bectrial Meningitis
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Questions and Answers

Which of the following is the most common route for bacteria to enter the cerebrospinal fluid (CSF), leading to meningitis?

  • Spread from an adjacent focus of infection, such as sinusitis or mastoiditis
  • Haematogenous spread from the nasopharynx or another infection site (correct)
  • Spread via a bony defect caused by head injury
  • Direct entry through the cribriform plate

    • Which of the following infections involves inflammation of the meninges?

  • Encephalitis
  • Meningitis (correct)
  • Mastoiditis
  • Sinusitis

    • Post-traumatic meningitis is commonly associated with which of the following?

  • Haematogenous spread from the nasopharynx
  • Fractures and persistent CSF leaks (correct)
  • Chronic sinusitis
  • Direct spread through mastoiditis

    • Which anatomical structure is occasionally implicated in bacterial entry into the CSF due to its proximity to the nasopharynx?

    <p>Cribriform plate</p> Signup and view all the answers

    Which of the following is not a common adjacent focus of infection leading to meningitis?

    <p>Otitis externa</p> Signup and view all the answers

    Inflammation of the brain parenchyma is referred to as:

    <p>Encephalitis</p> Signup and view all the answers

    Which of the following pathogens is a common cause of meningitis across all age groups?

    <p>Neisseria meningitidis</p> Signup and view all the answers

    Which organism is a frequent cause of neonatal meningitis?

    <p>Group B streptococcus (GBS)</p> Signup and view all the answers

    In elderly patients, which of the following is a typical pathogen responsible for meningitis?

    <p>Streptococcus pneumoniae</p> Signup and view all the answers

    Listeria monocytogenes is a notable cause of meningitis in:

    <p>Neonates and the elderly</p> Signup and view all the answers

    Which of the following host factors increases the risk of severe infections caused by encapsulated bacteria like Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis?

    <p>Asplenia</p> Signup and view all the answers

    Listeria monocytogenes meningitis is more likely to occur in individuals with: A) Diabetes mellitus B) Fractures or bony defects of the skull C) Altered cell-mediated immunity D) Inherited defects in late complement components

    <p>Altered cell-mediated immunity</p> Signup and view all the answers

    Recurrent invasive Neisseria meningitidis infections are commonly associated with:

    <p>Inherited defects in the late complement components</p> Signup and view all the answers

    Which of the following factors specifically increases the risk of meningitis caused by Streptococcus pneumoniae? A) Pregnancy, B) Alcohol abuse, C) Functional asplenia, D) Fracture or bony defect of the skull

    <p>Fracture or bony defect of the skull</p> Signup and view all the answers

    Pregnancy increases the risk of invasive meningitis due to which pathogen?

    <p>Listeria monocytogenes</p> Signup and view all the answers

    Which of the following is not considered a risk factor for bacterial meningitis? A) Living in a communal setting, such as a college dormitory B) Recent history of respiratory infection C) Use of immunosuppressant drugs D) Vaccination against Hib and MenACWY

    <p>Vaccination against Hib and MenACWY</p> Signup and view all the answers

    Pregnancy increases the risk of bacterial meningitis due to which pathogen if exposed through contaminated food?

    <p>Listeria monocytogenes</p> Signup and view all the answers

    Which of the following travel-related activities increases the risk of bacterial meningitis? (Select all that apply)

    <p>All of the above</p> Signup and view all the answers

    Which of the following conditions increases susceptibility to bacterial meningitis caused by encapsulated organisms such as Streptococcus pneumoniae and Neisseria meningitidis?

    <p>All of the above</p> Signup and view all the answers

    Which of the following best describes Haemophilus influenzae type b (Hib)? A) A zoonosis transmitted via contact with infected animals B) A historical major cause of childhood meningitis and epiglottitis, now reduced by vaccination C) Primarily acquired through ingestion of contaminated food D) Commonly seen in high-resource healthcare systems

    <p>A historical major cause of childhood meningitis and epiglottitis, now reduced by vaccination</p> Signup and view all the answers

    Listeria monocytogenes meningitis is most likely to occur in:

    <p>Pregnant women and neonates</p> Signup and view all the answers

    How is Listeria monocytogenes primarily acquired?

