28 Microbiology: Viral CNS infections

Question 1

Agents

• What are the 5 common viral causes of aseptic meningitis?

Answer 1

Question 2

Non-viral aseptic meningitis causes

• What are the common organisms for this?

Answer 2

Question 3

Clinical Manifestations of Viral Meningitis

• What do symptoms do patients present with?

Answer 3

Question 4

Clinical Manifestations of Viral Meningitis

• CSF
  
  • What is notable about:
    
    • Lymphocytes
    • Leukocytes
    • Protein
    • Glucose

Answer 4

Question 5

Enteroviruses

• How common are they the pathogenic agent in viral meningitis?
• What time of year are these viruses most abundant?
• What type of enteroviruses is particularly fatal for infants?
• What is notable about Enteroviruses 70 and 71?

Answer 5

Question 6

Other viral causes of meningitis

• Of the HSV family, which herpes virus is the most common cause of this?
• What other 5 viruses are known to cause meningitis?

Answer 6

Question 7

Encephalitis

• What is the main difference between this and meningitis in terms of how patients present with viral CNS infections?

Answer 7

Question 8

Viral Encephalitis

• Assign one of the follow to each A, B, or C
  
  • Arbovirsues
  • HSV
  • Rabies Virus

Answer 8

Question 9

Viral Encephalitis

• Name the 3 primary endemic viruses
• Name the 2 notable Arboviruses
• Others
  
  • NAme the 4 other viruses to remember for this prof… (lol)

Answer 9

Question 10

Viral Encephalitis

• For all types of encephalitis
  
  • Name the 9 basic tests to analyze the CSF and brain in suspected encephalities

Answer 10

Question 11

Treatment for Meningitis

• How do patients present?
• Initial treatment
  
  • 1st line treatment for non-acute?
  • If acute presentation
    
    • What are the 3 drugs you would give?

Answer 11

Question 12

Viral Encephalitis: Endemic - Herpes

• Which 2 HSV viruses can cause this?
  
  • Which one is genital herpes?
  • Which one causes cold sores?
• What is notable about the presence of this virus during the year?

Answer 12

Question 13

Viral Encephalitis: Endemic - Herpes

• When a patient becomes infected with an HSV virus, what is the first thing to occur?
• Where does latent infection take place?
• Recurrent disease
  
  • What 2 things can cause this type of viral encephalitis to reoccur?

Answer 13

Question 14

Herpes Simplex Virus Encephalitis

• What is notable about the incidence of this type of encephalitis?
• What percentage of cases are from primary exposure?
• What is notable about this condition’s fatality rate?
• Which virus predominates: HSV1 or HSV2?

Answer 14

Question 15

HSV Encephalitis

• What is notable about the age distribution of these infections?
• Besides a primary infection, what can cause this condition to occur?
• At the start of symptom manifestation:
  
  • What can you note about the presentation of symptoms on the body?

Answer 15

Question 16

HSV Encephalitis

• Clinically
  
  • How long can the initial headache and fever last before more serious symptoms start?
    
    • What are these serious symptoms? (4)
  • What genetic defect can this be linked to?

Answer 16

Question 17

HSV Encephalitis

• What lobes does is this infection usually localized to?
• What happens to the lobes?

Answer 17

Question 18

Tx for HSV Encephalitis

• What drug is used for this?
  
  • What percentage does it decrease mortality?
• If patients survive, what conditions do they usually have?

Answer 18

Question 19

Tx for HSV Infections

• What drug is a purine nucleoside analog?
  
  • What drug is a prodrug of the answer to the above question?
• What drug is a prodrug of penciclovir?

Answer 19

Question 20

Viral encephalitis: Varicella Zoster Virus

• How common is this in viral encephalitis?
• Children
  
  • About how long after a child has a chickenpox rash does this occur
  • What condition arises from this type of encephalitis?
• Adults
  
  • What causes this to happen in most adults?
  • How do adults present with this condition?

