Infectious Diseases of the Nervous System - Viruses and Fungi Flashcards
1
Q
This fungal species may cause conjunctivitis after topical corticosteroid and antibacterial therapy to inflamed eye
A
Candida
2
Q
This fungal species has been associated with a granulomatous conjunctivitis
A
Sporothrix schenckii
3
Q
What is the usual drug used to treat fungal conjunctivitis?
A
Itraconazole
4
Q
What drug is used to treat keratitis caused by H. simplex
A
Trifluridine
5
Q
What drug is used to treat keratitis caused by VZV
A
Famciclovir
6
Q
What drug is used to treat keratitis caused by fungus
A
Natamycin (5%) drops
7
Q
What drug is used to treat CMV retinitis?
A
Ganciclovir intraocular implant + Valganciclovir
8
Q
This family of viruses with over 100 serotypes can present as pharyngoconjunctival fever
A
Adenovirus
9
Q
This is one of the largest viral families, naked +ssRNA viruses
Virus shuts down cap-dependent translation
A
Picornaviruses
10
Q
This virus is the leading cause of aseptic meningitis
A
Enterovirus
11
Q
Echoviruses are in this family of viruses
A
Enteroviruses
12
Q
Coxsackie viruses are in this family of viruses
A
Enterovirus
13
Q
Do Enteroviruses appear with different seasonality?
A
In temperate climates = summer/fall
14
Q
This is the most susceptible host population to Enteroviruses
A
Infants and young children
15
Q
In neonates with proven enteroviral meningitis, this symptom is a ubiquitous finding
A
Fever
16
Q
Neurologic involvement in neonatal enteroviral meningitis may be associated with nuchal rigidity and this
A
Bulging anterior fontanelle
17
Q
Neurologic involvement in neonatal enteroviral meningitis may be associated with this and a bulging anterior fontanelle
A
Nuchal rigidity
18
Q
Are infants (younger than 1 year) more or less likely to demonstrate meningeal signs with enteroviral meningitis?
A
Less
19
Q
Are focal signs common with neonatal enteroviral meningitis?
A
Uncommon
(but mental status may be altered)
20
Q
With disease progression of neonatal enteroviral meningitis, can multiorgan involvement occur?
A
Yes
(with disease progression, a sepsis-like syndrome manifests)
21
Q
Is enteroviral meningitis beyond the neonatal period serious?
A
No
(severe disease and poor outcomes are rare)
22
Q
Presence of exanthems, Myopericarditis and Conjunctivitis are signs of meningitis caused by this type of virus
A
Enterovirus
23
Q
Many patients with this type of meningitis report improvement after lumbar puncture
A
Enterovirus
24
Q
Is there complete recovery after Enteroviral meningitis?
A
YES
complete recovery is the rule
25
In Enteroviral meningitis of this patient population, the onset of illness is usually sudden with fever that may be biphasic
Non-neonates
(older than 2 weeks)
26
Mumps virus belongs to this family
Paramyxovirus
27
What is the type of genome of Paramyxovirus family?
(DNA or RNA)
-ssRNA
28
What are the target tissues of the Mumps virus?
Epithelial cells of the URT and parotid gland
29
Is there one or multiple serotyes of Mumps virus?
Single serotype
30
What is the incubation period of Mumps virus?
16-18 days
31
In an unimmunized population, this virus is one of the most common causes of aseptic meningitis and encephalitis
Mumps
32
This is the most common neurologic manifestation of infection with mumps virus
Meningitis
33
Are males or females more likely to be affected by Mumps virus?
Males
(2-5x more likely)
34
This triad is the most frequent clinical manifestation of mumps CNS infection
Fever, vomiting, headache
35
Infection with this virus is often asymptomatic
Infection and swelling of the parotid gland, usually unilateral
Also infects the testes, ovaries, pancreas, thyroid, and other organs
Can cause meningoencephalitis (50% of patients)
Mumps
36
Mumps vaccine is this type
Live attenuated
37
What is the primary treatment for Mumps virus?
