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Cheng-Ching > ID > Flashcards

ID Flashcards

1
Q

Acute HIV meningitis

A

Aseptic meningitis in early HIV infection
aseptic - cognition preserved vs encephalitis
-initial HIV infection during seroconversion
-fever + meningeal signs with alertness preserved

-HIV Ab may not be detected/serology negative early on

-CSF: lymphocytic pleocytosis; normal glucose, mildly increased protein

Tx: no specific therapy; HAART

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2
Q

HIV Dementia

A

late stages CD4<200
-cog decline + psychomotor dysfxn , tremors, incoordination - rare focal neuro deficit
-subcortical cortex spared

Prevent: HAART

Tx: HAART-simple regimen of drugs b/c demented

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3
Q

primary CNS lymphoma

A

focal neurologic deficit
-EBV-HIV pt - immunocompetent pts don’t have EBV
Dx: positive EBV CSF ; cytology-atypical cells
Flow cytometry - monoclonal B lymphocytes
MRI: periventricular lesions/callosal lesions that contrast enhancement + mass effect**

Tx: high dose methotrexate + ART

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4
Q

PML

A

JC virus - polyomavius
-gradual focal neuro deficits

-MRI: nonenhancing coalescing white matter patchy enhancement: parieto-occipital

Dx: JC virus DNA PCR in CSF (-lots of ppl have serum Ab to virus, non specific)
gold standard - biopsy - large oligodendrocytes with intranuclear inclusions ; myelin loss, giant astrocytes
EM: spaghetti and meatballs virus

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5
Q

HIV neuropathy

A

direct effect of virus, cytokine upregulation, esp as CD4 drop
-distal sensory neuropathy

vs. acute inflammatory demyelinating polyradiculoneuropathy - 2/2 immune system dysregulation- at seroconversion

vs CMV polyradiculomyelitis -areflexia, sphincter dysfxn, leg pain + weakness

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6
Q

HIV myelopathy

A

in AIDS- spasticity, weakness, no pain, UE spared
lateral, post column demyelination, microvacuolar degeneration

DDx HTLV-1

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7
Q

HIV muscle wasting

A

-autoimmune myositis - HIV induces MHC1 expression causing muscle fiber injury
-muscle wasting syndrome - AIDS cachexia
-pyomyositis
mitochondrial myopathy -zidovudine
-HIV doesn’t invade muscles

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8
Q

Hypoglycorrhachia

A

hypoglycorrhachia - low CSF glucose

Neurosarcoid

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9
Q

Lyme disease

A

Ixodes deer tick carrying Borrelia burgdorferi -spirochete

Stage 1-local infection- Bull’s eye rash - erythema chronicum migrans (not marginatum) - serology negative

  1. disseminated stage (can test serology but does not rule in/out)
    -aseptic meningitis - lymphs + protein, Ab vs Borrelia in CSF
    -bilateral Bell’s palsy, other CN palsy
    -peripheral neuropathy, mononeuritis multiplex, polyradiculopathy
  2. Persistent infection months later - Intermittent migratory arthritis
    encephalomyelitis
    dementia
    axonal polyneuropathies (“straw man with arrow in head”)

Dx: B burgdorferi Ab in CSF + serum
Ab Index - IgG to Borrelia species in the CSF -true intrathecal antibody synthesis, suggesting neuroinvasive Lyme disease
ELISA+ western blot

MRI-leptomeningeal enhancements
Tx: ceftriaxone (doxycycline only if no CSF/cardiac Sx)

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10
Q

aspergillosis

A

immunocompormised pts-invasive in CNS
-invades blood vessels-strokes
-vasculitis, granulomas, abscesses

Histo: hyphae in blood vessels - septate hyphae branching at acute angles (corn field plant with acute angles)

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11
Q

Cryptococcus neoformans

A

encapsulated yeast
-HIV CD4<100, rare immunocompetent
meningoencephalitis confusion
MRI-hydrocephalus, pseudocysts, cryptococcomas, infarcts
CSF: high OP, high protein - yeast and capsules gunk up CSF

Dx: crypto CSF Antigen
India ink smear- encapsulated halos-not sensitive

biopsy: budding yeast near blood vessels (double buds); soap bubbles

Tx: Flute player, frogs, and pine cone - ampho B + flucytosine, then
fluconazole for long term maintenance
Tx increased ICP b/c increase mortality -> CSF drainage

