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Clinical Pathology > viral meningitis and encephalitis > Flashcards

viral meningitis and encephalitis Flashcards

1
Q

what does “itis” mean

A

inflammation

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2
Q

define meningitis

A

inflammation of the meninges

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3
Q

define encephalitis

A

inflammation of the brain

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4
Q

define menigo-encephalitis

A

inflammation of the meninges and the brain

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5
Q

define aseptic meningitis

A

white cell count in CSF >5x 10^6/L

negative bacterial culture

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6
Q

commonest causes of aseptic meningitis

A

viral- most common
partially treta bacterial meningitis (so culture is negative but WBC is high).
Malignancy
Autoimmune conditions and drugs, Listeria, TB, Syphilis.

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7
Q

most common cause of viral meningitis

A

unknown-37%
Enterovirus
Herpes simplex virus

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8
Q

most common enetroviruses to cause viral encephalitis

A

Echovirus, coxsackie virus, parencho virus, enterovirus and polio

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9
Q

most common herpes virus to cause viral encephalitis

A

HSV1, HSV2 , varicella zoster

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10
Q

how doe pathogens cause viral meningitis

A

colonise mucosal surfaces
invade epithelial cells
replicate cells
disseminate and CNS invasion

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11
Q

how do pathogens invade the CNS

A

cerebral microvascular endothelial cells
choroid plexus epithelium- bloodstream.
spread along the olfactory nerve.

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12
Q

clinical features of viral meningitis.

A

fever, meningism, viral prodrome (lethargy, myalgia’s, arthralgia’s, sore throat ), diahorrhea and vommitting and rash.

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13
Q

what is meningism (what 3 symptoms does it involve`0

A

headahce, neck stiffness and photophobia

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14
Q

clinal features of viral meningitis in children

A

nuchal rigidity (neck stiffness), bulging anterior frontelle.

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15
Q

what 3 examinations are carried out on suspected patients with viral meningitis

A

kernigs sign
Brudzinskis sign
nuchal rididity

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16
Q

what is Kernigs sign

A

hip and knee flexed at 90, knee cannot be extended due to pain and stiffness in hamstrings.

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17
Q

what is Brudzinski’s sign

A

flexing neck causes hips and knees to flex at it reduces stretch on spinal cord and meninges

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18
Q

what blood investigations are carried out in viral meningitis

A

Blood test- FBC, U and E, CRP, clotting (before LP), blood culture, renal function (dehydration).

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19
Q

why might a CT be used in viral meningitis

A

look for raised intracranial pressure and other diagnosis of mass, lesion, subarachnoid haemorrhage.

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20
Q

why should a lumbar puncture not be carried on a patient with raised intracranial pressure.

A

removing the CSF can cause the brain to herniate through the foramen magnum

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21
Q

when should a lumbar puncture be carried out on a patient with suspected viral meningitis

A

ASAP
before antibiotics and CT
within 1 hr of admission.

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22
Q

what can the CSF obtained from a lumbar puncture be used for

A

– Microscopy, culture and sensitivity (MCS)
– Protein
– Glucose (CSF and blood glucose)
– Viral PCR

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23
Q

what is the WBC in bacterial meningitis

A

100-20,000 mm ^2

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24
Q

what is the WBC in viral meningitis

A

5-500 mm^2

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25
Q

what is the glucose level in bacterial meningitis

A
26
Q

what is the glucose level in viral meningitis

A

30-70 mg/dL

27
Q

what is the protein level in bacterial meningitis

A

100-500 mg/dL

28
Q

what is the protein level in viral meningitis

A

30-150 mg/dL

29
Q

what microbiological investigations other than those obtained from CSF can be undertaken for viral meningitis

A

throat swab, stool sample

serology- Mumups, EBV/CMV/HIV

30
Q

what is the treatment for viral meningitis

A

Mainly supportive therapy (e.g. analgesia and antipyretics)
no antibiotics unless bacterial where you give IV cefotaxime.
some treat HSV/VZV with aciclovir

31
Q

is viral meningitis a notifiable condition

A

Yes

32
Q

Commoest cause of meningitis in the UK is

A

enterovirus

33
Q

what is the prognosis of enetrrovirus caused viral meningitis

A

full recovery.

