Intro to CNS infection - A. Prunuske

Question 1

Where do CNS infections occur???

Meningitis
Encephalitis
Abscess
Myelitis

Answer 1

Meningitis (subarachnoid space)
Encephalitis (diffuse parenchyma)
Abscess (focal parenchyma)
Myelitis (spinal cord)

Question 2

What type of virus is associated with the late summer to early fall?

Answer 2

Enterovirus

Question 3

Why would geography play a role when you are diagnosing a CNS infection?

Answer 3

Tick exposure, west nile virus, etc.

Question 4

What is best treatment for CNS infection?

Answer 4

Bactericidal, small, lipophilic, low affinity for plasma binding proteins, and not a ligand of the efflux pumps at the blood brain barrier.

Question 5

Aminoglycosides have a risk for what serious side effect?

Answer 5

ototoxicity

Question 6

Beta-lactam drugs have potential for what important side effect?

Answer 6

Inhibition of GABA-A release
Leads to higher risk of seizures

Watch out for renal problems

Question 7

Potential side effects with macrolides?

Answer 7

Ototoxicity!

Question 8

If you look at the CT or MRI and see a focal mass lesion, why should you NOT do a lumbar puncture?

Answer 8

Increased risk of brain herniation

Question 9

Difference between fungal and bacterial meningitis?

Answer 9

Hgher pressure in bacterial meningitis

Both cases have elevated white count, but in bacterial you wil have polymorphonulear leukocytes (neutrophils, basophils, eosinophils)

Fungal case - higher levels of lymphocytes

Bacterial also has decreased levels of glucose because the bacteria is eating it up as well

Question 10

Big 3 symptoms for a CNS infection?

Answer 10

Fever, headache, altered mental state

Question 11

What is the difference between an encephalopathy vs encephalitis?

Answer 11

Encephalopathy refers to diffuse cerebral dysfunction without inflammation usually due to toxin or metabolic dysfunction

Ecephalitis is caused by an infective agent

Question 12

I want you to think REAL hard.

Do you remember what virus can use retrograde axonal transport in the CNS to get where it wants to go?

Answer 12

Rabies!

Question 13

What are ToRCH infections? Why are they important to you as a future clinician?

Answer 13

TORCH infections are a group of congenitally acquired infections that cause significant morbidity and mortality in neonates. Acquired by the mother and passed either transplacentally or during the birth process.

T-oxoplasmosis
O-ther (Syphilis, HIV, VZV, parvovirus B19, enteroviruses)
R-ubella
C-MV (Cytomegalovirus)
H-SV (Herpes)