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Micro - Clinical Neuro > Meningitis/Bacterial CNS Infections > Flashcards

Meningitis/Bacterial CNS Infections Flashcards

1
Q

1 cause of bacterial meningitis?

A

Strep pneumo b/c of the capsule

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2
Q

what does it mean when neutrophils predominate in CSF?

A

bacterial infection

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3
Q

gram (-) cocci

A

Strep pneumo

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4
Q

gram (-) diplococci

A

Neisseria meningitidis

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5
Q

gram (-) rod

A

Haemophilus

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6
Q

parasites that cause encephalitis

A

Tosoplasma
Cryptococcus
Plasmodia

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7
Q

bacteria that cause encephalitis

A

Borrelia

Legionella

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8
Q

most common mechanism of meningitis

A

infection of cells lining the BBB

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9
Q

gram + cocci

A

Step agalactiae

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10
Q

gram (-) rod

A

E. coli

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11
Q

Gram + rod

A

Listeria

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12
Q

most common causes of bacterial meningitis in neonates?

A

Group B strep (Strep agalactiae)
enterics (E. coli)
Listeria monocytogenes

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13
Q

most common causes of bacterial meningitis in infants and kids i.e. older than 4 weeks?

A

Strep pneumo
N. meningitides
H. flu b (vaccine now so very uncommon)

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14
Q

cause of bacterial meningitis in teens and adolescents?

A

N. meningitidis

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15
Q

cause of bacterial meningitis in elderly?

A

Strep pneumo

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16
Q

which bugs have capsules that cause bacterial meningitis?

A

N. meningitidis, H. flu, Strep pneumo, Strep agalactiae, E. coli

  • the capsule is the virulence factor that helps bug cross BBB, survive/escape phagocytosis or opsonization
  • capsule is in the H. flu vaccine
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17
Q

infant meningitidis

A
  • nuchal rigidity, opisthotonos, bulging fontanelle, convulsions, photophobia, lethargy, irritability, seizures, coma
  • will have cardinal signs = fever, vomiting (common but not specific), nuchal rigidity
18
Q

what does a maculopapular or petechial rash tell you?

A

meningococcal meningitis = N. meningitidis

19
Q

pneumococcal meningitis

A
  • gram (+) diplococci
  • meningitis after bacteremia, sinusitis, otitis media; primarily in peds; sickle cell, elderly, and asplenic pts at higher risk
  • respiratory transmission; pts usually have pneumonia symptoms before it progresses to meningitis
  • dx: culture and gram stain; increased PMNs in CSF
  • tx: combo therapy; ceftriaxone + ampicillin
    if more than 2% resistance = ceftriaxone + vancomycin
  • prevention: vaccine schedule; 1 from 2-23 months; 2nd one over age 5
20
Q

Neisseria meningitidis

A
  • gram (-) diplococci
  • young healthy adults, teenager, military recruits, prisons, college dorms
  • inhaled, goes to pharynx into blood into CSF; doesn’t go to lungs
21
Q

N. meningitidis clinical disease

A
  • headache, fever, stiff neck from inflammation of meninges
  • LOS; cytokine storm, septic shock
  • will have recurrent infections if deficient in C6-9 = can’t make MAC
  • petechial/pupuric rash, DIC, shock
22
Q

Waterhouse-Friedrichsen syndrome

A
  • result of N. meningitidis
  • hemorrhagic necrosis of adrenal glands, fever, septic shock, DIC
  • very high mortality
23
Q

N. meningitidis: dx and tx

A
  • gram stain of CSF = increased WBCs
  • culture of blood and CSF
  • tx = ceftriaxone + ampicillin
    use chloramphenicol if pt allergic to penicillin
    give 2d rifampin prophylaxis to family members
24
Q

H. flu b

A
  • gram (-) coccobacilli
  • has capsule; look for unvaccinated pt hx
  • maternal antibody protects baby for 3-4 months; need to vaccinate babies early
25
Q

H flu b: dx, tx, prevention

A
  • dx: gram stain CSF, culture of blood and CSF
    does NOT grow on MacConkey or blood agar; culture on chocolate agar
  • tx: cefotaxime or ceftriaxone; rifampin prophylaxis for patient contacts
  • prevention w/ vaccine
26
Q

neonate meningitis - pathogenesis

A
  • acquired from vaginal tract via rupture of membranes = group b strep, E. coli, Listeria
  • travels in blood to meninges = local host immune response
  • can spread on respiratory equipment = Serratia marcescens, Pseudomonas, Proteus
  • uncommon but high mortality = Citrobacter, Salmonella, Proteus; would see brain abscesses
27
Q

clinical symptoms of neonate meningitis

A
  • will not have the “cardinal signs” usually
  • lethargy, irritability, fever or hypothermia, seizures, jaundice, shock
  • BULGING FONTANELLE = inc. ICP
28
Q

