Lecture 6 - Bacteria of CNS

Question 1

Generally speaking, ______ meningitis is less severe than _____.

Answer 1

Viral is less severe than Bacterial.

Question 2

In individuals greater than 2 years old, meningitis presents with 3 key symptoms:

1. _____ _____
2. _______
3. _____ ______

Answer 2

1. High Fever (higher than would be seen in something like the flu)
2. Headache
3. Nuchal Rigidity (stiff neck)

Question 3

In infants, the classic symptoms are sometimes absent or difficult to detect. Instead, infants often present as being slow, inactive, ______, Feeding poorly, and _____.

Answer 3

Irritable

Vomiting

Question 4

In order to diagnose meningitis, a spinal tap is used to examine the ______. To detect bacteria, you can perform a _____ stain.

Answer 4

CSF

Gram

Question 5

One of the ways to distinguish between viral and bacterial meningitis is by looking at the WBCs in the CSF. There will typically be higher counts of WBCs in ______ meningitis. Lymphocytes are more abundant with _____ meningitis while PMNs (neutrophils) are abundant in ______ meningitis.

Answer 5

Bacterial

Viral

Bacterial

Question 6

Glucose and lactate levels in the CSF are ______ and ______ respectively with bacterial infection but are _____ with viral infection (should make sense being that bacteria use glucose as a substrate for metabolism which produces lactate.)

Answer 6

Reduced

Elevated

Normal

Question 7

N. Meningitidis is part of the ___ flora of the nasopharynx. It is a gram ____ diplococcus bacteria. Like H. Influenza and S. Pneumoniae, N. meningitidis has a _____ that helps it escape phagocytosis by preventing ______.

Answer 7

Normal

Negative

Capsule

Opsonization

Question 8

N. Meningitidis virulence factors include:

1. Capsule
2. ____ Protease - prevents being swept out by secretory ____ in mucous membranes
3. Pili - helps with adhesion
4. LOS - variant of LPS, which acts as an endotoxin

Answer 8

IgA protease

IgA

Question 9

Neonatal meningitis is typically caused by either E. coli or ______ _______, whereas chronic meningitis is typically caused by M. _______, C. _______ (in AIDS patients), or Candida _______.

Answer 9

Listeria Monocytogenes

M. Tuberculosis

C. Neoformans

Candida Albicans

Question 10

N. Gonorrhea, unlike N. Meningitidis, is NOT part of the normal flora. It is a gram _____ diplococcus that causes inflammation of the _____ surfaces.

Answer 10

Negative

Mucosal

Question 11

The fact that males with Gonorrhea experience ______ is good in that it causes them to seek treatment. Women, however, are often ______, and without treatment the disease can progress to ______.

Answer 11

Pain

Asymptomatic

Pelvic inflammatory Disease (PID)

Question 12

N. Gonorrhea, unlike N. Meningitidis, does not have a ______. It ferments _____ but not _____ and is sensitive to both _____ and _____. To distinguish N. Gonorrhea in culture, an ______ medium is used to select against other, more populace bacteria. This allows N. Gonorrhea to grow enough to be recognized.

Answer 12

Capsule

Glucose but not Maltose

Cold and Drying

Enrichment medium

Question 13

Because it invades mucous membranes, it should make sense that one of its virulence factors is a ______ protease. It also has pili and _____ membrane proteins for attachment. and ______ for iron uptake.

Answer 13

IgA protease

Outer membrane proteins

Gonobactin

Question 14

Even though infection rates are declining, one of the big problems with N. Gonorrhea is its ______ to antibiotics. _____ _____ _____ (MDR) has become a recent problem.

Answer 14

Resistance

Multiple Drug Resistance

Question 15

N. Gonorrhea is also capable of two things that allow it to escape host immunity:

1. ____ variation –> alternates between being ____ and non-____ (the latter being less virulent, of course.)
2. ____ variation –> expresses different surface proteins.

Answer 15

Phasic

Piliated

non-Piliated

Antigenic

Question 16

Antigenic variation in N. Gonorrhea occurs as follows:

They contain a pil__ gene that is a complete gene with a functional _____. They also contain pil__ loci that are silent ______ (they cannot be expressed as they are.) Instead, they undergo _______ recombination (could include the entire ______ or just parts) with the pil__ variable region. The fact that N. Gonorrhea has multiple pil__ loci and that these can recombine in multiple ways with the pil__ gene provides significant variation in the pili it expresses.

Answer 16

pilE

Promoter

pilS

Cassettes

Homologous recombination

Cassette

pilE

pilS

pilE

Question 17

Syphilis is caused by T. ______. It is a gram _____ spirochete, but doesn’t show up well with gram staining because it’s long and thin (doesn’t take up stain.) It does contain an outer membrane with _____, and it has a _____ present in the periplasmic space (unique to spirochetes –> allows them to move in a corkscrew type fashion.)

Answer 17

Pallidum

Negative

LPS

Flagellum

Question 18

Generally, only _____ and _____ syphilis are infectious/transmittable.

Answer 18

Primary and Secondary

Question 19

Primary syphilis presents with a ____ at the site of infection and regional ______.

Answer 19

Chancre

Lymphadenopathy

Question 20

Secondary syphilis presents with disseminated ____, fever, generalized _______, and potentially meningitis.

Answer 20

Rash

Lymphadenopathy

Question 21

Tertiary syphilis is very severe, and affects basically all the bodily organs. It is not the infection that causes the tissue damage: rather, it’s the host’s ______ response.

Answer 21

Immune

Question 22

Treatment for syphilis is administration of _______ G, once the diagnosis has been confirmed by visualizing the bacteria using ____field microscopy or ____ stain. It can also be identified using PCR.

Answer 22

Penicillin G

Darkfield microscopy

Silver