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Psych Disorders > Meningitis > Flashcards

Meningitis Flashcards

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1
Q

Criteria for acute meningitis.

A

Onset: hours to days
<4 weeks duration
Aseptic (viral) or Septic (bacterial)

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2
Q

Time criteria for chronic meningitis.

A

> 4 weeks duration

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3
Q

Time criteria for recurrent meningitis.

A

multiple acute episodes <4 weeks apart

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4
Q

What are the 4 characteristics of acute meningitis?

A

Inflammation of meninges
Infection of subarachnoid space
Exudate of spinal cord and brain
CSF with inflamm changes

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5
Q

What is the most common bacteria that causes meningitis in young children and adults?

A

Strep Pneumo

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6
Q

What is the most common bacteria that causes meningitis in neonates?

A

Group B Strep (lives in mothers vaginal cavity)

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7
Q

What is the most common bacteria that causes meningitis in adolescents and young adults?

A

Neisseria Meningitidis

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8
Q

If you’re seeing a child with meningitis that recently came from overseas you may think of what bacteria?

A

Haemophilus Influenza

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9
Q

Listeria monocytogenes often affects which population in meningitis?

A

Elderly, neonate ,immunocompromised

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10
Q

What age group has the highest incidence of meningitis?

A

<2 mos. old

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11
Q

What are some risk factors for meningitis?

A

Malnutrition - lowered immune function
Asplenia - gram. negs engulfed in spleen / Sickle cell
Chronic disease - Diabetes, HIV, liver disease
Bacteremia
Sinus / otitis media infections
Head Trauma

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12
Q

The nasopharynx is a portal of entry for bacteria causing meningitis. What is the defense mechanism of the mucosa?

A

mucosal IgA

Encapsulated organisms / pili are virulence factors that help them to evade the immune defenses

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13
Q

Describe the 3 stages of neutrophil invasion into the CNS in meningitis.

A

Stage 1 (1-2hrs): IL-1 and TNF release in CSF due to bacteria + neutrophils increase binding to endothelial cells

Stage 2: IL-8 release by vascular endothelium + neutrophil diapedesis and entry into CSF

Stage 3: CSF cytokines activate neutros and degranulation occurs –> vasoactive lipids and ROS are released –> leakage of albumin into CSF due to BBB breakdown = EDEMA

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14
Q

What are the 3 types of edema in meningitis?

A

Vasogenic edema: BBB breakdown
cytotoxic edema: cellular injury increases intracell. fluid
Interstitial edema: purulent fluid in subarachnoid space blocks CSF reuptake

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15
Q

What are some common clinical characteristics of meningitis?

A 
Altered consciousness
stiff neck
fever/N/V
Brudzinski sign / Kernig sign
Photophobia 
Increased ICP (headache in adults / bulge fontanelle in kids)
Ataxia, seizure, coma 
Papilledema is sign for hernation
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16
Q

What is a special clinical characteristic of Neisseria meningitidis?

A

Petechiae

17
Q

What is a special clinical characteristic of Strep Pneumo meningitis?

A

Recent respiratory infection / ear or sinus infection

18
Q

What are your CSF values and characteristics for bacterial meningitis?

A 
High opening pressure
Clear CSF
Gram stain / culture of bacteria
>1000 cells
>500 WBCs
Low glucose // high protein
segmented cells
19
Q

What is the standard empiric treatment of meningitis?

A

Vancomycin + 3rd generation cephalosporin

Ampacillin + gentamycin (infants <6 weeks old)

20
Q

Which 2 strains of bacteria has it been shown that steroids are beneficial in treating meningitis?

A

Hib –> reduce deafness

Strep pneumo

21
Q

Is there immunization against Hib? What would be prophylactic treatment for suspected Hib infection?

A

Yes (Hib Vac series)

Rifampin

22
Q

Is there immunization against N. meningitidis? What would be prophylactic treatment for suspected N. meningitidis infection?

A

Yes (meningococcal vaccine)

Rifampin or ceftriaxone or ciprofloxacin

23
Q

Is there immunization against S. Pneumo?

A

Yes
Prevnar (7-valent) for kids
Pneumovax (23-valent) for adults

24
Q

What is the most common type of aseptic meningitis?

A

Viral … especially enterovirus (Echovirus / Coxsackie)

25
Q

What type of immune cells are most important for clearing viral infections?

A

T-cells

26
Q

What are the CSF lab values for tuberculosis meningitis?

A 
<500 cells
Low glucose // high protein
Monocytes
AFB (Acid Fast Baciili)
Slightly increased pressure
27
Q

What are the CSF lab values for fungal meningitis?

A 
<500 cells
Low glucose // high protein
Monocytes
India ink +
Slightly increased pressure
28
Q

What are the CSF lab values for viral meningitis?

A

<1000 cells
norm glucose // norm protein
monocytes
norm pressure

29
Q

Anti-virals are generally not recommended for treatment of viral meningitis. What is the exception?

A

HSV-1

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