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Micro- Winter > CNS Infections- Predisposing, Transmission, & Age groups > Flashcards

CNS Infections- Predisposing, Transmission, & Age groups Flashcards

1
Q

Meningeal inflammation resulting from an infection within the

A

subarachnoid space

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2
Q

Causes of meningitis

A
  1. viruses are the most common cause.
  2. bacteria are 2nd most common cause – 7 major agents.
  3. fungus are less common – Cryptococcus neoformans var. grubii
  4. protozoa are less common – Toxoplasma ghondii, Naegleria fowleri.
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3
Q

Tetanus mimics some S & S of ______ but tetanus is a ________

A

meningitis but tetanus is a neurotoxemia, like botulism

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4
Q

Encephalitis

A

Inflammation of the brain parenchyma

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5
Q

Encephalitis: Focal/Localized/Specifc areas of the brain affected, not all areas – caused primarily by __________

A

HSV-1

HSV-1 disease is treatable by antiviral therapy.

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6
Q

Encephalitis: Diffuse/affects all areas of the brain – caused primarily by _______

A

arbovirus – supportive therapy only

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7
Q

Encephalomyelitis – encephalitis with myelitis (spinal chord inflammation) – caused by ________

A

poliovirus and West Nile virus – supportive therapy only

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8
Q

Slow virus encephalitis diseases may be caused by ___________

A

HIV - HIV-1-associated cognitive/motor complex (AKA AIDS Dementia Complex).

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9
Q

Another type of slow viral encephalitis is Progressive multifocal leukoencephalopathy (PML) and is caused by ________

A

polyomaviruses – papovavirus: JC virus in severe T-cell suppression/AIDS or transplant patient or MS patient on immunosuppresive therapy.

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10
Q

Another type of slow viral encephalitis is Subacute, sclerosing panencephalopathy (SSPE) and is caused by ________

A

Measles virus

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11
Q

Lesion is macroscopic in size and of sufficient mass/volume to press against the normal brain tissue → increased intracranial pressure → _____________

A

focal seizures

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12
Q

Mass lesions/abscess of CNS; CT will show

A

CT scan showing ring-enhancing (mass) lesion supports the diagnosis

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13
Q

Etiologic agents of mass lesion or abscess of CNS are (3 listed)

A
  1. Abscess – S. aureus, anaerobes.
  2. Neurocysticercosis (cysts) – Taenia solium.
  3. Toxoplasmosis –(pseudocyts) - Toxoplasma gondii
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14
Q

Neurotoxic diseases - Pathology is due to a neurotoxin/exotoxin which affects either _________ or _________

A
  1. CNS – tetanus – Clostridium tetani (mimics some S & S of meningitis but tetanus is a neurotoxemia)
  2. PNS – botulism – Clostridium botulinum
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15
Q

PNS disease- Leprosy

A

Leprosy – Infection of sensory nerves – Mycobacterium leprae.

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16
Q

PNS Disease- Guillain-Barre’ Syndrome

A

Guillain-Barre’ Syndrome – demyelination of PNS - autoimmune disease –Campylobacter jejuni.

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17
Q

PNS disease- Botulism

A

Botulism – toxin inhibits nerves at the neuromuscular junction –Clostridium botulinum.

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18
Q

Prion diseases (2 types)

A
  1. New Variant Creutzfeldt-Jacob Disease: Prion of bovine spongiform encephalitis.
  2. Creutzfeldt-Jacob Disease (CJD). Human Prions.
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19
Q

Common BACTERIAL cause of purulent/pyogenic meningitis and more frequently result in severe disease. Age-dependent etiology is common. 7 major agents are ______

A
  1. Neisseria meningitidis, (young & old)
  2. Streptococcus pneumoniae (y & o)
  3. Haemophilus influenzae, type b (y & o)
  4. Streptococcus agalactiae (neonate)
  5. Escherichia coli K1 (neonate)
  6. Klebsiella pneumoniae (neonate)
  7. Listeria monocytogenes (elderly)
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20
Q

