Generalities of Mass lesions Flashcards
what are manifestations of mass lesions
Fever
Severe HA
Seizures
what is the most common single pathogen in mass lesions
s. areus
mixed anaerobic infections account for 1/2 the cases of what
mass lesions mostly GNR and GPC
what fungal agents can cause mass lesions
coccidoides immitis
candida albicans
what does ncc stand for
neurocysticercosis
what agent is responsible for ncc
taenia solium
what is the most common parasitic CNS disease
NCC
what is the most common cause of epilepsy in the world
NCC
many people carry cysticerci of what
t. solium
where is the prevalence of NCC the highest
Cental and South America, India and sub-saharan africa
why is the prevalence of NCC in US increasing
influx of immigrants
what is the pathogenesis of NCC
pt ingests ova- oncospheres release they disseminate and get lodged in CNS and develop cysicerci
what are parenchymal cysts
mature living cysticerci viable up to 10y suppress immune and the host is usually asymptomatic
what happens as cycticeri begin to die
they leak Ag an intense inflammatory response begins and host manifest with symptoms
what are extraparenchymal cysts
a few oncospheres can lodge in ventricles subarachnoid space or meninges can cause atypical cyst
what are the manifestations of NCC
depends on location of cyst
focal or gen tonic-clonic seizures, focal signs. altered mental, symptoms of elevated ICP (cyst in ventricle)
how do you diagnose NCC
symptoms usually only occur after cyst calcifies
histological
cyst seen on mri or ct
direct visualization on fundoscopic exam (live are noncontrast)
In absence of one or more of these results that confirm a diagnosis of neurocystticercosis, but with imaging results that suggests the diagnosis:
Positive EITB for detection of anticysticercal antibodies
CSF WBC with differential reveals an eosinophilia as high as 15%.
Patient signs and symptoms.
what is the treatment for NCC
Niclosamide destroys VIABLE cyst in CNS
Praziquantel destroys VIABLE cyst in CNS
Albendazole destroys VIABLE cyst in CNS
anticonvulsants, steroids, shunt or surgery, good prognosis w/ tx
what is the agent in toxoplasmosis
Tissue protozoan t. gondii
what type of pathogen is Tissue protozoan
eucaryote obligate intracellular parasite.
where can tissue protozoan trophozoite affect
any nucleated cell
what is a latent pseudocyst
found primarily in the brain and muscle – T. gondii cannot form a true cyst
Clinical implication of latent pseudocyst is with respect to
reactivation due to immunosuppresion
what is the 2nd most common cause of cns in aids pts besides hiv
t. gondii
what is the definitive host of t. gondii
cat
what type of host for t. gondii are humans
intermediate
how is ti. gondii transmitted
ingestion of psuedocyst from undercooked food
inhalation of a mature cyst from cat feces
what is the main pathogenesis of t. gondii
multifocal mass lesions
following release the protozoan spreads to all organs and tissues where trophozoites infect any nucleated cell
what is the sites where t. gondii lesions are found
CNS
EYE
LUNG
MUSCLE
reactivation diseases of t. gondii include
diffused encephalitis
multifocal mass lesions
disease of lung or eye
what is the symptoms of t. gondii
alterd mental, weakness, CN abnormalities, neuropsychiatric, focal or tonic clonic
what differential dx of mass lesions in aids pts
had, brain tumor (EBV), toxoplasmosis encephalitis, PML,Cryptococcal meningoencephalitis, CMV diseases
what would be seen in neuroimaging of t. gondii
CT- ring enhancing lesion
MRI-contrast enhancing lesion after admin of godolinium
what would shown in the mri of Toxoplasmosis encephalitis
multiple bilateral cerebral lesions in the juxtacortical and basal ganglia areas.
ganglia and are hypodense with ring-enhancement.
what would shown in the MRI of cerebral toxoplasmosis
Deep central gray nuclei or lobar gray-white junction.
what would be the serology results in t. gondii
IgM will not be present – disease is reactivation.
Absence of anti-Toxoplasma IgG makes a diagnosis of toxoplasmosis unlikely, even in an pt with advanced HIV/AIDS
what would be the brain biopsy results in t. gondi
trophs or multiple, ruptured tissue cysts in inflammatory lesions
what is the treatment of t. gondii
2→4 months of a combination of sulfonamides (sulfadiazine) or clindamycin plus pyrimethamine.
only treats trophozoites not latent infection of pseudocysts
what is the prevention of t. gondii
Pregnant women, Advanced HIV patients, SOT patients on immunosuppressive therapy, etc. should be instructed to avoid cats, cat feces and Cook pork well, not pink.
