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Questions and Answers
What is the primary characteristic of acute pyogenic meningitis (APM)?
What is the primary characteristic of acute pyogenic meningitis (APM)?
- It primarily affects the brain's cortex.
- It is an inflammation of the leptomeninges. (correct)
- It causes chronic inflammation of the brain.
- It is a slowly progressing infection of the spinal cord.
In which demographic is the median age of patients with APM currently reported to be?
In which demographic is the median age of patients with APM currently reported to be?
- Teens aged 13 to 19 years
- Children under 5 years
- Young adults aged 25 years (correct)
- Adults over 60 years
What risk factor is associated with neonatal APM?
What risk factor is associated with neonatal APM?
- Increased incidence in premature births (correct)
- A major cause being viral infections
- A decreased incidence in African-American populations
- Higher prevalence in females compared to males
Which race is noted to have a higher incidence rate of APM in pediatric populations?
Which race is noted to have a higher incidence rate of APM in pediatric populations?
Which statement accurately describes the nature of APM?
Which statement accurately describes the nature of APM?
Which of the following describes the prevalence of APM among older adults?
Which of the following describes the prevalence of APM among older adults?
What is the male-to-female ratio for cases of neonatal APM?
What is the male-to-female ratio for cases of neonatal APM?
What type of meningitis is primarily caused by bacteria?
What type of meningitis is primarily caused by bacteria?
How quickly does acute pyogenic meningitis typically spread?
How quickly does acute pyogenic meningitis typically spread?
What is a common clinical symptom reported in older children with CNS-specific issues?
What is a common clinical symptom reported in older children with CNS-specific issues?
What is the typical appearance of CSF in cases suggesting bacterial infection?
What is the typical appearance of CSF in cases suggesting bacterial infection?
What is the neutrophil count range in the CSF indicative of bacterial infections?
What is the neutrophil count range in the CSF indicative of bacterial infections?
What is the appropriate antibiotic for treating S.pneumoniae infections?
What is the appropriate antibiotic for treating S.pneumoniae infections?
How does the glucose concentration in CSF typically compare to serum glucose levels in bacterial infections?
How does the glucose concentration in CSF typically compare to serum glucose levels in bacterial infections?
What is a crucial characteristic of CSF findings in bacterial meningitis?
What is a crucial characteristic of CSF findings in bacterial meningitis?
Which antibiotic is preferred for H.influenzae if the strain is β-lactamase producing?
Which antibiotic is preferred for H.influenzae if the strain is β-lactamase producing?
What is the main reason glucose levels in CSF are typically at 50% of serum levels during bacterial infections?
What is the main reason glucose levels in CSF are typically at 50% of serum levels during bacterial infections?
In the context of CSF culture results, what is the percentage of positivity for bacterial cultures in cases of APM?
In the context of CSF culture results, what is the percentage of positivity for bacterial cultures in cases of APM?
Which antibiotic is suitable for treating Escherichia coli infections?
Which antibiotic is suitable for treating Escherichia coli infections?
Which condition is NOT considered a risk factor for infections that spread to the meninges?
Which condition is NOT considered a risk factor for infections that spread to the meninges?
What role do polysaccharide capsules play in central nervous system bacterial pathogens?
What role do polysaccharide capsules play in central nervous system bacterial pathogens?
At what age is Streptococcus pneumoniae more commonly associated with meningitis infections?
At what age is Streptococcus pneumoniae more commonly associated with meningitis infections?
Which of the following infections can directly extend to the subarachnoid space?
Which of the following infections can directly extend to the subarachnoid space?
What complication is caused by the rapid accumulation of exudate in the central nervous system?
What complication is caused by the rapid accumulation of exudate in the central nervous system?
What condition is a result of prolonged use of high-dose corticosteroids?
What condition is a result of prolonged use of high-dose corticosteroids?
Which of the following is a classic risk factor for bacterial meningitis in individuals aged 60 and older?
Which of the following is a classic risk factor for bacterial meningitis in individuals aged 60 and older?
Which of the following correctly describes the pathophysiological spread of infections causing acute purulent meningitis (APM)?
Which of the following correctly describes the pathophysiological spread of infections causing acute purulent meningitis (APM)?
