CNS Infections Flashcards by Anna Haddox

Acute bacterial meningitis- Neonatal

Group B strep
Listeria monocytogenes
E. coli

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Acute bacterial meningitis- children

Neisseria meningitidis

H. Influenza B

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Acute bacterial meningitis-adolescents

Neisseria meningitidis

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Acute bacterial meningitis- immunosuppressed

Listeria monocytogenes

Gram negative bacilli

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Acute bacterial meningitis-all ages

Strep pneumonia

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Acute viral meningitis

Enteroviruses- echovirus, coxsackievirus, nonparalytic pilio

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Waterhouse-Friderichsen Syndrome

Meningitis-associated septicemia

Hemorrhagic infarction of adrenal glands
Hypotension and shock
Petechiae or purpura from DIC
Adrenocortical insufficiency

Most common with meningococcal and pneumococcal meningitis

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Bacterial meningitis CSF

Neutrophils (PMNs)
Increase protein
Decrease glucose

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Viral meningitis CSF

Lymphocytes
Normal to elevated protein
Normal glucose

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Cerebral abscess

Most common sites- frontal and parietal lobes, cerebellum

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Subdural empyrean

Collection of pus in subdural space

Due to bacterial or fungal infection of skull bones or air sinuses

Thrombophlebitis of bridging veins- occlusion- infarction

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Chronic bacterial meningoencephalitis (TB)

Fibrinous exudate in subarachnoid space at base of brain, entrap cranial nerves and arteries, cause hydrocephalus by blocking outlet of 4th ventricle

Obliterative endarteritis of arteries crossing subarachnoid space

Acid fast mycobacterial culture

HA, malaise, confusion, vomiting, low grade fever

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Lyme disease

Chronic meningoencephalitis neuroborreliosis

Facial nerve palsies, encephalopathy

Microglial nodules, scattered organisms

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Viral meningoencephalitis CSF

First pmns then lymphocytes
Elevated protein
Normal glucose

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Viral meningoencephalitis histology

Perivascular lymphocytic cuffing, necrosis with neuronophagia, microglial nodules

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Viral meningoencephalitis Herpes simplex

Temporal and inferior frontal lobe, orbital gyri

Necrotizing, hemorrhagic encephalitis

Intranuclear cowdry A inclusions

PCR is used to identify virus

Viral meningoencephalitis CMV

Fetus infected in last trimester

Periventricular necrosis and calcification leads to microcephaly, chorioretinitis

Virus localized in paraventricular subependymal regions of the brain

Viral meningoencephalitis poliomyelitis

Fecal-oral

Causes a mild gastroenteritis invading CNS in fraction of patients

Selectively infects meninges and anterior horn motor neurons of spinal cord

Acute paralysis: muscle wasting, hyporeflexia

Viral meningoencephalitis rabies

Virus ascends peripheral nerve to CNS

Incubation: 1-3 months

Severe necrotizing encephalitis: midbrain, medulla, basal ganglia

Negri bodies in pyramidal neurons of hippocampus or purkinje cells without inflammation

HIV encephalopathy

Virus enters CNS in infected macrophages
Microglial nodules, giant cells

Mental slowing, memory loss, apathy, depression

Viral meningoencephalitis PML

Reactivation of JC virus in setting of immunosuppression

Infects oligodendrocytes
Widespread focal demyelination of cerebral white matter
Giant atypical astrocytes
Enlarged oligodendrocytes with intranuclear inclusions

High mortality

Viral meningoencephalitis SSPE

Uncommon since MMR vaccine

Seen in children and adults months to years after measles

Widespread gliosis
Myelin degeneration
Intranuclear inclusions
Variable inflammation
Neurofibrillary tangles

Spasticity if limbs
Seizures
Relentless, death in 1 to 2 years

Fungal meningoencephalitis

Cryptococcus neoformans
Candida albicans
Mucor sp.

Fungal meningoencephalitis patterns of infection

Vasculitis
Chronic meningitis
Parenchymal invasion

Protozoan CNS infections- toxoplasmosis

Toxoplasmosis Gondii intracellular Protozoa Common cause of neurologic disease in HIV/AIDS puts Brain abscess- cerebral cortex Central foci of necrosis with petechiae Tachyzoites and bradyzoites

Toxoplasmosis clinical features

Fever Symptoms of acute cerebral dysfunction Ring-enhancing mass lesion

Congenital toxoplasmosis

Risk of transplacental transmission increases with gestational age at maternal infection Infection causes calcification and ventricular dilation

Prion encephalopathies

Associated with abnormal form of normal cellular protein PrP Altered PrP facilitates conversion of normal PrP Intracellular vacuoles in neurons and glia

Creutzfeldt-Jacob disease

Most common human prion disease Peak incidence in seventh decade Progressive mental deterioration Myoclonus

CJD morphology

Neuronal loss Reactive gliosis Spongiform change in neurons and glia of cerebral white matter No inflammatory cells

Variant CJD

Younger age of onset Evidence links to bovine spongiform encephalopathy More psychiatric symptoms than CJD Amyloid plaques surrounded by spongiform changes Slower progression