Fungi, Prions, & Other Infectious Agents

Question 1

what are the signs & symptoms of subacute to chronic meningitis syndrome?

Answer 1

fever
headache
neck rigidity
with or without focal neurologic signs

Question 2

what are the CSF finding in px with fungal infections of the CNS?

Answer 2

glucose = subnormal;
pleocytosis (>1,000/mm3) = moderate
protein = elevated
lymphocytes predominate

Question 3

what are the species of Cryptococcosis causing CNS infecctions?

Answer 3

Cryptococcus neoformans
Cryptococcus gatti (not that common)

Question 4

what are common S/Sx of Cryptococccosis?

Answer 4

• 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

Question 5

what are CSF findings in Cryptococcosis?

Answer 5

<50 cells/mm3 lymphocytic pleocytosis

Question 6

what is the tx for Cryptococcosis?

Answer 6

Amphotericin B

Question 7

if there are failures or relapse in Cryptococcosis tx, what should u give?

Answer 7

Amphotericin B + Flucytosine

continued for at least 6 weeeks

Question 8

what is a characteristic of Toxoplasmosis?

Answer 8

ring-enhancing cerebral lesion or multiple lesions in cerebral imaging studies

Question 9

why is lumbar tap CI in Toxoplasmosis?

Answer 9

mass lesion

Question 10

what are possible tx of Toxoplasmosis?

Answer 10

Oral Sulfadiazine and Pyrimethamine
OR if cost/availability is an issue

Sulfamethoxazole-Tripethorim

Question 11

what is the characteristic features of Amoebic meningoencephalitis in MRI?

Answer 11

scattered, round, enhancing lesions

Question 12

what are clinical manifestations of Malaria?

Answer 12

Headache
seizures
coma
with diffuse cerebral edema

Question 13

what are pathognomonic findings of Malaria?

Answer 13

Durck nodes = dotted with small foci of necrosis surroudned by glia in the brain

Question 14

what tx is given to px with Malaria if cerebral symptoms is not pronounced?

Answer 14

Quinine & Artesunate

Question 15

what tx is given to px with Malaria if cerebral symptoms appear?

Answer 15

Dexamethasone

Question 16

what are the clinical manifestations of Trypanosomiasis?

Answer 16

1st = chancre & localized lymphadenopathy (Winterbottom sign)

Posterior cervical adenopathy = Winterbottom sign

Question 17

in trypanosomiasis, what is the pronounced pain at sites of minor injury?

Answer 17

Kerandel hyperesthesia

Question 18

what are the tx for Trypanosomiasis?

Answer 18

Eflornithine with nifurtimox = gambiense diseasse
Pentamidine & Suramin = early stages of the African form

Chagas disease = Nifurtimox

Question 19

what are the clinical manifestations of Trichinellosis?

Answer 19

mild gastroenteritis w abdominal pain

• low-grade fever
• pain & tenderness of muscles
• edema of the conjunctivae and particulary of the eyelids
• Fatigue

Question 20

what are the tx for Trichinellosis?

Answer 20

Albendazole & Corticosteroids

Question 21

what is the most common symptom of Cysticerosis (T. solium)?

Answer 21

Seizures

Question 22

what are the complications that can occur if Cysticercosis is located at the basilar subarachnoid space?

Answer 22

hydrocephalus
vasculitis
stroke
CN palsies

Question 23

what are the tx for Cysticerosis?

Answer 23

Albendazole or Praziquantel

Corticosteroids = added at onset of tx but more important if there is a large single lesion causing symptoms

Question 24

what species of Schistosoma affects the brain?

Answer 24

Cerebral hemispheres = S. .japonicum
Spinal cord = S. mansoni

Question 25

what are the most common symptoms presented in adults in the early stages of HIV?

Answer 25

limb incoordination gait ataxia impairment of smooth pursuit and saccadic eye movements

Question 26

what are the most common symptoms presented in adults in the later stages of HIV?

Answer 26

heightened tendon reflexes Babinski signs Grasp and suck reflex Leg weakness progressing to paraplegia Bladder & bowel incontinence abulia

Question 27

what are important radiologic imaging featuers of HIV?

Answer 27

CT scan: widening of sulci & Ventricular enlargement => Cerebral atrophy MRI: patchy but confluent or diffuse white matter changes with ill-defined margins & cerebral atrophy

Question 28

what are the clinical features of CMV in radiologic imaigng?

Answer 28

MRI = hyperintensities in periventricular areas in T2 signal

Question 29

what are the tx used for CMV?

Answer 29

Ganciclovir and Foscarnet

Question 30

how do u differentiate meningitis from encephalitis?

Answer 30

Meningitis = fever, headache, neck rigidity Encephalitis = fever + prominent mental/behavioral changes at onset (confusion, hallucination, psychotic symptoms, agitation, personality changes)

Question 31

how do u approach dxing CNS infections?

Answer 31

1.. is there a CNS infection? 2. Meningitis/Encephalitis? 3. Acute/Chronic? 4. Do lumbar tap 5. Interpret CSF analysis result

Question 32

what test is used for analyze CSF with pressure?

Answer 32

Queckenstedt test = when we ccompress the jugular vein on one side, the CSF should INC due to DEC drainage of CSF the IJV

Question 33

what is the test that differentiates betw TB and fungal meningitis in chronic CNS infections?

Answer 33

CALAS test

Question 34

what is the interpretation if CALAS test is postiive or neg?

Answer 34

(+) = px has fungal or cryptococcal meningitis (-) = does not have fungal meningitis

Question 35

what drug can be given while watiing for CSF analysis for probable viral cause of CNS infection?

Answer 35

Acyclovir

Question 36

what are the clin manifestations of Creutzfeldt-Jakob disease in the early neurologic stage?

Answer 36

- confusion, hallucinations, delusions, agitation - Brownell-Oppenheimer variant - Heidenhain variant

Question 37

what are the clin manfiestations of the Brownell-Oppenheimer variant & Heidenhain variant in CJD?

Answer 37

BOV = cerebellar ataxia precedes mental changes HV = visual disturbances precede mental changes

Question 38

what are the main characteristics of Mad Cow Disease?

Answer 38

progressive cerebellar ataxia Corticospinal tract signs dysarthria nystagmus mild dementia