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CNS infections Flashcards

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1
Q

What are the four questions that should be answered with CNS infections?

A
  • Acute or chronic
  • Etiology
  • Work up?
  • Treatment
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2
Q

What are the major non-infectious etiologies of CNS problems?

A
  • Neoplasia
  • Collagen vascular disease
  • Meds
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3
Q

What is the best way to assess for infectious CNS infections?

A

Spinal fluid

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4
Q

What is the major confounding factor of spinal glucose levels?

A

Pts has DM

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5
Q

How do you assess spinal fluid glucose levels in the diabetic patient?

A

ratio of serum to CSF should be less than 0.6

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6
Q

What is the normal opening pressure of CSF?

A

50-195 in the lateral decubitus position

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7
Q

What commonly complicates CSF fluid samples?

A

Prior abx treatment

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8
Q

What is a high CSF opening pressure most commonly seen in? Why?

A

Cryptococcal meningitis

Occludes the arachnoid villi

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9
Q

india ink stain = ?

A

Cryptococcal neoformans

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10
Q

True or false: with elevated intracranial pressure from cryptococcus infx, doing an LP is both diagnostic and therapeutic

A

True

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11
Q

When is flow cytology useful with CSF samples?

A

Diagnosing lymphomas

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12
Q

What is xanthochromia?

A

Yellowish supernatant of CSF that is a result of RBC lysis, indicated the presence of oxyhemoglobin, methemoglobin, and bili

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13
Q

How long does it take for RBCs to breakdown in the CSF to cause xanthochromia? Why is this important?

A

2-4 hours

Means that a traumatic tap will not cause this–this is pathologic

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14
Q

What is the normal WBC count in CSF in children and adults?

A

Both 0-5 /mm^3

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15
Q

What are the three etiologies of elevated WBC in the CSF?

A

Meningitis
Encephalitis
Parameningeal focus

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16
Q

What is the formula for the true WBC in CSF?

A

Actual WBC - (WBC in blood x RBC in CSF/ RBC in blood)

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17
Q

What is pleocytosis?

A

Increased WBC in the CSF

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18
Q

What non-infectious condition can produce a transient CSF pleocytosis?

A

Seizures

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19
Q

White counts in CSF are usually highest in what type of infectious etiology?

A

bacterial

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20
Q

What WBC cell predominates with viral meningitis?

A

Mononuclear

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21
Q

What WBC cell predominates with bacterial meningitis?

A

PMNs

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22
Q

What WBC cell predominates with TB meningitis?

A

Mononuclear

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23
Q

What WBC cell predominates with cryptococcal meningitis?

A

Mononuclear

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24
Q

What is the WBC range for viral meningitis?