    <p>Ingestion of contaminated meat, vegetables, or dairy products</p> Signup and view all the answers

    What is the mortality rate of Hib meningitis if left untreated?

    <p>Up to 90%</p> Signup and view all the answers

    Which of the following is not a complication associated with Hib meningitis?

    <p>Chronic arthritis</p> Signup and view all the answers

    Which of the following groups are at increased risk of Listeria monocytogenes infection?

    <p>All of the above</p> Signup and view all the answers

    What are the common environmental sources of Cryptococcus neoformans?

    <p>Soil, bird droppings, and rotting vegetation</p> Signup and view all the answers

    Cryptococcus neoformans meningitis is most commonly seen in patients with:

    <p>HIV infection and other immunocompromised states</p> Signup and view all the answers

    The symptoms of Cryptococcus neoformans meningitis usually develop: A) Within hours, similar to acute bacterial meningitis B) Gradually over days to weeks, with headache as the predominant symptom C) Sudden onset of fever and confusion D) With a rapid onset of neck stiffness and seizures

    <p>Gradually over days to weeks, with headache as the predominant symptom</p> Signup and view all the answers

    Which of the following is a distinguishing feature of Mycobacterium tuberculosis meningitis compared to acute bacterial meningitis?

    <p>Symptoms that develop gradually over weeks</p> Signup and view all the answers

    Mycobacterium tuberculosis meningitis is most difficult to diagnose because:

    <p>CSF TB culture may be negative</p> Signup and view all the answers

    Which of the following groups is at higher risk for Mycobacterium tuberculosis meningitis? A) Individuals living in high-income countries B) Those with malnutrition and immunocompromised individuals C) People with a recent history of head trauma D) Healthy young adults

    <p>Those with malnutrition and immunocompromised individuals</p> Signup and view all the answers

    Which of the following is Leptospira interrogans primarily considered? A) A bacterial pathogen primarily affecting the respiratory system B) A zoonosis that can cause meningitis C) A fungal pathogen causing meningitis in immunocompromised individuals D) A viral pathogen causing encephalitis in children

    <p>A zoonosis that can cause meningitis</p> Signup and view all the answers

    Which of the following clinical features is typically associated with Leptospira interrogans infection and meningitis?

    <p>Lymphocytic pattern in CSF</p> Signup and view all the answers

    Which occupation or activity is a potential risk factor for Leptospira interrogans infection?

    <p>Water sports such as kayaking</p> Signup and view all the answers

    Which of the following is a clinical clue that may suggest Leptospira interrogans infection, especially in the context of meningitis?

    <p>Jaundice</p> Signup and view all the answers

    When considering a diagnosis of Leptospira interrogans meningitis, which of the following should also be considered if present?

    <p>Renal or hepatic failure</p> Signup and view all the answers

    Which of the following is a common symptom of meningitis in infants?

    <p>Tense, bulging fontanelle (soft spot)</p> Signup and view all the answers

    Which of the following symptoms is often seen in older children and adults with meningitis?

    <p>Phonophobia and photophobia</p> Signup and view all the answers

    Which of the following clinical features suggests a systemic manifestation of meningitis, particularly in the case of meningococcal infection?

    <p>Petechiae and rash</p> Signup and view all the answers

    A patient with meningitis presents with a stiff neck and discomfort with bright lights. These symptoms are most commonly associated with which part of the body? A) Ears B) Eyes C) Neck D) Trunk

    <p>Neck</p> Signup and view all the answers

    Which of the following is not typically associated with older children and adults presenting with meningitis?

    <p>Unusual cry and moaning</p> Signup and view all the answers

    Which of the following symptoms is a significant warning sign of meningitis that could indicate the need for urgent medical attention?

