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MNI (immuno path) > L38- Nervous System and Special Senses Infections II > Flashcards

L38- Nervous System and Special Senses Infections II Flashcards

1
Q

define aseptic meningitis

A

meningitis that is caused by a pathogen that will not grow on culture w/in 48hrs:

  • atypical bacteria
  • viruses
  • fungi
  • parasites
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2
Q

list the types of Tb meningitis based on geography

A

High-incidence regions:

  • tuberculous meningitis
  • intracranial tuberculoma
  • spinal tuberculous arachnoiditis

Low-incidence regions (US, Europe):
-tuberculous meningitis

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3
Q

list the complications from Tb meningitis- basilar meningitis

A
  • hydrocephalus
  • vasculitis –> can cause arterial or venous occlusion / stroke
  • CN deficit
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4
Q

list the symptoms of Tb meningitis based on stage of the disease (include timing)

A

1) Early, days - wks: NO NEURO DEFICITS or altered consciousness, fatigue, malaise, lethargy, behavior changes
2) Intermediate, wks - mos: meningeal irritation, minor neuro deficits — mainly CNs
3) Late, mos - yrs: abnormal movements, convulsions, stupor to coma, severe neuro deficits

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5
Q

CSF sample results in Tb meningitis:

  • (1) appearance
  • (elevated/depressed) WBC + type
  • (elevated/depressed) proteins
  • (elevated/depressed) glucose
A

1- fibrin-web like
2- elevated, lymphocytes
3- elevated
4- depressed

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6
Q

______ are the common causes of Spirochete meningitis

A

Lyme Disease —- Borrelia burgdorferi

Syphilis, Treponema pallidum

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7
Q

list the results of CSF sample in Lyme disease meningitis (WBC type, protein levels, glucose levels)

A
  • lymphocytic pleocytosis (inc lymphocytes)
  • elevated protein
  • normal glucose
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8
Q

diagnosis of Lyme disease starts with (1) and is confirmed with (2)

A

1- ELISA

2- western blot (Igs)

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9
Q

list the four main clues into a suspected diagnosis of Lyme Disease meningitis

A
  • travel to endemic region // tick bite
  • ECM (erythema chronicum migrans)
  • facial palsy
  • papilledema
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10
Q

list the results of CSF sample in Syphilitic meningitis (WBC type, protein levels, glucose levels)

A

(treponema pallidum)

  • lymphocytic pleocytosis (inc lymphocytes)
  • elevated protein
  • low glucose
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11
Q

describe diagnosing procedure for Syphilitic meningitis

A

1) serum + CSF serology

2) (confirmation) fluorescent treponemal Ab absorption (FTA-ABS)

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12
Q

______ is the most common cause of meningitis in general (start broad and include subtypes)

A

Viral, 85% enterovirus:

  • coxsackievirus A, B
  • echovirus
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13
Q

Coxsackievirus A, B meningitis:

  • (1) route of transmission
  • (2) predominant season
  • (3) describe brief pathogenesis
A

1- fecal-oral
2- summer-fall (Jun-Oct) // year round in tropical/sub-tropical areas

3:

i) naspharynx –> lymph
ii) infects LNs –> 1st viremia
iii) target tissue (many, but in this case meninges or brain) –> 2nd viremia

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14
Q

______ is defined as recurrent episodes of aseptic meningitis- include most likely cause

A

Mollaret’s meningitis- HSV-2

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15
Q

Herpesviruses and meningitis:

  • (1) are the most common causes
  • (2) is most common cause of neonatal herpes infection
  • (3) are infrequently associated with meningitis
A

1- HSV1 > HSV2
2- HSV2 (75%)
3- VZV, EBV, CMV, HHV6, HHV7

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16
Q

herpesviruses general viral features

A

dsDNA, enveloped –> latency

17
Q

LCMV = (1) — meningitis:

  • (2) family, genome, structure
  • (3) source / transmission
  • (4) predominant season
A

1- lymphocytic choriomeningitis virus
2- Arenavirus, enveloped, (-)ssRNA
3- rodents
4- winter mos

18
Q

Influenza A, B:

  • (1) family, genome, strucure
  • (2) predominant season
  • (3) population is at most risk
A

1- orthomyxovirus, (-)ssRNA, enveloped
2- winter mostly (Jan-Feb)
3- children <5yr via Influenza A

19
Q

Rabies:

  • (1) family, genome, structure, shape
  • (2) transmission, (3) is most common reservoir in US
  • causes (meningitis/encephalitis)
A

1- rhabdovirus, (-)ssRNA, enveloped, bullet shaped
2- bites or inhalation
3- raccoons
4- meningoencephalitis

20
Q

Rabies meningoencephalitis:

  • incubation period
  • symptoms in each stage
A

Incubation: typically 20-60 days, can be 6 days - 7 yrs
1) Prodromal, 2-10 days: non-specific; fever, n/v/d
(note Tx must occur in prodromal phase)
2) Furious: agitation, disorientation, seizures, twitching, (neck / pharyngeal spasms –> painful swallowing = hydrophobia)

3) Dumb: paralysis, disorientation, stupor

21
Q

describe diagnosis of rabies meningoencephalitis (samples, testing)

