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Block 8 Week 2 Colt > CNS Infections - Kozel > Flashcards

CNS Infections - Kozel Flashcards

1
Q

Glucose concentrations in the CSF are what percent of the serum level?

A

60%

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2
Q

What are some specific tests you can order based on clinical suspicion?

A 
Nucleic acid amplification
Stain and culture for AFB
VDRL test
India ink negative stain
Cryptococcal polysaccharide antigen
Fungal culture
Viral culture
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3
Q 
What are the following CSF findings for viral infections?
WBC count
WBC cell type
Glucose
Protein
A

WBC: 50-1000
Mononuclear
Glucose >45
Protein <200

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4
Q 
What are the following CSF findings for bacterial infections?
WBC count
WBC cell type
Glucose
Protein
A

WBC: 1000-5000
Neutrophilic
Glucose <40
Protein 100-500

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5
Q 
What are the following CSF findings for tuberculous infections?
WBC count
WBC cell type
Glucose
Protein
A

WBC: 50-300
Mononuclear
Glucose <45
Protein 50-300

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6
Q 
What are the following CSF findings for cryptococcal infections?
WBC count
WBC cell type
Glucose
Protein
A

WBC: 20-500
Mononuclear
Glucose 45

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7
Q

Basically what is the only type of CNS infection that will raise glucose above 45?

A

viral

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8
Q

What is the only type of CNS infection that will have a neutrophilic infiltrate?

A

bacterial

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9
Q

What is the normal range of glucose in the CSF?

A

50-80

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10
Q

What is the normal WBC count in the CSF

A

0-5

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11
Q

what is the effect of blood in the CSF on the WBC count?

A

need to adjust the count

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12
Q

What are the reasons for decrased glucose in the CSF?

A
  1. Increased glycolysis by leukocytes and bacteria
  2. Increased metabolic rate of brain and spinal cord
  3. Altered glucose transport between blood and CSF
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13
Q

What are the reasons for increased protein in the CSF?

A

disruption of BBB; must also be adjusted if there is blood in the CSF

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14
Q

what are the contraindications for LP?

A

papilledema; increased ICP

neurological suggestion of intracranial mass

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15
Q

What are the three things you need to do in the initial management of acute meningitis?

A
  1. Lumbar puncture and CSF analysis
  2. Empiric antimicrobial therapy based on patient age
  3. Adjunctive dexamethasone if appropriate
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16
Q

What is the most common cause of viral meningitis?

A

enterovirus

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17
Q

What is the most common cause of bacterial meningitis?

A

Strep pneumo

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18
Q

What are the two causes of spirchetal meningitis

A

Treponema pallidum

Borrelia burgdorferii

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19
Q

T/F: you can get helminths in the brain

A

true

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20
Q

what is the invasion process of bacterial meningitis?

A

Mucosal/nasopharyngeal colonization
Local invasion
Intravascular survival
Meningeal invasion – Moxon experiment
Induction of subarachnoid space inflammation
Alterations of blood-brain barrier
Cerebral edema and increased intracranial pressure

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21
Q

what are the three types of cerebral edema?

A
  1. vasogenic from increased BBB permeability
  2. cytotoxic from swelling of cellular elements of the brain
  3. interstitial from obstruction of normal flow of CSF
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22
Q

what are the common bacterial pathogens for meningitis of the neonate?

A

Strep agalactiae
E. coli
Listeria monocytogenes
Klebsiella spp.

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23
Q

What are the common bacterial pathogens for meningitis of the 1-23 month old?

A 
S. agalactiae
E. coli
H. flu 
Strep pneumo
N. meningitidis
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24
Q

What are the common bacterial pathogens for meningitis of the 2-50 year old?

A

S. pneumo

N. meningitidis

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25
Q

What are the common bacterial pathogens for meningitis of the >50 year old?

A

S. pneumo
N. meningitidis
Listeria monocytogenes
Aerobic gram-negative bacilli

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26
Q

What allows disruption of the BBB that allows Abx to reach the brain?

A

inflammation

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27
Q

what effect do corticosteroids have on abx penetration of the brain?

A

they reduce inflamm so they also reduce abx penetration of the bbb

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28
Q

What are the features of abx with good CNS penetration in the absence of meningeal inflammation?

A
  1. Low molecular weight
  2. Low degree of ionization at 3. physiological pH
  3. High lipid solubility
  4. Low degree of protein binding
  5. Absence of active efflux systems
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29
Q

What is the Tx for meningitis in the 1 month old?

