Exam 5 CNS flashcards

1
Q

Encaphalitis

A

agents in brain and spinal cord

Agents are specific for location

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2
Q

Viral vs bacterial meningitis

A

Bacterial is way worse!!

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3
Q

Poliomyelitis

A

“infantile paralysis”

Really likes the spinal cord

Clean water increased occrurance!

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4
Q

Polio morph

A

picornovirus

ACID STABLE

Three antigenic types

EXPELLED IN FECAL MATTER

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5
Q

Polio epi

A

Humans only host

Vaccines will drive to extinction

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6
Q

Polio path

A

replicates in GI tract

Spreads to CNS

Assymetric paralysis

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7
Q

Non polio enteroviruses

A

More problematic for neonates
(unlike polio)

ECHO

Coxsakie

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8
Q

NP enteroviruses

A

newborn bulgin fontanelle

Older kids and alduts get less severe meningitis

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9
Q

NP enteroviruses treatment

A

Usually won’t grow in culture

Use serology

Picovar can treat

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10
Q

NP enteroviruses epi/prevention

A

season: summer, fall

No vaccines

Wash hands

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11
Q

Enterovirus D68

A

usually mild

Can produce polio type paralysis

Common in crowded areas

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12
Q

LCMV

A

arenavirus

Two ssRNA circles

+ and ambisense
(alllows delayed transcription)

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13
Q

LCMV resevoir

A

mice

Risk for child if mom is infected

Immunocompromised

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14
Q

Arboviruses

A

mosquitos are vectors

Birds and mammals are reservoirs

Worse outcomes in kids

Late fall and summer

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15
Q

arbovirus id

A

MAC-ElISA

Doesn’t require culture

Look for IgM in CSF

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16
Q

Colorado Tick fever

A

can be detected by fluorescent assay

Or rt-PCR

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17
Q

Togaviruses

A

EEE

WEE

VEE

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18
Q

Flaviviruses

A

St Louis encephalitis

West Nile virus

Yellow fever virus

Japanese Encephalitis

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19
Q

Bunyavirus

A

California encecpalitis
(lacrosse)

Most common in midwest

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20
Q

EEE

A

east of mississippi

Horses
(infected but not risk factor)

Kids under 15, adults ages over 55

swamps

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21
Q

WEE

A

pediatric cases

Unpredictable season

Common in farms

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22
Q

st louis enecp

A

Midwest

Summer-fall

Mosquito vector, bird resevoir

Sparrows

Low economic status

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23
Q

west nile virus

A

flavivirus

Some antigenic sim w/ StLE

Greatest risk for age > 50

Result or air travel

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24
Q

WNV disease

A

can paralyze like polio

Measles like syndrome w/ rash

Neuronphagia of anterior horn

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25
Q

WNV detection/treatment

A

spread by blood transfusion, mosquito bites

Check IgM antibodies

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26
Q

Japanese Enceph

A

Vaccine available
(military)

Can amplify in herd animals

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27
Q

California E

lacrosse

A

kids that play outside

Unique daytime feeding mosquito

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28
Q

Colorado Tick fever

A

Tick

Small mammal reservoir
(summer)

Similar to rotavirus

SADDLEBACK FEVER
(up and down)
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29
Q

WEE

A

chimera

EEV and Sindibis

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30
Q

Rabies virus

A

dogs are bridge vector

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31
Q

Rabies virus vaccine

A

Use virus to infect animal

Collect antibodies

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32
Q

Viruses that go retrograde to CNS

A

Polio, rabies, HSV

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33
Q

Rabies Clinical

A

2 year incubation

Where bite was determines length

Prodrome: fever etc

Excitatory phase: “hydrophobio”
-swelling of throat causes painful swallowing

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34
Q

Rabies Pathology

A

Negri bodies (eosinophils in cytoplasm)

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35
Q

Rabies epidemiology

A

global distribution

Small mammals

Bats!

