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GEN PATH > Meningitis > Flashcards

Meningitis Flashcards

1
Q

Inflammation of the Leptomeninges - Pia mater covering the Brain and CSF within
Subarachnoid space, usually caused by infection.

A

Meningitis

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2
Q

Pathogenesis of Meningitis

Direct implantation :
Hematogenous spread:
Local extension:
Axonal transport:

A

Direct implantation : Traumatic
Hematogenous spread: Arterial
Local extension: Established infection in an air sinus
Axonal transport: Peripheral nerves (Rabies and Herpes zoster)

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3
Q

Etiology Pathogens differ among groups in Bacterial Meningitis

Neonates:
Infants/Children:
Adolescents/young adults:
Elderly:

A

Neonate

  • B – Streptococcus group B
  • E – E. coli (IgM)
  • L – Listeria monocytogenes

Infants/Children (IgG) 1st 2 m

  • Haemophilus influenza (IgA)
  • Streptococcus pneumoniae
  • Neisseria meningitidis

Adolescents/young adults
- Neisseria meningitidis “severe” 1996-1.M case

Elderly

  • S. Pneumoniae
  • L. monocytogenes
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4
Q

Bacteria in subarachnoid space attract

A

Neutrophils

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5
Q

Clinical Manifestations of Bacterial Meningitis

A
  • Fever
  • Headache
  • Photophobia
  • Clouded sensorium
  • Nuchal rigidity/torticollis
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6
Q

Risk Factors of Bacterial Meningitis

A
  • Peak incidence: Children 75%
  • Undernutrition, Otitis media
  • Pneumonia
  • Immunodeficiency
  • Viral infection
  • Sickle cell diseases
  • Craniofacial abnormality
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7
Q

Spinal Tap Diagnosis of Bacterial Meningitis

1st tube:
2nd tube:
3rd tube:
4th tube:

A

1st tube: chemical or serologic tests
2nd tube: microbiologival tests including molecular diagnostics
3rd tube: microscopic examination, differential count
4th tube: cytological examination

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8
Q

Normal CSF Findings

Specific Fravity:
Pressure:
Protein:
Glucose:
Lactate:
WBC count
RBC count:
A 
Gross Appearance 
Specific gravity=  1.006-1.009
Pressure = 8-20 mmHg
Protein = 15-45 mg/dL
Glucose = 40-80 mg/dL
Lactate = <35mg/dL
WBC count 
  ✔Newborns: 30 microL
  ✔Infants: 19 microL
  ✔Adults:0.6 microL
RBC Count = NONE
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9
Q

Laboratory FIndings in Bacterial Meningitis

  1. ) Protein
  2. )Leukocyte:
  3. ) Lactate:
  4. ) Glucose
A

✔ Increased CSF

  1. ) Protein >15-45 mg/dL
  2. )Leukocyte: Neutrophils
  3. ) Lactate: >35 mg/dL

✔ Decreased
3.) Glucose <40-80 mg/dL

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10
Q

Absence of bacterial culture in patient with manifestations of meningitis :

  1. ) Meningeal irritation
  2. ) Fever
  3. ) Alterations of consciousness (acute onset)
A

Viral Meningitis

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11
Q

Most Common cause of Viral Meningitis

A

Enterovirus – Coxsackievirus 80%

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12
Q

Route of Viral Meningitis

A

Oral-Fecal Route

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13
Q

Laboratory findings Viral Meningitis

A

1.) Moderate increased to normal CSF Protein: > Vessel Permeability
2.) Increased Total CSF Leukocyte count: Neutrophils 🡪 Lymphocytes in 24-48H
“Lymphocytic Pleocytosis”
3.) NORMAL CSF Glucose

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14
Q
  • Maybe part of active disease elsewhere in the body or appear in isolation following seeding from silent lesion’s usually the lungs
  • Primary complications of pulmonary tuberculosis caused by Mycobacterium tuberculosis
  • It may affect the brain om the meninges and usually involved the base of the brain
A

Tuberculous meningitis

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15
Q

Clinical manifestations Tuberculous meningitis

A
  • Headache
  • Malaise
  • Mental confusion
  • Vomiting
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16
Q

Most common Tuberculous meningitis

A

Diffuse meningioencephalitis

17
Q

Morphology of Tuberculous meningitis in subarachnoid

A
  1. ) Gelatinous/Fibrous exudate

2. ) Granulomas: at the Base encasing cranial nerves

18
Q

Laboratory findings of Tuberculous meningitis

  • MODERATE CSF mononuclear cells Pleocytosis predominant:
  • Protein:
  • Glucose
A

MODERATE CSF mononuclear cells Pleocytosis predominant: Lymphocytes
ELEVATED Protein
Moderately reduced or Normal Glucose

19
Q

Complications of Tuberculous meningitis

A
  1. ) Hydrocephalus- arachnoid fibrosis

2. ) Infarction- Obliterative endarteritis

20
Q

Etiology of Fungal Meningitis

A

Cryptococcus neoformans

21
Q

Meningitis

  • Not Contagious
  • Hematogenous
  • AIDS: fulminant/fatal 2 weeks, or chronic
  • Poultry contacts
A

Fungal Meningitis

22
Q

Morphology of Fungal Meningitis

A

soap bubbles

23
Q

Direct Dx of Fungal Meningitis

A
  1. ) Direct CSF sample with india ink stain

2. ) Detection of Cryptococcus capsule antigens using assays

24
Q

Laboratory findings of Fungal Meningitis

  1. ) Protein
  2. ) CSF Leukocytes
  3. ) Glucose
A 
Increased 
1.) Protein
2.) CSF Leukocytes: Lymphocytes
Decreased
3.) Glucose
25
Q

CSF Fndings of of Different Meningitis: Bacterial

  • Differential Count
  • CSF Glucose
  • CSF Protein
  • Gram Stain
  • Total Cell count
A
  • Differential Count: Neutrophils
  • CSF Glucose: Decreased
  • CSF Protein: Increased
  • Gram Stain: 60-90% +
  • Total Cell count: Increased
26
Q

CSF Fndings of of Different Meningitis: Tuberculosis

  • Differential Count
  • CSF Glucose
  • CSF Protein
  • Gram Stain
  • Total Cell count
A
  • Differential Count: Lymphocytes
  • CSF Glucose: Moderately Decreased to NORMAL
  • CSF Protein: Increased
  • Gram Stain: + until 2 months
  • Total Cell count: Increased
27
Q

CSF Fndings of of Different Meningitis: Viral

  • Differential Count
  • CSF Glucose
  • CSF Protein
  • Gram Stain
  • Total Cell count
A
  • Differential Count: 24-48 H: Neutrophils Lymphocytes after
  • CSF Glucose: NORMAL
  • CSF Protein: Moderately increased
  • Gram Stain: —
  • Total Cell count: NORMAL – slightly Increased
28
Q

CSF Fndings of of Different Meningitis: Fungal

  • Differential Count
  • CSF Glucose
  • CSF Protein
  • Gram Stain
  • Total Cell count
A
  • Differential Count: Lymphocytes
  • CSF Glucose: Decreased
  • CSF Protein: Increased
  • Gram Stain: +
  • Total Cell count: NORMAL to slightly Increased

GEN PATH (17 decks)

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