VIRAL INFECTIONS Flashcards
Mumps, measles, and VZV enter via the _________
respiratory passages.
________ AND _________ enter by the
oral-intestinal route, and______ enters mainly via the oral
or genital mucosal route.
Polioviruses and other enteroviruses
HSV
The fetus may be infected transplacentally by
_____, ________ AND ______
rubella virus, CMV and HIIV
viruses that utilize the retrograde axoplasmic transport system
HSV, VZV, and
rabies
Some infections
are confined to meningeal cells, ________being the
most common, in which case the clinical manifestations
are those of aseptic meningitis.
enteroviruses
In __________there is a selective lysis of oligodendrocytes,
resulting in foci of demyelination
progressive multifocal leukoencephalopathy
(PML),
________________that is more severe than that
associated with other febrile states is the most frequent
symptom OF VIRAL meningitis
Headache
mild depression
of the CSF glucose (never below 25 mg/ dL) occurs with
the meningitis caused by ___________
mumps, HSV-2, lymphocytic
choriomeningitis, or VZV.
MC etiology of aseptic meningitis
most common are from
enterovirus-mainly echovirus and Coxsackie virus
It is also recognized that infection with __________ may
present as acute, self-limited aseptic meningitis with an
infectious mononucleosis-like clinical picture
HIV
HSV-1 has
been isolated from the CSF of patients with recurrent
bouts of benign aseptic meningitis so-called_____________
Mollaret meningitis
A number of __________infections are associated with exanthemata and may be associated with the grayish vesicular lesions of oral herpangina
echovirus and Coxsackie virus (particularly group A)
Pain in the back and neck and in the muscles
should suggest ______ or _________
poliomyelitis or dengue.
Lower motor
neuron weakness may also occur with _______________ virus infections, but it is usually mild and
transient in nature.
echo, West Nile, and Coxsackie
present. It should be noted that
orchitis is not specific for mumps but occurs occasionally
with _______, ________ and _________
group B Coxsackie virus infections, infectious mononucleosis,
and lymphocytic choriomeningitis
The natural host of the ______ virus is the common
house mouse, Mus musculus
lymphocytic choriomeningitis
Neurologic manifestation of Parvovirus
brachial neuritis
____ and _____meningitis may be associated with a
cauda equina neuritis
HSV and HIV
LCM should be suspected if there is an intense lymphocytic pleocytosis.
Counts above ______ in the spinal fluid, particularly
if the cells are all lymphocytes,
1,000 cells/mm3
dx of aseptic meningitis
an infection is demonstrated by a
fourfold increase in titer from acute to convalescent serum drawn at least 10 days apart using ELISA
PCR is most sensitive during
the _________, in contrast to serologic
tests, which are more accurate ______
active stage of viral replication
later in the course of the
infection
An idiosyncratic, presumably immunologic meningitis
may result from the use of _______ intravenous____________________(due probably to a carrier
chemical in the solution), and, rarely, from other drugs,
including certain antibiotics
nonsteroidal antiinflammatory drugs,
immune globulin
In the neoplastic group, _____ and _____
are the most common sources of meningeal infiltrations
leukemias and lymphomas
Occlusion of many small cerebral blood vessels by
_________ may also excite a reaction in meningeal
vessels and a pleocytosis that includes eosinophils.
cholesterol emboli
The special problem of chronic neutrophilic meningitis is associated with the ff species:
Nocardia, Aspergillus, Actinomyces, or
certain Mycobacterium species
combinations of iridocyclitis, depigmentation of a thick swath of hair (poliosis circumscripta) and of the skin, vitiligo, around the eyes, loss of eyelashes, dysacusis, and deafness (the pathologic basis of the syndrome is not known);
Vogt-KoyanagiHarada
syndrome,
characterized by episodes of acute meningitis
with severe headache and sometimes low-grade
fever, lasting for about 2 weeks, and recurring over a
period of several months or years
Mollaret recurrent meningitis,
Mollaret recurrent meningitis, is usually assocayed with _____
HSV1
A special
syndrome that has been associated with ______ is that of aseptic meningitis and bladder failure and vaginal
or vulvar pain after a bout of genital herpes
HSV-2
It is essentially a diffuse inflammatory disease of small
blood vessels that has several other characteristic features
such as oral and genital ulcers and is more appropriately
considered with the vasculitides
Behc;et disease
The common practice is to assume
that viral meningitis causes only fever, headache, stiff neck,
and photophobia; if any other CNS symptoms are added,
the condition is generally called __________
meningoencephalitis.
several agents, notably the________, may cause encephalitic
lesions with only mild meningeal symptoms.
arboviruses
expressed by a low-grade fever
and cerebral symptoms such as confusion, seizures, coma,
or ataxia. The spinal fluid shows slight inflammation and
elevation of protein-sometimes a more intense reaction,
and there are usually characteristic confluent, scattered,
bilateral lesions in the white matter in imaging studies,
findings that differ from those of viral encephalitis
ADEM
In viral encephalitis, Death occurs in ________of these patients and residual signs, such as mental deterioration, amnesic defect, personality change, recurrent seizures, and hemiparesis, are seen in approximately another ________
5 to 20 percent
20 percent
age range of HSV enceph
Its age distribution is slightly skewed and biphasic,
affecting persons mainly between ages S and 30 years
and those older than age SO years
Many other viruses,
exemplified by the _____ have a characteristic
geographic and seasonal incidence.
arboviral encephalitides,
__________which is a primary infection
with EBV, is complicated by meningitis, encephalitis facial palsy, or polyneuritis of the Guillain-Barre type in a
small proportion of cases
infectious mononucleosis
various movement
disorders, including parkinsonism, are being seen
as a residua of encephalitis from the ______
Flaviviruses
The incubation
period after Arbovirus bite transmission is_________
5 to 15
days.
