Infective Disorders Tutorial Flashcards
Who are more likely to pick up infections that lead to encephalitis or meningitis?
People with weakened immune systems - children, elderly, immuno-compromised
University students - meeting many new people in small spaces
What makes it difficult to diagnose encephalitis or meningitis?
These infections present very similarly to other infections
What is an infection of the spinal cord known as?
Vertebral osteomyelitis
Transverse myelitis
What is meningitis?
Inflammation of the meninges
What is encephalitis?
Inflammation of the brain
What types of infections can cause encephalitis and meningitis?
Encephalitis:
Viral (most common)
Bacterial
Meningitis:
Bacterial (most common)
Viral
Fungal
copy off lecture
What are the hallmarks for encephalitis?
Initially symptoms are flu-like with pyrexia (high body temperature) and headache
Subsequently, within hours, days or weeks: Confusion or disorientation Seizures or fits Changes in personality and behaviour Difficulty speaking Weakness or loss of movement Loss of consciousness
What are the hallmarks for meningitis?
High temperature Cold hands and feet Vomiting Confusion Breathing quickly Muscle and joint pain Pale, mottled or blotchy skin Spots or a rash Headache Stiff neck Photophobia Being very sleepy or difficult to wake fits (seizures)
Babies may also:
Refuse feeds
Be irritable
Have a high-pitched cry
Have a stiff body or be floppy or unresponsive
Have a bulging soft spot on the top of their head
What would you use to diagnose encephalitis?
What might be found on these tests?
CT - swelling of the brain
Lumbar puncture - CSF would not be clear, probably milky / white. Check fluid for bacteria, fungi
EEG - look for seizures (would show normal brain waves interrupted by abnormal brain waves)
MRI - swelling of the brain
Blood test
What would you use to diagnose meningitis?
What might be found on these tests?
Lumbar puncture - CSF often shows low sugar (glucose) level along with an increased white blood cell count and increased protein
Blood test
CT scan / MRI - may show hydrocephalus = enlarged ventricles (filled with more CSF due to blockage of drainage)
What treatment options are commonly used for encephalitis?
Steroids - reduce inflammation
Anti-convulsants - reduce seizures
Viral: anti-virals e.g. anticyclovir
Bacterial: antibiotics
Fungal: anti-fungals
Plasmapheresis – a procedure which removes the substances that are attacking the brain from the blood
What treatment options are commonly used for meningitis?
Steroids - reduce inflammation
Anti-convulsants - reduce seizures
Viral: anti-virals e.g. anticyclovir
Bacterial: antibiotics
Fungal: anti-fungals
What are some of the long term effects of meningitis?
Hearing impairment / loss - due to lack of blood supply to the cochlea
Recurrent seizures (epilepsy)
Problems with memory and concentration
Co-ordination, movement and balance problems
Learning difficulties and behavioural problems
Vision impairment / loss
Loss of limbs – amputation is to stop the infection spreading
Bone and joint problems, such as arthritis
Kidney problems
Cognitive decline, mental impairment
How do encephalitis patients present differently to meningitis (and vice versa)?
Encephalitis =
Behavioural / personality changes (inflammation of the brain so brain functions affected)
Seizures
Meningitis =
Neck stiffness - nuchal rigidity, nuchal membrane hurts when trying to place chin on sternum
Meningism = feature of a headache that points to issue with the meninges
Rash
Photophobia - sensitivity to light
Nausea and vomiting
How is a lumbar puncture carried out?
At L2
Pass the dura and arachnoid
CSF fluid comes out of the central canal, which is a continuation of the 4th ventricle (should be clear in a healthy individual)
MUST NOT carry out LP if there is increased intracranial pressure as the sudden drop in pressure may push the brain out the foramen magnum
