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Neuro 2 > Micro: Bacterial Meningitis > Flashcards

Micro: Bacterial Meningitis Flashcards

1
Q

Bacterial Meningitis

A

medical EMERGENCY
Sx: headache, vomiting, stiff neck, fever, photophobia, irritability, varying degrees of neurological dysfunction
Dx: gram stain and culture of CSF and blood, rapid antigen detection, PCR
CSF: PMNs, elevated protein, reduced glucose

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2
Q

bacterial meningitis agents: birth to 3 months

A

Group B strep (strep. agalactiae)
enteric GNR
Listeria

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3
Q

bacterial meningitis agents: 3 months to 2 years

A

Strep. pneumoniae
N. meningitides
H. influenzae type B

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4
Q

bacterial meningitis agents: 2 years to 18 years

A

N. meningitides

Strep. pneumoniae

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5
Q

bacterial meningitis agents: older patients

A 
S. pneumoniae
N. meningitidis
H. influenzae
Listeria
Gram neg.: enteric, P. aeruginosa
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6
Q

bacterial meningitis: immunocompromised

A

Staph
enteric GNR
P. aeruginosa
Listeria

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7
Q

Streptococcus pneumoniae virulence factors

A
  1. capsule
  2. pili
  3. cell wall components
  4. choline binding proteins
  5. hemolysins
  6. H2O2
  7. Neuraminidase
  8. IgA Protease
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8
Q

capsule

A

interferes with phagocytosis

S. PNEUMONIAE, N. MENINGITIDIS, H. INFLUENZAE, CRYPTOCOCCUS

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9
Q

pili

A

attachment of encapsulated bacteria cell to epithelial cell in upper respiratory tract: initial event in invasive disease
S. PNEUMONIAE, N. MENINGITIDIS

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10
Q

cell wall components

A

inflammation that causes Sx of pneumonia, otitis media, meningitis
S. PNEUMONIAE

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11
Q

choline binding protein

A

adhesion that interacts with pulmonary epithelial carbohydrates
allow: CROSS BBB in MENINGITIS
S. PNEUMONIAE

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12
Q

hymolysins

A

lyse host cell and activate complement

S. PNEUMONIAE

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13
Q

H2O2

A

damage host cell and bactericidal effect against S. aureus

S. PNEUMONIAE

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14
Q

neuraminidase

A

invasion of host tissue at mucosal surface

S. PNEUMONIAE

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15
Q

IgA protease

A

destruction of IgA at mucosal surface

S. PNEUMONIAE

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16
Q
  1. pneumovax

2. prevnar

A

S. pneumo vaccines

  1. multivalent, non-conjugated; older patients and high risk groups
  2. heptavalent (or 13), conjugated, anamnestic (memory) response; infants
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17
Q

meningitis in crowded conditions (jail, day care, military)

A

N. meningitidis

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18
Q

Meningococcal Meningitis

A

N. meningitidis
Early: neck stiff, mental change
Late: PETECHIA, PURPURA
VERY RAPID PROGRESSION

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19
Q

lipooligosaccharide (LOS/ LPS)

A

N. meningitidis

ENDOTOXIN

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20
Q

phase variation

A

allows invasion
turning off CAPSULE (many other systems) genes, then turning them on again once in blood stream
ON-OFF control
N. MENINGITIDIS

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21
Q

Tx of N. meningitidis

A

PENICILLIN
if allergic/ resistant: 3rd generation cephalosporin and vancomycin
give dexamethasone first

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22
Q
  1. menomune

2. menactra

A 
N. MENINGITIDIS vaccines
for: A, C, Y, W135
neither covers serogroup B
1. unconjugated; military and high risk
2. conjugated; children 11-12 yrs old
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23
Q

antigenic variation

A

N. gonorrhoeae: pili genes

change in genes leading to expression of different forms of similar genes

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24
Q

What serotype is most important pathogen of H. influenzae?

