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MICN201 2025 Infection & Immunity > Meningitis > Flashcards

Meningitis Flashcards

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1
Q

What are the three main lecture objectives regarding meningitis?

A
  1. Different classifications of meningitis
  2. Aetiology of bacterial meningitis
  3. Laboratory diagnosis & treatment
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2
Q

What is the clinical presentation of meningitis?

A

Varies; symptoms include fever, stiff neck, headache, altered mental state, vomiting, diarrhea, photophobia, muscle pain, seizures.

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3
Q

What is the significance of finding any organism in the CSF?

A

It is significant because the meninges & CSF are normally sterile sites.

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4
Q

What are the infective and non-infective causes of meningitis?

A

Infective: bacteria, viruses, fungi; Non-infective: lymphoma, leukaemia, subarachnoid haemorrhage, drug reactions, autoimmunity, trauma.

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5
Q

Which microorganism is most important for causing meningitis in individuals aged 3 months to 50 years?

A

Neisseria meningitidis

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6
Q

What is the classic triad of symptoms indicative of meningitis?

A

Fever, stiff neck, headache

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7
Q

True or False: Viral meningitis is usually severe and requires aggressive treatment.

A

False

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8
Q

What are common symptoms of meningitis in infants?

A

Lethargy, irritability, poor feeding, high-pitched cry, bulging fontanelle.

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9
Q

Fill in the blank: The most common cause of viral meningitis is _______.

A

Enteroviruses

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10
Q

What are the routes through which microorganisms can enter the CNS?

A
  • Haematogenous spread
  • Direct inoculation
  • Contiguous spread
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11
Q

What are the key virulence factors of Neisseria meningitidis?

A
  • Pili/Opa & Opc for attachment
  • Outer membrane porins (PorA/PorB) for translocation
  • Capsule to inhibit phagocytosis
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12
Q

What are the treatment options for suspected bacterial meningitis?

A

IM ceftriaxone or penicillin pre-hospital; IV ceftriaxone at the hospital.

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13
Q

What is the most common symptom in acute bacterial meningitis cases?

A

High fever (>39˚C)

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14
Q

What are the complications associated with meningitis?

A
  • Death
  • Amputation
  • Hearing loss/blindness
  • Epilepsy/cerebral palsy
  • Cognitive issues/developmental delay
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15
Q

True or False: The presence of a rash is always indicative of meningitis.

A

False

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16
Q

What is the significance of a haemorrhagic rash in meningitis?

A

It is associated with the sepsis stage of Neisseria meningitidis infection.

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17
Q

What is the age group most at risk for Neisseria meningitidis infection?

A

Infants (3 months - 1 year) and adolescents (>20 years)

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18
Q

What are the clinical features of meningitis?

A
  • Fever
  • Neck stiffness
  • Photophobia
  • Neurological symptoms (headache, altered mental state)
  • Rash
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19
Q

Which organisms are common causes of meningitis in neonates?

A
  • E. coli
  • Streptococcus agalactiae
  • Listeria monocytogenes
  • HSV
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20
Q

What is the typical age range for significant Neisseria meningitidis infections?

A

3 months to 50 years

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21
Q

Fill in the blank: The outer layer of the meninges is called the _______.

A

Dura

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22
Q

What is the role of the capsule in Neisseria meningitidis?

A

Inhibits phagocytosis and complement action.

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23
Q

What are the common laboratory diagnostic methods for bacterial meningitis?

A

CSF analysis, culture, and sensitivity tests.

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24
Q

What is the danger of delayed treatment in bacterial meningitis?

A

High morbidity and mortality rates.

