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Medicine: PBL wrap-ups > Unit 6 Case 1: Meningitis > Flashcards

Unit 6 Case 1: Meningitis Flashcards

1
Q

key diagnostic symptoms of meningitis

A

focal neurological signs
abnormal eye movement
fever
facial palsy
nuchal rigidity
photophobia
altered mental state
balance problems/hearing impairment
headaches

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2
Q

other symptoms of meningitis

A

coma
delirium
irritability
confusion
vomiting
nausea

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3
Q

risk factors for meningitis

A

close contact exposures e.g. military barracks and college dorms
incomplete vaccinations
immunosuppression
children younger than 5 and adults over 65
alcohol use disorder

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4
Q

symptoms of meningitis in newborns

A

high fever
constant crying
sleepy/irritable/ hard to wake from sleep
inactive/sluggish
poor feeding
vomiting
not waking to eat
bulging fontanelle

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5
Q

physical examinations done to investigate meningitis

A

glass test, non blanching rash
brudzinskis sign
kernels sign
nuchal rigidity
eye exam
ear exam

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6
Q

kernels and brudzinksis sign

A
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7
Q

blood test to investigate meningitis

A

FBC to compare to CSf results
antibody test to detect a potential cause
blood cultures if suspected septicaemia

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8
Q

lumbar puncture

A

l3/4/5
spinal cord ends l1/2
take sample of CSF
may cause: headaches, lower back pain and swelling at the site of needle insertion

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9
Q

normal CSF results

A

clear and colourless
0-5 micro litres of WBC no neutrophils mainly lymphocytes
0-10mm3 RBC
1% serum conc of protein
60% plasma glucose conc
10-20cm H2O opening pressure

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10
Q

CSF results for meningitis

A
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11
Q

CT scan

A

view any fluid changes in the brain

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12
Q

gram stating

A

negative in up to 60% cases of bacterial meningitis, prior to antibiotics
predominance of lymphocytes doesn’t exclude bacterial meningitis
neutrophils may predominate in viral meningitis ever after first 24 hours
if CSF is abnormal treat for bacterial meningitis
gram negative, pink staining diplococci, meningococci

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13
Q

different meningitis vaccines

A

MenB
6 in 1
pneumococcal
Hib/MenC
MMR
MenACWY

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14
Q

men B vaccine

A

present in 90% of paediatric cases
vaccinated at 8 and 16 weeks then again at 1 year
side effects: pain, localised swelling, D&V
give preventative paracetamol post vax
contains: 3 proteins that are present on MenB surface and 1 membrane of the MenB strain

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15
Q

6 in 1 vaccine

A

protects against: diphtheria, tetanus, whooping cough, hepB, polio, haemophiliac influenza B
given at 8,12,16 weeks
side effects: localised pain, fever, vomiting
not administered: neuro condition or allergy to the drug
contains: Hib/MenC
given booster at 1 year

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16
Q

pneumococcal vaccine

A

streptococcus pneumoniae bacteria
given to: babies, risk children, adults and aged 65+
PCV, conjugate= under 2s
PPV, polysaccharide= over 2s
13 strain protection
not live
side effects: localised pain, fever, allergic reaction

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17
Q

Hib/MenC vaccine

A

inactivated Hib
contains: capsular polysaccharide form Hib cultures, conjugated with protein
given in combination with other vaccines
tetanus toxid proteins often in children, increase inmmunogeneticity
side effects: localised pain, fever, decreased appetite

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18
Q

MMR vaccine

A

relevant as meningitis can be a complication of one of these conditions
measles mumps and rubella

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19
Q

MenACWY vaccine

A

teenagers and freshers under 25
protects against meningococcal and groups A C W135 and Y
contains: polypeptide coating found on the surface of each bacteria
not administered when: bleeding condition, fever, pregnant or breastfeeding

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20
Q

which drug is administered if suspected meningitis

A

benzylpenicillin

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21
Q

benzylpenicillin

A

aka penicillin G
beta-lactam antibiotic
treats gram positive streptococci and staphylococci
gram negative= meningococcal
prescribed

