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Micro 3010 > Unit 15 - CNS Infections > Flashcards

Unit 15 - CNS Infections Flashcards

1
Q

What agents cause meningitis?

A
  • Neisseria meningitidis
  • Haemophilus influenzae
  • Streptococcus pneumonia
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2
Q

Encephalitis

A

inflammation of the brain

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3
Q

Meningitis

A

inflammation of the meninges caused by viral or bacterial infection

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4
Q

What can cause encephalitis?

A
  • HSV
  • Polio
  • WNV
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5
Q

What does the CNS include?

A

brain, spinal cord, cranial nerves

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6
Q

What is the CNS protected by?

A

bone and membrane layers

ex. brain - skull
ex. spinal cord - vertebral column

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7
Q

Blood-borne invasion across BBB to cause _____

A

encephalitis

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8
Q

Blood-borne invasion across CSF to cause ______

A

meningitis

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9
Q

How can microbes cross BBB?

A

1-Growing across, infecting the cells that comprise the barrier
2-Being passively transported across in intracellular vacuoles
3-Being carries across by infected white blood cells

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10
Q

Normal:

Cells/mL

A

0-5

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11
Q

Normal:

Protein (mg/dL)

A

15-45

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12
Q

Normal:

Glucose (mg/dL)

A

45-85

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13
Q

Septic (purulent meningits):

Cells/mL

A

200-20,000 (mainly neutrophils)

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14
Q

Septic (purulent meningits):

Protein (mg/dL)

A

high (>100)

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15
Q

Septic (purulent meningits):

Glucose (mg/dL)

A

<45

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16
Q

Septic (purulent meningits):

Causes?

A

bacteria, amoebae, brain abscess

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17
Q

Aseptic meningitis or meningoencephalitis:

Cells/mL

A

100-1000 (mainly mononuclear)

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18
Q

Aseptic meningitis or meningoencephalitis:

Protein (mg/dL)

A

moderately high (50-100)

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19
Q

Aseptic meningitis or meningoencephalitis:

Glucose (mg/dL)

A

Normal

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20
Q

Aseptic meningitis or meningoencephalitis:

Causes?

A

viruses, Mtb, fungi, brain abscess, partly treated bacterial meningitis

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21
Q

Describe bacterial meningitis

A
  • More severe but less common
  • Prior to 1990s, Hib most common
  • Neisseria meningitidis, Streptococcus pneumoniae are the other two key pathogens
  • Life-threatening
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22
Q

Neisseria meningitis:

Virulence factors

A
  • Capsule
  • IgA Protease
  • Pili
  • Endotoxin
  • Outer membrane proteins
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23
Q

Haemophilus influenzae:

Virulence factors

A
  • Capsule
  • IgA Protease
  • Pili
  • Endotoxin
  • Outer membrane proteins
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24
Q

Streptococcus pneumoniae:

Virulence factors

A
  • Capsule

- IgA Protease

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25
Q

Possible causes of bacterial meningitis in Neonates (<1 month)

A

Gram negative bacilli

  • E. coli, Klebsiella, Enterobacter
  • Streptococcus agalactiae (group B)
  • Listeria monocytogenes
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26
Q

Possible causes of bacterial meningitis in Infants (1-23 months)

A
  • Streptococcus agalactiae (group B)
  • E. coli
  • Haemophilus influenza
  • Streptococcus pneumoniae
  • Neisseria meningitidis
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27
Q

Possible causes of bacterial meningitis in Children (>2 yrs) & Adults

A
  • Streptococcus pneumoniae

- Neiserria meningitidis

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28
Q

Possible causes of bacterial meningitis in Older Adults (>65 yrs)

A
  • Streptococcus pneumoniae
  • Neisseria meningitidis
  • Listeria monocytogenes
  • Aerobic gram-negative bacilli
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29
Q

Meningococcal Meningitis:
____% of population is carrier
*Higher carrier rates during epidemics

A

20

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30
Q

Meningococcal Meningitis:

___ for attachment to epithelium of nasopharynx

A

pili

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31
Q

Meningococcal Meningitis:

Invasion of blood and meninges _____

A

rare

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32
Q

Meningococcal Meningitis:

Presence of Abs to capsular Age protects from _____

A

invasion

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33
Q

Meningococcal Meningitis:

Individuals with _____ _________ deficiency more susceptible

A

C5-C9 complement

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34
Q

Meningococcal Meningitis:

Who is at greater risk?

