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Micro: Bacterial Meningitis Flashcards

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1
Q

Bacterial Meningitis

A

medical EMERGENCY
Sx: headache, vomiting, stiff neck, fever, photophobia, irritability, varying degrees of neurological dysfunction
Dx: gram stain and culture of CSF and blood, rapid antigen detection, PCR
CSF: PMNs, elevated protein, reduced glucose

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2
Q

bacterial meningitis agents: birth to 3 months

A

Group B strep (strep. agalactiae)
enteric GNR
Listeria

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3
Q

bacterial meningitis agents: 3 months to 2 years

A

Strep. pneumoniae
N. meningitides
H. influenzae type B

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4
Q

bacterial meningitis agents: 2 years to 18 years

A

N. meningitides

Strep. pneumoniae

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5
Q

bacterial meningitis agents: older patients

A 
S. pneumoniae
N. meningitidis
H. influenzae
Listeria
Gram neg.: enteric, P. aeruginosa
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6
Q

bacterial meningitis: immunocompromised

A

Staph
enteric GNR
P. aeruginosa
Listeria

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7
Q

Streptococcus pneumoniae virulence factors

A
  1. capsule
  2. pili
  3. cell wall components
  4. choline binding proteins
  5. hemolysins
  6. H2O2
  7. Neuraminidase
  8. IgA Protease
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8
Q

capsule

A

interferes with phagocytosis

S. PNEUMONIAE, N. MENINGITIDIS, H. INFLUENZAE, CRYPTOCOCCUS

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9
Q

pili

A

attachment of encapsulated bacteria cell to epithelial cell in upper respiratory tract: initial event in invasive disease
S. PNEUMONIAE, N. MENINGITIDIS

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10
Q

cell wall components

A

inflammation that causes Sx of pneumonia, otitis media, meningitis
S. PNEUMONIAE

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11
Q

choline binding protein

A

adhesion that interacts with pulmonary epithelial carbohydrates
allow: CROSS BBB in MENINGITIS
S. PNEUMONIAE

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12
Q

hymolysins

A

lyse host cell and activate complement

S. PNEUMONIAE

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13
Q

H2O2

A

damage host cell and bactericidal effect against S. aureus

S. PNEUMONIAE

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14
Q

neuraminidase

A

invasion of host tissue at mucosal surface

S. PNEUMONIAE

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15
Q

IgA protease

A

destruction of IgA at mucosal surface

S. PNEUMONIAE

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16
Q
  1. pneumovax

2. prevnar

A

S. pneumo vaccines

  1. multivalent, non-conjugated; older patients and high risk groups
  2. heptavalent (or 13), conjugated, anamnestic (memory) response; infants
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17
Q

meningitis in crowded conditions (jail, day care, military)

A

N. meningitidis

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18
Q

Meningococcal Meningitis

A

N. meningitidis
Early: neck stiff, mental change
Late: PETECHIA, PURPURA
VERY RAPID PROGRESSION

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19
Q

lipooligosaccharide (LOS/ LPS)

A

N. meningitidis

ENDOTOXIN

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20
Q

phase variation

A

allows invasion
turning off CAPSULE (many other systems) genes, then turning them on again once in blood stream
ON-OFF control
N. MENINGITIDIS

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21
Q

Tx of N. meningitidis

A

PENICILLIN
if allergic/ resistant: 3rd generation cephalosporin and vancomycin
give dexamethasone first

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22
Q
  1. menomune

2. menactra

A 
N. MENINGITIDIS vaccines
for: A, C, Y, W135
neither covers serogroup B
1. unconjugated; military and high risk
2. conjugated; children 11-12 yrs old
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23
Q

antigenic variation

A

N. gonorrhoeae: pili genes

change in genes leading to expression of different forms of similar genes

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24
Q

What serotype is most important pathogen of H. influenzae?

