Exam 5 CNS flashcards
1
Q
Encaphalitis
A
agents in brain and spinal cord
Agents are specific for location
2
Q
Viral vs bacterial meningitis
A
Bacterial is way worse!!
3
Q
Poliomyelitis
A
“infantile paralysis”
Really likes the spinal cord
Clean water increased occrurance!
4
Q
Polio morph
A
picornovirus
ACID STABLE
Three antigenic types
EXPELLED IN FECAL MATTER
5
Q
Polio epi
A
Humans only host
Vaccines will drive to extinction
6
Q
Polio path
A
replicates in GI tract
Spreads to CNS
Assymetric paralysis
7
Q
Non polio enteroviruses
A
More problematic for neonates
(unlike polio)
ECHO
Coxsakie
8
Q
NP enteroviruses
A
newborn bulgin fontanelle
Older kids and alduts get less severe meningitis
9
Q
NP enteroviruses treatment
A
Usually won’t grow in culture
Use serology
Picovar can treat
10
Q
NP enteroviruses epi/prevention
A
season: summer, fall
No vaccines
Wash hands
11
Q
Enterovirus D68
A
usually mild
Can produce polio type paralysis
Common in crowded areas
12
Q
LCMV
A
arenavirus
Two ssRNA circles
+ and ambisense
(alllows delayed transcription)
13
Q
LCMV resevoir
A
mice
Risk for child if mom is infected
Immunocompromised
14
Q
Arboviruses
A
mosquitos are vectors
Birds and mammals are reservoirs
Worse outcomes in kids
Late fall and summer
15
Q
arbovirus id
A
MAC-ElISA
Doesn’t require culture
Look for IgM in CSF
16
Q
Colorado Tick fever
A
can be detected by fluorescent assay
Or rt-PCR
17
Q
Togaviruses
A
EEE
WEE
VEE
18
Q
Flaviviruses
A
St Louis encephalitis
West Nile virus
Yellow fever virus
Japanese Encephalitis
19
Q
Bunyavirus
A
California encecpalitis
(lacrosse)
Most common in midwest
20
Q
EEE
A
east of mississippi
Horses
(infected but not risk factor)
Kids under 15, adults ages over 55
swamps
21
Q
WEE
A
pediatric cases
Unpredictable season
Common in farms
22
Q
st louis enecp
A
Midwest
Summer-fall
Mosquito vector, bird resevoir
Sparrows
Low economic status
23
Q
west nile virus
A
flavivirus
Some antigenic sim w/ StLE
Greatest risk for age > 50
Result or air travel
24
Q
WNV disease
A
can paralyze like polio
Measles like syndrome w/ rash
Neuronphagia of anterior horn
25
WNV detection/treatment
spread by blood transfusion, mosquito bites
Check IgM antibodies
26
Japanese Enceph
Vaccine available
(military)
Can amplify in herd animals
27
California E
| lacrosse
kids that play outside
Unique daytime feeding mosquito
28
Colorado Tick fever
Tick
Small mammal reservoir
(summer)
Similar to rotavirus
```
SADDLEBACK FEVER
(up and down)
```
29
WEE
chimera
EEV and Sindibis
30
Rabies virus
dogs are bridge vector
31
Rabies virus vaccine
Use virus to infect animal
Collect antibodies
32
Viruses that go retrograde to CNS
Polio, rabies, HSV
33
Rabies Clinical
2 year incubation
Where bite was determines length
Prodrome: fever etc
Excitatory phase: “hydrophobio”
-swelling of throat causes painful swallowing
34
Rabies Pathology
Negri bodies (eosinophils in cytoplasm)
35
Rabies epidemiology
global distribution
Small mammals
Bats!
36
Rabies transmission
not only bites, can just be contact
Aerosol transmission
37
Milwuakee Protocol
Induce coma, give adamantine
38
Rabies Control
prophylaxis, avoid animals
39
Rabies prophylaxis
HRIG vaccine into wound,
| Then 4 shots in deltoid over 4 weeks
40
Herpes Simplex Virus
Most common fatal encephalitis in US
HSV-1 death usually from reactivation
And attacking frontal/temporal lobe
41
HSV-1
Casual contact early in life
42
HSV-2
from sex
43
HSV treatment
treat newborn with acyclovir if suspected
44
acyclovir treatment
stop virus polymerase from DNA rep
45
Prions
“slow virus infections”
Ex: scrapies and visna
Get into brain and change animal behaviour
Dementia in humans
46
Transmissable spongiform encepalopathies
| SPEs
sheep: scrapie
Cows: mad cow
Humans: CJD
47
kuru
shaking disease in papa new guinea
Cannabilistic rituals
Amyloid placques
48
CJD
frequent in 60-70yo
Resembles kuru
15-20m invubation
New variant: effects younger people
(associated with mad cow)
Plaques (not in mad cow)
49
Prion genome
No DNA or RNA!
Infectious protein
50
Killing prions
resist uv light, heat
Surgically spread
Inactivated by sodium hypchlorite and NaOH
51
Prion propagation
change of shape, forms B pleeted sheets
Cant be undone
52
CJD manifestation
No immune response (unlike alzheimers)
| Rare genetic predisposition
inherited form
53
CJD treatment
None
54
Sporadic CJD
```
most cases
(no genetic predisposition)
```
55
Infectious CJD
direct inoculation
Human pGH injections
56
nvCJD
believed to be transfer of mad cow disease
Cows eat meat bone meal
57
PML (white matter disease)
JC virus reactivation
More common in AIDS
58
Multiple sclerosis
demeyelination of white matter
Relapse or intermittent, chronic progresion
Possible virus etiology
59
Most fungal CNS
candida
Cryptococcus is most commonly tested
60
crypto neoformins morph and transmisson
polysaccharide capsule!!
