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Nervous System Infections Flashcards

1
Q

what causes meningitis

A

bacteria, viruses, or fungi

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2
Q

what is the diagnostic testing for meningitis

A

lumbar puncture
- direct sampling of CSF
- CSF can be analyzed for by culture and gram stain

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3
Q

the causes of meningitis depends on

A

age and risk factors

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4
Q

what is the risk factor for cryptococcus meningitis

A

HIV

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5
Q

what are the three most common bacterial causes of meningitis

A
  1. strep pneumonia
  2. neisseria meningitides
  3. haemophilus influenzae type B
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6
Q

which bacteria are part of the normal microbiota of the URT and how are they transmitted

A
  • s. pneumonia
  • neisseria meningitides
  • haemophilus influenzae type B
    • through contact with respiratory droplets
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7
Q

when can bacterial meningitis spread from URT to the blood

A

depends on the invasive potential of the bacterial strain and the immune status of the host

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8
Q

how does bacterial meningitis get into the blood and what happens when it does

A
  • capsule helps evade phagocytosis and virulence factor that evades mucosal IgA antibodies
  • enter bloodstream
  • cross BBB (blood-brain barrier) to meninges
  • triggers inflammation
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9
Q

are gonococcal infections most often local and rarely lethal

A

yes

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10
Q

when meningococcal infection enters the bloodstream does it become systemic and a life-threatening disease

A

yes

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11
Q

what is the shape of neisseria meningitidis

A
  • encapsulated
  • gram-negative diplococci
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12
Q

does gonococci have a capsule

A

no

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13
Q

what are the functions of the capsule and IgA protease of neisseria meningitidis

A
  • capsule protects from phagocytosis and the complement system
  • IgA protease destroys IgA antibodies
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14
Q

what is the epidemiology of meningococcal meningitis

A
  • many people are asymptomatic carriers -> part of the microbiota in pharynx
  • transmission via contact with respiratory droplets
  • remains endemic in sub-Saharan Africa
  • epidemics occur in U.S. as it spreads among people living in close contact (college dorms and army barracks)
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15
Q

what are signs/symptoms of meningococcal meningitis

A
  • early symptoms = common cold
  • acute onset of severe throbbing headache and stiff neck
  • symptoms quickly escalate: confusion, coma, endotoxic shock, and death can occur within hours
  • long term effects: hearing loss, brain damage, amputation, and nervous system problems
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16
Q

what happens after meningococcal meningitis bacteria infect the URT and enter the blood

A

they damage skin capillaries
- the tiny hemorrhages appear as petechiae on the legs and feet
- usually NOT present in other forms of meningitis

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17
Q

what kind of vaccine is used against serogroup B of N. meningitides

A
  • conjugate vaccine consisting of purified capsular polysaccharides from four serogroups (A,C,W,Y)
  • a subunit recombinant protein vaccine for serogroup B
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18
Q

who is prophylactic vaccination recommended for

A

to first-year college students living in dorms

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19
Q

what is the treatment for meningococcal meningitis

A
  • antibiotics given while cause being determined
    • if untreated, case-fatality rate can approach 100%
    • even with treatment, 10-20%
  • survivors may suffer permanent disabilities
  • antibiotic prophylaxis = recommended for close contacts to those diagnosed to prevent the disease
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20
Q

what is the shape of pneumococcal meningitis

A

aka strep pneumoniae
- encapsulated
- gram-positive lancet-shaped diplococci

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21
Q

where is pneumococcal meningitis found

A

in the microbiota of the pharynx

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22
Q

how is pneumococcal meningitis transmitted

A

via contact with respiratory droplets

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23
Q

what is the number overall cause of bacterial meningitis to children, young adults, adults, and the elderly

