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Infectious Diseases > Meningitis / Encephalitis > Flashcards

Meningitis / Encephalitis Flashcards

1
Q

Meningitis is inflammation of…

A

Leptomeninges (inner two layers - arachnoid and pia mater). May be direct or haematogenous.

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2
Q

Broad causes of meningitis

A
  1. Infection (most common)
  2. Autoimmune disease e.g. SLE
  3. Adverse reaction to medication
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3
Q

Most common bacteria pathogens causing meningitis per age group

A
  1. Newborns: strep agalacticae (GBS), e coli, listeria
  2. Adolescents: n meningitides, s. pneumoniae, h influenzae (unvaccinated)
  3. Adults & elderly: strep pneumoniae, n meningitides, listeria monocytogenes
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4
Q

Viral causes of meningitis

A

Common:

  • Enteroviruses (coxsackie)
  • HSV
  • HIV

Uncommon:

  • Mumps
  • VZV
  • Lymphocytic choriomeningitis
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5
Q

Other infections causes of meningitis (fungal, parasitic, other bacterial)

A
  • Fungal: cryptococcal, coccidiodes
  • Tubercular meningitis
  • Parasitic: P falciparum
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6
Q

Ix and Rx algorithm for presentation of suspected bacterial meningitis

A

Blood cultures
Urgent LP
Commence dexamethasone and empiric antibiotics
CTB prior to LP if concern for raised ICP: focal neurology, papilloedema, new onset seizures, deteriorating conscious state

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7
Q

DDx meningitis

A

Focal CNS disease
SAH
Immunocompromised - risk of mass lesions

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8
Q

Initial rx regimen for suspected bacterial meningitis

  • Gold standard
  • If concern re listeria
  • If concern for MRSA/reduced sens strep
  • If severe hypersensitivity to pencillins
A

Dexamethasone 10mg IV with or prior to antis, then QID for 4/7

Cetriaxone 3g BD

ADD
Benpen 2.4g IV 4 hourly if concern for listeria (intrinsically resistant to cephalosporins) i.e. in >50y/o, immunocompromised.
Alternative if allergic: bactrim

ADD vancomycin
If gram stain - gram pos diplococci resembling staph OR strep (to cover MRSA, low sens strep), recent beta lactam use

IF severe hypersensitivity to penicillins - use moxifloxacin instead of cephalosporins

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9
Q

Which bacteria has dex shown efficacy against?

A

Reduces inflammation/damage from: strep pneumoniae, h influenzae, strep suis

No evidence for n meningitides - can consider stopping if it’s not the causative organism

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10
Q

Meningoencephalitis pathogens that may be associated with:

  1. Cerebellar ataxia
  2. Parotitis
  3. Gastrointestinal prodrome
  4. Flaccid paralysis
A
  1. EBV or VZV
  2. Mumps virus
  3. Shigellosis
  4. West Nile virus
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11
Q

HSV encephalitis:

  • Classic imaging findings
  • Complications
  • Mortality rate
  • Diagnosis
  • treatment
A
  • Imaging: frontoTEMPORAL lobe involvement on MRI
  • Complications; seizures, ICH, cerebral oedema, brainstem herniation, long-term neurocog impairment
  • Diagnosis: CSF HSV PCR positive. MRI brain is gold standard imaging for encephalitis.
  • Morality: 30% with treatment, >80% without treatment
  • Rx: IV acyclovir 10mg/kg TDS for 14-21 days
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12
Q

Encephalitis:
a. Most common infectious causes

b. Consider this organism in meningoencephalitis in elderly/immunocompromised
c. Consider this organism in HIV/immunocompromised
d. Non infectious causes

A

a. HSV is the most common cause of sporadic encephalitis
Consider: Murray Valley encephalitis virus, Hendra virus, enterovirus, JEV. Consider VZV, EBV, CMV, herpes B virus

b. Listeria
c. Toxoplasma gondii
d. Autoimmune e.g. anti-NMDAR encephalitis

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13
Q

VZV encephalitis:

  • Imaging findings
  • Clinical associations
  • Treatment
A

Vasculitis, strokes, demyelination, cerebral oedema
Usually associated with vesicular rash. May also have meningitis
Rx: Iv acyclovir

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14
Q

EBV encephalitis

  • Clinical features
  • Prognosis
  • Rx
A
  • Usually no EBV symptoms. Odd visual disturbances
  • Good prognosis
  • Supportive care
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15
Q

Herpes B virus

  • Cause
  • Clinical features
  • Mortality
A

Macaque monkey bites
Features: fevers, lymphadenitis, peripheral neuropathy followed by hemorrhagic meningoencephalitis
High morality
Rx: acyclovir

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16
Q

Lab investigations for encephalitis

  • CSF PCRs
  • Serum IgM and IgG
  • CSF IgM
  • Other?
A

CSF biochem:
Usually: elevated WCC with lymphocyte predominance, elevated protein, normal glucose, red cells usually absent

CSF PCRs:
- HSV-2, HSV-2, VZV, EBV, CMV, HHV6, enterovirus, measles, HIV, mumps, arboviruses, rabies

Serum IgG/IgM (most important if PCRs negative and not improving)
- VZV, EBV, CMV, measles, mumps, HIV borrelia

Consider the above depending on epidemiology
Consider CSF IgM
Consider resp PCR (rare)
Consider fungal Ix
Consider QFN gold
17
Q

West Nile V. encephalitis clinical features

A

Flaccid paralysis

Maculopapular rash also seen in half of cases - not expected with other viral encephalitides

18
Q

Encephalitis: involvement of thalamus or basal ganglia on imaging may indicate which viral aetiologies?

A

Respiratory viral infection
Creutzfeldt-Jakob disease
Arbovirus
TB

19
Q

Aside from HSV, which other causes of viral encephalitis may have temporal involvement on imaging?

A

VZV, EPV, HHV6

20
Q

Encephalitis: presence of hydrocephalus on imaging may suggest?

A

Non-viral aetiology, bacteria, fungal

21
Q

What is the most common viral cause of meningitis

A

Enteroviruses (coxsackie or echovirus)

Infectious Diseases (13 decks)

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