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Central Nervous System Block > L11 - INFECTIONS OF THE NERVOUS SYSTEM : VIRAL INFECTIONS > Flashcards

L11 - INFECTIONS OF THE NERVOUS SYSTEM : VIRAL INFECTIONS Flashcards

1
Q

What is the name given to teh infection at brain?

A

Encepahlitis

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2
Q

What is the name given to the infection of meninges?

A

Meningitis

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3
Q

What is the name given to the infection of Spinal cord?

A

Myelitis

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4
Q

What is the name given to the infection of peripheral nerves

A

Neuritis/ Neuropathy

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5
Q

What are the two pathogenesis of viral CNS disease?

A

Direct invasion of the CNS

Post infectious syndromes; Acute disseminated encephalomyelitis (ADEM)

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6
Q

What are the laboratory diagnosis of viral infection?

A

Virus detection (Clinical specimens, CSF, Brain (biopsy, autopsy), throat swab (mumps, enteroviruses); stool (enteroviruses))

Serology
Clinical specimens: serum & CSF

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7
Q

What is the limitation in virus limitation?

A

Isolation rate in CSF of encephalitis is very low

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8
Q

When is PCR used for diagnosis of CNS infeciton?

A

Herpes simplex encephalitis
CMV encephalitis/ myelitis
VZV encephalitis/ meningitis/ myelitis

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9
Q

In what way can serology be applied in diagnosis?

A

Rising antibody titres
IgM
Intra-thecal (in CSF) antibody synthesis

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10
Q

When is rising antibody titres (serology) used for diagnosis?

A

Flu A/B, VZV, HSV, entero, mycoplasma (mumps, meales)

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11
Q

When is IgM antibody used for diagnosis?

A

JE, EBV

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12
Q

What is intra-thecal (in CSF) antibody?

A

It is used in the diagnosis by serology. However, it is only detectable later in illness. Paired serum or CSF specimens can be used as antibody index

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13
Q

What is the aetiology of viral meningitis?

A

Enteroviruses (ECHO, Coxackie A/B)

Herpes simplex type 2

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14
Q

What is the aetiology of Hand Foot and mouth disease?

A

Enterovirus (Cox A, EV 71)

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15
Q

What is the aetiology of viral encephalitis?

A

H. simplex type 1 (HSV 2 in neonates)
Enteroviruses
Varicella-zoster virus

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16
Q

What is the location of herpes simplex encephalitis in our brain?

A

Lesions characteristically in temporal lobe or orbital surface of frontal lobe. Ajdacent frontal, parietal or occipital lobes and cingulate gyri may also be involved

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17
Q

What are the clinical features of viral encephalitis?

A

History: Altered consciousness, headache, seizures, vomiting, memory loss

Clinical findings: fever, PERSONALITY CHANGE, dysphasia, autonomic dysfunction, ataxia, hemiparesis, seizures, cranial nerve deficits

18
Q

What is the method used to diagnose herpes encephalitis?

A

HSV DNA detection by PCR in CSF is method of choice

19
Q

What is the mortality of untreated herpes encephalitis?

A

70%

20
Q

What is the treatment of herpes encephalitis?

A

Acyclovir

21
Q

What is the treatment for relapse of HSE?

A

14 to 21 days acyclovir therapy

22
Q

What is the prognosis of Japanese encephalitis?

A

For those who are symptomatic, the mortality is 10-30% and many of the survivors have permanent brain damage

23
Q

What is the reservoir of the virus of Japanese encephalitis?

A

Zoonotic infection maintained in an animal

24
Q

How is the virus of japanese encephalitis transmitted?

A

Transmission between animals is by a mosquito typically associated with rice fields

25
Q

What is the causative agent for myelitis/ neuropathy?

A 
Enteroviruses (EV71, Polio, other)
VZV 
EBV 
CMV
Exanthems 
mumps 
HSV 2 
Japanese encephalitis
26
Q

What is the reservoir for rabies?

A

Anmial reservoir (Dogs, cats) and other mammals (Fox, wolves, jackals, mongoose)

27
Q

When is the last case of rabies in Hong Kong?

A

1981 for human

1987 for animals

28
Q

What is the parthenogenesis of rabies?

A
  • Virus replicates in striated muscle at the site of the bite –> enters nerve ending
  • Carried by axonal transport to the brain/ spinal cord. Hence bites on the face usually have a shorter incubation period - virus has less distance to travel
  • After replication in brain (encephalitis), the virus travels down the peripheral nerves to salivary glands (virus present in saliva), skin, muscles
29
Q

What is the incubation period of Rabies encephalitis?

A

20-90 days, maybe more than a year

30
Q

How is rabies encephalitis diagnosed?

A 
Viral antigen by immunofluroescence 
Inclusion bodies (Negri bodies)
31
Q

How are animal bites managed?

A

Wound toilet: clean with soap/ water, good debridement, instill antiseptics, avoid suturing if possible. Manage other potential complcaitions e.g. tetanus and other bacterial infections

Assess rabies risk

32
Q

How is the risk of animal bites assessed?

A

What animal?
Endemic area?
Behaviour of animal
Is animal available for observation

33
Q

If risk of rabies exposure is present, what is the further action of prevention?

A

Active immunisation: human diploid cell vaccine, 6 doses

Passive immunisation: Human rabies immune globulin

34
Q

What is an isoform

A

Same amino acid sequence but different 3D conformation

35
Q

What is a prion

A

Infectious protein

36
Q

What are the characteristics of encephalopathies of prion

A

Associated with accumulation of Prion-related protein in brain
Loss of neurons
Spongiform vacuolation of brain
Lack of an inflammatory reaction or immune response
Long incubation period

37
Q

What are the symptoms of Spongiform encephalopathies

A

Rapidly progressive dementia, loss of memory and intellect, personality changes, unsteadiness/ clumsiness, myoclonic jerks

38
Q

What are the causative agents of spongiform encephalopathies

A

Kuru

Creutzfeldt-Jakb disease (CJD)

39
Q

How is prion transmitted in contaminated medical instruments?

A

Electrodes in brain

Neurosurgical instruments in brain

40
Q

List four effective disinfectants method

A

Chlorine
Sod hydroxide
Propriatary enzymatic and alkaline detergents
Formic acid

41
Q

Give two ways of effective processes of disinfecting prion contacted instruments

A

Immerse in 1M NaOH for 2 hrs plus autoclave 121C for 30 min in downward displacement displacement autoclave
Autoclave (134C for > 18 min (prevacuum); 132C for 60 min (gravity))

Central Nervous System Block (2 decks)

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