CNS

Question 1

Lymphocytic Choriomeningitis Virus transmission . . .

Answer 1

> by contact with rodents (hamsters, rats, mice) or their excreta

Question 2

Herpes Simplex Encephalitis

 Clinical features

Answer 2

> Fever, personality change, dysphasia, autonomic dysfunction

Question 3

Varicella-zoster virus Encephalitis

Answer 3

> Can occur without rash (zoster sine herpete)

Question 4

 Epstein-Barr virus CNS infection

Answer 4

> Encephalitis and/or transverse myelitis

Question 5

West Nile Virus (WNV) Encephalitis key points

Answer 5

 Birds are main reservoirs
 Mosquito vector
 Transplanted organs
 Blood transfusions
 Occupational

Question 6

West Nile Virus Clinical Syndromes

Answer 6

 No clinical illness or symptoms (~80%)
 West Nile Fever (~20%)

 Meningitis
 Encephalitis/Meningoencephalitis
 Poliomyelitis-like flaccid paralysis

Question 7

West Nile Virus Encephalitis Diagnosis

Answer 7

 Serum IgM antibody (8-14 days of illness onset)

 CSF IgM (positive in >90%)

Question 8

Other Arboviruses encephalitis

Answer 8

 St. Louis encephalitis virus
Urinary symptoms early; SIADH (one-third of cases)

 Japanese encephalitis virus
Seizures and parkinsonian features; poliomyelitis-like flaccid paralysis

 Powassan virus
Tick vector (Ixodes scapularis in NE); rodent reservoir

 Tickborne encephalitis virus
Eastern Russia, central Europe
Poliomyelitis-like paralysis

 La Crosse virus
Serology; CSF IgM; SIADH (~20%)

 Eastern equine encephalitis virus
Abrupt onset with fulminant course; seizures common

Question 9

Noninfectious encephalitis

Answer 9

Acute disseminated encephalomyelitis (ADEM)

 Post-infectious

 Post-immunization

 Anti-N-methyl-D-aspartate receptor (Anti-NMDAR)

Question 10

OTHER BACTERIAL MENINGITIS

Diphtheroids (e.g., Cutibacterium acnes)

Risk Factors

Answer 10

CSF shunts and drains

Question 11

OTHER BACTERIAL MENINGITIS

Streptococcus salivarius

Risk Factors

Answer 11

Spinal anesthesia, myelogram

Question 12

OTHER BACTERIAL MENINGITIS

Streptococcus suis

Risk Factors

Answer 12

Vietnam, eating undercooked pig blood or pig intestine, pig exposure

Question 13

ANGIOSTRONGYLUS CANTONENSIS

MENINGITIS PEARLS

Answer 13

 Thailand, Malaysia, Vietnam, Indonesia, Papua New Guinea,
Taiwan, Pacific Islands; outbreaks in Jamaica and China

 after ingestion of raw mollusks or other sources of the parasite

 CSF: moderate pleocytosis with 16-72% eosinophils; larvae are occasionally found in CSF