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25
True or False: Meningitis can only be caused by infectious agents.
False
26
What are the two main classifications of meningitis based on duration?
Acute (<4 weeks) and chronic (>4 weeks)
27
What percentage of cases present with the classic triad of meningitis symptoms?
20-66%
28
Fill in the blank: Meningitis is inflammation of the _______ and _______.
meninges; cerebrospinal fluid (CSF)
29
What are the common complications of bacterial meningitis?
Death, amputation, hearing loss, epilepsy, cognitive issues.
30
What is the role of sialic acid in preventing C' activation/opsonisation?
Prevents C' activation/opsonisation ## Footnote Sialic acid is a component that helps bacteria evade the immune system.
31
What is the significance of sIgA protease?
It cleaves secretory IgA, aiding bacterial evasion of the immune response ## Footnote Secretory IgA is an important antibody in mucosal immunity.
32
What does catalase do in the context of bacterial infections?
Breaks down hydrogen peroxide, protecting bacteria from oxidative stress ## Footnote Catalase is an enzyme that helps bacteria survive in hostile environments.
33
What is LOS and its role in proinflammatory response?
Lipooligosaccharide, contributes to proinflammatory response ## Footnote LOS is a component of the outer membrane of some bacteria, like Neisseria.
34
How many cases of Neisseria meningitidis were notified in NZ in 2024?
43 cases notified ## Footnote This reflects a decrease from 59 cases in 2023.
35
What age groups had the highest incidence of Neisseria meningitidis in NZ?
Infants (<1 yr) and young adults (15-19 yrs) ## Footnote B strain was the most common cause of infection in these groups.
36
What was the peak number of meningococcal disease cases in NZ and when did it occur?
648 cases in 2001 ## Footnote This corresponds to an incidence rate of 17.4 per 100,000.
37
What percentage of meningococcal cases in 2023 were caused by B strains?
74% identified isolates ## Footnote B strains have been the most common cause of infection.
38
What is the normal appearance of cerebrospinal fluid (CSF)?
Clear, colourless, watery ## Footnote Any turbidity or discoloration can indicate infection.
39
What does visible turbidity in CSF suggest?
Suggestive of bacterial meningitis ## Footnote Turbidity typically indicates the presence of cells or infection.
40
What is the clinical triad of symptoms for acute bacterial meningitis?
Fever, headache, neck stiffness ## Footnote This triad is not always present in all cases.
41
What is the recommended initial treatment for acute bacterial meningitis?
Prompt empiric antimicrobials ## Footnote Delayed treatment can lead to significant mortality and complications.
42
What specific antibiotic is recommended for Neisseria meningitidis?
IV ceftriaxone ## Footnote This is the empiric and targeted treatment for N. meningitidis.
43
What is the role of dexamethasone in the treatment of meningitis?
May be beneficial in decreasing complications/mortality ## Footnote Dexamethasone can affect the transport of antimicrobials across the blood-brain barrier.
44
What are the common causes of meningitis in neonates?
* E. coli * S. agalactiae * S. epidermidis * Listeria monocytogenes * HSV ## Footnote Neonates have an immature immune system, making them vulnerable.
45
What is the most common cause of meningitis in adolescents?
Neisseria meningitidis ## Footnote Viral infections are also common in this demographic.
46
What is the typical CSF finding in acute bacterial meningitis?
Increased WBC (neutrophils), decreased glucose, increased protein ## Footnote This is indicative of a bacterial infection.
47
True or False: Prior antimicrobial treatment affects the sensitivity of Gram stain and culture in diagnosing meningitis.
True ## Footnote Prior treatment can lead to false negatives in laboratory tests.
48
What is the vaccination recommendation for meningitis?
* S. pneumoniae * H. influenzae b * N. meningitidis (A, C, Y, W and B strains) ## Footnote Vaccination is recommended for risk groups, especially infants and young adults.
49
What is the difference between purulent and aseptic meningitis?
Purulent is bacterial; aseptic is viral ## Footnote Aseptic meningitis typically has a better prognosis.
50
What is the classic triad of symptoms for meningitis?
Fever, neck stiffness, headache ## Footnote Not always present in every case (20-66% of cases).
51
What is the most common symptom of acute bacterial meningitis?
Fever (95% of cases) ## Footnote Typically ranges from 39-40˚C.
52
What are some general symptoms of meningitis in infants?
Lethargy, irritability, poor feeding, high-pitched cry, bulging fontanelle ## Footnote Symptoms can vary significantly.
53
What type of rash is associated with N. meningitidis?
Petechiae (early) and purpuric (late) ## Footnote Non-blanching rash tested with the glass test.
54
What are Kernig's and Brudzinski's signs indicative of?
Meningeal irritation ## Footnote Low sensitivity; <50% positive.
55
List some complications of meningitis.
* Death * Amputation * Hearing loss/blindness * Epilepsy/cerebral palsy * Cognitive issues/developmental delay
56
Who are at risk groups for developing meningitis?
* Infants * Elderly * Adolescents * Immunosuppressed individuals * Those with trauma or infections (e.g., otitis media, sinusitis)
57
What is Neisseria meningitidis commonly referred to as?
Meningococcus ## Footnote It is a Gram-negative diplococcus.
58
How is N. meningitidis transmitted?
By respiratory aerosols ## Footnote Carriers can transmit to non-immune individuals.
59
What is a significant characteristic of N. meningitidis virulence?
Capsule ## Footnote 13 types, with A, B, C, W, Y causing >90% infections.
60
What is the most common cause of meningococcal infections in New Zealand?
B strain ## Footnote Responsible for 74% of identified isolates.
61
What is the initial method for diagnosing meningitis?
CSF via lumbar puncture ## Footnote Ideally before antimicrobials are given.
62
What does visible turbidity in CSF indicate?
Possible bacterial meningitis ## Footnote Normal CSF is clear, colorless, and watery.
63
What is the typical WBC count in acute bacterial meningitis?
Increased WBC (neutrophils), decreased glucose, increased protein ## Footnote Aseptic (viral) shows increased lymphocytes, normal glucose.
64
What is the role of Gram stain in diagnosing meningitis?
Direct initial antimicrobial therapy ## Footnote Affected by prior antimicrobial treatment.
65
What is the recommended empiric treatment for N. meningitidis?
IV ceftriaxone ## Footnote Resistance to penicillin is possible.
66
What additional treatment may be beneficial for certain bacterial meningitis?
Dexamethasone ## Footnote May decrease complications/mortality.
67
What vaccinations are recommended for risk groups against meningitis?
* S. pneumoniae * H. influenzae b * N. meningitidis (A, C, Y, W) ## Footnote B strain is now part of the vaccine schedule.
68
What is the mortality risk associated with sepsis from N. meningitidis?
>50% mortality ## Footnote Sepsis can lead to circulatory collapse and multiple organ dysfunction syndrome (MODS).
69
What is a potential outcome of untreated bacterial meningitis?
Significant mortality and complications ## Footnote Prompt antimicrobial therapy is crucial for better outcomes.
70
True or False: All symptoms of meningitis are always present.
False ## Footnote Symptoms can vary and overlap with other CNS conditions.

MICN201 2025 Infection & Immunity (7 decks)

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