A

Hib

serotype B

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25
Q

Hib

A

H. influenze vaccine
capsule conjugated to carrier protein (diphtheria toxoid added because T capsule is T cell independent)
children 2-15 months

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26
Q

Who does H. influenzae occur in?

A

unvaccinated children

also can have: non-typable H. flu

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27
Q

What kind of immunity is required to combat Listeria and why?

A

CELL MEDIATED

intracellular parasite

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28
Q

Who does Listeria meningitis and bacteremia occur in?

A
  1. immune-compromised adults: AIDS
  2. pregnant women
  3. infants
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29
Q

can amplify during cold storage in unpasteurized food

A

LISTERIA MONOCYTOGENES

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30
Q

invades epithelial cells and MACROPHAGES

Mechanism?

A

LISTERIA

  1. endocytosis
  2. Listeriolysin O: release from phagolysosome
  3. F-actin based motility
  4. invasion of adjacent cell
  5. replication
  6. cell death
31
Q

internalin

A

binds E-cadherin expressed on epithelial cell: mediates endocytosis
LISTERIA

32
Q

How does Listeria spread?

A

spreads directly cell to cell

avoids exposure to humoral immune system

33
Q

F-actin

A

motility

Listeria

34
Q

listeriolysin

A

release from phagolysosome

Listeria

35
Q

Strep. pneumoniae risk factors

A
  1. splenic dysfunction
  2. skull fracture, anatomic defect
  3. severe ear infections
  4. cochlear implant
  5. AIDS
36
Q

oxidase positive

A

N. MENINGITIDIS

37
Q

Tx for N. meningitidis

A

dexamethasone
Pen
3rd gen cephalosporin

38
Q

3rd gen. cephalosporin

A

cefotaxime

ceftriaxone

39
Q

Requires Factor X (hemin) and V (NAD/NADP)

A

H. influenzae

40
Q

can cause epiglottis

A

H. influenzae

41
Q

Rank order of otitis media in children

A
  1. Strep. pneumo
  2. H. flu
  3. Morexella
42
Q

H. flu Tx

A

dexamethasone and 3rd gen cephalosporin

43
Q

Other Haemophilus infections

  1. H. ducreyi
  2. H. aphrophilus
A
  1. soft chancre

2. part of HACEK: subacute bacterial endocarditis on defective heart valves

44
Q

gram (-) kidney bean

A

N. meningitidis

45
Q

gram (+) club shaped

A

Listeria

46
Q

What meningitis bacteria may not show up on gram stain?

Why?

A

Listeria

facultative anaerobe

47
Q

unpasteurized food, hot dogs, deli meat

A

Listeria

48
Q

empiric Tx of bacterial meningitis

A

ceftriaxone
add ampicillin if suspect: Listeria
add vancomycin if suspect: S. pneumo

give dexamethasone before antibiotics

49
Q

fungal meningitis

A

IMMUNOCOMPROMISED, contaminated epidural steroid injection
blood stream to CNS
Dx: CSF sample, antigen detection for Cryptococcus
Tx: amphotericin B for extended time and flucytosine/ voriconazole

50
Q

Cryptococcus neoformans

A

MOST COMMON fungal meningitis
IMMUNOCOMPROMISED: HIV
Dx: antigen detection of capsule, CSF: YEAST with HALO in INDIA INK
PIGEON DROPPINGS
NOT dimorphic: encapsulated yeast
initially asymptomatic pulmonary infection with increased ICP

51
Q

Cryptococcus gatti

A

SUB-TROPICAL region
found on trees
healthy people

52
Q

Exserohilum rostratum

A

fungal meningitis in healthy people that
received epidural steroid injection
found in black mold
Dx: culture CSF and send to CDC for PCR

53
Q

Viral meningitis

A

mild and self resolving
Sx: fever, headache, stiff neck, pt. does not appear extremely ill
CSF: low glucose, high: protein, WBC, PMN
Tx: as if fungal/bacterial just in case it is

54
Q

Causes of viral encephalitis

A
  1. arbovirus
  2. enterovirus
  3. HSV-1
55
Q

arbovirus

A

MOSQUITO/ TICK
encephalitis
replicate: spleen, macrophage, lymph node
req. SECONDARY VIREMIA for systemic infection
includes flaviviruses?