A

ampicillin plus ceftoxamine
or
ampicillin plus an aminoglycoside

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30
Q

What is the Tx for meningitis in the 1-23 month old?

A

Vancomycin plus a third gen cephalosporin

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31
Q

What is the Tx for meningitis in the 2-50 year old?

A

Vancomycin plus a third gen cephalosporin

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32
Q

What is the Tx for meningitis in the >50 year old?

A

vancomycin plus ampicillin plus third gen cephalosporin

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33
Q

What is the recommended drug for strep pneumo meningitis?

A

vancomycin plus third gen cephalosporin

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34
Q

What is the alternative tx for strep pneumo?

A

Meropenem

Fluoroquinolone

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35
Q

What is the tx for N. meningitidis?

A

Third gen cephalosporin

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36
Q

what is the alt. tx for N. meningitidis?

A

PCN G
Ampicillin
fluoroquinolone

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37
Q

What is the tx for listeria monocytogenes?

A

ampicillin

PCN G

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38
Q

What is the alt. tx for listeria monocytogenes?

A

TMP-SMX

Meropenem

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39
Q

What is the tx for strep. agalactiae?

A

Ampicillin

PCN G

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40
Q

What is the alternative tx for strep agalactiae?

A

third gen cephalosporin

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41
Q

What is the tx for h flu?

A

third gen cephalosporin

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42
Q

what is the alt. tx for h flu?

A

cefepime
meropenem
fluoroquinolone

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43
Q

What is the tx for E. coli?

A

third gen cephalosporin

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44
Q

what is the alt. tx for E. coli?

A 
Cefepime
meropenem
aztreonam
fluoroquinolone
TMP-SMX
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45
Q

what are the two things that define chronic meningitis?

A

indolent onset of greater than four weeks

signs of chronic inflamm in CSF

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46
Q

What are the early symptoms of chronic meningitis?

A

HA
nausea
decreased memory and comprehension

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47
Q

What are the differences you see in chronic meningitis vs. acute?

A

onset is more gradual
fever is lower
assc’d with lethargy and disability
pt is often immunocompromised

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48
Q

What are the mycoses that can cause chronic meningitis?

A

Cryptococcosis
Coccidioidomycosis
Histoplasmosis
Candidiasis

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49
Q

what are the bacteria that can cause chronic meningitis?

A

Mycobacterium tuberculosis
Treponema pallidum
Borrelia burgdorferii

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50
Q

what are the parasites that can cause chronic meningitis?

A

Acanthamebiasis
Cysticerosis
Angiostrngylus cantonensis

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51
Q

what are the two defining features of encephalitis?

A

inflamm in the brain parenchyma

clinical or lab evidence of neuro dysfunction

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52
Q

What are the symptoms of encephalitis?

A

fever and HA

altered mental status–EARLIER than meningitis

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53
Q

Describe the CSF profile in enceph?

A

normal glucose
elevated protein
Lymphocytic pleocytosis (elevated lymphs)–magnitude changes with etiology

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54
Q

What are the most common viral etiologies of enceph?

A 
HSV-1 and HSV-2
Varicella-Zoster virus
CMV
HHV-6
Arboviruses
HIV
enterovirus ---polio
rabies virus
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55
Q

(Vira/bacterial) sources are most common for enceph

A

viral

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56
Q

What are the possible bacterial causes of enceph?

A 
Listeria monocytogenes
Rickettsia spp.
Ehrlichia spp.
Bartonella spp.
Mycoplasma pneumoniae
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57
Q

Is the capsule of a brain abscess well or poorly vascularized?

A

well vascularized

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58
Q

What are the three sources of a brain abscess?

A
  1. Contiguous spread from sinusitis, otitis media, or mastoiditis
  2. hematogenous spread
  3. trauma
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59
Q

What are the symptoms of a brain abscess?

A

HA, N/V, FOCAL NUERO FINDINGS BASED ON SIDE OF ABSCESS

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60
Q

Are brain abscesses singular or mixed in their etiology?

A

MIxed

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61
Q

What are the two most common sources of brain abscesses?

A

Strep spp. 70%

Staph aureus 10-20%

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62
Q

What are the most common fungal brain abscesses?

