infections Flashcards

(28 cards)

1
Q

commonest cause of meningitis in neonates

A

Group B Streptococcus

(then E.coli, listeria moncytogenes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

commonest cause of meningitis in kids and adults

A

neisseria meningitidis
strep pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

commonest cause of meningitis in immunosuppressed

A

listeria monocytogenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

meningococcal septicaemia

A

= when meningococcus is in bloodstream
o cause of non-blanching rash -> indicates disseminated intravascular coagulopathy (DIC) + subcutaneous haemorrhages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

presentation of bacterial meningitis

A

headache, fever
photophobia, neck stiffness
drowsiness
non-blanching rash (meningococcal septicaemia)

Neonates + babies -> Non-specific
 Hypotonia
 Poor feeding
 Lethargy
 Hypothermia
 Bulging fontanelle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

which test are used in suspected meningitis

A

Kernig’s test
o Lying on back, flexing one hip + knee to 90 then slowly straightening knee whilst keeping hip flexed at 90
 Creates stretch in meninges -> will produce pain or resistance to this movement

Brudzinski’s test
o Lying on back lift their head + neck off bed + flex chin to chest
 Positive – involuntary flex of hips + knees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

meningitis investigations

A

lumbar puncture
CT
MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

when to delay lumbar puncture

A

raised ICP
continous or uncontrolled seizure
GCS <=12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

appearance of bacterial CSF

A

cloudy
high protein
low glucose
high WCC (neutrophils)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

appearance of viral CSF

A

clear
protein normal/mildy raised
normal glucose
high WCC - lymphocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

management of kids in community with suspected meningitis AND non-blanching rash

A

IM benzylpenicillin

<1yr - 300mg
1-9yr - 600mg
>10yrs - 1200mg

then immediate transfer to hospital (watch for pen allergy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management of meningitis

A

IV antibiotics
- <3months = amoxicillin + ceftriaxone
- 3month-50yrs = ceftriaxone
- >60yrs = ceftriaxone + amoxicillin

IV dexamethosome
- esp if strep pneumoniae
- start before or with 1st dose of Abx - no later than 12hrs after
- NOT in shock, septicaemia, *following surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

prophylaxis for meningitis contacts

A

ciprofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

complications of meningitis

A

sensorineural hearing loss
seizures, epilepsy
cognitive impairment, learning disability
memory loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

where do multiple abscesses tend to occur in the brain

A

at grey + white matter border

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

pyogenic meningitis

A

thick layer of supparative exudate cover leptomennges over the surface of brain

exudate in basal + convexity surface

neutrophils in subarachnoid space

17
Q

listeria meningidis

A

gram pos
over 60s, alcoholic

Q will sound like meningitis but mention risk factor

18
Q

steroids in meningococcal management

A

Give to all patients suspected of bacterial meningitis
o 10mg IV 15-20min before or with the first dose of antibiotic + then every 6hrs for 4d

Pneumococcal meningitis benefits the most from this

  • DO NOT give in post surgical meningitis, severe immunocompromised, meningococcal, septic shock or hypersensitive to steroids
19
Q

causes of viral meningitis

A

enteroviruses - coxsackie, echovirus
mups
herpes simplex virus, CMV, herpes zoster
HIV
measles

20
Q

management of viral meningitis

A

CSF PCR to diagnose

self limiting, supportive treatment

aciclovir if secondary to HSV

21
Q

encephalitis commonest cause

A

HSV-1 (cold sore)
- (HSV-2 in neonates)

(encephalitis = brain parenchyma inflamed)

22
Q

presentation of encephalitis

A

fever, headache, psychiatric symptoms, seizures
focal features - aphasia
personality/behavioural change

(typically affect temporal + inferior lobes)

23
Q

encephalitis MRI findings

A

medial temporal + inferior frontal changes (petechia haemorrhages)

24
Q

management of encephalitis

A

pre-emptive aciclovir

25
cribiform plate fracture causing meningitis causative organism
strep pneumoniae also hospitalised patients, diabetics, cochlear implants
26
who should undergo CT prior to lumbar puncture?
immunocompromised history of CNS infection new onset seizure papillodema abnormal level of consciousness focal neurologic deficit
27
cryptococcal meningitis
fungal subtle neurological presentation aseptic picture on CSF mainly in HIV - CD4<100 IV amphotericin B/flucytosine fluconazole
28
antibiotics for bacterial meningitis in penicillin allergy
chloramphenicol + dexamethosone add co-trimoxazole if over 60