Exam 2: [CNS Infectious Diseases] Flashcards
Routes by which Infection can get into the CNS
1) Haematogenous (Bacteremia, Virema)
2) Directly from Local Infection
3) Penetrating injuries (Cribiform Plate or Ear Fractures provide pathway to the cranium)
Primary Infections of the MENINGES [CNS] List
1) Acute Bacterial (suppurative meningitis)
2) Acute Viral Meningitis
3) Chronic Meningitis: tuberculosis, cryptococcidiosis
Acute Bacterial (Suppurative) Meningitis : Site of Infection, Components Increased/Decreased:
- Infection is in Leptomeningitis
- CSF shows increased pressure
- Contains: organisms, increased protein decreased glucose, neutrophils (pus) so CSF looks cloudy
- Type of organism varies depending on pt. Age
Acute Bacterial (Suppurative) Meningitis: Organisms in Different Age Groups
Neonates/Infants: group B strep, E. Coli, Listeria
6 mo-5yrs (FORMER): H. Influenzae strain B
6 mo-5yrs (CURRENT): Streptococcus pneumonia
5yrs-Young Adult: Neisseria Meningitidis
Older Adults: S. Pneumoniae & Gram Negatives
Acute Bacterial (Suppurative) Meningitis: Pathology
- Meninges Congested & Inflamed
- Neutrophils & Fibrin Present
- Bacteria are Obvious on CSF Smear
- Culture Gives Sensitivities
Acute Bacterial (Suppurative) Meningitis: Clinical Features
- Fever, Headaches, Stiff Neck, Altered Mental Status, Kernig’s Sign, Brudzinski’s Sign
- May have symptoms of the previous infection
Acute Bacterial (Suppurative) Meningitis: Treatment & Progression
- Progresses Very Rapidly
- Medical Emergency
- Prognosis related to rapidity of treatment
What should be suspected from an adult who was previously well and may resent as part of an epidemic?
N. Meningitidis
Acute Bacterial (Suppurative) Meningitis: Complications
1) Epilepsy, Hydrocephalus, Neuro Deficits (mental retardation, CN palsies of CNII & CNVIII, spinal nerve neuropathies)
2) Significant Mortality Rate
Meningococcus Complications
1) DIC (Disseminated Intravascular Coagulation) abnormal blood clotting
2) Septic Shock
3) Waterhouse-Friedrichsen Syndrome
Neurosyphilis: Caused by what Organism, Symptoms occur when? Infiltrate & what + Test?
- Cause by organism Treponema Pallidum
- Symptoms may occur years after infection
- 2/3 yrs after infection Meninges have Lymphocytic Infiltrate and a (+) VDRL Test (cure=penicillin)
When does Meningovascular Syphillis Occur?
- 3 Years following infection
- Chronic inflammation of meninges -> cranial nerve palsies
- Some cases have “Gummas” that act as space-occupying lesions
Neurosyphillis: After 10 years
- “Parenchymous Syphillis” at this Stage
- General Paresis (dementia & paralysis)
- Tabes Dorsalis
What Symptoms does Tabis Dorsalis Have?
- In spinal cord (lightning pains, sensory loss, hypotonia, areflexia)
- Argyll-Robinson Pupils
- Charcots Joints
What Does General Paresis show?
Progressive dementia & psychosis with cerebral atrophy
Causative Agents of Viral Meningitis
1) Coxsackievirus B
2) Mumps
3) EBV
4) Echovirus
Viral Meningitis Features
- Produces Aseptic Meningitis (No Bacteria)
- Benign, Self-Limiting
- May spread to Encephalitis
- CSF is clear
- Cells = Lymphocytes
- Protein moderately raised, Glucose is Normal
Chronic Meningitis Causative Agents
1) Mycobacterium Tuberculosis
2) Cryptococcus
3) Brucella Species
4) Treponema Pallidum
Meningeal Appearance in Chronic Meningitis
- Thick Meninges (all 3)
- Fibrinous Exudate in the Subarachnoid Space
Chronic Meningitis Leads To:
Fibrous Adhesions Causing Obstructive Hydrocephalus
Chronic Meningitis Cellular Components
[In CSF]
- Increased # of Mononuclear Cells
- Increased Protein
- Decreased Glucose
Chronic Meningitis: Signs/Symptoms & Prognosis
- Insidious Onset & Less Marked than in the Acute Forms
- Poor Prognosis
Different Ways Viruses can Affect the Brain
- From Systemic Infection
- Direct Target of the Brain
- Specific areas of Brain OR All-Over
- Specifically target Neurons
- Specifically Target Neuroglia
- Healthy OR Immunocompromised Individuals
Viral Encephaltis: Pathological Features
- Perivascular Cuffing of Mononuclear Cells
(Lymphocytes, plasma cells, monocytes) - Microglial Nodules often Present
- Neuronophagia if Neuron has Dies
- Inclusion Bodies in Neurons
Viral Encephalitis: Prognosis
Very Serious Condition that can lead to Death or Permanent Neurological Defects
Arbovirus Infections
1) St. Louis Encephalitis
2) Eastern Equine Encephalitis
3) Venezuelan Encephalitis
4) California Encephalitis
5) West Nile Encephalitis
Sporadic Viral Infections
1) Herpes Simplex Encephalitis
2) Cytomegalovirus
3) Progressive Multifocal Leukoencephalopathy
4) Subacute Sclerosing Panencephalitis (SSPE)
Epidemic Viral Infections
1) Arbovirus Infections
2) HIV Encephalitis
St Louis Encephalitis: Vector/Reservoir, Time of Year, Population at Risk
Vector: Mosquito
Reservoir: Birds (including Poultry)
Late Summer & Early Fall
Very Young & Elderly @ Highest Risk
St. Louis Encephalitis: Histology
- Perivascular Infiltrates
- Glial Nodules [Brain Stem]
St. Louis Encephalitis: Clinical Signs/Symptoms
- Fever, Photophobia, Meningism
- Consiousness Disurbances, Convulsions
- Focal Neurological Signs & Symptoms
**In fatal cases: Body temp keeps rising, patient goes into a coma, then dies
HIV Encephalitis (AIDS- dementia or HIV Encephalitis): % that Show changes, Change in HIV-1, What does it produce?