A 
Aspergillus
Candida
Cryptococcus
Mucorales
Coccidioides
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63
Q

What is the most common protozoal/helminthic brain abscess?

A

toxoplasma gondii

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64
Q

Neurocysticercosis is caused by the larval form of (blank)

A

Taenia solium

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65
Q

What are some other notable causes of helminthic brain abscesses?

A

Trypanosoma cruzi, Entamoeba histolytica, Shistosoma spp.

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66
Q

What are isolates from a brain abscess caused by sinus and dental infection?

A 
Aerobic and aneorbic streptococci
Bacteroides
Prevotella spp.
Enterobacterieriae
Staph aurues
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67
Q

What are isolates from a brain abscess caused by penetrating trauma?

A

Staph aureus
Aerobic streptococci
Enterobacteriae
Clostridium

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68
Q

What are isolates from a brain abscess caused by pulmonary infection?

A 
Fusobacterium
Actinomyces
Bacterioides
Prevotella 
Nocardia
Streptococci
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69
Q

What are isolates from a brain abscess caused by congenital heart disease?

A

Streptococci

Staph aureus

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70
Q

What are isolates from a brain abscess caused by HIV infection?

A 
TOXOPLASMA GONDII
Nocardia
Mycobacterium
Listeria monocytogenes
Cryptococcus neoformans
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71
Q

What are isolates from a brain abscess caused by transplantation?

A 
Aspergillus
Candida
Mucorales
Nocardia
Toxoplasma Gondii
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72
Q

What are isolates from a brain abscess caused by neutropenia?

A

Aerobic gram-neg bacilli
Aspergillus
Candida
Mucorales

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73
Q 
Which bug is this?
Gram negative cocci
Fastidious pathogen;
A) grows on blood, chocolate, and Thayer-Martin Medium
B) can only culture on Thayer-Martin
A

Neisseria

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74
Q

Neisseria produces (blank) oxidase which can be used to ID it

A

indphenol oxidase

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75
Q

T/F: Neisseria is easily killed by sunlight, heat, and chemicals

A

true

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76
Q

Neisseria has a (blank)-specific CPS

A

group specific

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77
Q

Which group of neisseria is the epidemic strain?

A

group A

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78
Q

Groups B, C, Y, and W-135 are which type of Neisseria strains?

A

endemic

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79
Q

Which group of Neisseria is a polymer of sialic acid?

A

Group B

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80
Q

Group B Neisseria is (poorly/stronlgy) immunogenic

A

poorly; seen as self

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81
Q

Group B Neisseria ag is expressed in what specific tissue?

A

neonatal!

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82
Q

Which group of the endemic Neisseria strains can occasionally become epidemic?

A

group C

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83
Q

Neisseria has (group/type) specific outer membrane protiens and lipooligosacchardies

A

type specific

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84
Q

T/F: Meningococcemia can occur with or without meningitis

A

true

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85
Q

What are the general findings in a meningococcal infection?

A

Meningococcemia
Meningitis
Petechial lesions

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86
Q

Petechiae correlate with the degree of (blank) due to DIC

A

thrombocytopenia

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87
Q

T/F: patients with fulminant sepsis and meningitis show purpura, petechia, and echymoses

A

true

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88
Q

what part of neiserria makes it antiphagocytic?

A

the capsule

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89
Q

What part of neiserria is extremely toxic and produces inflamm?

A

LOS

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90
Q

LOS contains lipid (A/C) and the core oligosaccharaide

A

lipid A

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91
Q

T/F: LOS has the O antigen

A

false; lacks the O ag

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92
Q

How is LOS released from neisseria?

A

from the bacterial surface as the membrane blebs

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93
Q

Neisseria has (pili/flagella)

A

pili

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94
Q

Neiserria first gains access to the body where?

A

nasopharynx

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95
Q

Neiserria uses its (blank) to adhere to the epi cells of the nasopharynx

A

pili

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96
Q

besides prevent phagocytosis, what else does the capsule of neiserria do?

A

prevents complement mediated lysis

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97
Q

Which part of Neisseria causes tissue damage?

A

LOS

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98
Q

DIC from Neisseria is caused by what toxic part of the bacteria?

A

LOS

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99
Q

Multiple attacks of Neisseria is associated with depletion of which complement factors?

A

C5,6,7,8

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100
Q

What types of specimens do you need to collect to Dx Neisseria?

A

blood
CSF
NP secretions in the carriers

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101
Q

How do you visualize Neisseria?

