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RB Y3 1.2 Neurology > CNS Infections > Flashcards

CNS Infections Flashcards

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1
Q

normal values of WCC, red cells, protein and glucose in CSF

A

White cells: <5/mm3

Red cells: <5mm

Protein: 150-450 mg/L

Glucose: 60-70% of blood glucose

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2
Q

what are most aspectic meningitis cases caused by

A

viruses

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3
Q

pathology of bacterial meningitis

A
  • subarachnoid space is congest with polymorphs, layer of pus forms over the brain
  • can form adhesions - CN palsies and hydrocephalus
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4
Q

what is the most common cause of spread for bacterial meningitis

A

nasopharyngeal colonisation

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5
Q

aetiology of brain infection

A
  • Nasopharyngeal colonisation
    • Most common
  • Direct extension of bacteria
    • Parameningeal foci (sinusitis, mastoiditis, brain abscess)
    • Across skull defects or fracture
  • Post-trauma, post-surgery
  • From remote foci of infection
    • Endocarditis, pneumonia, UTI
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6
Q

what is the classic triad of meningitis

A

headache, neck stifness and feve

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7
Q

other CF

A
  • photophobia
  • vomiting
  • altered mental state - GCS
  • fever, rigors
  • rash
  • seizures
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8
Q

describe the classical meningococcal rash and its signifance

A

non blanching on tumbler test, may be only 1 or 2 spots

Neisseria meningitidis infection

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9
Q

Kernig’s sign

A

inability to extend the knee with the hip fuly flexed

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10
Q

what is a risk factor for infection with encapsulated bacteria

A

Hyposplenism is a risk factor for encapsulated bacteria: H influenzae, Strep pneumoniae

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11
Q

most common organism in children

A

H influenzae - uncommon now due to vaccination

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12
Q

vaccination schedule for HiB

A

in the 6 in 1 at 2,3,4 months

wtih MenC at 12-13 months

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13
Q

gram stain for HiB

A

aerobic gram negative bacilli

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14
Q

2 most common organisms for bacterial meningitis

A

Neisseria meningitidis and S pneumoniae

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15
Q

in which age groups are s pneumoniae and n meningitidis most common

A

NM from 1-0-21, SP > 21

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16
Q

neisseria meningitidis classification

A

gram negative encapsulated diplococci aerobic, is intracellular

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17
Q

strep pneumoniae classification

A

gram positive, alpha haemolytic streptococci

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18
Q

in which conditions does listeria multiply

A

poorly refridgerated temperatures

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19
Q

which pt are more liekly to be infected with listeria, and what precuation is taken for these individuals

A

IS, elderly, alcoholics, chemo, neonatal

amoxicillin is given until culture results returned in those >60 and IS as a precaution

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20
Q

how does Neisseria usually spread to the brain

A

found in the throats of health people, bacteria probs gain access through blood stream

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21
Q

what type of vaccine is the HiB vaccine

A

conjugated

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22
Q

which pt are more susceptible to strep p infection

A

patients with skull fractures, hospitalized pt, diabetics, alcohlics, youn children

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23
Q

which surgical procedure particularly increases the risk of s pneumoniae

A

cochlear implant

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24
Q

which other group of organisms are implicated eg in head trauma/surgery

A

skin commensals (Staph (epidermidis), gram neg bacilli)