A

50-1000

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25
What is the WBC range for bacterial meningitis?
1000-5000
26
What is the WBC range for TB meningitis?
50-300
27
What is the WBC range for cryptococcal meningitis?
20-500
28
What are the glucose levels with viral meningitis?
More than 45
29
What are the glucose levels with bacterial meningitis?
Less than 40
30
What are the glucose levels with TB meningitis?
Less than 45
31
What are the glucose levels with Cryptococcal meningitis?
Less than 40
32
What are the protein levels in viral meningitis?
Less than 200
33
What are the protein levels in viral meningitis?
Less than 200
34
What are the protein levels in bacterial meningitis?
100-500
35
What are the protein levels in TB meningitis?
50-300
36
What are the protein levels in cryptococcal meningitis?
more than 45
37
What indicates an abnormal CSF-serum glucose ratio?
Less than 0.5
38
What is the cause of CSF hypoglycorrhachia? (3)
- WBCs and bacteria eat it - Increased metabolism in brain and spinal cord - Lower uptake d/t inhibition of transporters
39
What concentrations of protein in the CSF is considered abnormal?
More than 50 mg/dL
40
How do you correct for protein levels with a traumatic LP?
Subtracting 1 mg/dL of protein for every 1000 RBCs/mm^3
41
What is usually preferred for CNS infections: CT or MR?
MR, since is more sensitive and specific
42
Who should get neuroimaging (2, non-obvious ones only)?
- Increased ICP | - Neonates with enlarging head circumference
43
What are the two major qualities of abx for the treatment of CSF infx?
- Must cross BBB | - bactericidal
44
What quality is better for penetration into the CSF, drugs with: low or high molecular weight
Low
45
What quality is better for penetration into the CSF, drugs with: low or high ionizability
Low
46
What quality is better for penetration into the CSF, drugs with: low or high Lipid solubility
High
47
What quality is better for penetration into the CSF, drugs with: low or high degree of protein binding
Low
48
Why are bactericidal abx preferred in the treatment of CSF infx?
Usually occur in the immunocompromised host, and immune system is limited here
49
What is the role of corticosteroids for the treatment of meningitis?
reduce the inflammatory response of killing bacteria
50
What is the only real time to call a surgeon for CSF infx?
If you suspect an abscess
51
What is the most common bacterial cause of meningitis outside of adolescence? When in adolescence?
Strep Pneumoniae | Neisseria meningitidis
52
What are the two most common causes of viral meningitis?
enterovirus | Herpes
53
What are the noninfectious causes of acute meningitis?
Craniopharyngioma | Teratoma
54
Which age ranges does listeria infect more often? Why?
Neonates and the elderly new and old immune systems cannot kill intracellular pathogens well
55
What is the treatment for HiB meningitis?
Third gen cephalosporin
56
What is the treatment for Neisseria meningitis?
Third gen cephalosporin
57
What is the treatment for Strep pneumoniae meningitis?
Vanco + 3rd gen cephalosporin
58
What is the treatment for listeria meningitis?
Ampicillin and an aminoglycoside
59
What is the treatment for GBS meningitis?
Ampicillin + aminoglycoside
60
What is the treatment for e.coli meningitis?
Third gen cephalosporin
61
Meningitis in pts who have recently undergone neurosurgery is commonly caused by what? Why?
Coagulase negative Staph species Part of the normal skin flora
62
Does ceftriaxone treat pseudomonas?
no
63
What is the treatment for meningitis with an immunocompromised state?
Vanco + ampicillin
64
What is the treatment for meningitis with an basilar skull fracture?
vanco + 3rd gen ceph
65
What is the treatment for meningitis with head trauma/neurosurgery?
Vanco + ceftazidime
66
Why isn't picnazo (commonly used in sepsis) used for meningitis?
Does not cross the BBB
67
What is the only organism that causes meningitis that is appropriate for steroid used? What is the timeframe that they should be given in?
Strep pneumo | Within 15-20 minutes of abx administration
68
What are the two bacterial causes of meningitis that can be treated with abx for 7 days?
Neisseria meningitidis | HiB
69
What is the duration of treatment for strep species?
2-3 weeks
70
What is the duration of treatment for listeria?
over 3 weeks
71
What is the duration of treatment for aerobic gram negative bacilli?
3 weeks
72
What is the species of tick that carries borrelia burgdorferi?
Ixodes
73
What is the chemical that should be used on clothing to repel ticks?
Permethrin
74
What is the rash that occurs with lyme disease? How often does this occur?
Erythema migrans | 80-90% of the time
75
What are the ssx of neuroborreliosis?
Cranial neuropathy meningitis motor or sensory radiculoneuropathy
76
What are heart ssx of untreated lyme disease?
complete heart block
77
True or false: Even without abx, the immune system will kill borrelia
True
78
What percent of patients with lyme disease have arthritis?
60%
79
What is the treatment for lyme disease?
14-21 days of doxycycline or amox
80
What is normal opening pressure?
50-180 cm of water
81
What is the treatment for cryptococcal meningitis?
Months of amp B or fluconazole
82
What is the complication from chronic meningitis?
Hydrocephalus
83
What are the late ssx of chronic meningitis?
Visual changes, confusion, CN involvement, unsteady gait, emesis
84
Why is n/v common with cryptococcal meningitis?
Increased ICP
85
What are the top three nonbacterial causes of chronic meningitis?
Cryptococcal Histoplasma Coccidioidomycosis
86
What are the top three bacterial causes of chronic meningitis?
TB Syphilis Brucellosis
87
True or false: since aspirated material is usually polymicrobial, then abscesses that form in the body are also polymicrobial
True
88
What is the most common encephalitis?
Herpes

Infectious Disease (18 decks)

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