Viral CNS Infections Flashcards
acute inflammation of brain parenchyma
encephalitis
acute inflammation in the subarachnoid space or leptomeninges
meningitis
What kind of meningitis outnumbers all other causes in the US?
viral (aseptic) meningitis
What is the MCC of viral meningitis
enterovirus
What is the general prognosis of aseptic meningitis
usually self-limiting lasting 7-10 days
What is the MCC of acute encephalitis?
HSV 1
What are the targets in the CNS of each of these viruses?
polio
VZV
Rabies
HIV and HSV
- motor neurons
- peripheral sensory neurons
- brainstem neurons
- anything
In general, what is the MC manifestation of viral CNS infection?
meningitis
hallmarks in pediatric viral meningitis include
more malaise and fever
tend not to have neck stiffness
neonates: hypotonia, irritability, poor feeding
What are CSF findings in viral/aseptic meningitis?
- WBC - pleocytosis, lymphocytes predominate
- protein - nl to slightly elevated
- glucose - normal
- culture, gram stain, acid fast stain all normal
In CSF we are finding increased lymphocytes and normal or decreased glucose. What are we thinking?
cryptococcus or another fungi
What will CSF look like with bacterial meningitis?
- WBCs - PMNs predominate
- glucose is low
Tx for aseptic meningitis is usually supportive, but if it looks like meningoencephalitis, what should I do?
start empiric abx (for possible bacterial pathogens) and acyclovir (for HSV)
What two viruses are known to cause septic shock in babies? What should we do because we know this?
enterovirus and HSV
abxs and acyclovir should be started ASAP
What is the MCC of sporadic lethal encephalitis?
Herpes simplex encephalitis (HSE)
Where will I see necrotizing inflammation from HSE?
inferior frontal and anterior temporal lobes
What are the top five clinical features of HSE?
- change in consciousness
- fever
- change in personality
- headache
- seizures
What is the most important study in regards to meningitis/encephalitis?
PCR
What is tx for HSE?
IV acyclovir started empirically when suspected
- prolonged oral course following IV course
When do most relapses of HSE occur?
within 3 months of completing initial tx
What are some primary syndromes a/w HIV in the CNS?
- AIDS dementia complex
- HIV meningitis
- HIV myelopathy (SC)
- HIV sensory neuropathy
- Primary CNS lymphoma
My pt has non-AIDs PML, what should I be considering?
malignancy
CT disease
organ transplant
sarcoid
cirrhosis
medications
fecal oral route
acute flaccid paralysis via infection of anterior horn cells (proximal worse than distal)
poliomyelitis
