Week 221 - Meningitis Flashcards by Carey Girling

Week 221

What is the most common cause of meningitis?

Enteroviruses i.e. Echovirus, Coxsackie, Poliovirus, Mumps, Herpes Simplex

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Week 221

Herpes Simplex and Varicella zoster can cause which life-threatening condition?

Meningo-encephalitis

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Week 221

What is the most common cause of bacterial meningitis?

N. Meningitidis. This is a capsulated gram -ve Diplococcus.

This is also what causes the red flag “purpuric rash” symptom.

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Week 221

Other than N Meningitidis, which two other bacterial infections are common causes of bacterial meningitis?

Streptococcus Pneumoniae (9%)

Haemophilus Influenza B (1%)

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Week 221

What could be a cause of a slow onset meningitidis?

M. Tuberculosis.

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Week 221

Which part of the brain do bacteria cross (in meningitis), in order to access the CSF?

The choroid plexus.

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Week 221

What is Brudzinski’s sign?

This is involuntary flexion of hips when the neck flexed

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Week 221

What is Kernig’s sign?

There is pain in the leg, when the pt raises it whilst knee is flexed.

This happens because the sciatic N is stretched, pulling on the meninges.

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Week 221

How does normal CSF appear?

0-4 lymphocytes per mm-3

Protein 0.15-0.40 g/l

Glucose 2.7-4.0 mmol/l

Clear and colourless

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Week 221

What CSF results would you expect in bacterial meningitis?

++ Polymorphs (different forms/shapes)

+ Protein

Glucose is decreased or absent

Opaque and turbid

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Week 221

What are the CSF results in Viral meningitis?

+ Polymorphs

++lymphocytes

Protein +

Glucose is normal (unlike bacteria, viral infections don’t use up sugar)

Clear and colourless

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Week 221

What are the CSF results in tuberculous meningitis?

+Polymorphs

Lymphocytes later

+Protein

Low/absent glucose

Clear or opalescent appearance

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Week 221

What are the CSF results in viral encephalitis?

+polymorphs, then initially

Protein +

Glucosen normal

Clear and colourless

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Week 221

A -ve gra stain of CSF fluid suggests which cause of infection?

N Meningitidis

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Week 221

A +ve Gram stain of CSF suggests which cause of meningitis?

Strep Pneumoniae

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week 221

An AFB stain of CSF suggests what cause of meningeal infection?

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Week 221

What is the first line treatment for adults with meningitis (bacterial?)

Ceftriaxone

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Week 221

Why is it more difficult for pathogens to enter the CNS through the capillaries of the blood/brain parenchyma, than through the choroid plexus?

Entry via the capillaries is difficult because of tight cell junctions between endothelial cells, and a low endocytosis rate - both of which reduce transcellular reflux.

The choroid plexus is an easier route of entry because there are fenestrations between endothelial cells, and there is also a high endocytosis rate.

Week 221

Other than by infection from the blood - what are the other ways in which a meningeal infection may occur?

Direct implantation - IE Trauma
Local spread - I.E from mastoiditis (ear infection)
From peripheral nervous system - I.E V. Zoster virus

Week 221

A patient with suspected meningeal infection has an MRI head scan. There is noted extensive, asymetric necrosis of the temporal lobes. Which infection causes this?

Herpes Simplex

Week 221

What are transmissable spongiform encephalopathies, and how are they caused?

These are caused by prions (different forms of familiar proteins).

It’s kind of like a zombie wave - when a prion touches a normal protein, it makes that protein a prion, and so a chain reaction starts. Think walking dead, but on a small scale.

Result? Spongy brain parenchyma.

It progresses with rapidly progressive dementia.

Example: Creutzfeld- Jacob disease

Week 221

How is african Typanosomiasis transmitted?

Via tsetse fly during a blood meal.

Week 221

What are the things you could be asked from Week 221?

ANATOMY

Meninges, bridging veins, dura, major external structures.

EMQ/DATA - MRI (unlikely) or Comparison of CSF fluid (V likely)

Week 221 what are the functions of CSF?

While the **primary function of CSF** is to cushion the brain within the skull and serve as a shock absorber for the central nervous system, CSF also circulates nutrients and chemicals filtered from the blood and removes waste products from the brain

Week 221 what is the foramen of luschka?

This is a small aperture through which CSF flows. It is located anterior to the cerebellum, and alllows CSF to flow from the fourth ventricle into the sub arachnoid space.

Week 221 what is the forman magendie?

This is an aperture at the top of the spinal cord, just below trhe cerebellum. Like the forman of lushcke, it allows flow of CSF into the subarachnoid space.

Week 221 What type of cells produce CSF?

**Ependymal cells of the choroid plexus** produce more than two thirds of CSF. The choroid plexus is a venous plexus contained within the fourventricles of the brain, hollow structures inside the brain filled with CSF.

