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Medicine Year 2 > Week 221 - Meningitis > Flashcards

Week 221 - Meningitis Flashcards

1
Q

Of the 3 main causes of meningitis (bacterial, viral, fungal) which is the most common form?

A

Viral

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2
Q

Which has a worse prognosis bacterial or viral meningitis?

A

Bacterial

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3
Q

What is the initial treatment for suspected meningitis if it presents in the GP?

A 
Antibiotics in case it is bacterial
Call 999 (ambulance transfer to hospital)
Call hospital to warn of a suspected meningitis case
possibly give paracetamol, O2 if necessary / possible
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4
Q

What sort of antibiotics is the GP likely to give and why?

A

Whilst you would ideally treat with broad-spectrum antibiotics most GPs will have access to penicillin and so that narrow spectrum AB will be used

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5
Q

What it the management process once the patient is admitted to A&E?

A

ABCDE; Cannulate - Fluids (20mls/kg); bloods
Seizure control
LP when safe / not contraindicated
Get consultant involved and inform public health

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6
Q

What are the signs of shock that may present if sepsis/septicaemia sets in?

A

Drop in BP (although children hang on to BP longer than adults); reduced urine output (normal = ~1ml/kg/hr); slow cap refill, increase HR

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7
Q

What bloods are you going to want with suspected meningitis?

A

FBC (WCC up? and Hb down?), ESR, CRP, Cultures, U&E (low Na - inappropriate ADH?), LFT, glucose, coagulation, ABG (acidotic account for any confusion?)

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8
Q

What conditions might predispose a child / someone to meningitis?

A

Ear or sinus infections
Hydrocephalous (foreign bodies in head used for Tx)
Immunosuppression

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9
Q

List some risk factors for meningitis

A

Immunosuppression; young; elderly; alcoholism; lack of vaccines; DM; renal / adrenal insufficiency; CF; splenectomy; malignancy; Thalasaemia major

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10
Q

What colour should CSF be normally?

A

Clear

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11
Q

What structure within the ventricles produces CSF?

A

the choroid plexus

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12
Q

What colour will CSF be if bacterial meningitis is present?

A

Cloudy

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13
Q

What other changes, besides cloudiness of the CSF will be found on a CSF film?

A

High neutrophil count, High protein count, Low or absent glucose

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14
Q

What accounts for the low to absent glucose on a CSF film in the presence of bacterial meningitis?

A

The bacteria will be using it to replicate and survive

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15
Q

What is the risk associated with increased CSF protein?

A

Vascular obstruction (protein heavy CSF is thick and goopy) can cause thrombi etc

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16
Q

What will the CSF profile likely be in the presence of viral meningitis?

A

clear to turbid, lymphocytes high, protein normal to high, glucose normal

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17
Q

If mycobacteria is the cause of meningitis what will the CSF profile look like?

A

Clear to turbid, v high lymphocytes, v high protein, low glucose

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18
Q

Where is CSF found?

A

In the subarachnoid space within the meninges - in the ventricles of the brain and the spinal cord

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19
Q

Where does all CSF drain to?

A

The internal jugular veins (via the sigmoid sinuses)

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20
Q

Which venous sinuses drain the anterior skull base?

A

The cavernous sinuses

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21
Q

Name the venous sinuses of the brain

A

The superior and inferior sagittal sinuses
The transverse sinuses
The cavernous sinuses
The sigmoid sinuses

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22
Q

Name the 4 septa of the dura mater

A

The falx cerebri
The falx cerebelli
The tentorium cerebelli
The diaphragm sellae

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23
Q

What is the relationship between the septa of the dura and the venous sinuses?

A

The Inferior and Superior Sagittal sinuses follow the inferior and superior surfaces of the Falx Cerebri, and the anterior/posterior surfaces of the Falx Cerebelli
The Transverse sinuses follow the posterior line of the Tentorium Cerebelli
The Cavernous Sinus sits beneath the Diaphragma Sellae

24
Q

What are the 4 route by which microbes enter the CNS?

A 
via blood (most commonly) 
via direct implantation (traumatic, iatrogenic, congenital); via local extension of established infections (sinuses, teeth, middle ear)
From PNS (rabies, herpes simplex, shingles)
25
Q

What condition is caused by Herpes Simplex Virus?

A

Cold sores; genital herpes

26
Q

What condition is caused by Herpes Zoster Virus?

A

Chicken Pox; Shingles

27
Q

At what site do microorganisms cross the blood brain barrier?

A

The choroid plexus

28
Q

How is it easier for microorganisms to cross the BBB through the choroid plexus than the brain microvascular endothelial cells (BMEC) of the brain parenchyma?