4 Agents causing bacterial encephalitis &/or mass lesions

A
  1. Mycoplasma pneumoniae.
  2. Listeria monocytogenes
  3. S. aureus
  4. anaerobic [mixed] infections.
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21
Q

2 Agents causing Neutrotoxic disease

A
  1. Clostridium botulinum

2. Clostridium tetani

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22
Q

Viruses. A given virus may cause aseptic meningitis or encephalitis but ________

A

one site predominates over another

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23
Q

Aseptic (viral) meningitis, (most common agents of meningitis) often runs a benign course and rarely cause neurological sequelae Age-dependent etiology is often seen (8 of them):

A
  1. *Human herpes virus-6 and -7 (in infants & young children
  2. Non polio enteroviruses (Echo virus, coxsackie, entero 68-71)
  3. Arbovirus
  4. *HSV 2
  5. *LCMV
  6. HIV
  7. *Mumps
  8. Polio
    * different from list of viruses that cause high mortality and neuro problems
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24
Q 
Viral Encephalitis (unlike viral meningitis) cases have high mortality and high incidence of significant/severe neurological sequelae. 
9 Causes are:
A
  1. herpes simplex virus-1
  2. arboviruses
  3. rabies
  4. polio
  5. non-polio enteroviruses (Echovirus, Coxsackie viruses, enteroviruses 68→71)
  6. HIV.
  7. JC virus.
  8. Measles virus (rare only due to vaccination of humans: measles infectious encephalitis, SSPE)
  9. VZV & CMV.
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25
Q

Viral Encephalitis: Diffuse Encephalitis caused by Arbovirus (a Zoonosis) primary cause of epidemic diffuse encephalitis in summer/fall months, 8 causes are:

A
  1. Eastern equine encephalitis (EEE) – EEEV.
  2. Western equine encephalitis (WEE) – WEEV.
  3. St. Louis encephalitis (SLE) – SLEV.
  4. California encephalitis serogroup: Jamestown canyon, La Cross viruses.
  5. West Nile encephalitis (WNE Africa, Europe, US) – WNEV.
  6. Powassan encephalitis (POW) is caused by POWV via the tick.
  7. Coltiviruses: Colorado tick fever
  8. Others: HSV-1 and the non-polio enteroviruses
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26
Q

Viral Encephalitis: Focal encephalitis, 7 causes are

A
  1. **HSV-1 usually, sporadic, focal encephalitis all year round.
  2. Arboviruses and the non-polio enteroviruses.
  3. **Rabies virus – Rabies (rare due to vaccination of dogs and cats)
  4. **Encephalomyelitis – encephalitis with myelitis (spinal chord inflammation): poliovirus (rare due to vaccination of humans) & West Nile virus (an arbovirus)
  5. CMV in the patient with severe T cell immunosuppression/AIDS or transplant pt.
  6. VZV (rare only due to vaccination of humans).
  7. C virus and PML.
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27
Q

Viral Encephalitis: Slow virus encephalitis diseases, 3 causes are

A
  1. HIV - HIV-1-associated cognitive/motor complex (AKA AIDS Dementia Complex).
  2. Progressive multifocal leukoencephalopathy (PML): polyoma – papovavirus: JC virus severe T-cell suppression/AIDS or transplant pt.
  3. Subacute, sclerosing panencephalopathy (SSPE): Measles (Rubeola virus).
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28
Q

Fungal causes of meningitis

3 most common agents are:

A
  1. Cryptococcus – a meningoencehalitis
  2. Candida. – meningitis
  3. Coccidioides immitis – a meningoencehalitis.
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29
Q

Prions in CNS, causes of meningitis are

A
  1. Bovine spongiform encephalopathy prion

2. Creutzfeldt-Jacob Disease

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30
Q

Parasites usually cause a meningoencephalitis; 6 of them are

A
  1. **Toxoplasma gondii (protozoan- Toxoplasmosis).
  2. **Taenia solium, agent of neurocysticercosis (NCC; helminth).
  3. Echinococcus granulosus or multilocularis (Cystic Echinococcosis-hydatid cyst)
  4. Baylisascaris procyonis (Raccoon Round Worm Encephalitis/Baylisascariasis)
  5. Toxocaria cannis or cati (Toxocaria)
  6. **Naegleria fowleri predominate agent (Amoeba –Amoebic meningoencephalitis)

Others are Acanthamoeba spp., Balamuthia mandrillaris, Vahlkampfia spp., Hartmanella spp.

