Microbe

Sketchy
video
Descripti
on

Pathoge
nesis

Presenta
tion

Diagnosi
s

Treatme
nt

Neisseria
Meningitids
Noir Series-A
Shocking Death
on Campus
-Gram
diplococci
-aerobic
-oxidase +

-Polysaccharide
capsule
(serotyping)
-Pili (type IV)colonize the upper
airway mucosal
surface
-LOS (lack O
antigen & drives
inflammatory
response)
Human (host)person-person
transmission
(aerosols of
respiratory
secretions)
Meningococcemi
a -Petechial or
purpuric rash (can
occur w/o clinical
evidence of
meningitis)
-DIC coagshock
-high blood
content of
endotoxin
Waterhouse
Friderichsen
Syndrome-failure
of adrenal gland to
fxn (bleeding into
the
gland)adrenocor
tical insufficiency
(fatal)
-fastidious growth
utilizes: glucose
+ maltose

Vaccination:
-Polysacchride
vaccine
-multiple
conjugate
vaccines etc.

Streptococcus
Agalactiae
Galactic
Baby
-Group B
streptococci
-gram +, cocci
arranged in
pairs or chains
-Beta-hemolytic
Most common
cause of
meningitis in
newborns
-Vaginal flora
-Attacks
neonates
during vaginal
delivery
-Type-specific
sialic acid
capsule
(inhibits
activation of
alternative
complement
pathway)

-Infects
neonates during
vaginal
deliveryMenin
gitis,
pneumonia,
sepsis

Streptococcus
pneumoniae
The Alpha
Knight
Tournament
-Gram +
diplococci
-lancet shaped
-facultative
anaerobe
-Alpha hemolytic
-Optochin sensitive

Haemophilus
influenza
Phyllis Chocolate
Covered
Strawberries
-Gram coccobacilli
(may appear gram
+)
-nonmotile facultative
anaerobes
-6 identifiable types
(a-f)

Listeria monocytogenes

-C
polysaccharide
-Polysaccharide
capsule
-Quellung rxn
-sIgA protease
-colonized humans
(reservoir)
-person-person
transmission
(aerosols of
respiratory
secretions)

Polyribosyl ribitol
phosphate (PRP)
capsule

-grow at wide range of temperatures

& high salt
-intracellular-macrophage-mediated
dissemination
-Internalins: cell attachment factors
-Hemolysins: Listeriolysin O (LLO) &
Phospholipase C
-Actin directed intracellular
motility (cell-cell spread)
-ActA coordinates assembly of actin
-predilection for placenta & CNS

Meningitis
Otitis media
Pneumonia
Sinusitis

Meningitis
Otitis media
Pneumonia
Sinusitis

Febrile gastroenteritis
-mean incubation (1 day)
-fever, headache, abdominal
cramps, watery diarrhea

Bacteremia

Bacteremia
Epiglottitis
Cellulitis

Meningitis & meningoencephalitis

Sinusitis

-need enrichment
with blood to
support growth

-requires preformed
growth factors that
are present in blood:
chocolate agar

Motile: lab identification

X factor (hemin)
V factor (NAD or
NADP)
Hib Vaccinecapsular
polysaccharide
conjugate

-culture: Gram stain, hemolytic

activity, tumbling motility test

-23-valentpneumococcal
polysaccharide
vaccine (>2 y/o +)
-13-valentconjugated
pneumococcal
vaccine (<2 y/o)
-series of 4 doses

-all virulent strains

produce:
neuraminidase &
IgA protease

Santas List

-Gram+ bacillus
-facultative anaerobe

-gram stain of CSF: typically show

no organisms

Other

Serogroups
associated with
meningitis (US:
B,C,Y &
Underdevelop: A,
W135)

Found in soil, water, intestinal tracts

of animals
-Outbreaks: contaminated foods
(undercooked)
-low level-GI colonization

Susceptible
populations:
-children <5
-institutionalized
individuals
-military barracks
-Patients with late
complement
deficiences

-Human-human transmission: mom to

child in utero or at birth
-high risk: neonates, pregnant women,
elderly, patients with defects in cellmediated immunity

Objectives
1. Describe the clinical presentation of acute bacterial meningitis.
Fever, Nuchal rigidity, Change in mental status, Headache, Nausea vomiting,
Seizures, Skin rash
Pathogenesis:
o Hematogenous following colonization
o Direct inoculation usually associated with trauma
o Penetration at the choroid plexus
2. Describe additional conditions and syndromes associated with meningitis infections of
CNS!
Meningitis
o Inflammation of the meninges
o Bacteria, viruses, and fungi
Encephalitis
o Inflammation of the brain parenchyma, manifest by neurologic dysfunction
o Viruses
Meningoencephalitis
o Inflammation of the brain and meninges
o Most commonly viruses, uncommonly bacteria
Meningococcemia
Waterhouse Friderichson Syndrom
Listeriosis
Brain abscess
o Focal infection of the brain parenchyma, manifest by focal deficits
o Bacteria, fungi, and parasites
3. List etiologic agents of bacterial meningitis. See table above
4. Identify host susceptibility factors and the most common etiologic agent based on age.
Host susceptibility factors:
o Failure to vaccinate
o Immune deficiency (Complement deficiency, Antibody deficiency, Asplenia,
HIV infection)
o Bacteremia
o Head trauma
Most commonly attacked:
o Neonates 3 months: Group B Streptococcus
o >3 months: Streptococcus pneumoniae
o Elderly: Streptococcus pneumoniae

5. Recognize bacteriologic principles involved with identification and differentiation of

bacteria that cause meningitis. See table above
6. Explain the importance of bacterial capsules associated with bacteria that cause
meningitis.
7. Describe the diagnostic and treatment approach for bacterial meningitis.
Diagnostic:
o Exam for nuchal rigidity (burdzinski sign, kernig sign, jolt accentuation of
headache)
o Blood work (50-90% of patients have + blood culture)
o Lumbar puncture for CSF= hallmark
Elevated opening pressure
o CSF analysis
Treatment:
o Antibiotic therapy should be initiated immediately (Empiric vs directed
therapy)
o Antibiotics must penetrate the CSF in active form and concentration.
o High therapeutic index for b-lactam antibiotics (~15% in CSF)
o Dexamethasone if pneumococcus is known or suspected.
8. Explain the importance of vaccination in prevention of bacterial meningitis.
common sense