Neuro - Dugan - Bacterial Infections Ii

Front 1

What are the acute findings of bacterial meningitis?

Back 1

Abrupt onset fever, severe H, stiff neck, photophobia

Rash (purpura) = Neisseria meningititis, N, V

Severe = impaired consciousness, delirium, seizures, or other neurological symptoms

Front 2

How do organisms enter to cause meningitis?

Back 2

Enters blood stream via mucous membranes of oropharynx --> Penetrate BBB at choroid plexus --> inflamm on blood side --> spillage into CNS

Front 3

A microbial load above what indicates pathological meningitis?

Back 3

> 10 ^5

Front 4

Why are microbes more able to exist in CSF than blood?

Back 4

CSF = less host defenses - low complement and Abs = reduced phagocytosis

Front 5

Where does N. meningititis enter CSF?

Back 5

At capillaries that make CSF

Front 6

What are the clinical symptoms of meningitis due to?

Back 6

inflammatory response to meningeal invasion

Pus in sub-arachnoid space may spread over surface of brain, cerebellum, spinal cord --> becomes thick --> blocks foramina and inc CSF pressure --> H and N

Front 7

What causes the severe disease seen with meningitis infection?

Back 7

Neurological deficits caused by dec. in cerebral cortical blood flow

Front 8

Define Waterhous-Friderichsen Syndrome

Back 8

A Gangrenous condition

Front 9

A native American without easy access to medical care unfortunately dies from a bacterial meningitis infection that could have been easily treated. What does the pathologist see when he sections the brain of this pt?

Back 9

Yellow-tan exudate of acute bacterial meningitis - obscures sulci

Maybe some transtentorial hernaition

Front 10

Pt has an acute decline in consciousness caused by seizures and a big head because their name is (insert any Fox News caster here). They are started on Abx but fail to improve. Whats your next move?

Back 10

Image because those are the indications for doing so (decline in consciousness presumably caused by seizures and acute hydrocephalus ie big head...and Failure to improve after attempting treatment with Abx

Front 11

A pt comes in with Limb drift and say they see yellow unicorns in their upper left visual field of view. They can't quite say unicorn, however, and it comes out sounding like "uni-brow". What do you do

Back 11

FIRST = initiate Abx.

Abnormal sensorium, limb drift, Aphrasia and Abnormal visual fields all are symptoms characteristic of a decline in consciousness and this pt needs to be imaged for possible acute meningitis

Front 12

When we take CSF specimen for meninigtis, what do we do with tubes 1, 2, and 3, subsequently?

Back 12

1 = chemical analysis
2 = gram stain and culture
3 = cell count (least contaminated)

Front 13

Whats the defining feature of a bacterial meningitis?

Back 13

inc cell count, esp PMNs

Front 14

Why is glu low in bacterial meningitis CSF samples?

Back 14

bacteria use it up (note: its also low in Tuberculous and Fungal meningitis)

Front 15

We can use antigen detection to detect what types of bacterial meningitis?

Back 15

Strep pneumo, N. meningitidis, H. influ, Group B strep, E. coli

- can substitute methylene blue or acridine orange for gram stain for spinal tap

Front 16

Just know these pics

Back 16

Front 17

What antibody opsonizes immunoglobulin?

Back 17

IgG2 immunoglobulin on polysaccharide capsule

Front 18

When does IgG2 immunoglobulin on the polysaccharide capsule of many bacteria that cause meningitis pass the placenta?

Back 18

Only during the last stages of gestation

Front 19

Whats the empiric tx for Bacterial meningitis?

Back 19

Vancomycin + Ceftaxime or Ceftriaxone + Dexamethazone

Once etiological agent determined, adjust therapy

Front 20

T/F: The antibiotics does not need to penetrate the BBB to have an effect on the meningitis infection

Back 20

FALSE - it must penetrate BBB

Front 21

A pt with a meningitis infection wants to know how she can protect her 4 and 6 year old kids from the infection. What drug can be used prophylactically in her kids?

Back 21

Rifampin

Front 22

What are each of the following vaccinated with?