None
38
Measles is caused by this virus
Rubeola virus
39
Measles virus envelope contains these two proteins
Fusion protein (F)
Hemagglutinin (H)
40
Does Measles virus envelope has neuraminidase?
No
41
Subacute sclerosing panencephalitis is a chronic degenerative fatal neurologic disease occurs years after an attack of this virus
Measles
42
This is a chronic degenerative fatal neurologic disease that occurs on average 7 years after an attack of measles, particularly in children who had measles before 2 years of age
Subacute sclerosing panencephalitis
43
Is herpes simplex encephalitis or meningitis a potentially fatal condition?
Encephalitis
44
Is herpes simplex encephalitis or meningitis a self-limited syndrome?
Meningitis
45
Is herpes simplex encephalitis serious?
Yes - is potentially fatal
46
Is herpes simplex meningitis serious?
No - is a self-limited syndrome
47
The syndrome of HSV aseptic meningitis is most commonly associated with primary genital infection with this HSV type
Type 2
48
Primary genital infection with this HSV type rarely results in meningitis
Type 1
49
Meningitis associated with this HSV type is usually characterized by stiff neck, headache, and fever
Type 2
50
A diffuse vesiculopustular rash may be seen in meningitis caused by this virus
VZV
51
This viral infection is associated with meningitis in conjunction with roseola
HHV6
52
This herpesvirus can exhibit persistence in the CNS and has been demonstrated in the CSF of asymptomatic persons
HHV6
53
These two types of Herpesviruses may cause aseptic meningitis in association with a mononucleosis syndrome, particularly in the immunocompromised
CMV and EBV
54
Can HIV cause meningitis?
Yes
(HIV can cross the meninges early and persist in the CNS after initial infection)
55
Acute encephalitis and meningitis may both present with this triad of symptoms
Fever, headache, altered mental status
56
Mental status changes occur early in meningitis or encephalitis?
Encephalitis
57
With encephalitis, are mental status changes noted early or late?
Early
58
What are the levels of glucose in CSF with viral encephalitis?
Normal
59
What are the levels of protein in CSF with viral encephalitis?
Elevated
60
In neonates, this is a complication of an overwhelming sepsis-like syndrome with 10% mortality
Encephalitis
61
Enteroviruses may cause this condition, particularly in patients with hypogammaglobulinemia and neonates
Encephalitis
62
This virus can rarely cause an acute postinfectious encephalitis
Resulting in 20% mortality
Measles
63
Measles can also produce a chronic infection in neurons, resulting in this condition that is rare and uniformly fatal
Subacute sclerosing panencephalitis (SSPE)
64
This virus can also produce a chronic infection in neurons resulting in subacute sclerosing panencephalitis (SSPE)
Measles
65
Subacute sclerosing panencephalitis occurs this much time after initial measles infection (which usually occurs in children younger than 2 years)
5-15 years
66
This type of HSV is the most common cause of sporadic viral encephalitis
HSV-1
67
This type of HSV is the most common cause of recurrent, benign lymphocytic meningitis
HSV-2
68
HSV-1 is the most common cause of this
Sporadic viral encephalitis
69
HSV-2 is the most common cause of this
Recurrent, benign lymphocytic meningitis
70
Is HSV-1 or HSV-2 more likely to cause an encephalitis?
HSV-1
71
Is HSV-1 or HSV-2 more likely to cause a meningitis?
HSV-2
72
What is the age distribution of HSV encephalitis?
Bimodal
(<20, >50)
73
This is the drug of choice for HSV encephalitis
Acyclovir
74
Is mortality rate of untreated HSV encephalitis high or low?
60-80% so kind of high
75
Neurologic complications from this viral infection in adults:
Retinitis, encephalitis, polyradiculomyelopathy, and neuropathy
All of which occur predominantly in immunocompromised hosts
CMV
76
What is the initial treatment for CMV neurological infections?
