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Infections of the CNS Flashcards

(52 cards)

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1
Q

what might meningococcal disease present with

A

meningitis
sepsis
or both

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2
Q

what is the most dangerous type meningitis

A

bacterial meningitis
eg. from meningococcal

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3
Q

what does meningitis mean

A

inflammation of the meninges

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4
Q

what is classic about meningococcal sepsis

A

petechial/ purpuric rash- non blanching
does not fade under a glass
Meningococcal bacteria reproduce in the bloodstream and release poisons (septicemia). As the infection progresses, blood vessels can become damaged. This can cause a faint skin rash that looks like tiny pinpricks.
presents in skin all over the body- sign of inflammation in bloodstream not just central nervous system.

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5
Q

what other infections of the central nervous system can you get

A

encephalitis- inflammation of brain parenchyma

normally viral

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6
Q

why is the purpuric rash so concerning and needs urgent medical care?

A

it can progress to PURPURA FULMINANS AND GANGRENE
-disordered coagulation
-inflammation in vessels
-severe damage and poor vascular supply
-may need amputation

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7
Q

what are the mortality rates for meningococcal meningitis vs meningococcal sepsis

A

5-15%
40+%

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8
Q

what are long term complications that affect 20+% of survivors

A

meningitis
-seizures
-hearing difficulties
-cranial n problems
-focal paralysis
-hydrocephalus
-intellectual disability
-ataxia

sepsis
-limb amputations
-arthritis and join pain
-skin necrosis and scarring
-organ dysfunction, liver, kidney, adrenal glands

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9
Q

what is the definition of sepsis

A

life threatening organ dysfunction
caused by dysregulated host response to infection

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10
Q

what is sepsis 6

A

Blood cultures
Urinary output
Fluids
Antibiotics (IV)
Lactate
Oxygen (high flow)

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11
Q

how does infection get there

A
  1. BBB
    -tightly packed endothelial cells line blood vessels in brain mechanically supported by thin basement membrane. hard to get across
    -if breach–> encephalitis
    get across by inflammation as cells are close to infectious agents, and become leaky
    skull fracture, BBB damaged
  2. blood CSF barrier
    -breach–>meningitis
  3. direct
    -sinuses
    -otitis media
    -skull fracture
  4. +2. =haematological spread
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12
Q

how do the barriers in the brain get breached

A

rare occasions they can traverse barriers= typical inflammatory response

-growing across and infecting cells comprising barrier
-passive transfer in intracellular vacuoles
-carriage across in infected white blood cells

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13
Q

what causes meningits

A

infection
auto-immune disease
malignancy

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14
Q

what are some common bacteria causing meningitis

A

Neisseria meningitidis

Haemophilus influenzae

Streptococcus pneumoniae

Mycobacterium tuberculosis

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15
Q

what are some common viruses causing meningitis

A

ENTEROVIRUSES:
-Echovirus
-Coxsackie viruses A and B
-poliovirus

HERPES VIRUSES
-Herpes simplex 1 and 2

PARAMYXOVIRUS
-complication of mumps

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16
Q

what is a common fungi causing meningitis

A

Cryptococcus neoformans

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17
Q

what are some common protozoa causing meningitis

A

Amoeba
Naegleria
Acanthamoeba

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18
Q

the main causative organisms of bacterial meningitis very by age and other risk factors
what is the most common pathogen found in neonates

A

Escherichia coli
Group B Streptococcus
Listeria monocytogenes

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19
Q

how do you find out what organism is causing meningitis

A

take csf sample
take blood

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20
Q

what are the most common pathogen found in children under 5 years

A

Neisseria meningitidis
Haemophilus influenzae

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21
Q

what is the most common type of pathogen found in young adults

Study These Flashcards
A

Neisseria meningitidis

22
Q

what are the most common pathogen found in older age group

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A

Streptococcus pneumoniae
Listeria monocytogenes

23
Q

what are the most common pathogen found in the immunosuppressed

Study These Flashcards
A

Mycobacterium tuberculosis
Cryptococcus neoformans

24
Q

why does age matter for working out the organism

Study These Flashcards
A

gives an idea as to what the organism may be can give treatment straight away while waiting for blood/csf sample results

