Case Study - Meningitis
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Case Study - Meningitis

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Questions and Answers

What symptoms did Malorie present that are characteristic of meningitis?

  • Severe headache, fever, and stiff neck (correct)
  • Confusion, seizures, and diarrhea
  • Fatigue, muscle pain, and cough
  • Nausea, vomiting, and rash

    • What was revealed by Malorie's spinal tap?

  • Clear CSF with elevated protein levels
  • Clear CSF with normal WBC and glucose levels
  • Cloudy CSF with no WBC count
  • Cloudy CSF with high neutrophils and low glucose (correct)

    • Which organism was identified as the cause of Malorie's bacterial meningitis?

  • Neisseria meningitidis (correct)
  • Haemophilus influenzae
  • Streptococcus pneumoniae
  • Escherichia coli

    • Which agar plates did Malorie's CSF cultures grow on?

    <p>Chocolate Agar and Thayer-Martin Agar</p> Signup and view all the answers

    What is the most common cause of bacterial meningitis in the US?

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

    Which of the following is NOT a common cause of bacterial meningitis?

    <p>Candida albicans</p> Signup and view all the answers

    Which of the following pathogens is mentioned as being a cause of bacterial meningitis in higher-risk categories?

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

    What laboratory finding can indicate bacterial meningitis?

    <p>Elevated protein and cloudy CSF</p> Signup and view all the answers

    Which of the following is an immediate consequence of Malorie's symptoms and lab results?

    <p>Immediate administration of antibiotics</p> Signup and view all the answers

    Which group is the second most common cause of bacterial meningitis after Streptococcus pneumoniae?

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

    What is the primary function of the meninges?

    <p>To protect the brain and spinal cord</p> Signup and view all the answers

    Which of the following accurately describes the Gram stain characteristics of Neisseria meningitidis?

    <p>Gram-negative cocci typically found in pairs</p> Signup and view all the answers

    What prominent virulence factor is common to all pathogenic strains of Streptococcus pneumoniae?

    <p>Polysaccharide capsule</p> Signup and view all the answers

    Which method is used to identify different capsular strains of Streptococcus pneumoniae?

    <p>Quelling test</p> Signup and view all the answers

    What is the primary clinical manifestation of meningococcemia related to Neisseria meningitidis?

    <p>Subcutaneous hemorrhages (petechiae)</p> Signup and view all the answers

    How does Neisseria meningitidis primarily spread from person to person?

    <p>Via aerosolized droplets</p> Signup and view all the answers

    What distinguishes Streptococcus pneumoniae from Viridans streptococci during laboratory testing?

    <p>Sensitivity to optochin</p> Signup and view all the answers

    Which agar type is most appropriate for the cultivation of Neisseria meningitidis?

    <p>Chocolate agar</p> Signup and view all the answers

    What is a common symptom of bacterial meningitis?

    <p>Stiff neck</p> Signup and view all the answers

    What is the role of the polysaccharide capsule in Neisseria meningitidis?

    <p>To provide resistance against phagocytosis</p> Signup and view all the answers

    What is the primary virulence factor associated with Haemophilus influenzae type B serotype?

    <p>Polysaccharide capsule</p> Signup and view all the answers

    How does Haemophilus influenzae primarily spread among individuals?

    <p>Direct contact</p> Signup and view all the answers

    What significant impact has the Hib vaccine had on the epidemiology of Haemophilus influenzae infections?

    <p>Dramatically decreased the number of cases</p> Signup and view all the answers

    Which clinical manifestation is primarily associated with Haemophilus influenzae in young children?

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

    Which bacterium is commonly linked to causing meningitis in neonates?

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

    What type of vaccine is the Hib vaccine classified as?

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

    Which of the following is NOT a common cause of meningitis in neonates?

    <p>Mycobacterium tuberculosis</p> Signup and view all the answers

    Which Gram-negative rod is primarily known for causing meningitis in neonates?

    <p>Escherichia coli</p> Signup and view all the answers

    What other common cause of meningitis is caused by Gram-positive cocci, especially in neonates?

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

    In addition to H. influenzae, which pathogen is known for causing meningitis in immunocompromised individuals?