What is a common risk factor related to immune defenses in meningitis infections?
What is a common risk factor related to immune defenses in meningitis infections?
What is a potential danger of performing a spinal tap in a patient with a brain abscess?
What is a potential danger of performing a spinal tap in a patient with a brain abscess?
Which sign is indicated by a patient experiencing pain in the hamstrings upon knee extension with hips flexed at 90°?
Which sign is indicated by a patient experiencing pain in the hamstrings upon knee extension with hips flexed at 90°?
Which of the following clinical manifestations is least likely to be present in a patient with APM?
Which of the following clinical manifestations is least likely to be present in a patient with APM?
What role does polymerase chain reaction testing of CSF play in diagnosing CNS infections?
What role does polymerase chain reaction testing of CSF play in diagnosing CNS infections?
How is the microbial agent responsible for APM related to the patient?
How is the microbial agent responsible for APM related to the patient?
When is a CT scan typically recommended in the context of suspected CNS infections?
When is a CT scan typically recommended in the context of suspected CNS infections?
Which of the following symptoms in young infants may suggest APM?
Which of the following symptoms in young infants may suggest APM?
What does a positive Brudzinski sign indicate?
What does a positive Brudzinski sign indicate?
What is the primary cause of neck and back stiffness seen in CNS infections?
What is the primary cause of neck and back stiffness seen in CNS infections?
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Study Notes
Disease Summary
- Acute pyogenic meningitis (APM) is a serious inflammation of the leptomeninges, which includes the pia mater and arachnoid, affecting the cerebrospinal fluid (CSF) and ventricular system.
- APM, commonly referred to as bacterial meningitis, is predominantly caused by various bacteria.
- The infection spreads rapidly due to CSF circulation around the brain and spinal cord.
Prevalence
- Higher incidence of meningitis in older adults compared to young children, with a median patient age of 25 years.
- Neonatal APM incidence is 0.25–1 case per 1,000 live births, with 2.5 cases per 1,000 premature births.
- Among neonates, the male-to-female ratio is 3:1, showing a disparity in incidence rates among pediatric African-American and Native American populations.
Causes and Risk Factors
- Bacterial causes of APM vary according to patient age and include conditions that allow infections to reach the meninges.
- Key risk factors include:
- Respiratory tract infections
- Otitis media (middle ear infections)
- Mastoiditis (inflammation of the mastoid process)
- Sinusitis
- Neurosurgery and head trauma
- Alcoholism and high-dose corticosteroid use
- Conditions like splenectomy, sickle cell disease, and immunoglobulin deficiency
Pathophysiology
- APM typically arises from infections in other body areas, with microbes entering through the bloodstream or extending from infected sites to the subarachnoid space.
- Common bacterial pathogens include:
- Haemophilus influenzae and Neisseria meningitidis in ages 1 month to 29 years
- Streptococcus pneumoniae in ages 30-60 years
- S. pneumoniae, gram-negative enterics, and Listeria monocytogenes in patients over 60
- Accumulation of exudate leads to increased CSF viscosity, hindering normal flow and raising intracranial pressure.
Diagnosis
- Rapid testing methods like polymerase chain reaction for bacteria and CT scans are vital for timely diagnosis.
- There are significant clinical manifestations relevant to CNS infections, including:
- Headache, fever, chills, neck and back stiffness, nausea, vomiting, photophobia
- CSF abnormalities, positive Kernig sign (pain when extending knees in hip flexion), positive Brudzinski sign (flexing knees when neck is flexed)
Clinical Presentation
- Common Signs:
- Infants may show irritability, altered sleep, high-pitched cry, decreased appetite.
- Older children may exhibit lethargy, somnolence, and confusion.
- Analysis of CSF reveals:
- Cloudy appearance, neutrophil count of 200–200,000/mm³, glucose concentration at 50% of serum glucose level, and elevated protein concentration (≥50 mg/dL).
Treatment
- Antibiotic therapy should be tailored based on the identified pathogens:
- Penicillin G is preferred for S. pneumoniae and N. meningitidis.
- Cefotaxime or ampicillin is used for H. influenzae according to strain type.
- Cefotaxime or ceftriaxone is indicated for Escherichia coli infections.
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