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31
Q

7 Encapsulated agents that cause meningitis are

A
  1. S. pneumoniae
  2. S. agalactiae
  3. H. influenzae, type b (Hib)
  4. N. meningitidis
  5. E. coli K1
  6. K. pneumoniae
  7. Cryptococcus neoformans var. neoformans
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32
Q

Predisposing factors to contract meningitis are

A

Immunodeficiency:

  1. T cell.
  2. B cell.
  3. Terminal complement deficiency and N. meningitidis.
  4. Long-term corticosteroid therapy.
  5. Immunosuppression of solid organ transplant (SOT) patient.
  6. Cancer due to chemotherapy or to form of cancer, e.g., lymphoma
  7. AIDS
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33
Q

Humoral immunity (B cell-mediated immunity) is required to prevent disease caused by the following extracellular bacteria whose primary virulence factor is an antiphagocytic capsule:

A
  1. S. pneumoniae.
    2. S. agalactiae.
    3. H. influenzae, type b (Hib)
    4. N. meningitidis.
    5. E. coli K1.
    6. K. pneumoniae.
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34
Q

Cell-mediated-immunity (T cell-mediated) is required to prevent disease caused by the following agents with are either facultative or obligate intracellular agents:

A
  1. Listeria monocytogenes.
    2. Toxoplasma gondii.
    3. Cryptococcus neoformans
    4. cytomegalovirus (CMV)
    5. Mycobacterium tuberculosis
    6. JC virus and PML
    7. HIV
    8. LCMV.
    9. E. coli K1??
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35
Q

Chronic or debilitating disease that predispose you are

A
  1. Advanced HIV/AIDS.
    2. Sickle cell disease.
    3. Lymphoma/cancer.
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36
Q

The physician must have high index of suspicion with the elderly because of all of the following:

A
  1. often hypothermic so don’t manifest with fever.
  2. neck arthritis so already manifest with nuchal rigidity.
  3. dementia masks lethargy and irritability.
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37
Q

Newborns with fever should be ______

A

routinely tapped because so few S & S in this age group.

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38
Q

Nosocomial causes predisposing someone

A
  1. Intraventricular catheters (IVC)

2. choclear implant:

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39
Q

Bacterial Reservoirs

Carriage is in nasopharynx and humans are only host for these bacteria:

A
  1. S. pneumoniae;
  2. H. influenzae, type b (Hib)
  3. N. meningitidis,
  4. S. agalactiae (also in vagina, GIT, skin).
    * Humans are only host Mycobacterium tuberculosis**
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40
Q

Bacterial Reservoirs

Carriage is in nares for

A

Staphylococcus aureus

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41
Q

Bacterial Reservoirs

Carriage in humans is primarily on mucosal surfaces for

A

endogenous anaerobic flora

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42
Q

Bacterial Reservoirs

Carriage in humans is primarily in the colon for

A
  1. Streptococcus agalactiae,
  2. E. coli
  3. K. pneumoniae
  4. Listeria monocytogenes.
  5. with migration to the vagina and vaginal colonization and migration to urethra → cystitis:
    Streptococcus agalactiae, E. coli, K. pneumoniae
43
Q

Bacterial Reservoirs

Animals and/or humans are reservoir for:

A
  1. E. coli K1.
  2. K. pneumonia.
  3. L. monocytogenes.
  4. M. leprae.
  5. Streptococcus agalactiae,
  6. Animals and/or humans are reservoir for Staphylococcus aureus but humans are the primary source of infections.
44
Q

Bacterial Reservoirs

Soil is the reservoir for

A
  1. C. tetani, (soil reservoirs),
  2. C. botulinum. (soil, water, animal reservoirs),
  3. L. monocytogenes (ubiquitous).
45
Q