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

    Match the following bacteria with their characteristics:

    <p>Haemophilus influenzae = Tiny, gram-negative, pleomorphic rods Escherichia coli = Gram-negative rods, common in neonates Streptococcus agalactiae = Gram-positive cocci, common in neonates Listeria monocytogenes = Gram-positive rods, common in immunocompromised individuals</p> Signup and view all the answers

    Match the following diseases with their associated bacteria:

    <p>Meningitis = Haemophilus influenzae Pneumonia = Streptococcus pneumoniae Epiglottitis = Haemophilus influenzae Tuberculosis = Mycobacterium tuberculosis</p> Signup and view all the answers

    Match the following bacteria with their typical patient population:

    <p>Haemophilus influenzae = Young children Escherichia coli = Neonates Listeria monocytogenes = Immunocompromised individuals Mycobacterium tuberculosis = Patients with reactivated tuberculosis</p> Signup and view all the answers

    Match the following conditions to their common causes:

    <p>Bacterial meningitis = Haemophilus influenzae Bronchitis = Haemophilus influenzae Sinusitis = Haemophilus influenzae Meningitis in neonates = Escherichia coli</p> Signup and view all the answers

    Match the following definitions with their corresponding terms:

    <p>Gram-negative rods = Escherichia coli Subunit vaccine = Hib vaccine Acid-fast bacilli = Mycobacterium tuberculosis Gram-positive cocci = Streptococcus agalactiae</p> Signup and view all the answers

    Match the following bacteria with their transmission methods:

    <p>Haemophilus influenzae = Direct contact Streptococcus agalactiae = Vertical transmission Listeria monocytogenes = Foodborne transmission Mycobacterium tuberculosis = Airborne transmission</p> Signup and view all the answers

    Match the following bacterial species to their gram staining characteristics:

    <p>Haemophilus influenzae = Gram-negative Streptococcus agalactiae = Gram-positive Listeria monocytogenes = Gram-positive Mycobacterium tuberculosis = Acid-fast</p> Signup and view all the answers

    Match the following bacterium to its typical diseases:

    <p>Haemophilus influenzae = Meningitis and epiglottitis Escherichia coli = Meningitis in neonates Listeria monocytogenes = Meningitis and sepsis Mycobacterium tuberculosis = Respiratory infection and meningitis</p> Signup and view all the answers

    Match the following vaccine to its impact on disease rates:

    <p>Hib vaccine = Dramatically reduced cases of Haemophilus influenzae PCV = Reduces pneumonia caused by Streptococcus pneumoniae BCG vaccine = Prevents tuberculosis DPT vaccine = Prevents diphtheria, pertussis, and tetanus</p> Signup and view all the answers

    Match the bacterial pathogens with their primary characteristics:

    <p>Streptococcus pneumoniae = Gram-positive diplococcus, causes most bacterial meningitis cases Neisseria meningitidis = Gram-negative diplococcus, transmitted via aerosolized droplets Haemophilus influenzae = Primarily affects young children, associated with respiratory infections Streptococcus agalactiae = Known cause of meningitis in neonates, gram-positive cocci</p> Signup and view all the answers

    Match the causes of bacterial meningitis with their hallmark features:

    <p>Streptococcus pneumoniae = Optochin sensitive, major virulence factor is capsule Neisseria meningitidis = Meningococcemia with petechiae, endotoxin can cause shock Haemophilus influenzae = Associated with Hib vaccine in young children Listeria monocytogenes = Typically found in contaminated food, affects immunocompromised individuals</p> Signup and view all the answers

    Match the bacterial meningitis symptoms with their descriptions:

    <p>Headache = Often severe, caused by inflammation Fever = Common response to infection Stiff neck = Indicator of meningeal irritation Nausea = Can accompany the headache and fever</p> Signup and view all the answers

    Match the feature of bacterial meningitis to its clinical manifestation:

    <p>Cloudy CSF = Indicates presence of white blood cells Elevated glucose levels = Not typically seen in bacterial meningitis Pronounced neutrophils = Indicator of infection in CSF Increased protein concentration = Results from inflammation in the CNS</p> Signup and view all the answers

    Match the pathogen with its transmission method:

    <p>Neisseria meningitidis = Spread via respiratory droplets Streptococcus pneumoniae = Typically endogenous from nasopharynx Haemophilus influenzae = Primarily spreads in child care settings Listeria monocytogenes = Ingestion of contaminated food products</p> Signup and view all the answers

    Match the bacterial cell types to their characteristics:

    <p>Gram-positive cocci = Streptococcus pneumoniae and Streptococcus agalactiae Gram-negative cocci = Neisseria meningitidis Gram-negative bacilli = Haemophilus influenzae Gram-positive bacilli = Listeria monocytogenes</p> Signup and view all the answers

    Match the bacterial meningitis pathogen with the specific agar used for culture:

    <p>Neisseria meningitidis = Thayer-Martin agar Haemophilus influenzae = Chocolate agar Streptococcus pneumoniae = Blood agar Listeria monocytogenes = Listeria selective agar</p> Signup and view all the answers

    Match the bacterial meningitis causative agents with their prevalence:

