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Year 3 Medicine Block > INFECTIOUS DISEASES: Neuro infections > Flashcards

INFECTIOUS DISEASES: Neuro infections Flashcards

1
Q
A
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1
Q

Define meningitis

A

Inflammation of the meninges

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2
Q

Gram stain of Neisseria meningitidis?

A

Gram negative diplococci

PURPLE

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3
Q

Symptoms of meningitis?

Signs of meningitis?

A

Symptoms: fever, headaches, photophobia, nausea and vomiting, seizures, drowsiness,

Signs: purpuric rash (non-blanching), neck stiffness

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4
Q

Common bacterial causes of meningitis in 6 years - 60 years?

A

Neisseria meningitidis
Streptococcus pneumoniae

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5
Q

Causes of meningitis? (i.e which pathogen groups?)

A

Viral
Bacterial
Fungal
Parasitic (v rare)

Bacterial meningitis is most clinically significant form because of its high mortality and morbidity

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6
Q

Most common bacterial cause of meningitis in neonates (0-3m)?

A

Group B Streptococcus (usually contracted during birth Group B strep that live harmlessly in the vagina).

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7
Q

Name of special tests to look for meningeal irritation?

A

Kernigs test
Brudzinki’s test

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8
Q

Describe Kernig’s test

A

Lying pt on back
Flex one hip and knee to 90deg
Slowly straighten knee while keeping hip flexed at 90deg
This creates stretch in meninges. If meningitis is present = spinal pain, or resistance to movement

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9
Q

Describe Brudzinki’s test

A

Pt lays flat on back
Examiner lifts pt’s head and neck off the bed and flex pt’s chin to chest
If meningitis is present = cause involuntary flex of hips and knees.

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10
Q

Most common cause of meningitis in older people ?

A

Listeria monocytogenes

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11
Q

Viral causes of meningitis?

A

Herpes simplex virus
Enterovirus
Varicella zoster virus

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12
Q

Causes of non-infective meningitis?

A

Malignancy (leukaemia, lymphoma and other tumours)
Chemical meningitis
Drugs (NSAIDs, trimethoprim)
Sarcoidosis
Systemic Lupus Erythematosus
Behcet’s disease

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13
Q

Investigations for meningitis?

A

Nice guidelines:

  • FBC
  • CRP
  • Coag screen
  • Blood culture
  • Whole-blood PCR
  • Blood glucose
  • ABG/VBG
  • Lumbar puncture - CSF analysis (if no signs of raised ICP)
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14
Q

Initial management of bacterial meningitis?

A

2g of IV ceftriaxone (or cefotaxime) twice daily.
Add IV amoxicillin if neonate or older person

Also require dexamethasone with 1st dose

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15
Q

Management of meningococcal meningitis?

Management of pneumococcal meningitis?

A

MM: Intravenous benzylpenicillin or ceftriaxone (or cefotaxime)

PM: IV ceftriaxone

If penicillin allergic = chloramphenicol IV

16
Q

Management of meningitis with non-blanching rash in community setting before hospital transfer?

A

IM benzylpenicillin

17
Q

Complications of meningitis?

A

Septic shock
DIC
Coma
Subdural effusions
SIADH
Seizures

Delayed complications : Sensorineural Hearing loss (most common), cranial nerve dysfunction, hydrocephalus, intellectual deficits, ataxia, blindness
Death

18
Q

Patient with TB has insidious onset of personality change and headache. Also has N&V. What is top differential?

A

TB meningitis

19
Q

Why does pt with miliary TB need lumbar puncture?

A

Exclude TB meningitis

20
Q

Characteristics of CSF with bacterial meningitis:
Appearance?
Protein level?
Glucose level?
WCC?
Culture?

A

Appearance - cloudy
Protein level - high >1g
Glucose level - low; less than half of plasma.
WCC - neutrophils, 1000+
Culture - bacteria - diplococci, Gram -ve

21
Q

Characteristics of CSF with viral meningitis:
Appearance?
Protein level?
Glucose level?
WCC?
Culture?

A

Appearance - clear (sometimes cloudy)
Protein level - normal/slightly raised
Glucose level - 60-80% of plasma
WCC - lymphocytes, 1000+
Culture - no bacteria culture

22
Q

Characteristics of CSF with TB meningitis:
Appearance?
Protein level?
Glucose level?
WCC?

A

Appearance - clear, slightly cloudy. Fibrin web may develop.
Protein level - high >1g
Glucose level - low
WCC - lymphocytes, 1000+

23
Q

Encephalitis features?

A

Fever, headache, psychiatric symptoms, seizures, vomiting

Focal features e.g. aphasia

24
Q

Causes of encephalitis?

A

HSV-1 responsible for 95% of cases in adults

25
Q

Where does encephalitis typically affect?

A

Temporal and inferior frontal lobes

26
Q

Investigations + results for encephalitis?

A

CSF: lymphocytosis, elevated protein

PCR for HSV

Imaging: MRI is best- medial temporal and inferior frontal changes

Imaging normal in 1/3 of pts

ECG pattern: lateralised periodic discharges at 2Hz

27
Q

Managment of encephalitis?

A

IV aciclovir should be started in all cases of suspected encephalitis

28
Q

Prognosis of encephalitis?

A

Prompt treatment: 10-20% mortality

Untreated: 80% mortality

29
Q

Aciclovir side effects?

A

Generalised fatigue/malaise (common)

Gastrointestinal disturbance (common)

Photosensitivity and urticarial rash (common)

Acute renal failure

Haematological abnormalities

Hepatitis

Neurological reactions

30
Q

When should you suspect encephalitis?

A

Sudden onset behaviour changes, new seizures and unexplained acute headache with meningism

31
Q

What is Waterhouse-Friderichsen syndrome?

A

Complication of meningoccoal meningitis- it is adrenal insufficiency secondary to adrenal haemorrhage

32
Q

What is discitis?

A
  • infection in the intervertebral disc space.
  • It can lead to serious complications such as sepsis or an epidural abscess.
33
Q

Features of discitis?

A

Back pain

Pyrexia

Rigors

Sepsis

Neurological features: e.g. changing lower limb neurology

34
Q

Causes of discitis?

A

Bacterial- staphyloccocus aureus

Viral

TB

Aseptic

35
Q

Diagnosis of discitis?

A

MRI- highest sensitivity

CT guided biopsy may be required for

36
Q

Treatment of discitis?

A

6-8 weeks of IV antibiotics (flucloxacillin for staph aureus )

Choose antibiotic based on cultures

37
Q

Complications of discitis?

A
  • sepsis
  • epidural abscess
38
Q

What else do you need to be aware of for discitis?

A

Usually due to haematogenous spread implying bacteriaemia and seeding has occured.

Consider doing an transthoracic echo as pt may have endocarditis

Year 3 Medicine Block (56 decks)

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