Stillwell Flashcards
Meningitis
-MEDICAL EMERGENCY
what should you do if you aren’t sure if a LP should be done or not?
-DO IT ANYWAYS
aseptic meningitis
-negative aerobic CSF culture but CAN STILL BE DUE TO INFECTION (actually septic)
which organism likes to invade TEMPORAL lobes causing encephalitis?
HSV
Most common organisms to cause meningitis
- strep pneumo #1
- GBS #2
- N. meningitides #3
- H. influenzae (most common w/o HIB)
- Listeria monocytogenes
-also Strep Suis (pigs/hogs)
neonatal meningitis
- GBS #1
- E. coli #2
- Listeria #3
children > months old meningitis
- strep pneumo #1
- N. meningitides #2
adult meningitis
- strep pneumo #1
- N. meningitides #2
-if over 50 or immunocompromised -> LISTERIA
pulmonary AV malformations
- allow pathogens to enter CNS
- Hx of telangiectasis, Osler-weber syndrome, cardiac malformations
Cavernous sinus thrombosis
- DANGEROUS TRIANGLE
- retrograde flow of infection -> damage CN3,4,6, V1,V2
- STAPH AUREUS
meningitis - Treponema Pallidum (syphilis)
-tertiary -> ARGYLL-ROBERTSON PUPILS and TABES DORSALIS (dorsal columns) + gummas
neurosyphilis diagnosis
- RPR sometimes neg
- if neg but still have suspicion -> do FTA-ABS anyways
- neuro Sx + pos serology -> do LP -> considered pos syphilis if there is any abnormality (VDRL, cell count, glucose, protein)
-67-72% have pos CSF VDRL
-meningitis - Leptospira Interrogans (Weil’s Disease)
- ASEPTIC MENINGITIS, HEPATITIS, ACUTE RENAL FAILURE W/ HEMATURIA, CONJUNCTIVITIS
- tropics
Tx: Doxy or Azithromycin
Post-Lyme syndrome
- autoimmune, NOT due to infection w/ Borrelia Burgdorferi
- NO antibiotics needed
how to diagnose Borrelia Burgdorferi (Lyme disease)
- SEROLOGY 1ST -> ELISA IgM/IgG -> follow w/ Western blot
- ECM LESION
- Tx: Ceftriaxone/Cefotaxime, Penicillin
meningitis - Nocardia
- immunocompromised -> PARENCHYMAL BRAIN ABSCESS
- loves to go brain
meningitis - mycobacteria TB
- BASILAR meningitis -> affect CNs
- need 3 or more specimens to find a +AFB stain
cochlear implants
-STREP PNEUMO infection
meningitis - Brain abscess
-POLYMICROBIAL
mycotic aneurysm
- usually infected (NOT just fungal)
- Staph Aureus #1, Salmonella #2…abdominal aorta > thoracic aorta and involves vasa vasorum
CNS infection/meningitis in IVDA
-Staph aureus #1
- Clostridium tetani -> tetanus toxin -> lockjaw/tetanus
- Clostridium botulinum -> botulinum toxin -> descending muscle weakness
treatment for bacterial meningitis
-Ceftriaxone or Cefotaxime + Vancomycin (+ Ampicillin for Listeria coverage if >50 y/o or immunocompromised)
corticosteroids (Dexamethasone)
-lower mortality and most ptxs benefit when started just before 1st dose of antibiotics*** (no help if started after)
RMSF
-likes to invade endothelial cells
the most common cause of meningitis in adults
-VIRAL
viral meningitis
- lymphocytes, high protein, NORMAL glucose
- 1st 12-24hr. -> NEUTROPHIL predominance then revert to LYMPHOCYTES
HSV-1 encephalitis
-bilateral, periodic sharp spikes in TEMPORAL regions on EEG
most common cause of viral (aseptic) meningitis
ENTEROVIRUSES (Coxsackie, Echovirus)
poliovirus
- Afghanistan and Pakistan
- ACUTE FLACCID PARALYSIS
HSV-2
- MENINGITIS
- recurrent “Mollaret’s” meningitis -> reactivation of HSV-2 -> GHOST and MOLLARET cells (footprints)
HSV-1
- ENCEPHALITIS
- TEMPORAL LOBES (bilateral)
CMV meningitis/encephalitis
- congenital -> periventricular calcifications
- HIV+ ptx -> diffuse micronodular encephalitis, MYELITIS, POLYRADICULOPATHY
-OWLS EYE
MYELITIS vs. POLYRADICULOPATHY in CMV
- myelitis: UMN -> hyperreflexia, +babinski
- polyradiculopathy: LMN -> hyporeflexia
EBV meningitis/encephalitis
-PRIMARY CNS LYMPHOMA (diffuse large B cell) in HIV ptxs -> SOLITARY deep white matter, subependymal lesions on MRI/CT
HHV-6 (Roseola)
-child w/ high fever, FEBRILE SEIZURES, and maculopapular rash (torso -> extremities)
Eastern equine encephalitis virus
- arbovirus -> mosquitos
- MOST SEVERE
- FLORIDA
Japanese encephalitis virus
- arbovirus -> mosquitos
- ASIA and WESTERN PACIFIC
- seizures and Parkinsonian syndrome
- vaccine in US
California encephalitis virus
- arbovirus -> mosquitos
- SEIZURES in CHILDREN
Powassan virus
- arbovirus -> Ixodes ticks
- NE/North central; upper Midwest US
Colorado tick fever virus
- arbovirus -> Dermacentor tick
- SADDLEBACK/biphasic fever
Chikungunya virus
- arbovirus -> mosquitos
- also biphasic fever
- RASH and severe ARTHRALGIAS/ARTHRITIS***
- meningoencephalitis
Zika virus
- mosquito and sexual
- RASH, ARTHRALGIAS, CONJUNCTIVITIS
- palmar rash
- microcephaly
Measles/Rubeola
- SUBACUTE SCLEROSING PANENCEPHALITIS (SSPE)j
- 7-10 years later
Rabies (Rhabdovirus)
- neurotropic
- histo: NEGRI BODIES (bullet shaped)
- parasthesias, hydrophobia, aerophobia, hyper salivation/lacrimation/sweat or ascending paralysis
Cryptococcus Neoformans
- cryptococcomas in brain and lungs
- NARROW base budding and India ink
- Dx: CRYPTO ANTIGEN on CSF best***
- Tx: liposomal amph. B + 5-FC
- keep OP <20cm H2O w/ LPs
Aspergillus
- brain abscess
- 45 degree branching
- high serum golactomannan and beta D glucan
Mucomycosis
- brain abscess
- 90 degree branching
- black necrotic lesions
Naegleria Fowleri
- amoebia
- fatal meningitis
- motile trophozoites
- check both uncentrifuged and centrifuged CSF -> TEARS UP AMOEBAE***
Acanthamoeba and Balmuthia
- amoebas
- granulomatous encephalitis
- giant cells and granulomas
Toxoplasma gondii
-MULTIPLE ring enhancing lesions on brain abscesses
rat lungworm from ASIA after eating undercooked snails/vegetables that causes EOSINOPHILIC meningitis
- ANGIOSTRONGYULUS CANTONENSIS***
- also Gnathostoma spinigerum and Baylisascariasis
Lyme disease
Bell’s palsy
which organism loves to invade endothelial cells?
RMSF
non-ring enhancing lesions on CT in immunocompromised ptx
PML of JC virus
