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52 terms
Terms | Definitions |
|---|---|
 Meningitis: acute septic | Bacterial |
| Meningitis: aseptic | Viral |
| Meningitis: chronic | fungal or TB |
| neck stiffness that prevents flexion | nuchal rigidity |
| supine position with legs flexed at hip and knee; will resist extension of the leg at the knee | Kernig's sign |
| passive neck flexion induces flexion of hip and knee | Brudzinski's sign |
| -inflammation of the meninges -can be due to non-infectious or infectious causes | meningitis |
| -fever -headache -neck stiffness -photophobia -nausea -vomiting -cerebral dysfunction +/- (lethargy, confusion, coma) | meningitis |
| -symptoms evolve over hours to days -increased NEUTROPHILS in CSF -Neutrophilic pleocytosis -Bacterial | Acute Septic Meningitis |
| -symptoms evolve over hours to days -increased MONONUCLEAR cells in the CSF -Lymphocytic pleocytosis -Bacteria or Fungi are not readily cultured -usually caused by viruses | Aseptic Meningitis |
| -symptoms develop over several weeks -granulomatous inflammatory disease -MONONUCLEAR cells in CSF -usually caused by mycobacteria or fungi, occasionally parasites | Chronic Meningitis |
| -inflammation of brain parenchyma -manifestations include alterations in level of consciousness, seizures, confusion, personality changes -primarily of VIRAL etiology | Encephalitis |
| -both meningeal and encephalitic symptoms are present -viral, bacterial, or parasitic causes | Meningoencephalitis |
| causes of bacterial meningitis: -Group B Streptococcus -E. coli K1 -Listeria monocytogenes -Klebsiella | < 1 month |
| causes of bacterial meningitis: -Streptococcal pneumoniae -Neisseria meningitidis -Haemophilus influenzae -GBS; E. coli K1 | 1-23 months |
| causes of bacterial meningitis: -Streptococcus pneumoniae -Neisseria meningitidis | 2-50 years |
| causes of bacterial meningitis: -Streptococcus pneumoniae -Neisseria meningitidis -Listeria monocytogenes -Aerobic Gram - Rods (E. coli, Klebsiella, Pseudomonas, others) | > 50 years |
| causes of viral meningitis: -Enterovirus (most common) -Arbovirus -HIV (early infection) | infants and children |
| causes of viral meningitis: -HIV (early infection) -Arbovirus | Adults |
| causes of chronic meningitis: -Mycobacterium tuberculosis -Treponema pallidum | bacterial pathogens |
| causes of chronic meningitis: -Cryptococcus neoformans -Coccidioides immitis -Histoplasma capsulatum -other endemic dimorphic _______ | fungal pathogens |
| Pathogenesis of Meningitis: How do organisms access the CNS? ____1____ spread from distant sites of infection or colonization - most often from ____2_____. Must be able to cross the ____3______. The ___4____ is more permeable compared to the rest of the CNS vasculature. Some agents cross following infection of ____5_____ cells. | 1) Hematogenous 2) respiratory tract 3) BBB 4) choroid plexus 5) endothelial |
| Pathogenesis of CNS infection: What are the non-hematogenous routes by which organisms access the CNS? ____1_____ spread following head trauma or secondary to ____2____ or ______3____. ____4____ Route. | 1) direct contiguous 2) sinusitis 3) otitis media 4) Neural |
| Neural spread of CNS infections: ___1____ nerves: Rabies ___2____ nerve: HSV-1, Naegleria fowleri | 1) peripheral 2) olfactory |
| after entry, the trophozoite penetrates the nasal mucosa and migrates along mesaxonal spaces of unmyelinated olfactory nerves, terminating at the olfactory bulb in the subarachnoid space. This space is quite vascularized and is a route of dissemination of trophozoites to other areas of the CNS. | Naegleri fowleri |