Week 221 What is the most common fungal cause of meningitis?

Cryptococcus neoformans

Week 221 Which of these is NOT a classical symptom of Bacterial Meningitis? A. Photophobia B. Neck Stiffness C. Headache D. Fever E. Pharyngitis

Week 221 What sign does the picture show? A. Kernig’s Sign B. Pastia’s Sign C. Bulging Fontanelle D. Brudzinski’s Sign E. Exopthalmos

**C.** Kernigs - Pain on hip/knee flexion Pastia - lines on elbows - scarlett fever Brudzinskis - flexion of knee/hips on neck flexion Exopthalmus - big eyes!

Week 221 The **Posterior Fontanelle** closes by ____ months of age and the **Anterior** by ____ months.

The Posterior Fontanelle closes by 2-3 months of age and the Anterior by 18 months.

Week 221 Which of the following is NOT a contraindication to lumbar puncture? A. Infection at site of entry B. Increased ICP C. Coagulopathy D. Anaemia E. Brain abscess

Week 221 Which of these is the **most common** cause of **Bacterial** **Meningitis** in the **first month** of life? A. Listeria monocytogenes B. Mycoplasma Pneumonia C. H. influenzae D. Staph aureus

Week 221 What is the **mortality rate for children** with Meningococcal disease?

1 in 10 (approx)

Week 221 What would be your first choice antibiotic for bacterial meningitis in a **5 year old** child? A. Ampicillin B. Gentamicin C. Cephalosporin D. Trimethoprim E. Vancomycin

A/C #• First line treatment in **Neonates is usually Ampicillin** and an Aminoglycoside or a Cephalosporin such as Cefotaxime * Children between **30 and 60 days old need Ampicillin and a Cephalosporin**. * **In older children a Cephalosporin or Ampicillin plus Chloramphenicol can be used**.

Week 221 Which of the following is the most common complication of Strep Pneumonia Meningitis? A. Mortality B. Retardation C. Spasticity D. Deafness E. Seizure Disorder

**D** Hearing loss is the most common complication of Pneumococcal Meningitis, with around 21% of children who survive the disease suffering from some form of hearing impairment.

Week 221 Which of these is **NOT** a risk factor for Meningitis? A. Age 5-60 B. Alcoholism C. IV Drug Abuse D. Malignancy E. Diabetes

A The 2 most at risk groups for Meningitis are those **above 60** **or below 5** years of age

Week 221 An 8 year old child has been diagnosed with laboratory confirmed meningococcal meningitis. The child has been treated with cefotaxime and is making an uneventful recovery. Assuming that there were no contraindications, what would you prescribe in the following situations? (please choose an option A, B, C or D, for each scenario) **A Ciprofloxacin 500 mg as a single dose** **B Ciprofloxacin 250 mg as a single dose** **C Ciprofloxacin 125 mg as a single dose** **D Chemoprophylaxis not indicated** 1. The child’s 10 year old sibling who has lived in the same household for the past week. 2. The child’s father who has lived in the same household for the past week. 3. The child’s 4 year old cousin who stayed overnight in the same room as the child four days before the child became unwell. 4. The child themselves, who has been diagnosed with laboratory confirmed meningococcal meningitis. 5. The child’s 6 year old cousin who stayed overnight in the same room as the child nine days before the child became unwell.

1. The child’s 10 year old sibling who has lived in the same household for the past week. B 2. The child’s father who has lived in the same household for the past week. A 3. The child’s 4 year old cousin who stayed overnight in the same room as the child four days before the child became unwell. C 4. The child themselves, who has been diagnosed with laboratory confirmed meningococcal meningitis. B The case should receive chemoprophylaxis when able to take oral medication and before discharge from hospital, unless the disease has already been treated with ceftriaxone. Those treated with cefotaxime should still receive prophylaxis because it is not known whether cefotaxime eradicates carriage. 5. The child’s 6 year old cousin who stayed overnight in the same room as the child nine days before the child became unwell. D They are likely to have been in prolonged close contact with the child at the time of the visit. However, this contact was over seven days before the onset of the illness.

Week 221 What are the normal vaccinations given at 2 months of age?

* Diphtheria ,Tetanus ,Pertussis ,Polio ,Haemophilus influenza (DTaP/IPV/Hib) * Pneumococcal Conjugate Vaccine (PCV) * Rotavirus

Week 221 Wht are the normal vaccinations given at **3 months** of age?

Men C

Week 221 Which vaccine is usually recieved at between 12 and 13 months of age?

MMR

Week 221 Which vaccine do GIRLS ONLY receive at between 12-13 years?

HPV

Week 221 When is the second MMR vaccine recieved (usually)?

3 years 4 months

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Week 221 - Meningitis Flashcards

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