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YR5 Microbiology > Crash course: CNS infections + STIs > Flashcards

Crash course: CNS infections + STIs Flashcards

1
Q

What is meningitis?

A

Inflammation of the meninges

Can be bacterial, viral or fungal (or TB)

Presents with meningism

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2
Q

What are the signs of meningism?

A

Stiff neck (nuchal rigidity)
Kernig’s sign
Brudzinski’s sign

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3
Q

List 5 symptoms of meningitis

A

Headache
Photophobia
Fever
N+V
Drowsiness

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4
Q

Give 4 signs of meningococcal disease

A

Non-blanching petechial rash
Altered mental status
Skin mottling
Cold + painful extremities

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5
Q

What is encephalitis?

A

Inflammation of brain parenchyma

Usually viral, rarely AI

Presents systemically unwell, altered mental state- personality change

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6
Q

What is a brain abscess?

A

Infective collection in the brain parenchyma

Presents with swinging fevers + SOL

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7
Q

What are the most common causes of meningitis in neonates?

A

Group B Strep
Listeria monocytogenes
E. coli

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8
Q

What are the most common causes of meningitis in adults?

A

Neisseria meningitidis
Streptococcus pneumoniae

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9
Q

What are the other causes of meningitis in the elderly in addition to Neiserria and Steptococcus?

A

Group B Strep
Listeria monocytogenes

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10
Q

What can cause meningitis in the
immunocompromised?

A

TB

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11
Q

What are the three classifications of meningitis? What are the usual causative organisms?

A

Acute: bacterial
Chronic: TB, Spherocytes, Cryptococcus
Aseptic: acute viral

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12
Q

Which organism causes meningococcal meningitis?

A

Neiserria Meningitidis

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13
Q

What are the 3 most common causes of meningitis in children/ young adults?

A

Neiserria Meningitidis
Haemophilus influenzae (rare in vaccinated countries)
Streptococcus pneumoniae

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14
Q

What are the viral causes of meningitis?

A

Enterovirus: Adenovirus, Cocksackie
HSV-2
HIV seroconversion (rarely)

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15
Q

Name 2 fungal causes of meningitis. In which patients?

A

Cryptococcus neoformans: HIV

Cryptococcus gattii: immunocompetent

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16
Q

How is meningitis diagnosed?

A

LP
Ideally LP before abx, but like with cultures, don’t delay abx
If any Sx consistent with raised ICP or SOL, need brain imaging first

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17
Q

Give 4 signs of raised ICP

A

Focal neurology
Papiloedema
Reduced GCS
Seizures

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18
Q

What analytics are used on CSF in meningitis?

A

Biochemical analysis
Gram stain for bacteria
PCR for viruses
Ziehl-Neelson stain forTB
India ink stain for Cryptococcus

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19
Q

Describe the appearance, white cells, protein, glucose of CSF and opening pressure on LP in BACTERIAL meningitis?

A

Cloudy + turbid
↑↑↑ WCC
Massive neutrophilia
↑↑ Protein
↓ glucose (<40% plasma glucose, as bacteria consuming)
↑ opening pressure

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20
Q

Describe the appearance, white cells, protein, glucose of CSF and opening pressure on LP in VIRAL meningitis?

A

Clear
↑ WCC
Lymphocytosis
N/ ↑ protein
N glucose (>60% plasma glucose)
N/ ↑ opening pressure

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21
Q

Describe the appearance, white cells, protein, glucose of CSF and opening pressure on LP in FUNGAL meningitis?

A

Fibrin web
N/ ↑ WCC
Lymphocytosis
N/ ↑ protein
N/ ↓ glucose (<40% plasma glucose)
↑ / ↑↑ opening pressure

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22
Q

Describe the appearance, white cells, protein, glucose of CSF and opening pressure on LP in TB meningitis?

A

Cloudy + viscous
↑ WCC
Lymphocytosis
↑↑ protein
↓↓ glucose (<30% plasma glucose)
↑ opening pressure

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23
Q

What is normal opening CSF pressure?

A

10-20

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24
Q

Describe management of meningitis

A

In community: IM Benzylpenicillin

In hospital:
IV Ceftriaxone/ Cefotaxime
(+ Amoxcillin/ Ampicillin if baby or >50y)
+ Acyclovir if can’t exclude encephalitis

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25
Q

When should steroids be used for meningitis ?

A

Give dexamethasone as if caused by strep pneumoniae or haemophilus influenzae, 5d dex reduces the incidence of sensorineural hearing loss

Give dex with the 1st dose of cef, once LP done + organism confirmed, if S. pneumoniae or H. influenzae continue for 5d.
If neither, stop dex

26
Q

When should meningitis prophylaxis be given?

A

If meningococcal meningitis + exposure within 7d before onset

Oral ciprofloxacin or Rifampicin

27
Q

What is the most common cause of encephalitis in the UK?

A

HSV 1

28
Q

Name 2 rare causes of encephalitis

A

Previous hx of measles: subacute sclerosing panencephalitis (SSPE)

HIV/ on monoclonals: Progressive multifocal leukoencephalopathy

29
Q

What is the treatment for encephalitis?

A

Empirically treat with Acyclovir

MRI + CSF PCR can help identify precise organism

30
Q

What usually causes brain abscesses?