Group B strep

A
  • Strep agalactiae = gram + cocci in short chains
  • dx w/ gram stain, culture
    CAMP test = beta-hemolytic; bacitracin resistant; Group B strep antigen in CSF
  • tx = penicillin G or ampicillin; vanco if allergic to penicillin
  • prevention: no vaccine; can do chemoprophylaxis in neonates
29
Q

E. coli

A
  • gram (-) rods
  • at time of birth or shortly after
  • beta hemolytic on blood agar; K1 capsule
  • dx w/ LP and CSF culture: lactose + on MacConkey; indole +
  • tx w/ ceftriaxone
30
Q

Listeria monocytogenes

A
  • gram + rods in pairs/short chains
  • mom gets it from cold cuts, baby exposed during birth
  • in adults = IC pts
  • neonates = bulging fontanelle, PMNs in CSF, could have seizures
  • dx w/ blood culture, LP - CSF culture; will grow in cold; CAMP test
  • tx w/ ampicillin (+ gentamicin); TMP-SMX if allergic to penicillin
31
Q

neurotoxins: 2 of them + general info

A
  • Clostridium botulinum and C. tetani
  • anaerobic, gram + rods, spore-forming
  • GI (botulinum) and wound infections (tetani)
32
Q

C. botulinum

A
  • adult = home canning food; baby = honey
  • heat-labile toxin that inhibits ACh
  • adults: blurred vision, dry mouth, dilated pupils, abd pain, no fever, CONSTIPATION
  • infant: floppy baby syndrome = flaccid paralysis, constipation, “failure to thrive”
  • dx: H&P; culture food source or fecal sample (baby)
  • tx: antitoxin ASAP, then antibiotics
33
Q

C. tetani

A
  • toxin blocks glycine and GABA release
  • lock jaw in most cases, drooling, dysphagia, hydrophobia
  • CSF usually normal so dx by H&P
  • descending spastic paralysis
  • tx = supportive care, wound debridement; antimicrobial therapy = metronidazole, penicillin; tetanus immunoglobulin to bind toxin
34
Q

aseptic meningitis

A
  • caused by bacteria and viruses (usually viruses) = no bugs in CSF
  • inflammation of meninges, headache and fever, increased lymphocytes
35
Q

neurosyphilis

A
  • primary = painless ulcer; secondary = copper colored rash; tertiary = neurosyphilis
  • also affects heart and causes gummas
  • can detect w/ VDRL
  • CSF = inc WBCs, inc protein, dec glucose
  • increased risk in AIDS pts
  • tx w/ penicillin G
36
Q

Lyme disease

A
  • CN palsies, meningitis, chronic meningoencephalitis
  • stage 1 = bulls eye rash; stage 2 = can get into CSF
  • will have negative VDRL, some neutrophils in CSF, hx of tick bite
  • tx w/ ceftriaxone
37
Q

Leptospira

A
  • obligate aerobic spirochetes
  • causes aseptic meningitis during second phase of disease
  • risk factors = hx, Hawaii, jet skis (bug you get from rat poop contaminating water)
  • tx = IV penicillin G (severe) or for mild you can use doxycycline, ampicillin, amoxicillin
38
Q

Brucellosis

A
  • intracellular bacteria
  • headache, depression, fatigue, acute meningoencephalitis
  • common risk factors = being a vet, farmer; but found in aborted sheep/cow fetuses
  • dx w/ serology or blood cultures
  • tx = doxycycline w/ rifampin and/or TMP-SMX
39
Q

Mycobacterium tuberculosis

A
  • acid-fast bacilli, gram +
  • usually pulmonary; associated w/ military TB
  • gradual onset of apathy, anorexia, malaise; photophobia, nuchal rigidity, impaired consciousness
  • tx = isoniazid, rifampin, pyrazinamide, streptomycin
40
Q

Nocardia

A
  • gram +, catalase + (filamentous) rods
  • dx w/ CT or MRI; CSF will have inc leukocytes and protein, dec glucose
  • tx = surgery for lesions; sulfonamides for CNS penetration
41
Q

other bacteria in CNS infections

A
  • bartonella henselae
  • rickettsia ricketsii
  • mycoplasma

Micro - Clinical Neuro (4 decks)

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