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Medicine Phase 2a Neuro > Infection > Flashcards

Infection Flashcards

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1
Q

Infective causes of meningitis

A

Bacterial
Viral
Fungal
Parasitic

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2
Q

Non-infective causes of meningitis

A

Paraneoplastic
Drug side effects
Autoimmune e.g. vasculitis/SLE

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3
Q

How does infection enter body

A

Via bloodstream i.e. bacteraemic
Neurosurgical complications (Post op, Infected shunts, Trauma)
Extracranial infection e.g. nesopharynx, ear, sinuses (nasal carriage, otitis media, sinusitis etc)

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4
Q

Pathophysiology of infection

A

Bacteria enter CSF and can be isolated from immune cells due to BBB, replication
Blood vessels become leaky
Therefore WBCs can enter the CSF, meninges and brain
Meningeal inflammation with or without brain swelling

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5
Q

Key symptoms of patient with infection

A

Fever
Headache
Neck stiffness (Meningism)

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6
Q

What % of people infected with bacterial meningitis die and what % have permanent effects as result of infection

A

5% mortality (when treated)

20% permanent effects

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7
Q

Permanent effect of bacterial meningitis

A 
Skin scars
Amputation
Hearing loss
Seizures
Brain damage
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8
Q

**Immediate management of bacterial meningitis

A
  1. Assess GCS (Glasgow Coma Scale)
  2. Blood cultures
  3. Broad spectrum antibiotics
  4. Steroids (IV dexamethasone)
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9
Q

Medial management of bacterial meningitis

A

First line antibiotics – either ceftriaxone or cefotaxime

Steroids to reduce neurological sequelae and therefore reduce morbidity (particularly with strep. Pneumoniae)

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10
Q

Examples of first line (broad spectrum) antibiotics for bacterial meningitis

A

Cephalosporins such as:
Ceftriaxone
OR
Cefotaxime

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11
Q

What can GCS help us determine

A

How sick the patient is, the lower the GCS, the sicker the patient!
If they can maintain their own airway (if <8 then no -> intubate!)
If there is any raised intracranial pressure

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12
Q

3 examples of what GCS tests

A

Best eye response
Best verbal response
Best motor response

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13
Q

What type of antibiotic is cephalosporins

A

Beta-lactam family

need a bactericidal antibiotic to eliminate infection quickly

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14
Q

What special considerations need to be taken for those to use antibiotics

A

Are they penicillin allergic?
Immunocomprimised?
Recent travel (<6 months)?

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15
Q

If someone has a reaction with penicillin, what is the chance of a reaction with cephalosporin

A

10%

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16
Q

If penicillin allergic patient develops a rash reaction, what is give

A

Cephalosporin

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17
Q

If penicillin allergic patient has an anaphylactic reaction, what is given

A

Chloramphenicol

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18
Q

If patient with bacterial meningitis is immunocomprimised, what can they be at risk of?

A

Listeria

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19
Q

If bacterial meningitis patient is immunocompromised, what is added to cephalosporin and why

A

Amoxicillin

Risk fo listeria

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20
Q

Why is it important to ask about any recent travel in bacterial meningitis

A

Some countries have higher incidence of penicillin resistant strep pneumoniae

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21
Q

What is added to cephalosporin if patient suspected to have penicillin resistant infection from recent travel?

A

Vancomycin

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22
Q

*Once immediate management of bacterial meningitis is done, what is done after to DIAGNOSE MENINGITIS

A

Lumbar puncture

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23
Q

What is done with the lumbar puncture sample

A

Microscopy, Gram stain, Culture, Protein, Glucose, viral PCR

Viral or bacterial?

