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Neuro 1 > Meningitis > Flashcards

Meningitis Flashcards

1
Q

What do you see with bacterial meningitis? (lab)

A

decreased glucose, increased protein, increased WBC w/ mostly PMNs

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2
Q

What do you see with aseptic/viral meningitis? (lab)

A

No change glucose, slightly increased protein, increased wbc (mostly lymphocytes)

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3
Q

> 85% viral meningitis associated with _______

Other major causes

A

enteroviruses (coxsackievirus, echovirus, human enteroviruses 68-71)
HSV 2
Arthropod-borne viruses (arboviruses)
HIV?

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4
Q

Nuchal rigidity MORE associated with ________

A

bacterial meningitis (vs viral)

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5
Q

Big three organisms for bacterial meningitis

A

S. pneumoniae (most common)
N. meningiditis (most common young, dorm, gram -)
H. influenza type b (gram -)

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6
Q

Ceftriaxone = _________ kind of abx

A

3rd gen cephalosporin (beta-lactam)

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7
Q

primary mechanism of ceftriaxone

A

inhibit transpeptidation of peptidoglycan to inhibit cell wall synthesis

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8
Q

spectrum ceftriaxone

A

broad, used for streptococci and more serious Gram - infections, can cross BBB

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9
Q

resistance ceftriaxone

A

inactivation of drug by beta-lactamases, change in penicillin binding protein

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10
Q

side effects ceftriaxone

A

allergies (beta-lactam, penicillin), seizures

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11
Q

Most common

A

group B strep

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12
Q

Most common 11-18 (etiology bac. men)

A

Neisseria meningitidis (strep p still high)

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13
Q

Most common adults (etiology bac men)

A

strep pneumoniae (most common overall)

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14
Q

Listeria most common etiology for bac men for what populations

A

babies, over 65

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15
Q

Meningitis develops in __________, which lacks _____ and ________ required for ________

A

Meningitis develops in subarachnoid space, which lacks antibody and complement production required for phagocytosisd

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16
Q

Clinical symptoms meningitis

A

Fever and headache

Nuchal rigidity (30% cases), photophobia, rash (gram -), upper respiratory symptoms, anorexia, nausea, vomiting, diarrhea, altered mental state

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17
Q

General causes of meningitis (5)

A 
Acute = aseptic (viral, drugs), bacteria
Chronic = mycobacteria, fungi, protozoa
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18
Q

Overview for management of meningitis

A

H&P, blood culture then start empiric tx, neuroimaging if altered MS/papillidema, lumbar puncture, ID organism (gram stain/PCR), switch to definitive tx and/or support

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19
Q

Routine lumbar puncture tests

A 
WBC w/ diff
RBC
Glucose
Protein
Gram stain
Bacterial culture
Do other tests if worrying about specific things
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20
Q

Lumbar puncture: needle inserted between –

A

3rd and 4th lumbar vertebrae into subarachnoid space (CSF)

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21
Q

tx aseptic meningitis (often viral, maybe noninfectious)

A

supportive tx and recover on their own, but can be fatal in neonatal period

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22
Q

aseptic meningitis syndrome incidence highest _____

A

during first year of life

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23
Q

enteroviruses: dna or rna

A

rna (+ sense, single stranded)

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24
Q

enterovirus transmission

A

hand to mouth

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25
Q

type of virus enterovirus

A

ss +RNA
capsid symmetry, icosahedral
naked

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26
Q

Development of bacterial meningitis:

A
  1. Mucosal colonization at nasopharynx
  2. Invasion and multiplication in bloodstream
    3,4. Cross blood brain barrier and egress into CSF
  3. Release of inflammatory cytokines in CSF by astrocytes and microglia
  4. Increased permeability of BBB
  5. Diapedesis of leukocytes into CSF
  6. Edema and increased intracranial pressure
  7. Neuronal injury including hearing loss (cranial nerve VIII)
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27
Q

Virulence factors: N. menin

A

capsule, IgA protease, Pili, endotoxin (gram neg), outer membrane proteins

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28
Q

Virulence factors: H. ib

A

capsule, IgA protease, Pili, endotoxin (gram neg), outer membrane proteins

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29
Q

Virulence factors: S. pneu

A

capsule, IgA protease (gram +)

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30
Q

endotoxin (=?) is shed from outer cell membrane of gram _____ bacteria

A

lipopolysaccharide

negative

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31
Q

N. men structure slightly different =

A

lipooligosaccharide, which mimics brain sphingolipids so recognized as self

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32
Q

LPS activates ________ leading to ______

A

macrophages –> release of NO (hypotension, shock), and IL-1 (fever) and can activate disseminated intravascular coagulation leading to purpuric skin rash

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33
Q

Pili allow —— (vf)

A

colonization of nasopharynx

34
Q

IgA protease —— (vf)

A

cleaves IgA facilitating colonization of mucosa

35
Q

Capsule composed of acidic polysaccharides protects from ——- (vf)

