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Tropical medicine - All clinical images copyright Gorgas course - : Instituto de Medicina Tropical Alexander von Humboldt > CNS specific > Flashcards

CNS specific Flashcards

1
Q

3 main causes pyogenic meningitis

A

S pneumo

N meningitidis groups A B C W and Y

H influenzae type B

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2
Q

Spell 3 causes of a eosinophilic CSF in meningitis

A

PT BAG

Paragonimus westermani
Taenia solium (cysticercosis)
Baylisascaris procyonis (racoon)
Angiostrongylus cantonesis
Gnathostoma spinigerum

[Gnathostoma has all the edges and spini round]

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3
Q

CSF stain for bacteria? TB? Cryptococcal?

A

Gram
ZN or auramine
india ink

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4
Q

Pneumococcal meningitis not responding to cef?

A

Meropenem

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5
Q

Who gets H. influenza meningitis

A

Kids

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6
Q

Meningococcal outbreak management

A

Early recognition Eg >15 cases / 100,000
Identify organism and drug sensitivities
Alert authorities
Produce diagnostic algorithms and case definitions
Mass chemoprophylaxis/vaccination

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7
Q

What is cryptococcus? full name? Usually found in the environment due to?

A

Yeast like fungus
cryptococcal neoformans

Bird droppings

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8
Q

Usual mechanism for infection with cryptococcus ? Presentation?

A

Inhalation
Subacute / chronic meningitis (similar to TB)

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9
Q

Dx cryptococcal meningitis…csf stain?
blood test?

A

Either with india ink of CSF
CSF/ blood culture
Latex agglutination tests detect Cryptococcal polysaccharide antigen (CrAg)

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10
Q

Cryptococcal meningitis Rx ?
Consolidation phase?
Secondary prophylaxis ?

A

Amphotericin B (10mg/kg single dose)
+ flucytosine (25mg/kg QID) for 2 weeks
+fluconazole 1200mg QID for 2 weeks

Consolidation phase 8 weeks fluconazole 800mg

Fluconazole 200mg daily for life works

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11
Q

Cryptococcal meningitis prevention

A

screening for CrAg and rx with fluconazole (especially if HIV positive)

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12
Q

When fluconazole prophylaxis in HIV

A

CD4 <100

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13
Q

Arboviruses are transmitted by?

A

Insects
Arbo = ARthropod BOrn

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14
Q

3 key types of of arbovirus causing CNS disease

A

Flavivirus
-Japanese encephalitis / West Nile / tick-borne
-[dengue / zika / yellow fever - less likely CNS]

Alphaviruses
Bunyaviruses

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15
Q

Japanese encephalitis 70k cases per year - how many have long term neurological sequale?

A

50%
20-30% die

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16
Q

vector and hosts of japanese encephalitis? Geography

A

culex mosquito (Eg Culex tritaeniorhynchus)
-Mostly birds [egret/heron]
-Domestic pigs major amplifying host

China, SE Asia and India

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17
Q

Japanese encephalitis sx

A

10% develop Non specific fever with systemic upset …

<1% develop meningeal/encephalitis reduced consciousness with
- focal CNS eg seizures/parkinsonism
-or flaccid paralysis (polio-like) or Ascending (guillian-barre like)

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18
Q

Japanese encephalitis ix? where are characteristic changes on imaging?

A

CSF - MAY be normal early in disease
-Viral picture (lymphocytes, normal glucose, mild rise protein)
- ELISA IgM of CSF
[PCR often already negative as viraemia transient]

CT/MRI - Midbrain changes

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19
Q

Japanese encephalitis control

A

Vaccination
Treating rice paddys with neem cake (insecticide)
Individual protective measures from mosquito bites

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20
Q

West nile flavivirus geography? transmission?

A

More or less everywhere (africa, asia, middle east, Europe, USA
Culex pipens mosquito

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21
Q

Tick bourne ecephalitis virus spread by? Features

A

ixodes ticks spread through rodents and other small mammals

high fever for 1 week, then afebrile
then meningoencephalitis

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22
Q

The historical key cause of acute flaccid paralysis? Sx?

A

Polio

Fever - then afebrile period followed by assymetrical flaccid paralysis of one or more limbs (may be painful)

23
Q

Where do viruses affect to cause flaccid paralysis

A

Direct viral damage to the anterior horn cell

24
Q

Compare cause of flaccid paralysis Gilllian barre vs direct viral damage. Onset? pattern? Time to reach max paralysis? sensory ? csf findings?

A

Direct viral - Eg Enterovirus 71 / Polio
Rapid onset eg 2 days often with fever
Asymmetrical
No sensory
CSF lymphocytosis

GBS
Slow onset eg 2 weeks and often weeks after illness
symmetrical
common sensory issues
Raised protein in CSF

25
Q

Which countries’ polio still an issue?

