INFECTIOUS DISEASE Flashcards by MA CARMELA CONCEPCION SALES

Type of arteritis in TB NSP

Neutrophils and lymphocytes migrate from the adventitia
to the subintimal region, often forming a conspicuous
layer. Later there is subintimal fibrosis.

Heubner arteritis

How well did you know this?

Not at all

Perfectly

Cortical thrombophlebitis
of the larger veins does not usually develop before the
end of the ______ of the bacterial infection.

second week

How well did you know this?

Not at all

Perfectly

The much more frequent
occurrence of thrombosis in veins than in arteries
is probably accounted for by the ______and the
_______ in the former

thinner walls

slower current of blood flow

How well did you know this?

Not at all

Perfectly

approximately
______of infants with meningitis younger than 18
months of age develop subdural effusions.

40 percent

How well did you know this?

Not at all

Perfectly

These cytokines are believed to

stimulate and modulate the local immune response

TNF, cytokines

How well did you know this?

Not at all

Perfectly

In a survey of community-acquired bacterial meningitis, hydrocephalus
occurred in only________ percent, but it was associated with
poor outcome

How well did you know this?

Not at all

Perfectly

account for approximately 75 percent of sporadic cases of bact men

H. influenzae, N. meningitidis, and S. pneumoniae

How well did you know this?

Not at all

Perfectly

________which
are usually a consequence of lumbar puncture, spinal
anesthesia, or shunting procedures to relieve hydrocephalus

Pseudomonas and

the Enterobacteriaceae, such as Klebsiella, Proteus,

How well did you know this?

Not at all

Perfectly

____occurs most often in children and adolescents but is also
encountered throughout much of adult life, with a sharp
decline in incidence after the age of 50 years.

Meningococcal meningitis

How well did you know this?

Not at all

Perfectly

_______predominates in the very young and in older

adults.

Pneumococcal

meningitis

How well did you know this?

Not at all

Perfectly

The most common meningeal pathogens are all normal
inhabitants of the______ in a significant part of
the population and depend on _________ for survival in the tissues of the
infected host

nasopharynx

antiphagocytic capsular
or surface antigens

How well did you know this?

Not at all

Perfectly

The isolation of anaerobic streptococci,
__________________
from the CSF should suggest the possibility of a brain
abscess with an associated meningitis

Bacteroides, Actinomyces, or a mixture of microorganisms

How well did you know this?

Not at all

Perfectly

rash may

be observed with ________

echovirus serotype 9, enteroviruses,

S. aureus infections

How well did you know this?

Not at all

Perfectly

Meningitis in the presence
furunculosis or following a neurosurgical procedure
directs attention to the possibility of a ___________

coagulase-positive

staphylococcal infection.

How well did you know this?

Not at all

Perfectly

Ventricular shunts or drains

inserted for the relief of hydrocephalus

with coagulase-negative staphylococci

and Proprionobacerium acnes and diphteroids.

How well did you know this?

Not at all

Perfectly

Focal cerebral signs in the early stages of the disease,

although seldom prominent, are most frequent in ________

pneumococcal and H. influenzae meningitides

How well did you know this?

Not at all

Perfectly

Cranial nerve abnormalities are particularly frequent ________

with pneumococcal meningitis

How well did you know this?

Not at all

Perfectly

Cell counts of more than

50,000 I mm3 raise the possibility of a ______

brain abscess having

ruptured into a ventricle.

How well did you know this?

Not at all

Perfectly

Substantial hemorrhage or substantial numbers of

red cells in the CSF seen in

anthrax meningitis (see Lanska) as well
as certain rare viral infections (Hantavirus, dengue fever,
Ebola virus

How well did you know this?

Not at all

Perfectly

Cultures of the spinal fluid, which prove to be positive in ______ percent of cases of bacterial meningitis

70 to 90

How well did you know this?

Not at all

Perfectly

_______ is present in most cases of posttraumatic
meningitis, but it may be transient and difficult
to find

CSF rhinorrhea

How well did you know this?

Not at all

Perfectly

The most specific and sensitive test for C􀄃F
otorrhea and rhinorrhea is the finding of
(tau), not found in fluids other than CSF.

b2 transferrin

How well did you know this?

Not at all

Perfectly

Currently, ______ of H. influenzae
isolates produce the beta-lactamase enzyme, but almost
all remain sensitive to third-generation cephalosporins
(e.g., cefotaxime, ceftizoxime, ceftriaxone).