A

pneumococcal meningitis

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24
Q

what are s. pneumoniae virulence factors

A
  • the capsule helps the bacteria evade phagocytosis when it gets into the bloodstream -> spreads to meninges
  • produces choline-binding proteins (cbpA) that interfere with IgA antibody function
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25
what are some signs/symptoms of pneumococcal meningitis
similar to meningococcal meningitis (throbbing headache and common cold at first) - often distinguished by lack of petechiae and endotoxic shock
26
what is the prevention of pneumococcal meningitis for adults
capsular polysaccharide vaccine against 23 pneumococcal strains that cause over 90% of disease
27
what is the prevention of pneumococcal meningitis for infants and children
conjugate vaccine against 13 strains
28
what is the shape of haemophilus influenza type B (Hib)
- encapsulated - gram-negative coccobacillus
29
true or false - haemophilus influenzae that causes pneumonia is not encapsulated and that's the distinguishing factor from Hib
true
30
Hib causes meningitis in
babies and young children (<5 years)
31
the adult carriers of Hib often are a source of infection by transmitting through
contact with respiratory droplets
32
what are the virulence factors of Hib
capsule and IgA protease
33
what are the signs/symptoms of Hib meningitis
- begin with mild cold; progress to severe headache, fever, vomiting - older children may have stiff neck - infants may show bulging fontanelle (gap btwn plates of skull) and may have a rigid body with arched back and head thrown backward - untreated case-fatality rate ~90%
34
describe the Hib vaccine
- pre-vaccine era: HiB caused meningitis in 1 out of 200 children under age 5 - conjugate Hib vaccine has type b polysaccharide bound to bacterial protein - reduced incidence over 99%
35
how is neonatal meningitis acquired
during birth (listeria can cross placenta)
36
what are some common pathogens of neonatal meningitis
- strep agalactiae (GBS) - listeria monocytogenes - e. coli
37
what are signs/symptoms of neonatal meningitis
- bulging fontanel (swelling at the soft spot) - stiff neck - lethargy, sleepiness - rigid body with arched back and head thrown backward - poor feeding - temperature instability
38
what is the shape of s. agalactiae (ie group B strep)
- encapsulated - gram-positive cocci arranged in chains
39
what is the most common cause of neonatal meningitis
s. agalactiae (GBS)
40
true or false - s. agalactiae is part of the women's transient vaginal microbiota; mother passes it to the baby during birth (bacteremia leads to infection of meninges)
true
41
is there a vaccine for s. agalactiae
no
42
what is the shape of e. coli meningitis
- encapsulated - gram-negative rods
43
what is the second most common cause of neonatal meningitis
e. coli meningitis
44
true or false - NMEC (neonatal E. coli pathovar) is part of the women's transient vaginal and intestinal microbiota
true
45
who is the high risk group for neisseria meningitides
children and young adults
46
who is the high risk group for Hib
children <5 years
47
who is the high risk group of s. pneumoniae
adults and young adults
48
who is the high risk group for s. agalactiae
neonates
49
who is the high risk group for e. coli
neonates
50
describe viral meningitis
- usually clears up in a week or two with no specific treatment - common; rarely serious - increased lymphocytes rather than neutrophils in CSF
51
which meningitis is considered a type of aseptic meningitis
viral meningitis
52
viral meningitis is caused by a number of different viruses, describe them
- coxsackie A and B viruses are pretty common - spread via fecal contamination of food, water, or hands
53
what fungal pathogen causes meningitis
cryptococcus neoformans
54
true or false - cryptococcus neoformans is an encapsulated yeast
true
55
what kind of fungal pathogen is cryp neoformans
opportunistic
56
what is the function of the capsule in cryp neoformans
inhibits phagocytosis
57
describe cryptococcus epidemiology
- typically found in soil or in bird (pigeon) droppings - non-communicable (can't go from person to person) - airborne transmission: inhaling dust contaminated with the yeast - infects the lung but is usually mild or asymptomatic in otherwise healthy individuals
58
describe cryptococcosis epidemiology
- rare until AIDS epidemic - it is the most common potentially fatal fungal infection in AIDS patients - symptomatic infection sometimes first indication of AIDS - low CD4 count predisposed to severe cryptococcal infection
59
what are signs/symptoms of cryptococcosis
- in immunocompromised, infection starts in lungs: - pulmonary cryptococcosis: chronic pneumonia-like illness with cough, fever, and lung nodules - in immunocompromised, infection spreads from lungs via blood to meninges - cryptococcal meningitis
60
what are signs/symptoms of cryptococcal meningitis
- headache, fever, neck pain, nausea and vomiting, confusion or changes in behavior, can also spread to surround brain tissue to cause meningocephalitis

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