A
  • Young children who have lost maternal Abs

- Adolescents who never encountered infecting serotype

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35
Q

Meningococcal Meningitis:

_______ infection

A

droplet

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36
Q

Droplet infection

A

An infection transmitted from one individual to another by droplets of moisture expelled from the upper respiratory tract through sneezing or coughing.

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37
Q

Droplet infection is worse during ______ and ________

A

overcrowding and confinement (prisons, college dorms, military barracks, etc.)

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38
Q

Meningococcal Meningitis:

Peak?

A

winter/early spring with carrier rates between 60-80%

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39
Q

Meningococcal Meningitis:

Incubation time?

A

1-3 days

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40
Q

Meningococcal Meningitis:

Causes sudden onset of ??? (symptoms)

A
  • headache
  • sore throat
  • drowsiness
  • fever
  • stiff neck
  • hemorrhagic skin rash (indicates septicemia)
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41
Q

Meningococcal Meningitis:

Mortality (untreated)

A

100%

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42
Q

Meningococcal Meningitis:

Mortality (treated)

A

10-15%

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43
Q

Meningococcal Meningitis:

Is there a vaccine available?

A

yes

44
Q

Meningococcal Meningitis:

Which serotypes are in the vaccine?

A

Serotypes A, C, Y and W135 (routine childhood vaccination)

45
Q

Meningococcal Meningitis:

There are two vaccines, please describe them

A

1) Meningococcal polysaccharide vaccine (MPSV4)

2) Meningococcal conjugate vaccine (MCv4) - 11 to 55 yr old

46
Q

Meningococcal Meningitis:

Describe the lab diagnosis

A
  • essential
  • takes a gram stain of CSF
  • cultures it
  • counts white cell count
47
Q

Haemophilus Meningitis:

What causes it?

A

Haemophilus influenzae B

48
Q

Haemophilus Meningitis:

How many serotypes of Haemophilus influenzae B are there?

A

six serotypes a-f based on capsules

49
Q

Haemophilus influenzae B:

Natural resident of ??

A

respiratory tract of infants and children

50
Q

Haemophilus influenzae B:

What protects infants until 3-4 months when Abs wane

A

Maternal antibodies

*this provides a window of susceptibility when Abs wane

51
Q

Haemophilus Meningitis:

Incubation time

A

5-6 days

52
Q

Haemophilus Meningitis:

How fatal is it compared to meningococcal and pneumococcal meningitis?

A

Less fatal than both

53
Q

Haemophilus Meningitis:

What can it cause?

A
  • hearing loss
  • delayed language development
  • mental retardation
  • seizures
54
Q

Haemophilus Meningitis:

Is there a vaccine?

A
  • Yes
  • HiB vaccine
  • given >2 months
55
Q

Pneumococcal Meningitis:

_____ cause of meningitis

A

common

56
Q

Pneumococcal Meningitis:

is _______

A

encapsulated

57
Q

Pneumococcal Meningitis:

Carried in _____ of many healthy people

A

throats

58
Q

Pneumococcal Meningitis:

Invasion of blood and meninges ____

A

rare

59
Q

Pneumococcal Meningitis:

Low levels of capsular Abs allows for _______

A

susceptibility

60
Q

Pneumococcal Meningitis:

Abs type _____

A

specific

61
Q

Pneumococcal Meningitis:

_____ capsule types

A

> 85

62
Q

Pneumococcal Meningitis:

Compare the mortality rate to Haemophilus Meningitis and Meningococcal Meningitis

A

Mortality rate of pneumococcal meningitis > HiB and meningococcus

63
Q

Pneumococcal Meningitis:

Is there a vaccine?

A

Yes

64
Q

Pneumococcal Meningitis:

Which vaccine is for 2-23 months and immunocompromised?

A

Heptavalent protein-conjugate

65
Q

Pneumococcal Meningitis:

Which vaccine is for children > 5 years?

A

23-valent

66
Q

Neisseria meningitidis:

Patients?

