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Clinical Microbiology > CNS Infections > Flashcards

CNS Infections Flashcards

1
Q

Protozoal infections of the CNS is most commonly caused by…?

A

Toxoplasmosis

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2
Q

What type of microorganisms can cause acute meningitis?

A

Bacteria

Virus

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3
Q

What type fo microorganism can cause subacute meningitis?

A

Bacteria

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4
Q

What are the signs and symptoms of meningitis?

A 
Headache
Neck stiffness
Reduced GCS
Fever
Confusion
Rash (purpuric)
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5
Q

What underlying disorders can result in pnuemonoccocal infection of the meninges?

A 
Middle ear disease
Head injury
Neurosurgery
Alcohol
Immunosuppresion
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6
Q

What factors are. associated with an adverse outcome in patients with bacterial meningitis?

A 
Pneumococcal infections
Reduced GCS
CNS signs
Older age >60 years
CN palsy
Bleeding
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7
Q

What investigations and examinations should be conducted in suspected meningitis?

A 
Throat examination
Blood cultures
Throat culture
Viral gargle
FBC
U&Es
LFTs
CRP
Lumbar puncture
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8
Q

In suspected meningitis when should a CT be conducted before a lumbar puncture is done?

A 
CNS <12
CNS signs
Papilloedema
Immunocompromised
Seizure
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9
Q

In suspected meningitis, when is a lumbar puncture contraindicated?

A 
Brain shift
Rapid GCS reduction
Severe sepsis
Rapidly evolving rash
Infection at lumbar puncture site
Respiratory/cardiac compromise
Coagulopathy
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10
Q

Meningococcal and pneumococcal infections of the meninges should be treated with which antibiotics?

A

IV Ceftriaone

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11
Q

Listeria infections of the meninges should be treated with which antibiotics?

A

IV amoxicillin

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12
Q

What are the concerns with pre-hospital antibiotic therapy?

A

Microbe lysis pre-hospital leading to a cytokine storm
Exacerbation of sepsis
Lack of supportive measures

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13
Q

Viral meningitis is usually only diagnosed after exclusion of bacterial meningitis. How is this treated?

A

Supportive treatments

Aciclovir only if the patient is immunocompromised

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14
Q

What are the symptoms of viral encephalitis?

A

Confusion
Fever
Seizures

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15
Q

How is viral encephalitis treated?

A

IV acyclovir for 2-3 weeks

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16
Q

How is viral encephalitis investigated?

A

EEG
MRI
Lumbar puncture - lymphocytic CSF

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17
Q

Intra-cerebral TB may be unmasked during treatment for other TB infection. T/F?

A

True

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18
Q

Which cranial nerves are commonly affected by intracerebral TB?

A

CN 3, 4, 6 and 9

19
Q

How is intracerebral TB treated?

A

Steroids for one year

20
Q

What are the possible complications of HIV brain disease?

A

Encephalitis
Dementia
Neurological-syphillis
Opportunistic infections such as TB, cryptococcus, toxoplasmosis and JVC

21
Q

What is progressive focal multifocal leucoencephalopathy?

A

A progressive motor dysfunction which typically affects immunocompromised individuals.

22
Q

What organism causes intra-cerebral toxoplasmosis?

A

Toxoplasma gondii

23
Q

What are the signs and symptoms of intra-cerebral toxoplasmosis?

A

Headache
Seziures
Focal CNS signs

24
Q

How is intra-cerebral toxoplasmosis treated?

A

Sulphadiazine

Pyrimethamine

25
Q

How is crytococcal meningitis treated?

A

Amphotericin B

Flucytosine

26
Q

Cryptococcal meningitis can cause a raised ICP. How can this be treated?

A

Shunt

27
Q

What is the classic train of symptoms which defined meningitis?

A

Fever
Nuchal rigidity
Change in mental status

28
Q

What type fo headache typically occurs in meningitis?

A

Severe and generalised meningitis

29
Q

What. is the Brudzzinski sign?

A

Spontaneous flexion of the hips during attempted flexion of the neck. illustrates meningism; used to examine for neck stiffness/nuchal rigidity

30
Q

What is the Kernig sign?

A

The inability or reluctance to allow full extension fo the knee, when the hip is flexed 90 degrees. Indicates meningitis

31
Q

What three important contraindication may delay/defer perfuming a lumbar puncture?

A

Evidence of raised intracranial pressure (mass effect on CT, clinical. signs of impending herniation)
Spinal epidural abscess
Thrombocytopenia

32
Q

What are the common causative organisms of meningitis in developed countries?

A

Strep.pneumoniae
N.meningitidis
H.influenzae
Group B strep

33
Q

What are the CSF findings that would be suggestive of bacterial meningitis?

A

High white blood cell count with a polymorph predominance
High protein >200mg/dL
Low glucose <40 mg/dL

34
Q

What are the CSF findings typical of asceptic (viral) meningitis?

A 
WBC elevated (but generally less than seen in bacterial meningitis) with lymphocyte predominance
Slightly raised protein
Normal glucose
35
Q

What characterises Purpura fulminant (a possible complications of meningococcal septicaemia)?

A

Cutaneous haemorrhage and necrosis due to DIC

36
Q

What is the long-term consequence of bacterial meningitis?

A

Sensorineural hearing loss

37
Q

What are the four common causes of community acquired bacterial meningitis in adults in developed countries?

A

Streptococcus penumoniae
Neisseria pneumoniae
H. influenzae
Group B streptococcus

38
Q

Listeria monocytogenes is an important bacterial cause of meningoencephalitis in which patients?

A

Neonates
Pregnancy
Immunosuppressed
Elderly

39
Q

A small proportion of patients may be hypothermic with meningitis. T/F?

A

True

40
Q

What is Brudzinski sign in meningitis?

A

Spontaneous flexion of the hips during attempted passive flexion of the neck used to examine for neck stiffness

41
Q

What is Kernig’s sign in meningitis?

A

The inability or reluctance to allow full extension of the knee when the hip is flexed to 90 degrees

42
Q

What CSF findings are suggestive of bacterial meningitis?

A

High wight blood cell count with polymorph predominance
High protein
Low glucose

43
Q

What CSF findings would you expect in viral meningitis?

A

WBC elevated (but not as much as in bacterial meningitis) with a lymphocyte predominance
Slightly high protein
Glucose normal

44
Q

Purpura fulminans is a complication of meningococcal septicaemia What is it characterised by?

A

Cutaneous haemorrhage and necrosis due to DIC.

Clinical Microbiology (17 decks)

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