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infection > meningitis > Flashcards

meningitis Flashcards

1
Q

meningism

A

symptom complex

headache
photophobia
vomiting with muscle spasm
neck stiffness: stiffness on passive neck flexion is key

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2
Q

causes of meningism

A

meningitis
SAH
infection w bacteraemia

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3
Q

meningitis

A

infection of meninges
inflammation and meningeal irritation
can cause death, permanent disability

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4
Q

meningitis pathophysiology

A
  1. attachment to mucosal epithelial cells e.g.bacteria to nasopharynx mucosa, enterovirus to gut mucosa
  2. transgression of mucosal barrier
  3. survival in bloodstream
  4. entry into CNS
  5. production of overt infection in meninges +/- encephalopathy
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5
Q

common bacterial causes meningitis

A

neisseria meningitis
streptococcus pneumoniea

neonates: e.coli, group b strep

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6
Q

common viral causes meningitis

A 
enterovirus
parechovirus
coxasackie A, B 
mumps 
HSV
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7
Q

common non-infectious causes meningitis

A

tumour cells in CSF
drugs
SLE, sarcoid

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8
Q

aseptic meningitis

A

CSF elevated lymphocytes and protein

no organism cultured/detected

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9
Q

when should meningeal infection be suspecter

A

every pt with Hx URTI and one meningeal symtpoms

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10
Q

acute meningitis

A

signs/symptoms <24hrs and rapidly progressive e.g. meningococcal

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11
Q

subacute meningitis

A

signs/symptoms 1-7days e.g. viral

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12
Q

acute meningitis risk factors

A

recent skull trauma
DM
alcoholism
exposure to meningococcus

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13
Q

meningitis Ix

A

LP - CSF testing
blood cultures
CT if focal signs or papilloedema
FBC, U&Es, LFTs

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14
Q

CSF testing

A

biochem: Glc, protein
microbio: gram stain, differential cell count, bacterial culture, antigen detection test

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15
Q

normal adult CSF features

A 
clear
small number cells <5
mostly lymphocytes 
normal Glucose (60% blood level) 
normal protein
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16
Q

bacterial meningitis CSF features

A 
turbid 
inc cell number
mostly neutrophils
reduced Glc
inc proteins
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17
Q

viral meningitis CSF features

A 
clear to turbid 
inc cell number
mostly lymphocytes
glucose normal 
increased proteins
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18
Q

TB meningitis CSF features

A 
clear to turbid
inc cell numbers
lymphocytes or mixed
reduced Glc
inc protein
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19
Q

greatest risk factor for bacterial meningitis

A

colonisation

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20
Q

reducing death rate of acute meningitis

A

early clinical recognition
rapid antigen detection
rapid initiation bacteriocidaal antimicrobial Rx
early treatment of sequelae: DIC, acidosis
antibiotic prophylaxis for contacts

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21
Q

bacterial meningitis antibiotic therapy

A

benzylpenicillin only reaches CSF in sufficient amount if meningeal inflammation and 4hrly doses

ceftriazone reaches CSF in efficient quanitities only if inflammed meninges

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22
Q

meningococcal meningitis

A

neisseria meningitis
children and young adults

gram stain shows gram negative diplococci

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23
Q

meningococcal meningitis features

A

+/- septicaemia
petechial skin rash
meningeal symptoms
systemic upset

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24
Q

fulminant meningococcal septicaemia

A 
very sudden onset
purpuric skin rash
reduced consciousness, fever
septicaemic shock, renal failure CSF
CSF sterile
50% die first 24hrs
25
Q

MX meningococcal meningitis

A

if GP suspects it give parenteral penicillin prior to hosp transmission
ceftriazone prior to LP but after taking blood cultures
benzylpenicillin or ceftriaoxne
supportive management

rifampicin or ciprofloxacin at discharge to erradicate neisseria meningitidis carriage

26
Q

meningococcal meningitis bad prognostic markers

A

clinical: delay antib, extremes age, purpuric lesions, hyperpyrexia
lab: DIC, metabolic acidosis, absence polymorph leucocytosis