Young kids, Young adult, elderly

Back 22

Young kids = conjugate Hib, 7 valent S. pneumo, and N. meningitidis
Young Adult = Conjugate vaccine with N. meningitidis and W135 polysaccharide vaccine when entering military or college
Elderly = S. pneumo (Pneumovax)

Front 23

****TEST questions: Whats the difference between Polysaccharide (= T cell independent) and Conjugate (=T cell dependent) vaccine?

Back 23

Conjugate is conjugated to a strong immunogenic protein that causes it to be picked up by antigen presenting cell = presents it to TH2 cell = undergoes activation - releases interleukins and chemokines

SO ANSWER IS: Presents it to B cells --> produces MEMORY B Cells

Produces a better IgG = stronger and binds better

Front 24

Whats the most important characteristic between these two features of conjugate vaccines (=T cell dependent)?

Presents it to B cells --> produces MEMORY B Cells

Produces a better IgG = stronger and binds better

Back 24

Produces a better IgG

Front 25

Just to beat this to the ground re-state the characteristic of T cell-dependent Ab production (ie conjugate)

Back 25

Protein Ag
IgG high affinity
Adequate memory

(T cell independent = Polysaccharide Ag, IgM Ab, Lack of memory response, Little boosting achieved)

Front 26

What bacterial diseases can manifest as chronic meningitis?

Back 26

Tuberculosis, Syphilis, Lyme disease, Cryptococcosis, Coccidiomycosis, Histoplasmosis

Front 27

What causes Tuberculosis meningitis and how does it occur?

Back 27

Rupture of superficial infective focus in subarachnoid space --> mycobacterium tuberculosis infection --> ocular palsies (50% of cases)

Front 28

What causes Syphilis meningitis?

Back 28

Treponema pallidum

Front 29

Lymphocytic pleocytosis in CSF. Dx?

Back 29

Tuberculosis meningitis

Front 30

VDRL (=Venereal disease research lab test) on CSF is positive, so you confirm with an FTA. Dx?

Back 30

Syphilis meningitis

Front 31

What causes Lyme meningitis?

Back 31

Borrelia Burgdorferi

Front 32

Whats a major clue you have been infected with Borrelia burgdorferi that caused your meningitis?

Back 32

Multiple erythema migrans

Neurological symptoms in 1/3 of untreated cases

Front 33

Lab for Borrelia burgdorferi meningitis?

Back 33

>80% mononuclear cells, H > 5 days, cranial neuritis = cranial nerve palsy or neuritis

Front 34

Pt presents with erythema migrans and Lab results for a pt show 85% mononuclear cells. Tx?

Back 34

Think Borrelia burgdorferi. Tx = Ceftriaxone

Front 35

***TEST Define Brain Abcess

Back 35

A focal infection of brain parenchyma that causes specific focal deficits

Contiguous infection of (paranasal sinuses, middle ear, or mastoids) frequently caused by mixed facultative and anaerobic bact.

Front 36

How does a brain abcess often present?

Back 36

Usually starts as a septic emboli, trauma or surgery case where staph a. spreads hematogenously

Front 37

How do we Dx brain abcess caused by staph a.?

Back 37

CT or MRI

Note - this is prob the test question - DO NOT DO A LUMBAR PUNCTURE - its contraindicated.

Front 38

Pt post-Sx comes in with brain abcess which you know b/c you're not a dummy and did a CT then MRI to confirm (NOT a lumbar puncture). How do you tx this pt?

Back 38

Drain abcess and give approproate Abx

Front 39

A pt has an amoeba which is eating her brain. (ie primary amoebic meningoencephalitis) What stages infected her?

Back 39

Naegleria fowleri Flagellated or trophozoite can both enter nose and penetrate nasal mucosa, migrating to brain via olefactory n.

Front 40

A female preggo is bitten by a pig, mouse, sheep, and her cat crapped on her pillow which she didn't wash. What stage of the infective organism does it change into once it has infected her with the cyst form?

Back 40

Think Toxoplasma --> Cyst infects then transforms into Tachyzoites