- GBS #1 - E. coli #2 - Listeria #3

- strep pneumo #1 - N. meningitides #2 -if over 50 or immunocompromised -> LISTERIA

- autoimmune, NOT due to infection w/ Borrelia Burgdorferi - NO antibiotics needed

Stillwell Flashcards by Cole Connelley

Meningitis

-MEDICAL EMERGENCY

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what should you do if you aren’t sure if a LP should be done or not?

-DO IT ANYWAYS

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aseptic meningitis

-negative aerobic CSF culture but CAN STILL BE DUE TO INFECTION (actually septic)

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which organism likes to invade TEMPORAL lobes causing encephalitis?

HSV

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Most common organisms to cause meningitis

strep pneumo #1
GBS #2
N. meningitides #3
H. influenzae (most common w/o HIB)
Listeria monocytogenes

-also Strep Suis (pigs/hogs)

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neonatal meningitis

GBS #1
E. coli #2
Listeria #3

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children > months old meningitis

strep pneumo #1

- N. meningitides #2

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adult meningitis

strep pneumo #1
N. meningitides #2

-if over 50 or immunocompromised -> LISTERIA

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pulmonary AV malformations

allow pathogens to enter CNS

- Hx of telangiectasis, Osler-weber syndrome, cardiac malformations

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Cavernous sinus thrombosis

DANGEROUS TRIANGLE
retrograde flow of infection -> damage CN3,4,6, V1,V2
STAPH AUREUS

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meningitis - Treponema Pallidum (syphilis)

-tertiary -> ARGYLL-ROBERTSON PUPILS and TABES DORSALIS (dorsal columns) + gummas

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neurosyphilis diagnosis

RPR sometimes neg
if neg but still have suspicion -> do FTA-ABS anyways
neuro Sx + pos serology -> do LP -> considered pos syphilis if there is any abnormality (VDRL, cell count, glucose, protein)

-67-72% have pos CSF VDRL

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-meningitis - Leptospira Interrogans (Weil’s Disease)

ASEPTIC MENINGITIS, HEPATITIS, ACUTE RENAL FAILURE W/ HEMATURIA, CONJUNCTIVITIS
tropics

Tx: Doxy or Azithromycin

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Post-Lyme syndrome

autoimmune, NOT due to infection w/ Borrelia Burgdorferi

- NO antibiotics needed

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how to diagnose Borrelia Burgdorferi (Lyme disease)

SEROLOGY 1ST -> ELISA IgM/IgG -> follow w/ Western blot
ECM LESION
Tx: Ceftriaxone/Cefotaxime, Penicillin

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meningitis - Nocardia

immunocompromised -> PARENCHYMAL BRAIN ABSCESS

- loves to go brain

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meningitis - mycobacteria TB

BASILAR meningitis -> affect CNs

- need 3 or more specimens to find a +AFB stain

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cochlear implants

-STREP PNEUMO infection

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meningitis - Brain abscess

-POLYMICROBIAL

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mycotic aneurysm

usually infected (NOT just fungal)

- Staph Aureus #1, Salmonella #2…abdominal aorta > thoracic aorta and involves vasa vasorum

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CNS infection/meningitis in IVDA

-Staph aureus #1

Clostridium tetani -> tetanus toxin -> lockjaw/tetanus
Clostridium botulinum -> botulinum toxin -> descending muscle weakness

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treatment for bacterial meningitis

Study These Flashcards

-Ceftriaxone or Cefotaxime + Vancomycin (+ Ampicillin for Listeria coverage if >50 y/o or immunocompromised)

corticosteroids (Dexamethasone)

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-lower mortality and most ptxs benefit when started just before 1st dose of antibiotics*** (no help if started after)

RMSF

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-likes to invade endothelial cells

the most common cause of meningitis in adults

-VIRAL

viral meningitis

- lymphocytes, high protein, NORMAL glucose | - 1st 12-24hr. -> NEUTROPHIL predominance then revert to LYMPHOCYTES

