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YEAR 3 NEURO > MICROBIOLOGY - CNS infections > Flashcards

MICROBIOLOGY - CNS infections Flashcards

1
Q

what does pyogenic meningitis look like macroscopically

A

thick layer of suppurative exudate covering the leptomeninges over the surface of the brain
exudate in basal and convexity surface

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2
Q

what does pyogenic meningitis look like microscopically

A

neutrophils in the subarachnoid space

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3
Q

when should you consider listeria spp as the causative organism of pyogenic meningitis

A 
over 60s
immunocompromised
diabetics
alcoholics 
neonates
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4
Q

what found is listeria assoc. with

A

soft cheese

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5
Q

what organisms should you consider in pyogenic meningitis in neonates

A

listeria
group B strep
E. coli

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6
Q

what organisms should you consider in pyogenic meningitis in children

A

H influenza

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7
Q

what is the most common cause of pyogenic meningitis in 10 - 21 year olds

A

N. meningitidis

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8
Q

what should be considered as cause of pyogenic meningitis in over 21s

A

strep pneumoniae

n. meningitidis

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9
Q

what should be considered in over 65s as cause of pyogenic meningitis

A

strep pneumoniae

listeria

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10
Q

what is the triad of meningism

A

fever
stiff neck
head ache

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11
Q

what rash is seen in meningococcal meningitis

A

non blanching purpuric rash

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12
Q

what are some s/s of meningitis

A 
fever + stiff neck + headache
rash
fever
photophobia, change in consciousness, lethargy, confusion
vomiting
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13
Q

what is kernigs sign

A

pain and resistance on passive extension of the knee with flexed hip

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14
Q

what is the treatment of meningitis NPA

A

ceftriaxone + dexamethasone

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15
Q

what is the treatment of meningitis PA

A

chloramphenicol + vancomycin + dexamethasone

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16
Q

when should dexamethasone be started when treating meningitis

A

with or just before first course of antibiotics

- if already started can be started up to 12 hours after first dose

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17
Q

if listeria cover required what should be added

A

amoxicillin

or co-trimoxazole alone if PA

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18
Q

if recent travel to area of high rates of penicillin resistant pneumococci then what should be added

A

vancomycin or rifampicin

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19
Q

if no organism is identified how long should treatment go on for

A

10 days

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20
Q

how long should treatment go on for identified meningococcus

A 
5 days (up to 7) ceftriaxone
stop dexamethasone
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21
Q

how long should treatment go on for identified pneumococcus

A 
10 days (up to 14) ceftriaxone 
\+ 4 days dexamethasone
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22
Q

how long should treatment go on for identified penicillin resistant/cephalosporin resistant pneumococcus

A

14 days ceftriaxone + vancomycin

+ 4 days dexamethasone

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23
Q

why is vancomycin not used as a monotherapy

A

concerned about CSF penetration

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24
Q

how long should treatment go on for identified listeria sp

A

at least 21 days amoxicillin

+ stop dexamethasone

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25
Q

how long should treatment go on for identified H influenza

A

10 days ceftriaxone

+ stop dexamethasone

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26
Q

how long should treatment go on for identified other gram negative bacteria

A

21 days agreed antibiotic regime

+ stop dexamethasone

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27
Q

what 4 organisms is decreased cell mediated immunity a risk factor for

A

listeria
strep pneumoniae
n. meningitidis
pseudomonas aeruginosa

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28
Q

neurosurgery / head trauma is a risk factor for what organisms

A

staph epidermidis
staph aureus
gram negative bacilli

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29
Q

fracture of the cribriform plate is a risk factor for what organism

A

strep pneumonia

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30
Q

basilar skull fracture is a RF for what organisms

A

strep pneumonia
h influenza
b-haemolytic strep group A

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31
Q

CSF shunt if a RF for what organisms

A

s. epidermidis
s. aureus
pseudomonas aeruginosa (aerobic GNR)
propionbacterium acnes

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32
Q

what are 4 complications of bacterial meningitis

A

purulence clusters at base of brain
invasion
cerebral oedema
ventriculitis/hydrocephalus