A

Typically mixed organisms
Staphylococcus/ Streptococcus + anaerobes is common

If patient with HIV: suspect toxoplasmosis

31
Q

In HIV patients, what organisms are associated with what pathology?

A

Cryptococcus: meningitis

Toxoplasmosis: brain abscess

32
Q

What investigations are used for brain abscesses?

A

MRI:
Classically shows a ring-enhancing lesion

(CT)

33
Q

What is used for treatment of brain abscesses?

A

Abx: Gentamicin + metronidazole

Surgical drainage

Consider steroids + anti-seizure meds (load on Levateracitam)

34
Q

What is the most common STI?

A

Chlamydia
caused by Chlamydia trachomatis

35
Q

How does chlamydia present?

A

Asymptomatic: 70%

F: cervicitis (discharge, bleeding) + dysuria, PID

M: discharge, dysuria

Reactive arthritis

36
Q

What are 5 symptoms of reactive arthritis?

A

Anterior uveitis
Dysuria
Oligoarthritis
Balanitis
Keratoderma blennorrhagicum

37
Q

How do serovars L1-3 of chlamydia present? In which patient groups?

A

Lymphogranuloma venereum

Presents first with proctitis

Painful, swollen, enlarged inguinal LN = Bubos

Common in MSM

38
Q

How does chlamydia present in neonates? When?

A

Ophthalmia neonatorum
1-2w after birth

39
Q

How is chlamydia diagnosed? What treatment is used?

A

NAAT (can’t culture)

Tx: Doxycycline (7d) or Azithromycin (STAT)

40
Q

How does gonorrhoea present?

A

Less commonly asymptomatic

Typical STI Sx: PID

Disseminated gonococcal infection

41
Q

How does gonorrhoea present in neonates? When?

A

Ophthalmia neonatorum
First few DAYS after birth

42
Q

How is gonorrhoea diagnosed?

A

Culture = GS

In practice NAAT

43
Q

What is treatment for gonorrhoea?

A

IM ceftriaxone

44
Q

What are 3 key symptoms of disseminated gonococcal infection?

A

Migratory poly/ oligoarthritis

Dermatitis: maculopapular or vesicular

Tenosynovitis

45
Q

List 3 further complications of disseminated gonococcal infection

A

Septic arthritis
Endocarditis
Perihepatitis: Fitz-Hugh-Curtis syndrome

46
Q

What s the most common cause of septic arthritis in young adults?

A

Neisseria gonorrhoea

47
Q

What causes syphilis?

A

Treponema pallidum

48
Q

What are the stages of syphilis?

A

Primary: painless CHANCRE

Secondary: Unwell, condyloma lata, lymphadenopathy, maculopapular rash

Latent phase: can last decades

Tertiary: gummatous disease, aortitis, neurosyphilis, tabes dorsalis

49
Q

What is a chancre?

A

Painless ulcer on genitals
(occasionally oral)

50
Q

What are condyloma lata?

A

greyish warty, painless lesions, on genitals or mouth

51
Q

Describe the 4 features of tertiary syphilis

A

Gummatous disease: erodes through cartilaginous structures in mouth + face

Aortitis: inflammation + formation of aneurysms

Neurosyphillis: argyll robinson pupils

Tabes dorsalis: degeneration of spinal cord

52
Q

What is treatment for syphilis?

A

IM Benzathine penicillin

53
Q

What must you be aware of when treating syphilis?

A

Jarish Herxheimer reaction

When started on abx for a couple of days feel worse: fevers, rigors

When killing sphirocytes they release preformed toxin → inflammatory response
→ give paracetamol

Rarely can be more unwell → steroids

54
Q

What is the investigation for primary syphilis?

A

Darkfield microscopy of chancre sample

55
Q

If a chancre sample is not possible, what investigations should be used for syphilis?

A

Non-treponemal tests = VDRL, RPR tests

Treponemal tests =TPHA,TP-EIA

56
Q

Give an advantage and disadvantage of non-treponemal tests and treponemal tests

A

NT: Titre reduces with Tx. NOT specific to syphilis +ve for HIV, lupus

T: Specific. But stay +ve even if treated

57
Q

How should non treponemal and treponemal tests be interpreted?

A

If both +ve: active syphilis

If NT +ve, T -ve: probably cross reaction indicating something else

If NT -ve, T +ve: previous treated syphilis

58
Q

What are the buzzwords/ phrases for Chancroid?

A

Caused by Haemophilus ducreyi

Painful ulcers +/- lymphadenopathy

Tropical regions

59
Q

What are the buzzwords/ phrases for Donovanosis/ Granuloma inguinale?

A

Caused by Klebsiella granulomatis

Painless red ulcers “beefy”

Tropical regions

Donovan bodies on histology

60
Q

What are the buzzwords/ phrases for Trichomoniasis?

A

Cause by Trichomonas vaginalis

Yellow-green discharge

Strawberry cervix

61
Q

What are the buzzwords/ phrases for genital warts?

A

Human papillomavirus

62
Q

What are the buzzwords/ phrases for HSV?

A

Painful ulcers
Fluid filled vesicles

YR5 Microbiology (23 decks)

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