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Neurology-Week 2 > CNS Microbiology > Flashcards

CNS Microbiology Flashcards

1
Q

CNS has the same amount of complement as serum because it can make it’s own (True or False)

A

False; can synthesize its own, but levels are <1% of serum’s

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2
Q

The only MHC expression in the CNS are from what cells

A

Microglia

Perivascular Macrophages

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3
Q

Resident innate immune cell in the CNS; expresses TLR4 and can produce TGF-b; thus is involved with BOTH pro-inflammatory activity and immune/inflammatory suppression

A

Astrocytes

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4
Q

Resident tissue macrophages in CNS; highly phagocytic, poor APCs but do express TLR4

A

Microglia

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5
Q

T cells (can/can’t) enter the CNS

A

Can only when stimulated by an antigen in the periphery

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6
Q

When can B cells enter the CNS

A

In response to inflammation with increased permeability of BBB

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7
Q

Most likely causes of BACTERIAL meningitis in NEWBORNS (3 total)

A

E. coli
L. monocytogenes
Strep. agalactiae (Group B)

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8
Q

Most likely causes of BACTERIAL meningitis in persons >3 months old (2 total)

A

S. pneumoniae

N. meningitidis

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9
Q

What are some examples of Non-Viral pathogens of the CNS

A 
E. coli
H. influenzae
Neisseria meningitidis
Staphylococcus aureus
Streptococcus agalactiae (Group B)
Streptococcus pneumoniae
Listeria monocytogenes
T. pallidum
Mycobacterium tuberculosis
Cryptococcus neoformans
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10
Q

CNS pathogen; Gram-negative rod; encapsulated; lactose positive and commonly found in GI tract

A

E. coli

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11
Q

CNS pathogen; Gram-negative coccobacilli, extracellular bacteria; sometimes encapsulated; commonly found in Upper Respiratory Tract and can cause epiglottitis

A

H. influenzae

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12
Q

CNS pathogen; Gram-positive cocci in chains; B-hemolytic; found in GI tract and lower female genital tract (thus implicated in with neonate infections during birth)

A

Streptococcus agalactiae (Group B)

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13
Q

CNS pathogen; Gram-positive “lancet shaped” diplococcus; encapsulated; a-hemolytic; found in Upper Respiratory tract; cause of lobar CAP with rust colored sputum

A

Streptococcus pneumoniae

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14
Q

CNS pathogen; Gram-positive cocci in clusters; beta-hemolytic; commonly found on skin and in nares; implicated with acute endocarditis, post-influenza pneumonia and food poisoning

A

Staphylococcus aureus

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15
Q

Difference between Streptococcus pneumoniae and Streptococcus aureus/agalactiae (in regards to hemolysis)

A

Pneumoniae: alpha-hemolytic

Aureus/Agalactiae: beta-hemolytic

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16
Q

CNS pathogen; Gram-positive rod; facultative intracellular bacteria; found in GI tract; associated with dairy products and soft cheeses

A

Listeria monocytogenes

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17
Q

CNS pathogen; acid-fast bacilli; found in lower respiratory tract; primary infection is usually asymptomatic, but can form Ghon’s complex

A

Mycobacterium tuberculosis

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18
Q

CNS pathogen; spirochete; spreads from oral and genital lesions; can cause deafness and “tree bark” aorta

A

T. pallidum (Syphilis)

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19
Q

CNS pathogen; Gram-negative diplococci; encapsulated; found in upper respiratory tract; especially dangerous for sickle cell patients or those with C5-9 complement deficiencies (MAC problems)

A

Neisseria meningitidis

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20
Q

CNS pathogen; encapsulated, round yeast; associated with inhalation around pigeon poop (ewww); can cause pneumonia-like illness as well; typically only seen in immunodeficient patients (HIV)

A

Cryptococcus neoformans

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21
Q

CNS pathogen; spirochete etiologic agent of Lyme disease

A

B. burgdorferi

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22
Q

CNS pathogen; protozoa spread by fecal cysts by cats or undercooked pork/lamb; escape from gut and travels to brain

A

Toxoplasma gondii

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23
Q

Tapeworm associated with CNS infection

A

Taenia solium (pork tapeworm)