A

Direct exam with gram stain of the CSF

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102
Q

What type of culture and special conditions are needed to culture Neisseria?

A

Culture IMMEDIATELY
incubate in CO2
Use Thayer-martin agar

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103
Q

What is the gram stain and general appearance of Neisseria?

A

gram negative diplococci

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104
Q

What is the oxidase status of Neisseria?

A

oxidase positive

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105
Q

Neisseria oxidatively produces acid from what?

A

sugars, eg glucose and maltose

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106
Q

How is Neisseria spread man to man?

A

airborne transmission via respiratory droplets

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107
Q

Which populations are most susceptible to Neisseria?

A 
young kids (no Abs)
college students and military recruits (crowding and fatigue)
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108
Q

What is the carrier rate of Neisseria?

A

1-40%; few carriers develop disease

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109
Q

T/F: Neisseria only happens in outbreaks

A

false; may occur sporadically or in epidemics, hence the multiple strains

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110
Q

immunity to meningococcus is due to what?

A

anticapsular AB

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111
Q

what are the MOA’s of immunity to Neisseria?

A

complement mediated lysis and opsonization

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112
Q

Anticapsular Ab is the major factor that determines (blank vs. blank)

A

resistance vs. susceptibility

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113
Q

What explains the risk of Neisseria in kids between 6-24 months?

A

lack of anticapsular Ab

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114
Q

Naturally ocurring Abs to Neisseria are probably due to the carrier state and to cross reacting with what other bacteria?

A

E. coli

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115
Q

The tetravalent meninogcoccal vaccine has which four Neisseria strains?

A

A
C
Y
W-135

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116
Q

What part of the bacteria does the meningococcal vaccine contain?

A

purified polysaccharide only

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117
Q

T/F: The tetravalent vaccine is one of two vaccines used for adults older than 56

A

false; the only one

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118
Q

The (polysacc/polysacc-protein) vaccine is used to vaccinate adolescents against meningitis

A

polysacc-protein conjugate

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119
Q

Which four strains does the polysacc-protein conjugate vaccine against meningitis have?

A

A
C
Y
W-135

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120
Q

When do kids get the meningitis vaccine?

A

11-12

121
Q

when do you get a meningitis booster?

A

16-18

122
Q

What are the special populations that should receive the meningococcal vaccine besides adolescents?

A 
College freshmen living in dormitories
Microbiologists with potential exposure
Military recruits
Travelers to endemic regions
Terminal complement deficiencies
Anatomic or functional asplenia
123
Q

Why is group B neisseria not included in any vaccine?

A

poorly immunogenic

124
Q

The vaccine for group B neisseria targets (blank)

A

factor H protein

125
Q

what is the vaccine for cholera?

A

inactivated v. cholera

126
Q

what is the vaccine for diphtheria?

A

toxoid

127
Q

what is the vaccine for h. flu?

A

CPS-protein conjugate

128
Q

What is the vaccine for meningococcus?

A

Multivalent CPS or CPS-protein conjugate

129
Q

What is the vaccine for pertussis?

A

Inactivated or disrupted B. pertussis

Acellular vaccine of purified proteins

130
Q

What is the vaccine for pneumococcus?

A

Multivalent CPS or 13-valent CPS-protein conjugate

131
Q

What is the vaccine for tetanus?

A

toxoid

132
Q

What is the vaccine for TB?

A

live attenuated BCG

133
Q

what is the vaccine for typhoid?

A

heat killed S. typhi

live attenuated oral vaccine

134
Q

What is the std. Tx. if N. meningitidis is ID’d?

A 
1. Third gen cephalosporin
or
PCN G or Ampicillin
2. extensive supportive care
3. chemoprophylaxis for family contacts using rifampin
135
Q

Why is a third gen cephalosporin or PCN G/Amp used to Tx N. meningitidis?

A

readily penetrates inflamed meninges

136
Q

what are some of the clinical signs of H flu in the newborn?

A

fever
refusal to eat
grunting respirations
hypertonicity

137
Q

what causes Brazilian purpuric fever?

A

H. flu biogropu aegyptius

138
Q

What causes acute purulent conjunctivitis?

A

H. aegyptius

139
Q

What causes soft chancre veneral disease?

A

H. ducreyi

140
Q

What is the morphology of H. flu?

A

very small gram neg. rods

141
Q

What are the special nutritional requirements of H. flu?

