EXAM 2 CNS Infections Flashcards
what are 3 sources of infectious (transmissible) diseases?
bacterial, fungal, other
what are the 4 types of infections involving the CNS?
abscess, empyema, meningitis, and encephalomyelitis
what are the possible sites of infection involving the CNS?
brain and spinal cord
what is the etiology of infections involving the CNS?
bacterial, fungal, and other
describe the oral sequence of CNS infections
- direct extension of acute oral infections
- caries - pulpitis
- apical periodontitis
- phlegmon/abscess formation
- necrotizing ulcerative gingivitis/periodontitis
- bacteremia, usually transient
what are the types of bacterial CNS infections?
- encephalomyelitis
- abscesses
- cerebral
- spinal
- empyema
- meningitis
___ is the most common CNS infection secondary to dental pathology/procedure
CNS abscess
what are the symptoms of CNS abscesses?
- changes in consciousness
- focal neurologic signs
- speech
- visual field defects
- paresis
- vomiting
- fever
what are the risk factors for bacterial abscesses?
- immunocompromised
- meningitis
- oral pathology
- oral procedures
- chronic illness
- chronic heart disease
- skull fracture
- sinus infection
how are CNS abscesses diagnosed?
- symptoms
- physical exam
- imaging (the most important)
- laboratories
- peripheral blood
- CSF
- cultures
describe the treatment of bacterial abscesses
- antibiotics
- surgery (if >2.5cm)
the pathology of bacterial abscesses is ___
liquefactive breakdown of parenchyma of the brain
describe the etiology of dental CNS infections
- underlying intra-oral pathology 87%
- 40% dental symptoms precede neurologic symptoms
- 70% ipsilateral
- diffuse/bilateral oral pathology common (gingivitis)
- preceding procedures 47% (including all without oral pathology)
- most related to molar teeth
what is the most common dental procedure associated with CNS infection? what is the % frequency?
extraction (60%)
describe the oral cultures, blood, and CNS microbiology of CNS infections with dental origins
- oral cultures
- 61% matched CNS cultures
- blood
- 89% negative
- CNS
- negative - 3.6%
- monomicrobial 49.1%
- polymicrobial 47.3%
what are the 2 most common neurosurgical procedures used to address CNS infections of dental origin?
craniotomy and burr hole aspiration
these are high risk surgeries
Mycoses infections generally occur in ___ patients
immunocompromised
___ are the most common neurosurgical organism
mycoses
describe mycoses
- pathogenic molds
- aspergillus
- zygomycetes
- candida spp.
- cryptococcus neoformans
- dimorphic fungi
___ is the most common pathogen that causes CNS infections and infections of the sinuses
aspergillus fumigatus
what is the etiology of aspergillus?
- oral -> sinus -> CNS
- immunocompromised hosts
- presentation - focal symptoms
describe the pathology of aspergillus
- single/multiple abscess
- granulomata
- infarcted brain
what is the treatment for CNS infections caused by aspergillus?
- aggressive surgical excision
- amphotericin B + flucytosine
describe the risk factors and presentation of zygomycetes
aka mycormycosis
- risk factors - diabetes and immunosuppression
- presentation - rapidly progressive facial swelling
what are the 3 species of zygomycetes?
mucor spp., rhizomucor spp., and rhizopus spp.
what is the morphology of zygomycetes?
wide/ribbon-like, 90* branching
are candidial CNS infections common?
no
oral etiology unproven
immunocompromised
what are the 3 forms of candidial infections?
- meningitis
- encephalitis
- abscess
what is the treatment for candidial infections?
multimodal antifungals
what are 4 other organisims responsible for CNS infections?
parasites, spirochetes, viruses, prion disease
which 2 parasites can cause CNS infections? describe them.
- helminths
- neurocystercercosis
- taenia solum (pork tapeworm)
- neurocystercercosis
- protozoa
- toxoplasmosis
- toxoplasma gondii
- toxoplasmosis
describe spriochetes
uncommon neurosurgical specimens
dental/oral CNS infection not known
spirochetes cause which 2 diseases? describe them.
- neurosyphilis
- treponema pallidum
- lyme disease
- borrelia burgdorferi
- gumma - inflammatory pseudotumors
what are the main 2 viruses responsible for CNS infections?
- herpetic gingivostomatitis
- herpes simplex encephalitis
describe herpetic gingivostomatitis
- HSV1 or HSV2
- very common
- peak incidence 6mos - 5 years and 20 years
describe the incidence of herpes simplex encephalitis
rare: 3 cases/ million person - years
what is prion disease? what are the types?
- aka “slow” viruses
- types
- creutzfeldt/jakob disease (CJD) = sporadic/ iatrogenic
- CJD new variant
- gerstmann-straussler syndrome (GSS)
- kuru (extinct)
what is the treatment for prion diseases?
there is no treatment