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33
Q

exudate can form around what cranial nerves

A

III and VI particularly vulnerable

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34
Q

what prevents meningitis becoming an abscess

A

pia

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35
Q

how can abscesses cause meningitis

A

cause secondary ventriculitis and hence meningitis

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36
Q

mycobacterium tuberculosis, nocardia asteroids and cryptococcus neoformans can be seen in what patients

A

immunocompromised patients

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37
Q

how is meningitis diagnosed

A

blood culture and coag
throat swab (meningococcal)
blood EDTA for PCR (meningococcal)
CSF fluid (LP) if clinically feasible

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38
Q

you should do a LP before/after antibiotics

A

after

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39
Q

what would CSF look like in bacterial meningitis

A

high WBC count
high neutrophils (may be lower if partially treated)
high protein
low glucose

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40
Q

how many tubes of CSF should be taken

A

4

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41
Q

what are the 3 tubes of CSF for

A

1 - haematology - cell count, differential
2 - microbiology - gram stain, culture
3 - chemistry - glucose, protein
4 - haematology

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42
Q

why might CSF be culture negative

A

pre-LP antibiotics

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43
Q

where is N. meningitidis found

A

throats of healthy carriers

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44
Q

how does gain access to the meninges

A

through the blood stream

45
Q

where may N. meningitidis be found in the CSF

A

in leukocytes

46
Q

what causes the symptoms of N. meningitidis

A

endotoxin

47
Q

N. meningitidis disease occurs most in

A

young children

10 - 21

48
Q

who gets vaccinated against N. meningitidis and why

A

army

prevent epidemics in camps

49
Q

apart from meningitis what other local disease can N. meningitidis cause

A

conjunctivitis

arthritis

50
Q

N. meningitidis is gram ___ and what shape

A

gram negative diplococci

51
Q

H. influenza is part of what normal microbiota

A

throat

52
Q

H. influenza requires what for growth

A

blood factors

53
Q

what is the most common cause of meningitis in children under 4

A

H. influenza type b

54
Q

is there a vaccine against H. influenza

A

yes

55
Q

H. influenza is gram ___ and what shape

A

negative

coccobacilli

56
Q

where is strep pneumonia commonly found

A

nasopharynx

57
Q

who is at risk of strep pneumoniae

A 
hospitalised patients
CSF skull fracture
diabetics
alcoholics
young children
58
Q

strep pneumoniae can be related to CNS devices such as

A

cochlear implant

59
Q

some strep pneumoniae meningitis can occur secondary to what

A

strep pneumoniae pneumonia

60
Q

is there a vaccine for strep pneumoniae

A

yes

61
Q

strep pneumoniae is gram ___ and what shape

A

positive

cocci in chains

62
Q

listeria monocytogenes is gram ____ and looks like what

A

negative

bacilli/rods

63
Q

who is at risk of listeria monocytogenes

A

neonates
immunocompromised esp malignancy
> 55

64
Q

what is the antibiotic of choice for listeria monocytogenes

A

amoxicillin

65
Q

when can tuberculosis meningitis be seen

A

reactivation of latent TB in the elderly

66
Q

what might you do if you suspect tuberculosis meningitis

A

chest XR to see if previous TB

67
Q

what is the treatment for TB

A

isoniazide + rifampicin + pyrazinamide + ethambutol

68
Q

name a type of fungal meningitis and when it might be seen

A

cryptococcal meningitis

HIV when CD4 < 100

69
Q

crytococcal meningitis will have an ____ picture on CSF and a subtle ____ presentation

A

aseptic

neurological

70
Q

what is the treatment for crytococcal meningitis

A

IV amphotericin / flucytozine

fluconazole

71
Q

true/false

neutrophilic pleocytosis and low CSF glucose always means bacterial meningitis

A

false

72
Q

what should be disrupted and swabbed or aspirated in early patient management for microscopy and culture

A

any petechial or purpuric rash

73
Q

who should get a LP

A

all adults with suspected meningitis except if CI or there is confident clinical dx of meningococcal meningitis with typical meningococcal rash

