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75 Cards in this Set

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infx of the CNS
meningitis, encephalitis, brain abscess
virchows robins spaces
perivscular spaces in the brain that contai lymphocytes and macrophages that help to protect
down side to brains on defenses?
doesn't allow for expansion when inflammatio occurs, and it hard to get help to the area (immune defenses and abx)
steps to meningitis?
mucosal colonization>blood stream invasion>BBB penetration>mult in CSF
common characteristics of meningitis?
neurotropism, encapsulation, IgA protease, pili
most common way for microbe to enter the brain?
hematogenous
types of hematogenous spread?
heavy bacterial load enters resp tract (strep, N men), bites, transplacentally
how do microbes cross the BBB?
strep pneumo/N men: loosen the tight junctions
H influ: endocytosis at jnct
Grp B strep: produce hyaluaronidase
what pathway is important to providing some defense once microbe is in brain?
alternate pathway
sickle cell and splenectomy can inhibit this
bacteria assoc with meningitis?
S pneumo, N menin, H influ
which bacteria is assoc with newborns vs adults vs elderly?
newborn: grp B, e coli, listeria
adults: s pneumo, N men
elderly: s pneumo, listeria
most common time in life for ppl to get meningitis? Why?
6 mo - 2 yrs because this is the time you are losing the fetal ab and gaining new ones
microbes of summer, fall, winter
summer: arbovirus
fall: enterovirus
winter: bacterial
characteristics of s pneumo?
gram +, diplococi, encapsulated, techoic acid (inflammation)
which antigenic type of H influ is most commonly linked to meningitis?
commonly found?
B
in URIs
virulence factors of H influ?
encapsulated, pili
carrier rates of N men?
serogrp typing?
high levels, nasopharynx (moist, high CO2)
ABC W135 Y
virulence factors of N men?
capsule, LPS (endotoxin), pili, IgA protease
Common viral pathogens of meningitis?
enterovirus (non-enveloped, 85-90% infants)
arbovirus: mosquito bite west nile>progress to encephalopathy in elderly
microbes associated with traumatic direct innoculation of meningits?
s pneumo (CSF fistula from sinuses)
e coli, kleibsiella, pseudomonas (penetration)
what causes inflammation in meningitis?
LPS ; H influ, N men
techoic acid: s pneumo
most common causes of brain abscess?
dental abscess, mild ear infection, sinusitis
common organisms in brain abscess?
organisms in immunocompromised?
s aureus, grp A strep. usually polymicrobial
crytococcus, toxoplasma
causes of encephalitis?
HSV, arbovirus, enterovirus
where does HSV lye dormant?
CN V, and infects frontal and mporal sinus
who does encephalitis commonly affect?
used to be kids but now its predominantly older adults
top 4 bacteria of meninigits?
s pneumo, N men, listeria, H influ
distinguishing causitive organisms?
s pneumo: pneumonia, splenectomy, head trauma,
N men: young adults, complement defect, prior viral URI
Listeria: elderly, immunocomp
grp B: neonates
classic triad of meningitis?
fever, mental status changes, meningeal irritation (nuccal rigidity, kerigs and brudzinski sign)
acute vs sunacute meningitis?
acute: sudden onset, 24 hrs, seizure, mental status changes, neuro signs
subacute: over 1-7 days
subacute lumbar puncture picture?
CSF cultures 80% +, gram stain 60-90% +, complete: protein and glucose exceed 40, WBC exceed 100
factors that will increase a risk herniation?
age, immuno-comp, CNS dz, seizure recently
slide 49***
???
if there is a risk of herniation what should you do?
check for papilledema, mental status changes, and focal deficits
if pt has acute presentation what should u do?
stat LP, or at least blood culture and treat empirically
treatment algorythm for menigitis?
slide 51
tx principles for meningitis?
dont delay, bacteriocidal, high concentration, IV
empiric IV tx of meningitis?
