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35 Cards in this Set

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Signs of Acute Bacterial Meningitis
CSF
Fever, headache, irritability, stiff neck, convulsions, drowsiness, coma
CSF: gram stain and/or bacteria culture usually positive UNLESS pt treated w/ antibiotics prior to eval
Meningitis definition
inflammation of the meninges of the brain or spinal cord, infection located within the subarachnoid space
CSF
Acute, Recurring, and Chronic
Encephalitis definition
inflammation of the brain
Myelitis definition
inflammation of the spinal cord
Brain abscess definition
focal intrcranial infection in the brain
Develops into a collection of pus surrounded by capsule
Subdural empyema definition
infection between dura mater and arachnoid
Epidural abscess definition
localized infection between the dura mater and the overlying skull or vertebral column
Routes of Infection of the CNS
Hemtogenous spread with most infectious agents From extracranial foci or by retrograde propagation of infected thrombi within emissary veins
Neurotropic spread in the case of some viruses (herpes simplex and rabies)
Spread of organisms through bone
Injury - traumatic inoculation of extradural bacteria
Surgury - shunts etc
congenital problems
Otitis - by extension
Sinusitis - by extension
Haemophilus influenzae ID & route of transmission
gram -, pleomorphic bacilli
spread via aerosol, some have polysacch capsule, req. factor X (hemin) & V (NAD/NADPH) on choco agar for growth
Haemophilus influenzae disease
meningitis: 1/3 survivors have deafness
Haemophilus influenzae predisposing factors & menigitis spread
pharyngitis, otitis media, usually hematogenous spread
Nasopharyngeal carriers = high incidence of meningitis, non-type B
Haemophilus influenzae prophylaxis
Immunize w/ Hib conjugate at 2 months old
Haemophilus influenzae strains
type B capsule = disease
nasopharyngeal = common non-B type, (high incid of menigitis)
encapsulated = more virulent (non-encapsulated now dominates c/o immu)
Common bacterial meningitis species
H. influenzae > N. meningitidis > S. pneumonia > S. agalactiae > L. monocytogenes > other/unknown
Streptococcus pneumoniae ID
Gram + diplococcus, α-hemolytic (green color), Optichin positive, pili
Streptococcus pneumoniae virulence
& pathogenesis
antiphagocytic capsule, pili (attachment), cross endothelial via receptor
#1 c/o meningitis in adults
complication of bacteremia, pneumonia, mastoiditis, endocarditis, sinusitis, OR head wound
#1 c/o meningitis in adults
Streptococcus pneumoniae
Neisseria meningitidis ID
Gram - diplococcus, oxidase positive, Opa (opaque protein - opaque if present)
Ferments glucose & maltose
Grow on blood or choco agar (not fastidious) (need Thayer-Martin Selective agar to exclude other species - grows only Neisseria)
Neisseria meningitidis transmission
virulence/pathogenicity
Respiratory transmission - overcrowing (winter/early spring epidemics, military)
Virulence: 1) Antiphagocytic capusle - invasive (13serotypes)
2) pili (mucosal attachment)
3) Opa (downregulated during invasive growth)
4) LOS (coat selves w/ host sialic acid attached to galactose on LOS)
Neisseria meningitidis growth
V-C-N inhibitor: (Vanco, colistin, nystatin) use to grow only N. meningitidis
V-C-N-T: (Same but w/ trimethoprim) for better recovery/growth of Neisseria
Listeria monocytogenes
Gram + motile rod, food borne
death in fetus & maternal in pregnant or immunocompromised
Strep agalactiae classification
found where
GBS, in vagina of some women
Strep agalactiae disease
mengitis, pneumonia, sepsis in newborn
Aerobic Gram - bacilli
E. coli (esp. K-1) - rod from perineal flor of mother
Klebsiella spp
serratia marcescens
pseudomonas aeruginosa
Salmonella
Conditions predisposing to bacterial meningitis
head trauma, neurosurgery, neonate, elderly, immunocompromised
Staph causing meningitis
predisposing factors
Staph aureus
staph epidermidis
factors: neurosurgery, CSF shunts, head trauma, sinusitis, pneumonia
Chronic meningitis definition
frequency
Neuro signs/symptoms persist and CSF abnormal for 4 weeks
rarer than acute meningitis
Chronic meningitis causes
m. tuberculosis, brucellosis, syphilis, Lyme disease
Brain abcess definition
spread
focal infxn of brain itself
spread from contiguous source (otitis media, mastoiditis, sinusitis, dental, trauma)
less commonly from distant site (hematogenous or heart or lung)
Brain abcess etiology
Aerobic/anaerobic/microaerophilic strep
Bacteroides
Aerobic cocci (staph aureus)
gram - RARE
Toxoplasma gondii (esp. in HIV +)
Intracranial Epidural abcess definition
lesion creating space btwn dura mater & skull (must peel dura from skull)
Intracranial Subdural empyema definition
infxn btwn dura mater & arachnoid mater
Etiology/bugs of intracranial abcess/empyema
staph aureus, anaerobes, gram -, H influenzae (extension of meningitis)
Paranasal sinus source in >50% cases
middle ear/mastoid in 10-20% cases
can follow truama, surgery, pre-existing subdural hematoma
Spinal subdural empyema definition
epidural abcess spread/etiology
actual space in spine (epidural space) - infxn spread unimpeded
source from osteomyelitis or paravertebral infxn, hematogenous spread
Etiology/bugs of spinal abcess/empyema
staph aureus, anaerobic or anaerobic strep, gram - bacilli
spread from distant source of sepsis