Combination of Ganciclovir and foscarnet
(Generally maintained for 2-3 weeks, followed by lower dose maintenance therapy)
77
This herpes virus can manifest with a myriad of CNS syndromes
Including meningitis, encephalitis, transverse myelitis, and Guillain-Barre syndrome
EBV
78
Exanthem subitum (roseola) in infants, febrile seizures, and lymphadenopathy syndromes can occur with this viral infection
HHV-6
79
This herpesvirus is increasingly recognized as a cause of encephalitis in immunocompromised adults
HHV-6
80
Only nonhuman herpesvirus that also infects humans resulting in high mortality
Herpesvirus B
81
Humans develop disease with this virus after a monkey bite, scratch, or mucosal contact with infected body fluid
Herpesvirus B
82
Vesicles develop at the site of exposure with this virus, followed by onset of a flu-like syndrome (fever, chills, myalgias, headache)
When the virus invades the CNS, the patient develops diplopia, ataxia, hyperesthesias, agitation, and ascending paralysis
Herpesvirus B
83
Mortality approaches this percentage after CNS symptoms develop with Herpesvirus B
100%
(Treatment should be initiated on exposure, rather than delayed until onset of symptomatic disease)
84
What is the drug treatment for Herpesvirus B?
Valacyclovir or acyclovir
85
Togaviruses are in this family of viruses
Arboviruses
86
Flaviviruses are in this family of viruses
Arboviruses
87
Bunyaviruses are in this family of viruses
Arboviruses
88
This family of Arboviruses includes Eastern, Western, and Venezuelan equine encephalitis
Togaviruses
89
This family of Arboviruses includes West Nile encephalitis virus, St. Louis encephalitis, Japanese encephalitis, Powassan, Zika virus
Flaviviruses
90
This family of Arboviruses includes California encephalitis group, La Crosse virus
Bunyaviruses
91
Arboviruses replicate in the local tissue and lymph nodes, resulting in a primary viremia that disseminates the virus to this and other sites
Mononuclear phagocyte system
92
Do Arboviral infections tend to be symptomatic?
No
Mainly asymptomatic
93
Are there vaccines for Arboviruses?
No
94
Togaviruses and Flaviviruses have this type of genome
+ssRNA
95
Vector-borne togaviruses belong to this genera
Alphavirus
96
Is immune response to Togaviruses and Flaviviruses humoral or CMI?
Both
97
This immune response to Togaviruses and Flaviviruses prevents secondary viremia
Antibody
98
Does antibody or CMI response to Togaviruses and Flaviviruses prevent secondary viremia?
Antibody
99
What is the treatment for Togaviruses and Flaviviruses?
Supportive
100
West Nile Virus is this type of virus
Flavivirus
101
Most common cause of epidemic viral encephalitis in the US
West nile virus
102
West Nile Virus is transmitted via this
Culex mosquito
103
West Nile Virus is Usually diagnosed by demonstration of this in CSF by ELISA
WNV-specific IgM
104
Is there a specific therapy for West Nile Virus?
No
105
Some infected individuals with this virus develop a flu-like illness
A maculopapular rash involving the trunk and limbs can occur
Rarely can develop neuroinvasive disease, including meningitis, encephalitis, and acute flaccid paralysis
West nile virus
106
St. Louis Virus is this type of virus
Flavivirus
107
What is the geographical distribution of St. Louis encephalitis?
North America
(found in a broad range from Canada and the US to Central and South America)
108
Is it common for St. Louis virus to develop into encephalitis?
Yes, but varies by age
<20 years = 50%
<60 years = 90%+
109
What is the vector for St. Louis encephalitis?
Culex mosquito
110
Japanese encephalitis is this type of virus
Flavivirus
111
Is the mortality rate of Japanese Encephalitis high or low?
~low = 20-30%
(but 50% of survivors have severe neurologic sequelae)
112
What is the vector for Japanese Enceaphlitis?
Culex mosquito
113
Powassan virus is this type of virus
Flavivirus
113
This is the vector for Powassan virus
(humans are dead end hosts)
Deer ticks (Ixodes species)
114
What is the geographical distribution of Powassan virus in the US?