25
what are the dangers/ risk factors of neonatal meningitis
early onset -occurs <7 days -infected by heavily colonised mother -premature rupture of membranes -preterm delivery -60% fatality rate most likely to pick up from birth canal- greater risk if birth canal is heavily colonised by bacteria -bit dependent on mother late onset -occurs <3 months -lack of maternal antibody -poor hygiene in nursey -20% fatality rate
26
Neisseria meningitidis
gram neg. intracellular diplococci normal in NASOPHARYNX droplet spread only infect humans 12+ SEROTYPES 5 PATHOGENIC SEROGROUP STRAINS- A, B, C, W135, Y
27
why do you want to know serotypes
important in vaccine development outbreak tracing
28
is meningococcal meningitis vaccine preventable
yes vaccines against all major serotypes
29
Haemophilus influenzae
gram -ve coccobacilli rod 6 serotypes (a-f) type B most virulent (Hib)
30
H influenzae vaccine preventable?
childhood vaccination programme
31
Streptococcus pneumoniae
gram +ve diplococci normal in NASOPHARYNX over 90 bacterial serotypes common cause of meningitis in young, adults with risk factors (older, diabetic, alcohol xs, asplenic)
32
is invasive pneumococcal disease vaccine preventable
yes vaccines against lots of different types of serotypes eg. PCV13 against 13 commonest serotypes
33
why do you have to keep monitoring serotypes
most pathogenic get rid of and another one comes in to fill ecological niche
34
what are clinical features of babies/ small children with meningitis
they cant report so have to observe tense/bulging fontanelles refuse to feed irritable when picked up, high pitched moaning cry stiff body with jerky movement or floppy and lifeless
35
what clinical features do both septicaemia and meningitis have in common
fever/vomiting rash anywhere confused delirious very sleepy/vacant/difficult to wake
36
what clinical features are present in meningitis and not septicaemia
severe headache stiff neck (less common in young) dislike of bright lights (less common in young) seizures
37
what clinical features are common in septicaemia but not meningitis
limb/joint/muscle/pain cold hands and feet/shivering pale/mottled skin fast breathing
38
what are some diagnostic tests for meningitis
Blood -U&E, CRP, lactate, glucose -FBC, clotting -blood culture, meningococcal and pneumococcal PCR, HIV test CSF -protein and glucose -white cc, gram stain, bacterial culture and pneumococcal PCR, viral pcr tests, special tests-- tb (microscopy, molecular tests, culture) cryptococcal (indian ink, CrAg, fungal culture)
39
how will the csf fluid collected from a lumbar puncture present
will be inflamed with high protein low glucose (been consumed by infecting organism) also high pressure fluid, cloudy (bacterial) take matched blood and CSF glucose samples collect enough fluid and some spare can tell about pathogen by appearance of csf if antibiotics given before csf hard to tell
40
when should you delay or omit a lumbar puncture
-risk of bleeding if disordered coagulation -if raised csf caused because focal neurology suggesting a mass lesion in the brain-- brain descend into CSF, blocks of spinal column -papilloedema-- do ct/mri and see what is causing it before lumbar
41
when do we need CNS imaging
to exclude mass lesions/ oedema-- making LP dangerous if there is a reduction in csf pressure below the lesion this could precipitate herniation of the brainstem or cerebellar tonsils BRAIN ABSCESS SUPDURAL EMPYEMA TUMOUR NECROTIC SWOLLEN LOBE IN ENCEPHALITIS
42
what is treatment of bacterial meningitis
main way IV antibiotics (high dose) so crosses BBB 1st try: HIGH dose Penicillin HIGH dose Ceftriaxone maybe with steroids duration depend on pathogen eg. pneumococcal longer
43
how do you prevent bacterial meningitis
Vaccines against: Haemophilus influenzae b Pneumococcus Meningococcus ABCWY also against: polio, tetanus Notify, Prevention, Control sufficietly dangerous prophylaxis antibiotics to close contact
44
discuss viral meningitis
less serious more common identify by PCR of CSR no specific treatment usually regarded as benign and self-limiting long term neuropsychiatric sequelae have been described
45
what is the commonest cause of viral meningitis
HSV-2 commonest cause of viral meningitis
46
what is Mollaret's meningitis
recurrent meningitis might happen with hsv as the viruses can recur
47
what is the most common cause of encephalitis
Herpes Simplex Virus-1
48
how is encephalitis different from meningitis
more likely to be confused/drowsy earlier in disease process
49
encephalitis symptoms? investigations? treatment?
altered cerebration -confusion, abnormal behaviour, seizures, fever csf, temporal lobe changes on mri high dose IV aciclovir
50
brain abscess factors? causes? pathophysiology? symptoms? investigations? treatment?
invasion on an infection nearby -otitis media, mastoiditis, sinusitis often oral nasopharyngeal microbiota -aerobic (s. aureus, strep. milleri) -anaerobic (bacteroides sp., fusobacterium sp.) diffuse inflammation--> focal lesion and pia mater suppuration headache, focal neurology, seizures CT/MRI - risk with LP antibiotics- CEFTRIAXONE AND METRONIDAZOLE
51
what is the problem of immunocompromised patients and cns infections
They may be at risk from a wider range of pathogens
52
what is transmissable spongiform encephalopathies
rare prion disease -proteinacious infectious particles cause vacuoles and plaques in nervous tissue highly resistant to heat, chemical agents and irradiation no treatment, no vaccine

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