INFECTIOUS DISEASE Flashcards
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
Cortical thrombophlebitis
of the larger veins does not usually develop before the
end of the ______ of the bacterial infection.
second week
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
approximately
______of infants with meningitis younger than 18
months of age develop subdural effusions.
40 percent
These cytokines are believed to
stimulate and modulate the local immune response
TNF, cytokines
In a survey of community-acquired bacterial meningitis, hydrocephalus
occurred in only________ percent, but it was associated with
poor outcome
5
account for approximately 75 percent of sporadic cases of bact men
H. influenzae, N. meningitidis, and S. pneumoniae
________which
are usually a consequence of lumbar puncture, spinal
anesthesia, or shunting procedures to relieve hydrocephalus
Pseudomonas and
the Enterobacteriaceae, such as Klebsiella, Proteus,
____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
_______predominates in the very young and in older
adults.
Pneumococcal
meningitis
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
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
rash may
be observed with ________
echovirus serotype 9, enteroviruses,
S. aureus infections
Meningitis in the presence
furunculosis or following a neurosurgical procedure
directs attention to the possibility of a ___________
coagulase-positive
staphylococcal infection.
Ventricular shunts or drains
inserted for the relief of hydrocephalus
with coagulase-negative staphylococci
and Proprionobacerium acnes and diphteroids.
Focal cerebral signs in the early stages of the disease,
although seldom prominent, are most frequent in ________
pneumococcal and H. influenzae meningitides
Cranial nerve abnormalities are particularly frequent ________
with pneumococcal meningitis
Cell counts of more than
50,000 I mm3 raise the possibility of a ______
brain abscess having
ruptured into a ventricle.
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
Cultures of the spinal fluid, which prove to be positive in ______ percent of cases of bacterial meningitis
70 to 90
_______ is present in most cases of posttraumatic
meningitis, but it may be transient and difficult
to find
CSF rhinorrhea
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
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
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
_______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
31
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
50
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
32
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