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25
how does TB meningitis present
* Develops over 1-3 weeks: fever, headache, vomiting, abdominal pain, drowsiness, meningism, delirium ± seizures
26
what is a typical feature of TB meningitis
cranial nerve palsies
27
management of TB meningitis
isoniazid and rifampicin are key for 12m (add pyrazinamide and ethambutol)
28
what is cryptococcus
a fungus that is found in soil and bird droppings
29
who tends to egt cryptococcal meningitis
seen mainly in HIV, those with a low CD4 count (\<100)
30
presentation of crytopcoccal
subtle neurological presentation, aseptic picture on CSF
31
what are the likely organisms in neonatal meningitis
Group B Strep and Listeria
32
how does Group B strep get passed on to neonate
acquired from mother (vaginal colonisation), occurs within the first few days after birth subtle presentation
33
management and prevention of Group B Strep for neonatal meningitis
* *Management:* benzylpenicillin and gentamicin * *Prevention:* intrapartum ABx given if pre-term labour, prolonged rupture of membranes, fever, known past infection/colonisation
34
how does Listeria infect neonate in neonatal meningitis
* Found in various foods (poorly refrigerated temperatures) * Transplacental infection, causes stillbirth as well as neonatal sepsis/meningitis
35
management of Listeria causing neonatal meningitis
amoxicillin and gentamicin
36
sequelae of meningitis
Fatal disease. 25% of those who survive suffer from limb loss deafness, blindness, cerebral palsy, quadriplegia and severe mental impairment. Layer of pus can form adhesions - CN palsies (III and IV) and hydrocephalus
37
should you admit someone to hospita with just eg a headache if they have had contact with meningococcal infection
yes even if they have received prophylactic ABx
38
pt presents with suspicion of bacterial meningitis
* bloods and LP * treatment * throat swab, swab any lesions
39
contra indications/reasons to delay lumbar puncture
* **ANY sign of raised ICP** * IC * history of CNS disease * new onset seizure * altered consciousness * focal neurological deficit * **GCS ≤12** * **signs of severe sepsis or rapidly evolving rash** * **bleeding risk** * **severe resp/cardio compromise**
40
suspected meningitis, w/ raised ICP, w/ severe sepsis/rapidly evolving rash:
perform CT first
41
42
what would happen if you did a LP in someone with inc ICP
forms a low pressure shunt - CSF and brain mass shift towards low pressure outlet - herniation
43
why is LP normally performed before ABx given
use of ABx first would lower gram stain and culture positivity
44
ABx
ceftriaxone and dexamethasone IV
45
ABx penicillin allergy
chloramphenicol and vancomycin
46
Listeria coverage
Amoxicillin (Co-t if penicillin allergic)
47
when should Listeria coverage be given first instance
if there is a risk eg old age, IS, alcoholic, chemo
48
which organism do steroids have the best benefit for
pneumococcal meningitis
49
who should not receive steroid therapy
post surgical, severe IC, septic shock, hypersenitive to steroids
50
LP results for viral, bacterial and TB infection
51
contact prophylaxis
rifampicin, ciprofloxacin, ceftriaxone
52
women on rifampicin
reduces the effiacy of oral contraceptive
53
must you inform public health about meningitis ?
yes
54
vaccination schedule: meningitis
Men C at 3 months Men B at 2m, 4m, 12-13m MenC/HiB 12-13 m Men ACWY at 13-14y
55
what is a brain abscess
inflammation and collection of infected material
56
how do brain abscesses arise
either local spread of infection or 2y to remote infective process
57
clinical features of brain abscess
classic triad of fever, headache and focal neurological signs seizures
58
microbiology of brain abscess
Streptococci (**S milleri**), coliforms (e.g. Proteus), anaerobes, S aureus, Actinomyces
59
diagnosis of brain abscess
ring enhancing lesion on CT
60
strep pneumoniae
61
management of brain abscess
drainage, ceftriaxone (gram neg and pos) and metronidazole (anaerobes) for 6 weeks modify in light of culture
62
when is viral meningitis more common
late summer/autumn (freshers)
63
describe the course of viral meningitis
bengin and self limiting (4-10 days) headache may follow on for some months after, no serious sequelae normally
64
is there pus, polymorphs, adhesions etc in viral meningitis?
no it is a predominantly lymphocytic inflammatory reaction - no adhesions etc form - little or no cerebral oedema
65
key features of viral meningitis history
GI symptoms and travel history
66
what is the main cause of viral meningitis
enteroviruses
67
diagnosis of viral meningitis
LP - lymphocytes viral stool culture, throat PCR and CSF PCR
68
treatment of viral meningitis
supportive as it is self limiting
69
clinical features of encephalitis
* personality and behavioural change - reduced level of consciousness - coma * seizures * focal neurological deficits
70
what is the onset of encephalitis like
insidious
71
what is encephalitis caued by, and treatment
HSV, IV acyclovir
72
investigations of encephalitis
LP EEG CT MRI viral PCR
73
what is a CT/MRI of encephalitis likely to show
focal oedema in temporal lobes inflammation and swelling
74
which lobe does HSV encephalitis tend to affect
temporal
75
management of encephalitis
As shown below: ABCDE and glucose - LP (if ok) - MRI/CT - ACYCLOVIR - PCR Results (pre-emptive acyclovir is beneficial)
76
what are 2 positive movement signs in bacterial meningitis

RB Y3 1.2 Neurology (23 decks)

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