meningitis and TB Flashcards
what causes meningitis?
Bacterial infection
- meningococcus or pneumococcus
- streptococcus pneumoniae
- neisseria meningitis
Viral infection
- HSV, VZV, HIV
fungal infection
- cryptococcosis, aspergilloma
what are the early signs of meningitis?
headache fever leg pains cold hands and feet absnormal skin colour
what are the late signs of meningitis?
neck stiffness
photophobia
+ve Kernigs and Brudzinskis (Kernig’s = knee, Brudzinski’s = back of head)
reduced GCS or coma
seizures and focal CNS signs
petechial rash
shock
what investigations are performed in meningitis?
blood culture serum pneumococcal and meningococcal PCR viral gargle and culture lumbar puncture FBC neuroimaging
what would FBC show in meningitis?
leucocytosis, anaemia and thrombocytopenia
hypocalcaemia or hypokalaemia
hyponatraemia
hypo or hyperglycaemia
what would LP show in BM?
turbid CSF appearance raised cell count neutrophils and lympocytes Glucose <1/2 plasma value Increased protein
What would LP show in VM?
clear appearance increased cell count lymphocyte predominate normal glucose increased protein (less than BM)
when is an LP contraindicated in meningitis?
Brain shift Rapid GCS decline Resp/cardiac compromise severe sepsis coagulopathy
how is BM treated?
Supportive care
IV dexamethasone 10mg 6hourly for 4 days
IV ceftriaxone
- chloramphenicol if B-lactam allergic
how is VM treated?
supportive care
IV aciclovir
how is fungal meningitis treated?
amphotericin B + fluconazole
what are the complications of meningitis?
HACTIVE
- hydrocephalus
- abscess
- cerebritis/cranial nerve lesion,
- thrombosis
- infarct
- ventriculitis/vasculopathy
- extra-axial collection
Shock, seizures, sepsis
Cognitive, academic or behavioural issues
what bacterium causes TB?
mycobacterium tuberculosis
what are the systemic features of TB?
low grade fever anorexia weight loss fatigue night sweats clubbing erythema nodosum
what are the pulmonary symptoms of TB?
cough pleurisy haemoptysis pleural effusion SOB
what are the LN, GI, spinal and CNS symptoms of TB?
painless cervical lymphadenopathy
ileocaecal disease with colicky abdo pain and vomiting
bowel obstruction due to thickening
Chronic back and bony tenderness. Neuro symptoms. Potts vertebrae
headache, meningism, confusion, seizures, focal neuro deficit
what is Pott’s vertebrae?
Spinal tuberculosis (TB) or Pott’s spine is the commonest extrapulmonary manifestation of TB. It spreads through hematogenous route. Clinically, it presents with constitutional symptoms, back pain, tenderness, paraplegia or paraparesis, and kyphotic or scoliotic deformities
what InV are done in TB?
CXR
- fibronodular opacities in upper lobes
- hilar lymphadenopathy
- Ghon lesion
- Pleural effusion
Sputum acid fast bacilli smear
- Ziehl Neelson stain positive for TB
sputum culture
FBC
- leucocytosis and anaemia
Mantoux test
what is the treatment of TB?
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
(RIPE)
R&I for 4 months, P&E for 2
what are the SE’s of rifampicin?
red body secretions and LFT derrangement
what are the SE’s of Isoniazid? what drug must be given alongside?
peripheral neuropathy (secondary to B6 depletion) - pyridoxine given alongside
hepatitis
what are the SE’s of pyrazinamide?
hepatotoxic
what are the SEs of ethambutol?
colour blindness
decreased visual acuity
optic neuritis
what are the complications of TB ?
ARDS PTX Meningitis Empyema bronchiectasis Neuro deficit