A

X factor aka hematin
V. factor aka NAD
Chocolate agar

142
Q

Why must chocolate agar be heated for H. flu?

A

lyses RBCs to release X and V factors

inactivates inhibitor of V factor

143
Q

(blank) can causes satelliting on plates of H. flu as it also releases X and V factors

A

S. aureus

144
Q

T/F: H. ducreyi also requires X and V factors

A

false; only needs X factor

145
Q

WHat part of H. flu prevents phagocytosis?

A

CPS

146
Q

how many types of H flu capsule are there?

A

a-f

147
Q

WHat type of H flu causes almost all systemic disease>?

A

H flu B

148
Q

H flu B secretes what unique chemical?

A

polyribitol phosphate

149
Q

T/f; there are many common non-typable strains of H flu that lack a capsule

A

true

150
Q

H flu begins where?

A

as nasopharyngitis

151
Q

Which strains of H flu most commonly migrate to the sinuses or middle ear? What else can do this?

A

non-typeable strain

can also be strep pneumo or Moraxella catarrhalis

152
Q

H flu that extends to the blood and meninges is what type?

A

B

153
Q

(blank) strains of H flu cause epiglotitis

A

encapsulated strains

154
Q

H flu pneumonia is secondary to (blank) virus infection

A

influenza

155
Q

H flu B capsule is able to block (blank) mediated lysis

A

complement

156
Q

H flu b is releases what that causes meningeal inflamm?

A

endotoxin

157
Q

WHat types of samples do you need to collect to ID Hib?

A

NP swab, blood, CSF

158
Q

Gram stain of (blood/CSF) can give a provisional Dx of H flu

A

VSF

159
Q

What must be done to culture H flu?

A

culture immediately; does not survive well

160
Q

The ID of H flu is made on the need for what nutritional supplements?

A

X and V factor

161
Q

Latex agglutination is an assay to detect (blank) in the CSF

A

H flu B capsular antigen

162
Q

What percent of pts with H flu meningitis have neuro sequelae?

A

30-50%

163
Q

What is URT carrier rate of H. flu in kids?

A

30-50%

164
Q

most carrier strains of H flu are (typeable/non-typeable)

A

non-typeable causing otitis media

165
Q

There are (many/few) asymptomatic carriers of H flu B

A

few

166
Q

What is the primary risk factor for H flu meningitis?

A

lack of anticapsular Ab

167
Q

What is the MOA of protection of the anticapsular Ab to H flu?

A

opsonization and complement mediated lysis

168
Q

H flu meningitis is most common in what age group?

A

6 months and 3 years

169
Q

Maternal Abs protect against H flu until what age?

A

6 months

170
Q

Exposure to Hib carriers and cross reactive ags protect kids until what age?

A

3

171
Q

What was in the old vaccine for Hib?

A

polyribitol phosphate aka the CPS

172
Q

What was the issue with the old vaccine?

A

poorly immunogenic in kids younger than 18 months

173
Q

What is in the current vaccine for H flu?

A

protein conjugate;

174
Q

What is in the connaught vaccine for H flu?

A

PRP coupled to diptheria toxoid

175
Q

what is in the Praxis Biologics vaccine for H flu?

A

PRP coupled to nontoxic mutant of diphtheria toxin

176
Q

What is in the Merck, Sharp, and Dohme vaccines for H flu?

A

PRP coupled to the N meningitidis OMP

177
Q

When is the H flu vaccine given?

A

2 months

178
Q

T/F: the vaccine for Hib reduces the carrier rate

A

true; goal is elimination of Hib

179
Q

Should you wait for pos cultures before treating for H flu?

A

NO; NEEDS IMMEDIATE TX

180
Q

What is the firstline Tx for H flu?

A

broad spectrum cephalosporin with CNS penetration; aka cefotaxime or ceftriaxone

181
Q

What is used to cleanse carriers of H flu?

A

rifampin

182
Q

What causes this?
Following conjunctivitis– Acute onset of fever, vomiting and abdominal pain, followed by purpura, vascular collapse and death

A

Brazilian purpuric fever
aka
H flu biogroup aegyptius

183
Q

Where is H. ducreyi common?

A

Afrika

184
Q

What is a probable co-factor in transmission of AIDS in Afrika?

A

H. ducreyi

185
Q

What is the morphology of Strep pneumo?

