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Microbiology-HH3 > Central Nervous System > Flashcards

Central Nervous System Flashcards

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1
Q

3 components of the meninges?

A

dura mater, arachnoid mater, pia mater

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2
Q

CNS?

A

brain and spinal cord

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3
Q

What does inflammation fo the Brian cause?

A
  • pressure increase in the brain

- brain is enclosed in a hard bone skull, brain can only swell so big

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4
Q

Blood-Brain Barrier?

A
  • capillaries that limit access to CSF and brain tissue
  • limits toxin and chemical access tot the brain
  • pharmacologically it can be difficult if treating a brain infection/ injury
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5
Q

CNS Host Factors?

A
  • sterile site
  • no normal flora
  • few immune cells present (b/c it is sterile)
  • pathogen has advantage when infection occurs due to lack of normal flora and immune cells
  • inflammation increases permeability of BBB (pathogen entry increases, more permeable to toxins as well as immune cells and medications
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6
Q

CNS Infections: Portals of Infection?

A
  • trauma to skull and meninges
  • peripheral neurons (migrates to the CNS such as rabes)
  • respiratory system
  • GI
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7
Q

Inflammation of the meninges?

A

-can occur due to infection or not because of infection

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8
Q

Acute Meningitis?

A
  • fast onset
  • less than 2 weeks
  • medical emergency
  • seriously ill
  • bacterial cause mainly
  • always caused by an infection
  • increases ICP
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9
Q

Chronic and Aseptic Meningitis?

A
  • more than 2 weeks
  • viral cause
  • usually caused from a weak pathogen that can cause damage in immunosuppressed patients
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10
Q

Systemic infection: clinical findings?

A
  • fever
  • myalgia
  • rash
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11
Q

Meningeal Inflammation: clinical findings?

A
  • neck stiffness
  • brudzinki’s sign
  • kernig’s sign
  • jolt accentuation of headache
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12
Q

Cerebral Vasculitis: clinical findings?

A
  • inflammation of cerebral vasculature

- seizures

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13
Q

Elevated ICP: clinical findings?

A
  • headache
  • nausea and vomiting
  • seizures
  • neurologic symptoms
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14
Q

Signs and Symptoms of Meningitis?

A
  • no single S and S is sufficient for diagnosis

- fever, headache, neck stiffness, altered metal state

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15
Q

Meningitis clinical triad?

A

fever, nuchal rigidity (neck stiffness), headache

-present in 44% of patients

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16
Q

Absence of all 3 meningitis triad symptoms?

A
  • rule out meningitis
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17
Q

When is nuchal rigidity (neck stiffness) considered absent?

A
  • flexion of neck is painful but full ROM is present

- chin to neck movement

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18
Q

Brudzinki’s sign?

A
  • unconscious movement

- patient lyes on their back, neck is flexed forward. and knees will pop up to release pressure in spinal cord

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19
Q

Kernig’s sign?

A
  • patient on their back
  • hip flexed at 90 degrees
  • try to extend and straighten the knee, pain in lower back or posterior thigh and/ orresistance is a positive test result
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20
Q

Jolt accentuation of headache?

A

-worsening of headache with active horizontal head Turing at 2-3 turns per second

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21
Q

Can you rule out meningitis with absent jolt accentuation, Brudzinski’s and Kerning sign, but positive fever, headache and altered mental state?

A

-No

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22
Q

What procedure should you preform with any client suspected with meningitis?

A

-lumbar puncture

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23
Q

CSF glucose, WBC and protein levels in bacterial meningitis?

A
  • low CSF glucose
  • high CSF proteins
  • elevated WBC, mainly neutrophils
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24
Q

why are CSF glucose levels low in bacterial meningitis?