A

Hib

serotype B

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25
Hib
H. influenze vaccine capsule conjugated to carrier protein (diphtheria toxoid added because T capsule is T cell independent) children 2-15 months
26
Who does H. influenzae occur in?
unvaccinated children | also can have: non-typable H. flu
27
What kind of immunity is required to combat Listeria and why?
CELL MEDIATED | intracellular parasite
28
Who does Listeria meningitis and bacteremia occur in?
1. immune-compromised adults: AIDS 2. pregnant women 3. infants
29
can amplify during cold storage in unpasteurized food
LISTERIA MONOCYTOGENES
30
invades epithelial cells and MACROPHAGES | Mechanism?
LISTERIA 1. endocytosis 2. Listeriolysin O: release from phagolysosome 3. F-actin based motility 4. invasion of adjacent cell 5. replication 6. cell death
31
internalin
binds E-cadherin expressed on epithelial cell: mediates endocytosis LISTERIA
32
How does Listeria spread?
spreads directly cell to cell | avoids exposure to humoral immune system
33
F-actin
motility | Listeria
34
listeriolysin
release from phagolysosome | Listeria
35
Strep. pneumoniae risk factors
1. splenic dysfunction 2. skull fracture, anatomic defect 3. severe ear infections 4. cochlear implant 5. AIDS
36
oxidase positive
N. MENINGITIDIS
37
Tx for N. meningitidis
dexamethasone Pen 3rd gen cephalosporin
38
3rd gen. cephalosporin
cefotaxime | ceftriaxone
39
Requires Factor X (hemin) and V (NAD/NADP)
H. influenzae
40
can cause epiglottis
H. influenzae
41
Rank order of otitis media in children
1. Strep. pneumo 2. H. flu 3. Morexella
42
H. flu Tx
dexamethasone and 3rd gen cephalosporin
43
Other Haemophilus infections 1. H. ducreyi 2. H. aphrophilus
1. soft chancre | 2. part of HACEK: subacute bacterial endocarditis on defective heart valves
44
gram (-) kidney bean
N. meningitidis
45
gram (+) club shaped
Listeria
46
What meningitis bacteria may not show up on gram stain? | Why?
Listeria | facultative anaerobe
47
unpasteurized food, hot dogs, deli meat
Listeria
48
empiric Tx of bacterial meningitis
ceftriaxone add ampicillin if suspect: Listeria add vancomycin if suspect: S. pneumo give dexamethasone before antibiotics
49
fungal meningitis
IMMUNOCOMPROMISED, contaminated epidural steroid injection blood stream to CNS Dx: CSF sample, antigen detection for Cryptococcus Tx: amphotericin B for extended time and flucytosine/ voriconazole
50
Cryptococcus neoformans
MOST COMMON fungal meningitis IMMUNOCOMPROMISED: HIV Dx: antigen detection of capsule, CSF: YEAST with HALO in INDIA INK PIGEON DROPPINGS NOT dimorphic: encapsulated yeast initially asymptomatic pulmonary infection with increased ICP
51
Cryptococcus gatti
SUB-TROPICAL region found on trees healthy people
52
Exserohilum rostratum
fungal meningitis in healthy people that received epidural steroid injection found in black mold Dx: culture CSF and send to CDC for PCR
53
Viral meningitis
mild and self resolving Sx: fever, headache, stiff neck, pt. does not appear extremely ill CSF: low glucose, high: protein, WBC, PMN Tx: as if fungal/bacterial just in case it is
54
Causes of viral encephalitis
1. arbovirus 2. enterovirus 3. HSV-1
55
arbovirus
MOSQUITO/ TICK encephalitis replicate: spleen, macrophage, lymph node req. SECONDARY VIREMIA for systemic infection includes flaviviruses?
56
HSV encephalitis
TEMPORAL LOBE CSF: RBC due to NECROSIS Dx: PCR (can get false negative) Tx: acyclovir (curable if treated early, high mortality without Tx)
57
enterovirus
meningitis, encephalitis: family epidemic: URI or GI
58
Causes of viral meningitis
MOST: enterovirus other: Mumps (without MMR) recurrent aseptic: HSV-2, HIV, VZV
59
flaviviridae
enveloped, + RNA INSECT transmission includes: Hep C. and flaviviruses: St. Louis encephalitis, West Nile, Japanese encephalitis
60
Replication cycle of Flavivirus
1. endocytosis; pH dependent 2. host ribosomes replicate RNA: single polyprotein cleaved by proteases 3. viral polymerase replicates RNA 4. transport to cell surface and release
61
St. Louis encephalitis
arbovirus/flaviviridae syndromes: febrile headache, aseptic meningitis, encephalitis low fatality (die in 1st 2 weeks if die)
62
West Nile
arbovirus/flaviviridae mosquitos: blood from infected birds Sx: febrile headache, MYALGIA, RASH, SWOLLEN LYMPH NODES if severe: stiff neck, stupor, coma, death Tx: supportive
63
Japanese encephalitis
arbovirus/flaviviridae ASIA has VACCINE
64
Togaviridae
enveloped, + RNA | includes: Rubivirus (rubella) and alpha viruses (western equine encephalitis, EEE, VEE)
65
alphavirus
``` asymptomatic to severe replicates: muscle, fibroblasts Sx: 2 week failure then abrupt encephalitis Pts. become COMATOSE and DIE NO Tx ```
66
Bunyaviridae
enveloped, segmented, (-) RNA California encephalitis, La Crosse encephalitis replication like influenza but exclusively in cytoplasm
67
LaCrosse encephalitis
bunyaviridae most COMMON cause of arboviral induced PEDIATRIC encephalitis SEIZURE, FOCAL NEURO Sx low mortality
68
Rhabdoviridae
enveloped, (-) RNA BULLET SHAPED Lyssavirus (RABIES), vesiculoviruses replication similar to paramyxovirus: except enters cell in pH dependent manner
69
Rabies
replicates in muscles then in neurons: disseminates once reaches brain high concentrations in SALIVARY GLAND transmission: ANIMAL BITE, open wound, inhalation long incubation: 1 week -3 months depending on how close brain is to wound effects in: limbic, midbrain, hypothalamus
70
phases of rabies infection
1. prodromal: mild Sx, abnormal sensation around bite 2. acute neurologic: furious rabies or paralytic rabies; hydrophobia (exaggerated gag, resp. tract reflex) 3. coma: death due to respiratory arrest
71
Rabies Tx
postexposure prophylaxis: effective due to long incubation anti-rabies Ig multiple doses of rabies vaccine
72
Arenaviridae
enveloped, segmented, AMBISENSE RNA contain host cell ribosomes: SANDY LMCV
73
Arenaviridae replication
1. pH dependent endocytosis 2. genome used as a template for transcription: NP and L mRNAs produced 3. polymerase then produces full length antigene for each segment 4. (+) sense antigene is used as template for transcription of glycoprotein nRNA 4. assembly and release
74
lymphocytic choriomeningitis (LMCV)
``` arenavirdae inhalation of RODENT FECES or saliva initial phase: fever, headache, N/V later: ASEPTIC MENINGITIS most recover, can get DEAFNESS ```

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