Viral Agents- Zoonosis reservoir

A
  1. Arboviruses – animals (mammals &/or birds) and arthropods (mosquito or tick).
  2. Rabies virus– mammals.
  3. LCMV – mammals, especially rodents.
46
Q

Viral Agents- Humans are sole reservoir for:

A
  1. enteroviruses
  2. measles virus
  3. herpes viruses, HSV-1, HSV-2, HHV-6, HHV-7, CMV
  4. HIV.
  5. JC & BK viruses.
  6. mumps virus
47
Q

Reservoir for Cryptococcus neoformans

A

(soil and animal [bird] reservoirs) – fungus

48
Q

Reservoir for Toxoplasma gondii

A

(animal reservoir) – protozoan

49
Q

Reservoir for Taenia solium

A

(pig and humans reservoir) – tape worm.

50
Q

Reservoir for Echinococcus granulosus or multilocularis

A

(Cystic Echinococcosis-hydatid cyst)

51
Q

Reservoir for Baylisascaris procyonis

A

(Raccoon Round Worm Encephalitis/Baylisascariasis)

52
Q

Reservoir for Toxocaria cannis or cati

A

(Toxocaria) in cat or dog round worm

53
Q

Reservoir for Amoebic meningoencephalitis:

A

mainly Naegleria fowleri – warm water reservoir.

54
Q

Mode of transmission for Arboviruses

A

animals (mammals &/or birds) and arthropods (mosquito or tick).

55
Q

Mode of transmission for Rabies virus

A

Bat mostly, raccon-East Coast, skunk-mid-West in US – Dog, WW

56
Q

Mode of transmission for LCMV

A
  • from rodent

- exposure to rodents, droppings, seretions, fluids

57
Q

General zoonosis is the mode of transmission for: (7 of them)

A
  1. Listeria monocytogenes
  2. Mycobacterium leprae
  3. Toxocaria cannis or cati (Toxocaria)
  4. Toxoplasma gondii (cysts bearing larvae)
  5. Echinococcus granulosus or multilocularis (Cystic Echinococcosis-hydatid cyst)
  6. Bovine spongiform encephalopathy prion (AKA new variant Creutzfeldt-Jacob Ds)
  7. C. botulinum
58
Q

Mode of transmission for Baylisascaris procyonis

A

(Raccoon Round Worm; Encephalitis/Baylisascariasis)

59
Q

Mode of transmission for Cryptococcus neoformans

A

(animal-bird mechanical vector)

60
Q

Consumption of tainted food may transmit:

3 of them

A
  1. Bovine spongiform encephalopathy prion.
  2. Taenia solium (cysts bearing larvae) – not directly to CNS, indirectly.
  3. Toxoplasma gondii (cysts bearing trophs or bradyozoites)
61
Q

Fecal-oral route / food is contaminated with feces (leads to CNS disease):

(8 of them)

A
  1. Taenia solium (ova) neurocysticercosis from human,
  2. Toxoplasma gondii (ova) Toxoplasmosis from cat litter, soil.
  3. enteroviruses (polio, ECHO & Coxsackie viruses, enteroviruses 68→71).
  4. Listeria monocytogenes from many sources.
  5. LCMV from rodent.
  6. Echinococcus granulosus or multilocularis (Cystic Echinococcosis-hydatid cyst)
  7. Baylisascaris procyonis (Raccoon Round Worm Encephalitis/Baylisascariasis)
  8. Toxocaria cannis or cati (Toxocaria)
62
Q

CNS Infections transmitted in utero (vertical)

8 of them

A
  1. Streptococcus agalactiae (less common than during parturition)
  2. Listeria monocytogenes (more common than during parturition)
  3. Non-polio enterovirus (Coxsackie & Echoviruses, enteroviruses 68→71).
  4. LCMV.
  5. Toxoplasma - Toxoplasma gondii.
  6. Rubella
  7. CMV
  8. Herpes simplex virus
63
Q

CNS infections transmitted during parturition

5 of them

A
  1. Streptococcus agalactiae (more common than In utero transmission)
  2. Listeria monocytogenes
  3. E. coli
  4. K. pneumoniae
  5. Herpes virus and CMV (more common In utero transmission)
64
Q

