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Meningitis Flashcards

1
Q

what is the most common route of microbial entry into the CNS

A

1)via the blood

can also enter via:

2) direct implantation,
3) local spread from other infections,
4) from the PNS

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2
Q

which two routes can microbes enter the CNS via the blood

A

capillaries within the brain parenchyma –> encephalitis or brain abscesses

the choroid plexus –> meningitis

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3
Q

what features of the brain microvascular endothelian cells makes crossing of pathogens more difficult in the brain parenchyma

A

tight junctions have strong electrical resistance and therefore there is REDUCED PARACELLULAR FLUX

BMEC also has an extra slow rate of fluid-phase endocytosis therefore there is REDUCED TRANSCELLULAR FLUX

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4
Q

what facilitates/inhibits the crossing of pathogens at the choroid plexus

A

1) fenestrated endothelium –> INCREASED PERMEABILITY
2) epithelium has fast rate of endocytosis –> INCREASED TRANSCELLULAR FLUX
3) weaker tight junctions and weaker electrical resistance –> INCREASED PARACELLULAR FLUX

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5
Q

which bacteria meningitis is associated with a haemorrhagic skin rash

A

Neisseria meningitidis

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6
Q

during which season is enterovirus meningitis more common

A

in the summer

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7
Q

which time of the year do epidemics of meningococcal meningitis tend to occur

A

the first quarter of the year

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8
Q

which organism do meningitis C vaccines protect against

A

neisseria meningitidis

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9
Q

describe the structure of neisseria meningitidis bacteria

A

gram-negative diplococcus

capsulated

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10
Q

which group of meningococcus causes the highest frequency of CNS infection

A

Group B

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11
Q

describe the structure of streptococcus pneumoniae

A

gram-positive capsulated coccus

naturally present in the throat

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12
Q

what is the pathogenesis of streptococcus pneumoniae

A

RT (pneumonia) -> blood (bacteraemia) –> meninges

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13
Q

which streptococcus pneumoniae vaccine is given to the <2s

A

PCV 13 which protects against 13 meningitis causing serotypes

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14
Q

which streptococcus pneumoniae vaccine is given to the >65s

A

PPV which protects against 23 pneumonia causing serotypes

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15
Q

which infections do non-invasive streptococcus pneumoniae cause

A

otitis media
sinusitis
bronchitis

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16
Q

describe the structure of Haemophilus influenzae

A

gram-negative coccobacillus naturally present in the throat

present both as capsular and uncapsular - capsulated type b capable of causing meningitis in young children

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17
Q

which infections can capsulated strains of H. influenzae cause

A

meningitis
epiglottitis
pneumonia
bacteraemia

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18
Q

how does mycobacterium tuberculosis present

A

gradual onset

infection focus usually elsewhere (usually the lungs)

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19
Q

in which age group is TB meningitis most common in areas where TB prevalence is high

A

children < 5

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20
Q

in which age group is TB meningitis most common in areas where TB prevalence is low

A

adults

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21
Q

how do fungal meningitis present

A

gradually

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22
Q

which type of fungus causes the most cases of fungal meningitis

A

cryptococcus neoformans

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23
Q

wht condition can cause a pure encephalitis which infects the brain via the PNS

A

RAbies

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24
Q

which is the most common cause of encephalitis in the UK

A

HSV type 1
characterised by extensive and asymmetric necrosis of the temporal lobes
neonates can acquire primary infection as pass through birth canal!