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22
Q

pharmacology of benzylpenicillin

A

interferes with bacterial cell wall synthesis causing bacterial cell death
inhibits transpeptidases, essential to cross-link peptidoglycan chains
cell wall weakens
bacteria became vulnerable to osmotic pressure
leads to bacterial cell death

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23
Q

physiology of benzylpenicillin

A

bacteria can no longer reproduce
clears infection
prevents spread

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24
Q

clinical benzylpenicillin

A

given as an IV drug

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25
Q

most common side effects of benzylpenicillin

A

nausea
diarrhoea
headaches
abdominal pain

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26
Q

rare side effects of benzylpenicillin

A

allergic reactions
seizures
neurological problems
GI disturbances

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27
Q

long term impact of meningitis

A

kidney problems
hearing loss, either partial or total so given hearing test a few weeks later
epilepsy
memory and concentration difficulties
coordination, movement and balance issues
learning difficulties and behavioural problems
vision loss
loss of limbs, amputation
bone and joint problems

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28
Q

physical consequences of meningitis

A

fatigue
not being able to return to normal life immediately
disturbed sleep
bedwetting
fear of doctors or hospitals
personality changes: aggression, anxiety mood swings
depression
isolation
low self-esteem

29
Q

impact of communicable diseases

A

disease spreading: guilt, shame and embarrassment
isolation
stigma
sick pay, SSP: £99.35 for up to 28 weeks, single parents may struggle
family/ relationships: sick parent can’t care for the child so may need family support

30
Q

function of the meningeal layers of the brain

A

supportive framework for vasculature
act with CSF to protect CNS from mechanical damage

31
Q

what are the meningeal layers

A

dura mater
arachnoid mater
pia mater

32
Q

dura mater

A

outermost layer
between skull and vertebral column
thick, tough and inextensible
2 layers: periostea and meningeal and between are dural venous sinuses
vasculature: middle meningeal artery and vein
innervation: trigeminal nerve
4 dural reflections

33
Q

what are dural venous sinuses

A

responsible for venous drainage of cranium and empty into the internal jugular veins

34
Q

arachnoid mater

A

middle layer
avascular, no innervation
underneath is the subarachnoid space
arachnoid granulations
leptomeninges

35
Q

subarachnoid space

A

contains CSF
cerebral arteries and veins

36
Q

function of the arachnoid granulations

A

allow CSF to re-enter circulation via dural sinuses

37
Q

pia mater

A

inner layer
under the subarachnoid space
very thin
follows contours of the brain
highly vascularised: blood vessels to neural tissue
leptomeninges

38
Q

what are the 4 dural reflections

A

falx cerebri
tentorium cerebelli
falx cerebelli
diaphragmatic sellae

39
Q

falx cerebri

A

projects down to separate right and left cerebral hemispheres

40
Q

tentorium cerebelli

A

separates occipital lobes from cerebellum

41
Q

falx cerebelli

A

separates right and left cerebellar hemispheres

42
Q

diaphragmatic sellae

A

covers hypophysical fossa of the sphenoid bone

43
Q

3 meningeal spaces

A

epidural
subdural
subarachnoid

44
Q

describe the epidural space

A

between superficial layer of dura mater and bone of skull

45
Q

describe the subdural space

A

between dura mater and arachnoid mater

46
Q

describe the subarachnoid space

A

between arachnoid and Pia mater
contains CSF and major blood vessels
provides expansions, cisterns
subarachnoid spaces of cranium and vertebral column are continuous with each other
creates closed route for CSF circulation

47
Q

what is CSF

A

cerebrospinal fluid
clear and colourless
located in the subarachnoid space and central canal of the spinal cord
produced by choroid plexus
500ml produced daily
150ml in body at a given time

48
Q

choroid plexus

A

invagination of Pia mater to ventricles of brain
covers 2 lateral ventricles, roof of 3rd and 4th ventricles
forms selectively permeable BBB, controls movement of water and solutes into the CSF

49
Q

structures in the BBB superficial to deep

A

choroid ependymal cells and their tight junctions
pia mater
endothelial cells of capillaries
basal membrane of endothelial capillary cells

