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MD2 Microbiology > Meningitis and Encephalitis > Flashcards

Meningitis and Encephalitis Flashcards

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1
Q

What is meningitis and encephalitis?

A

Meningitis = inflammation of meninges

Encephalitis = inflammation of branc parenchyma

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2
Q

What barriers exist to prevent CNS infection?

A

Physical barriers - skull, vertebrae, meninges

Blood brain barrier

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3
Q

How can pathogens cause CNS infection?

A

BArriers must be disrupted

  • Capsule - neurotropic virulence factor
  • Bloodstream infection combined with immature BBB
  • Trauma - disruption in physical barriers
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4
Q

What is the classic triad of meningitis presentation?

A
  • Fever
  • Altered mental state (confusion, drowsiness)
  • Neck stiffness
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5
Q

What three symptoms are seen in meningism?

A

Headache + photophobia + neck stiffness

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6
Q

Sequelae of meningitis?

A
  • Raised ICP due to cerebral oedema → headache, nausea, vomiting
  • Neurological signs → seizures, hemiparesis, nerve palsies
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7
Q

Is recovery common in meningitis?

A

Yes. complete recovery is very common

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8
Q

CLinical features of encephalitis?

A

Much the same as meningitis

  • Headache, fever, nausea
  • Altered mental status → confusion, drowsiness
  • Seizures
  • Focal neurological abnormalities → hemiparesis, herve palsies, speech/movement disorders
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9
Q

Which is more likely to cause permanent neurological sequelae - meningitis or encephalitis?

A

Encephalitis

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10
Q

Causes of meningitis: bacterial (3), viral (1), fungal (1)?

A

Bacterial:

  • Neisseria meningitidis
  • Streptococcus pneumoniae
  • Listeria monocytogenes

Viral:

  • Enteroviruses

Fungi:

  • Cryptococcus
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11
Q

2 viral causes of encephalitis?

A
  • Herpes simplex virus 1
  • Arboviruses - JEV, West Nile, Murray valley
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12
Q

Majority of encephalitis is ____ and meningitis is _____

A

Encephalitis = viral

Meningitis = bacterial

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13
Q

Which bacteria are often asymptomatically carried in nasopharynx?

A

Neisseria meningitidis and streptococcus pneumoniae.

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14
Q

Neisseria meningitidis, streptococcus pneumoniae and listeria monocytogenes - Gram stain and treatment?

A

Neisseria meningitidis

  • Gram neg - pink stain
  • IV ceftriaxone

Streptococcus pneumoniae

  • Gram positive - purple stain
  • IV ceftriaxone

Listeria monocytogenes

  • Gram positive - purple stain
  • Not treatable by ceftriaxone
  • Most common on ends of age spectrum - neonates and older adults
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15
Q

Is there a meningococcal vaccine?”

A

Yes - routine in Aus - serogroup A/C/W/Y

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16
Q

Prognosos of Neisseria and Streptococcus CNS infection with treatment

A

Still have 15-20% mortality with treatment of both.

17
Q

Which bacterial CNS infectio may result in pregancy loss?

A

Listeria monocytogenes

18
Q

Common causes of meningitis and neonate and why?

A

BActerial meningitis is most common in first month of life - underdeveloped immune system and BBB

Causes:

  • Strep agalactiae
  • E. coli
  • Enterobacteriaceae
19
Q

Commonest cause of viral meningitis and treatment?

A

Enteroviruses

No specific treatment.

20
Q

Two subtypes of fungal cause of meningitis

A

Crytpcoccus neoformans and gattii

21
Q

Which demographic is fungal meningitis most often seen

A

Immunocompromised

22
Q

What is the most common cause of viral encephalitis?

A

HSV-1

23
Q

What is the worst kinda of viral encephalitis?

A

Arboviral - Murray Valley, West Nile, JEV

Getting encephalitis from arboviruses is rare, but is really bad if you do get it

  • 33% mortality
  • Permanently neurological abnormalities
24
Q

Treatment for HSV-1 encephalitis?

A

Antivirals - aciclovir

Still 10%-30% mortality

25
Q

Sequelae of HSV-1 encephalitis?

A
  • Disseminated infection
  • Cognitive impairment
26
Q

Gold standard of meningitis and encephalitis diagnosis?

A

Lumbar puncture with CSF analysis.

CSF tested for:

  • protein and glucose
  • Microscopy, culture and sensitivities (MC&S)
  • PCR
27
Q

ROle of CT and MRI in meningitis/encephalitis diagnosis?

A

CT

  • Looks normal in both conditions
  • Used to exclude other conditions

MRI

  • More sensitive
28
Q

What can a gram stain tell you about causes of meningitis?

A

Gram negative diplococci - Neisseria meningitis

Gram positive diplococci - Streptococcus pneumoniae

Gram postivie bacilli - Listeria monocytogenes

29
Q

Findings of MC&S?

A

Normal CSF is clear, high WCC will make it turbid.

Raised WCC = pleiocytosis

Neutrophilic pleiocytosis = bacterial cause

Mononuclear pleiocytosis = viral cause

30
Q

What is the definitive way to diagnose viral meningitis/encephalitis?

A

PCR

MD2 Microbiology (2 decks)

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