Meningitis

Question 1

Age meningitis

Answer 1

children <5 (due to undeveloped immune system) but also hits over 65’s (poorly functioning immune system) and 19-25 yrs (due to different social behaviour)

Question 2

How are bacteria transferred?

Answer 2

Through secretions of nose/throat

Question 3

incubation period

Answer 3

1-3 days

Question 4

skin rash is associated with….

Answer 4

septicemia by N. meningitidis

Question 5

1st line blind treatment

Answer 5

benzyl penicillin (pen G) IV
OR
high dose 3rd gen ceph

Question 6

What are your 3rd gen cephs used?

Answer 6

IV ceftriaxone

IV cefotaximine

Question 7

1st line if pen allergic

Answer 7

Chloramphenicol qds

Question 8

Why not intrathecal admin?

Answer 8

Has to be made up especially as cannot contain preservatives

Question 9

Advantage of bezyl pen

Answer 9

broad spec
rapid absorb
non-toxic in high conc
penetration to CSF

Question 10

Most common causative organism

Answer 10

Neisseria meningitidis

80%

Question 11

Most common strains on Neisseria meningitidis

Answer 11

Type B (80-90%)
Type C (10%)

Type A, Y, W135 vaccines

Question 12

Neisseria meningitidis pt group

Answer 12

<5

19-25

Question 13

2 other common species

Answer 13

Streptococcus pneumoniae (65)
Haemophilus influenzae B  (now there are vaccines) (<5)

Question 14

Add a steroid to…

e.g.

Answer 14

reduce inflammation (dexamethasone) - beta lactams cause cell lysis and LPS and cell products are released - inflam resposnse

Question 15

MOA chloramphenicol

Answer 15

inhibit protein synthesis, bind to 50S subunit

Question 16

MOR chloramphenicol

Answer 16

1. plasmid encoded chloramphenicol acetyltransferase gene (acetylates cholam gene so can no longer bind to ribosome)
2. Also reduced uptake

Question 17

MOA penicillins

Answer 17

inhibit cell wall synthesis (prevent x linking of PG chain)

Question 18

MOR

Answer 18

1. beta lactamases
2. altered PBP (lower af)
3. Reduced perm due to porin mutations (gram -ve)

Question 19

If pen resistant S. pneumoniae suspected treat with

Answer 19

Rifampicin or vanc

Question 20

MOA Vanc

Answer 20

Inhibit cell wall synth (bind to terminal on 2 amino acids in peptide side chain, prevents incorporation of PG monomers into the PG chain)

Question 21

MOR Vanc

Answer 21

Dala Dala to Dala Dlac - reduces binding of vanc

Question 22

Prophylaxis for N meningitidis? - WHO

Answer 22

Close relatives - prolonged contact

Question 23

Prophylaxis for N meningitidis? TREATMENT

Answer 23

-Rifampicin 600mg bd 2 days
OR
-Ciprofloxacin 500mg stat

Question 24

Prophylaxis for S pneumoniae?

Answer 24

Nein, danke

Question 25

Prophylaxis for H. Influenzae B?

Answer 25

If pt is unvaccinated child < 4 whole household given Rifampicin (most children are vaccinated at 4 months)

Question 26

What vaccines are available

Answer 26

H influ Type B N menig Type C P. pnmoae PVC

Question 27

Why does viral have a lower inflammatory response?

Answer 27

Virus is usually present in cells and not visible to phagocytic macrophages

Question 28

Common viruses

Answer 28

enterococcus coxsackie Herpes simplex

Question 29

Treatment for fungal

Answer 29

Amphotericin, flucytosine and fluconazole

Question 30

Causative fungi

Answer 30

C. albicans cryptococcus neoforms histoplasma