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24
Q

Fungi that can cause CNS infection (3 total)

A

Aspergillus
Rhizopus
Candida

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25
Q

What are the CNS pathogens that are encapsulated (5 total)

A 
H. influenzae
E. coli (K1 capsule)
Staph. aureus
Strep. pneumoniae
Neisseria meningitidis
Cryptococcus neoformans
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26
Q

Which type of Neisseria meningitidis capsule type has no vaccination (at least until 2015)

A

Group B

*similar to carbohydrates in fetal brain, concerns of cross-reactive antibodies

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27
Q

What are the vaccines for Strep. pneumoniae

A 
Pneumovax 23 (Pure Polysaccharide)
Prevnar 13 (Conjugate Polysaccharide)
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28
Q

Examples of protein-based vaccines

A

TDaP

4CMenB

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29
Q

Examples of Conjugate polysaccharide vaccines

A

Neisseria meningitidis
H. influenzae (type B) (HiB)
Strep. pneumoniae (Prevnar 13)

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30
Q

Unique characteristics of Meningococcal infection (skin and CNS)

A

Skin: Hemorrhagic skin lesions (macular or non-blanching petechiae)
CNS: very high blood and CSF concentrations

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31
Q

Signs of Meningococcal meningitis when doing a Lumbar Puncture and CSF analysis

A 
Elevated opening pressure
CSF cloudy
Elevated WBCs (>80% PMNs)
Elevated protein (>100mg)
Dec. glucose (compared to serum)
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32
Q

Pattern of hematogenous spread of viruses into the brain

A

Choroid plexus–> CSF–> ependymal cells–> brain tissue

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33
Q

inflammation of the meninges covering the brain and/or spinal cord

A

Meningitis

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34
Q

Meningitis can be infectious or non-infectious (True or False)

A

True (can have “aseptic” meningitis due to viruses)

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35
Q

Bacteria and fungal meningitis is more common than aseptic/viral meningitis (True or False)

A

False: Aseptic meningitis is more common (especially viral)

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36
Q

Inflammation of the brain

A

Encephalitis

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37
Q

Inflammation of BOTH the meninges and brain

A

Meningoencephalitis

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38
Q

Enteroviruses, which include Polio and Coxsackie, are (single/double) stranded (positive/negative) sense RNA viruses

A

single-stranded, positive sense RNA viruses

*also naked with a icosahedral capsid

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39
Q

Types of Enteroviruses

A

Polio
Coxsackie A & B
Echo

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40
Q

Enterovirus; has 3 serotypes, transmitted fecal-oral (mostly water); spreads via MOTOR neurons; no antivirals, but two vaccines (Salk & Sabin)

A

Poliovirus

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41
Q

CNS virus; SINGLE stranded, NEGATIVE sense RNA; Bullet shaped, enveloped with helical capsid; transmitted by bite from infected animal (usually wild); chance of meningitis varies by where the bite is (head/face ~60%)

A

Rabies

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42
Q

Animal sources of Rabies virus

A 
Raccoons*
Bats*
Skunks
Foxes
Dogs (developing countries)

*most common

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43
Q

Describe the viral spread of Rabies in the body

A

Bite–> retrograde from PNS–> Spinal cord–> Brain–> anterograde to salivary glands

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44
Q

Signs of Rabies infection

A

Fever
Headache
Dysphagia (inc. muscle tone)
HYDROPHOBIA

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45
Q

Important histologic feature of Rabies virus

A

Negri bodies (smooth, round inclusions in neurons)

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46
Q

How to diagnose Rabies (both in animal and human)

A

Animal: brain tissue sample (2 different areas)
Human: Saliva/serum/CSF/skin samples

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47
Q

What are 3 familes of Arboviruses

A

Togaviridae (Eastern/Western/Venezuelan Equine Encephalitis viruses)
Flaviviridae (Yellow Fever, West Nile virus, St. Louis Encephalitis and Zika virus)
Bunyaviridae (California Encephalitis)

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48
Q

Most common outcome of Arbovirus infection

A

Asymptomatic infection (even most deadly)

49
Q

Describe the transmission of Arboviruses

A

Mosquitoes/ticks to humans

50
Q

Examples of Togaviridae (family of Arboviruses) (3 total)