A

Pakistan, Afghanistan and Nigeria

26
Q

virus causing acute flaccid paralysis endemic in Asia that isn’t polio?

A

Enterovirus 71

27
Q

Nipple / bellybuten sensory level

A

T4
T10

28
Q

Name 2 Ways TB can cause paralysis

A

Potts disease - TB of vertebral bones -> collapse and cord compression

TB meningitis -> secondary arteritis and cord infarction

Tuberculoma compresses cord

29
Q

Most common cause of spinal epidural abscess? Triad of Sx?

A

S aureus
Fever, Back pain, radiculopathy

-> spastic paralysis, bladder/bowel dysfunction, sensory loss

30
Q

Transverse myelitis caused by many viruses and which key bacteria?

A

mycoplasma pneumonia

[HIV, schisto, syphylis, denge, scrub typus, lime disease, leptospirosis…]

31
Q

When do you get HIV myelopathy? Other considerations if this is a differential?

A

Often with AIDS-dementia complex
-Due to direct viral damage

  • consider lympoma, cryptococus and herpes in AIDS
32
Q

Subacute degeneration of the spinal cord due to B12 deficiency. What infections may cause this? Super common signs?

A

Tropical spure
Fish tapeworm - diphyllobothrium lactum

Upgoing planters with a reduced knee jerk. Macrocytosis

[pernicious anaemia, coeliac, IBD, surgery]

33
Q

HIV negative with progressive spastic paralysis, loss of proprioception and vibration. Bowel / bladder dysfunction? cause? transmission?

A

Tropical spastic paraparesis
Human T lymphotropic virus type 1 (HTLV-1)
breast milk or rarely blood born

34
Q

What is rabies

A

Bullet shaped RNA Rhabdovirus

35
Q

Rabies mostly found in salavia of infected animals - how does it get to CNS

A

Along peripheral nerves
-> Longer time to symptoms if bitten on hand/foot compared with face bite

36
Q

Rabies is usually clinical diagnosis - how might you confirm?

A

Saliva for NAAT / PCR testing only reliable way

Brain biopsy if dead

37
Q

Rabies Rx if high risk exposure in unvaccinated?

A

Rabies Ig + 4 site post exposure vaccine

38
Q

When commence ART if dx with crptococcal meningitis

A

After 4-6 weeks

39
Q

When investigating flavivirus what Ix do you need to do

A

CSF/Serum serology (IgM)
[PCR often negative by time of presentation ]

40
Q

59 yo male returned from a vacation in Bali with fever, headache, confusion
Developed flaccid paralysis, altered mentation, respiratory failure
CSF lymphocytosis, N protein, glc
Respiratory failure, pneumonia, and death
Most likely?

A

Japanese encephalitis

41
Q

Which travellers should get Japanese encephalitis vaccine?

A

> 4 wks to endemic region
during transmission season

42
Q

Name 3 main types of enterovirus? Diagnosis of these is based on?

A

Polio
Coxsackie
Echovirus

PCR
- serotyping (monoclonal antibodies)
- microneutralization

43
Q

Polio transmission

A

Faecal oral

44
Q

Polio most commonly is asymptomatic 1000:1? What are the other presentations?

A

GI upset

Paralysis
- due to anterior horn infection

Hypogammaglobulinemia/Agammaglobulinemia
-Encephalitis

45
Q

What is post polio syndrome

A

Slow continuous decline in strength over years following acute polio

46
Q

Name a benefit of live attenuated oral polio and inactivated polio vaccine.

A

Live oral - spread to close contacts ie protects more than just the person getting vaccine
-High levels of luminal antibodies (and that’s how polio gets in)

IPV - Can give to immunocompromised
-No Vaccine-associated Paralytic Polio

47
Q

Where in the world is meningitis most prevalent

A

Meningitis belt across Africa

48
Q

Contraindications to LP before CT scan in meningitis

A
  • Focal neurologic deficits (except CN palsies)
  • New onset seizures
  • Severely altered mental status (GCS <10)
  • Severely immunocompromised state
49
Q

What physiological issue prevents gent from working

A

Low pH

50
Q

Listeria monocytogenes meningitis rx

A

Ampicillin + gent

51
Q

Strep agalacticae meningitis rx

A

Ampicillin

52
Q

Name 3 bacteria that present as an aseptic meningitis

A

Leptospira interrograns
Orienta tsutsugamushi
Rickettsia ssp eg prowazekii / typhi

53
Q

Name 3 DDx of subacute meningitis

A

Tuberculosis
Cryptococcal disease
Noninfectious (Sarcoid, malignancy)
Spirochetes (Syphilis, Lyme)

[Less common
Other fungi (e.g. Histo, cocci),
Other bacteria (Brucella, Melioidosis, Scrub typhus, Whipple’s)
Parasites (T solium)
vasculitis]

Tropical medicine - All clinical images copyright Gorgas course - : Instituto de Medicina Tropical Alexander von Humboldt (26 decks)

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