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24
Q

Complications of lumbar puncture

A 
Abnormal clotting (platelets/coagulation)
Petechial rash
Raised intracranial pressure
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25
Causative organisms of meningitis
Neisseria meningitidis | Streptococcus pneumoniae
26
How would you tell causative organism of meningitis between Neisseria and strep pneumoniae
Gram stain: gram Negative cocci = Neisseria gram Positive cocci = Pneumococcus (strep.pneumoniae)
27
What % of adults and teenagers carry Neisseria meningitidis
5-11% adult carriage | 25% teenagers
28
Causes of acute bacterial infection
Neisseria meningitidis (gram negative diplococci) Strep. pneumoniae (gram positive diplococci) Listeria spp. (gram positive rod) Group B Strep (gram positive cocci) Haemophilus influenzae B (gram negative rod) E.coli (gram negative rod)
29
Causes of acute viral infection
Enterovirus Herpes Simplex Virus (HSV) Varicella Zoster Virus (VZV)
30
Causes of chronic bacterial infection
``` Mycobacterium tuberculosis (TB) Syphilis ```
31
Causes of chronic fungal infection
Cryptococcal
32
Bacterial infection causes in neonates
Listeria monocytogenes Group B streptococcus Escherichia coli
33
Bacterial infection causes in children
Neisseria meningitidis Streptococcus pneumoniae Haemophilus influenzae
34
Bacterial infection causes in adults
Neisseria meningitidis | Streptococcus pneumoniae
35
Bacterial infection causes in elderly
Neisseria meningitidis Streptococcus pneumoniae Listeria
36
Once condition of patient with Neisseria meningitidis (or meningitis in general) is more stable, what would you do after
Inform Public Health England For Neisseria, identify 'close contacts' who have a 1/300 risk of developing meningitis (particularly first 7 days) Antibiotic prophylaxis reduces risk and prevents onward transmission
37
Examples of antibiotic prophylaxis to reduce risk and prevent onward transmission
Ciprofloxacin | Rifampicin
38
What is Encephalitis | Causes of Encephalitis
Infection (and inflammation) of the brain parenchyma Usually viral: *Herpes Simplex Varicella Zoster
39
Other causes of encephalitis (not herpes simplex or varicella zoster)
``` ASK ABOUT TRAVEL Japanese encephalitis virus Tick-borne encephalitis Rabies West Nile etc ``` Non-infective - autoimmune, paraneoplastic
40
Clinical presentation of encephalitis
Hours to days: preceding "flu-like" illness Then: Altered GCS - confusion, drowsiness, coma Fever, Seizures, Memory loss Also: headache, altered behaviour and altered mental status. Less commonly; hemiparesis, dysphagia, seizure and coma.
41
Investigations of encephalitis
``` Viral serology (LP and CSF studies) CT: Check for space occupying lesions ``` ``` MRI head with or without EEG Lumbar puncture after Lymphocytic CSF Viral PCR HIV test ```
42
Treatment of encephalitis
Mostly supportive Aciclovir if HSV or VZV (2-3 weeks of antivirals providing end of treatment CSF is –ve on PCR; extend course if ongoing viral presence)
43
Infection process of tetanus
Inoculation through skin with Clostridium tetani spores (found globally in soil) e.g. stepping on a nail, dirty wounds Bacteria produce toxins
44
What toxins are produced in tetanus infection
Tetanolysin (tissue destruction) | Tetanospasmin (clinical tetanus)
45
What bacteria causes tetanus and what type of bacteria is it
Clostridium tetani Gram +ve anaerobe with spores
46
Pathophysiology of tetanus
Tetanospasmin toxin in tetanus can travel retrogradely along axons Interferes with neurotransmitter release -> increased neurone firing -> unopposed muscle contraction and spasm
47
Incubation time for tetanus
8 days
48
Generalised tetanus signs and symptoms
``` Opisthotonos (generalised spasms) Lock jaw and possibly risus sardonicus Also: Respiratory compromise Pain Hypertension, tachycardia, arrhythmias Fever ```
49