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25
complications of bacterial meningitis
``` sepsis -> shock -> death cerebral oedema (raised ICP) cerebral thrombophlebitis permanent neurological complications cerebral abscess subdural empyema leptomeningeal fibrosis (ostructive hydrocephalus) epilepsy ```
26
what may be evident on TB meningitis pathology
thick basal exudate granulomas with caseation arachnoid fibrosis tuberculomas
27
what is tabes doralis
syphilitic myelopathy - slow demyelination resulting in: - lightning pains - ataxia and stamping gait - neuropathic joints - Argyll Robertson pupils - ptosis and optic atrophy secondary to syphilis infection
28
shingles can cause encephalitis, how?
reactivation of the varicella zoster virus following primary infection of chicken pox
29
which are the most common intra-uterine CNS infections
CMV Rubella Toxoplasmosis
30
in which period of pregnancy is the highest risk from CMV
2nd trimester causes necrotising encephalitis this results in mental retardation, microcephaly and deafness
31
in which period of pregnancy is the risk of malformation greatest from rubella
the first - decreases as pregnancy continues causes heart defects, cataracts, deafness and mental retardation
32
in which period of pregnancy is toxoplamosis most dangerous
1st trimester: abortion/stillbirth 2nd: severe brain and organ damage 3rd: moderate cerebral damage, chorioretinitis
33
what is acute disseminated encephalomyelitis
rare sequel to viral infections presents as: fever, headache, vomiting, drowsiness, coma, focal neurology, widespread patchy demyelination and perivascular inflammation
34
what is acute haemorrhagic leukoencephalitis
a more severe form of acute disseminated encephalomyelitis
35
what is subacute sclerosing panencephalitis
rare late sequel of measles | presents as mental deterioration, fits, myoclonus and pyramidal signs
36
what are the clinical features of Creutzfeld-JAcob disease
rapidly progressive dementia ataxia myoclonus psychiatric features (new variant)
37
what would be seen on pathology in Creutzfeld-Jacob disease
``` spongiform change amyloid PrP rich plaques neuronal loss gliosis atrophy ```
38
in which age group is the highest incidence of meningitis
<2 months | 80.69 per 100,000 population
39
which organism is the most common cause of bacterial meningitis in the first month of life
group B strep e coli listeria
40
which organism is the most common cause of bacterial meningitis in 1 month - 3 months
group B strep gram ive s pneumoniae n meningitis
41
which organism is the most common cause of bacterial meningitis in 3 months - 3 years
s pneum n mening group B strep gram -ve
42
which organism is the most common cause of bacterial meningitis 10yrs-19yrs
n mening
43
list 3 risk factors to meningitis
``` >60 or <5 DM renal/adrenal insuff CF HIV splenectomy sickle cell disease ALCOHOLICS! crowing recent exposure dural defect Thalassaemia major IV drug use bacterial endocarditis VP shunt malignancy ```
44
what are the two patterns of presentation of acute bacterial meningitis
progressive (preceded by febrile illness) | acute and fulminant (develops rapidly, signs of sepsis, associated with severe brain oedema)
45
what is Cushing's triad
late sign of raised ICP - systemic hypertension - bradycardia - respiratory depression
46
what are the signs and symptoms of bacterial meningitis in neonatal - 3 months
``` maternal infection or pyrexia at delivery hyper/hypothermia change in sleeping or eating habits irritability/lethargy high pitched cry seizures bulging fontanelle paradoxical irritability ```
47
how does nuchal rigidity manifest
``` inability to place chin on chest limited passive neck flexion Kernig sign ( cannot extend knee) Brudzinski signs ( flexes lower extremities during attempted passive flexion) ```
48
under what circumstances must you do a brain CT before performing an LP
``` suspicion of raised ICP (papilloedema, raised BP/low HR) focal neurology abnormal level of consciousness seizure within 1 week of presentatino known CNS lesions immunocomprimise >60 years ```
49
which CT findings are absolute contraindications to LP
``` midline shift loss of suprachiasmatic and basilar cisterns posterior fossa mass loss of superior cerebellar cistern loss of quadrigeminal plate cistern raised ICP ```
50
which two conditions are relative contraindications to LP
coagulopathy brain abscess infected skin at needle entry is an absolute contraindication
51
which antibiotics should be used for neonates in the treatment of meningitis
ampicillin and cefotaxime or aminoglycoside
52
