Term
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Definition
| onset within hours to d ays , duration less than four weeks. |
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Term
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Definition
| greater than or equal to four weeks |
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Term
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Definition
| multiple acute episodes within four week peirod |
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Term
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Definition
| ifnlammation fo the meningnes , infeciton tohe subarachnoid space, exudate over psinal cord, and brain, csf with inflammatory changes (pleocystis) |
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Term
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Definition
| mechanical buffer/cushion. Maintains constant intracranial pressure, and posses some antibacterial properties. |
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Term
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Definition
| tight junctions mediated b y endothelial cells preent intercelular trnasport.b |
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Term
| CNS is immunollogically compromised |
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Definition
| facilliates growth of bacteria. |
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Term
| most common organisms cause ofm eningitis |
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Definition
| streptocuss pneumoniae (25-35 percent penicillin resisant, primary agent in adults and young children, leading cuase of bacterial meningitis after inluenza type B vaccine). Hib , G- enterics- E.coli and such more common I neonates. Listeria monocytogenes- elderly neotnatesi mmunocompromised. S. aureaus-uncommon. B. anthracis.s. N meningitiidis- most common in chidlren adolescent young adults, group b strep- most common in neonates |
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Term
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Definition
| highest incidenceo f menigitis, with less than 2 months highest inicidnece. If one person is diagnosed immprotant ot prophylax family membrs. |
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Term
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Definition
| S. pnuemonoeiae- winter, ne menintitids- year round. |
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Term
| prdisposing factors meningittis |
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Definition
| altered immune status (malnutrition steroid chemotherapy , complement deficiency, HIV) . Asplenia (cant clean out system)-funcitonal or congenital (i.e. sickle cell). Chronic disease (diabetes , alcoholism, hiv lvier disease). Bacteremia. Contigous focus of infection (near your CNS). Head trauma (csf leak), neurosurgery. Household/day care , military baracks, college dorms (N. Meningitidis). |
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Term
| pahotgeneiss of bacterial meningitis |
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Definition
| Hematogenous spread (most common). Can also be direct spread orextension- neighboring infection, posturgical ro cranial injury, or congenital malformation. Replciation of orgnaism in subepithelial tissue, hematogenoussperead, seeding of eninges via choroird plexus (max mixing with cns fluid with blood). Penetration of blood-rain barrier. Infflammatory response- brain edeman d increasedi tnracranial pressure, Brain ischemia. |
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Term
| meningitis pota lfo entry |
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Definition
| nasopharynx0 attachment of bacteria to mucosal epithelium( pili). Orognism then breeches host sdefences ( i.e. n meningitidis produced IgA protease.) |
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Term
| host defense mchenciams against mening |
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Definition
| host defense maehcanisms - cmlemetn emdiated antibody phacgotcyotsis, alternative comlmeent pathway, opsonoization. |
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Term
| deelopent of ifnamltory repsone menigtitidis |
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Definition
| cytokiens produced. Cells fo Cns injured by coytokiens and bacterial toxins- increased permeability of blood-brain barrier. Meninges gets inflamed, latering of CSF dynamics.- Brain edema, increased inctracraial ressure leading to reduced cerebral blood flow. -> thrombosis and vasculitis of cerebral blood vessels leading ot brain ischemeiaia and neronal injury. |
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Term
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Definition
| cyotkien release within csf (il-1 tnf in response_ to bacterial repication or lysis, enhanced binding of neutrophils to endothelial cells. |
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Term
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Definition
| cytokine stimulations causes relases of il-8 by vacualr endotheium-> neutorphile diapedis and entry int ocsf. |
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Term
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Definition
cyotkiens acitvate neturohils cauging degranulation, release of basocative lipid auacoids nad toxic oxxyegne metabolimtes,Impairment of blood-brain-barrier with leakage of
albumin into CSF . Increased permeability of blood-brain-barrier. Brain edema |
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Term
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Definition
| vasogeni c- dsruptino fo BBB and leakge of capilarry vessels, cyototixc edema- increaed itnracellualr lfuid secondary to injury, interstitial eddema- area between cells: exudate in arachnodi obstructs reasprop ofcsf |
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Term
| clinical charecetritis fo bacterial meningitis |
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Definition
| lfie thretening emergenc, acute and fulimainatn rpesneatiton common findings : fevern eck stiffnefss ,abnormal state of consciousness . Other findings asosciated with inflamed meningenes- nausie vomiting, confussion /irritbaility pain on neck flexion, brudzinki (flexion leadsto jerking knee) an d kernig (flexign hip and kneee and patient keels over) reflexes, photofobia and lethargy. INcreased intracranial presusre (bulging fontanelle in infants, adults= headaches0. Cerebral edema and sichemia, thrombosis of cerebral vessels, cortical necrosis-> coma ataxiasesirziures, cranil nerve palsis. |
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Term
| special features/clues of baacterial meningitis |
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Definition
| N. meningitits- associated wit petechiae and purpura. S. Pnuemoniae0 associated with respiratory ifnections (ear or sinus infection). Neonates- nonspecific findings. |
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Term
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Definition
| csf examination- look at pressure, appearance (should look like water), cell count (wbcs and rbcs). Chemistries (glucose and protein). Gram stain and bacterial culture). |
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Term
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Definition
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Term
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Definition
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Term
| csf findings in bacterial meining |
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Definition
| more than 500 wbc, normally Csf glucose is 60 percent of blood glucose, less than that is cause for concern. Also high protein (albumin from capilalary leakage). Traumatic spinal tap may cause increased CSF protein. Neonates normally haveh igher csf protein. |
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Term
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Definition
