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PY367 Vaccines > Understanding meningitis > Flashcards

Understanding meningitis Flashcards

1
Q

what is meningitis

A
  • inflammation of the meninges
  • meninges are the 3 membranes which enclose the brain and spinal cord
  • meningism is the signs and symptoms that accompany the inflammation
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2
Q

give examples of the agents that can cause meningitis

A
  1. microbial agents
  2. bacteria
  3. viruses
  4. fungi
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3
Q

who is particularly at risk of meningitis

A
  1. babies and young children
  2. teenagers and young adults
  3. elderly
  4. people with a weak immune system
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4
Q

how are the microbial agents of meningitis acquired

A
  1. usually caused by organisms which colonise the back of the nose and throat
  2. sometimes acquired from the mother during birth
    - streptococci, e coli
  3. through food- listeria, e coli
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5
Q

how can microbial agents of meningitis be spread

A

through kissing, coughing, sneezing

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6
Q

what is viral meningitis

A
  1. most common form
  2. relatively benign illness and usually doesn’t need medical attention
  3. usually presents as a mild flu like illness- headache, fever
  4. more severe cases- neck stiffness, joint pain, vomiting, diarrhoea
  5. usually make a full recovery but rarely can be left with residual side effects
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7
Q

give examples of viruses implicated in meningitis

A
  1. enteroviruses- echovirus, coxsackie virus
  2. mumps
  3. herpes viruses
  4. HIV
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8
Q

what are the causative fungi in fungal meningitis

A
  1. cryptococcus neoformans
  2. candida
  3. coccidioides immitis
  4. histoplasma
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9
Q

what is cryptococcus neoformans and what symptoms does it cause

A
  1. associated with immune deficiency- eg pre existing HIV infection
  2. symptoms appear more gradually over days or weeks
  3. symptoms: headache, fever, nausea, vomiting, stiff neck, changes in mental state and hallucinations
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10
Q

what is bacterial meningitis

A
  1. usually more severe than viral meningitis
  2. high fatality rate unless treated immediately
  3. even with antibiotic therapy, many left with disorders
    - most commonly hearing loss, epilepsy
  4. most commonly caused by streptococcus pneumoniae and niesseria meningitidis
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11
Q

outline the progression to bacterial meningitis

A
  1. nasopharyngeal colonisation
  2. invasion of the bloodstream
  3. bacteraemia
  4. meningeal invasion
  5. multiplication in subarachnoid space
  6. release of bacterial products and cytokines
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12
Q

what can neisseria meningitidis cause

A

can cause meningococcal meningitis and meningococcal septicaemia

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13
Q

describe what meningococcal disease is

A
  1. communicable
  2. gram - diplococci, various virulence factors
  3. meningococci colonise the oropharynx in some healthy people (carriers)
  4. in these people, transition from carrier state to invasive disease occurs due to unknown factors
  5. many serotypes- A, B, C, W, X , Y
  6. bacteria can enter the bloodstream and cross blood brain barrier to cause meningitis
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14
Q

describe how meningococcal septicaemia occurs

A
  1. results when bacteria enters the blood and multiply uncontrollably
  2. toxins damage lining of the blood vessels leading to leakage
    - presents as non blanching rash
  3. lower blood volumes is insufficient to carry oxygen to all parts of the body
    - blood supply reduced
  4. clots may form in skin/muscle tissue- may lead to amputation
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15
Q

what are the early warning signs of meningitis

A
  • fever
  • headache
  • vomiting
  • muscle pain
  • fever with cold hands and feet
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16
Q

what are the specific symptoms of meningitis

A
  1. rash
  2. stiff neck
  3. dislike of bright light
  4. confusion
  5. seizures
17
Q

what are the specific symptoms of meningococcal septicaemia

A
  1. aching limbs
  2. cold hands and feet
  3. rash which starts like pin prick spots and develops rapidly into purple bruising
  4. confusion
18
Q

what is the tumbler test

A
  1. to identify meningococcal septicaemia rash, press a glass tumbler against it and if the rash doesn’t fade, it could be meningococcal septicaemia
  2. on dark skin, check for the rash on lighter parts of the body
  3. keep checking as rash may fade at first
19
Q

how is meningitis diagnosed in the laboratory

A
  1. cerebrospinal fluid may be taken
    - visually inspected (clear or turbid)
    - cell count performed
    - protein is analysed
    - glucose levels are analysed
    - a centrifuged deposit is gram stained and inoculated onto a range of media to support main pathogens
    - further specific tests performed
  2. blood cultures
20
Q

what is cerebrospinal fluid

A

clear, colourless liquid that bathes the brain and spinal cord, providing shock absorption and support

21
Q

how is a CSF specimen obtained

A

by doing a lumbar puncture
- long thin hollow needle is inserted between 2 bones in the lower spine and into the space where CSF circulates

22
Q

what characteristics of CSF may be present in viral meningitis

A
  1. clear or turbid appearance
  2. leukocytes 50-500
  3. raised protein
  4. normal glucose
23
Q

what characteristics of CSF may be present in bacterial meningitis

A
  1. turbid appearance
  2. leukocytes 100-10000
  3. very raised proteins
  4. reduced glucose
24
Q

outline the treatment of fungal meningitis

A
  • amphotericin B
  • Flucytosine
  • fluconazole
25
Q

outline the treatment of viral meningitis

A
  • no specific antiviral therapy but aciclovir for herpes simplex virus
26
Q

outline the initial empirical therapy for bacterial meningitis

A
  1. transfer patient to hospital urgently
  2. if meningococcal disease suspected, benzylpenicillin given prior to transfer
  3. consider adjunctive treatment with dexamethasone
  4. unknown aetiology 3 months- 50 years: cefotaxime
  5. unknown aetiology 50+ years: cefotaxime and amoxicillin, possibly with vancomycin
27
Q

why are the vaccines against meningitis so important

A

meningitis and septicaemia can kill in under 4 hours
- bacteria multiply in body with alarming speed, overwhelming immune system
- early symptoms can be flu like, making it difficult to diagnose

28
Q

what vaccines exist which can prevent cases of bacterial or viral meningitis

A
  1. MMR vaccine
  2. DTaP/IPV/Hib (haemophilus influenza b)/Hep B 6 in 1 vaccine
  3. PCV (pneumococcal conjugate vaccine)
  4. Hib/Men C vaccine
  5. Meningitis ACWY vaccine
  6. Men B vaccine

PY367 Vaccines (10 decks)

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