74
Q

what are some CI to LP

A

immunocompromised
papilloedema
focal neurological signs
altered consciousness

75
Q

how can secondary cases of meningitis be prevented

A

report to public health

prophylactic treatment for close contacts

76
Q

what is the prophylaxis regimen for 12+ ages

A

600mg rifampicin 12 hourly 4 doses
or
ciprofloxacin single dose

77
Q

what warnings should be given about rifampicin

A

red urine
reduced efficacy of OCP
staining of contact lenses

78
Q

what is the prophylaxis regimen for children under 12

A

125mg ceftriaxone IV single dose
or
in children aged 3-11 can do 10mg/kg 4 doses orally of rifampicin

79
Q

what vaccines for meningitis exist

A

n. meningitidis serogroups A and C
H influenza b
strep pneumonia

80
Q

steroids have the most benefit in what type of meningitis

A

pneumococcal

81
Q

when should steroids not be given

A 
post surgical meningitis 
severe immunocompromised 
meningococcal
septic shock 
allergy
82
Q

who should undergo CT prior to LP to rule out raised ICP

A 
immunocompromised
history of CNS disease
new onset seizure within 1 week of presentation
papilloedema
abnormal level of consciousness
focal neurological deficit
83
Q

what is the most common cause of meningitis

A

viral

84
Q

when is viral meningitis most common

A

late summer/autumn

85
Q

what is the most common cause of viral meningitis

A

enteroviruses - ECHO virus

86
Q

what other viruses cause viral meningitis

A

coxsackie

HSV

87
Q

how is viral meningitis diagnosed and treated

A

viral stool culture
throat swab
CSF PCR
supportive tx

88
Q

what is aseptic meningitis

A

non pyogenic / pus forming

infective or non-infective

89
Q

what are some infectious causes of aseptic meningitis

A

syphilis, tb, crytococcus, hsv, lyme disease, others

90
Q

what are some non-infectious causes of aseptic meningitis

A

vasculitis
sarcoidosis
drugs - cotrim, NSAIDs

91
Q

what is encephalitis

A

inflammation of brain parenchyma

92
Q

what causes encephalitis

A

HSV, VZV, CMV, HIV

93
Q

how should encephalitis be investigated

A

LP, EEG and MRI

94
Q

what would MRI in HIV show

A

bilateral focal temporal lobe enhancement

95
Q

what should be started as prompt therapy in encephalitis

A

aciclovir

96
Q

a single abscess is caused by

A

local extension e.g. mastoiditis or direct implantation e.g. skull fracture

97
Q

multiple abscess are caused by

A

haematogenous spread

98
Q

where do multiple abscesses tend to occur

A

at white grey matter border

99
Q

what does an abscess look like

A

central necrosis
oedema
fibrous capsule

100
Q

what are some s/s of abscess

A

fever

raised ICP - headache, drowsy, focal neurological signs

101
Q

how is abscess ix and tx

A

CT or MRI
aspiration for culture and tx
neurosurgical referral for urgent drainage

102
Q

E coli is gram ___ and what shape

A

negative

rods

103
Q

how does bacterial meningitis cause hydrocephalus and raised ICP

A

inflammation of the leptomeninges and CSF within subarachnoid space - arachnoiditis which can later cause lack of CSF absorption

104
Q

what causes progressive multifocal leukoencephalopathy

A

JC virus causing demyelination

105
Q

what are some RF for JC virus

A

immunosuppression
AI disease
use of MS drugs e.g. tysabri

106
Q

ix progressive multifocal leukoencephalopathy

A

LP: JC virus DNA and multifocal enhancing lesions on imaging

107
Q 
CSF: what kind of meningitis:
cells - lymphocytes
negative gram stain for bacteria
negative bacterial antigen detection
protein normal/slightly high
glucose normal
A

viral

108
Q 
CSF: what kind of meningitis:
cells - neutrophils/polymorphs
gram stain and bacterial antigen positive
high protein
low glucose
A

bacterial

109
Q 
CSF: what kind of meningitis:
cells - lymphocytes
gram stain for bacteria - positive or negative
bacterial antigen detection - negative
protein - high or very high
glucose - low
A

TB

YEAR 3 NEURO (12 decks)

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