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Flashcards in CNS Infections Deck (77)
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31

What are military recruits vaccinated with to prevent outbreaks of meningococcal meningitis in training camps?

Purified capsular polysaccharide

32

What type of H. influenza is the most common cause of meningitis in children under 4yo?

Type B

33

Where is S. pneumoniae commonly found in the nasopharynx?

Nasopharynx

34

Who are most susceptible to S. pneumonia meningitis?

Hospitalised patients, patients with CSF skull fractures, diabetics, alcoholics and young children

35

What does the conjugate vaccine for pneumoccal pneumonia always provide protection against?

Pneumococcal meningitis

36

What is listeria monocytogenes?

Gram +ve bacilli

37

What cultures should be taken in suspected listeria monocytogenes meningitis?

Blood cultures

38

Who are most likely to have listeria monocytogenes meningitis?

Neonates
>55yo
Immuno-suppressed esp. malignancy

39

What is the antibiotic of choice in listeria monocytogenes meningitis?

IV Ampicillin/Amoxicillin
Ceftriaxone has no value as intrinsically resistant

40

Describe tuberculous meningitis

Can reactivate in elderly
Often non specific ill health
Previous TB on CXR
Poor yield from CSF

41

How is tuberculous meningitis treated?

Isoniazid + rifampicin (add pyrazinamide + ethambutol)

42

Describe cryptococcal meningitis?

Fungal
Mainly HIV
CD4

43

How should cryptococcal meningitis be treated?

IV Amphotericin
B/Flucytosine
Fluconazole

44

What are the clinical signs of bacterial meningitis?

Fever
Stiff neck
Alteration in consciousness

45

What are some signs and symptoms in bacterial meningitis?

Headache
Vomiting
Pyrexia
Neck stiffness
Photophobia
Lethargy
Confusion
Rash

46

Who are signs of bacterial meningitis often absent or atypical in?

Very young/old
Immunocompromised

47

What DDx should be suspected in possible bacterial meningitis?

Meningitis
Encephalitis
Cerebral abscess
Severe sepsis from other source
SA haemorrhage
Cerebral tumour

48

What is the rule regarding LP's and bacterial meningitis?

LP is CSF pleocytosis, not symptoms of bacterial meningitis

49

What should be in each LP tube for interpretation?

Tube 1. Haematology: cell count, differential
Tube 2. Microbiology: gram stain, cultures
Tube 3. Chemistry: glucose, protein
Tube 4. Haematology: cell count, differential

50

How should meningitis be diagnosed?

Blood cultures
Throat swab (meningococci)
Blood EDTA for PCR (meningococci)
CSF (LP)
Microscopy, biochemistry, culture, antigen detection

51

What bacteria will be found in the ddx of meningitis in normal patients?

Enteroviruses
HSV1, HSV2
VZV
M. tuberculosis
B. burgdorferi
Pneumococci
Meningococci
H. influenza

52

What bacteria will be found in the ddx of meningitis in immunocompromised patients?

EBV
CMV
HHV-6/7
T. gondii
JC virus

53

What are the CSF findings in viral acute adult meningitis?

10^1-10^3 cells (lymphocytes)
Negative gram stain
Negative bacterial antigen detection
Normal or slightly high protein
Usually normal glucose

54

What are the CSF findings in bacterial acute adult meningitis?

10^1-10^4 cells (predominantly polymorphs)
Positive gram stain
Positive bacterial antigen detection
High protein
Less than 70% glucose

55

What are the CSF findings in tuberculous acute adult meningitis?

10^1-10^3 cells (predominantly lymphocytes)
Positive or negative gram stain
Negative bacterial antigen detection
High or very high protein
Less than 60% glucose

56

What test results are predictive of bacterial meningitis with 99% accuracy?

WBC >2000
Neutrophils >1180
Protein >220mg/dl
Glucose

57

If not bacterial meningitis, what infectious conditions may cause neutrophilic pleocytosis and low csf glucose?

Viral meningitis (early phase only)
Some parameningeal foci/ cerebritis
Leakage of brain abscess into ventricle
Amebic meningoencephalitis
TB meningitis (rarely, & usu. only early)

58

If not bacterial meningitis, what non-infectious conditions may cause neutrophilic pleocytosis and low csf glucose?

Chemical-meningitis (contrast…)
Behcet syndrome
Drug –induced ( NSAIDs, Sulfa, INH, IVIG, OKT3…)

59

What is aseptic meningitis?

A term used to mean non-pyogenic bacterial meningitis
It describes a spinal fluid formula that has:
low number of WBC
minimally elevated protein
normal glucose

60

What are some infectious treatable causes of aseptic meningitis/encephalitis syndrome?

HSV 1 and 2
Syphilis
Listeria (occasionally)
Tuberculosis
Cryptococcus
Leptospirosis
Cerebral malaria
African tick typhus
Lyme disease