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36
Q

Rabies transmission

A

not only bites, can just be contact

Aerosol transmission

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37
Q

Milwuakee Protocol

A

Induce coma, give adamantine

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38
Q

Rabies Control

A

prophylaxis, avoid animals

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39
Q

Rabies prophylaxis

A

HRIG vaccine into wound,

Then 4 shots in deltoid over 4 weeks

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40
Q

Herpes Simplex Virus

A

Most common fatal encephalitis in US

HSV-1 death usually from reactivation
And attacking frontal/temporal lobe

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41
Q

HSV-1

A

Casual contact early in life

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42
Q

HSV-2

A

from sex

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43
Q

HSV treatment

A

treat newborn with acyclovir if suspected

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44
Q

acyclovir treatment

A

stop virus polymerase from DNA rep

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45
Q

Prions

A

“slow virus infections”

Ex: scrapies and visna

Get into brain and change animal behaviour

Dementia in humans

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46
Q

Transmissable spongiform encepalopathies

SPEs

A

sheep: scrapie

Cows: mad cow

Humans: CJD

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47
Q

kuru

A

shaking disease in papa new guinea

Cannabilistic rituals

Amyloid placques

48
Q

CJD

A

frequent in 60-70yo

Resembles kuru

15-20m invubation

New variant: effects younger people
(associated with mad cow)
Plaques (not in mad cow)

49
Q

Prion genome

A

No DNA or RNA!

Infectious protein

50
Q

Killing prions

A

resist uv light, heat

Surgically spread

Inactivated by sodium hypchlorite and NaOH

51
Q

Prion propagation

A

change of shape, forms B pleeted sheets

Cant be undone

52
Q

CJD manifestation

A

No immune response (unlike alzheimers)

Rare genetic predisposition
inherited form

53
Q

CJD treatment

A

None

54
Q

Sporadic CJD

A
most cases
(no genetic predisposition)
55
Q

Infectious CJD

A

direct inoculation

Human pGH injections

56
Q

nvCJD

A

believed to be transfer of mad cow disease

Cows eat meat bone meal

57
Q

PML (white matter disease)

A

JC virus reactivation

More common in AIDS

58
Q

Multiple sclerosis

A

demeyelination of white matter

Relapse or intermittent, chronic progresion

Possible virus etiology

59
Q

Most fungal CNS

A

candida

Cryptococcus is most commonly tested

60
Q

crypto neoformins morph and transmisson

A

polysaccharide capsule!!

Found in environment
(pigeon droppings)

Not transmitted p2p

61
Q

crypto lab

A

inda wet mount, sabourad agar culture

Latex agglut can detect antigen even in CNS

62
Q

crypto virulence

A

Capsule avoids phago

Melanin in cell wall: antioxidant

Mannitol: also antioxidant
(inhibits neut killing)

63
Q

crypto treatment

A

amphotericin B

Can enhance with fluconazole

64
Q

Candida CNS

A

budding yeast, germ tubes,
Psuedo and true hyphae

Commensal but problematic in
Immunocompromised

BAD if desseminates

65
Q

Candida CNS disease

A

High mortality if not treaeted

66
Q

Aspergillosis CNS background

A

branching septate hyphae

Environmental

67
Q

aspergillosis pathophys

A

Enters through lungs or ear

Surgical wounds

Treat with
Amphotercin B
Fluconazole
Voriconazole

68
Q

Mucormycosis

A

mucor and rhizopus

Branching, non septate hyphae

Pt with diabetic ketoacidosis

69
Q

Amoebic CNS (PAM)

A

naegleria fowleri

Protozoan in water

Contracted swimming in the sumer

70
Q

PAM background

A

flagellated form enters nasal passage

Transforms to amoeboid form

Migrates along olfactory nerve to the brain

71
Q

Toxoplasmosis

A

don’t eat cat shit

passes oocyst

72
Q

Bacterial meningitis

A

HiB (vaccine now)

Listeria (food)

Neisseira (dorms)

Group B strep (mother to child)

Strep pneumonia (Abx resistence)

73
Q

pathogenesis

A

mucosa to bloodstream to bbb

Release of inff cytokines, WBCs enter CSF

Perm of bbb increases

Causes edema and IC pressure

74
Q

most common route of b CNS infections

A

blood to BBB

75
Q

Triad of b CNS

A

Fever

BAD headache

Neck stiffness

76
Q

Pint glass on skin?

