Infectious diseases

Question 1

T/F. Fever and cervical hyperesthesia are considered classic features of bacterial meningoencephalitis.
(Dewey textbook)

Answer 1

True, reported in 40% and 20% of cases, respectively.

Question 2

T/F. In acute bacterial meningoencephalitis, CSF analysis often reveals degenerate and toxic-appearing neutrophils, and low protein levels.
(Dewey textbook)

Answer 2

False. Elevated protein levels.

Question 3

CSF is abnormal in over __% of cases of bacterial meningoencephalitis.
(Dewey textbook)

Answer 3

90%.

Question 4

Is it possible to have a negative culture in a confirmed bacterial meningoencephalitis case?
(Dewey textbook)

Answer 4

Yes, approximately 80% of cultures are negative in these cases.

Question 5

Hematogenous spread, extension from a neighboring focus (otitis), and what other 2 are routes of infection for bacterial meningitis?
(Rawson 2022)

Answer 5

Foreign body migration.
Traumatic or iatrogenic inoculation.

Question 6

T/F. Meningeal contrast enhancement can be observed in bacterial meningoencephalitis.
(Rawson 2022)

Answer 6

True, also empyema an parenchymal involvement.

Question 7

T/F. Bacterial meningoencephalitis is a common infectious disease process.
(Rawson 2022)

Answer 7

False.

Question 8

What is an important ddx for bacterial meningoencephalitis?
(Rawson 2022)

Answer 8

Steroid-responsive meningitis arteritis, bc causes similar CS (pyrexia, neck pain, lethargy).

Question 9

T/F. Vestibular dysfunction can be commonly seen in dogs with bacterial meningoencephalitis.
(Rawson 2022)

Answer 9

True, 42% of the dogs.

Question 10

The prognosis for bacterial meningoencephalitis is poor/good.
(Rawson 2022).

Answer 10

Good, 83% of dogs surviving to hospital discharge.

Question 11

T/F. The optimal antibiotic duration of treatment for bacterial meningoencephalitis remains unclear.
(Rawson 2022)

Answer 11

True.

Question 12

Name 3 antibiotics used for bacterial meningoencephalitis.
(Dewey textbook)

Answer 12

Ampicillin (22 mg/kg/6h).
Enrofloxacin (10 mg/kg/12h), if gram-negative.
Metronidazole (10 mg/kg/8h), if anaerobic.

Question 13

What is a desirable characteristic of antibiotics used for bacterial meningoencephalitis?
(Dewey textbook)

Answer 13

Bactericidal. Also, low-level protein binding, and able to cross the BBB.

Question 14

Name 1 bacteriostatic antibiotic that is broad spectrum, crosses the BBB, but has been associated with a high relapse rate?
(Dewey textbook)

Answer 14

Chloramphenicol.

Question 15

What should be the duration of the antibiotic treatment for bacterial meningoencephalitis?

Answer 15

For up to 10-14 days after resolution of clinical signs (Dewey).

Question 16

T/F. Clinical benefit of glucocorticoid use in dogs with bacterial meningoencephalitis remains unclear.
(Rawson 2022)

Answer 16

True.

Question 17

T/F. CBC abnormalities occurred in 80% of canine bacterial meningoencephalitis cases.
(Dewey textbook)

Answer 17

False. Leukocytosis, leukopenia and thrombocytopenia reported in approx. 57%.

Question 18

Bacterial infections of the brain may result in neuro dysfunction by producing a mass effect, release of ____ ____, and the secondary ______ response induced by the bacteria.
(Dewey t)

Answer 18

bacterial toxins
inflammatory response

Question 19

The most commonly implicated organisms in canine and feline bacterial meningoencephalitis are… (name 3).
(Dewey t)

Answer 19

Staphylococcus sp, Streptococcus sp, Pasteurella multocida.
Also, E. coli, and Klebsiella.

Question 20

Name the most common fungal organism associated with meningoencephalitis in dogs and cats.
(Dewey t)

Answer 20

Cryptococcus neoformans.

Question 21

Name 5 fungal organisms that may invade the CNS.
(Dewey t)

Answer 21

Cryptococcus, Coccidioides, Blastomyces, Histoplasma, and Aspergillus.
(And phaeohyphomycoses).

Question 22

Fungal disease is typically contracted by dogs and cats via ______.
(Dewey t)

Answer 22

Inhalation of fungal spores, and it reaches the CNS via local extension or hematogenously.

Question 23

Name 1 breed of dogs and 1 breed of cats apparently predisposed to Cryptococcosis.
(Dewey t)

Answer 23

American cocker spaniel and siamese.

Question 24

T/F. Clinical evidence of extraneural fungal infection is uncommon in cases of fungal meningoencephalitis.
(Dewey t)

Answer 24

False, common.

Question 25

T/F. With cryptococcosis, extra neural infection of the pulmonary system is typical.
(Dewey t)

Answer 25

False, head region is most likely. With coccidioidomycosis, pulmonary most likely.

Question 26

Identifying the fungal organism in a CSF sample is more likely to occur with __________.
(Dewey t)

Answer 26

Cryptococcus infection (93% in dogs).

Question 27

Name the 2 cell types most commonly observed on CSF of CNS fungal infections.
(Dewey t)

Answer 27

Usually neutrophils and mononuclear cells.

Question 28

Testing of CSF and/or serum for antibodies to fungal antigens is very reliable for…
(Dewey t)

Answer 28

Cryptococcus, Coccidioides, Blastomyces.
Less so for Aspergillus.

Question 29

Testing of CSF and/or serum for antibodies to fungal antigens is NOT reliable for…
(Dewey t)

Answer 29

Histoplasma infections.

Question 30

T/F. Hypercalcemia is one of the bloodwork abnormalities that can be observed with fungal disease.
(Dewey t)

Answer 30

True, due to granulomatous disease.

Question 31

Can antifungal therapy be prolonged for over a year?
(Dewey t)

Answer 31

Yes.
It was the minimum treatment for 36 dogs with coccidioidomycosis meningoencephalitis.

Question 32

What factors should guide the decision of when to discontinue anti fungal therapy?
(Dewey t)

Answer 32

Clinical signs, repeat CSF results, and CSF/serum titers.

Question 33

T/F. Itraconazole penetrates the BBB.

Answer 33

False, it does not. Fluconazole does.

Question 34

What is the preferred anti fungal agent for CNS fungal infection?
(Dewey t)

Answer 34

Fluconazole (5 mg/kg/12h).