which antibiotic should be used for the first line treatment of meningitis
cephalosporin: cefotaxime or ceftriaxone chloramphenicol can be used if allergies
53
which childhood immunizations can protect against meningitis
Hib Men C Strept pneumoniae MMR
54
what is the mortality rate for neonates in meningitis
15-25%
55
what must be treated in order to improve outcome in meningococcaemia
hypovolaemia hypotension acidosis respiratory impairment
56
which signs are present in meningitis
triad: 1. headache 2. neck stiffness 3. fever also: - photophobia - petechial rash - vomiting - intense malaise - rigors
57
what is the gold standard test for confirming bacterial meningitis
LP | will be clouding in >90% of pts owing to WCC>100
58
what is the most common complication of strep pneumonia meningitis
deafness - all children should have an audiological assessment after meningitis infection
59
what would the CSF look like in viral meningitis
clear | increased lymphocytes
60
what would you expect to find on the CSF for bacterial meningitis
turbid appearance raised neutrophils raised protein dereased glucose
61
why does strep pneumoniae meningitis have a worse prognosis
it produces cytotoxins
62
what would you expect to see on mycobacterial meningitis CSF
``` clear/mildly turbid appearance early -> neutrophils then lymphocytes raised protein decreased glucose positive AFB ```
63
what is the main cuase of encephalitis in the UK
herpes simplex causes extensive asymmetric necrosis of temporal lobes
64
which protozao can cause meningitis
malaria | african typanosomiasis
65
what are transmisible spongiform encephalopathies caused by
prions
66
how do the bacteria causing meningitis cross the blood brain barrier
at the choroid plexus
67
briefly outline the inflammation process in meningitis
1) cytokine production - activates pain receptors and leads to meningeal damage 2) increased bloodflow and permeability - oedema and raised ICP 3) immune cell recruitment - increased inflammation and tissue damage
68
what is opistonus
hyperextension and spascity of the back
69
what do gram stains on CSF indicate
gram +ve -> strep pneumoniae gram -ve -> n meningitidis
70
name three complications post treatment of meningitis
deafness learning difficulties cerebral palsy
71
which antibiotics are used as chemoprophylaxis for meningitis
ciprofloxacin rifampicin ceftriaxone these are the only 3 abx with an evidence basis
72
who should receive chemoprophylaxis for meningitis
transmission of meningococci only likely to occur following prolonged close contact
73
what is the maximum incubation period
2-7 days
74
what is the absolute risk of a house hold contact transmitting meningitis
1 in 500 within the next month
75
what is the aim of chemoprophylaxis
eliminate the carriage of meningococci | reduces the risk by 90%
76
list 3 risks of chemoprophylaxis of meningitis
1) increased exposure to abx -> resistance 2) side effects 3) affects commensual organisms - eg neisseria lactamina which has similar surface proteins to nm and therefore aids natural immunity
77
should a child who has been diagnosed with meningitis receive chemoprophylaxis
yes! to erradicate carriage unless already treated with ceftriaxone
78
what would you see on the CSF in herpes simplex encephalitis
lymphocytosis mildly raised protein usually normal glucose HSV on PCR
79
what are the clinical features of herpes zoster (shingles)
blistering rash affecting dermatome if affects eye (V1) can cause corneal abrasions Ramsey Hunt syndrome
80
what is the most likely cause of meningitis following skull fracture, ear disease or congenital CNS lesion
pneumococcal infection
81
what is the most likely cause of meningitis folowing rash and pleuritic pain
enterovirus infection
82
what is the most likely cause of meningitis following working in water and presenting with myalgia, conjuctivitis and jaundice
leptospirosis
83
what are the late signs of raise ICP
``` bulging fontanelle neck stiffness opisthotonos rash fall in BP ```
84
what is idiopathic intracranial hypertension, who is it most common in and what is it associated with?
CSF pressure> 200 in nonobese (250 in obese) in young women associated with obesity
85
what is the difference between communicating and non-communicating (blocked) hydrocephalus
communicating - blockage after the ventricles at the cisterns. Often caused by SAH and meningitis non-communicating - one of the narrow passages connecting the ventricles is blocked
86
what is the triad of clinical symptoms in normal pressure hydrocephalus
gait disturbance, dementia and incontinence

defence (12 decks)

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