Lecture 38 - Fever and headache

Question 1

Signs/symptoms of meningitis

Answer 1

• headache
• photphobida
• nick stiffness
• drowsiness

-sometimes if lifting leg, then makes headache worse - stretching meningies and good clinical sign if the patietn has this

systemic inflammation
-fever, drowsiness, septic shock, rash (niserea meningitis)

-this is due to inflammation of subarachnoid space - the cerebrospinal fluid contains bacteria, white blood cells, inflammatory proteins, cell debris

Question 2

Bacterial meningitis

Answer 2

• illness is precede by nasopharyngeal colonisation
• 10-20% of young adults colonised with this in their nasopharynx
• bacteria enter subarachnoid space and propagate into blood
• infection can spread down into pia mater
• Can get bacteria in blood into this layer (not supposed to be), there are many other nutrients - glucose ect. here that the bacteria can live off
• this is usually a sterile area, with not many immune cells

Question 3

Bacterial vs Viral meningitis

Answer 3

bacterial - is serious

• main causes are niceria meningitidis, sterptococcus pneumoniae
• these orginiate from the nasophargynx , colonise healthy humans , bacteria get into the sub arachnoid space
• increase protein, wbcs, nuetrophils, decrease glucose , gram stain negative or positive , may see positive streptococal antigen test

viral - is not too bad and is benin ,get over it yourself. Cause can be common colds, influenza, and enteroviruses (from gastrointestinal tract) , herpes simplex 2 can also cause this
-get increase protein, normal glucose, increase wbcs, lymphotcytes increase , no gram stain

-yeasts and molds rarely cause meningitis

Question 4

Bacterial vs Viral meningitis

Answer 4

bacterial - is serious

• main causes are niceria meningitidis, sterptococcus pneumoniae
• these orginiate from the nasophargynx , colonise healthy humans , bacteria get into the sub arachnoid space
• increase protein, wbcs, nuetrophils, decrease glucose , gram stain negative or positive

viral - is not too bad and is benin ,get over it yourself. Cause can be common colds, influenza, and enteroviruses (from gastrointestinal tract) , herpes simplex 2 can also cause this
-get increase protein, normal glucose, increase wbcs, lymphotcytes increase , no gram stain

-yeasts and molds rarely cause meningitis

Question 5

PCR

Answer 5

amplify a certain amount of DNA and then can work with it better

• important for meningitis - e.g for GP - take blood cultures and give antibiotics
• PCR test - can diagnose it , quite sensitive

Question 6

How come you can see rash sometimes?

Answer 6

THis is with a bacterial infeciton, get the bacteria and otehr ifnlamatory products that have been stuck underneath the skin

• rapid inflammation in capillary bed and it bursts - then get little bits of blodo in tissue looks like rash
• could culture this and PCR and get this type of bacteria causign the meningitis

Question 7

How come you can see rash sometimes?

Answer 7

THis is with a bacterial infeciton, get the bacteria and otehr ifnlamatory products that have been stuck underneath the skin
-rapid inflammation in capillary bed and it bursts - then get little bits of blodo in tissue looks like rash

Question 8

How can niserea meningitids be good at causign meningitis?

Answer 8

• It is good at avoiding complement
• thick polysacharide capsule around outside - prevents opsonisation
• Factor H - can bind to this on human cells and down regulates complement forming
• Pilli - can bind to C4 binding protein and then prevents conversion to C3
• lipopolysacharide - similar to blood group antigens so our immuen system can not pick this up
• high levels of polysacharide - people die, means very serious disease , if get in early, then levels of polyscharide dont get to high
• this bacteria releases extra polysacharide and can get sick very quickly (maybe so bodies immune system fights this instead of the ..)

Question 9

What happens when get very high bacterial load and nutrophils die

Answer 9

When lipolysacharide level gets very high, and our body through platelets - thinks we are at end, our neutorphils commit suicde and released dna
-Dna is sticky and traps bacteria, red blood cells, and platelets
-this can localise immune response when it is all over hte place
-in septic shock , get capilaries in brain cloging up like this , kindyes, liver, msucels, not getting oxygen , nutirents ec.t
-and can die from this
-correlates with load of polysacharides
-

Question 10

What should be given for viral vs bacterial

Answer 10

Viral - analgesia, rest

Bacteria - treat cause, if streptococcus - give dexamethason (antiinflammatory drug, reduces risk of death) and then give antibiotics Penicilin