HSV Encephalitis prognosis

A

Poor :-(

Mortality 10-40%

HIGH risk for neuro deficits

46
Q

What neuro deficits can develop due to HSV encephalitis?

A

Personality disorders/changes
Dementia
Aphasia
Memory - inability o form new memories (hippocampal destruction)

47
Q

What is the leading cause of epidemic encephalitis?

A

Arbovirus

48
Q

When is Arbovirus prevalent?

A

Summer - early autumn

49
Q

Incubation period for Arbovirus

A

2-18 days after mosquito bite

50
Q

Range of arbovirus

A

Mild to severe

51
Q

Types of Arbovirus

A 
Eastern equine encephalitis
Western equine encephalitis
St. Louis encephalitis
Californian encephalitis
Venezuelan equine
West Nile Virus
Mumps
52
Q

What are the natural hosts of West Nile Virus (WNV)?

A

Animals (most commonly horses)

Humans are only incidental

53
Q

Prevalence of WNV

A

99% of cases are asymptomatic or self-limiting

1% results in severe illness

54
Q

What increases risk of severity for WNV?

A

Age over 50 yo increases risk of severe course 20-fold

55
Q

Signs and Symptoms of NSV

A 
Abrupt Onset!
Fever
Malaise
Profound fatigue
Weakness
\+/- headache, eye pain, nausea and vomiting
56
Q

PE findings for WNV

A

Occipital LAN (generalized LAN)
+/- maculopapular rash
Conjunctivitis
Flushing

57
Q

Diagnosis of WNV

A

CBC- leukopenia

Lumbar Puncture 
	-Lymphocytosis
	-Normal glucose
	\+/- elevated protein
	- IgM ELISA (positive 8-21 days after onset)
58
Q

Treatment of WNV

A

Supportive
Research trials: ribavirin, interferon
Fatigue may last for WEEKS
Poliomyelitis-like syndrome

Neurology Module (7 decks)

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