A

rash from neisseria does not blanch

77
Q

Neonatal b CNS signs

A

bulging fontanelle

Weird cry

Limp

Hypothermia (death)

78
Q

signs of b CNS in CSF

A

Cloudy

Gram stain

DNA probes

Culture (may take too long)

79
Q

Blood studies for b CNS

A

glucose will be lower in CSF than blood

80
Q

b CNS treatment

A

steroids for swelling

Intrathecal Abx

81
Q

b menin most common

A

group B strep

E coli

Listeria

82
Q

how has neonatal meningitis decreased?

A

group b strep vaccine

83
Q

Transmission rate for neontal if not give Abx

A

50%

Meningitis if immunocomp

84
Q

Group b strep morph

A

B hemolysis (complete RBC lysis)

85
Q

Late onset neonatal meningitis

A

bone/joint problems

86
Q

Diagnosis of B strep

A

CAMP strip using CSF

Confirmative treatment after treatment

Uses staph a as control

87
Q

Unique Listeria virulence factor

A

Listeriolysin O (LLO)

Punches hole to escape killing

88
Q

HiB basics

A

LOS in cell wall

Requires RBC growth factors but can’t lyse

Capsule needed for diesase

Often starts as pneumonia

89
Q

Virulence factors HiB

A

PRP capsule

Neurominidas and IgA protease

Fimbriae needed for nasopharynx colonization

LOS: kills cilia, epi cells

90
Q

HiB culture

A

Culture with staph to look for satellites

91
Q

Pneumococcus virulence

A

Capsule prevents C3b from coating

Autolysin

Pneumolysin: pore former, cell lysis

92
Q

s pneumoniae confirmation

A

bile lysis (clear tube)

Quelling reaction for capsule

Optochin sensitivity

93
Q

S pneumo treatment

A

Penicillin

Vancomycin if resistant

94
Q

S pneumo vaccine

A

23-valent for old

13-valent for kids

95
Q

Meningoccal Meningitis

A

Neisseria meningitids

G- kidney shaped cocci

Encapsulated, 5 types
Vaccine for all 5

College, military

96
Q

Meningitis epi

A

humans only carrier

Requires close contact

97
Q

Meningitis Clinical

A

Non blanching rash

Sepsis and shock

98
Q

Leprosy

A

fastidious, acid fast bacilli

Found in 9anded armadillo

Like slightly lower temp
(periperal nerves)

Transmittted by respiratory droplets

99
Q

Polar tuberculoid

A

TH-1 Cell mediated response

Fewer organisms

TT, BT BB

Fewer lesions, non necrotizing

100
Q

Polar lepromatous

A

TH-2 anti body response

More organisms

Many smaller lesions

101
Q

Leprosy Reversal Reaction

A

Type 1

Spont. Increase in cell immunity

102
Q

Erythema nodosum leprosy

A

Type 2

Type 3 response (immune complex)

103
Q

Leprosy Treatment

A

multi drug

Steroids

104
Q

Clostridium spp

A

Gram + rods

Neuro toxins

105
Q

C tetani

A

spastic paralysis

Tetanospasmin (plasmid)

106
Q

C botulinum

A

flaccid paralysis

Botulinum neurotoxin (chromosome)

107
Q

C toxins (general)

A

A-B toxin

108
Q

Botulinum toxin

A

cleaves snare proteins

Prevents Ach release

Muscle can’t do anything = flaccid

109
Q

botulism

A

spored germinate in intestine

  1. Kids: arent protected by normal flora
  2. Foodborne: Improperly canned food
  3. Wound: contaminated by spores
    (spores)
110
Q

Botulism signs/symptoms

A

fatigue

Vision

GI

Progression from periphery to lungs

Death by repiratory paralysis

111
Q

Botulism treatment

A

anti toxin

112
Q

Tetanus toxin

A

binds to peripheral motor nerve terminals

Works retrograde to inhibitor neurons

Prevents muscles from being able to relax

Spastic paralysis

113
Q

Tetanus infection

A

Generalized: broken skin, umbilical

Localized: partially immune

Cephalic: only facial muscles

114
Q

Tetans signs/symptoms

A

Lock jaw

Hypertension, tachycardia

Jerking/seizures

Death by cardiac/respiratory complications

115
Q

Tetanus treatment

A

treat: tetanus Ig (antitoxin)

Immunization: tDAP etc