    <p>Streptococcus pneumoniae = Most common in all age groups Neisseria meningitidis = Second most common, known for outbreaks Haemophilus influenzae = Historically significant prior to Hib vaccination Listeria monocytogenes = Associated with older adults and pregnant women</p> Signup and view all the answers

    Match the complications of bacterial meningitis with their outcomes:

    <p>Meningococcemia = Possible necrosis from petechiae Cerebral edema = May lead to increased intracranial pressure Septic shock = Life-threatening complication from endotoxin Deafness = Common sequelae following bacterial infection</p> Signup and view all the answers

    Match the bacterial pathogens with their respective virulence factors:

    <p>Streptococcus pneumoniae = Capsule and optochin sensitivity Neisseria meningitidis = Fimbriae and endotoxin Haemophilus influenzae = Polysaccharide capsule Listeria monocytogenes = Ability to invade host cells</p> Signup and view all the answers

    Study Notes

    Meningitis Case Study - Malorie

    • Malorie, a 20-year-old college student, was hospitalized due to severe headache, fever, and stiff neck, all classic symptoms of meningitis.
    • A lumbar puncture (spinal tap) was performed and revealed cloudy cerebrospinal fluid (CSF) with elevated white blood cell (WBC) count, particularly neutrophils, low glucose levels, and high protein levels.
    • Gram stain of CSF showed gram-negative diplococci which later grew on both Chocolate Agar and Thayer-Martin Agar, leading to a diagnosis of bacterial meningitis caused by Neisseria meningitidis.

    Bacterial Meningitis

    • Neisseria meningitidis is the second most common cause of bacterial meningitis.
    • Other common causes of bacterial meningitis in the US include:
      • Streptococcus pneumoniae
      • Haemophilus influenzae
    • While these are the most common, other pathogens should be considered, especially in high-risk individuals:
      • Escherichia coli
      • Streptococcus agalactiae
      • Listeria monocytogenes
      • Mycobacterium tuberculosis

    Bacterial Meningitis Severity

    • Bacterial meningitis is often a severe illness that may result in serious complications, including death.

    Bacterial Meningitis

    • Inflammation of meninges, three layers of membrane protecting the brain.
    • Bacteria enter bloodstream via oral or nasal pharynx, cross blood-brain barrier, and spread in the cerebrospinal fluid (CSF).
    • CSF changes: Cloudy appearance due to bacterial growth and an increase in white blood cells (neutrophils).
    • Symptoms: headache, fever, nausea, vomiting, stiff neck.

    Streptococcus pneumoniae

    • Leading cause of bacterial meningitis in all age groups.
    • Gram-positive, lancet-shaped diplococci, may form short chains.
    • Also a key cause of bacterial pneumonia.
    • Virulence Factor: Pronounced capsule present in all pathogenic strains.
    • Quelling Test: Identifies different capsular strains.
    • Epidemiology: Found in nasal pharynx of approximately 5-50% of people.
    • Transmission: Endogenous infections are common; person-to-person spread is rare.
    • Clinical Manifestations: Meningitis, respiratory infections, otitis media.
    • Diagnosis: Gram stain revealing a Gram-positive diplococcus in CSF.
    • Culture: Grows on blood agar exhibiting alpha hemolysis.
    • Differentiation from Viridans Streptococci: Sensitive to optochin (pneumococcus is sensitive, Viridans streptococci are resistant).

    Neisseria meningitidis

    • Second most common cause of bacterial meningitis.
    • Gram-negative, commonly found in pairs with flattened adjacent sides.
    • Virulence Factors: Polysaccharide capsule, fimbriae, IgA protease, endotoxin (lipopolysaccharide).
    • Serotypes: 12 strains with Serotypes A, B, and C causing most meningitis cases.
    • Epidemiology: Natural reservoir in humans, found in 3-30% of the adult population.
    • Transmission: Spreads person-to-person via aerosolized droplets.
    • Clinical Manifestations: Rapid onset, fever, stiff neck.
    • Complications: Meningococcemia (caused by endotoxin release) leading to subcutaneous hemorrhages (petechiae) and potentially necrosis or limb amputations.
    • Diagnosis: Gram stain of CSF, blood, or nasopharyngeal specimen.
    • Culture: Fastidious growth on chocolate agar, with selective cultivation on Thayer-Martin agar.
    • Prevention: Vaccines against serotypes causing common outbreaks.
    • Treatment: Antibiotic prophylaxis recommended for close contacts.