Answer 20

Question 21

Viral encephalitis: Varicella Zoster Virus

• What is the tx for this?
• What can prevent it?
• How deadly is it?

Answer 21

Question 22

Viral encephalitis: Other Viruses

• EBV
  
  • What kind of neurological features does this have?
  • Is this severe or mostly benign?
• HHV-6
  
  • What age group is this most common in?
  • What kind of signs and symptoms do these patients have?

Answer 22

Question 23

Viral encephalitis: Rabies

• What cell does this virus initially have replication in?
• How does this virus get into the CNS?
• In what way does infection spread to the peripheral nerves?

Answer 23

Question 24

Viral encephalitis: Rabies virus

• Associate each decade with a rabid animal
  
  • 1980’s
  • 1990’s
  • 2010’s

Answer 24

Question 25

Viral encephalitis: Rabies Virus

• This shows the animals with highest number of rabid members in the US
  
  • What animal is
    
    • A
    • B
    • C
    • D

Answer 25

Question 26

Viral encephalitis: Rabies Virus

• What contents have the highest risk for rabies contact?

Answer 26

Question 27

Viral encephalitis: Rabies Virus

• How does rabies patients initially present?
• 1 to 2 weeks after an infection
  
  • What does furious rabies present with?
  • What does paralytic rabies present with?

Answer 27

Question 28

Viral encephalitis: Rabies Virus

• What is the tx for people who have rabies?

Answer 28

Question 29

Arboviral Encephalitis

• What are the viruses that mosquitos can give to humans under this group (that we talked about)?
• What virus can be transmitted by ticks?

Answer 29

Question 30

Arboviral Encephalitis

• When do neurologic symptoms usually emerge?
• Besides encephalitis, what else can this cause in the CNS?

Answer 30

Question 31

Arboviral Encephalitis

• What kind of symptoms do patients present with, BEFORE getting encephalitis?
• How can you treat this?
• Sequalae
  
  • What virus do about 30% of patients have neurological sequelae? How does this percentage relate to that viruses’ fatality rate?
  • What virus do about 10% of patients have neurological sequelae? How does this percentage relate to that viruses’ fatality rate?

Answer 31

Question 32

Arboviral Encephalitis: St. Louis Encephalitis

• What states have the highest rate of infection?

Answer 32

Question 33

Arboviral Encephalitis: La Crosse Encephalitis

• What states have the highest rate of infection?

Answer 33

Question 34

Arboviral Encephalitis: West Nile Virus

• How common is this virus in the US?
• Is encephalitis from this virus common?

Answer 34

Question 35

Arboviral Encephalitis: West Nile Virus

• What states have the highest rate of neuroinvasive disease from this virus?
  
  • Hint: Think ICOM rotation sites for 4 out of the 7 top infection rate states.

Answer 35

Question 36

Arboviral Encephalitis: Equine Encephalitis

• What animals transmit this virus?
• What kind of fatality rate does it have?
• What do people who survive this disease usually have?
• What population is at a higher risk for this condition?

Answer 36

Question 37

Arboviral Encephalitis: Equine Encephalitis

• What states have high infection rate for this virus?

Answer 37

Question 38

Just be aware of these random arboviral infections

Question 39

Lymphocytic Choriomeningitis Virus

• What animal acts a reservoir for this?
• How can people get it?
• What is the clinical hallmark for this?
  
  • What symptoms can be present?
  • Do patients improve?

Answer 39

Question 40

List the 5 childhood infections that may cause encephalitis

Answer 40

Question 41

What non-polio enteroviruses have neurological manifestations that cause mild encephalitis?

Answer 41

Question 42

Mumps and Measles

• How common is encephalitis in these diseases?
• What about measles?
• Measles
  
  • What is the mortality rate for this, and what is present in 25% of survivors?

Answer 42

Question 43

Measles

• What chronic progressive neurological condition is associated with this?
• When can it manifest?
• Is it deadly?

Answer 43

Question 44

Be aware of these viruses that can cause CNS pathology long after primary infection