CNS infections from inhalation of infectious dust (2 of them)

A
  1. Cryptococcus neoformans

2. LCMV

65
Q

Agents of CNS disease associated with familial/close –contact outbreaks include:

A
  1. hib.
  2. meningococcus.
  3. Non-polio enterovirues.
  4. T. solium – if someone is shedding ova.
  5. Very rare, very, very uncommon agents that can cause outbreaks in USA are: M. leprae (lepromatous form), mumps virus, measles virus, rabies virus, polio virus
66
Q

Predisposing factors for Neisseria meningitis

A

human exposure, terminal complement deficiency

67
Q

Associated factor for non polio enteroviruses, polio enteroviruses, and Taenia solium ova

A

human feces

68
Q

Predisposing factor for Naegleria fowleri

A

Exposure to fresh water with algae

69
Q

Predisposing factors for Streptococcus. agalactiae

A

low birth weight infant, rupture of membranes >24h before delivery, colonized vaginal canal

70
Q

Predisposing factor for Streptococcus pneumoniae

A

congenital CSF leak

71
Q

Associated factor for Toxoplasma gondii ova

72
Q

Associated factor for Toxoplasma gondii pseudocyst

A

under cooked or uncooked meat

73
Q

Bacterial meningitis accounts for _____ of all cases of meningitis while Viral meningitis (aseptic meningitis) accounts for _____
However, most cases of viral meningitis are ________

A

less than ½
viral- the majority

not definitively diagnosed

74
Q

Most common agents of viral meningitis in children→ adults are the ___________

Problem for physician is differentiating between bacterial pyogenic/purulent meningitis, which is _______ and benign viral meningitis.

A

ECHO and Coxsackie viruses, then the arbovirues, HSV-2, etc.

a medical emergency

75
Q

Most common agents of viral meningitis are

A
  1. Non-polio enteroviruses (ECHO viruses and Coxsackie viruses).
  2. HHV-6, HHV-7
76
Q

Seasonality for Arbovirus

A

late summer→early fall seasonality

cause meningitis & diffuse encephalitis.

77
Q

HSV-1 causes

A

focal encephalitis

no seasonality

78
Q

HSV-2 causes

A

if manifesting with primary symptomatic infection (genital herpes) – meningitis.

79
Q

Seasonality and cause of LCMV

A

if winter seasonality and history of rodent exposure – meningitis

80
Q

Seasonality of Polio

A

Polio (late summer and early fall seasonality, meningitis primarily young children → adults) and Mumps (rare due to vaccination).

81
Q

Meningococcal disease is the most frequent cause of bacterial meningitis in __________ in the United States (approximately 2800 cases of meningococcal disease in the United States each year)

A

infants, children, adolescents, and young adults

Of the 3000 cases> 60% are in individuals over 11 years old (this age group has the highest mortality rate; 25% versus 10-14% overall)

Of the 3000 cases, 11%-19% of survivors are left with long-term disabilities: hearing loss, cognitive impairment, renal failure, limb amputations.

82
Q

__________ has the highest case mortality rate for any bacterial agent of meningitis.

A

S. pneumoniae

its the most common infectious agent associated with patients with recurrent meningeal infections.

83
Q

About 1/2 of all cases of meningitis in the US are _________

A

nosocomial-acquired meningitis

hospital acquired

84
Q

Bacteria with year round seasonality

A
  1. S. agalactiae.
  2. E. coli K1
  3. K. pneumoniae
85
Q

Bacteria with summer seasonality

A

L. monocytogenes

86
Q

Bacteria with late winter-early spring seasonality

A
  1. H. influenzae type b (Hib)
  2. N. meningitidis
  3. S. pneumoniae
87
Q

Viruses with year round seasonality

A
  1. HHV-1
  2. HHV-2
  3. HHV-6 & -7
  4. CMV
  5. HIV
  6. Rabies
88
Q

Viruses with late summer and early fall seasonality

A
  1. ECHO viruses and Coxsackie viruses
  2. Polio virus
  3. Arboviruses
89
Q

Viruses with winter seasonality

90
Q

ALL major agents with seasonality in late summer/early fall

A
  1. ECHO viruses and Coxsackie viruses
  2. Polio virus
  3. Arboviruses
  4. Listeria monocytogenes,
  5. Neglaria fowleri
91
Q

