Prayson Infection Flashcards
Epidural abcess
Most common organsims: Streptococcus and Staphylococcus. Usually 2/2 extension from bones (trauma, osteomyelitis) > soft tissue
Spinal- Staph aureus, Lumbar and thoracic, more common than intracranial
Intracranial - extension from sinus infection
Subdural abcess
1 Strep, #2 Staph. Bone/sinus infection via thrombophlebitis. Dorsolateral cerbrum, frontal pole, and interhemispheric fissure. Spinal rare
Leptomeninges
Fever, HA, nausea, vomiting, confusion, nuchal rigidity, Kernig’s and Brudzinski’s signs.
Neonatal- Strep agalactiae (Group B, exudate over vertex) and E. coli (hemorrhage, necrotizing, arteritis, necrosis) are most common, Proteus, Listeria (microabcesses)
Children- Nisseria meningitidis (basal aspect of brain, Waterhous Friederichesen)
Adults- S. pneumonia, Listeria monocytogenes
Abcess
#1 Streptococcus #2 gram-negative bacilli #3 Staphylococcus frequently multiple organisms
Mycobacterium tuberculosis
Necrotizing granulomas; Ziehl-Neelsen & Fite have low yeild (<50%)
CSF: lymphocyte predom
Epidural- extension from vertebral infxn (Pott’s), subdural- milliary or en-plaque, abcsess-tuberucloma, meningitis- base of brain, neutrophils, endarteritis.
Mycobacterium avium
Perivascular macrophages with orgasisms
Sarcoid
Non-casseating granulomas, base of brain post. fossa, Optic nerve and chiasm common, near vessels in meninges,
Whipple’s dx
Tropheryma whippelii, gram + actinomyocete. Males, dementia, gaze palsies, and myoclonus. PAS+ organsims in perivascular macs
Early Syphilis
Treponema pallidum; Steiner, Warthin-Starry, Dieterle stains. Subacute secondary lymphocytic meningitis, meningovascular lymhs, plasma cells, and gummata (central necrosis surrounded by epithelioid histiocytes, no organisms), arteritis, Heubner’s endarteritis obliterans, pachymeningitis cervicalis.
General paresis Syphilis
Progressive dementia, Argyll Robertson pupils, late frotnal atrophy, subacute encephalitis, loss of neurons, astrocytosis, perivascular inflammation, microglial with iron. Spirochetes hard to identify. 3 year course
Lissauer’s dementia
Cuased by syphilis (7-8 year course), variant of general paresis. Epileptic or aapoplectic attacks, temporal atrophy w/ pseudolaminar degenration.
Tabes Dorasalis
Degeneration of spinal dorsal roots and columns, lumbosacral and lower thoracic cord, dorsal root ganglia unaffected.
Caused by syphillis. Pain, loss of reflexes, loss of pain sensation and joint position, ataxia, Charcot joints. Optic nerve atrophy
Congenital syphilis
Meningovascular inflammation with obstructive hydrocephalus. Keratitis, chroiretinits, and deafness. cerebellar general paresis
Lyme disease
Borrelia burgdorferi, spirochete transmitted by ioxodid tick. Lymphoplasmacytic leptomeningitis, crainial neuropathy. Erythema chroncia migrans, cardiac involvement, and arthritis.
Actinomycosis
BT w/ fungal like morphology, thin filaments. Gram +, acid fast -. Sulfur granules, cervicofacial entry. Granulomas and basilar meningitis
Nocardia
Nocardia asteroides most common. BT w/ fungal like morphology, thin filaments. Gram+, partial acid fast +. lung entry. Granulomas, small and multiple with neutrophils
Cryptococcus
Budding yeast w/ thick mucopolysaccharide wall. Bird excrement. IMMUNOCOMPROMISED, M>F, pulmonary entry.
Leptomeningitis, gelatinous “bubbly” exudate, macs, perivascular extension giving a grossly HONEYCOMB look, granulomas, abscess. PAS, mucicarmine +
Candidiasis
Budding cells, branching pseudohyphae, Skin/GI entry, CNS dx 2/2 systemic or endocarditis. Chronic granulomas, microabscesses, GMS and PAS +
Aspergillis
Dichotomously branching septate hyphae. Airborn lung infxn followed by hematogneous spread. Immunocompromised. A. fumigatus and A. flavus most common.
Granulomas with basal meningitis, septic infarcts, focal cerebritis, especially white matter
Mucormycosis
Broad branching, non-septate. Entry from sinus or aspiration into lung. Rhinocerebral dx associated with DM and ketoacidosis. Hematogenous dx assoc w/ immunocompromised or IV drug use.
Acute meningeal inflammation, hemorrhagic coagulative necrosis of the brain (ventral), vascular lumen and mural invasion.
Coccidiodes immitis
South America and Southwest US. Double contoured refractile capsules with endospores. Very rarely involves CNS. Basilar meningitis w/ neutrophils and fibrinous exudate later becomes granulomas and fibrosis; cranial osteomyelitis; parenchymal granulomas rare. Largest.
Blastomyces dermatitidis
M>F, agricultural workers. Southwestern US, contaminated soil. Broad-based budding. Abscess
Histoplasma capsulatum
Central and eastern states (Ohio and Mississippi river valleys). Inhalation of dust or soil contaminated by spores. Small ovoid and budding bodies, PAS and GMS+. Rarely involves CNS, Immunocompromised. Necrosis with macs containing organisms, lymphs and plasma cells
Cowdry A inclusions
Intranuclear, spherical, halo. CMV, HSV, PML