A

Eastern/Western/Venezuelan Equine Encephalitis viruses

51
Q

Togaviridae and Flaviviridae are both… (what sense and what kind of genome)

A

Positive sense, ssRNA genome with an enveloped icosahedral capsid

52
Q

Examples of Flaviviridae viruses (family of Arboviruses) (5 total)

A 
Yellow Fever
West Nile
Zika
St. Louis Encephalitis
Japanese Encephalitis
53
Q

Togaviridae virus; positive sense, ssRNA genome; enveloped; mosquitoes–> birds; EASTERN seaboard

A

Eastern Equine Encephalitis virus (EEV)

54
Q

Togaviridae virus; positive sense, ssRNA genome; enveloped; mosquitoes–> birds; WEST of the Mississippi and SA

A

Western Equine Encephalitis virus (WEE)

55
Q

Togaviridae virus; positive sense, ssRNA genome; enveloped; mosquitoes–> rodents or EQUINES

A

Venezuelan Equine Encephalitis virus (VEE)

56
Q

Flaviviridae virus; positive sense, ssRNA genome; enveloped; mosquitoes–> nonhuman PRIMATES; Africa and SA; has a LIVE attenuated vaccine

A

Yellow Fever

57
Q

Flaviviridae virus; positive sense, ssRNA genome; enveloped; mosquitoes–> BIRDS; 80% of infections are sub-clinical, rarely flaccid paralysis; NO VACCINE

A

West Nile virus

58
Q

Flaviviridae virus; positive sense, ssRNA genome; enveloped; mosquitoes–> nonhuman PRIMATES; also SEXUAL transmission; South/Central America, Africa, Asia and Caribbean; associated with birth defects; NO VACCINE

A

Zika virus

59
Q

Flaviviridae virus; positive sense, ssRNA genome; enveloped; mosquitoes–> birds; 30% fatal in elderly; NO VACCINE

A

St. Louis Encephalitis

60
Q

Flaviviridae virus; positive sense, ssRNA genome; enveloped; mosquitoes–> PIGS and birds; Korea, Japan, SE Asia; INACTIVATED vaccine

A

Japanese Encephalitis

61
Q

Which Flaviviridae viruses have vaccinations?

A 
Yellow Fever (live attenuated)
Japanese Encephalitis (inactivated)
62
Q

Herpesviridae, such as HSV, are (single/double) stranded (RNA/DNA) viruses with an envelope

A

double stranded DNA virus

63
Q

Examples of Herpes viruses

A 
HSV 1/2
VZV
CMV
EBV
HHV 6/8/9
64
Q

Herpesviridae virus; linear, double stranded DNA; enveloped; usually acquired either via saliva exchange or genital contact; usually a LOCALIZED infection (stay in generalized area); corneal scarring and ulcerative skin lesions near face or genitals; neonates at risk for severe disseminated infection if mother infected

A

Herpes Simplex virus (HSV)

*HSV-1 more oral/saliva, HSV-2 is more genital contact

65
Q

Where is the life-long latency of a Herpes Virus located?

A

DRG of sensory neurons

66
Q

HSV (1/2) is transmitted more-so via saliva (oral-oral or oral-genital)

A

HSV-1

67
Q

HSV (1/2) is transmitted more-so via genital-genital contact

A

HSV-2

68
Q

Systemic inflammatory response due to a robust and unregulated expression of cytokines in response to an infection

A

Sepsis

69
Q

Fundoscopic finding for HSV infection

A

Corneal scarring (anterograde spread from ophthalmic branch from Trigeminal)

70
Q

Describe the spread of HSV-1 from primary infection to latency

A

Break in skin (or mucous membrane)–> sensory nerve ending–> retrograde to neuron cell body in DRG–> latency with periodic reactivation and anterograde spread

71
Q

Once reactivated, retrograde spread of HSV-1 from trigeminal ganglion frequently results in meningitis (True or False)

A

False: rarely spreads to CNS, and if it does it results in ENCEPHALITIS

72
Q

(Trigeminal/Sacral) ganglia are the principle site of HSV-1 latency

A

Trigeminal (remember typically oral-oral or oral-genital spread via saliva)

73
Q

(Trigeminal/Sacral) ganglia are the principle site of HSV-2 latency

A

Sacral (remember typically genital-genital spread)