A

Gram pos
ovoid or lancet shaped in pairs
aerobic

186
Q

Is strep pneumo neked or encapsulated?

A

ENCAPSULATED

187
Q

Older cultures of strep pneumo undergo (blank), which is activated by surfactants such as bile and detergents

A

autolysis

188
Q

Strep pneumo can undergo a rough-to-smooth conversion via…..

A

transformation

189
Q

what agar must be used to grow strep pneumo?

A

blood agar

190
Q

What is the major ag in strep pneumo?

A

CPS

191
Q

the CPS of strep pneumo is (T/B) independent

A

T independent

192
Q

incubation of encapsulated bacteria with antibody makes the capsule refractile is known as the (blank) reaction

A

Quellung

193
Q

Strep pneumo C polysaccharaide is aka….

A

teichoic acid

194
Q

teichoic acid is a cell wall CHO that reacts with which acute phase protein?

A

CRP

195
Q

strep pneumo pneumonia is (lobar/hilar) in 80-90% of cases

A

lobar

196
Q

Strep pneumo is the most common cause of (blank() in children older than three months

A

otitis media

197
Q

Strep pneumo is the most common cause of (blank) among the young and the elderly

A

meningitis

198
Q

What are some other complications of a strep pneumo infection?

A

peritonitis, endocarditis, arthritis

199
Q

What are the characteristics of meningitis from strep pneumo?

A

by abrupt onset, toxicity, fulminant course and DIC

200
Q

What is the actual dz state due to with infx of strep pneumo?

A

inflammatory response to both the bacteria and its products

201
Q

T/F: the CPS of strep pneumo is essential for its virulence

A

true

202
Q

What part of strep pneumo is antiphagocytic?

A

the CPS

203
Q

What type of Ab protects against strep pneumo via opsonization only?

A

anticapsular ab

204
Q

What does the the anticapsular Ab against N. meningitidis and Hib do that the one for strep pneumo can’t?

A

activate complement mediated lysis

205
Q

(blank) is a porin similar to Streptolysin O found in strep pneumo

A

Pneumolysin

206
Q

What is the effect of pneumolysin?

A

contributes to inflammation

207
Q

PDG and lipoteichoic acid are components of the….

A

cell wall

208
Q

PDG and lipoteichoic acid activate the (classical/alternative) complement pathway

A

alternative

209
Q

PDG and lipoteichoic acid elicit which two cytokines?

A

IL1

TNFa

210
Q

What two components of strep pneumo are largely responsible for the inflammatory response?

A

PDG

lipoteichoic acid

211
Q

t/F: natural resistance to strep pneumo is very high

A

true; 40-70% of people carry strep pneumo in the NP

212
Q

WHat are the natural defensive barriers against strep pneumo?

A

Cough and epiglottal reflex
Mucus and cilia
Phagocytosis by alveolar macrophages
Splenic clearance from blood

213
Q

What are some of the conditions that lower resistance to strep pneumo?

A 
depressed action of cilia
depressed epiglottal reflex
hyposplenia or asplenia
SICKLE CELL DISEASE
malnutrition
214
Q

What are some causes of depressed epiglottal reflex?

A

EtOH, morphine, anesthesia

215
Q

What are some causes of depressed action of cilia?

A

viral infx aka flu

216
Q

What are the characteristics of pneumococcal pneumonia?

A
  1. sudden onset with shaking chill, fever, and sharp pleural pain
217
Q

What does the sputum look like in pneumococcal pneumonia?

A

bloody and rusty

218
Q

Where in the lungs does pneumococcal pneumonia localize in the lung?

A

lower lobes

219
Q

What types of samples do you need to Dx pneumococcal meningitis?

A

sputum and body fluids:
CSF
pus
etc

220
Q

What two things must you do to do a direct examination of strep pneumo?

A

gram stain

DNA PROBE

221
Q

what type of agar do you need to use to isolate strep pneumo?

A

blood agar

222
Q

What are the three things that differentiates strep pneumo from strep viridans?

A

alpha hemolytic
Optochin sensitive
Bile soluble

223
Q

What types of serologic tests can you do to test for strep pneumo?

A

free ag in body fluids

pneumococcal C polysacc

224
Q

T/F: most infections with strep pneumo are endogenous

A

true

225
Q

Despite most infections with strep pneumo being endogenous, most healthy adults lack the (blank), unlike N. meningitidis and Hib

A

anticapsular ab

226
Q

What are the steps to prevent and control strep pneumo infx?

