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Greenberg > 20-21 Infection > Flashcards

20-21 Infection Flashcards

1
Q

What is Waterhouse-Friderichsen syndrome?

A

Complication of meningococcal infection, occurs in 10-20% of children with acute meningitis. Petechial haemorrhages and haemorrhage into adrenals and DIC.

Increased ICP may occur

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2
Q

What are the commonest pathogens causing meningitis in immunocompetent patients?

A

Neisseria Meningitidis
Strep Pneumoniae
H. Influenza Type B

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3
Q

Which form of meningitis is likely to present with hydrocephalus?

A

Cryptococcal meningitis

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4
Q

Usual organisms in post-neurosurgical procedure meningitis?

A

coag -ve staph
staph aureus
enterobacter
pseudomonas

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5
Q

What pathogens to consider in immunocompromised with infection?

A

Cryptococcus
TB
Listeria Monocytogenes
HIV aseptic meningitis

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6
Q

How do you treat a post traumatic meningitis?

A

broad spectrum ABx with good CNS penetration e.g. Vanc and Mero.
Pneumococcal vaccine as most commonly associated with a CSF leak.
Consider exploration or insertion with lumbar drain. May stop spontaneously but this may be due to obscuration by encarcerated brain and high potential for CSF leak later.

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7
Q

Causes of recurrent meningitis?

A

dermal sinus,
CSF fistula,
neurenteric cyst

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8
Q

Causes of chronic meningitis?

A

TB
fungal infections
neurocystericosis

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9
Q

Borrelia burgdorferi causes what neurological deficit?

A

BB -> Lyme disease. Can cause facial nerve weakness. May appear weeks after the initial rash

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10
Q

WHat is the treatment for Listeria monocytogenes?

A

Ampicillin and gentamicin. (Cephalosporins are inactive against listeria) treat for 21 days

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11
Q

Commonest pathogen causing cerebral abscesses?

A

streptococcus

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12
Q

What stage does necrosis begin in abscess formation?

A

Stage 2 - late cerebritis (day 4-9)

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13
Q

What are the stages of abscess formation?

A

Stage 1 - early cerebritis Day 1-3
Stage 2 - late cerebritis Day 4-9
Stage 3 - early capsule Day 10-14
Stage 4 - late capsule >14days

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14
Q

What stage of abscess formation do you get neovascularisation?

A

Stage 3 - early capsule - Day 10-14

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15
Q

What is different about the scarring left by an abscess?

A

Collagen scar as opposed to glial scar

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16
Q

Commonest cause of fungal abscesses?

A

Aspergillus - although uncommon to cause meningitis or meningoencephalitis

17
Q

What organism causes neurocytercosis?

A

Taenia solium

18
Q

child with polycystic lesion (and ?fever)

A

Echinococcus

19
Q

What percentage of subdural empyemas occur in the spine?

A

5%

20
Q

what is the likely pathogen in a brain abscess secondary to otitis externa?

A

Pseudomonas

21
Q

In what condition might you see oculomasticatory myorhythmia?

A

Whipples disease

22
Q

What is the commonest neurological involvement in HIV/AIDS

A

AIDS encephalopathy

23
Q

Commonest part of the spine to get epidural abscesses?

A

Thoracic (50%) then lumbar (35%) then cervical (15%)

Most are posterior (82%)

24
Q

Commonest source of infection in spinal epidural abscess?

A

Haematogenous spread from skin infections.

Furuncle may be found in 15% of cases.

25
Q

What is the risk of treating spinal epidual abscess with antibiotics alone?

A

Can develop rapid neurological deterioration (mechanism may be compression, venous infarcts or direct infiltration of infection into spinal cord)

26
Q

Which patients should have abx treatment only with spinal epidural abscess?

A

Antibiotic treatment should be reserved for

  1. patients unfit for GA
  2. Involvement of extensive length of spinal canal
  3. Complete paralysis >3days
27
Q

Commonest pathogen to cause vertebral osteomyelitis and spinal epidural abscess?

A

Staph Aureus

28
Q

In VB osteomyelitis what is the yield from blood cultures versus needle biopsy?

A

50% for blood cultures
60-90% for needle biopsy

15% get different organisms from BC vs needle Bx!

29
Q

Pathogen that is most likely to cause discitis in IVDU?

A

Pseudomonas

30
Q

What are the risk factors for shunt infection in myelomeningocoele patients?

A

Age - evidence that waiting until child is 2 weeks old reduces risk of infection
longer procedure - shunting at same time as repair associated with higher risk of infection
open defect more likely to get infected.

31
Q

Which pathogens most likely to cause infections in neonates?

A

E Coli

Strep haemolyticus

32
Q

What is an additional complication of a ventriculovascular shunt?

A

shunt nephritis - immune complex deposition in renal glomeruli

33
Q

How does gram -ve bacillus infection differ from staph CSF infection

A

More severe clinical course

higher protein and lower glucose with more neutrophils on CSF analysis

34
Q

What antibiotics would you start a patient with shunt infection on?

A

IV Vancomycin and Meropenem

35
Q

Organism associated with haemolytic uraemic syndrome?

A

E.Coli

Greenberg (13 decks)

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