74
Q

What can cause the reactivation of HSV-1

A 
Stress
Nerve damage
Exposure to sunlight
Illness
Immuno-suppression
75
Q

Signs/Symptoms of HSV-2 infection

A

Genital sores
Painful urination/discharge
Inguinal adenopathy
Flu-like symptoms

76
Q

Type of Herpes virus (double stranded DNA virus); DISSEMINATED infection; transmitted via respiratory droplets or direct contact with lesions; appear in successive “crops”; etiologic agent of Chicken pox; infection in ADULTS is more severe and complicated

A

Varicella Zoster Virus (VZV)

77
Q

Describe the spread of the Varicella virus in a disseminated state

A

Respiratory epithelium–> regional lymph nodes–> systemic (liver, spleen, skin, brain, etc.)

*latency is in spinal ganglia

78
Q

Primary infection with Varicella and complications are more severe in (children/adults)

A

Adults

79
Q

Complications of Varicella infections

A

Encephalomyelitis
Hemorrhagic Varicella (Immunocompromised patients)
Secondary Pneumonia
Reyes Syndrome (acute encephalopathy)

80
Q

Reactivation of Varicella Zoster Virus; vesicles and rash coalesce into large lesions, commonly thoracic dermatomes and along trigeminal nerve; post-herpetic neuralgia is common due to extensive damage to affected nerves

A

Shingles

81
Q

Treatment for Herpes viruses (HSV 1/2 and Varicella Zoster); prodrug that gets activated by Thymidine Kinase; binds to viral DNA polymerase and prevents dGTP incorporation (stop growing DNA strand) because of no 3’OH for the next phospho-diester bond

A

Acyclovir (ACV)

82
Q

Treatment for Herpes viruses (HSV 1/2 and Varicella Zoster); PRO-DRUG form of Acyclovir, thus a much higher bio-availability and higher oral dose with less frequent intervals

A

Valacyclovir

83
Q

Treatment for Herpes viruses (HSV 1/2 and Varicella Zoster); PRO-DRUG form of Penciclovir, thus a much higher bio-availability and higher oral dose with less frequent intervals

A

Famciclovir

84
Q

Treatment for Herpes viruses, Adenovirus and Poxvirus; mono-phosphorylated cytosine so it DOESN’T need to be activacted by Thymidine Kinase

A

Cidofovir

85
Q

Viral resistance to Nucleoside analog drugs is almost EXCLUSIVE to immuno(compentent/compromised) patients

A

Immunocompromised patients (AIDS, Leukemia, etc.) due to chronic antiviral therapy and high levelos of viral replication

86
Q

Enzyme that phosphorylates several nucleoside anti-viral drugs to active form

A

Thymidine kinase

87
Q

Herpresvirus drug; binds directly to DNA polymerase and prevents cleavage of pyrophosphate from growing DNA strand; low therapeutic index, thus used only for ACV-resistant viruses

A

Foscarnet

88
Q

How can you grossly tell if brain tissue has a bacterial meningitis?

A 
Loses transparency (filled with pus)
Adopts a cloudy/opaque coloration
89
Q

How can bacteria spread into the meninges? (2 main ways)

A

Bacteremia (hematogenous spread)

Direct extension from mastoid, sinuses, skull, etc.

90
Q

Signs/Symptoms of Meningitis

A 
Fever and headache
AMS
STIFF NECK
Brain edema
Brain ischemia/infarcts
Inc. ICP
Nerve palsies
Communicating hydrocephalus (Meningeal fibrosis)
91
Q

Difference between Acute vs. Subacute/Chronic Meningitis

A

Acute: onset in HOURS
Subacute: weeks to months

92
Q

Organisms responsible for SUBACUTE/CHRONIC meningitis

A

TB
Fungi (Cryptococcus)
Spirochetes (Syphillis, Borrelia burgdorferi)

93
Q

Sarcoidosis can cause chronic meningitis (True or False)

A

True (diagnosis of exclusion if noncaseating granulomas without infection)

94
Q

Tuberculous meningitis involves a (granulomatous/nongranulomatous) inflammation mainly affecting what part of the brain?