A

prevent primary damage
immunization as needed
isolation to prevent transmission to pts at risk

227
Q

Strep pneumo enters and exits the body via the…

A

URT

228
Q

What do both of the pneumonia vaccines contain?

A

purified capsular polysacc

229
Q

The pneumonia vaccine is (poly/monovalent)

A

polyvalent

230
Q

What is the MOA of the pneumo vaccine?

A

induction of opsonic Ab

231
Q

What is the efficacy of the pneumo vaccine?

A

60-80%

232
Q

The titers for the pneumo-vax last for how long?

A

5 years

233
Q

The Ag involved in the pneumo vax is (T/B) independent and therefore not suitable in kids younger than two

A

T independent

234
Q

What are the populations that should be vaccinated with pnuemovax?

A

all adults older than 65 or in series with PCV 13

anyone 6-18 with specific risk factors

235
Q

What is different about the polysacc-protein conjugate pneumo vax?

A

also covers 65% of acute otitis media in kids younger than six
also T independent
Reccomended for ALL children
Reduces carriage and produces herd immunity

236
Q

What is the firstline Tx for strep pneumo?

A

PCN or ceftriaxone IF SUSCEPTIBLE; increasing reports of resistance

237
Q

Strep pneumo resistance means that the lab needs to do more (blank) to determine the right abx

A

sensitivity testing

238
Q

What is the MOA of strep pneumo resistance?

A

acquisition of a PBP with reduced affinity for abx

239
Q

What are the alt. abx used for strep pneumo?

A

vancomycin
macrolides
doxycycline
quinolone

240
Q

What is the empiric treatment for pneumococcal meningitis?

A

ceftriaxone or PCN + vancomycin

241
Q

What is the reason to use ceftriaxone for pneumo meningitis?

A

better CNS penetration

242
Q

Why do we include vancomycin in the Tx for pneumo meningitis?

A

coverage if resistant to B lactam

243
Q

PCN (does/does not) pass through the normal BBB

A

does not

244
Q

What is the ironic part of giving PCN to treat pneumo meningitis?

A

kills bacteria, which releases more PDG and TA, resulting in more inflamm, which causes increased ICP and IRREVERSIBLE BRAIN DAMAGE

245
Q

How can you reduced the inflamm when giving abx for pneumo meningitis?

A

corticosteroids

246
Q

GBS is part of the normal flora of….

A

GI and GU tracts

247
Q

What is the leading cause of neonatal sepsis and meningitis?

A

GBS

248
Q

what are the risk factors in adults that lead to systemic GBS?

A

diabetes
cancer
HIV infx

249
Q

What is the key virulence factor in GBS?

A

antiphagocytic capsular polysaccharide

250
Q

t/F: the Ab to the CPS of GBS is protective even in the newborn

A

true

251
Q

When does GBS onset in the newborn

A

within the first week

252
Q

How is GBS in the newborn acquired?

A

in utero or during birth

253
Q

What are the symptoms of infx with GBS in the newborn?

A

bacteremia
pneumonia
and/or meningitis

254
Q

When does late onset neonatal infections happen?

A

1 week to 3 months

255
Q

How is late onset neonatal infections acquired?

A

from mother or another infant

256
Q

WHat are the symptoms of late onset neonatal infection?

A

bacteremia and meningitis

257
Q

How does GBS infx present in older adults>?

A

bacteremia, pneumonia, bone/joint infection and skin and soft tissue infection

258
Q

WHat are the risk factors for early onset neonatal disease?

A
  1. Exposure to bacterium via mother carrier, prolonged membrane rupture, or intrapartum fever
  2. Absence of anticapsular Ab from mom lacking it or delivery sooner than 37 weeks
259
Q

How do you ID GBS in the lab?

A

Gram stain
BETA hemolytic
Agglutination test for Lancefield Group B AG

260
Q

What are the methods of preventing early onset neonatal disease?

A
  1. unverisal screening of all preg women at weeks 35-37 for rectal/vaginal colonization of GBS
  2. intrapartum abx prophylaxis
261
Q

When do you give intrapartum abx prophylaxis?

A
  1. at time of labor when membrane ruptures
  2. all preg women who test pos for GBS
  3. Give PCN G or Ampicillin
262
Q

Is there a vaccine to prevent early onsent neonatal disease?

