Neuroinfectious

Question 1

What does this show?

Answer 1

Granulomatous inflammation and Langerhand Cell (second slide)

Question 2

Risk Factors for CNS tuberculosis (5)

Answer 2

1. Age (more common in children)
2. HIV infection
3. Malnutrition
4. Disease prevalence area
5. Recent measels in children

Question 3

Classic symptpoms of congenital toxoplasmosis (3) and other (7)

When does infection typically occur?

How is it treated?

Answer 3

Classic triad

1. Hydrocephalus
2. chorioretinitis
3. intracranial calcifications

Other symptoms

1. fever
2. rash
3. HSM
4. Jaundice
5. Thrombocytopenia
6. seizures
7. Psychomotor retardation

Typically infection occurs in the third trimester

Treated with pyrimethamine, sulfadiaine, leukovorin +/- prednisone later on

Question 4

West nile virus

1. Neurologic symptoms (6)
2. Eye symptoms (3)
3. Skin findings (1)
4. CSF findings (4)
5. Serology notes (2)
6. Treatment

Answer 4

1. Neurolgic Symptoms
   
   1. meningitis / encephaliits
   2. Flaccid paralysis
   3. Motor axonal polyneuropathy
   4. Brachial plexopathy
   5. GBS-like syndrome
   6. Myasthenia gravis
2. Eye symptoms
   
   1. Chorioretinitis
   2. vitreitis
   3. retinal hemorrhage
3. Skin findings
   
   1. morbilliform or maculopapular rash
4. CSF findings
   
   1. moderate pleocytosis (~200 cells/mm³)
   2. increased protein
   3. Normal glucose
   4. (gimme) west nile IgM strongly associated with CNS infxn
5. Serology note
   
   1. Early false negatives
   2. IgM can remain + for >1 year
6. Treatment : supportive

Question 5

Important bug to consider when thinking of GBS-like picture and what sepparates it (2)?

Answer 5

Poliomyositis

1. HIGH WBCs, normal to slightly elevated protein
2. Asymmetric paralysis, peaks within 48 hours

Question 6

Patient with:

Recurrent meningitis
uveitis
depigmentation of skin and hair
hearing loss

Answer 6

Vogt-Koyangagi-harada (VHK) syndrome

“very krazy hair, very krappy hearing, very kopied headaches”

Question 7

Patient presents with meningitis and cranial neuropathies.

What are ways you can distinguish West nile (3) from Lyme (3)?

Answer 7

West Nile:

• Sensory findings = MINIMAL
• Encephalopathy = NOT present
• Preceded by flu-like illness

Lyme:

• Typically question stem will involve joint symptoms, multiple cranial neuropathies
• CAN have sensory loss on exam
• (gimme) will see characteristic rash

Question 8

Patient with HIV comes in to office. What do you worry about when his CD4 count is below:

• >500 (2)
• 200-500 (2)
• <200 (2)
• <50 (1)

Answer 8

• >500:
  
  • autoimmune disorders
  • Seroconversion
• 200-500
  
  • Neurocognitive disorder
  • VZV radiculopathy
• <200
  
  • Opportunistic infections
  • Tumors
• M<50
  
  • Toxoplasmosis

Question 9

Patient with SIRS develops encephalopathy with myoclonus

what is the medication to blame?

What condition can predispose to this?

Answer 9

Cefepime

Renal failure increases risk

Question 10

Arboviruses

1. Non-specific findings (photophobia, headaches, meningitis/encephalitis) +/- flaccid paralysis or Mobiliform rash
2. # 1 but from asian countries
3. Multiple cranial neuropathies, cardiac abnormalties
4. Blanching rash progressing to petechial rash

Answer 10

1. West nile
2. Japanese Encephalitis
3. Lyme
4. Rocky mountain spotted fever

Question 11

Fungal infection with chronic sinusitis

Answer 11

Aspergillosis

Question 12

Treatment criteria for Kawasaki disease

Answer 12

Must fulfill 4 of 7 criteria:

WBC >12,000
PLT <350,000
CRP >3+
Hct <35%
Albumin <3.5
Age <12 months
Male sex

Question 13

Managment of Fungal infections:

Cryptococcus (2)
Aspergillosis (2)
CNS histoplasmosis (2)

Answer 13

1. Cryptococcus
   
   1. Amphoteracin B
   2. Flucytosine
2. Aspergillosis
   
   1. Voriconazole
   2. Amphoteracin B
3. CNS histoplasmosis
   
   1. Amphotericin B
   2. followed by itraconazole

Question 14

(mnemonic)

Facultative intracellular organisms

Answer 14

“Legions of Salmon, Rabbits, N’ Cows Tumble IN MY yard

Legionells
Salmonella
Fransciscella (rabbits)
Neisseria
Brucella (cows)
Listeria (tumble)
IN = intracellular
Mycobacterium (my)

Question 15

CSF feature that can help differentiate TB meningitis from viral meningitis

Answer 15

TB meningitis will often have low chloride levels.