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12
Q

Toxoplasmosis

A

Protozoa
-can get from raw meat, water or oocytes in poop of cats (kitty litter box)
-acquire earlier; reactivate when HIV CD4<100 (cat with $100 bill)
Sx: seizures, focal deficits
MRI: ring enhancing lesions; eccentric target sign

Tx: Sulfadiazine + pyrimethamine + folinic acid (FOLIAGE)
(sulfa+pyrimethamine affect folate)
sulfa allergy: clindamycin (CLEAN CAT)

prophy: TMP/SMX when CD4<100

biopsy: big round blob - encysted bradyzoite

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13
Q

neurocystercircosis

A

Tanea soleum

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14
Q

west nile virus

A

Flavivirus -Hep C, (high C flavor) Dengue, Yellow fever, West Nile

WNV - anterior horn cells - Birds with red feathers on head
(transmitted via mosquitos); encephalitis, meningitis, flaccid paralysis
-summer infection, initial fever then AMS
-nadir 3-8 days
-cranial neuropathies, tremor (flapping bird wings - tremor)

-esp in elderly

Dx: IgM in CSF (PCR less sensitivity but diagnostic)

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15
Q

Mucormycosis -

A

zygomycosis - mucor, rhizopus, rhizomucor- enter respiratory tract
-right angle branching (tool on wall of car repair)
-necrotizing angioinvasive
-CVST-cavernous sinus sinus
risk: DM, iron chelation with deferoxamine, immunocomp
Tx: ampho B
ampho B: renal failure, hypokalemia + hypomagnesemia (boggy frog low level electrolytes)

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16
Q

Meningitis most common causes

A

Neonates: Listeria, GBS, E coli + other enteric gram negative bacilli (Klebsiella, salmonella, shigella, pseudomonas, etc)

1 month-23 months: Strep pneumo, Neisseria, Strep Agalctiae, Haemophilus influenza (Tx ceftriaxone; if B- lactamase negative can use ampicillin), E coli

2-50: Strep pneumoniae + Neisseria
>50: Strep pneumo, Neisseria, listeria, aerobic gram negative bacilli

Listeria: only 30% positive gram stain (higher for gram-neg bacilli)

Post NSGY: pseudominas, Staph, propionibacterium acnes (NOT strep pneumo for hospital acquired meningitis)

17
Q

TB

A

Pott’s disease-thoracic spine
-hematogenous spread to anterior vertebral bodies
-kyphosis, scoliosis

Meningitis - base of brain- cranial neuropathies b/c brainstem
MRI: meningeal enhancement
CSF: high protein, low glucose, OP elevated
PCR more sensitive; acid fast smear and CSF cultures low sensitivity
Tx: 4 drugs x 2 months, then 2 drugs

Tuberculomas - space occupying

Peripheral neuropathy is M leprae

18
Q

Leprosy

A

Mycobacterium leprae - spreads via resp tract but no resp Sx (Hasen disease)
-tropism for cool areas of body; Schwann cells

Lepromatous variant - cellular immunity compromised pts - spread to skin + nerves->maculopapular rash+nodules; sensory loss over coolest regions of body-pinna of ears, dorsum hands/feet

Tuberculoid variant - normal immunity pts - asymmetric peripheral neuropathies + thickened nerves, less localized lesions
-demarcated hypopigmented lesions
-delayed hypersensitivity rxn, not direct invasion vs. lepromatous variant
ulnar N-Claw hand -(DDx mononeuritis multiplex)- foot drop
Dx: biopsy-granulomas + acid fast

Tx: rifampin, dapsone, clofazimine (Deputy Dapson with rifampin riffle and cloth clofazimine)

19
Q

Brain abscesses

A

Before abscess ->cerebritis - poorly defined irregular lesion, hyperintense on T2

Polymicrobial - spread via contiguous infection or hematogenous
-focal neuro Sx
MRI: ring enhancing lesions, edema

1st - cerebritis -> central necrosis -> capsule formation
Tx: drain + ABx IV 6-8 wks

20
Q

Syphilis

A

primary - painless chancre

secondary syphilis - 2-12 weeks-dissemination - meningitis, cranial neuropathies

tertiary syphilis - aortitis, gummas,
tabes dorsalis -myelopathy+arelfexia, ataxia, loss pain/temp ->Charcot joints-

meningovascular syphilis - after years of infection - stroke in arterial distribution b/c vasculitis, endarteritis obliterans

parenchymatous syphilis - general paresis - dementia, neuropsych manifestations, pupil problems, speech problems