A

nope

263
Q

What is the empiric treatment of early onset neonatal disease?

A

Ampicillin plus aminoglycoside

264
Q

What is the specific Tx for ID’d GBS neonatal disease?

A

PCN G

265
Q

What are the indications for intrapartum GBS abx prophylaxis?

A
  1. previous bebe with GBS dz
  2. GBS bacteriuria during current pregnancy
  3. Positive GBS screen
  4. GBS status unknown plus any:
    a) delivery before 37 weeks
    b) amniotic membrane rupture greater than 18 hours
    c) intrapartum temp >100.4
266
Q

Cryptococcus neoformans is a (naked/encapsulated) yeast

A

encapsulated

267
Q

What is the foundation of Dx of cryptococcus?

A

Assay for CrAg (cryptococcal ag)

268
Q

How many serotypes of cryptococcus are there?

A

four: A-D

269
Q

WHat species are serotypes A and D?

A

C. neoformans

270
Q

What species aer serotypes B and C of cryptococcus?

A

C. gatti

271
Q

Globally, what is the most serious and life threatening of the pathogenic fungi?

A

Cryptococcus

272
Q

Where is cryptococcus found?

A

Saprophyte found in pigeon droppings and associated with EUCALYPTUS TREES

273
Q

Which species of cryptococcus is associated with eucalyptus trees?

A

C. gatti

274
Q

T/F: Cryptococcus is likely present in all people

A

true; causes a subclinical infection that goes latent

275
Q

Why does cryptococcus reactivate in HIV/AIDS?

A

drop in T cell function

276
Q

Where do we see most cases of cryptococcus acutely?

A

Sub-Saharan Africka; think AIDS

277
Q

Cryptococcal infections in AIDS is well controlled with the use of ….

A

HAART

278
Q

Pulmonary cryptococcosis begins as what type of infx?

A

pulmonary, duh

279
Q

Which strain is most commonly the cause of pulmonary cryptococcus?

A

C. gatti

280
Q

Cryptococcal meningitis is highly neuro(blank)

A

neurotropic

281
Q

What are the other manifestations of a cryptococcal infx?

A

Skin lesions
Ocular infection
Prostatic involvement – possible asymptomatic reservoir

282
Q

Since cryptococcus is opportunistic, in what situations do we see active infx?

A

HIV/AIDs

immunosuppresion aka organ transplant

283
Q

What strain of cryptococcus do we see in NON-HIV and NON-transplant hosts?

A

C. gatti

284
Q

What types of specimens do you need to collect in order to Dx cryptococcus?

A

Blood/serum AND CSF

285
Q

What types of stains do you need to do to visualize cryptococcus?

A

india ink looking for an encapsulated yeast

286
Q

Ag detection of cryptococcus can happen via what three fluids?

A

serum
plasma
CSF

287
Q

What are the three methods of assaying for CrAg?

A

latex agglutination
enzyme immunoassay
LFI

288
Q

What i the lowest reliability Dx for cryptococcus?

A

india ink stain in NON-AIDS pts; only 50% sensitivity

289
Q

T/F: cryptococcal tx can be mono or combo

A

true

290
Q

What are the antifungals you would use against cryptococcus?

A

Amphotericin B
Flucytosine
Fluconazole

291
Q

T/F: Tx of cryptooccus is different for immunocompromised pts

A

true

292
Q

What are the three phases of Tx of cryptococcus?

A

Induction
Consolidation
Maintenance

293
Q

What is Immune reconstitution inflammatory syndrome (IRIS)?

A

Occurs at initiation of HAART

Overwhelming inflammatory response to previously acquired OI

294
Q

In symptomatic pts, how do you initially Dx cryptococcal infection?

A

CSF, or if access to LP limited, THEN do serum CrAg

USE THE LFI

295
Q

What drugs should be used in the induction phase of crypto tx?

A

Amphotericin B
Flucytosine
Fluconazole
TOGETHER

296
Q

What drugs should be used in the consolidation phase of crypto tx?

A

Fluconazole

297
Q

What drugs should be used in the maintenance phase of crypto tx?

A

Fluconazole

298
Q

WHen should all AIDS pts be screened for CrAg?

A

prior to starting ART

299
Q

T/F: all CrAg pos pts should be treated BEFORE starting ART

A

true

Block 8 Week 2 Colt (6 decks)

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