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Year 3 Human Disease > Meningitis > Flashcards

Meningitis Flashcards

1
Q

what drug caused big decrease in mortality of meningitis

A

penecillin

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2
Q

what is the mortality rate of meningitis

A

10-100%

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3
Q

5 disabilities caused by meningitis

A
  • deafness
  • paralysis
  • speech problems
  • epilepsy
  • neuro-psychiatric problems
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4
Q

where is csf produced

A

choroid plexus in the ventricles

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5
Q

order of meninges out-in

A

DAP
Dura
arachnoid
pia

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6
Q

define meningitis

A

inflammation of lepto-meningeal membranes

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7
Q

4 infectious causes of meningitis and examples

A

virus (enterovirus, mumps (zosterovirus), herpes)
bacteria (meningococci, pneumococci, h influenzae)
fungus (cryptococcus neoformans, coccidiodomycosis)
parasitic (naegleria fowleri, acanthamoeba)

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8
Q

3 routes by which organisms reach the cns

A
  • bacteraemia/ viraemia/ parasitaemia: in the blood, esp through choroid plexus
  • direct spread: chronic infections in cranial bones, ears, sinuses, oral cavity or upper resp tract
  • neuronal spread: infection of peripheral neurones, axonal transport, replication and cell-cell spread of infection to connecting neurones on CNS
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9
Q

flowchart of meningitis pathogenesis 9 (see lecture)

A

mucosal colonisation –>
intravascular survival –>
meningeal invasion –>
survival in subarachnoid space –>
inflammatory response, inc BBB permeability, cerebral vasculitis –>
oedema, CSF flow disturbances –>
inc intracranial pressure, dec cerebral blood flow –>
loss of cerebro-vascular autoregulation –>
coma, death

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10
Q

4 factors influencing cause of bacterial meningitis

A
  • age ( BBB not fully formed. >75, BBB weakens)
  • geography (overcrowding, high temp –> epidemics)
  • immunity (chemo/ transplants/ steroids)
  • trauma/ post-neurosurgical (esp base of skull, as oropharyngeal trauma enter skull)
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11
Q

why do neonates have different bacterial causes of bacterial meningitis to other age groups?

A

due to mothers bacteria during birth

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12
Q

what are the common bacterial causes of bacterial meningitis in >50s, immunocomp, basilar skull fracture 2

A

s pneumoniae

n meningitidis

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13
Q

additional bacteria in

a. >50/immunocompromised
b. basilar skull fracture

A

a. >50/immunocompromised: listeria, gram - bacilli, pseudomonas aeruginosa (immunocomp)
b. basilar skull fracture: group A beta-hemolytic strep

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14
Q

4 bacterial causes of head injury/ post neurosurgery meningitis and why these are different to most

A

-s aureus
-s epidermis
-aerobic gram - bacilli
-p aeruginosa
oropharyngeal/ skin flora

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15
Q

5 symptoms of meningitis

A
  • fever
  • neck stiffness
  • altered mental state
  • headache
  • photophobia
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16
Q

3 signs of meningitis

A
  • neck rigidity
  • kernigs sign
  • brudzinski’s sign
17
Q

problems with
A. signs
b. symptoms of meningitis

A

a. signs: common to many illnesses, normally not all present in meningitis
b. symptoms: only 5% sensitivity

18
Q

what is the gold standard test in CNS infection diagnosis

A

lumbar puncture

19
Q

normal csf:

a. colour
b. opening pressure
c. lymphocyte count
d. protein
e. glucose
f. gram stain
g. culture

A

a. colour: clear
b. opening pressure: 5-20cm
c. lymphocyte count: 60% of blood glucose
f. gram stain: NOS
g. culture: sterile

20
Q

csf findings in meningitis TABLE
when is a CT/ MRI scan needed before lumbar puncture 3
and WHY

A
  • fitting
  • focal neurological disorder
  • dec on coma scale
  • -> may be something else where lumbar puncture contraindcated, eg cerebral tumour, subarachnoid haemorrhage, frontal sinusitis
21
Q

6 indications of neuro-imaging in meningitis

A
  • history of unconsciousness
  • history of seizures
  • focal neurology
  • low gcs
22
Q

4 main complications of bacterial meningitis and explain each

A
  • seizures (scar epilepsy): scarring of brain tissue are foci of epileptic activity
  • hydrocephalus: thickened CSF/ fibrinoid accumulations –> CSF builds up in brain –> pressure on brainstem –> cardiorespiratory arrest
  • infarcts:vascular pressure/ vasculitis –> failed blood supply –> tissue dies –> haemoplegia, palsy
  • transtentorial herniation: inc intracranial pressure –> pressure on brainstem (resp and motor centres) –> coma, death
23
Q

management of meningitis 5

A
  • supportive care
  • specific antimicrobial therapy
  • steroids
  • surgical intervention
  • prophylaxis
24
Q

6 aspects of supportive care of meningitis

A
  • airway
  • breathing
  • circulation
  • nutrition
  • physiotherapy
  • rehabilitation
25
Q

6 considerations of specific antimicrobial therapy for meningitis

A
  • pathogen
  • sensitivities/ resistance of pathogen
  • csf penetration
  • allergy, renal function etc
  • route (IV, IT, IM, PO)
  • duration of therapy
26
Q

name antibiotics with good penetration 4

A
  • penicillin
  • ceftriaxone
  • meropenem
  • chloramphenicol
27
Q

name antibiotics with poor penetration 2

A

vancomycin

gentamycin

28
Q

when to use steroids to treat meningitis

A

BEFORE anything else (antibiotics, lumbar puncture etc)

29
Q

2 roles of neurosurgery in meningitis management

A
  • definitive (eg must drain csf in hydrocephalus)

- supportive: for IT antibiotics, external ventricular drain (EVD)

30
Q

2 prophylaxis methods of meningitis

A

antibiotics

vaccines

Year 3 Human Disease (28 decks)

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