    <p>Convulsions or seizures</p> Signup and view all the answers

    Which of the following describes the Kernig sign in meningitis? A) Involuntary flexion of the legs when the neck is flexed B) Flexion of the leg at the hip with pain on extension of the leg C) Non-blanching, purpuric rash D) Fever and cold hands and feet

    <p>Flexion of the leg at the hip with pain on extension of the leg</p> Signup and view all the answers

    Which of the following describes the Brudzinski sign in meningitis?

    <p>Involuntary flexion of the legs when the neck is placed in flexion</p> Signup and view all the answers

    A non-blanching, purpuric rash is commonly associated with which of the following conditions?

    <p>Meningococcal sepsis</p> Signup and view all the answers

    Which of the following best defines sepsis?

    <p>An infection that triggers a host response leading to organ dysfunction</p> Signup and view all the answers

    Which of the following is a central nervous system (CNS) complication of bacterial meningitis?

    <p>Hearing loss</p> Signup and view all the answers

    Which of the following complications is related to increased intracranial pressure due to bacterial meningitis?

    <p>Hydrocephalus</p> Signup and view all the answers

    A patient with bacterial meningitis presents with cranial nerve palsies. Which of the following could be a possible complication?

    <p>Both B and C</p> Signup and view all the answers

    Which of the following is a potential outside the CNS complication of bacterial meningitis?

    <p>Septic shock</p> Signup and view all the answers

    A complication of bacterial meningitis that leads to septic shock is most commonly associated with which of the following?

    <p>Bloodstream infection (BSI)</p> Signup and view all the answers

    Which of the following is the mainstay for diagnosing meningitis? A) Blood cultures B) Radiology C) Clinical assessment D) Lumbar puncture (LP)

    <p>Lumbar puncture (LP)</p> Signup and view all the answers

    Which of the following is used to confirm the clinical impression of meningitis?

    <p>Lumbar puncture (LP), blood cultures, and PCR</p> Signup and view all the answers

    Which of the following radiological indications may warrant imaging in suspected bacterial meningitis?

    <p>If there is concern over the safety of performing a lumbar puncture</p> Signup and view all the answers

    Why is imaging not routinely used to diagnose bacterial meningitis? A) It is more effective than lumbar puncture B) Findings are not sensitive or specific C) It can confirm the type of bacterial infection D) It is necessary for identifying complications like meningococcal infection

    <p>Findings are not sensitive or specific</p> Signup and view all the answers

    When should radiology be used in cases of bacterial meningitis? (Select one)

    <p>To assess for complications like abscess or ventriculitis</p> Signup and view all the answers

    When is a CT brain typically indicated in a suspected case of bacterial meningitis?

    <p>Only when there is concern about the safety of performing a lumbar puncture</p> Signup and view all the answers

    Which of the following is NOT a contraindication for performing a lumbar puncture (LP)?

    <p>Normal macroscopic appearance of CSF</p> Signup and view all the answers

    What is the ideal appearance of cerebrospinal fluid (CSF) when there is no infection present?

    <p>Clear and colorless</p> Signup and view all the answers

    What should be done if a CT brain is indicated in a suspected case of bacterial meningitis?

    <p>Blood cultures should be taken, and empiric antimicrobials should be started immediately</p> Signup and view all the answers

    What happens if empiric antimicrobials are started before a lumbar puncture (LP) in suspected bacterial meningitis?

    <p>It reduces the likelihood of culturing the causative microorganism from the CSF</p> Signup and view all the answers

    Which laboratory test is most commonly used to quickly identify the causative organism in bacterial meningitis?

    <p>CSF Gram stain</p> Signup and view all the answers

    What is the expected white blood cell (WCC) count in bacterial meningitis?

    <p>Raised WCC with a predominance of polymorphs</p> Signup and view all the answers

    In viral meningitis, what is typically observed in the cerebrospinal fluid (CSF)?

    <p>Raised WCC with predominantly lymphocytes</p> Signup and view all the answers

    What is the key feature of CSF in tuberculous meningitis (TB meningitis)?