Localised tetanus signs and symptoms
Injury to right head | 2 days later unopposed flexion of fingers and spasm of forearm
50
Management of tetanus
Vaccination to prevent Supportive - muscle relaxants and paracetamol/cooling Immunoglobulin to mop up toxin Metronidazole to clear any residual bacteria
51
How many people die of rabies per year
35-50,000 | Once symptomatic, invariably fatal
52
Transmission of rabies
Inoculation through skin with saliva of rabid animal (dogs, cats, foxes etc) e.g. lick, lite, splash Travels retrogradely along nerves
53
Incubation time of rabies
2 weeks to years depending on site and size on inoculation
54
Pathophysiology of rabies
Travels retrogradely along nerves Reaches CNS Furious or paralytic presentation
55
Management of rabies
Sedatives Prophylaxis: Pre-exposure prophylaxis (vaccination) Post-exposure prophylaxis (vaccination and immunoglobulin)
56
What is meningitis
Inflammation of the meninges
57
What is Shingles
Varicella zoster virus reactivation | Herpes zoster
58
Aetiology of Shingles
Varicella-zoster. Usually occurs in childhood, but lies dormant for years/decades.
59
Pathophysiology of Shingles
After infection, the virus lies dormant in the sensory nervous system in the geniculate, trigeminal or dorsal root ganglia. Eventually flares up -> Virus travels down the affected nerve over 3-4 days, causing perineural and intraneural inflammation.
60
Clinical presentation of Shingles: pre-eruptive
Pre-eruptive: No skin lesions, but burning itching in one dermatome. Usually a day or two before eruption. Rash does not cross dermatomes.
61
Clinical presentation of Shingles: eruptive
Eruptive phase: Skin lesions appear (infectious until dried). Erythmatous, swollen plaques. Rash does not cross dermatomes
62
Diagnosis of Shingles
Clinical | Based on rash within a dermatome
63
Treatment of Shingles
Oral aciclovir
64
``` Protein levels in infection that is: Bacterial Viral TB Cryptococcal ```
Bacterial - low Viral - normal TB - low Cryptococcal - low
65
``` Cells found in microscopy in infection that is: Bacterial Viral TB Cryptococcal ```
Bacterial - neutrophil polymorphs Viral - lymphocytes TB - lymphocytes Cryptococcal - lymphocytes
66
``` Appearance of CSF in infection that is: Bacterial Viral TB Cryptococcal ```
Bacterial - cloudy Viral - clear TB - 'fibrin web' Cryptococcal - 'fibrin web'
67
Viral causes of meningitis
``` Mumps virus Echo virus Coxsackie virus Other enteroviruses Herpes simplex virus Lymphocytic chorio meningitis virus Poliovirus ```
68
Diagnosis of meningitis
``` Lumbar puncture - CSF Blood culture Nose and throat swabs - put on chocolate agar and examined for virus Stool Blood is taken for serology (antibodies) ```
69
What tests are done with CSF in diagnosis of meningitis
Cell count, gram film, protein assay, glucose assay, culture on blood agar/chocolate
70
Appearance of CSF
Gin-clear normally
71
Clinical presentation of meningitis
Stiffness of neck Photophobia Severe headache Bacterial or viral meningitis: Fever, unwell and may have a rash (characteristically haemorrhagic)
72
What is meningitis
Inflammation of the pia and arachnoid mater | Micro-organisms infect the cerebrospinal fluid
73
What is encephalitis
Inflammation of the cerebral cortex
74
Clinical symptoms of encephalitis
Lethargy and fatigue | Decreased levels of consciousness and fever
75
Cause of encephalitis
``` Generally viral infection and viral causes are: Herpes simplex virus Varicella zoster virus Paroviruses HIV Mumps virus Measles virus ```
76
Diagnosis of encephalitis
CSF - cultured on cell monolayers to detect viral growth. HSV can be detected by polymerase chain reaction Serology of blood - acute and convalescent blood is taken to detect a rise in antibody to HSV, VZV, mycoplasma, mumps virus and measles

Medicine Phase 2a Neuro (28 decks)

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