A

The BMECs have weaker tight junctions between them, the endothelium is fenestrate increasing permeability, thus intracellular flux is increased

29
Q

What are the possible early signs and symptoms of meningitis?

A

severe headache, malaise, fever, lethargy, n&v, irritibility

Sometimes: photophobia, rash, drowsiness progressing to unconsciousness, convulsions, hamstring rigidity

30
Q

What is Brudzinski’s sign?

A

A test of meningeal irritation.

With pt supine flex the head towards their chest, involuntary flexion of hips and knees is a +ve Bradzinski’s sign

31
Q

What is Kernig’s Sign?

A

A test of meningeal irritation.
With pt supine, flex their hip and knee and then try to extend their knee - back pain and resistance to extension is a +ve Kernig’s sign

32
Q

What combination of information / findings helps you diagnose meningitis?

A

signs, symptoms, CSF profiling, culture (perhaps with Kernig’s / Brudzinski’s signs tested for on examination)

33
Q

What causes the petechial rash sometimes found with meningitis?

A

Septicaemia. Inflammation causes vessels to become leaky so subepithelial haemorrhage can occur

34
Q

What terms are used to describe viral meningitis due to the CSF profile it produces?

A

“Aseptic” or “Lymphocytic”

35
Q

What viruses usually cause meningitis?

A

Echoviruses; Coxackie Viruses (A + B); (polio rare now in UK)
Can be as a complication of other viral infections: Mumps; Herpes Simplex; Herpes Zoster; HIV

36
Q

Anatomically how is encephalitis different to meningitis?

A

Encephalopathy occurs when the infection affects the brain parenchyma rather than the meninges

37
Q

Where dose replication typically take place once an enterovirus has been ingested or inhaled?

A

Oro-pharynx or Peyer’s Patches

38
Q

In an individual between the ages of 3 months and 65 years what are the most likely organisms to cause BACTERIAL meningitis?

A 
Neisseria meningitidis (meninigococcal)
Streptococcus pneumonia (Pneumococcal)
39
Q

In neonates (<3 months) with bacterial meningitis what is the most likely causative organism?

A

Group B Streptococcus (Streptococcus agalactiae) (or E. coli according to GP)

40
Q

What is the most common cause of bacterial meningitis in the UK?

A

Neisseria meningitidis (gram -ve, capsular)

41
Q

What is the pathogenesis of Neisseria meningitidis?

A

nasopharynx > blood > meninges

42
Q

What is the pathogenesis of Streptococcus pneumonia, Haemophilus influenza and Cryptococcus neoformans?

A

Resp tract > blood > meninges

43
Q

List these bacterial pathogens: Hib, Pneumococcus, Meningococcus, in order of severity of meningitis they cause (generally) most to least severe

A

Pneumoccocus, meningococcus, Hib

44
Q

How does meningitis develop if Mycobacterium tuberculosis is the causative organism?

A

Gradual onset, normally with a preceding focal infection elsewhere in the body e.g. lung

45
Q

What is the pathogenesis of Mycobacterium tuberculosis meningitis?

A

Resp tract > Blood > meninges > burst from small abscesses then get symptoms

46
Q

What is the best indicator of a fungal source of meningitis infection?

A

the India Ink Stain

47
Q

What organism is responsible for causing most cases of fungal meningitis?

A

Cryptococcus neoformans (gradual onset of symptoms)

48
Q

If symptoms are slow to develop what two organisms are likely to have caused the meningitis?

A

Mycoplasma tuberculosis or Cryptococcus

49
Q

What is the main cause of encephalitis?

A

Herpes Simplex Virus (HSV type I)

50
Q

Physically, what characterises encephalitis?

A

Extensive, asymmetric, necrosis of temporal lobes (resulting in altered mental status and personality and seizures )

51
Q

How would you diagnose HSV encephalitis?

A

Head CT and MRI

52
Q

What is the treatment for HSV encephalitis?

A

Aciclovir for 21 days

53
Q

Reactivation of HSV infection in what area is most associated with HSV encephalitis?

A 
Trigeminal ganglia 
(mother can also pass to baby through birth canal)
54
Q

Although ‘pure encephalitis’ (only affecting the parenchyma without meningeal involvement) is rare name a cause of it

A

Rabies Virus - infects the brain via the PNS

55
Q

Describe briefly what a brain abscess is, how caused and how treated

A

Focal infection of brain parenchyma, most caused by bacteria (fungi + parasites can), often result of local extension of infection, blood transportation or direct implantation. CT / MRI, aspiration to diagnose (though difficult so high mortality). Tx: surgical drainage or at least 1month of ABx

56
Q

Which form of meningitis causes the non-blanching rash and how?

A

Meningococcal AKA Neisseria meningitidis

Medicine Year 2 (28 decks)

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