Microbiology Flashcards
What is an infection of the brain parenchyma called?
Encephalitis
or
Brain Abscess
What is an infection of the meninges called?
meningitis
What is an infection of the spinal cord tissue called?
myelitis
What is the definition of meningitis?
Meningitis is an inflammation of meninges with exudative response in CSF
Infectious agents that can cause meningitis include:
bacteria
viruses
fungi
What is the #1 cause of meningitis in the US? Out of the US?
USA: Streptococcus pneumoniae
Other: Haemophilus Influenzae Type b
What are conditions that predispose patients to bacterial meningitis?
- Age: very young or very old
- Immunocompromised state
- basal skull fracture
- head trauma, post neurosurgery
- cerebrospinal fluid shunt
What are key steps in the development of bacterial meningitis?
- Hematogenous delivery of bacteria to subarachnoid space
- Host immune response
- Edema
- Increased intracranial pressure
- Decreased cerebral blood flow
- Damage, seizures, herniation
What are the clincal presentations of bacterial meningitis?
Headache
Fever
Meningismus - Irritated meninges (i.e. stiff neck)
Altered sensorium
Kernig’s sign
Brudzinski’s sign
What is Kernig’s sign?
positive when the thigh is bent at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful (leading to resistance)
What is Brudzinski’s neck sign?
appearance of involuntary lifting of the legs when lifting a patient’s head, while lying down
What diagnostic laboratory tests suggest bacterial meningitis?
CSF findings:
WBC count >= 1000/mm3
Cell differential: Mostly PMNs
Protein: Mild to marked elevation
CSF-to-serum glucose ratio: Normal to marked decrease
What are characteristics of Neisseria?
Gram (-) cocci in pairs
Oxidase +
(have cytochrome C oxidase)
Aerobic
Can multiply in microaerophilic conditions
Cultured on chocolate agar
Sugar reactions are completed to determine species
What are key virulence factors of Neisseria meningitidis?
Capsule
Antiphagocytic: interfere with complement deposition and prevent C3b-mediated uptake
12 serogroups: Groups B and C most commonly meningitis in US
Lipooligosaccharide (LOS)
antibodies directed against capsular polysaccharide are bactericidal in the presence of complement
What is Lipooligosaccharide (LOS)?
toxic properties of N. meningitidis that is made up of an inner and outer saccharide layer and Lipid A
How does Neisseria meningitidis present clinically?
- Asymptomatic pharyngeal carriers
- Meningococcemia: meningococci in blood
May occur with or without:
- *- Petechiae and/or purpura**
- Waterhouse-Friderichsen syndrome
- *- Meningitis**
- Chronic recurring meningococcal disease
What is Waterhouse-Friderichsen syndrome?
Present in Neisseria meningitidis infection, caused by LOS, presents with:
Shock
Disseminated Intravascular Coagulation (DIC)
bilateral destruction of adrenal glands
What vaccinations are used against Neisseria meningitidis?
Tetravalent conjugate vaccine called MCV4:
contains capsular polysaccharide from A, C, Y, and W135
each conjugated to diphtheria toxoid
Why is group B neisseria meningitidis not included in the vaccine if it is one of most common causes of meningitis?
Vaccines against B don’t work b/c of molecular mimicry
What is the most common cause of neonatal meningitis?
Group B streptococci
“B” is for Baby
E. Coli
What are characteristics of Group B strep?
Gram (+) cocci
Catalase (-)
beta hemolyti
bacitracin insensitive
Group B-specific cell wall antigen
How is neonatal Group B strep infections prevented?
Prophylactic penicillin G i.v. during labor (ampicillin alternative) to women at risk of delivering a baby with group B strep infection (i.e. Group B strep in vaginal flora)
What are properties of Listeria monocytogenes?
Gm (+) rod
Aerobic
Grows at cold temperatures
widely distributed in nature
Typically a food-borne pathogen