| Pathogenesis of Bacterial Meningitis: 1. Colonization of infection of mucosa at ___1_____. 2) Entry into ____2_____ and evasion of ___3___ and ____4_____ 3) ____5_____ in blood 4) Cross the ____6_____ 5) Continued replication in the _____7_____and infection of the _____8_____ 6) Incite ___9___ response which leads to increased ____10____ of the BBB 7) Edema, increased _____11______, and ____12_____ 8) Release of inflammatory mediators, infiltration of ____13______ and edema leads to ___14____ damage. | 1) distant sites 2) bloodstream 3) complement 4) antibody 5) replication 6) BBB 7) CSF 8) meninges 9) Inflammatory 10) permeability 11) intracranial pressure 12) pleocytosis 13) WBCs 14) neuronal |
| Gross: the leptomeninges contain abundant, creamy, purulent exudate; most prominently over the superior surface of the cerebellum. The underlying brain is swollen and the vessels are congested. | Acute Septic Meningitis |
| Histo: Subarachnoid space is filled with neutrophils, plasma cells, and lymphocytes. Brain tissue looks normal. | Acute Septic Meningitis |
| CSF: Gram positive cocci = _______1____, treat with _____2_____ | 1) Strep pneumo 2) Vancomycin + ceftriaxone |
| CSF: Gram negative cocci = ____1______, treat with ___2______ or ____3____ if resistant | 1) Neisseria meningitidis 2) Penicillin G 3) ceftriaxone |
| CSF: Gram positive rod = ______1____, treat with ____2______ plus an ____3______ | 1) Listeria monocytogenes 2) Ampicillin 3) Aminoglycoside (ex. gentamycin) |
| CSF: Gram negative rod = ____1_____, treat with __2_____ plus an _____3_____ | 1) E. coli or HIB (influenza B) 2) Ceftriaxone 3) Aminoglycoside |
| -Cell count: 100-5,000 -Neutrophils -decreased Glucose -elevated Protein | Bacterial meningitis |
| -Cell count: 10-500 -Lymphocyte -normal Glucose -Elevated Protein | Viral meningitis |
| -Cell count: 0-1,000 -Lymphocytes -decreased Glucose -elevated Protein | TB meningitis |
| -Cell count: 0-500 - Lymphocytes -normal to decreased Glucose -Elevated Protein | Fungal meningitis |
| normal protein levels < ________mg/dl | 40 |
| normal glucose level _______mg/dl | 40-70 |
| normal WBC level ________ | 0-5 |
| -Growth on blood agar -alpha hemolytic -optochin sensitive -Bile soluble | Streptococcus pneumoniae |
| causes: -meningitis -pneumonia -sinusitis -otitis media | Strep pneumo |
| -leading cause of serious infections worldwide -widespread antibiotic resistance -meningitis (any age group, but mostly in children-very serious) -nasopharyngeal colonization common (5-20% healthy adults, 20-40% healthy children) -human reservoir: direct person to person transmission -90 different serotypes -member of viridans groups | Strep pneumo |
| empiric treatment of meningitis caused by strep pneumo: | vancomycin + 3rd generation cephalosporin |
| Resistance of Strep pneumo: MIC <0.1 micrograms/ml Penicillin: ___1____ MIC 0.1-1 :____2______ MIC >1: _____3_____ MIC >2 :____4____ | 1) susceptible 2) intermediate 3) resistant 4) highly resistant |
| Strep Pneumo vaccine: -Recommended for >65 years and individuals lacking functional spleen, institutionalized, immune suppressed | 23 valent vaccine |
| Strep pneumo vaccine: -infants and toddlers -4 doses @ 2,4,6, and 12-15 months | 13 valent conjugate vaccine |
| -no growth on blood agar, except as satellite colonies around Staph aureus -tiny colonies grown on chocolate agar -growth on Thayer Martin agar | Hib |
| one national multi-center surveillance reported Beta-lactamase production in 36% of isolates of ________ | Hib |
| empiric therapy for Hib meningitis :(2) | 1) vancomycin + 3rd generation cephalosporin 2) Dexamethasone |
| Hib specific target therapy: if Beta lactamase negative: _____1_____ Beta lactamase positive: ____2______ | 1) Ampicillin 2) 3rd generation cephalosporin |
| _______ vaccine consists of a capsular polysaccharide covalently bound to a protein (varies with manufacturer) | Hib |
| capsular polysaccharide of Hib only stimulates ____1____ with no ____2____. Attachment to protein stimulates ____3____ response. Use of Hib vaccine has decreased the incidence of Hib meningitis by >_____4____% | 1) IgM 2) memory 3) IgG memory 4) 90 |
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