Micro U3 L3.

Question 1

What is the MC form of meningitis in the US?

Answer 1

viral - usually resolve without treatment

Question 2

What is the MC cause of viral meningitis? Symptoms?

Answer 2

enterovirus - usually cause no symptoms or illness

Question 3

What are other causes of viral meningitis besides enterovirus?

Answer 3

HSV, EBV, influenza, mumps, measles, VZV, arboviruses

Question 4

MCC of bacterial meningitis - who is at greatest risk?

Answer 4

streptococcus pneumoniae - infants under 2 and compromised immune systems

Question 5

Meningococcal meningitis

Answer 5

MCC of bacterial meningitis in children and young adults, highly contagious, neisseria meningitidis

Question 6

Which common cause of bacterial meningitis has had a decreased incidence due to vaccination?

Answer 6

haemophilus influenzae type b

Question 7

What are the MC causes of meningitis in the neonate?

Answer 7

group b strep, escherichia coli, listeria monocytogenes (passed mother to baby)

Question 8

Chronic meningitis causes

Answer 8

mycobacterium tuberculosis (TB), treponema pallidum (syphilis), fungi

Question 9

MCC fungal meningitis

Answer 9

crytococcus neoformans (found in dirt and bird droppings) - usually seen in immune-compromised patients

Question 10

Which form of meningitis is not contagious?

Answer 10

fungal = inhale spores from environment

Question 11

parasitic meningitis - MC - treatment

Answer 11

rare, lethal = naegleria fowleri (single cell in warm water lakes and rivers) = no antimicrobial agents so frequently fatal

Question 12

encephalitis causes

Answer 12

HSV, enteroviruses, rabies, arboviruses (bacterial, fungal, parasitic encephalitis are rare)

Question 13

MC arbovirus encephalitis in the US

Answer 13

West Nile virus

Question 14

Which encephalitis tends to be the most severe?

Answer 14

EEE (eastern equine encephalitis)

Question 15

Which encephalitis has a vaccine?

Answer 15

Japanese encephalitis in rural farming areas in Asia

Question 16

Signs and symptoms of meningitis and encephalitis

Answer 16

fever, headache, stiff neck, sensitivity to light, mental changes, lethargy (encephalitis may also include neurological problems)

Question 17

Which group is at highest risk for complications?

Answer 17

newborns

Question 18

How does normal CSF analysis appear?

Answer 18

clear and colorless (like water)

Question 19

CSF protein

Answer 19

small amount normally present in CSF - increases common with meningitis, brain abscess, neurosyphilis

Question 20

CSF glucose

Answer 20

normal = 2/3 concentration of blood glucose - decreased when there are abnormal cells metabolizing such as bacteria or WBCs

Question 21

How does the WBC differential change in a bacterial infection? viral infection? parasitic?

Answer 21

bacterial: increase neutrophils. viral: increase lymphocytes. parasitic: increase eosinophils

Question 22

What are the follow up tests to abnormal CSF?

Answer 22

detection of viruses with PCR, CSF cryptococcal antigen to detect fungal infection, AFB smear for TB, VDRL for syphilis

Question 23

CSF lactic acid

Answer 23

increased with bacterial and fungal meningitis

Question 24

CSF lactate dehydrogenase

Answer 24

used to differentiate between bacterial and viral meningitis

Question 25

CSF C-reactive protein (CRP)

Answer 25

acute phase reactant and elevated with inflammation - increased with bacterial meningitis

Question 26

procalcitonin

Answer 26

high blood level is strong indication of bacterial meningitis

Question 27

What difference in the titer of antibody between two samples collected a month apart indicates a recent infection by a microorganism?

Answer 27

four fold increase

Question 28

EEG

Answer 28

electroencephalography - detects abnormal brain waves

Question 29

Which causes of meningitis/encephalitis have vaccines?

Answer 29

haemophilus influenzae type b, streptococus pneumoniae, neisseria meningitidis

Question 30

Neisseria meningitidis - what can be done for prevention?

Answer 30

meningococcal - vaccine or antibiotics for a few days if they had close respiratory contact with it

Question 31

Treatment of encephalitis and menigitis

Answer 31

targeted to cause of infection along with bed rest, fluirds, pain relief, anti-inflammatory drugs, anti-seizure medication, sedatives, anti-nausea agents, corticosteroids to reduce tissue and brain swelling

Question 32

Treatment for bacterial causes of encephalitis/menigitis

Answer 32

broad-spectrum antibiotic - must be able to pass BBB - IV - continued for weeks, months or years - drain infected abscesses or sinuses