infectious/inflamm disorders

Question 1

Encephalitis: causes, presentation, Ix, Mx

Answer 1

Inflammation of the brain, requires urgent Rx
Causes: HSV, VZV, EBV, MMR, rabies, rick, AI, paraneoplastic

Presentation

• Flu like syx
• Headache
• Altered consciousness
• Unusual behaviour
• Focal neuro syx: aphasia
• seizures
• Vomiting

Ix

(1. ) LP + viral PCR
(2. ) MRI
(3. ) HIV test

Mx

• Urgent admission
• IV antiviral
• Repeat LP
• FU, support, rehabilitation required after

Question 2

Meningitis: causes, presentation

Answer 2

Acute infection, medical emergency
Causes: viral, bacteial (strep pneumoniae, n.meningitidis, l.meningitis, h.influenzae), fungal, parasitic

Presentation

• Fever
• Headache
• Meningism (headache, photophobia, neck stiffness, kernig’s sign, Brudzinski’s sign)
• N+V
• Meningococcal Septicaemia: Non-blanching purpuric rash, necrosis, high mortality

Question 3

Meningitis: Mx

Answer 3

(1. ) Primary care: IM benzylpenicillin and ADMIT PT - do not let abx delay ambulance
(2. ) Notify PH + identify close contacts + prophylaxis

Secondary care: ABCDE

(3. ) IV dexamethasone
(4. ) Ceftriaxone - LP taken prior

Investigations

(1. ) CT - prior to LP if: >60y, IMC, seizures, GCS <14, focal neuro deficits, papilledema
(2. ) LP - confirms Dx**
- MC&S, protein, glucose, viral PCR, histology
- CI: abnormal clotting, petechial rash, ricp
(3. ) Bloods: FBC, CRP, coag, BM, VBG, cultures

Question 4

What would you expect to see in CSF for viral, bacterial, TB meningitis

Answer 4

• Viral = clear appearance, lymphocytes, high protein, normal glucose
• Bacterial = cloudy appearance, high protein, low glucose
• TB = fibrin web appearance, high protein, low glucose