27
Q

what is most frequent cause bacterial meningitis in adults

A

pneumococcal meningitis - strep pneumoniae

28
Q

pneumococcal meningitis microbiology

A

gram positive diplococci

alpha haemolytic

29
Q

pneumococcal meningitis predisposing factors

A 
pnuemonia
sinusitis
alcoholism 
head trauma
endocarditis
splenectomy
30
Q

pneumococcal meningitis clinical

A

acute onset - 1/2 days
more likely to have reduced consciousness/focal neuro signs than meningococcal and hameophilus
petechiae uncommon
concurrent sinus/ear infection

31
Q

pneumococcal meningitis complications

A 
death
hearing loss
CN deficits
hemiparesis
hydrocephalus
seizures

dexamethasone reduces likehood of complications occuring

32
Q

pneumococcal meningitis management

A

early administration high dose ceftriaxone

33
Q

Hib meningitis clinical features

A

young kids
mild URTI then rapid detioration
fever, drowsy, lethargy
nuchal rigitidy often absent

late disaese: coma, seizures

34
Q

Hib meningitis microbiology

A

gram negative cocci and bacilli

35
Q

Hib meningitis treatment

A

ceftriaxone +/- dexamethasone

rifampicin prophylaxis to close contancts

36
Q

TB meningitis

A

meningitis follows rupture of subependymal tubercle into subarachnoid space

kids assoc w miliary TB or effusion

37
Q

TB meningitis clinical

A

subacute onset
lethargy
headache
change in mentation

38
Q

TB meningitis poor prognostic markers

A

extremes age
illness >2mo
neuro defiict

39
Q

leptospirosis and lyme disease

A

caused by spirochates

may cause apparent aseptic meningitis

40
Q

leptospirosis features

A 
septicaemic illness
fever, rigors
myalgia, vomiting
conjunctical effusion 
meningism 
rash
liver and renal damage
41
Q

lyme disease features

A

skin rash
neurological symptoms inc meningitis
peripheral or cranial neuropathies

42
Q

most common causes viral meningitis

A

enteroviruses - echovirus, coxsackie

43
Q

viral meningitis features

A

non-specific prodromal ilness
rapid onset: headache, photophobia, stiff neck, fever
rash if enteroviral
pt usually lucid and alert

44
Q

viral meningitis Ix

A

CSF PCR

  • enteroviruses
  • mumps
  • HSV
45
Q

viral meningitis prevention

A

MMR

good hand hygeine

46
Q

viral meningitis treatment

A

enterovirus and parechovirus: supportive Rx, usually recover 72hrs
chronic infection (immunocompromised): IVIg
HSV: aciclovir

47
Q

cryptococcal meningitis

A

cryptococcus neoformans

HIV, immunosuppressed, lymphoma, DM

48
Q

fungal meningitis microbiology

A

organism is yeast with a polysacharride capsule
gram stain shows yeast cells
culture C. neoformans
serum cryptococcal polysacharide antigen

49
Q

fungal meningitis clinical features

A 
subacute onset
fever
headache
nausea
lethargy 
confuson 
abdo pain 
mengism less common but can develop
50
Q

fungal meningitis Mx

A

parenteral amphocetin +/- flucytosine

high dose fluconazole as alternative

51
Q

fungal meningitis prevention

A

if HIV pt gets cryptococcal meningitis then prophylaxis with fluconazole

52
Q

how does neonatal meningitis differ from adult

A

features non-specific, not well localices

GBS, e.coli, l. monocytogenes

53
Q

neonatal meningitis predisposing factors

A

low birth wait
PROM
maternal DM

54
Q

group b strep

A

gram +ive cocci

benzylpenicillin, amoxycillin

55
Q

e.coli

A

gram - bacilli

cefotaxamine

56
Q

l.monocytogenes

A

g + bacilli

ampicillin and gentamicin

57
Q

neonatal meningitis early onset

A

within 3days birth
resp distress, ,bactermia

assoc w prematurity, difficult/prolonged birth

58
Q

neonatal meningitis late onset

A

> 1wk after birth

pulm involvement rare

59
Q

diagnosing neonatal meningitis

A

bacterial: CSF, blood cultures
viral: CSF, EDTA blood, faecal + nasopharyngeal secretions

infection (36 decks)

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