Fungi, Prions, & Other Infectious Agents Flashcards
what are the signs & symptoms of subacute to chronic meningitis syndrome?
fever
headache
neck rigidity
with or without focal neurologic signs
what are the CSF finding in px with fungal infections of the CNS?
glucose = subnormal;
pleocytosis (>1,000/mm3) = moderate
protein = elevated
lymphocytes predominate
what are the species of Cryptococcosis causing CNS infecctions?
Cryptococcus neoformans
Cryptococcus gatti (not that common)
what are common S/Sx of Cryptococccosis?
- headaches, fever & stiff neck = lacking
- gradually increasing ICP bcos of hydrocephalus = confusional state, dementia, cerebellar ataxia, spastic paraparesis, usually w/o other focal neurologic deficit
what are CSF findings in Cryptococcosis?
<50 cells/mm3 lymphocytic pleocytosis
what is the tx for Cryptococcosis?
Amphotericin B
if there are failures or relapse in Cryptococcosis tx, what should u give?
Amphotericin B + Flucytosine
continued for at least 6 weeeks
what is a characteristic of Toxoplasmosis?
ring-enhancing cerebral lesion or multiple lesions in cerebral imaging studies
why is lumbar tap CI in Toxoplasmosis?
mass lesion
what are possible tx of Toxoplasmosis?
Oral Sulfadiazine and Pyrimethamine
OR if cost/availability is an issue
Sulfamethoxazole-Tripethorim
what is the characteristic features of Amoebic meningoencephalitis in MRI?
scattered, round, enhancing lesions
what are clinical manifestations of Malaria?
Headache
seizures
coma
with diffuse cerebral edema
what are pathognomonic findings of Malaria?
Durck nodes = dotted with small foci of necrosis surroudned by glia in the brain
what tx is given to px with Malaria if cerebral symptoms is not pronounced?
Quinine & Artesunate
what tx is given to px with Malaria if cerebral symptoms appear?
Dexamethasone
what are the clinical manifestations of Trypanosomiasis?
1st = chancre & localized lymphadenopathy (Winterbottom sign)
Posterior cervical adenopathy = Winterbottom sign
in trypanosomiasis, what is the pronounced pain at sites of minor injury?
Kerandel hyperesthesia
what are the tx for Trypanosomiasis?
Eflornithine with nifurtimox = gambiense diseasse
Pentamidine & Suramin = early stages of the African form
Chagas disease = Nifurtimox
what are the clinical manifestations of Trichinellosis?
mild gastroenteritis w abdominal pain
- low-grade fever
- pain & tenderness of muscles
- edema of the conjunctivae and particulary of the eyelids
- Fatigue
what are the tx for Trichinellosis?
Albendazole & Corticosteroids
what is the most common symptom of Cysticerosis (T. solium)?
Seizures
what are the complications that can occur if Cysticercosis is located at the basilar subarachnoid space?
hydrocephalus
vasculitis
stroke
CN palsies
what are the tx for Cysticerosis?
Albendazole or Praziquantel
Corticosteroids = added at onset of tx but more important if there is a large single lesion causing symptoms
what species of Schistosoma affects the brain?
Cerebral hemispheres = S. .japonicum
Spinal cord = S. mansoni
what are the most common symptoms presented in adults in the early stages of HIV?
limb incoordination
gait ataxia
impairment of smooth pursuit and saccadic eye movements
what are the most common symptoms presented in adults in the later stages of HIV?
heightened tendon reflexes
Babinski signs
Grasp and suck reflex
Leg weakness progressing to paraplegia
Bladder & bowel incontinence
abulia
what are important radiologic imaging featuers of HIV?
CT scan: widening of sulci & Ventricular enlargement => Cerebral atrophy
MRI: patchy but confluent or diffuse white matter changes with ill-defined margins & cerebral atrophy
what are the clinical features of CMV in radiologic imaigng?
MRI = hyperintensities in periventricular areas in T2 signal
what are the tx used for CMV?
Ganciclovir and Foscarnet
how do u differentiate meningitis from encephalitis?
Meningitis = fever, headache, neck rigidity
Encephalitis = fever + prominent mental/behavioral changes at onset (confusion, hallucination, psychotic symptoms, agitation, personality changes)
how do u approach dxing CNS infections?
1.. is there a CNS infection?
2. Meningitis/Encephalitis?
3. Acute/Chronic?
4. Do lumbar tap
5. Interpret CSF analysis result
what test is used for analyze CSF with pressure?
Queckenstedt test = when we ccompress the jugular vein on one side, the CSF should INC due to DEC drainage of CSF the IJV
what is the test that differentiates betw TB and fungal meningitis in chronic CNS infections?
CALAS test
what is the interpretation if CALAS test is postiive or neg?
(+) = px has fungal or cryptococcal meningitis
(-) = does not have fungal meningitis
what drug can be given while watiing for CSF analysis for probable viral cause of CNS infection?
Acyclovir
what are the clin manifestations of Creutzfeldt-Jakob disease in the early neurologic stage?
- confusion, hallucinations, delusions, agitation
- Brownell-Oppenheimer variant
- Heidenhain variant
what are the clin manfiestations of the Brownell-Oppenheimer variant & Heidenhain variant in CJD?
BOV = cerebellar ataxia precedes mental changes
HV = visual disturbances precede mental changes
what are the main characteristics of Mad Cow Disease?
progressive cerebellar ataxia
Corticospinal tract signs
dysarthria
nystagmus
mild dementia
