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Transition Block > Phenomenal CNS infections microbiology > Flashcards

Phenomenal CNS infections microbiology Flashcards

1
Q

Is gonorrhoea gram negative or gram positive?

A

Gram negative diplococcus (2 kidney beans)

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2
Q

What organism could cause viral meningitis?

A

ECHO

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3
Q

Diagnosis of viral meningitis?

A

Viral stool culture
Throat swab
and CSF PCR

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4
Q

Treament for viral meningitis?

A

Supportive, generally self limiting

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5
Q

How quickly must you diagnose herpes simplex viral encephalitis?

A

Rapidly within 6 hours of admission

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6
Q

Treatment for herpes simplex encephalitis

A

Aciclovir high dose

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7
Q

How can you tell if someone has varicella zoster encephalitis? and how do you treat it?

A

They will have a history of shingles

-Treat with high dose aciclovir

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8
Q

Travel related causes of viral encephalitis

A

West nile
Japanese B encephalitis
Tick borne encephalitis

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9
Q

Prompt therapy for encephalitis?

A

If delay start pre-emptive aciclovir as prompt therapy improves outcomes [death]

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10
Q

Investigations for encephalitis

A

LP
EEG
MRI

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11
Q

Causes of bacterial meningitis in neonates?

A

Listeria
Group B strep
E. coli

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12
Q

Causes of bacterial meningitis in children

A

Haemophilus influenza

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13
Q

Causes of bacterial meningitis in adults

A

10 to 21: meningococcal

21 onward: pneumococcal >meningococcal

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14
Q

Causes of bacterial meningitis in elderly?

A

Pneumococcal > listeria

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15
Q

Type of bacterial meningitis in decreased immune system?

A

Listeria

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16
Q

Type of bacterial meningitis in neurosurgery/open head trauma

A

Staphylococcus
Gram Negative Rods
S. epidermidis

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17
Q

Bacterial causes of meningitis in CSF shunt

A

S. epidermidis
S. aureus
Areobic gram negative rods
Propionibacterium acnes

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18
Q

Bacteria causing meningitis in basilar skull fracture

A

S. pneumoniae
H. influenzae
beta-hemolytic strep group A.

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19
Q

Pathogenesis of bacterial meningitis

A

1) Nasopharyngeal colonization

2) Direct extension of bacteria.
Parameningeal foci  (sinusitis, mastoiditis, or brain abscess)
Across skull defects/fracture

3) From remote foci of infection
(e. g., endocarditis, pneumonia, UTI…)

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20
Q

Bacteria found in the nose

A

Strep

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21
Q

Bacteria found in the throat

A

Neisseria

Haemophilus influenza

22
Q

Which bacteria may be found in leukocytes in the CSF?

A

Neisseria

23
Q

Military recruits are vaccinated with purified capsular polysaccharide to prevent what meningitis?

A

Neisseria Meningitis (Meningococcal meningitis)

24
Q

What does h. influenzae require for growth?

A

Blood factors

25
Q

How many types of h. influenzae are there?
What are they based on?
Which is the most common type?

A

There are six types of H.influenzae based on capsule differences.
H. influenzae type b is the most common cause of meningitis in children under 4 years old.

26
Q

What vaccine is available for haemophilus influenza?

A

A conjugated vaccine directed at the capsular polysaccharide antigen

27
Q

Where is s. pneumonia found?

A

In the nasopharynx

28
Q

Hospitalized patients, patients with CSF skull fractures, diabetics/ alcoholics and young children are most susceptible to which meningitis?

A

S. pneumoniae meningitis

29
Q

Appearance and stain of listeria?

A

Gram positive rod (LEARN !!)

30
Q

Cryptococcal mainly found in HIV when CD4 count drops below ___

A

less than 100

31
Q

Treatment for cryptococcal meningitis

A

IV amphotericine B / flucytosine

Fluconazole

32
Q

What medications do you have to give if you’re going to do a lumbar puncture?

A

Treat with antibiotics first

33
Q

What does tube 1 of CNS look at?

A

Haematology: cell count, differential

tube 4 also goes to haematology

34
Q

What does tube 2 of CNS look at?

A

Microbiology; gram stain, cultures

35
Q

What does tube 3 of CNS look at?

A

Chemistry: glucose, protein

36
Q

What does tube 4 of CNS look at?

A

Haematology: cell count, differential

37
Q

Microbiological diagnosis of meningitis?

A

Blood cultures
Throat swab (meningococcal)
Blood EDTA for PCR (meningococcal)
CSF (lumbar puncture)

38
Q

WBC above what to accurately diagnose bacterial meningitis

A

> 2000

39
Q

Neutrophils above what number to accurately diagnose bacterial meningitis?

A

> 1180

40
Q

Protein above which level to diagnose bacterial meningitis?

A

> 220 mg/dl

41
Q

Glucose below what to diagnose bacterial meningitis?

A

less than 34 mg/dl

42
Q

Glu (CSF/serum) below which level to diagnose bacterial meningitis?

A

less than 0.23

43
Q

What is aseptic meningitis? Composition of spinal fluid? (WBC, protein, glucose)

A

Aseptic meningitis = non-pyogenic
Low WBC
Minimally elevated protein
Normal glucose

I think HIV meningitis can be aseptic)

44
Q

If someone has papillodema or focal neurological signs, what investigation MUST you do?

A

CT scan (or nuclear magnetic resonance scan)

45
Q

Warning signs

A 
Marked depressive conscious level (GCS  fluctuating conscious level (fall in GCS >2)
Focal neurology
Seizure before or at presentation
shock
Bradycardia and hypertension
Papilloedema
46
Q

Why do you give steroids?

A

They decrease cytokine inflammatory response and cerebral oedema

47
Q

What medication must you give as well as antibiotics?

A

Give to all patients suspected of bacterial meningitis (10mg iv 15-20 min before or with the first dose of antibiotic and then every 6 hours for 4d)
Unfavourable outcome reduced from 25% to 15% and mortality from 15 to 7%

48
Q

Steroids are particularly amazing in which type of meningitis?

A

Pneumococcal

49
Q

When should you not give steroids?

A

Do not give in post-surgical meningitis, severe immunocompromised, meningococcal or septic shock or those hypersensitive to steroids

50
Q

Contact prophylaxis for meningitis?

A

ciprofloxacin orally as a single dose for adults and children aged more than 12 years (not yet licensed for this purpose but has been extensively used in school and community outbreaks) (IV). Use of ciprofloxacin in younger children is not recommended (this was in BOLD)

or Rifampicin (for adults and children over 12) Specific warnings about reduced efficacy of OCP, red colouration of urine and staining of contact lenses

or ceftriaxone IM single dose for adults or IV single dose for children under 12

51
Q

Which serogroups does the travel vaccine protect against?

A

Neisseria meningitis groups A and C

52
Q

Which vaccines are currently available for meningitis?

A

Neisseria meningitis - serogroups A and C (commonly used in travel vaccination)

Strep. pneumonia- polysaccharide and conjugate

Haemophilus influenza B (HiB)

Transition Block (2 decks)

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