A

phagocytosis by polymorphonuclear granulocytes

36
Q

meningococcal meningitis pathogen

A

n. meningitidis

37
Q

outbreaks of mm associated with

A

spring, winter

overcrowding (dorms)

38
Q

mm transmission

A

respiratory droplets

39
Q

mm: LOS –>

A

thrombocytopenia, assoc. with disseminate intravascular coagulation leading to hemorrhagic skin rash (doesn’t fade under pressure)

40
Q

mm tx

A

definitive and prophylactic tx w/ ceftriaxone

41
Q

pneuomococcal meningitis pathogen

A

streptococcus pneumonia

42
Q

s. pneu type of bacteria

A

lancet shape

gram + diplococci

43
Q

pm transmission

A

respiratory droplets

44
Q

pm secondary to

A

paranasal sinusitis and otitis media

45
Q

most common cause of meningitis over 2 months old

A

s. pneu

46
Q

s. pneu and previously on abx

A

predict resistant strain 19A-resistant s. pneu, treat w/ vanco

47
Q

mm vaccine

A

13 serogroups, vaccine covers 4 ACWY (b new)

48
Q

pm vaccine

A

heptavalent protein-conjugate vaccine

49
Q

Hib bacteria type

A

gram neg coccoid-rod

50
Q

Hib common in

A

unvaccinated infants/young children

51
Q

Hib infection can be followed by

A

hearing loss

52
Q

Hib prevention

A

Hib vaccine - B capsular polysaccharide

53
Q

Hib lab test

A

chocolate agar w/ factors V (NAD+) and X (hematin)

54
Q

Perinatal meningeal infections pathogens

A

group b strep, e. coli, listeria monocytogenes

55
Q

GI and GU tract flora –> meningitis

A

group B strep (strep agalactiae)

56
Q

transmission group b strep

A

vertical to infant (in utero or during vaginal delivery)

57
Q

prevention transmission group b strep

A

pregnant women screened (25% carriers) and give penicillin G as prophylactic

58
Q

group b strep lab results

A

bacitracin resistant, catalase neg, CAMP reaction (synergistic hemolysis of RBC by phospholipase of GBS and B hemolysin of S. aureus)

59
Q

e. coli K1 bacteria type

A

gram neg rod

60
Q

e. coli pathogeneiss

A

enteric organism –> bacteremia –> transcellular permeation of BBB
LPS, K1 capsular polysacc prevents fusion with lysosome

61
Q

e coli tx

A

if expressing b-lactamases, ceftriaxone not enough, use carbapenem

62
Q

Listeria monocytogenes bacteria type

A

gram pos rod

63
Q

L. mono common in

A

immunosuppressed, pregnancy, older adults, newborns

64
Q

sxs L. mono

A

fever, HA, no nuchal rigidity, diarrhea

65
Q

L. mono pathogenesis

A

intracellular bacteria, internalin induces phagocytosis by epithelial cells of intestine, phospholipase and listeriolysin O allow escape from vacuole, actin tails facilitate spread from adjacent cells

66
Q

L. mono testing

A

50% blood tests come back negative

67
Q

L. mono tx

A

ampicillin + gentamicin for 3 weeks

68
Q

test mycobacterium tuberculosis

A

acid fast bacilli stain (ziehl-neelsen) and culture

69
Q

tx m. tuberculosis

A

RIPE = rifampin, isoniazid, pyrazinamide, ethambutol

70
Q

vaccine m. tuberculosis

A

BCG vaccine

71
Q

prevalence m. tuberculosis

A

25% miliary cases have meningeal involvement

more common in immunocomprimised

72
Q

rifampin mechanism

A

inhibits DNA-dependent RNA polymerase,

induces formation of drug-metabolising enzymes including cytochrome P450

73
Q

isoniazid mechanism

A

inhibits mycolic acids (mycobacterial wall).

Note: acetylation by liver varies genetically and fast acetylators may require faster dose.

74
Q

pyrazinamide mechanism

A

unknown

75
Q

ethambutol mechanism

A

inhibits cell wall synthesis by binding arabinosyl transferase

76
Q

__________ inhaled as spores and can disseminate hematogenously to CNS in IC individuals

A

cryptococcus neoformans (fungus)

77
Q

C. neoformans tx

A

liposomal amphotericin + flucytosine until culture negative, followed by fluconazole for 3-12 months, or life

78
Q

test c. neoformans

A

stain w india ink, latex agglutination test

79
Q

amphotericin B mechanism

A

binds ergosterol creating holes in fungi membrane –> leakage of electrolytes

80
Q

flucytosine mechanism

A

antimetabolite selectively taken up and converted to 5-fluorouracil in fungi, interferes w DNA/RNA synthesis

81
Q

Fluconazole mechanism

A

binds fungal P-450 enzyme to block production of ergosterol (associated with drug interactions)

82
Q

Sxs viral men vs bac men

A

viral - less stiff neck, less mental confusion, photophobia
bacterial - stiff neck, neurological dysfunction, irritability

Both headache, fever

Neuro 1 (13 decks)

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