    <p>Low glucose levels with raised WCC and predominantly lymphocytes</p> Signup and view all the answers

    Which laboratory technique is used to identify Mycobacterium tuberculosis (TB) in CSF for TB meningitis?

    <p>Ziehl-Neelsen (ZN) or auramine stain for acid-fast bacilli (AFB)</p> Signup and view all the answers

    Which of the following statements is TRUE regarding PCR testing in meningitis diagnosis?

    <p>PCR is used to detect specific pathogens directly from blood and CSF</p> Signup and view all the answers

    Why is it important to take a blood culture in patients with suspected bacterial meningitis?

    <p>To check for potential bloodstream infections and identify the causative organism</p> Signup and view all the answers

    Why might organisms fail to grow from CSF in some cases of bacterial meningitis?

    <p>The blood culture is often more sensitive and can grow the organism when CSF does not</p> Signup and view all the answers

    What is the role of PCR in diagnosing bacterial meningitis?

    <p>It helps identify specific bacterial organisms from blood and CSF, especially in cases with negative CSF cultures</p> Signup and view all the answers

    Which of the following is a common bacterial pathogen found in blood cultures of patients with suspected bacterial meningitis?

    <p>Neisseria meningitidis</p> Signup and view all the answers

    Which organism is most likely to be identified in blood cultures from a patient with suspected meningococcal meningitis?

    <p>Neisseria meningitidis</p> Signup and view all the answers

    Why is it important to obtain EDTA blood tubes for PCR in suspected bacterial meningitis?

    <p>To identify subtypes of Neisseria meningitidis and other pathogens</p> Signup and view all the answers

    What is a key diagnostic test for cryptococcal meningitis?

    <p>Cryptococcal antigen detection in CSF</p> Signup and view all the answers

    In diagnosing cryptococcal meningitis, which of the following is rarely used now?

    <p>CSF India ink stain</p> Signup and view all the answers

    Which patient group is particularly at risk for cryptococcal meningitis and should be suspected for the condition?

    <p>HIV patients with low CD4 count</p> Signup and view all the answers

    When suspecting meningitis before hospital admission, which of the following is a red flag symptom of invasive meningococcal disease?

    <p>Confusion, photophobia, rash, neck stiffness or pain</p> Signup and view all the answers

    What is the immediate pre-hospital management for suspected meningitis in patients with fever and a petechial/purpuric rash?

    <p>Administer benzylpenicillin or ceftriaxone/cefotaxime without delay</p> Signup and view all the answers

    Which of the following is less sensitive than CSF for detecting cryptococcal antigen in suspected cryptococcal meningitis?

    <p>Blood culture</p> Signup and view all the answers

    When treating meningitis in the hospital, which of the following is the first priority for initiating treatment?

    <p>Start IV antimicrobials immediately, even before imaging or diagnostic results</p> Signup and view all the answers

    Which of the following is NOT typically part of initial management in a patient with suspected meningitis?

    <p>Oral antimicrobials</p> Signup and view all the answers

    In cases of meningitis, which of the following might be required due to increased intracranial pressure? A) Fluid restriction B) IV steroids for inflammation only C) Administration of oral antibiotics D) Intubation to assist breathing

    <p>Fluid restriction</p> Signup and view all the answers

    If a patient is suspected to have meningitis, which of the following is essential and needs to be done immediately?

    <p>Start treatment immediately, without waiting for imaging or diagnostic results</p> Signup and view all the answers

    What is the main reason for giving IV antimicrobials instead of oral ones in meningitis treatment?

    <p>IV antimicrobials can penetrate the blood-brain barrier (BBB) more effectively</p> Signup and view all the answers

    Which of the following is a legal requirement when diagnosing meningitis? A) Immediate hospital admission of the patient B) Inform the Public Health Department, as meningitis is a legally notifiable disease C) Inform the patient's family immediately D) Confirm the diagnosis with a lumbar puncture before notifying authorities

    <p>Inform the Public Health Department, as meningitis is a legally notifiable disease</p> Signup and view all the answers

    In the treatment of infants less than 3 months with suspected bacterial meningitis, which of the following is NOT included in the empiric antimicrobial regimen?