ALL major agents with winter seasonality

A
  1. LCMV
  2. H. influenzae type b
  3. S. pneumoniae
92
Q

ALL major agents with year round seasonality

A
  1. HHV-1, HHV-2, HHV-6 & -7
  2. CMV
  3. HIV
  4. Rabies
  5. Streptococcus agalactiae (more common than In utero transmission)
  6. E. coli
  7. K. pneumoniae
93
Q

Age dependent infections- transmitted in utero

A
  1. S. agalactiae.
  2. L. monocytogenes.
  3. Non-polio enterovirus (Coxsackie & Echoviruses).
  4. LCMV
  5. Toxoplasma
  6. Rubella
  7. CMV
  8. herpes simplex virus
94
Q

Age dependent infections- transmitted during parturition

A
  1. Streptococcus agalactiae (more common than In utero transmission)
  2. Listeria monocytogenes,
  3. E. coli
  4. K. pneumoniae
  5. Herpes virus and CMV (more common In utero transmission)
95
Q

Congenital infections – The unborn child’ s infection is acquired in-utero and results in a diseased child at birth. The common agents of congenital infections are ________

A

“TORCH” agents

  1. Toxoplasma → TO
  2. Rubella →R
  3. Cytomegalovirus [CMV] →C
  4. Herpes simplex virus [HSV]) -2 or -1 →H
96
Q

Describe TORCH test

A

a test to detect a congential (AKA intrauterine infection) infection in a neonate via presence of specific IgM in chord blood.

97
Q

_______ is leading cause (by far) of infection and morbidity in the neonate. It is estimated that 40,000 neonates born in the US each year are infected with this and 8,000 of these will have serious neurological sequelae.

A

CMV infection

98
Q

Common causes of CNS disease in neonates

A
  1. S. agalactiae - Highest incidence of infection & morbidity among procaryotes.
  2. E. coli K1.
  3. K. pneumoniae.
  4. L. monocytogenes.
  5. ***Cytomegalovirus (CMV) - Highest incidence of infection & morbidity of all agents.
  6. ***Herpes simplex virus (HSV) 1 or 2
  7. ***Non-polio enterovirus (Coxsackie & Echoviruses)
  8. Human herpes virus-6 and –7 (HHV-6 and HHV-7)

***=MOST common in neonates

99
Q

Common causes of CNS disease in infants and young children

A
  1. HH-6, HH-7
  2. **HSV 1 & 2
  3. **non-polio enterovirus (Coxsackie & Echoviruses).
  4. N. meningitides
  5. S. pneumoniae
  6. Mycobacterium tuberculosis.
  7. **Arboviruses
  8. **LCMV
  9. Mumps

ALL of these are the same for adolescents and elderly except #1 & 2

**= most common over the age of 2

100
Q

Common causes of CNS disease in adolescents and elderly

A
  1. non-polio enterovirus (Coxsackie & Echoviruses).
  2. Arboviruses.
  3. N. meningitides,
  4. S. pneumoniae
  5. *L. monocytogenes – those over 50-y-o-age.
  6. Mycobacterium tuberculosis.
  7. Mumps (Adolescents)
101
Q

Most common viral cause in 6 mo to 2 years

A

HHV-6 & HHV-7

102
Q

Common BACTERIAL agents by age: Neonate

A

a. S. agalactiae,
b. E. coli K1,
c. L. monocytogenes
d. K. pneumoniae K1, K2

a= most common, d=least common

103
Q

Common BACTERIAL agents by age: Infant to adult

A

a. N. meningitides
b. S. pneumoniae

a is most common, b is second most common

104
Q

Common BACTERIAL agents by age: Elderly

A

a. N. meningitides
b. S. pneumoniae
c. L. monocytogenes

Micro- Winter (26 decks)

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