A

children and adolescents

67
Q

Neisseria meningitidis:

Important clinical features?

A 
acute onset (6-24 hr)
skin rash
68
Q

Neisseria meningitidis:

Mortality (% of treated cases)

A

7-10

69
Q

Neisseria meningitidis:

Sequelae (major CNS deficit, in addition, up to 10% of patients develop deafness)

A

<1

70
Q

Haemophilus influenzae:

Patients?

A

children <5 yrs

71
Q

Haemophilus influenzae:

Important clinical features?

A

onset often less acute (1-2 days)

72
Q

Haemophilus influenzae:

Mortality (% of treated cases)

A

5

73
Q

Haemophilus influenzae:

Sequelae (major CNS deficit, in addition, up to 10% of patients develop deafness)

A

9

74
Q

Streptococcus pneumoniae:

Patients?

A

all ages, especially children under 2 and elderly

75
Q

Streptococcus pneumoniae:

Important clinical features?

A

acute onset may follow pneumoniae and or septicaemia in elderly

76
Q

Streptococcus pneumoniae:

Mortality (% of treated cases)

A

20-30

77
Q

Streptococcus pneumoniae:

Sequelae (major CNS deficit, in addition, up to 10% of patients develop deafness)

A

15-20

78
Q

Viral Meningitis:

most ______ type

A

common

79
Q

Viral Meningitis:

____ than bacterial meningitis

A

milder

80
Q

Viral Meningitis:

symptoms?

A

headache
fever
light sensitivity (photophobia)

*milder symptoms than bacterial meningitis

81
Q

Viral Meningitis:

complete recovery is _____

A

typical

82
Q

Viral Meningitis:

Difficult to isolate virus from CSF so how is diagnosis done?

A

with a viral genome detection

ex. PCR

83
Q

Viral Meningitis:

______ is often the cause

A

enteroviruses

84
Q

Encephalitis

A

inflammation of brain parenchyma

85
Q

Encephalitis:

Is it usually viral or bacterial?

A

viral

86
Q

Encephalitis:

_______ dysfunction is typical

A

cerebral

87
Q

Encephalitis:

What does cerebral dysfunction cause?

A

abnormal behaviour, seizures, nausea, vomiting, fever

88
Q

Encephalitis:

What virus is the most common cause?

A

HSV (herpes simplex virus)

89
Q

How can neonates get HSV encephalitis?

A

passage down birth canal of female shedding HSV-2

90
Q

How can older children and adults get HSV encephalitis?

A

HSV-1 viral reactivation in nerves in skull (trigeminal ganglia) and the infection spreading back to temporal lobe of brain

91
Q

HSV Encephalitis:

___% fatality if not treated

A

70

92
Q

HSV Encephalitis:

Treatment?

A

Antiviral therapy for 21 days

93
Q

Poliovirus Encephalitis:

Used to be the ______ cause of encephalitis

A

common

94
Q

Poliovirus Encephalitis:

Symptoms?

A

1-4 days of fever, sore throat, malaise, followed by signs of meningitis

affect on motor neurons - can cause paralysis

95
Q

Poliovirus Encephalitis:

Global efforts have _____ polio

A

eradicated

96
Q

West nile virus:

Carried by?

A
  • Birds and culicine mosquitoes

- Humans and horses, incidental hosts

97
Q

West nile virus:

Previously in ____ and ______________

A

Africa

Middle East

98
Q

West nile virus:

In the 1999 outbreak, how was this spread?

A

migrating birds

99
Q

West nile virus:

How do you diagnose it?

A

WNV RNA detection of IgM Ab in sera/CSF

100
Q

West nile virus:

Is there a vaccine?

A

no

101
Q

West nile virus:

How do you control it?

A

mosquito control

102
Q

West nile virus:

What suggested neurological conditions may arise from WNV?

A
  • MS
  • Parkinson’s
  • Schizophrenia
  • Senile dementia
103
Q

Summary:

____ limits the spread of infection to CNS

A

BBB

104
Q

Summary:
Once BBB is crossed, pathogens can cause neurologic disease by involving the meninges to cause _______ or the brain substance to cause __________.

A

meningitis

encephalitis

105
Q

Summary:

_____ meningitis most common

A

Viral

Micro 3010 (20 decks)

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