- 90% show changes at autopsy
- 60% show neurological changes
- In HIV-1, Brain shows Atrophy
- Produces Progressive Neurological Disease
HIV Encephalitis (AIDS- dementia or HIV Encephalitis): Histology
- Perivascular Infiltrates
- Glial Nodules
- Multinucleated Giant Cells
- Changes most obvious in (White Matter & Basal Ganglia)
Herpes Simplex Encephalitis: MC type in Adults & Neonates
Adults: HSV-1 Infection
Neonates: HSV-2
Herpes Simplex Encephalitis: Produced Pathologies, MC Location & Treatment
- Produces: Hemorrhagic Necrotizing Encephalitis
- MC Location: Temporal Lobes & Frontal Orbital Areas
- Treatment: Acyclovir (reduces mortality)
Herpes Simplex Encephalitis: Histology
- Perivascular Infiltrates
- Glial Nodules
- Inclusion bodies in the nuclei of affected Neurons
Cytomegalovirus Encephalitis: Population Affected & Area of the Brain Affected)
- Neonates & Immunocompromised Individuals
- Affects Ependyma (may affect any brain area)
Cytomegalovirus Encephalitis: Histology
- Perivascular Infiltrates
- Glial Nodules
- Enlarged Neurons with obvious Intranuclear Inclusions
Progressive Multifocal Leukoencephalopathy: Population Affected & Produced Pathologies
- AIDS or Immunocompromised Individuals
- Acute, rapidly progressive illness with Multifocal Cerebral Dysfunction
Progressive Multifocal Leukoencephalopathy: Cause & Tissue Affected
- Cause: JC Virus (in the papovavirus group)
- Affects Oligodendrocytes Production in areas of Demyelination
What are the Acute Disseminated Encephalomyelitis Diseases? (Definition)
Monophasic Demyelinating Disease that follows a Viral Illness or in Immunization for a Virus
Acute Disseminated Encephalomyelitis: Preceding Viruses
1) Measles
2) Chicken Pox
3) Rubella
Acute Disseminated Encephalomyelitis: Preceding Immunizations
1) Smallpox
2) Rabies
3) Pertussis
Acute Disseminated Encephalomyelitis: Symptoms
- Occur 1 week following illness
- Longer if following an Immunization
Subacute Sclerosing Panencephalitis: Definition
Slowly progressing Dementia that Occurs a few years after a child has had Measles
(Chronic Measles Infection)
Subacute Sclerosing Panencephalitis: Histology
- Degeneration (Brain) Gray Matter & Basal Ganglia
- Intranuclear Inclusions seen in Infected Cells
Subacute Sclerosing Panencephalitis: Symptoms
- Personality Changes
- Myoclonic Type Movements
- Death in 1-2 Years
Poliomyelitis: Etiological Agent Transmission
(Poliovirus) that is transmitted by the fecal-oral route
Poliomyelitis: Internal Pathological Pathway
- Multiplies in Lymphoid Tissues of Oropharynx & Intestine for 2 Weeks
- Then goes into Blood Stream & Causes Flu-Like Illness
- Virus then gets into the Meninges producing Acute Lymphocytic Meningitis
Poliomyelitis: Cells Affected
[In small % of Individuals]
- Involves the Lower Motor Neurons in the Anterior Horn
- Motor Nuclei of the Medulla
Poliomyelitis: How is the Spinal Cord Affected?
Spinal Cord: Asymmetric and Flaccid Paralysis with Muscle Atrophy & Loss of Deep Tendon Reflexes
Poliomyelitis: How is the Medulla Affected?
Can be involvement of the muscles for Respiration producing Problems with Ventilation
Poliomyelitis: Long-Term Effects
- Surviving patients have varying degrees of Paralysis
- Some required assisted Ventilation
- Post-Polio Syndrome in Long-Term Survivors
Polio Immunizations
Injected vaccine > Oral Vaccine
[due to issues of Polio Infections caused by the Oral Vaccine