HSV-1 encephalitis

-bilateral, periodic sharp spikes in TEMPORAL regions on EEG

most common cause of viral (aseptic) meningitis

ENTEROVIRUSES (Coxsackie, Echovirus)

poliovirus

- Afghanistan and Pakistan | - ACUTE FLACCID PARALYSIS

HSV-2

- MENINGITIS | - recurrent "Mollaret's" meningitis -> reactivation of HSV-2 -> GHOST and MOLLARET cells (footprints)

HSV-1

- ENCEPHALITIS | - TEMPORAL LOBES (bilateral)

CMV meningitis/encephalitis

- congenital -> periventricular calcifications - HIV+ ptx -> diffuse micronodular encephalitis, MYELITIS, POLYRADICULOPATHY -OWLS EYE

MYELITIS vs. POLYRADICULOPATHY in CMV

- myelitis: UMN -> hyperreflexia, +babinski | - polyradiculopathy: LMN -> hyporeflexia

EBV meningitis/encephalitis

-PRIMARY CNS LYMPHOMA (diffuse large B cell) in HIV ptxs -> SOLITARY deep white matter, subependymal lesions on MRI/CT

HHV-6 (Roseola)

-child w/ high fever, FEBRILE SEIZURES, and maculopapular rash (torso -> extremities)

Eastern equine encephalitis virus

- arbovirus -> mosquitos - MOST SEVERE - FLORIDA

Japanese encephalitis virus

- arbovirus -> mosquitos - ASIA and WESTERN PACIFIC - seizures and Parkinsonian syndrome - vaccine in US

California encephalitis virus

- arbovirus -> mosquitos | - SEIZURES in CHILDREN

Powassan virus

- arbovirus -> Ixodes ticks | - NE/North central; upper Midwest US

Colorado tick fever virus

- arbovirus -> Dermacentor tick | - SADDLEBACK/biphasic fever

Chikungunya virus

- arbovirus -> mosquitos - also biphasic fever - RASH and severe ARTHRALGIAS/ARTHRITIS*** - meningoencephalitis

Zika virus

- mosquito and sexual - RASH, ARTHRALGIAS, CONJUNCTIVITIS - palmar rash - microcephaly

Measles/Rubeola

- SUBACUTE SCLEROSING PANENCEPHALITIS (SSPE)j | - 7-10 years later

Rabies (Rhabdovirus)

- neurotropic - histo: NEGRI BODIES (bullet shaped) - parasthesias, hydrophobia, aerophobia, hyper salivation/lacrimation/sweat or ascending paralysis

Cryptococcus Neoformans

- cryptococcomas in brain and lungs - NARROW base budding and India ink - Dx: CRYPTO ANTIGEN on CSF best*** - Tx: liposomal amph. B + 5-FC - keep OP <20cm H2O w/ LPs

Aspergillus

- brain abscess - 45 degree branching - high serum golactomannan and beta D glucan

Mucomycosis

- brain abscess - 90 degree branching - black necrotic lesions

Naegleria Fowleri

- amoebia - fatal meningitis - motile trophozoites - check both uncentrifuged and centrifuged CSF -> TEARS UP AMOEBAE***

Acanthamoeba and Balmuthia

- amoebas - granulomatous encephalitis - giant cells and granulomas

Toxoplasma gondii

-MULTIPLE ring enhancing lesions on brain abscesses

rat lungworm from ASIA after eating undercooked snails/vegetables that causes EOSINOPHILIC meningitis

- ANGIOSTRONGYULUS CANTONENSIS*** | - also Gnathostoma spinigerum and Baylisascariasis

Lyme disease

Bell's palsy

which organism loves to invade endothelial cells?

RMSF

non-ring enhancing lesions on CT in immunocompromised ptx

PML of JC virus

Stillwell Flashcards

(54 cards)