34
Q

common symptoms of enterovirus infection

A

fever, vomitting, anorexia, rash, upper respiratory tract symptoms.

35
Q

what condition does HSV1 infection cause

A

encephalitis (cold sores)

36
Q

what condition does HSV2 infection cause

A

meningitis (genital herpes)

37
Q

define mollaret’s meningitis and what organism causes it

A

recurrent aseptic meningitis and wide differential but major cause= HSV2

38
Q

what does primary infection of VSV cause

A

chickenpox

39
Q

what does secondary infection of VSV cause

A

shingles

40
Q

does viral meningitis occur during chickenpox and shingles to not

A

most commonly not, but it can occur with it.

41
Q

aciclovir is not used in what 2 pathogen caused viral meningitis

A

HSV and VZV

42
Q

when do CNS symptoms in mumps meningitis

A

5 days after onset of parotitis

43
Q

clinical features of mumps meningitis excluding for CNS symptoms

A

abdominal pain

Orchitis- inflammation of the testes

44
Q

prevention of Mumps meningitis

A

vaccine

45
Q

when does HIV meningitis occur

A

part of primary infection

46
Q

clinical features associated with HIV meningitis

A 
glandular fever
Fever
Lymphadenopathy
Pharyngitis
Rash
47
Q

what causes viral encephalitis

A

unknown-37%
herpes- HSV1
can be bacterial-
acute disseminated encephamyophaty (damages myelin)

48
Q

what part of a history is key to encephalitis and meningitis

A

travel history

49
Q

clinical presentation of encephalitis

A

Major features- low GCS.
Altered mental state (confusion, bizarre behaviour and even coma)
Fever, headache, meningism (may be absent)
+/- Focal neurology
Seizures, weakness, dysphasia, aphasia, cranial nerve palsy and ataxia.
Neuroexamination needed and get a collateral history from friend or relative to ask if they have noticed any confusion in the patient.

50
Q

what investigations are carried out for viral encephalitis.

A

blood test- – FBC, U&E,CRP, clotting, (Blood cultures), Serology

CT – likely to be necessary before LP- due to low GCS score focal neurology will need to be checked.

MRI – may see changes typical of HSV encephalitis
Lumbar puncture:
–	Microscopy
–	Culture and sensitivity
–	Protein/glucose
–	Viral PCR

EEG: In HSV encephalitis 75% will show abnormal temporal lobe activity

51
Q

In HSV encephalitis 75% will show abnormal activity in which lobe of the brain, what investigation is used to prove this

A

temporal lobe

EEG-electroencephalogram

52
Q

What is the treatment for viral encephalitis.

A

• High dose IV aciclovir
o 10mg/kg tds
o 14-21 days

53
Q

why is oral switch of acicolovir not recommended

A

long time period over which drugs might have to be taken.

54
Q

what is the bimodal distribution of herpes encephalitis

A

50 yrs.

55
Q

what signs are present in the neurological sequel of herpes encephalitis

A

– Paralysis
– Speech loss
– Personality change

56
Q

what is the pathogenesis of herpes in causing viral encephalitis.

A

o Direct transmission of the virus along neural/olfactory pathways
o Reactivation in the trigeminal ganglia (HSV1)

57
Q

Is herpes simplex encephalitis more common on primary infection or reactivation

A

primary

58
Q

define Acute focal necrotising encephalitis

A

brain tissue dies, increased ICP and increased Inflammation.

59
Q

what pathogenic organism infection causes Acute focal necrotising encephalitis

A

herpes simplex

60
Q

define Acute disseminated encephalomyelopathy

A

AUTOIMMUNE

immune mediated CNS demyelination
can follow viral infection or vaccine

61
Q

what investigation is useful in (ADEM) Acute disseminated encephalomyelopathy

A

MRI

62
Q

what is the main treatment for Acute disseminated encephalomyelopathy (ADEM)

A

Steroids and immunosuppression.

Clinical Pathology (45 decks)

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