    <p>Vancomycin</p> Signup and view all the answers

    For adults and children over 3 months with suspected bacterial meningitis, which of the following combinations of antimicrobials is part of the empiric therapy?

    <p>Ceftriaxone + Vancomycin</p> Signup and view all the answers

    In the empiric treatment of bacterial meningitis for patients over 50 years old, which of the following is added to the treatment regimen for an increased risk of Listeria?

    <p>Amoxicillin</p> Signup and view all the answers

    Which of the following bacterial pathogens is a key target for amoxicillin in the empiric treatment of bacterial meningitis in infants under 3 months?

    <p>Group B Streptococcus (GBS)</p> Signup and view all the answers

    Which of the following is the rationale for adding vancomycin to the empiric treatment regimen in children and adults over 3 months with suspected bacterial meningitis?

    <p>It covers resistant strains of S. pneumoniae</p> Signup and view all the answers

    In suspected bacterial meningitis, when should steroids be administered?

    <p>Prior to or with the first dose of antimicrobials</p> Signup and view all the answers

    In Haemophilus influenzae type b (Hib) meningitis, steroids are shown to:

    <p>Reduce overall mortality and incidence of deafness</p> Signup and view all the answers

    Steroids in pneumococcal meningitis are associated with: A) No impact on mortality B) A reduced mortality rate C) Increased risk of secondary infections D) Increased risk of hearing loss

    <p>A reduced mortality rate</p> Signup and view all the answers

    In tuberculous meningitis, steroids are used to:

    <p>Reduce fibrosis and the risk of secondary hydrocephalus</p> Signup and view all the answers

    For meningococcal meningitis, the data on the use of steroids is:

    <p>Inconclusive and does not support routine use</p> Signup and view all the answers

    After the blood culture and CSF culture results come back with a causative microorganism, what can be done with the antimicrobial therapy?

    <p>Adjust therapy according to the antimicrobial susceptibility results</p> Signup and view all the answers

    Which of the following vaccines is NOT available for preventing bacterial meningitis?

    <p>Group B Streptococcus (GBS)</p> Signup and view all the answers

    What is the single most important factor in preventing bacterial meningitis?

    <p>Vaccination</p> Signup and view all the answers

    Which bacterial meningitis vaccine is NOT available yet?

    <p>Vaccine for neonatal meningitis causative organisms</p> Signup and view all the answers

    Which of the following is included in the routine childhood immunization programme in Ireland since 1992?

    <p>Hib vaccine</p> Signup and view all the answers

    Which of the following is NOT part of the general strategy for meningococcal vaccination in Ireland?

    <p>Vaccination only for individuals with confirmed meningococcal infection</p> Signup and view all the answers

    At-risk groups, such as those with splenectomy, HIV, or complement deficiency, should receive vaccination against:

    <p>All serotypes of meningococcal infection</p> Signup and view all the answers

    What is the main effect of the Hib vaccination on invasive Haemophilus influenzae type B infections in many countries?

    <p>Hib infections are now rare in many countries</p> Signup and view all the answers

    Which of the following pneumococcal vaccines was introduced to the childhood vaccination schedule in Ireland in 2008?

    <p>PCV7 (7-valent pneumococcal conjugate vaccine)</p> Signup and view all the answers

    Which vaccine replaced PCV7 in the Irish childhood vaccination schedule in 2010?

    <p>PCV13</p> Signup and view all the answers

    Which of the following is NOT part of the at-risk groups that should receive pneumococcal vaccination?