30 percent

How well did you know this?

Not at all

Perfectly

In children and adults, ______________ is
probably the best initial therapy for the three major types
of community-acquired meningitides.

hird-generation cephalosporins

such as ceftriaxone, combined with vancomycin

How well did you know this?

Not at all

Perfectly

_______should be added to the regimen in cases of suspected Listeria meningitis, particularly in an imrnunocompromised patient

Ampicillin

N. meningitides, at least in the | United States, remains highly susceptible to _______

penicillin and ampicillin

In cases of meningitis caused by coagulase-positive S. aureus, including those that occur after neurosurgery or major head injury, administration of ______

vancomycin plus a third-generation cephalosporin (e.g., cefepime, ceftazadime, or meropenem)

Most cases of bacterial meningitis | should be treated for a period of ______

10 to 14 days

Prophylaxis for meningo

An alternative is a daily oral dose of rifampin-600 mg q12h in adults and 10 mg/kg q12h in children-for 2 days

The triad of pneumococcal meningitis, pneumonia, and endocarditis

OSLER

_____ percent of children with pneumococcal meningitis were left with persistent sensorineural hearing loss; for meningococcal and H. influenzae meningitis, the figures were 10.5 and 6 percent, respectively

Deafness in these infections is a result of _________ or, less often now, of the ototoxic effects of aminoglycoside antibiotics

suppurative cochlear destruction

bacterial infections that are | complicated by a special type of encephalitis or meningoencephalitis.

Mycoplasma pneumoniae infections, L. monocytogenes meningoencephalitis, and Legionnaire disease.

WHAT ORGNASIM CAUSES THESE: Guillain-Barre polyneuritis, cranial neuritis, acute myositis, aseptic meningitis, transverse myelitis, global encephalitis, seizures, cerebellitis, acute disseminated (postinfectious) encephalomyelitis, and acute hemorrhagic leukoencephalitis (Hurst disease)

Mycoplasma pneumoniae

Organism that may take the form of a brainstem encephalitis, or "rhombencephalitis

Listeria

Treatment of Listeria

The treatment is ampicillin (2 g intravenously q4h) in combination with gentamicin (5 mg/kg intravenously in 3 divided doses daily)

Treatment of Legionela

Treatment in adults has consisted of one | of levofloxacin, moxifloxacin, or azithromycin

Without such massive antimicrobial therapy and surgery, | some patients will die in________ patients with subdural empyema

, usually within 7 to 14 days

MC areas of septic thrombophlebitis

lateral (transverse), cavernous, petrous, and, less frequently; the longitudinal (sagittal) sinuse

However, contiguous involvement of the ___________emanating from it causes seizures and focal cerebral signs

superior sagittal sinus and cortical veins

The posterior part of the cavernous sinus may become infected via the_______ veins without the occurrence of orbital edema or ophthalmoplegia

superior and inferior petrosal

In approximately _______ of cases of abscesses, | the source cannot be ascertained.

20 percent

It is estimated that ______ of cases of congenital | heart disease are complicated by brain abscess

5 percent

The _______ by far the most common anomaly implicated CHD associated with abscess

tetralogy of | Fallot is

Type of pulmo telengiectasia associated with abscess

Osler-Rendu-Weber telangiectasia

most common organisms causing bacterial cerebral | abscess are _______

virulent streptococci,

enteric organisms in abscesses are almost always associated with ______

otitic infections;

The term _________ is loosely applied to this local suppurative encephalitis or immature abscess.

cerebritis

The abscess capsule tends to | be thinner on the______

side directed to the lateral ventricle

Practically all abscesses | larger than_____ produce positive scans.

1 em

The least satisfactory results are obtained if the patient is comatose before treatment is started; more than ______ percent of such patients in the past have died

TB Meningitis sx The early manifestations are usually low-grade fever, malaise, headache______ lethargy, confusion, and stiff neck ____

(more than 50 percent of cases), (75 percent of cases),

In approximately _____ of patients with tuberculous meningitis there is evidence of active tuberculosis elsewhere

two-thirds

Other causes of persistent | polymorphonuclear pleocytosis

Nocardia, Aspergillus, and Actinomyces

Most children with tuberculous meningitis have ______ | positive tuberculin skin tests

85%

Sn of TB PCR

80%

Anti-Kochs associated with highest penetration to CNS

INH and PZA

CS reduced mortality from 41 percent | to _____ percent but had no effect on residual disability

In patients who are treated late in the disease, when coma has supervened, the mortality rate is nearly ________

50 percent.