A special syndrome of febrile, flaccid, paralytic poliomyelitis resulting from___________
West Nile virus infection
The fever and neurologic signs of arboviral encephalitis
subside after_________ unless death supervenes
or destructive CNS changes have occurred
4 to 14 days
Of the arbovirus infections in the United States, ________________ is among the most serious,
as a large proportion of those infected develop encephalitis
eastern equine encephalitis (EEE)
disabling abnormalities associated with EEE
mental retardation, emotional disorders, recurrent
seizures, blindness, deafness, hemiplegia, extrapyramidal
motor abnormalities, and speech disorders.
Perivascular cuffing by lymphocytes and
other mononuclear leukocytes and plasma cells, as well
as a patchy infiltration of the meninges with similar cells,
are the usual histopathologic hallmarks of ______
viral encephalitis.
In HSV Encephalitis, Between________________ percent are fatal, and the majority of patients who
survive are left with serious neurologic abnormalities.
30
and 70
The ________herpesvirus may also cause acute
generalized encephalitis, usually in the neonate and in
relation to genital herpetic infection in the mother
type 2
site of predilection of HSV enceph
inferomedial or lateral portions
of the frontal and temporal lobes and the insula
Disturbed memory function
can often be recognized, but usually this becomes evident only later in the________ as the patient
awakens from stupor or coma.
convalescent stage
In HSV enceph, in ______________in some large series, the spinal fluid was normal in the first days of the illness
3 to 5 percent
Pathology of HSV enceph
The lesions take the form of an intense hemorrhagic
necrosis of the inferior and medial temporal lobes and
the mediorbital parts of the frontal lobes
EEG findings of HSV Enceph
lateralized periodic high-voltage
sharp waves in the temporal regions and slow-wave complexes at regular 2 to 3/s intervals
The only alternative way to establish the diagnosis of
acute HSV encephalitis is by __________
and by _______________ obtained from brain
biopsy
fluorescent antibody study
viral culture of cerebral tissue
In HSV encep, acyclovir significantly
reduces both ______ and _______ from the disease
mortality
morbidity
In HSV enceph,
Acyclovir is given intravenously in a dosage of _____and continued for _________ in order to prevent relapse
30 mg/kg/d
10 to 14 days
mechanism of relapse in HSV enceph
including an immune-mediated inflammatory
response, but treatment with too low a dose or for
too brief a period is undoubtedly the main cause of the
rare relapses that occur in adults
In HSV encephalitis,
The outcome of this disease, both mortality
and morbidity, is governed to a large extent by the
patient’s ________, _________ , ________
age and state of consciousness, particularly at
the time of institution of acyclovir therapy
In HSV encephalitis,
if treatment is
begun within 4 days of onset of the illness in an awake
patient, survival is__________
greater than 90 percent
Evaluation of patients 2 years after treatment showed
38 percent to be normal or nearly normal, whereas _________ were dead or severely impaired
53 percent
If there were
seizures during the acute illness, it is advisable to continue
antiepileptic medications for a year or more and
then judge the risk of discontinuing them on the basis of
__________, __________ and _________
further seizures, the EEG, and the patient’s exposure to
situations that pose a danger, such as driving
the cause of a medial temporal
lobe (limbic) encephalitis in adult patients following allogenic
hematopoietic stem cell bone marrow transplantation
H HV-6 Encep h a l itis
H HV-6 Encep h a l itis resembles ______ and _______
limbic encephalitis
paraneoplastic and anti-voltage-gated potassium channel
mundane __________can also produce
a severe medial temporal lobe encephalitis in bone
marrow transplant cases, in one of our patients associated with gray matter damage in the spinal cord
adenoviruses
The other viral agents that appear as causes of
encephalitis with some regularity in stem-cell and organ
transplant patients include ______, _______, _______ and ________
parvovirus, CMV, EBV, adenovirus,
HSV, and varicella zoster virus
Rare cases of rabies have been caused by inhalation of the _________
virus shed by bats;
In rabies infection, The incubation period is usually 20 to 60 days but may
be as short as__________, especially in cases involving
multiple deep bites around the face and neck
14 days
In rabies encephalitis, The main neurologic symptoms, following a _______ of fever, headache, and malaise
consist of apprehension, dysarthria, and psychomotor
overactivity, followed by dysphagia (hence salivation
and “frothing at the mouth”), spasms of throat muscles
2- to
4-day prodromal period