Quiz 4 - Weller - CNS Infections Flashcards by Brennan Stringam

What is meningitis?

Inflammation of the meninges

Fever, headache, stiff neck

Bacterial, viral, fungal, protozoan, parasitic

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What is encephalitis?

Inflammation (swelling) of the brain

Fever, headache, stiff neck

Often viral, but can be bacterial, fungal, protozoan, or parasitic

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What are brain abscesses/subdural empyema?

Similar symptoms to encephalitis

Mostly BACTERIAL

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What is purulent meningitis?

Meningitis with inflammatory exudate - usually bacterial

Mostly acute

Fever, stiff neck, irritability

Can be fatal

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What is chronic meningitis?

Gradual or subtle onset with progressive signs and symptoms over a period of weeks

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What is aseptic meningitis?

Inflammation from an increase of cells, usually WBCs in CSF and ABSENCE of bacteria/fungi

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T/F - Encephalitis is primarily viral etiology.

TRUE

Acute or chronic demyelinating diseases w/ or w/o inflammation can happen

Idiopathic encephalitis

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What is meningoencephalitis?

Pts with both meningeal and encephalitic manifestations

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What are the 4 routes leading to a CNS infection?

Hematogenous
-Blood
—Viral, bacterial, fungal

Contiguous focus
-Sinus, ear, face, oral cavity
—Bacterial

Direct inoculation/iatrogenic
-Trauma, surgery, lumbar puncture, congenital defects
—Bacterial

Nervous system
-Infection of systemic nn, retrograde movement to brain
—Viral

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What is contiguous focus exposure?

Any infection close to the CNS that spreads to the CNS - NOT BY BLOOD

Otitis media
Mastoiditis
Sinusitis

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What is a great example of a viral CNS direct inoculation?

Rabies virus

-Transmitted to peripheral neurons and travels via retrograde transport to CNS

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If there is a CSF infection, what do we look for, compared to normal values?

Bacterial

High WBC (Lots of PMNs)
LOW GLUCOSE
HIGH PROTEIN
High opening pressure

Viral

High WBC
NORMAL GLUCOSE
NORMAL PROTEIN
High opening pressure

Fungal

Very High WBC
LOW GLUCOSE
HIGH PROTEIN

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What is the most common type of meningitis?

VIRAL

Usually less severe than bacterial

Usually resolves on its own w/o treatment

Fever, headaches, stiff neck

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What is the most common cause of viral encephalitis?

Viruses

Fever, headache, altered cognition, seizure

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What are enteroviruses?

Most common cause of viral meningitis

*Especially active in the SUMMER and FALL months in children less than 15 years old

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Tell me about HSV meningitis.

Major cause of viral meningitis, 2nd only to enteroviruses

*In adults, majority of cases of meningitis are due to HSV-2

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HSV-1 is responsible for 90% of cases of ____ __________.

HSV encephalitis

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T/F - Varicella-Zosters Virus (VZV)is suspected in the presence of concurrent chickenpox or shingles, but also linked to meningitis and encephalitis w/o VZV characteristic rash.

TRUE

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____ _________ may produce aseptic meningitis, w/ or w/o associated infectious MONOnucleosis.

EBV infections

S Caleb Freeman

What should be suspected in any pt presenting with a viral meningitis w/ known or suspected risk factors for HIV infection?

HIV meningitis

This can occur following primary infection with HIV in 5-10% of cases and less commonly at later stages of illness

What is considered when clusters of meningitis and encephalitis cases occur in a restricted geographic region during the SUMMER or early FALL?

Arboviral meningitis

What is the classical presentation of encephalitic rabies?

Fever, fluctuating consciousness, autonomic hyperactivity

Newborns are at risk for meningitis via what organisms?

Group B strep/S. Agalactiae - GPC

E. coli - GNR

L monocytogenes - GPR

Klebsiella

Infants and children are at risk of meningitis via what organisms?

S. Pneumoniae - GPC

N. Menigitidis - GNDC

H. Influenzae - GNR

Adults are at risk for meningitis from what organisms?

Strep pneumoniae N meningitis

Difference b/t beta and alpha hemolysis.

Beta - Clear zone around bacterial colony. Complete lysis Alpha - greenish-brown colored halo around colonies. Partial lysis

Strep pneumoniae is known to cause what and where is it acquired?

Pneumonia, meningitis Normal oropharyngeal flora, aspiration to lungs/other parts of body Transmission to CNS may result in meningitis

What organism is the leading cause of sepsis and meningitis in the first few days of life for neonates?

Group B strep Found in lower GI and/or vaginal flora of 10-40% of women Can colonize the newborn if amniotic sac breaks and is open for longer than 18 hours and/or in the vaginal flora

What is another organism that commonly causes newborn meningitis?

E. coli From vaginal flora

__ _________ is strictly a human pathogen and found in nasopharyngeal flora of 20-80% of healthy people.

H influenzae Meningitis occurs in children in 2 years of age Immunization has dramatically reduced disease

What G- bacterium, that is usually found diplococcus and is exclusively a human parasite?

Neisseria meningitidis Nasopharyngeal colonization common *Common in pyogenic meningitis in all but most often in children

T/F - Listeria monocytogenes is a G+ rod that is beta hemolytic and spread in soil ground water, decayed veggies, and GI tract of animals we eat. It can grow at fridge temps.

TRUE

T/F - In 2006, the FDA authorized listeria-specific bacteriophage to be added to food products to combat listeria infections.

TRUE

What does listeria monocytogenes cause, how acquired, and symptoms?

Meningitis in newborns and immunocompromised Dairy, meat, vegetables Bacteremia, headache, stiff neck, confusion, convulsions

Mycobacterium tuberculosis causes what?

Tuberculosis

Other than tuberculosis, what else does mycobacterium TB cause?

Tuberculous meningitis - from the blood spread of primary or post primary TB Also can be acquired via exposure to individuals with active TB

T/F - Fungal pathogenesis is similar to bacteria, and most fungi are opportunists.

TRUE

Cryptococcus neoformans causes what?

Associated CNS involvement/meningitis development in immunocompromised pts These infections are rare in healthy people

T/F - Syphilis is a spirochete.

TRUE

How is syphilis acquired?

STD Primary infection is genitalia, secondary spreads beyond initial infection site Can cause neurosyphilis Headache, nausea, vomiting, neck stiffness, etc.

Lyme borreliosis is caused by _______ ___________.

Borrelia burgdorferi

What does Lyme disease cause?

Meningitis and/or chronic encephalopathy Transmitted by 14 species of tick Skin lesion, erythema, can spread to CNS

What are prions?

Protein molecules that have conformational changes of a normal prion protein (same protein, different folding/structure) **Protein material that can fold in multiple, structurally abstract ways, at least one of which is transmissible to other prion proteins, which leads to disease comparable to a viral infection Example: Creutzfeldt-Jakob disease

What are three examples of immunosuppression?

HIV, post organ-transplant, immunosuppression therapies

Tell me more about immunosuppression.

Reactivation of lantern infections -EBV, VZV, CMV Opportunistic susceptibility