CNS Infections- Viral Meningitis- HHV 6 & 7

Question 1

The brain is ________ for viral infection.

Answer 1

not a portal of entry.

-Infection in the CNS is usually a secondary infection, occurring days, weeks, months, or years after the initial infection.

Question 2

Viral meningitis a common syndrome. It was much more common. It is estimated that 30→40% of all meningitis cases are of viral etiology today only because ____________.

Answer 2

we vaccinate against mumps

Question 3

In contrast to bacterial meningitis, viral meningitis is usually ___________,

Answer 3

a benign disease with rapid resolution and little or no sequelae

Question 4

Most common agents are

Answer 4

1. ECHO viruses and Coxsackie viruses (non-polio enteroviruses).
2. HHV-6, HHV-7

Question 5

Less common are

Answer 5

1. Arboviruses – if late summer and early fall seasonality.
2. HSV-2 – if manifesting with primary symptomatic infection (genital herpes).
3. LCMV – if winter seasonality and history of rodent exposure

Question 6

HHV-6 & HHV-7 are most common in what age group?

Answer 6

6 months - 2 years

Question 7

Non-polio enteroviruses occurs in what age group?

Answer 7

from 2 years and older

Question 8

The problem for the physician is to differentiate between bacterial pyogenic/purulent meningitis, which is ___________ and _________

Answer 8

a medical emergency and benign viral meningitis

Question 9

S/S of viral meningitis are very similar to bacterial cause:

Answer 9

irritability, lethargy (altered mental status), fever, severe headache, nuchal rigidity, vomiting, opisthotonos, pressure on eyeball, photophobia

Question 10

HHV 6 & 7 are a major cause of acute febrile illness in:

Answer 10

in infants→young children

Question 11

HHV 6 & 7 are a major cause of many (33% of all) first time ____________

Answer 11

febrile seizures (CNS infection) among children 2 years old or younger

Question 12

Primary infection in immunocompetent infants/young children leads to either:

Answer 12

1. asymptomatic infection

2. Exanthem Subitum/Roseola Infantum +/- S & S of aseptic meningitis

Question 13

With either presentation (ayspmtomatic or symptomatic) HH-6 causes both

Answer 13

1. latent persistent infections:
   - latent infection in T lymphocytes, monocytes occurs.
   - latent infection in CNS occurs (virus is highly neurotrophic).
2. chronic persistent infections:
   - life-long, active infection in salivary gland occurs

Question 14

Manifestations with aseptic meningits are abrupt onset of S & S that last 4 → 6 days and include:

Answer 14

high fever (> 38 C; 100 F), lethargy, irritability, malaise, no rash, but then fever defervesces (in 4 → 6 days) and rash appears

Question 15

S & S of disease caused by these viruses are a common cause of presentation of infant/young children to ER and are suggestive of meningitis, so a ______ is done to confirm

Answer 15

spinal tap is done, but the tap is aseptic (indicating viral etiology)

Question 16

Treatment for otherwise health infants is

Answer 16

supportive, no antiviral therapy