Northeast and Great Lakes regions
115
Eastern Equine Encephalitis is this type of virus
Togavirus
116
What is the geographical distribution of Eastern Equine Encephalitis in the US?
Eastern coast, Gulf coast
(Typically within 5 miles of swamplands or marshlands)
117
Is it common for people exposed to Eastern Equine Encephalitis to develop disease?
1 in 30
118
Western Equine Encephalitis is this type of virus
Togavirus
119
Is Eastern or Western Equine encephalitis milder?
Western
120
Venezuelan Equine Encephalitis is this type of virus
Togavirus
121
What is the geographical distribution of epidemics with Venezuelan Equine Encephalitis?
northern South America
(Have extended as far north as Mexico and Texas)
122
In contrast to other arbovirus infections in humans, viremia in humans with this virus is sufficient to transmit virus to mosquitoes
Venezuelan Equine Encephalitis
123
What is the genome type of Bunyaviridae?
-ssRNA
124
Bunyaviridae have these two envelope proteins
G1 (adhesin) and G2
125
This supergroup of viruses steals the 5' cap similar to influenza
Unlike other RNA viruses, it has no matrix protein
Bunyaviridae
126
California Encephalitis Group is in this family of viruses
Bunyaviridae
127
This virus in the California Encephalitis Group is rare, and 1 in 1000 cases are symptomatic
California Encephalitis virus
127
This is the most common cause of disease in the California Encephalitis Group
La Crosse virus
128
Human exposure to this virus in the California Encephalitis Group is associated with camping or other activities in wooded areas
(transmitted by squirrels and chipmunks)
La Crosse virus
129
Jamestown virus is in this group of viruses
California Encephalitis Group
130
Jamestown Canyon virus is spread by this vector
Aedes and other mosquitoes
131
Is severe disease (meningitis and encephalitis) common with Jamestown Canyon virus?
No - rare
132
Tahyna virus is in this group of viruses
California Encephalitis group
133
This family of viruses has a sandy appearance on EM (ribosomes)
Arenaviruses
134
What is the type of genome of Arenaviruses?
-ssRNA
(2 circles)
135
Lymphocytic Choriomeningitis Virus (LCMV) is in this family of viruses
Arenaviruses
136
Does full recovery occur with Lymphocytic Choriomeningitis Virus (LCMV)?
Yes - full recovery is the norm
137
Lymphocytic Choriomeningitis Virus (LCMV) infects these animals
Hamsters and house mice
138
Lassa fever is caused by this virus family
Arenaviruses
139
Junin virus (Argentine hemorrhagic fever) is caused by this virus family
Arenaviruses
140
Machupo virus (Bolivian hemorrhagic fever) is caused by this virus family
Arenaviruses
141
Arenaviruses infect these cells, causing the release of mediators resulting in vascular damage
Macrophages
142
This drug has limited success in treating Arbaviruses
Ribavirin
143
What type of genome does Polyomavirus have?
dsDNA
144
Do polyomaviruses typically cause disease?
No
145
This type of Polyomavirus causes Progressive multifocal leukoencephalopathy
JC virus
146
This type of Polyomavirus causes renal disease
BK virus
147
JC virus binds to host cell sialic acids and serotonin receptors on these cells
Glial cells
148
JC virus binds to these on host glial cells
Sialic acids and serotonin receptors
149
Is Progressive multifocal leukoencephalopathy due to a primary infection with JC virus or reactivation of the virus?