    <p>Pregnancy</p> Signup and view all the answers

    Pneumococcal polysaccharide vaccine (PPV23) is available for individuals who are:

    <blockquote> <p>65 years (One dose)</p> </blockquote> Signup and view all the answers

    In the case of asplenia (surgical, congenital, or functional), long-term prophylaxis with daily oral penicillin is used to reduce the risk of: A) Pneumococcal infection B) Meningococcal infection C) Hib meningitis D) Viral meningitis

    <p>Pneumococcal infection</p> Signup and view all the answers

    Prophylaxis for contacts of pneumococcal meningitis is:

    <p>Not indicated</p> Signup and view all the answers

    Which of the following is the prophylactic treatment for contacts of meningococcal meningitis?

    <p>PO rifampicin x 2/7 or PO ciprofloxacin x 1 dose</p> Signup and view all the answers

    For close contacts of Hib meningitis or other invasive Hib disease, which of the following is the appropriate prophylaxis?

    <p>PO rifampicin x 4/7 or IV ceftriaxone OD x 2/7</p> Signup and view all the answers

    Which of the following is NOT a common cause of a brain abscess following trauma or neurosurgery? a) Staphylococcus aureus b) Escherichia coli c) Mycobacterium tuberculosis d) Toxoplasma gondii

    <p>Toxoplasma gondii</p> Signup and view all the answers

    Anaerobes, such as Bacteroides spp., are common pathogens in brain abscesses that arise from which condition?

    <p>Otitis media / mastoiditis / sinusitis</p> Signup and view all the answers

    Which of the following is a common cause of brain abscess resulting from contiguous spread?

    <p>Streptococcus milleri</p> Signup and view all the answers

    Which of the following organisms is most likely to cause a brain abscess in a patient with neutropenia or immunosuppression?

    <p>Aspergillus</p> Signup and view all the answers

    Which of the following organisms is most likely to be responsible for a brain abscess in a patient with endocarditis?

    <p>Staphylococcus aureus</p> Signup and view all the answers

    A brain abscess due to trauma or post-neurosurgery is most commonly caused by which of the following pathogens? a) Bacteroides spp. b) Staphylococcus aureus c) Streptococcus milleri d) Aspergillus

    <p>Staphylococcus aureus</p> Signup and view all the answers

    Which of the following is a non-bacterial cause of brain abscess, particularly in poorly-controlled HIV infection?

    <p>Toxoplasma gondii</p> Signup and view all the answers

    In a patient with a brain abscess, which of the following clinical features would be indicative of raised intracranial pressure?

    <p>Headache, nausea, and vomiting</p> Signup and view all the answers

    When diagnosing a brain abscess, why is CSF analysis often not helpful? a) Because infection is located in the brain parenchyma, not in the CSF b) Because there is often no elevated white blood cell count c) Because CSF culture is highly unreliable d) Because CSF analysis is only useful for bacterial meningitis, not abscesses

    <p>Because infection is located in the brain parenchyma, not in the CSF</p> Signup and view all the answers

    Which of the following is the most appropriate treatment approach for a brain abscess?

    <p>Empiric antimicrobial therapy and surgical drainage/aspiration</p> Signup and view all the answers

    In the management of a brain abscess, which of the following microbiological investigations should be performed on intraoperative specimens?

    <p>Gram stain, culture &amp; susceptibility, 16S PCR if culture negative</p> Signup and view all the answers

    Which of the following is a typical empirical antimicrobial regimen used in the treatment of brain abscess?

    <p>Ceftriaxone + Flucloxacillin + Metronidazole</p> Signup and view all the answers

    What is the expected treatment duration for brain abscesses with appropriate antimicrobial therapy?

    <p>Up to 6 weeks, depending on clinical response</p> Signup and view all the answers

    What is the primary concern with performing a lumbar puncture (LP) in a suspected brain abscess case?

    <p>Risk of high intracranial pressure leading to 'coning.'</p> Signup and view all the answers

    Which specimen is most commonly sent for microbiological investigation when a brain abscess is suspected?

    <p>Intra-operative specimens from craniotomy or burr hole aspiration</p> Signup and view all the answers

    What imaging method is primarily used for diagnosing a brain abscess?

    <p>Contrast CT or MRI</p> Signup and view all the answers

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