L19: Parasit Penyebab Infeksi Otak

Question 1

Plasmodium falciparum menyebabkan apa?

Answer 1

celebral malaria

Question 2

penyakit cerebral malaria di karakterisasi berdasarkan?

Answer 2

A clinical syndrome characterized by:

–a coma (WHO: Glasgow coma score <11 in adults or a Blantyre
coma score <3 in children) at least 1 hour after termination
of a seizure or correction of hypoglycemia,

–asexual forms ofPlasmodium falciparumparasites on
peripheral blood smears

–no other cause to explain the com

Question 3

Cerebral malaria punya variasi gen apa?

Answer 3

Malaria lives and multiply in red blood cells,
also express new antigen on the surface of
infected erythrocytes→ Pf-EMP1 (var-gene)

Question 4

clinical manifestation dari cerebral malaria?

Answer 4

impaired consciousness, with coma the most severe
manifestation.

Question 5

clinical manifestation dari cerebral malaria? (CHILD)

Answer 5

• coma develops suddenly with seizure onset often, following 1-3 days of fever.

–few children develop coma

Question 6

clinical manifestation dari cerebral malaria? (adults)

Answer 6

• Cerebral malaria is part of a multi-organ disease.

–Patients develop fever, headache, body ache and progressively, delirium and coma.

Question 7

diagnosis falciparum malaria?

Answer 7

Conventional Microscopy –Giemsa Stain
–Positive asexual stages
of P. falciparum in
blood smear

Question 8

laboratory diagnosis dari falciparum malaria

Answer 8

• Parasite Count
  –Serology : Antigen detection (HRP2, pLDH)
  –PCR

Question 9

CSF examination dari falciparum malaria?

Answer 9

raised of albumin and cytokines (TNF-α, IL-2
& IL-6) → probably immunological based mechanism

Question 10

patogenesis dari toxoplasmosis encephalitis

Answer 10

• HIV induces susceptibility to opportunistic infections such
  as toxoplasmosis are likely multiple.

–These include depletion of CD4 T cells; impaired
production of IL-2, IL-12, and IFN-gamma; and impaired
cytotoxic T-lymphocyte activity.

–These deficiencies may play a role in the development of
toxoplasmosis associated with HIV infection

Question 11

toxoplasmosis encephalitis ini paling sering menginfeksi di area otak mana?

Answer 11

The most common affected area is the basal ganglia but other lesions
may involve cerebellar and brain stem areas.

Question 12

The most common focal neurologic signs for toxoplasmosis encephalitis?

Answer 12

motor weakness and speech disturbances

Question 13

clinical manifestation kalau di brain stem si toxoplasmosis encephalitis?

Answer 13

Brain stem involvement : cranial nerve
lesions →many patients exhibit cerebral
dysfunction with disorientation, altered
mental state, lethargy, and coma.

Question 14

clinical manifestation kalau di spinal cord toxo ence nya?

Answer 14

Spinal cord involvement : motor or sensory
disturbances of single or multiple limbs, bladder
or bowel dysfunctions, or both and local pain

Question 15

diagnosis TE di CT/MRI?

Answer 15

abscesses as multiple ring-enhancing

Question 16

diagnosis TE

Answer 16

1. Histologically confirmed → presence of T. gondii in brain biopsy
2. Laboratory confirmed → PCR results found T. gondii DNA in CSF
3. Probable TE → clinically appropriate (+), one or multiple masses on
   neuroimaging (+),
   radiological response after 10-14 days of empirical TE therapy, or IgG
   antibodies (+)
4. Possible TE → died or left the hospital without radiological
   confirmation

Question 17

cysticercosis disebabkan sama apa?

Answer 17

taenia solium (tapeworms)

Question 18

manusia sebagai host apa pada taenia solium?

Answer 18

host definitive

carrier by containing adult stage in the intestine → taeniasis

clinical manifestation by containing encysted larvae stage in
various tissues

Question 19

Stages dari Naegleria fowleri (free living amoeba)?

Answer 19

Three stages:
1. Trophozoites: feeding and dividing. Moves rapidly by producing hemispherical
bulges (lobopodia) at the anterior end and exhibits eruptive locomotion.
2. Flagellate: transitory (N. fowleri → an ameboflagellate)
3. Cysts: spherical, double-walled

Question 20

biasanya naegleria fowleri dimana?

Answer 20

–Worldwide, can be found in soil, warm fresh water, hot springs, sewage.

–Thermophilic (up to 45°C).

–Causing primary amoebic meningoencephalitis (PAM), primarily in health
children and young adults, history of swimming in warm fresh-water lakes,
streams, pools, hot springs

Question 21

balamuthia mandrillaris bisa menyebabkan apa?

Answer 21

Slow, insidious and chronic disease → develop over a period of time from about
2 weeks to 2 years. Balamuthia cause both a granulomatous as well as an acute
meningoencephaliti

Question 22

diagnosis balamuthia mandrillaris

Answer 22

CSF: lymphocytic pleocytosis typically < 500 cell/mm3, increased protein (15 to 45
mg/dL) to over 1000 mg/dL, but near- or below-normal levels of glucose. Rarely,
Balamuthia amoebae have been isolated from the CSF.

–Detection of Balamuthia mitochondrial DNA in CSF by PCR

–Blood: Increased anti Balamuthia IgM and IgG antibodies

–CT scans are unremarkable

–MRI scans show single or multiple lesions of low density with peripheral ring
enhancement and mass effect. The lesions came to be enclosed by calcified walls
which, in turn, were surrounded by oedematous areas. With time, the lesions
regressed in size and the oedematous areas resolved