Reactivation
(typically in immunocompromised with decreased CMI response)
150
Progressive multifocal leukoencephalopathy is due to JC virus reactivation, which then infects these cells
Oligodendrocytes
151
Lyssaviruses (e.g. Rabies) is in this viral family
Rhabdoviruses
152
Rhabdoviruses have this type of genome
-ssRNA (helical)
153
These two proteins make up the RNA-dependent RNA pol of Rhabdoviruses
Large (L) and nonstructural (NS) proteins
154
Large (L) and nonstructural (NS) proteins make up this component of Rhabdoviruses
RNA-dependent RNA polymerase
155
This virus binds to nicotinic acetylcholine receptor and/or neural cell adhesion molecule of the PNS
The genome progresses centripetally, transneuronally by retrograde axoplasmic transport to the dorsal root ganglion and the spinal cord
Rabies
156
Rabies belong to this viral family
Lyssavirus (Rhabdoviruses)
157
Infection of this part of the brain with Rabies induces biting behavior
Limbic system
158
Rabies transmission requires simultaneous infection of these 2 structures
Brain and salivary gland
159
What is the incubation period of Rabies virus?
Can be days, weeks, 1-3 months
160
In either form of this virus, the symptomatic course usually runs 2-14 days before coma supervenes
Rabies
161
This viral infection may cause hydrophobia from pain associated with swallowing
Rabies
162
After incubation of this virus, a prodromal period of malaise, anorexia, fatigue, headache and fever
Pain and paresthesia at the site of exposure are the first specific symptoms
Rabies
163
What are the first rabies specific symptoms?
Pain and Paresthesia at site of exposure
164
Neuron degeneration occurs with this virus, but little histopathologic change is seen other than Negri bodies in infected neurons
Rabies
165
Neuron degeneration occurs with rabies, but little histopathologic change is seen other than these in infected neurons
Negri bodies
166
Does CMI have a role in Rabies immune response?
No
167
When are neutralizing antibodies seen in infection with rabies?
Not until after clinical disease is established
168
This immune response can block rabies progression to the CNS
Antibody
169
Testing should be done for this virus in all cases of acute, progressive human encephalitis of unknown etiology
Rabies
170
Hallmark of this viral infection are Negri bodies
(Intracytoplasmic accumulation of RNP)
Rabies
171
Negri bodies are characteristic of this infection
Rabies
172
Passive immunization with human rabies immunoglobulin (HRIG) should be administered to this site
Into and around the wound
(should not be administered in the same syringe or site as the vaccine)
173
Poliovirus is in the family of viruses
Picornavirus
(enterovirus)
174
What is the only natural host and reservoir for Poliovirus?
Humans
175
Inflammatory damage due to infection of the anterior horn cells of the spinal cord, recognized clinically as acute-onset lower motor neuron paralysis of one or more muscles
Poliomyelitis
176
Poliomyelitis occurs due to infection of this part of the spinal cord
Anterior horn cells
177
Does Poliovirus cause upper or lower motor neuron paralysis?
Lower
(infects the spinal cord)
178
Are most cases of poliovirus symptomatic?
No (>90% aymptomatic)
179
Paralytic poliomyelitis occurs this amount of time after minor illness has subsided
3-4 days
180
This virus is cytolytic for motor neurons of the anterior horn and brainstem
Poliovirus
181
Poliovirus is cytolytic for motor neurons of these two structures
Anterior horn and brainstem
182
Post polio syndrome occurs this much time after infection
Does not involve active virus
Much later in life (30-40 years)
183
This is the major immune response to Poliovirus
Antibody
184
This immune response can prevent establishment of poliovirus
Secretory antibody
185
This immune response to poliovirus prevents viremia
Serum antibody
186
This immune response to poliovirus is involved in pathology
CMI
187
Inactivated vaccine for poliovirus
Salk vaccine
188
Does Salk vaccine for poliovirus provide mucosal protection?
No
189
Is Salk vaccine for Poliovirus oral or injection?
Injection
(also needs booster)
190
Is Sabin vaccine for Poliovirus oral or injection?
Oral
191
Does Sabin vaccine for Poliovirus provide mucosal protection?
Yes
192
Chance of reversion occurs with this Poliovaccine
Sabin vaccine
193
Cognitive and motor syndromes may result from opportunistic infection or HIV injection of these two types of cells of the brain
Marcophages and microglial
194
Cell wall of this yeast may contain melanin
Cryptococcus neoformans/gattii
195
What type of fungus is Cryptococcus neoformans/gattii?
