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Host and Defense > EXAM 2 CNS Infections > Flashcards

EXAM 2 CNS Infections Flashcards

1
Q

what are 3 sources of infectious (transmissible) diseases?

A

bacterial, fungal, other

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2
Q

what are the 4 types of infections involving the CNS?

A

abscess, empyema, meningitis, and encephalomyelitis

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3
Q

what are the possible sites of infection involving the CNS?

A

brain and spinal cord

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4
Q

what is the etiology of infections involving the CNS?

A

bacterial, fungal, and other

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5
Q

describe the oral sequence of CNS infections

A
  • direct extension of acute oral infections
    • caries - pulpitis
    • apical periodontitis
    • phlegmon/abscess formation
    • necrotizing ulcerative gingivitis/periodontitis
  • bacteremia, usually transient
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6
Q

what are the types of bacterial CNS infections?

A
  • encephalomyelitis
  • abscesses
    • cerebral
    • spinal
  • empyema
  • meningitis
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7
Q

___ is the most common CNS infection secondary to dental pathology/procedure

A

CNS abscess

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8
Q

what are the symptoms of CNS abscesses?

A
  • changes in consciousness
  • focal neurologic signs
    • speech
    • visual field defects
    • paresis
  • vomiting
  • fever
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9
Q

what are the risk factors for bacterial abscesses?

A
  • immunocompromised
  • meningitis
  • oral pathology
  • oral procedures
  • chronic illness
  • chronic heart disease
  • skull fracture
  • sinus infection
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10
Q

how are CNS abscesses diagnosed?

A
  • symptoms
  • physical exam
  • imaging (the most important)
  • laboratories
    • peripheral blood
    • CSF
    • cultures
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11
Q

describe the treatment of bacterial abscesses

A
  • antibiotics
  • surgery (if >2.5cm)
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12
Q

the pathology of bacterial abscesses is ___

A

liquefactive breakdown of parenchyma of the brain

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13
Q

describe the etiology of dental CNS infections

A
  • 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
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14
Q

what is the most common dental procedure associated with CNS infection? what is the % frequency?

A

extraction (60%)

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15
Q

describe the oral cultures, blood, and CNS microbiology of CNS infections with dental origins

A
  • oral cultures
    • 61% matched CNS cultures
  • blood
    • 89% negative
  • CNS
    • negative - 3.6%
    • monomicrobial 49.1%
    • polymicrobial 47.3%
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16
Q

what are the 2 most common neurosurgical procedures used to address CNS infections of dental origin?

A

craniotomy and burr hole aspiration

these are high risk surgeries

17
Q

Mycoses infections generally occur in ___ patients

A

immunocompromised

18
Q

___ are the most common neurosurgical organism

A

mycoses

19
Q

describe mycoses

A
  • pathogenic molds
    • aspergillus
    • zygomycetes
  • candida spp.
  • cryptococcus neoformans
  • dimorphic fungi
20
Q

___ is the most common pathogen that causes CNS infections and infections of the sinuses

A

aspergillus fumigatus

21
Q

what is the etiology of aspergillus?

A
  • oral -> sinus -> CNS
  • immunocompromised hosts
  • presentation - focal symptoms
22
Q

describe the pathology of aspergillus

A
  • single/multiple abscess
  • granulomata
  • infarcted brain
23
Q

what is the treatment for CNS infections caused by aspergillus?

A
  • aggressive surgical excision
  • amphotericin B + flucytosine
24
Q

describe the risk factors and presentation of zygomycetes

A

aka mycormycosis

  • risk factors - diabetes and immunosuppression
  • presentation - rapidly progressive facial swelling
25
Q

what are the 3 species of zygomycetes?

A

mucor spp., rhizomucor spp., and rhizopus spp.

26
Q

what is the morphology of zygomycetes?

A

wide/ribbon-like, 90* branching

27
Q

are candidial CNS infections common?

A

no

oral etiology unproven

immunocompromised

28
Q

what are the 3 forms of candidial infections?

A
  • meningitis
  • encephalitis
  • abscess
29
Q

what is the treatment for candidial infections?

A

multimodal antifungals

30
Q

what are 4 other organisims responsible for CNS infections?

A

parasites, spirochetes, viruses, prion disease

31
Q

which 2 parasites can cause CNS infections? describe them.

A
  • helminths
    • neurocystercercosis
      • taenia solum (pork tapeworm)
  • protozoa
    • toxoplasmosis
      • toxoplasma gondii
32
Q

describe spriochetes

A

uncommon neurosurgical specimens

dental/oral CNS infection not known

33
Q

spirochetes cause which 2 diseases? describe them.

A
  • neurosyphilis
    • treponema pallidum
  • lyme disease
    • borrelia burgdorferi
    • gumma - inflammatory pseudotumors
34
Q

what are the main 2 viruses responsible for CNS infections?

A
  • herpetic gingivostomatitis
  • herpes simplex encephalitis
35
Q

describe herpetic gingivostomatitis

A
  • HSV1 or HSV2
  • very common
    • peak incidence 6mos - 5 years and 20 years
36
Q

describe the incidence of herpes simplex encephalitis

A

rare: 3 cases/ million person - years

37
Q

what is prion disease? what are the types?

A
  • aka “slow” viruses
  • types
    • creutzfeldt/jakob disease (CJD) = sporadic/ iatrogenic
    • CJD new variant
    • gerstmann-straussler syndrome (GSS)
    • kuru (extinct)
38
Q

what is the treatment for prion diseases?

A

there is no treatment

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