Bacterial Meningitis I
This is one of the defining aspects of bacterial meningitis (4 possible answers).
Inflammation of the meninges
Acute purulent infection within the subarachnoid space
Clinical evidence of meningeal signs
Abnormal CSF
This infectious agent is the more common etiology for children and young adults, primarily due to increased scenarios of crowding.
Neisseria meningitides
This is one of the defining characteristics of encephalitis. (3 possible answers)
inflammatory process of the brain
clinical evidence of parenchymal dysfunction
normal or abnormal exam
A 23-yo male presents to the ER with fever and delirium. His friend tells the ER physician that he hasn't been acting like himself and that he's been hallucinating. During the physical exam, he is noted to have weakness and uncoordinated movements on the right side. Based, on these findings and the presentation, the ER physician suspects this diagnosis.
Viral Encephalitis
Age: <5 or > 60 yo
Immunocompromised patients
Crowding (military recruits and college dorm residents)
Splenectomy and sickle cell disease
Alcoholism and cirrhosis
DM
Sinusitis, otitis
This is the classical triad of meningitis.
Fever, headache and meningismus
A 44-yo male presents to clinic with fever and weakness of the left side. During the patient interview, you also note the at the patient is not oriented to the setting. His wife helps by filling in most of the history telling you that he had the weakness of the left side as the earliest symptom, before eventually developing the fever and confusion. Concerned for viral encephalitis, the timeline of the patient's history tells you to test for this infectious agent.
West Nile Virus
Note: flaccid paralysis progressing to encephalitis
Transmission of poliovirus and coxsackieviruses
Fecal-Oral
Note: Person to person, Water borne, Insect vectors, Flies, Cockroaches
A 25-yo female presents to clinic with fever, headache, and nausea. During the interview, she tells you that she's also been experiencing muscle pain and weakness. In the physical exam, passive knee extension elicits pain, and you note non-blanching petechiae. Based on this presentation, you suspect this as the possible infectious agent for the patient's condition.
S. pneumoniae
Note: Adult, signs and ssx for general bacterial meningitis, non-blanching petechiae
A 3-wo male presents to clinic after having febrile seizures. His mother tells you that he's been very irritable and is not feeding well either. On physical exam, you note no other abnormal signs. Concerned for bacterial meningitis, you begin antimicrobial treatment that includes coverage of this organism.
Group B streptococcus
Note: 3-wo = neonate; Group B strep most likely
Others:
E. coli (K1 capsule type) – 25%
Listeria monocytogenes - 6-10%
S. pneumoniae (pneumococcus) - 10%
other organisms account for ~10% (GNRs, Group A Strep, H flu(NT)
A 36-yo female presents to clinic with low grade fever, headache, and muscle pain. In the interview, she notes going camping with her family 2 weeks ago. During the physical exam, you note a maculopapular rash on the the patients upper extremities and lymphadenopathy. Based on this presentation, you suspect this as viral genus.
Flavivirus
Note: This is West Nile Fever caused by West Nile Virus
A 27-yo male presents to clinic with concerns over a recent fever and headache. In the interview, he notes that his headache gets worse with exposure to light. When asked about any recent illness, he tells you he just got over a case of genital warts. Physical exam finds nuchal rigidity. Based on this presentation, you suspect this infectious agent as the causative agent.
HSV-1
Note: This is viral meningitis; genital warts clue to HSV-2 (generally more common with meningitis presentation).
A patient has a brain abscess with a well-formed necrotic center peripheral fibroblasts and neovascularity, indicating they are in this stage of the abscess development
Late cerebritis
Note:
You are treating a 25-yo patient with bacterial meningitis. They have fever, headaches, and a stiff neck. Prior CSF culture are positive for S. pneumoniae. In the patient's management, you decide to administer targeted antimicrobials and this drug, which is used to control the inflammatory response.
dexamethasone
A 26-yo female presents to ER with fever. You note that they also have decreased levels of consciousness. Her friend pulls you aside to tell you that she hasn't been acting like herself for the last few days. You order and MRI, which shows unilateral temporal lobe involvement. Based on these findings and imaging, you decide to initiate this as part of the patient's management.
Note: This is viral encephalitis caused by HSV-1
A 27-yo male presents to clinic with fever, headache, and malaise. He also notes that he's been having stomach issues recently. He tells you that in his spare time he likes to be outdoors and that he lives near a wooded area. Based on this history and presentation, you suspect this condition.
La Crosse Encephalitis
Note: This is a viral encephalitis. Ssx line up with diagnosis. Transmitted by mosquitoes, putting those in wooded areas at higher risks.
A 64-yo male presents to clinic with fever, headache, and sensitivity to light. While speaking with the patient, you find out they made the appointment due to experiencing a seizure a few days prior. You also notice that the upper and lower right face are drooped. Physical exam reveals spontaneous hip and knee flexion with flexion of the neck. At this point, you determine this is the next step in confirming the patient's diagnosis.
CT of the head
Note: This is bacterial meningitis
Age, seizure history, and facial palsy indications to get CT before doing an LP
Other Imaging:
MRI with contrast is the most sensitive neuro-imaging test to evaluate patients with encephalitis
CT with and without contrast if MRI is unavailable or cannot be performed
Electroencephalography (EEG) - identify patients with nonconvulsive seizure activity
You are treating a 34-yo female with fever, headache, and various focal neurological deficits. You also note neck stiffness and papilledema when completing their physical exam. You order a CT with contrast, which shows a hypodense lesion with surrounding enhancing ring and peripheral edema. Based on these findings, what diagnostic test should not be performed?
Lumbar puncture