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Infectious Pt. 2 Flashcards

1
Q

Which viruses (3) go through the peripheral nerves?

A

HSV
VZV
Rabies

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2
Q

Which viruses (3) go through the transplacental route?

A

Rubella
CMV
HIV

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3
Q

Which viruses (2) go through the oral-intestinal pathway?

A

Polio

Enterovirus

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4
Q

Which virus goes through the olfactory system?

A

HSV

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5
Q

Which virus goes through the sensory ganglia

A

VZV

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6
Q

Which virus goes through / hides in the kidney and bone marrow?

A

JC Virus

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7
Q

The JC virus depends on which cell-surface receptor to ingress into the cell?

A

Serotonin receptor

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8
Q

Which virus is associated with B cell lymphoma?

A

EBV

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9
Q

What are the 4 classifications of etiologic agents for acute aseptic meningitis?

A

Viral (majority)
Bacterial
Immune
Chemical irritant

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10
Q

Most common viral cause of acute aseptic meningitis?

A

Enterovirus

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11
Q

Dominant agent during local outbreaks for acute aseptic meningitis

A

Flaviviruses

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12
Q

Most frequent symptom of acute aseptic meningitis?

A

“Headache that is more severe than that a/w other febrile states”

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13
Q

What is the recognized host of Lymphocytic Choriomeningitis (LCM)?

A

Common house mouse

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14
Q

Etiologic agent: Mollaret Recurrent Meningitis

A

HSV-1

HSV-2 (most common)

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15
Q

Aseptic meningitis + bladder failure and vaginal/vulvar pain after herpes

A

Elsberg Syndrome

HSV-2, Mollaret Recurrent Meningitis

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16
Q

Most common encephalitis outside of North America?

A

Japanese B Encephalitis

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17
Q

Which area is known for having common birds (crows, jays) as arboviral encephalitis hosts?

a. West Nile
b. La Crosse
c. Powassan

A

ANS:
A. West Nile - common birds

Others:
B. La Crosse - Small Rodents

C. Powassan - Deer

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18
Q

Clinical picture of West Nile Virus?

A

Poliomyelitis
(febrile, flaccid, paralytic)
Facial paralysis

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19
Q

Which is more commonly a/w encephalitis, HSV-1 or HSV-2?

A

HSV-1

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20
Q

Which HSV presents with herpetic lesions of the oral mucosa?

A

ANS: HSV-1

HSV-1: oral mucosa
HSV-2: genital

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21
Q

How does HSV-1 differ in terms of clinical presentation vs. HSV-2?

A

HSV-1 Acute encephalitis

HSV-2 
Acute encephalitis (also in neonates)
Aseptic meningitis
Polyradiculitis
Myelitis
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22
Q

CSF picture of HSV encephalitis?

A

Increased pressure
Lymphocytic pleocytosis

**Hemorrhagic nature is INFREQUENTLY reflected in the CSF

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23
Q

Histopathologic findings in acute stages of HSV encephalitis?

A

Intranuclear eosinophilic inclusions (neurons, glial cells)

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24
Q

What are the 2 routes of infection of HSV encephalitis?

A

Route 1:
CNV ganglia -> nose, olfactory tract

Route 2:
CNV ganglia -> nerve fibers innervating leptomeninges (ant, mid fossae)