    Haemophilus influenzae

    • Tiny, Gram-negative pleomorphic rod.
    • Normal colonist of the nasopharynx.
    • Virulence: Type B serotype primarily responsible for meningitis in young children.
    • Transmission: Direct contact, outbreaks are not commonly associated with H.Flu.
    • Clinical Manifestations: Meningitis (mainly in young children), epiglottitis, otitis media, sinusitis, pneumonia, bronchitis.
    • Epidemiology: Cases have dramatically decreased due to the Hib vaccine.
    • Prevention: Hib vaccine (subunit vaccine based on Type B polysaccharide).

    Other Less Common Causes

    • Escherichia coli: Commonly causes meningitis in neonates.
    • Streptococcus agalactiae: Commonly causes meningitis in neonates.
    • Listeria monocytogenes: Causes meningitis mainly in neonates and immunocompromised individuals.
    • Mycobacterium tuberculosis: Causes meningitis in individuals with tuberculosis.

    Bacterial Meningitis

    • Inflammation of the meninges, the three layers of membrane surrounding the brain.
    • Bacteria typically enter the bloodstream through the oral or nasal pharynx.
    • They cross the blood-brain barrier, spread throughout the meninges, and multiply in the cerebrospinal fluid (CSF).
    • CSF is rich in glucose and other nutrients, providing a favorable environment for bacterial growth.
    • Cloudy CSF is a hallmark of bacterial meningitis, resulting from an influx of white blood cells, particularly neutrophils, fighting the infection.
    • Common symptoms include headache, fever, nausea, vomiting, and a stiff neck.

    Streptococcus pneumoniae (Pneumococcus)

    • Leading cause of bacterial meningitis across all age groups.
    • It's also the most common cause of bacterial pneumonia, accounting for 60-70% of cases.
    • Gram-positive, small, lancet-shaped cells arranged in pairs (diplococci) or short chains.
    • A prominent capsule, present in all pathogenic strains, is a major virulence factor.
    • Capsular types are differentiated using the Quellung reaction (capsular swelling test).
    • Found in 5-50% of individuals as normal flora in the nasopharynx.
    • Infections are usually endogenous, originating from the individual's own flora.
    • Diagnosed by a gram stain of a specimen, the presence of a gram-positive diplococcus in the CSF confirms the presumptive diagnosis.
    • Sensitive to optochin, distinguishing it from viridans streptococci.

    Neisseria meningitidis (Meningococcus)

    • Second most common cause of bacterial meningitis.
    • Spreads easily from person to person, resulting in frequent outbreaks.
    • Gram-negative diplococci.
    • Virulence factors include a capsule, fimbriae, IgA protease, and endotoxin.
    • 12 strains exist, with serotypes A, B, and C causing most cases.
    • Colonizes the nasopharynx of 3-30% of adults, with higher rates in institutional settings.
    • Transmitted through aerosolized droplets.
    • Onset is rapid, with classic meningitis symptoms.
    • Endotoxin can trigger hemorrhage and shock, potentially leading to death.
    • Meningococcemia, a serious complication caused by lipopolysaccharide release into the bloodstream, presents with:
      • Small hemorrhages (petechiae) on the trunk and appendages.
      • Petechiae can merge and lead to tissue necrosis.
      • Mortality rate can reach 15% even with treatment.
    • Diagnosed via gram stain of CSF, blood, or nasopharyngeal samples.
    • Cultured on chocolate agar or Thayer-Martin agar (selective media).
    • Vaccines are available against serotypes A, B, and C.

    Haemophilus influenzae (H. flu)

    • Primarily caused by serotype B.
    • Once the leading cause of bacterial meningitis in young children.
    • Tiny, gram-negative, pleomorphic rods.
    • Colonize the nasopharynx as normal flora.
    • Can cause meningitis, pneumonia, epiglottitis, otitis media, sinusitis, and bronchitis.
    • Transmitted via direct contact, with outbreaks less common than meningococcus.
    • The Hib vaccine (subunit vaccine targeting type B polysaccharide) has significantly reduced cases.

    Other Less Common Causes of Bacterial Meningitis:

    • Escherichia coli: Gram-negative rods, commonly observed in neonates.
    • Streptococcus agalactiae (group B strep): Gram-positive cocci, prevalent in neonates.
    • Listeria monocytogenes: Gram-positive rods, frequently found in neonates and immunocompromised individuals.
    • Mycobacterium tuberculosis: Acid-fast bacilli (AFB), primarily a respiratory infection, can spread to the brain and cause meningitis, particularly in patients with reactivated tuberculosis.

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    Description

    This quiz explores the case study of Malorie, a 20-year-old student diagnosed with bacterial meningitis caused by Neisseria meningitidis. It covers symptoms, diagnostic procedures, and common bacterial causes of meningitis. Test your knowledge on this critical topic in infectious diseases.

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