Encephalitis/Meningitis

Question 1

What are the 3 causes of CNS infections?

Answer 1

1. Invasion of bloodstream
2. Retrograde neuronal pathway-Olfactory or peripheral nerves
3. Direct contiguous spread

Question 2

Encephalitis presentation

Answer 2

1. AMS
2. Motor and or sensory deficits (abnormal cerebral function)-Focal neuro sx’s, CN deficits
3. Seizures
4. Altered behavior and/or personality change
5. Profound lethargy
6. Fever

Question 3

What is the number one cause of encephalitis?

Answer 3

Viral: HSV-1 (MC)

Question 4

Who is @ high risk for encephalitis?

Answer 4

1. Outdoors
2. Tavel to endemic areas
3. Immunocompromised
4. Lack of vaccines

Question 5

List the viral causes of encephalitis

Answer 5

1. Herpesvirus
2. West Nile Virus- Arthorpod-borne viruses
3. Rhabdovirus
4. HIV
5. Coxsackie-enteroviruses
6. Measles

Question 6

List bacterial causes for encephalitis

Answer 6

1. Borrelia Burgdorferi (lyme dz)
2. M. tuberculosis (TB)
3. T.pallidum (Syphillis)

Question 7

What organism would you suspect with flaccid paralysis PE findings?

Answer 7

West Nile Virus

Question 8

List autonomic and hypothalamic disturbances you may find on physical exam findings in encephalitis

Answer 8

1. Loss of temp and vasomotor control
2. Diabetes insipidus
3. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

Question 9

What is the preferred imaging for encephalitis? What area of the brain is MC involved?

Answer 9

MRI

Temporal lobe-HSV

Question 10

Encephalitis CSF findings

Answer 10

1. Lymphocytosis
2. Normal glucose
3. Increased protein
4. Straw colored

Question 11

When is an LP contraindicated?

Answer 11

1. Sign/Sx’s of Increased ICP: Decreased LOC, Focal neurologic sx’s, Papilledema
2. Severe coagulopathy or on anticoagulant therapy
3. Skin infection or spinal abscess @ LP site
4. Mass lesion

Question 12

Cushings triad

Answer 12

Sigs of increased ICP:

1. Respiratory depression
2. Bradycardia
3. Hypertension

Question 13

Caused for Pink-Red CSF

Answer 13

1. Traumatic LP
2. Subarachnoid hemorrhage
3. Intracerebral hemorrhage
4. Cerebral infarct

Question 14

What does leukopenia and thrombocytopenia on a CBC indicate?

Answer 14

Ricketssial

Viral fevers

Question 15

What does eosinophilia on a CBC indicate?

Answer 15

Drug induced encephalitis

Parasites

Question 16

What does hyponatremia indicate?

Answer 16

Rickettsial infection

SIADH

Question 17

What is the gold standard for encephalitis diagnosis?

Answer 17

Brain biopsy

Not routinely performed

Question 18

What is the most important treatment intervention in encephalitis? Why?

Answer 18

Acyclovir early

Decreases morbidity and mortality due to HSV and VZV encephalitis

Question 19

Meningitis risk factors

Answer 19

1. Extremes of age
2. Exposure risk-Close proximity
3. Birth hx/maternal infection
4. Vaccine status
5. Injection drug use

Question 20

What is the number one cause of viral meningitis?

Answer 20

Enteroviruses: Coxsackie, herpangina

Question 21

What strain of HSV do we see in viral meningitis?

Answer 21

HSV-2

Question 22

CSF findings in viral meningitis?

Answer 22

1. Clear or cloudy
2. Lymphocytosis
3. Normal glucose
4. Increase protein

Question 23

Pathogen in neonates in bacterial meningitis

Answer 23

Group B Streptococcus

Question 24

Pathogen in babies and children in bacterial meningitis

Answer 24

S. peneumoniae

Question 25

Pathogen in teens and young adults bacterial meningitis

Answer 25

N. meningitidis | Accompanying petechial/purpra rash

Question 26

Pathogen in adults in bacterial meningitis

Answer 26

S. peneumoniae

Question 27

bacterial meningitis presentation

Answer 27

1. Fever/chills 2. Meningeal sx: HA, nuchal rigidity, kernigs sign, brudzinski 3. AMS (DO NOT have to have this) 4. N/V 5. Photophobia

Question 28

When would you want to get a CT scan before LP?

Answer 28

signs of increased ICP-->r/o mass effect

Question 29

What is the first treatment intervention you want to do in bacterial meningitis?

Answer 29

Start empiric abx!!!

Question 30

What is the definitive dx for bacterial meningitis?

Answer 30

LP

Question 31

CSF findings in bacterial meningitis

Answer 31

1. Neutrophils 2. Decrease glucose (<45) 3. Increased protein 4. Increased CSF pressure 5. Yellow color

Question 32

What is empiric abx treatment in bacterial meningitis?

Answer 32

Ceftriaxone or Cefotaxine (3rd generation) + Vanco +Ampicillin IF 50+

Question 33

What is empiric abx treatment if you have a severe beta-lactam allergy in bacterial meningitis?

Answer 33

Vancomycin | + Fluroquinolone (Moxifloxacin)

Question 34

What is empiric abx treatment if you have a severe beta-lactam allergy in bacterial meningitis AND you are 50+?

Answer 34

TMP-SMX

Question 35

Who is Dexamethasone recommended for?

Answer 35

Suspected S. pneumoniae | Decreases risk of developing neurologic sequela that is highly associated with S.pneumo

Question 36

Who is post-exposure prophylaxis indicated for?

Answer 36

1. Prolonge contact: >8 hrs while in close proximity, <3 ft | 2. Direct exposure to patients oral secretions during 7 days prior to sx's onset AND until 24 hrs after initiating abx

Question 37

What serogroups does the quadrivalent meningococcal conjugate vaccine protect against?

Answer 37

A, C, W & Y

Question 38

Who is Menactra approved for?

Answer 38

9 mos-55 yrs.

Question 39

Who is Menveo approved for?

Answer 39

2 mos-55 yrs.

Question 40

List the vaccines that cover against serogroup B

Answer 40

1. Trumenb: 10-25 yrs, 2-dose and 3 dose series | 2. Bexsero: 10-25 yrs, 2-dose

Question 41

Who is Trumenb and Bexsero indicated for?

Answer 41

1. Persistent complement component deficiency 2. Asplenia 3. Microbiolgist routinely working with N.meningitidis 4. @ high risk