A

-inflammation causes impairment of glucose transport form the blood

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25
why are CSF protein levels high in bacterial meningitis?
- increased permeability of the BBB
26
WBC, glucose and protein levels in CSF of viral meningitis?
- normal glucose - normal-moderately high protein level - elevated WBC (from monocytes and lymphocytes
27
2 pathogens associated with 80% of bacterial meningitis?
- streptococcus pneumoniae | - neisseria meningitides
28
Pathogen associated with GI caused meningitis? | What bacterial meningitis causing pathogen do we have good vaccines for?
- listeria monocytogenes | - haemophilus influenza
29
Rare causing bacterial pathogen? (meningitis)
-group B streptococcus
30
gram - or +: S. pneumoniae and neisseria menigitidis?
S. pneumoniae= gram positive | N. M= gram negative
31
2 viruses that can cause meningitis?
- enteroviruses (Coxsackie B) | - herpes simplex virus
32
Pneumococcal Meningitis?
-caused by S. pneumoniae -505 of bacteria meningitis 75% of use are colonized with it in nasopharynx transmitted by respiratory. droplets -infectious 1-3 days prior to onset of symptoms and remains infectious until bacterium is absent in nasal and oral discharge
33
Pneumococcal meningitis public health implications and immunizations?
- reported to public health - no droplet precaution unless patients cough and sputum has increased - no cemoprophylaxis - infant pneumococcal conjugated vaccine - adult/elderly (65+) pneumococcal polysaccharide vaccine
34
Neisseria Meningitides: movement, fimbriae and capsule?
- move in and out of cells - attach with fimbriae - capsule protects against human immune system - steals iron from us
35
Meningococcal meningitis?
- caused from neisseria meningitides - affects children, adolescents and young adults - 25% of all bacterial meningitis - rates decline as you age - produces an endotoxin; fever, weakness, generalized aches, petechial rash - transmitted via droplets - infectious period 7 days prior to symptom onset and until pathogen is not present in nasal or oral discharge
36
Why is meningococcal meningitis associated with younger populations?
-associate with a lot of people when young
37
What causes the petechial rash?
- endotoxic shock and disseminated intravascular coagulation | - scattered all over the body
38
% of fatalities and % of permanent neurological or physical deficit with neisseria meningitides?
10% fatality | 20% of survivors show permanent neurological or physical deficits
39
Public health implicated of NEISSERIA MENINGITIDIS?
- vaccinations to control the outbreaks - MEN-C-C (ages 2months -11yrs - Men-C-ACYW (grade 7) - Bexsero (2 months-17 years old - ciprofloxacin and rifampin
40
Why is ciprofloxacin only given to patients aged 18 years+?
-change the development of cartilage in younger patients
41
leading cause of meningitis prior to 1986?
- H. influenza | - was once highly pathogenic
42
H. influenza caused meningitis implications?
resp. droplet trasmission | - isolation post targeted antibiotic therapy
43
Listeriosis?
-caused by listeria monocytgenes -transmission by ingestion of unpasteurized foods, deli meats, poor hand hygiene -young patients and elderly (extreme ages) and pregnant women 10% of meningitis cases
44
% of people colonized with S. pneumoniae?
75% of people colonized
45
Group B streptococcus
30% of women colonized 40-70% will transmit during delivery 1-3% will develop infection -swab rectum and vagina at 35-37 weeks gestation to test -comes through the mouth, moves into the blood stream and then into the brain
46
Risk factors for Group B streptococcus?
- GBS positive - premature labour (didn't swab swab yet) - UTI caused by GBS - treat with antibiotics
47
What age group is susceptible to GBS?
newborns-1 month olds
48
Basic bacterial meningitis treatment?
- bacterial antibiotic therapy - administered after blood cultures - directed at pathogens - antibiotic drugs that can cross BBB
49
General Treatment Regimen for bacterial meningitis?
corticosteroid co-administered with antibiotic | -antipyretics, fluid and electrolyte supplements, nutritional support
50
Viral meningitis?
- less acute in severity than bacterial | - supportive treatments
51
Enteroviruses: meningitis?
-85% of viral meningitis -direct contact, fecal-oral route most common in summer and fall -usually in immunocompromised patients -lasts 7-10days
52
% of meningitis survivor that have neurological or physical deficits?
40%
53
Encephalitis?
- inflammation of the brain - viral is the most common - seasonal, geography, travel history, occupational exposure, immune status of patient influence the risk of you acquiring it
54
Most common cause of encephalitis?
-viral
55
Clinical triad of signs and symptoms of encephalitis?
- fever - headache - altered LOC
56
Clinical findings of encephalitis? (CSF lab values, neurologic symptoms)
- disorientation - seizures - increased protein and lymphocyte and normal glucose in CSF - serology= look for antibodies for various viruses
57
Serology?
-looks for antibodies for various viruses
58
Viral encephalitis: initial sites of infection?
- Resp. tract - GI - GU - SC tissues - viruses most commonly access the brain via the blood stream
59
Viral encephalitis: HSV
- herpes simplex virus - most common cause of non-epidemic encephalitis in Canada - no cure - constantly reoccurs - some antivirals slow down the replication of the pathogen - start HSV therapy when we see viral encephalitis - control immune system with corticosteroids - older or younger you are, the worse the potential outcomes
60
Symptoms with Viral Encephalitis (HSV)?
-focal temporal lobe symptoms (hemiparesis, aphasia, visual field cut)
61
West nile virus?
-triggers swollen lymph noses and can cause both meningitis as well as encephalitis
62
Brain abscess?
-puss containing cavity surrounded by inflamed tissue -up to 25% mortality rates (infection within the brain)
63
Major symptoms of brain abscess?
- headache - mental status change - fever - focal neurologic deficits - symptoms depends on the location of the abscess
64
3 major predisposing conditions for brain abscesses?
1. Neutropenia 2. Transplantation 3. HIV
65
Diagnosing a Brian abscess?
CT SCAN with injection of contrast material | - can be treated without surgery
66
Empiric therapy for brain abscesses?
antimicrobial therapy - aspiration or surgery to remove abscess - corticosteroids when there is high ICP
67
How do you diagnose bacterial meningitis?
-hx, physical examination, lab tests

Microbiology-HH3 (6 decks)

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