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25
EEG findings of HSV encephalitis
1) Lateralized periodic high-voltage sharp waves in the temporal regions 2) Slow-wave complexes at regular 2-3s intervals
26
Treatment of HSV encephalitis?
Aciclovir IV 30mg/kg/d x 14-21 days
27
What is the main etiologic viral agent for encephalitis a/w stem cell transplant?
HHV-6
28
What are the common hosts for Rabies in Western Europe and in the US? For both A) Wild B) Domestic
WILD Racoons, skunks, foxes, bats DOMESTIC Dogs, cats
29
How long is rabies' incubation period?
20-60 days
30
Characteristic symptom of rabies that signifies inflammatory response when the virus reaches the sensory ganglion
tingling/numbness at bite site
31
What are the 2 forms of rabies and which aspects of the neuraxis are involved for each?
Rabid form - tegmental medullary nuclei Paralytic / Dumb form - spinal cord infection
32
Which among the 2 forms of rabies is associated with bat bites and administration of previous rabies vaccines? a. Rabid form b. Paralytic/dumb rabies
b. Paralytic/Dumb rabies
33
What are the clinical features of toxic Rabies patients?
Increased ICP SIADH DI Dysautonomia
34
2 main histopathologic features (eponyms!) of rabies
Negri bodies - cytoplasmic eosinophilic inclusions (pyramidal, purkinje cells) Babes nodules - focal collections of microglia
35
What are the 3 things to be done after a rabies bite?
1. Clean the wound - Zephiran - benzyl ammonium chloride 2. Surveillance of animal - 10 days 3. Post exposure prophylaxis - HRIG - DEV - HDCV (D0, 3, 7, 14, 28)
36
Acute ataxia of childhood is most commonly associated with?
Chickenpox
37
What are the DNA Viruses?
``` Herpes Viruses (CMV, EBV, HSV, HHV) JC Virus ```
38
What are the RNA viruses?
``` Rhabdoviruses Arboviruses Paramyxoviruses Enteroviruses Influenza ``` RAPE influenza
39
Herpes Zoster can also cause poliomyelitis. How is it different from acute anterior polio?
Unilateral, segmental Greater involvement of the dorsal horn, root, ganglion
40
Most commonly involved areas in VZV?
Trigeminal, thoracic ganglion cells
41
What is the "course" of VZV?
Vesicles -> sensory n. -> ganglion Activation -> axon -> skin
42
What are the inclusion bodies in VZV 2/2 multiplication in epidermal cells?
Lipschutz inclusion bodies
43
When does vesicular eruption occur in VZV?
Within 72-96 hours (3-4 days)
44
Rashes in VZV usually occur along a dermatomal level. If they occur in a generalized pattern, what is this indicative of?
Malignancy
45
Most common dermatomal sites where you can successfully diagnose VZV via Tzanck smear?
T5-T10
46
What can you see in CSF of patients with Zoster encephalitis?
VZV Membrane Antigen (VAMA)
47
Treatment of Zoster is Aciclovir. Which population merits the use of IV acyclovir?
Immunocompromised | Disseminated (>3 dermatomes) zoster
48
Topical treatment for postherpetic neuralgia
Capsaicin 2 ASA (crushed) + mixed w/ cold cream / chloroform 15 ml
49
Criteria for AIDS
Either of the ff: CD4 < 200 cells/uL Opportunistic infection
50
Most common neurologic complication in the later stages of HIV
HIV encephalopathy | presents as dementia
51
Most sensitive tests in the early stages of HIV dementia
tests of psychomotor speed
52
What is seen in HIV myelopathy?
Vacuolar degeneration
53
Most common neuropathic pattern in HIV-associated peripheral neuropathy
Dystal, symmetric, axonal polyneuropathy
54
What was the first proven viral polyneuritis in humans?
HIV neuropathy
55
Which ARV can cause myopathy?
Zidovudine 2/2 effects on mitochondria
56
Most common cause of focal neurologic complications among opportunistic infections of the CNS w/ HIV
Toxoplasmosis
57
Treatment of Toxoplasmosis?
Pyrimethamine 200mg, then 50mg/day Sulfadiazine 4-6 g/day x 4 doses Alternative: Clindamycin
58
Progressive multifocal leukoencephalopathy is known to occur at what CD4 level?
< 50 cells/uL
59
Treatment of Cytomegalovirus?
Ganciclovir | Foscarnet
60
Etiologic agents of TB for HIV-AIDS pts?
M. tuberculosis | M. avium-intracellulare
61
T or F. Syphilitic meningitis and meningovascular syphilis have an increased incidence in HIV pts.
True
62
Tropical Spastic Paraparesis is caused by?
HTLV-1
63
Known causes of acute anterior poliomyelitis? (give 4)
Poliovirus (most common) Coxsackie (A&B) Japanese Encephalitis West Nile Virus
64
In paralytic poliomyelitis, when does weakness occur?
At the height of fever or as temperature falls *Maximum severity: 48 hours
65
Bulbar paralysis due to poliomyelitis is more common in which patient population? Which part of the NS is affected?
Young adults Nucleus ambiguus
66
Earliest histopathologic changes in the anterior horns for polio?
Central chromatolysis of nerve cells
67
CD4 count at which JC virus occurs
< 200 cells/uL Most often < 50 cells/uL
68
PML is associated with all of the following EXCEPT: a. Lymphoma b. Chronic myelogenous leukemia c. HIV d. TB e. None of the above
e. None of the above
69
What is usually the first presentation of PML? a. Seizures b. Focal deficits c. Personality changes & intellectual impairment
c. Personality changes and intellectual impairment
70
Characteristic EEG finding for SSPE?
Periodic bursts (5-8s) of 2-3s high-voltage waves followed by a relatively flat pattern
71
Histopathologic hallmark of SSPE
Eosinophilic inclusions in cytoplasm and nuclei
72
What is von Economo Disease and its clinical features?
Encephalitis Lethargica Somnolence Ophthalmoplegia Hyperactivity Movement Disorders Delayed EPS (Parkinsonian syndrome in survivors)
73
CJD has a higher association among the following populations EXCEPT: a. Israelis (Libyan origin) b. Jews c. North African (immigrants to France) d. Slovakia
b. Jews
74
What is CJD's only clear mechanism of spread?
Iatrogenic
75
What is the primary pathogenic mechanism of CJD?
Conversion of PrpC -> PrPSc Cellular prion protein (PrPC) to its misfolded pathogenic form (PrPSc) which is protease resistant.
76
Which variant of CJD presents with cerebellar ataxia?
Brownell-Oppenheimer variant
77
Which variant of CJD presents with visual disturbances?
Heidenhai variant
78
What are the distinctive EEG changes in CJD?
1) Diffuse and nonspecific slowing 2) Stereotyped high-voltage slow and sharp-wave complexes (on an increasingly slow and low-voltage background) Pseudo-periodic high-voltage sharp waves
79
The most sensitive test for CJD? a. CSF studies b. EEG c. MRI d. Immunoassay
c. MRI Hyperintensity of cortex, BG, lenticular nuclei
80
What do immunoassay studies for CJD test for?
Peptide fragments of normal brain protein "14-3-3"
81
T or F. Prions can be detected in the urine of CJD pts.
True
82
Myoclonus and corresponding sharp waves in EEG of CJD patients are due to?
Loss of inhibitory neurons in the thalamic reticular nuclei
83
Which spongiform disease is familial (AD) that presents with dysesthesias, proximal lower extremity weakness as an early feature?
Gerstmann-Straussler-Sheinker Syndrome
84
Which part of the brain is affected in fatal insomnia?
Medial thalamic nuclei
85
Kuru is classically found in which patient population?
Fore tribe, New Guinea
86
What is the presentation of Kuru?
Ataxia, emotional lability, uncontrollable laughter
87
What are found in Kuru plaques?
Amyloid-like material, PAS positive stellate plaques
88
PRPsc has what kind of protein structure?
B-pleated sheet
89
Pleomorphic, less clearly circumscribed eosinophilic inclusions, rabies
Lyssa Bodies

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