Term
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Definition
| acute purulent infection within the subarachnoid space; associated with a CNS inflammatory rxn that may result in decreased consciousness, seizures, raised intracranial pressure, and stroke. The meninges, subarachnoid space and brain parenchyma are all involved in the inflammatory reaction - meningoencephalitis. |
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Term
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Definition
1. H. influezae meningitis declined precipitously following the introduction of the Hib vaccine in 1987; now accounts for <10% of cases
2. Cephalosporin and penicillin resistant strains are emerging. |
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Term
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Definition
(within 72 hours of birth)
1. E. coli
2. Group B Strep
3. Listeria monocytogenes |
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Term
| pathogens in infants less than 6 months |
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Definition
1. E. coli
2. Group B Strep
3. Streptococcus pneumoniae |
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Term
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Definition
1. streptococcus pneumoniae
2. neisseria meningitidis |
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Term
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Definition
| 1. neisseria meningitidis 2. streptococcus pneumoniae |
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Term
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Definition
1. streptococcus pneumoniae
2. neisseria meningitidis |
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Term
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Definition
1. streptococcus pneumoniae
2. group B streptococcus
3. listeria monocytogenes |
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Term
| Pathophysiology of Meningitis (5 steps) |
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Definition
1. colonization of nasopharynx
2. bacteria are transported across epithelial cells
3. bloodstream access
4. intraventricular choroid plexus
5. entry into CSF |
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Term
| pathophysiology within CSF |
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Definition
1. Bacteria rapidly multiply within CSF due to decreased WBCs, complement, and Igs
2. protein concentration and leukocytosis increase |
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Term
| role of cytokines and chemokines |
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Definition
1. TNF and IL-1 appear in the CSF within 1-2hr of intracisternal inoculation of LPS
2. increase the permeability of the blood-brain barrier
3. exudate and proteins decrease the resorptive capacity of the arachnoid granulations leading to obstructive and communicating hydrocephalus
4. increased expression of selectins
5. neutrophil degranulation results in the release of toxic metabolites that contribute to cytotoxic edema, cell injury, and death |
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Term
| cerebrovascular complications |
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Definition
1. narrowing of the large arteries at the base of the brain due to infiltration of the arterial wall by inflammatory cells with intimal thickening (vasculitis)
2. thrombosis of the major cerebral venous sinuses, and thrombophlebitis of the cerebral cortical vein
3. combination of interstitial, vasogenic, and cytotoxic edema leads to raised ICP and coma
4. cerebral edema, focal or generalized, can lead to cerebral herniation |
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Term
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Definition
H. influenzae: 6%
N. meningitidis 10%
Pneumococcus 25%
*mortality 100% without anitbiotics |
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Term
| classic triad clinical presentation |
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Definition
1. fever
2. headache
3. altered mental status
4. stiff neck |
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Term
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Definition
fever, confusion, headache, nuchal rigidity
-symptoms may not be present |
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Term
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Definition
(Knee)
patient lying supine and hips and knees flexed 90degrees
positive sign is present when extension of the knee from this position elicits resistance or pain in the lower back or posterior thigh |
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Term
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Definition
| passive neck flexion in a supine patient results in flexion of the knees and hips |
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Term
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Definition
| lumbar puncture required! |
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Term
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Definition
1. herniation
2. nerve injury
3. bleeding
4. infection |
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Term
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Definition
1. unilateral findings on PE
2. papilledema |
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Term
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Definition
1. low glucose (<40mg/dl or 0.5 CSF/serum ratio)
2. elevated protein (100-500)
.3 neutrophilic pleocytosis (>100wbc/hpf with >90% neutrophils)
4. positive gram stain |
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Term
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Definition
1. bacterial meningitis
2. viral meningitis/encephalitis
3. fungal meningitis
4. brain abscess
5. parameningeal focus |
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Term
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Definition
1. concentration of vancomycin in CSF is decreased by dexamethasone therapy
2. study did not have any cases of penicillin-resistant pneumococcus
3. as rates of PRSP increase, the advantage of steroid may decrease |
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Term
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Definition
1. hypotension, altered mental status, seizures
2. delay in therapy after arrival in the ED was associated with adverse clinical outcome when the patient's condition advanced to the highest stage of prognostic severity before the initial antibiotic dose was given. |
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Term
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Definition
1. vaccine
2. chemoprophylaxis |
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Term
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Definition
1. causes sporadic disease
2. leading cause of meningitis in young adults
3. high case-fatality ratio
4. epidemic killer world-wide associated with specific capsular polysaccharide types A, B, C, and Y
5. epidemics occur every 8-14 yrs in meningitis belt - subsaharan africa |
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Term
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Definition
1. results when virulent organisms invade the blood stream
2. ranges from low-level meningococcemia to fulminating sepsis
3. high fever, arthralgia, small vessel blockage
4. rash, petichiae
5. dusky red blotches - purpura fulminans
6. hemorrhage and necrosis
7. destruction of adrenal glands (waterhouse-friderichsen syndrome) |
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Term
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Definition
1. begins suddenly with severe headache, high fever
2. progressive stiffness of the neck, back , and shoulders
3. photophobia may be present
4. petechiae and purpura are sometimes present |
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Term
| meningococcal virulence factors |
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Definition
1. LOS
2. Peptidoglycan fragments (PGF)
3. pili (fimbriae)
4. IgA protease - cleaves human IgA
5. polysaccharide capsule - blocks phagocytosis, group B capsule is sialic acid |
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Term
| Treatment of Meningococcal meningitis |
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Definition
1. medical emergency
2. treat with high dose ceftriaxone or penicillin
3. increased incidence in terminal complement deficiency patients (C6-9) |
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Term
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Definition
1. new protein conjugated capsular vaccine with Group A, C, Y and W135 polysaccharide
2. long lasting immunity compared to the polysaccharide vaccine
3. initial concern with GBS, no association |
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Term
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Definition
1. gram positive rod
2. more frequently seen in immunocompromised patients
3. high frequency of disseminated infections in pregnancy
4. seen in neonates, elderly, immunocompromised
5. causes meningoencephalitis
6. tumbling motility, requires pasteurization, can multiply at 4degrees, associated with milk products
7. consider in T-cell immune deficiency (transplants and lymphomas) |
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