A

Granulomatous; Base of brain

95
Q

Tuberculous granuloma occurring within the cortex or meninges of the brain that ruptures into the subarachnoid space, causing tuberculous meningitis

A

Rich Focus

96
Q

Common cause of meningitis in immunocompromised patients; single budding yeast with a thick capsule “halo”; brain has outer slimy consistency, yellow-gray exudate in ventricles; ~50% of cases show MULTIPLE intraparenchymal cysts, AKA “soap bubbles” due to exuberant capsular material in the brain

A

Cryptococcus

97
Q

Key characteristics of a brain infected with Cryptococcus

A

Slimy consistency

Multiple intraparenchymal cysts (“soap bubbles”)

98
Q

The _______________________ ______________ can serve as a site of bacterial extension into the brain, forming Frontal Lobe abscesses

A

Paranasal sinuses (sinusitis)

99
Q

The ____________________ _____________ can serve as a site of bacterial extension into the brain, forming Temporal Lobe abscesses

A

Middle ear (or Mastoid air cells) (Otitis or Mastoiditis)

100
Q

Mechanisms of abscess formation in the brain

A

Direct extension (sinuses, middle ear, etc.)
Implantation (head trauma)
Bacteremia (usually causes MULTIPLE abscesses)

101
Q

Cause of brain abscesses; usually results in MULTIPLE abscesses and preferentially localizes to gray-white junction

A

Bacteremia

102
Q

Abscesses of the brain due to BACTERMIA like to prefer what area?

A

Gray-white junctions

103
Q

Consequences of Brain Abscesses

A 
Fever
Leukocytosis
Mass effect (headache, nauses, vomiting and herniation due to inc. ICP)
Brain destruction
Spread into ventricles
104
Q

(Bacteria/Viruses) are most common cause of Encephalitis

A

Virus (Herpesviruses, Arboviruses, Rabies, HIV, etc.)

105
Q

Consequences of VIRAL encephalitis

A

Necrosis (or Hemorrhagic)
Perivascular chronic inflammation
Viral inclusions

106
Q

Mechanisms of CNS viral infection

A 
Hematogenous
Via Axons (retrograde spread)
107
Q

Viruses that can use retrograde spread along axons to infect the CNS (2 total)

A

HSV-1

Rabies

108
Q

_____________ is a virus that commonly causes encephalitis of the Temporal and Frontal lobes

A

HSV-1 (remember is typically orally spread via saliva, so makes sense is centered around the mouth)

109
Q

_____________________ is a virus that commonly infects the Anterior Horns cells

A

Poliovirus

110
Q

____________________ virus commonly infects oligodendrocytes, causing Progressive Multifocal Leukoencephalopathy

A

JC (John Cunningham) virus

111
Q

________________ virus commonly infects the Hippocampus and Cerebellum

A

Rabies

112
Q

________________________ virus commonly infects the DRG

A

Varicella-Zoster virus (makes sense because of dermatomal distribution when reactivated)

113
Q

______________ _____________________ virus usually infects the leptomeninges (Arachnoid and Pia mater)

A

Lymphocytic Choriomeningitis virus

114
Q

Examples of Parasitic infections of the CNS

A

Cysticercosis (neurocysticercosis)
Toxoplasmosis (STORCH infection)
Amebiasis (Naegleria or Acanthamoeba)
Other (Malaria Echinococcosis, Schistosomiasis)

115
Q

MOST common parasitic CNS infection globally; etiologic agent is Taenia solium; due to ingestion of eggs (contaminated water or food); cysts can be either intra/extraparenchymal

A

Cysticercosis

116
Q

Cysticercosis is caused by the ingestion of undercooked pork with Taenia solium (True or False)

A

False: due to ingestion of EGGS in contaminated water or food (undercooked pork with cysts caused INTESTINAL, not CNS infection)

117
Q

Treatment for Naegleria fowleri

A

Amphotericin B

118
Q

2 main pathways for transmission of an infection to a fetus

A

Ascending (from vagina/cervix)

Transplacental

119
Q

What are the STORCH infections (can cause congenital encephalitis via transplacental spread)

A 
Syphilis
Toxoplasmosis
Other (HIV)
Rubella
CMV
HSV-2

Neurology-Week 2 (5 decks)

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