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Neuro Round 2 wk 1 > Path - CNS infectious dz > Flashcards

Path - CNS infectious dz Flashcards

1
Q

What is the difference between cerebritis and intraparenchymal abscess?

A

cerebritis is focal inflammation and infection, without capsule

abscess has a capsule

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2
Q

What is the general morphology associated with cerebral abscesses?

A

capsule is hyperemic (reddish), firm and gray (when mature)

liquefied, tan green, purulent center

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3
Q

What is the general morphology of cerebritis?

A

involved brain is hyperemic, more poorly defined than with abscess. No capsule

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4
Q

What does the micriscopic view of an abscess and cerebritis have?

A
  • central cavity with necrosis and neutrophils
  • collagenous capsule (abscess only)
  • exuberant granulation tissue
  • surrounding area of gliosis and edema
  • macrophages (halo cells)
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5
Q

What makes up the dense fibrotic capsule of a brain abscess? What stain should be used to visualize this?

A

Reticulin fibers from perivascular fibroblasts

reticulin stain

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6
Q

Where would I find the organisms responsible for an abscess or cerebritis?

A

within necrotic areas, not capsule or surrouding gliotic brain

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7
Q

What is usually from direct extension from skull bones, middle ear, or air sinuses, but can be from hematogenous spread of bacteria from lung infection?

A

subdural absecess/empyema

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8
Q

Are epidural abscesses more common in the brain or in the spinal cord?

A

spinal cord; epidural space does not normal exist in the cranium

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9
Q

Suppurative inflammation from spread of organisms from osteomyelitis or vertebral tuberculosis to the epidural space can lead to…

Epidural space in the spincal column is usually filled with

A

spinal epidural abscess

fat

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10
Q

inflammatory process of leptomeninges and CSF within the subarachnoid space

A

meningitis

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11
Q

What will the CBC of someone with acute pyogenic meningitis usually have?

A

peripheral blood leukocytosis, usually with neutrophilia and left shift

severe inf may cause leukopenia

possible thrombocytopenia

combo leukopenia and thrombocytopenia correlate with a worse prognosis

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12
Q

What labs should you get to work up meningitis?

A
  • CBC
  • Coag studies
  • chemistry studies
  • blood cultures
  • LP
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13
Q

What are contraindications for an LP?

A

no absolute contraindications

use caution if evidence of increased ICP, could cause herniation?

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14
Q

What are CSF findings in acute bacterial meningitis?

A
  • hazy, cloudy, frank pus
  • high opening pressure
  • increased leukocytes - neutrophils
  • increased protein
  • decreased glucose
  • increased lactate
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15
Q

Why is glucose low in acute bacterial meningitis?

A

consumed by inflammatory cells, not so much the organisms

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16
Q

What would I find microscopically looking at acute bacterial meningitis? grossly?

A
  • micro
    • acute inflammatory infiltrate (neutrophils) in subarachnoid space
    • arrowheads are pointing to inflamed meninges in cerebellum
  • gross
    • creamy purulent exudate covering teh cerebral hemispheres and settles along the base of teh brain, around the cranial nerves and the openings of the fourth ventricle
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17
Q

What are possible sequelae of meningitis?

A

cranial nerve deficits

ischemic infarction (invasion of leptomeningeal vessels)

hydrocephalus (after the purulent exudate fibroses and clogs the fourth ventricle)

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18
Q

meningitis with no recognizable organism in culture or gram stain and no pus in CSF is considered … and is usually/…

A

acute aseptic meningitis

viral

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19
Q

Would you rather have bacterial meningitis or acute aseptic meningitis?

A

acute aseptic - less fulminant, is self-limiting

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20
Q

Does bacterial or aspetic meningitis have associated mental status changes?

A

bacterial

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21
Q

What is the MCC of acute aseptic meningitis?

A

non-polio enteroviruses

22
Q

What are the morphologic findings of acute aseptic meningitis?

A

leptomininges/subarachnoid and perivascular spaces by lymphocytes (sparse or uneven distrib)

NO involvement of brain parenchyma

23
Q

What are typical CSF findings of aseptic meningitis?

A
  • increased WBCs (less than bacterial)
    • low number neutrophils and only for 48 hours
  • protein moderately increased
  • glucose normal
  • negative stains and cultures
24
Q

What is a parenchymal infection of the brain?

