Intro To Meningitis Flashcards by Brandon edlund

What are the three main symptoms with meningitis?

Fever
Headache
Stiff neck (30% of cases)

Can get nausea
Vomiting

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Where does meningitis develop?

Subarachnoid space

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How do you tell a TB meningitis?

More lymphocytes

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What is aseptic meningitis?

Sterile
Misnomer
Viral meningitis
Less likely to see neck sore

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when do you see aseptic meningitis?

First year of life

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What is the most common viral cause of meningitis?

Enterovirus (RNA virus)
Coxaky, echo
More common in fall

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What are characteristics of enterovirus/picornavirus?

Summer and fall
Pico for "small" and "RNA"
Transmitted orally or fecally
(+) sense RNA
Icosahedral capsid
No envelope

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What type of symptoms are associated with septic meningitis?

Acute

Neurological function

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What are some treatment for septic meningitis?

Vancomycin (MRSA)
Acyclovir (HSV-2)
Cefepine (pseudomonas)
Ampicillin (listeria)

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What are the big three bacterial meningitis organisms?

Streptococcus pneumonia
Neisseria meningiditis
Hemophilus influenza type b

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What etiology for septic meningitis is most common in adults?

Streptococcus pneumonia (75%)

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What etiology is most common is 11-17 year olds?

Neisseria meningitiditis

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What is the vaccine recommended for all adults over 65 for septic meningitis?

13 valent pneumococcal conjugate vaccine

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What is the development of meningitis by the 3 most common bacteria?

Mucosal colonization at nasopharynx
Invasion and multiplication on bloodstream
3,4. Cross BBB into CSF
Release of inflammatory cytokines in CSF by Microglia and astrocytes
Subsequent increased permeability of the BBB
Diapedesis of leukocytes into CSF
Edema and increased intracranial pressure
Neuronal injury including hearing loss (CN VIII)

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What virulence factors are common in all three major bacteria for septic meningitis?

Capsule

IgA protease

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What are the major virulence factors for Neisseria Meningitiditis?

Capsule
IgA protease
Pili (attachment to mucosa)
Endotoxin (gram neg)
Outer membrane proteins (gram neg)
(Gram negative bacteria)

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What are the major virulence factors for Haemophilus influenza?

Capsule
IgA protease
Pili
Endotoxin
Outer membrane proteins
(Gram neg)

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What are the virulence factors for streptococcus pneumonia?

Capsule
IgA protease
(Gram positive bacteria)

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What is the Endotoxin form gram negative bacteria?

LPS

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What is the Endotoxin in Neisseria meningiditides?

LOS lipooligosaccharide

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Why are endotoxins illusive?

They mimic brain sphingolipids

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What is LPS mode of action?

Activate macrophages leading to release of NO
And IL-1 (fever) and can activate coagulation leading to purpuric skin
Therefore if you have rash you should be thinking less of strep

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What does interleukin 1 do?

Fever

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What is the capsule of meningitis bacteria composed of?

Acidic polysaccharides which prevents phagocytosis by PMN Granulocytes

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What is S. Pneumonia transmitted by?

Respiratory droplets

What is meningitis secondary to when caused by S. Pneumonia?

Paranasal sinusitis and otitis media

What is the most common cause of septic meningitis in ages older than 2months?

Streptococcus pneumonia

What does strep pneumonia look like under a microscope?

``` Coccus Purple (gram positive) Usually in chains but can be singlets and doublets Diplococci Lancet shape ```

What is the most resistant type of strep pneumonia and what is the treatment?

19A-resistant | Treated with vancomycin

What is used to identify strep pneumonia serotype?

quelling (capsular swelling in response antiserum)

What is the most common cause of septic meningitis in infants and young children?

Hemophilus influenze type b

What are characteristics of Hemophilus type b under a microscope?

Grows in chocolate agar with factors V (NAD+) and X (hematin) Coccoid rod

Phone do you vaccinate against Hemophilus influenza type b?

With Hib vaccine-B capsular polysaccharide

what are TORCH infections?

Perinatal meningitis infections

What is the most common cause of TORCH infections?

GBS - group b strep

What are common causes of perinatal meningitis?

GBS, E. Coli, listeria

What is the antigen the GBS has?

Lancefield group b antigen

How is GBS aka streptococcus agalactiae commonly transmitted and from where?

It is common in the GI tract and genitourinary tract flora | Vertical transmission to intact in utero or from a vaginal birth

What does GBS cause?

Sepsis, pneumonia, and meningitis

What race is GBS most common in?

Twice as common in African American Infants

What is given prophylactically to pregnant women with GBS?

Penicillin G

What are some defining things about GBS?

Bacitracin resistant Catalase negative CAMP reaction

What E. coli strain and type cause meningitis and in what age group?

``` E. coli K1 Gram negative Rod LPS K1 capsular polysaccharide prevents fusion with lysosome Sometimes expresses beta lactamses ```

What is the treatment for E. coli?

Ceftriaxone If beta lactamses present use carbapenem

What causes chronic meningitis?

Syphillis Spirochetes TB Fungal (cryptococcis, candida)

What percent of TB cases also have meningitis?

25%

What drugs are used against TB?

Isoniazid - inhibits mycolic acids, acetylation by the liver stops the drug sometimes Rifampin - RNA polymerase, red body fluids, inhibits p450 Ethambutol - cell wall inhib by arabinosyl Pyrazlinamide - unknown

What is the main fungi cause meningitis?

Cryptococcis neoformans | Use India ink stain

What is the treatment for fungal meningitis?

Liposomal amohitericin B With flucytosine Followed by fluconazole for 3-12 months sometimes life

What is amphotericin b?

Binds to ergosterol Also cholesterol Neohrotoxic

What is flucytosine?

Similar to 5-fu Converted to 5-fu in fungi Narrow, yeast form Bone marrow suppression

What is the big anti fungal class?

Azoles Binds fungal p450 and inhibits ergosterol production Efflux Fluconazole is the best for CNS penetration

When do you get photophobia?

Aseptic meningitis

What does LPS do?

Causes you to not clot | Lower your platelet counts

What is a normal glucose in the CSF?

40-100

What is E. coli is associated with infants?

E. coli K1

What does Echo virus 9 cause in what age?

Meningitis | Teens

What grows on the chocolate agar?

H. Influenze type b

What is GBS?

Strep agalactiae

What drug is mostly likely to interfere with other drugs?

Rifampin | Inhibits p450

What test might you do do diff between a meningitis and encephalitis caused by a virus?

MRI | Maybe see more red blood cells with encephalitis with necrosis