Dx: late forms of neurosyphilis - serum treponemal tests should always be performed.
-reactive CSF-VDRL establishes the diagnosis of neurosyphilis but can be falsely negative

Tx: penicillin G; f/u CSF for response to therapy

21
Q

Whipple disease

A

Tropheryma whippelii

-EOM abnormalities, oculomasticatory myorhythmia, dementia

-hypopigmentation, adrenal insufficiency

Dx: biopsy GI - PAS + macrophage inclusions
-CSF PCR-T. whippelii

Tx: ceftriaxone then TMP/SMX

22
Q

CJD

A

PrPcellular ->PrP scrapie (more B pleated sheets)

MRI: cortical ribbon -restricted diffusion + caudate head restricts

hockey stick sign: hyperintensity caudate head+putamen
pulvinar sign - BL thalami hyperintensity

Familial CJD: AD-PPNP-Chr 20 (twenty twerpy cows)-susceptibility gene

Familial fatal insomnia - sympathetic hyperactivity, HTN, dementia, tremor, myoclonus, insomnia

Gerstmann-Straussler-Scheinker - inherited prion disease over yrs - ataxia, dysarthria, dementia

Dx: CSF- RT-QuIC is the most sensitive and specific CSF diagnostic test for sCJD.
EEG: repetitive sharp wave periodic pattern
biopsy: spongiform

23
Q

HSV

A

HSV1-MCC fatal sporadic viral encephalitis
-immediate CNS invasion vs reactivation with recurrent infection or reactivation in situ HSV in brain

MRI - hemorrhagic temporal lobe

Dx: CSF HSV PCR
Tx: IV acyclovir

VS MENINGITIS - HSV-2 (immunocompetent pts)

24
Q

Measles

A

Encephalitis

Post viral encephalomyelitis

ADEM

Subacute sclerosing panencephalitis - 2-12 yrs after infection - personality changes; seizures, ataxia, akinetic mutsim, choreoathetoid
-virus maturation in neural cells
EEG: pathognomonic - periodic delta waves on flat background
path: nuclear, cytoplasmic inclusion bodies

Immunocompromised: measles inclusion body encephalitis - 1-6 months after exposure, dementia, seizures, myoclonus, coma

25
Q

Tania soleum

A

neurocysticercosis - not from ingestion of pork meat b/c eat tapeworms; get infected from eggs in feces -> larvae penetrate tissues

seizures, hydrocephalus, vasculitic syndrome with strokes

MRI: contrast enhancement + calcifications
-Tx: albendazole - “strong man Al bending a bar” - circus scene
2nd line -Paraziquantal - Pretzel stand

26
Q

amebic meningoencephalitis

A

Naegleria fowleri - Niagara falls (others -acanthamaeoba, balamuthia mandrillaris)
-fresh water
-enter through cribiform plate

Acanthamoeba - hematogenous dissemination from corneal infection - contact lenses

path: trophozoites
-purulent meningitis, microabscesses

Frogs – Amphotericin treatment

27
Q

VZV

A

Chickenpox primary infection->latent in ganglia

Herpes zoster - thoracic dermatomes

Zoster sine herpete - sensory Sx without rash
Herpes zoster ophthalmicus - ophthalmic division trigeminal N; keratitis-> blindness

Ramsay Hunt - geniculate ganglion facial palsy + rash in external auditory meatus, vertigo; tinnitus

Necrotizing retinitis

VZV vasculopathy: small + large intracranial vessels - immunocompetent pts
-multifocal narrowing

Myelitis

Tx: acyclovir +/- steroids -
Dx: anti-VZV antibodies in CSF; higher yield vs DNA
-negative VZV DNA PCR does not exclude

28
Q

infective endocarditis

A

risk mycotic aneurysms - SAH if ruptured - distal bifurcations in vessels (not circle of Willis)
-superficial hemorrhage, no vasospasm

-if SAH during infective endocarditis - Dx: cerebral angiogram for mycotic aneurysms

29
Q

Rabies

A

Sx: dysphagia, neck/facial muscle spasms triggered by attempting to drink water -> hydrophobia
-frothing in mouth, increased salivation
-paralytic form - parethesias + weak bitten limb -> quadriplegia

Negri bodies: cytoplasmic eosinophilic inclusions purkinje cells + pyramidal cells of hippocampus
-little black dot perfect circle

-HDCV vaccine after exposure + rabies IG

Cheng-Ching (17 decks)

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