A

-usually based on Sxs and post-mortem

  • saliva and brain tissue with virus (Ags in serum, brain, CSF, corneal scrapings via IF)
  • **Intracellular eosinophilic inclusion bodies = Negri bodies
22
Q

describe Rabies treatment

A

passive and active post-exposure prophylaxis, must occur w/in first week or two of prodromal Sxs:
1) passive immunity via Antisera —- Human Rabies Immune Globulin (HRIG) at wound and IM

2) active immunity via inactivated vaccine — doses depends on preventative or post-exposure

23
Q

list the arboviruses that can cause viral meningitis by family

A

Flavivirus (enveloped, (+)ssRNA): **WNV (west nile), *SLE (St. Louis virus)

Bunyavirus (enveloped, (-)ssRNA): La Cross virus

Togavirus (enveloped, (+)ssRNA): EEE virus (eastern equine encephalitis), WEE virus (western equine encephalitis)

24
Q

WNV is transmitted via ______ (bonus- include what else it transmitts)

A

Culex mosquito —- all flaviviruses

25
Q

describe the presentation of Arbovirus meningitis

A

1) asymptomatic or prodromal / flu-like Sxs with variable severity
2) Range: febrile HA in aseptic meningitis - to - encephalitis [Note- indistinguishable from other causes]

26
Q

Fungal meningitis usually affects (1) population with (2) as the predominant cause

A

Note- rare, usually chronic
1- immuno-compromised

2- cryptococcus (bird droppings)

27
Q

Cryptococcus Neoformans - fungal meningitis:

  • (1) is hallmark microscopic feature
  • usually affects AIDS patients with (2) CD4+ T cell count
  • (3) describe diagnostic sequence
  • (4) results on imaging
A

1- encapsulated yeast
2- <100 cells/mm^3

3- neurological exam –> *serum cryptococcal antigen (CrAg) –> lumbar puncture

4- no pattern / variable – not helpful

28
Q

(1) are the clinically important parasitic causes of meningitis
(2) is a rare, but dangerous cause associated with swimming

A

1- Taenia solium (pork tapeworm), Toxoplasma gondii (opportunistic)

2- Naegleria fowleri – amebic meningitis

29
Q

Taenia solium:

  • (1) parasite type
  • (2) port of entry
  • (3) CNS effect
A

1- tapeworm, cestode

2- ???? possibly transported w/in WBCs

3- epileptic seizures

30
Q

Toxoplasma gondii:

  • (1) parasite type
  • (2) port of entry
  • (3) CNS effect
A

1- intracellular protozoa via cat feces or many other environments

2- transported w/in WBCs with active infiltration thru BBB endothelium

3- necrotizing encephalitis –> microglia forms nodules + chronic meningitis

31
Q

Neurocysticercosis:

  • (1) cause
  • most patients present with (2)
  • 1/3 pts present with elevated (3)
A

Note- most common parasitic CNS infection
1- Taenia solium – pork tapeworm via ingestion

2- seizures

3- raised ICP

32
Q

list the types of neurocystcercosis presentations (T. solium): indicate most common form + incubation period

A
  • *Intraparenchymal cysticerci- most common, usually 3-5yr incubation, but up to 30yrs
  • seizures and or HA

Extraparenchymal cysticeri- elevated ICP sxs (HA, n/v) + altered mental status —— involves ventricles, subarachnoid space, spine, and or eyes)

33
Q

Neurocystcercosis (T. solium) diagnosis:

  • (1) is main unique finding on routine CBC, LFTs
  • (2) parasitic response cell is importantly absent
  • (3) is not useful additional test as it might not be present at time of Dx
  • (4) is useful- include results
A

1- n/a
2- no eosinophilia
3- stool (no viable intestinal tapeworm may be present)

4- imaging: starry-sky appearance on CT/MRI = innumerable hyperdensities w/ eccentric calcific foci in both cerebral hemispheres

34
Q

______ is the hallmark feature for diagnosing Neurocystcercosis

A

(Taenia solium)

starry-sky appearance on CT/MRI: innumerable hyperdensities w/ eccentric calcific foci in both cerebral hemispheres

35
Q

Toxoplasma gondii is most serious in (1) populations as it usually presents as (2) is most people.

A

1- immuno-compromised or congenitally infected

2- asymptomatic (immuno-competent)

36
Q

(1) are the late clinical manifestations of untreated congenital Toxoplasmosis
(2) is the evaluation process of newborn with suspected infection

A

1- chorioretinitis, neurological abnormalities (motor abnormalities, intellectual disability, hearing loss)

2- maternal hx + serology –> complete PE –> T. gondii serology –> other ophthalmologic / neurological exams not in PE

37
Q

describe the diagnosis of toxoplasma gondii infection (hint- labs, imaging)

A

Labs:

  • CSF: mild/moderate protein elevation, mononuclear CSF pleocytosis (monocytes)
  • PCR

Imaging:

  • intracranial calcifications = single / multiple scattered throughout brain [multiple abscess like ring enhanced structures]
  • hydrocephalus (secondary to periaqueductal involvement)
  • cortical atrophy

MNI (immuno path) (14 decks)

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