_______focal collections of epithelioid cells surrounded by a rim of lymphocytes; frequently there are giant cells, but caseation is lacking.

Sarcoidosis

Primary CNS sarcoidosis incidence

5-10%

Describe the spinal cord pathology associated with sarcoidosis

longitudinally extensive myelopathy

The history or presence of ________further | raises suspicion of this process.

erythema nodosum or iritis

MRI of Sarcoid

Nodular or streak-like perivenular enhancement may be found on the contrast-enhanced MR

skin test for sarcoid: a granuloma in response to homogenate of spleen or lymph node from patients with known sarcoidosis.

Kveim-Siltzbach skin reaction

treponeme usually invades the CNS within ________ | months of inoculation with the organism

3 to 1 8

if the CSF is negative at the end of 5 years, the likelihood of developing neurosyphilis falls to ____

1 percent.

All forms of neurosyphilis begin as ______and | meningeal inflammation

meningitis

the late (secondary) ones are_____ followed even later by tertiary syphilis, ____

vascular syphilis (1 to 12 years), general paresis, tabes dorsalis, optic atrophy,

Hence the _______ represents a specific antibody response to the treponeme and is recognized as the presence of oligoclonal banding

gamma globulin

With either spontaneous or therapeutic remission of the disease, the ___disappear first; next the total ______ returns to normal; then the ________ concentration is reduced The positive serologic tests are the last to revert to normal

cells protein gamma globulin

more sn for diagnosis in sero-negative NSY

The fluorescent | treponema! antibody absorption (FTA-ABS)

M e n i n g e a l Syp h i l i s typically does so within the first ______ With adequate treatment, the prognosis is ____

2 years. good

occurrence of meningovascular syphilis/secondary | is ______ years after the original infection

6 to 7

Most of the | infarctions occur in the____

distal territories of medium- and small-caliber lenticulostriate branches that arise from the stems of the middle and anterior cerebral arteries.

Pa retic N e u rosyp h i l i occurs ______usually separate the onset of general paresis from the original infection

some 15 to | 20 years

The | changes are most pronounced in the ______ in NSY

frontal and temporal | lobes

The pathologic changes consist of perioptic meningitis, with subpial gliosis and fibrosis replacing degenerated optic nerve fibers.

Syp h i l it i c O ptic At ro p h y

Types of SC syph

syphilitic meningomyelitis spinal meningovascular syphilis,

Spinal meningovascular syphilis | may occasionally take the form of an ______

anterior spinal | artery syndrome.

Also rare is _____________ which allegedly gives rise to radicular pain, amyotrophy of the hands, and signs of long tract involvement in the legs

syphilitic hypertrophic pachymeningitis or arachnoiditis,

Pathology of Sy p h i l it i c N e rve Deafness a n d Vesti b u l o pathy

mainly endarteritis in | the cochlea and labyrinths

The treatment of all o f these forms of neurosyphilis consists of the administration of penicillin G, given intravenously in a dosage of ________ units daily (3 to 4 million units q4h) for _____

18 to 24 million 10 to 14 days

AIDS are particularly vulnerable to cryptococcal infection; estimates are that_______ of AIDS patients are subject to meningoencephalitis with the organism

6 to 12 percent

In patients without AIDS, this consists of intravenous administration of amphotericin B, given in a dose of _______

0.7 to 1 . 0 mg /kg/ d.

renal cx of ampho B

Renal tubular acidosis also frequently | complicates amphotericin B therapy.

The addition of _______to amphotericin B results in fewer failures or relapses, more rapid sterilization of the CSF, and less nephrotoxicity

flucytosine (100 mg /kg/ d)

this regimen, which has a success rate of __________ percent in immunocompetent patients, has proven to be much less effective in patients with AIDS.

75 to 85

fluconazole, an oral triazole antifungal | agent, for up to________or indefinitely to prevent relapse

1 year

______does not present as meningitis but hyphal invasion of cerebral vessels may occur, with thrombosis, necrosis, and hemorrhage; i.e., it is an infectious vasculitis.

Aspergillosis

_______, and echinocandins in some cases, is | the recommended treatment for aspergillosis

Liposoma amphotericin in combination | with voriconazole

Toxoplasma organisms is readily | recognized in _______

Wright- or Giemsa-stained preparations