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Clinical Pathology > Viral Meningitis and Encephalitis > Flashcards

Viral Meningitis and Encephalitis Flashcards

1
Q

What type of viruses have no lipid membranes

A

Adenoviruses

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2
Q

What is the classification of aseptic meningitis, with regards to the white cell count and the bacterial culture?

A

White cell count- >5x106/L in CSF

-ve bacterial culture of the CSF

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3
Q

What are the most common causes of aseptic meningitis?

A

Viruses, listeria, TB, syphilis, malignancy, autoimmune conditions, drugs

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4
Q

Which age group is viral meningitis common in?

A

2 peaks of hospital admissions; neonates and 5 yr olds

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5
Q

How does enterovirus enter your body?

A

Via the GI tract- faecal oral transmission

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6
Q

Causative organisms of viral meningitis

A 
Enterovirus
HSV
VZV
Mumps
HIV
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7
Q

Via what paths do viruses invade the CNS?

A

Via cerebral microvascular endothelial cells
via choroid plexus epithelium
spread along olfactory nerve

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8
Q

What are the 3 symptoms of meningism?

A

Headache, neck stiffness, photophobia

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9
Q

Apart from meningism, what other symptoms do you get in meningitis?

A

Fever

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10
Q

Is it easy to distinguish cliniclaly between viral and bacterial meningitis?

A

No

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11
Q

In infants, meningeal signs may be absent. What should you look for instead?

A 
nuchal rigidity (neck stiffness)
bulging anterior frontalle (only if severe intracranial pressure)
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12
Q

Examination sign for meningitis; flex hip and knee to 90, the knee cannot be extended due to hamstring stiffness

A

Kernig’s sign

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13
Q

Examination for meningitis- flexing the neck causes the hips and knees to flex

A

Brudzinski’s sign

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14
Q

What should you look for in a CSF specimen, with suspected meningitis?

A

Microscopy, culture and sensitivity (MCS)
Protein
Glucose (check blood glucose at the same time)
Viral PCR; enteroviruses, HSV, VZV

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15
Q

What is the opening pressure for bacterial meningitis?

A

Above normal (200-500)

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16
Q

Is the WBC count higher in viral or bacterial meningitis?

A

Bacterial

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17
Q

What is the WBC differential in viral meningitis?

A

Lymphocytic

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18
Q

What is the WBC differential in bacterial meningitis?

A

High neutrophil count

19
Q

What is the protein conc. for bacterial meningitis?

A

High

20
Q

What is the glucose ratio (CSF:blood) for bacterial meningitis?

A

Low

21
Q

What other specific bacterial test in the CSF is positive for bacterial meningitis?

A

Gram stain positive

22
Q

Treatment for bacterial meningitis

A

Cefotaxime

23
Q

Treatment for viral meningitis

A

Some argument suggest aciclovir

24
Q

Is meningitis a notifiable disease?

A

Yes

25
Q

Commonest cause of viral meningitis in the UK?

A

Enterovirus

26
Q

Cause of meningitis; late summer/autumn epidemics. Fever, vomiting, anorexia, rash, upper respiratory tract symptoms. No specific treatment and full recovery normal.

A

Enterovirus

27
Q

How does HSV1 manifest?

A

cold sores and encephalitis

28
Q

How does HSV2 manifest?

A

genital herpes and meningitis

29
Q

What is mollaret’s meningitis?

A

Recurrent aseptic meningitis. Recurrent cause- HSV2

30
Q

In what proportion of mumps cases do you get meningitis?

A

10-30%

31
Q

What is the cause of meningitis, 5 days after onset of parotiditis, abdo pain and orchitis (inflammation of 1 or more testicles) Preventable with vaccine.

A

Mumps

32
Q

At what point in the HIV infection does meningitis occur?

A

Occurs as part of primary infection

33
Q

What are the associated features of HIV meningitis?

A

Like glandular fever; fever, lympadenopathy, pharyngitis, rash

34
Q

What is the major viral cause of encephalitis

A

HSV1

35
Q

What are the common causes of viral encephalitis?

A 
HSV
VZV, EBV
Measles
Mumps
Enteroviruses
36
Q

What additional features do you find in viral encephalitis, compared with viral meningitis?

A

Altered mental state (confusion, bizarre behaviour)

Focal neurology, seizures, weakness, cranial nerve palsy, ataxia

37
Q

Treatment for viral encephalitis

A

High dose IV aciclovir

38
Q

What form of viral encephalitis is a medical emergecy- rare but high morbidity associated with it?

A

Herpes simplex encephalitis

39
Q

What age range is typical for Herpes simplex encephalitis?

A

Bimodal distribution (50yrs)

40
Q

What are the 2 stages of herpes simplex encephalitis?

A

Primary infection: direct transmission of virus along the neural/olfactory pathways
Reactivation: in the trigeminal ganglia

41
Q

What is a complication of herpes simplex encephalitis, that causes inflammation/swelling of the brain tissue?

A

Acute focal necrotising encephalitis

42
Q

Auto-immune mediated CNS demyelination, can follow viral illness or vaccination. Clinical features are the same as encephalitis.

A

Acute disseminated encephalomyelopathay (ADEM)

43
Q

How would you treat acute disseminated encephalomyelopathy (ADEM)?

A

Steroids/other immunosuppressants.

Clinical Pathology (53 decks)

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