meningitis Flashcards

1
Q

what symptoms are associated with meningitis

A

deafness, paralysis ,
speech problems
neuropsychiatric problems

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2
Q

what three layers cover the skull?

A

dura mater, arachnoid mater, subarachnoid space and pia mater

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3
Q

what does the subarachnoid space contain?

A

csf and blood vessels

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4
Q

define meningitis?

A
inflammation of the leptomeningeal covering 
4 branches:
1. infection 
2. inflammation 
3. parameningeal foci 
4. neoplastic and paraneoplastic
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5
Q

viral infectious agents?

A

Enterovirus and mumps

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6
Q

bacterial infectious agents?

A

meningicocci and pneumococci

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7
Q

fungal infectious agents?

A

cryptococcus neoformans

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8
Q

parasitic

A

Naegleria fowleri

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9
Q

bbb?

A

prevents infection reach the brain

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10
Q

how do organisms reach the brain?

A
  1. bacteriamia/viraemia/ parasitaemia : reach blood stream then go into choroid plexus=> cross bbb => reach csf
  2. direct spread: chronic infection in cranial bones, ears and sinuses and oral cavity and upper respiratory tract
  3. Neuronal spread: infection of the peripheral nerves and cell to cell spread of infection. e.g. dog bit leading to spread of infection
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11
Q

Pathogenesis of meningitis?

A

mucosal colonisation => intravascular survival => meningeal invasion => increased bbb permeability, ceralbral vasculitis and inflammation => oedema and csf flow disturbances=> increase in ICP and decreased cbf and finally result with loss of cerebro-vascular autoregulation

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12
Q

factors influencing bacterial mengitis?

A
  1. age
  2. geography
  3. immune system
  4. trauma/ post neurosurgical
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13
Q

Bacterial meningitis

neonates specie?

A

GBS or e coli

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14
Q

bacterial meningitis species upto 50 yrs?

A

s. pneumoniae and N. meningitidis

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15
Q

bacterial meningitis more than 50 yrs?

A

s. pneumoniae and N. meningitidis

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16
Q

immunocompromised state bacterial specie?

A

s. pneumoniae and N. meningitidis

17
Q

clinical manifestations?

A

head ache, neck stiffness, fever and altered mental state

18
Q

clinical signs?

A

neck rigidity
kernig’s sign
brudzinski’s sign

19
Q

what test is used to diagnose meningitis?

A

lumbar puncture

20
Q

what are normal csf values in lumbar puncture?

A

normally clear, less than 5 lymphocytes and 0.5g protein a

completely sterile in culture

21
Q

bacterial meningitis csf findings?

A

neutrophilic, 100-500 protein mg/dL, cell count 1000-10000

22
Q

viral meningitis csf comp?

A

50-1000, lymphocytic, protein <200 mg/dL

23
Q

csf extra tests?

A

PCR: completed for meningicocci and pneumococci

india ink: pneumococci

24
Q

when to use CT or MRI for LP?

A
unconsciousness 
seizures
focal neurology 
post trauma 
papilloedema
25
complications of bacterial meningitis?
1. seizures 2. transentorial herniation: uncontrolled infection so it herniates and inflames 3. hydrocephalus- csf becomes sticky so accumulation of fluids in the ventricles and ballooning occurs 4. infarcts
26
Management of meningitis?
``` supportive care antimicrobial therapy steroids surgical intervention prophylaxis ```
27
what is key to meningitis diagnosis?
early recognition via checking ABCDE | antibiotic therapy and referral to hospital
28
supportive care for meningitis?
airway, breathing, circulation, nutrition, physiotherapy and rehabilitation
29
what needs checking for specific antimicrobial therapy?
``` pathogen sensitivities CSF penetration allergy renal function route (I.V. or I.T or I.M or orally) duration of therapy ```
30
good antibiotics for csf penetration?
penicillin, ceftrianxone and chloramphenicol
31
poor antibiotics in csf penetration?
vancomycin and gentamicin
32
neurosurgery in menigitis?
drain pus to relieve pressure in the brain abcess
33
prophylaxis?
antibiotics and vaccines