| cbc and fierential- wbcs up with increased bandforms. , also culture ( petechila scrapintgs, tympanocentesis in otitis media, sinuses). Radiology- CT scan of head prior to lumbar puncutres hwen foca l sgsn are present (weakness, seizures, tosee if other reasons for focal signs). |
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Term
| treamtent of bacterila menigtitis |
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Definition
| principels of antibiotic sleciton - recognizem ost likely organism , sleecet a regiment effecitvea gainst al llikley organisms start treatment promptly. Thereapeuticdoses aer higehr htan those for blood ifnection. Respiratory isolation for first 24 horus of therapy. steroids- for antiinflammatory effect and decreased edema (more effective for adults than children) , supportive care (hyration ventilationoxygen, seziureand fever control). Treat other sites of infectin and predisoposign condition. |
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Term
| empiric unknown treatment |
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Definition
| broadsp ectrum covverage- vancomycins and 3rd gen cephalosporin, can get specific when culture reuslts known. Infant0 ampiccilin plsu gent (bettter for strep which is more common). |
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Term
| bacterial menigitis prognosis |
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Definition
| age- mortaility much higheri n infants than adults (30 per cent in adults). Immune status-suppresed immue system do poorly. Organism and innoculum size. Resposne of csf strelization and focal signs.duration of illness prior ot therapy. |
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Term
| immediate complciatios of acterial meningitits |
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Definition
| death shock , seizures SIAdh, subdural effusion, absecesses, hemmorghage, infract, cavernous sinuses thrombosis. |
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Term
| temporary or permanent sequelae |
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Definition
| deafness, ataxia , hydrophealus, develompental delay, speech disorders, visual problems,mental retardation, paralsis, cerbral plasy, seaizures, cranial enrve deficits. |
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Term
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Definition
| one third of children have sequale at time of discharge |
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Term
| prevention of H influenzae B- bacterial meinnigitits |
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Definition
| immunization availble. Postexposure prophylaxis- rifampin. |
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Term
| N. mengititisdis prevention |
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Definition
| immunization available (miltiary recruits, high risk/immunocompromised, colelge freshmen, travelelrs to endemic areas, adolescents). Postexposuure prohylaxis- rifampin, ciprpoflorxacin, ceftriaxone. … |
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Term
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Definition
| Immunization available . NO POSTExpoSure proph |
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Term
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Definition
| no immunization or post exposure prophylaxis |
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Term
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Definition
| negative bacteriologic csf , most common cause is viral, more common than septic. They are seasonal (summer/early fall). Animal.insect vectors. |
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Term
| aseptic menigitis etiology |
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Definition
| Enterovirus (most common,e chovirus and coxsachie b). Herpes virusses (HSV2), varicella zoster, CMV, EBV). HSV2 is only treatable one. Arbovirus ( insect vector). Mumps, HIV, LCV (rodents carry it). Bcterial causes -partially treated acterial inection, Tuberculosis, bartonella, brain abscess (in brain not meninges, when get csf is from meningeal fluid). Parameningeal focus. Ricketsseae (rocky mountain spoted fever) , spirchoestes (spyhpillis, lyme, leptospirosis), mycoplasma . protoza (toxoplsma gonddi malaria, amoeba). Nematodes , fungi. |
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Term
| pathophys viral meningitis |
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Definition
| mucosal colonization. escape host defenses- mucocilliary clearance, phagocytosis, gstric inactivation (acids) , neturalization with antibody. Dissemination and invasion of CNS. Hematgeonous sprad, invasion of CNS BBB cells . Inflammator yresposne- not well understood, immuenspeicfic involving lympocytes , inflammatory resposne with cyotkien production. Alteration of oBB- itnroduciton of serum m proteins , locla immunoglubilin syntehsis. Eradicationfo infection- te cell function most imporatnt for clearance. |
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Term
| clinical characteristics viral emnigitis |
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Definition
| fever , ehadacheand stiff eck are prodrome (brief). Mostcases are mild (non-polio eeterovirus). Some are severae an d fatal (HSv). Changes in mental status suggest concurrent encephalititis ( infeciton of brian cells). Other signs syptoms: UR ysmptoms, myalgias/arthralgias, rashes. |
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Term
| diagnosis of viral mengititis |
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Definition
| lumbar puncture with csf labs- cel count, opening presusre, glucose/protein,culture , and stain, PCR, serology |
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Term
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Definition
| less than 1000 cells, mostly monocytes, glucos and protein are nromal, h20 p normal india ainik negative. Cx (?). |
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Term
| treatmetn of viral meningitis |
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Definition
| symptomatic treatment, antivirals not dindicated except ofrr hsv. Ma not require hospitilization. Antipyretics for fever control. |
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Term
| prognosis of viral menigtitis |
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Definition
| most occurwihtout sequallae… |
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Term
| Mprevention of viral meningitits |
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Definition
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Term
| s pneumonaie time of year |
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Definition
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Term
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Definition
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Term
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Definition
| purpulent exudate over brain/spinal cord, purulent exudate over ventricles, spinal nerve/root inflammation ( cranial nerve palsies), hydrocephalus, thrombosis/occlusion, (subarachnoid hemmorhage), ischemia and encrosis.of cerebral tissue. subdural effusion. |
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Term
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Definition
| paracellular passage:transcellular transport (active passive tranascytosis, invasion withi nwbcs during diaspedis |
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Term
| look at pathophysiology table bacterial meningitits |
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Definition
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Term
| pathology of bacterial menigitits |
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Definition
| purulent exudate over brain and pinal corde, and vetnricles. Spinal nerve/root ifnlammation. hydrocephalus. Thrombosis/occlusion of cerebral vessels. Subdural effusion |
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