50
Q

route of CSf circulation

A

lateral ventricle
3rd ventricle
4th ventricle
through 2 lateral foramina of Luschka and medial foramen of Magendie
subarachnoid space and/or central canal of spinal cord
arachnoid villi (small protrusions of arachnoid mater)
drain to superior sagittal venous sinus to venous sinus

51
Q

functions of CSF

A

protection
homeostasis
clearing waste
clinical diagnosis
buoyancy

52
Q

protection as a function of CSF

A

acts as a shock absorber
prevents damage caused by brain hitting the cranium

53
Q

homeostasis as a function of CSF

A

regulates distribution of metabolites that surround the brain

54
Q

clearing waste as a function of CSF

A

waste products created by brain cells are excreted into CSF which then drains to blood stream

55
Q

clinical diagnosis as a function of CSF

A

lumbar punctures to obtain samples from subarachnoid space

56
Q

causes of meningitis

A

viral
bacterial
fungal
parasitic
amoebic
non-infectious

57
Q

meningitis most common in

A

babies, E coli
young children
teens
adults, N.men

58
Q

epidemiology of meningitis

A

N meniningitidis has 12 subtypes
transmitted via droplets, must pass the submucosal layer
incubation period is 4 days
10% population carries in bac of throat with no infection
notifiable disease

59
Q

neisseria meningitidis as a pathogen

A

gram negative, capsulated, diplococcus
type 4 plus involved in mucosal colonisation (host adhesion)
capsule helps to avoid phagocytes
major toxin: lipo-oligosaccharide (LOS) endotoxin found inside pathogen and released when pathogen is degraded

60
Q

3 methods of neisseria meningitidis to enter the CSF once in the bloodstream

A

paracellular
leukocyte-facilitated/ trojan horse
transcellular

61
Q

paracellular neisseria meningitidis

A

bind to the endothelial cells
deplete tight junctions (zona occludens) between endothelial cells in the BBB
creates signalling pathways, allows pathogens to travel through gaps in cells

62
Q

leukocyte facilitated neisseria meningitidis

A

once phagocytose in bloodstream they’re not degraded due to capsules
due to depletion of tight junctions by bacterial cells
they canc squeeze between gaps in the BBB

63
Q

transcellular neisseria meningitidis

A

pilus mediated adhesion induces formation of micro-villi like structures
triggers bacterial internalisation
pill-induced signalling= reorganisation of actin cytoskeleton= formation of membrane protrusions= engulfing bacterial pathogens
travel intracellular vacuoles
then exocytosed to CSF by transcytosis

64
Q

describe NMEC as a pathogen

A

gram negative
K1 capsule
rod shaped

65
Q

mechanism of action NMEC

A

protected form host immune response by K1 capsule
can prevent fusion of lysosomes and lysosomal degradation of bacteria once engulfed by phagocytes
bacteria across BBB into the CSF
attachment: type 1 pili bind to CD48 and ompA (outer membrane protein A)
CNF1 binds to 67LR (67kDa laminin receptor) as well as type 1 pili and IbeA inducing rearrangement of actin cytoskeleton in target cells for transcytosis across BBB

66
Q

mechanism of action of bacterial meningitis

A

pro-inflammatory cytokines secreted in response to pathogens in the CSF
MMP’s from pathogens and tissues can degrade tight junctions and increase endothelial permeability, changes CSF composition
altered cerebral blood flow due to thrombosis asa result fo clotting around pathogens and damaged blood vessels induced by DAMPs can cause schema and decreased perfusion pressure of blocked vessels
may result in increased inter cranial pressure and cerebral edema
proteolytic enzymes and reactive oxygen species: released from granulocytes causes damage to endothelial cells aswell as neural damage and increased BBB permeability
toxins and endotoxins: released by Bacteria when degraded can also cause tissue damage

67
Q

ischemia

A

lack of oxygen to tissue

68
Q

decreased perfusion pressure

A

less pressure required for substances to leave blood vessels

Medicine: PBL wrap-ups (21 decks)

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