56
Q

HSV encephalitis

A

TEMPORAL LOBE
CSF: RBC due to NECROSIS
Dx: PCR (can get false negative)
Tx: acyclovir (curable if treated early, high mortality without Tx)

57
Q

enterovirus

A

meningitis, encephalitis: family epidemic: URI or GI

58
Q

Causes of viral meningitis

A

MOST: enterovirus
other: Mumps (without MMR)
recurrent aseptic: HSV-2, HIV, VZV

59
Q

flaviviridae

A

enveloped, + RNA
INSECT transmission
includes: Hep C. and flaviviruses: St. Louis encephalitis, West Nile, Japanese encephalitis

60
Q

Replication cycle of Flavivirus

A
  1. endocytosis; pH dependent
  2. host ribosomes replicate RNA: single polyprotein cleaved by proteases
  3. viral polymerase replicates RNA
  4. transport to cell surface and release
61
Q

St. Louis encephalitis

A

arbovirus/flaviviridae
syndromes: febrile headache, aseptic meningitis, encephalitis
low fatality (die in 1st 2 weeks if die)

62
Q

West Nile

A

arbovirus/flaviviridae
mosquitos: blood from infected birds
Sx: febrile headache, MYALGIA, RASH, SWOLLEN LYMPH NODES
if severe: stiff neck, stupor, coma, death
Tx: supportive

63
Q

Japanese encephalitis

A

arbovirus/flaviviridae
ASIA
has VACCINE

64
Q

Togaviridae

A

enveloped, + RNA

includes: Rubivirus (rubella) and alpha viruses (western equine encephalitis, EEE, VEE)

65
Q

alphavirus

A 
asymptomatic to severe
replicates: muscle, fibroblasts
Sx: 2 week failure then abrupt encephalitis
Pts. become COMATOSE and DIE
NO Tx
66
Q

Bunyaviridae

A

enveloped, segmented, (-) RNA
California encephalitis, La Crosse encephalitis
replication like influenza but exclusively in cytoplasm

67
Q

LaCrosse encephalitis

A

bunyaviridae
most COMMON cause of arboviral induced PEDIATRIC encephalitis
SEIZURE, FOCAL NEURO Sx
low mortality

68
Q

Rhabdoviridae

A

enveloped, (-) RNA
BULLET SHAPED
Lyssavirus (RABIES), vesiculoviruses
replication similar to paramyxovirus: except enters cell in pH dependent manner

69
Q

Rabies

A

replicates in muscles then in neurons: disseminates once reaches brain
high concentrations in SALIVARY GLAND
transmission: ANIMAL BITE, open wound, inhalation
long incubation: 1 week -3 months depending on how close brain is to wound
effects in: limbic, midbrain, hypothalamus

70
Q

phases of rabies infection

A
  1. prodromal: mild Sx, abnormal sensation around bite
  2. acute neurologic: furious rabies or paralytic rabies; hydrophobia (exaggerated gag, resp. tract reflex)
  3. coma: death due to respiratory arrest
71
Q

Rabies Tx

A

postexposure prophylaxis: effective due to long incubation
anti-rabies Ig
multiple doses of rabies vaccine

72
Q

Arenaviridae

A

enveloped, segmented, AMBISENSE RNA
contain host cell ribosomes: SANDY
LMCV

73
Q

Arenaviridae replication

A
  1. pH dependent endocytosis
  2. genome used as a template for transcription: NP and L mRNAs produced
  3. polymerase then produces full length antigene for each segment
  4. (+) sense antigene is used as template for transcription of glycoprotein nRNA
  5. assembly and release
74
Q

lymphocytic choriomeningitis (LMCV)

A 
arenavirdae
inhalation of RODENT FECES or saliva
initial phase: fever, headache, N/V
later: ASEPTIC MENINGITIS
most recover, can get DEAFNESS

Neuro 2 (10 decks)

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