3rd gen cephalosporin add vanco for s pneumo resistance
use steroids if pneumococcal infx suspected NOT for N men
gram stain guided tx?
s pneumo: ceftriaxone + vanco (14 days)
H influ: ceftriaxone (7 days)
N men: penicillin G (7 days)
Listeria: ampicillin + gentamycin
hallmark of meningitis?
sepsis and rash
who should u suspect?
meningococcal prophylaxis?
young, hospital worker, close quart, late winter early sprng
within 14 days of prior contact
rifampin: every 12 hrs for 2 days
ciproflaxicon:once po
ceftriaxone: once im
who should have meningitis vaccine?
adolescents (age 11) with booster at 16
college freshmen and military recruits
55+ (use MPSV4)
at risk kids: comp deficiency and asplenia
aseptic meningitis
happens in summer, no bacteria on gram stain
enterovirus and arbovirus
encephalitis and meningitis overlapping themes?
inflammation, fever, A LOC, focal neuro findings
slide 63
???
3 esential steps for encepalitis?
brain MRI for all pt
acyclovir for anyone u suspect meningitis in
shift to specific tx once etiology known (etiology unknown in up 75% of pt)
where does endocarditis happen?
valves, chordae tendinae, endocardium, chamber walls
who is at risk of endocarditis?
IV drug users, ppl with replacement valves
which type of endocarditis is more common?
subacute: it is less virulent and attacks abnormal tissue, occurs in >6 weeks
tricuspid valve is usually infected by which organism?
staph aureus
organisms of endocarditis?
strep viridans (dental work)
enterococcus feacalis (GI/GU maniplation)
other organisms?
staph epidermidis, strep pneumo
native valve vs prosthetic valve microbes?
N: strep viridans, pneumo, staph aureus
Pros: staph aureas and epidermidis
2 most commonly effected valves?
Mitral and aortic
if bacterial release is transient what does that mean?
your going to need multiple cultures from multiple sites
venturi effect?
how bacteria takes hold in high flow areas, there is generally a low flow to the sides
body protection turned bad?
platelet and fibrin mesh that may normally help other infections give the bacteria a place to hide from other defenses of the host. can lie dormant and then break off causing infection in other areas. Techoic acid (entero) and FimA (strep viridans) help with the attachment
what can strep produce that allows it to attach?
dextran, mostly strep mutans
which organisms produce fibronectin?
staph aureus, enterococcus, strep
allows for attachment to fibrin
what factors help microbe resistant complement cascade?
capsules (strep p) and sialic acid
what causes constitutional symptoms and valvular dysfunction in endocarditis?
cytokines
infx of the valve
25 -35% of endocarditis pts have these and 45-65% of them die from it?
emboli
mitral vs tricuspid down stream problems?
m: kidney and vital organs
t: pneumonia, lung abscess
immune complex found on hands in endocardtis?
osler nodes and janeway lesions
infective endocarditis occurence in?
rheumatic fever (uncommon), increased age, pros valves, IV drug use
two most common causes of native valve endo?
prosthetic valves?
strep viridans and staphaureas
staph aureas, staph epider
what does the clincal picture result from in endocarditis?
infectious process on valves, septic emboli, bacteremia, circulating immune complex
clinical finding in subacute bacterial endo?
insidious onset of constitutional symptoms
murmurs
bacteremia
ocular findings
splenic and renal manifestations
clinical picture in acute bacterial endo?
abrupt onset, high fever, rigors prominent cutaneous symptoms
Dx testing for endo?
3 cultures over 24 hrs
TEE
Tx for various causes?
strep: penicillin G + gentamycin for 2 weeks
entero: same as above 4-6 weeks
staph: nafcillin, vanco if mrsa
HACEK: ceftriaxone
if abx not working?
surgical debridment
which pt might expect abx but u won't give them it?
mitral valve prolapse, rheumatic hrt dz, bicuspid valve, aortic stenosis, congenital hrt condition
events increasing risk of endo?
dental procedure, resp procedure
prophylaxis
amoxicllin 2g PO 1 hr prior to dental procedure