Yeast
196
What is the geographical distribution of Cryptococcus neoformans/gattii?
Worldwide
(Ubiquitous in soil, esp. enriched in pigeon droppings)
197
How is Cryptococcus neoformans/gattii transmitted?
Inhalation
198
This species is the most common cause of fungal meningitis
Cryptococcus neoformans/gattii
199
This fungus is a major opportunistic pathogen of AIDS patients
Seen mostly in patients with depressed CMI
Cryptococcus neoformans/gattii
200
What is the treatment for Cryptococcus neoformans/gattii?
Amphotericin B + flucytosine
Followed by fluconazole
201
Coccidioides immitis/posadasii is this type of fungus
Dimorphic
202
What is the geographic distribution of Coccidioides immitis/posadasii?
Desert southwest
(found in soil; growth enhanced by bat and rodent droppings)
203
How is Coccidioides immitis/posadasii transmitted?
Inhalation
(of arthroconidia)
204
Coccidioides immitis/posadasii is a primary disease of this organ
Lungs
(valley fever; allergic rxns cause skin lesions - type III)
205
Is Coccidioides immitis/posadasii visible in CSF?
Rarely
206
Is it safe to culture Coccidioides immitis/posadasii?
No - mold is highly infectious
207
Is mortality rate of Coccidioides immitis/posadasii high without treatment in disseminated infections?
Yes (>90%)
208
What is the treatment for Coccidioides immitis/posadasii?
Amphotericin B and fluconazole
209
Paracoccidioides brasiliensis is this type of fungus
Dimorphic
210
Paracoccidioides brasiliensis is an endemic throughout this geographical region
Latin America
211
How is Paracoccidioides brasiliensis transmitted?
Inhalation
212
Paracoccidioides brasiliensis is primarily a disease of this organ
Lungs
213
This fungus has characteristic "ship wheel" morphology
Paracoccidioides brasiliensis
214
What is the treatment for Paracoccidioides brasiliensis?
Itraconazole
(Amphotericin B for severe cases)
215
Blastomyces dermatitidis is this type of fungus
Dimorphic
216
How is Blastomyces dermatitidis transmitted?
Inhalation
(no person to person transmission)
217
What is the treatment for Blastomyces dermatitidis?
Amphotericin B for severe cases
Itraconazole for mild-to-moderate
218
Histoplasma capsulatum is this type of fungus
Dimorphic
219
Histoplasma capsulatum is localized to these geographical regions
Ohio and Mississippi River valleys
(found in soil with high nitrogen content)
220
How is Histoplasma capsulatum transmitted?
Inhalation (microconidia)
221
Histoplasma capsulatum becomes yeast in these two cell types
Macrophages and neutrophils
222
Histoplasma capsulatum is primarily a disease of this organ
Lungs
223
What is the treatment for Histoplasma capsulatum?
Acute infections = supportive, itraconazole can benefit
Severe acute cases = Amphotericin b
224
This fungus can invade deep layers of skin and subcutaneous tissues
CNS infection is rare and either secondary to hematogenous disease or associated with neurosurgical procedures
Candida albicans
225
This fungus may mimic bacterial meningitis
Candida albicans
226
What is the treatment for Candida albicans?
Amphotericin B + Flucytosine
227
How is Candida albicans transmitted?
Skin and hematogenous spread
228
Candida albicans is this type of fungus
Yeast
229
Mucormycosis is a disease seen mainly in patients with this
Ketoacidotic diabetes
or neutropenic patients
230
What is the treatment for Mucormycosis?
Surgical debridement and amphotericin B
231
Mucormycosis has this type of hyphae
Nonseptate
232
Mucormycosis is transmitted through inhalation of these
Sporangiospores
233
This fungal infection can present with rhinocerebral infection, frontal lobe abscess, paranasal swelling
Mucormycosis
(Mucor, Rhizopus, Absidia)
234
A patient with ketoacidotic diabetes is susceptible to this fungal infection
Mucormycosis
(Mucor, Rhizopus, Absidia)