A

viral encephalitis

25
Q

almost invariably, encephalitis has meningeal inflammation as well. this is called…

if it was the spinal cord involved too, it would be called…

A

meningoencephalitis

encephalomyelitis

26
Q

What are CSF findings in viral meningoencephalitis or encephalitis?

A
  • WBC pleocytosis - neutrophil early, mononuclear late
  • increased protein (as necrosis increases)
  • normal glucose
  • fungal and AFB cultures are negative
27
Q

What are we looking at?

A

micro appearance of viral encephalitis

  • later stages - predominatly lymphocytes and macrophages around blood vessels
    • perivascular cuffing (left)
  • activation and proliferation of microglia results in formation of ‘microglial nodules’ (right)
    • with neuronophagia of infected cells
  • necrotizing vasculitis is present in severe cases
    • no viral inclusions
28
Q

MC in teens and young adults, this form of encephalitis presents with alterations in mood, memory, and behavior

What area of the brain does it most often go after?

A

HSV-1 encephalitis

inferior frontal and temporal lobes (necrotizing and often hemorrhagic)

29
Q

What type of encephalitis is more likely to affect the brainstem, is seen in adults presenting as meningitis and is more likely the cause of neonatal encephalitis?

A

HSV-2

30
Q

Untreated neonatal HSV infection acquired at birth or transplacentally will present as what?

A

diffuse encephalitis with no prediliction for the frontal and temporal lobes

disseminated systemic disease with necrotizing encephalitis

31
Q

Seen in immunosuppresion or congenital infections, presenting with microcephaly, often plymicrogyria, and blueberry muffin babies

What cell type will be infected?

A

CMV encephalitis

any type of cell in CNS, with Cowdry type A (owls eye) intranuclear inclusions

32
Q

What is pathognomonic for rabies virus encephalitis?

A

Negri bodies - eosinophilic, well-circumscribed, cytoplasmic inclusion bodies seen in certain nerve cells, esp in pyramidal cells of the hippocampus

33
Q

HIV microscopically will have…

A

multinucleated giant cells with no viral inclusions

34
Q

What is the MCC of chronic bacterial meningitis?

A

mycobacterium tuberculosis (TB)

35
Q

If the CNS has a fungal infection, what was the most likely route?

A

almost always inhaled spores then spread to the brain

36
Q

What would be two fungal causes of chronic meningitis?

A

histoplasma capsulatum or cryptococcus neoformans

37
Q

What fungal CNS infections are really pretty much only found in immunocompromised patients?

A

candida albicans

rhizopus, mucor

aspergillus fumigatus

38
Q

What is the greatest risk factor for acquiring aspergillus?

A

neutropenia

39
Q

What fungus will appear in the body as spherules?

A

coccidioides immitis

40
Q

What fungal CNS infection will be mucicarmine positive?

A

cryptococcus neoformans

41
Q

Is histoplasma encapsulated?

A

no

42
Q

What am I looking at?

A

Negri bodies of rabies virus

43
Q

What am I looking at?

A

cryptococcus neoformans on india ink stain (left) and mucicarmine stain positive (right)

44
Q

What am I looking at?

A

disseminated cryptococcosis

setting of severe immunosuppression showing classic ‘soap bubble’ lesions

large colonies of cryptococci with thick mucoid capsules

45
Q

What is this? How is it handled in labs?

A

coccidioides immitus

not opened in labs because of risk of infection

46
Q

In toxoplasma gondii, what area of the brain is most often affected?

A

basal ganglia

shows ring enhancing lesions

47
Q

Primary Amoebic Meningoenceophalitis is most often an infection of what?

How quickly is the onset?

A

Naegleria fowleri and Balamuthia mandrillaris

death within 2-3 days of symptoms

48
Q

What am I looking at?

A

amoebic invasion

49
Q

Acanthomoeba or balamuthia may cause…

how does this compare to PAM?

A

GAE - granuloma amoebic encephalitis

acantho - has cysts (unlike naegleria) and is only gets immunocompromised or debilatated host

balamuthia is in person with hx of soil exposure

50
Q

What is special about prior disease pathology?

A

path is only in brain and no organism is associated - only misfolded proteins

no inflammation is present and CSF is normal

51
Q

What is the abnormal protein that is no longer water soluble or degradable by proteinases?

A

PrP sc

52
Q

What are we looking at?

A

Kuru plaques in the molecular layer of the cerebellum

bright pink-red eosinophilic aggregates of PrPsc protein

Neuro Round 2 wk 1 (15 decks)

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