Found in environment
(pigeon droppings)
Not transmitted p2p
61
crypto lab
inda wet mount, sabourad agar culture
Latex agglut can detect antigen even in CNS
62
crypto virulence
Capsule avoids phago
Melanin in cell wall: antioxidant
Mannitol: also antioxidant
(inhibits neut killing)
63
crypto treatment
amphotericin B
Can enhance with fluconazole
64
Candida CNS
budding yeast, germ tubes,
Psuedo and true hyphae
Commensal but problematic in
Immunocompromised
BAD if desseminates
65
Candida CNS disease
High mortality if not treaeted
66
Aspergillosis CNS background
branching septate hyphae
Environmental
67
aspergillosis pathophys
Enters through lungs or ear
Surgical wounds
Treat with
Amphotercin B
Fluconazole
Voriconazole
68
Mucormycosis
mucor and rhizopus
Branching, non septate hyphae
Pt with diabetic ketoacidosis
69
Amoebic CNS (PAM)
naegleria fowleri
Protozoan in water
Contracted swimming in the sumer
70
PAM background
flagellated form enters nasal passage
Transforms to amoeboid form
Migrates along olfactory nerve to the brain
71
Toxoplasmosis
don't eat cat shit
| passes oocyst
72
Bacterial meningitis
HiB (vaccine now)
Listeria (food)
Neisseira (dorms)
Group B strep (mother to child)
Strep pneumonia (Abx resistence)
73
pathogenesis
mucosa to bloodstream to bbb
Release of inff cytokines, WBCs enter CSF
Perm of bbb increases
Causes edema and IC pressure
74
most common route of b CNS infections
blood to BBB
75
Triad of b CNS
Fever
BAD headache
Neck stiffness
76
Pint glass on skin?
rash from neisseria does not blanch
77
Neonatal b CNS signs
bulging fontanelle
Weird cry
Limp
Hypothermia (death)
78
signs of b CNS in CSF
Cloudy
Gram stain
DNA probes
Culture (may take too long)
79
Blood studies for b CNS
glucose will be lower in CSF than blood
80
b CNS treatment
steroids for swelling
Intrathecal Abx
81
b menin most common
group B strep
E coli
Listeria
82
how has neonatal meningitis decreased?
group b strep vaccine
83
Transmission rate for neontal if not give Abx
50%
Meningitis if immunocomp
84
Group b strep morph
B hemolysis (complete RBC lysis)
85
Late onset neonatal meningitis
bone/joint problems
86
Diagnosis of B strep
CAMP strip using CSF
Confirmative treatment after treatment
Uses staph a as control
87
Unique Listeria virulence factor
Listeriolysin O (LLO)
Punches hole to escape killing
88
HiB basics
LOS in cell wall
Requires RBC growth factors but can't lyse
Capsule needed for diesase
Often starts as pneumonia
89
Virulence factors HiB
PRP capsule
Neurominidas and IgA protease
Fimbriae needed for nasopharynx colonization
LOS: kills cilia, epi cells
90
HiB culture
Culture with staph to look for satellites
91
Pneumococcus virulence
Capsule prevents C3b from coating
Autolysin
Pneumolysin: pore former, cell lysis
92
s pneumoniae confirmation
bile lysis (clear tube)
Quelling reaction for capsule
Optochin sensitivity
93
S pneumo treatment
Penicillin
Vancomycin if resistant
94
S pneumo vaccine
23-valent for old
13-valent for kids
95
Meningoccal Meningitis
Neisseria meningitids
G- kidney shaped cocci
Encapsulated, 5 types
Vaccine for all 5
College, military
96
Meningitis epi
humans only carrier
Requires close contact
97
Meningitis Clinical
Non blanching rash
Sepsis and shock
98
Leprosy
fastidious, acid fast bacilli
Found in 9anded armadillo
Like slightly lower temp
(periperal nerves)
Transmittted by respiratory droplets
99
Polar tuberculoid
TH-1 Cell mediated response
Fewer organisms
TT, BT BB
Fewer lesions, non necrotizing
100
Polar lepromatous
TH-2 anti body response
More organisms
Many smaller lesions
101
Leprosy Reversal Reaction
Type 1
Spont. Increase in cell immunity
102
Erythema nodosum leprosy
Type 2
Type 3 response (immune complex)
103
Leprosy Treatment
multi drug
Steroids
104
Clostridium spp
Gram + rods
Neuro toxins
105
C tetani
spastic paralysis
Tetanospasmin (plasmid)
106
C botulinum
flaccid paralysis
Botulinum neurotoxin (chromosome)
107
C toxins (general)
A-B toxin
108
Botulinum toxin
cleaves snare proteins
Prevents Ach release
Muscle can't do anything = flaccid
109
botulism
spored germinate in intestine
1. Kids: arent protected by normal flora
2. Foodborne: Improperly canned food
2. Wound: contaminated by spores
(spores)
110
Botulism signs/symptoms
fatigue
Vision
GI
Progression from periphery to lungs
Death by repiratory paralysis
111
Botulism treatment
anti toxin
112
Tetanus toxin
binds to peripheral motor nerve terminals
Works retrograde to inhibitor neurons
Prevents muscles from being able to relax
Spastic paralysis
113
Tetanus infection
Generalized: broken skin, umbilical
Localized: partially immune
Cephalic: only facial muscles
114
Tetans signs/symptoms
Lock jaw
Hypertension, tachycardia
Jerking/seizures
Death by cardiac/respiratory complications
115
Tetanus treatment
treat: tetanus Ig (antitoxin)
Immunization: tDAP etc
