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micro unit 3 > viral infections of the CNS > Flashcards

viral infections of the CNS Flashcards

1
Q

routes of viral infection of the brain

A

hematogenous, neuronal

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2
Q

sterile meningitis causes

A

virus, fungi, TB, infections near the CNS.

80% are enteroviruses, 10% are HSV 1/2, 10% arboviruses,

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3
Q

symptoms of viral meningitis

A

mental status normal (compare with encephalitis), HA, fever, chills, stiff neck, malaise, sore throat, nausea, vomiting, abdominal pain, photophobia.

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4
Q

diagnose viral meningitis

A

elevated lymphocytes in the CSF (no bacteria) viruses can be detected in the CSF.

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5
Q

treatment for viral meningitis

A

supportive care. there are drugs for herpes, and fungal.

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6
Q

prognosis for viral meningitis

A

usually benign and resolves in 2 weeks, encephalitis is rare complication.

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7
Q

nuchal rigidity sign for meningitis

A

brudzinski sign. the neck is so stiff that the knees flex when the neck is forcefully flexed.

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8
Q

encephalitis

A

brain inflammation. rare. mainly in infants and elderly.

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9
Q

causes of encephalitis

A

virus, influx of immune cells to the brain, cerebral edema, intracerebral hemorrhage distinguishes this from meningitis.

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10
Q

symptoms of viral encephalitis

A

altered mental status, fever, HA, vomiting, photophobia, stiff neck and back, confusion, sleepiness, irritability, stumbling.

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11
Q

urgent symptoms of encephalitis

A

unresponsiveness or coma. seizures, muscle weakness or paralysis. memory loss, flat, affect, withdrawal, poor judgment.

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12
Q

diagnosis of viral encephalitis

A

tap indicates inflammation of the CSF, PCR is gold standard, EEG for seizures, MRI and CT can show foci of inflammation or hemorrhage.

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13
Q

treatment for viral encephalitis

A

supportive care and symptom relief. can give antivirals (acyclovir) for HSV. anti seizure meds such as dilantin, anti-inflammatory tend to decrease the cerebral edema. sedatives.

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14
Q

prognosis of viral encephalitis

A

can be benign or severe. some total recovery

permanent damage of systems can results.

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15
Q

pathogenesis of viral encephalitis

A

cytolytic viruses directly kill neurons/tissues. death of neurons.

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16
Q

host factors that effect viral encephalitis

A

age and immune status (young and elderly more susceptible), genetics (innate differences in susceptibility).

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17
Q

what affect does activity have on the dissemination of viral infections?

A

exercise and activity cause further dissemination of viral infections to the CNS

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18
Q

acute disseminated encephalomyelitis

A

post infectious encephalitis following viral infection 1-2 weeks. associated with measles, mumps, VZV, influenza, parainfuenza virus. this is an autoimmune disorder.

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19
Q

examples of neuronal spread

A

herpes (alpha-viruses), rabies

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20
Q

fecal-oral spread examples

A

picornaviruses (enteroviruses)

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21
Q

insect vector virus example

A

flavivirus, togavirdae viruses (arboviruses)

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22
Q

which herpes virus causes meningitis/encephalitis

A

HSV-2»HSV-1 to cause meningitis. HSV-1 most common cause of sporadic viral encephalitis.

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23
Q

HSV-1 encephalitis

A

most common. 10-20% of all cases.

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24
Q

treatment of herpes encephalitis

A

aggressive treatment with acyclovir.

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25
Q

routes of infection for herpes encephalitis

A

primary -oropharynx > trigeminal nerve > CNS
recurrent -trigeminal nerve > CNS
also can reactivate in situ (or in the CNS)

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26
Q

signs and symptoms of viral encephalitis

A

altered mental status, focal cranial nerve deficits, hemiparesis, slurred speech, stumbling, seizures, fever.

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27
Q

diagnosing herpes encephalitis

A

PCR of CSF, brain imaging shows predominant unilateral temporal lobe abnormalities.

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28
Q

rabies virus transmitted

A

through the bite of an infected animal or by aerosols in caves populated by infected bats.

29
Q

what happens after the rabies virus gets into the body through a bite?

A

it replicates in muscle. incubation period is about weeks to months. it then infects peripheral nerves and uses them to travel to the brain.

30
Q

what symptoms occur when the rabies virus gets to the brain?

A

it replicates in the brain causing hydrophobia, seizures, hallucinations, paralysis, coma and death.

31
Q

how can we prevent rabies?

A

postexposure vaccination can prevent disease because of its long incubation period.

32
Q

rabies virulence/transmittance summary

A

virus inovulated > replicates in muscle > enters peripheral nervous system > replicates in the dorsal root ganglion > rapidly ascend the spinal cord > infects the spinal cord, cerebellum, brain stem

33
Q

picornavirus examples

A

poliovirus, coxsackie, echovirus, enterovirus, rhinovirus. many of these cause paralytic disease, meningitis and encephalitis.

34
Q

transmission of picornaviruses (enterovirus)

A

fecal-oral route.

35
Q

populations at risk for enterovirus

A

poliovirus: young children (asymptomatic to mild disease) older children, adults (mild to paralytic disease).
coxsackie and enterovirus: newborns and neonates at highest risk.

36
Q

what times of the year are more prevalent for these viruses?

A

polio is ubiquitous but almost completely irradiated.

enteroviruses are more common in the summer.

37
Q

are there vaccines for picornaviruses?

A

poliovirus has a vaccines live oral or inactivated. not vaccines or antivirals for others.

38
Q

dissemination of the picornaviruses

A

oral > replicates in oropharynx and intestine > lymph node > blood > skin, muscle, brain, meninges, etc.

39
Q

when picornavirus reaches the skin what happens?

A

can cause hand-foot-mouth disease, rash, herpangina. (coxsackie)

40
Q

when picornavirus reaches the muscle what happens?

A

(echovirus, coxsackie A/B) reach the heart and thorax can cause pericarditis, myocarditis, and pleurodynia.

41
Q

when picornavirus reaches the brain what happens?

A

(polio and coxsackie A/B) cause paralytic disease to encephalitis.

42
Q

when picornavirus reaches the meninges what happens?

A

echo, polio and coxsackie all cause meningitis

43
Q

togavirdae examples

A

Venezuelan equine virus, eastern and western equine, chikungunya, rubella.

44
Q

VEE vector and disease

A

ades and culex mosquitoes. causes mild systemic and severe encephalitis

45
Q

EEE vector and disease

A

aedes and culiseta mosquitoes. causes mild systemic and encephalitis

46
Q

WEE vector and disease,

A

culex and culiseta mosquitoes. mild systemic and encephalitis.

47
Q

chikungunya vector and disease

A

aedes mosquitoes. fever, arthralgia, arthritis.

48
Q

rubella vector and disease.

A

no vector causes rubella.

49
Q

EEE vectors, hosts and dead end hosts

A

hosts are birds, vectors are the aedes and culiseta mosquitoes. dead end hosts are horses and people.

50
Q

flavavirdae that cause encephalitis. examples

A

Japanese encephalitis virus. west nile, st, luis encephalitis virus, russian spring summer, powassan virus.

51
Q

JE vector and disease

A

culex mosquitoes, encephalitis

52
Q

west nile vector and disease

A

culex mosquitoes, fever, encephalitis, hepatitis

53
Q

SLE vector and disease

A

culex mosquitoes, encephalitis

54
Q

russian spring summer vector and disease

A

ixodes, dermacenter ticks; encephalitis

55
Q

powassan vector and disease

A

ioxdes ticks; encephalitis

56
Q

where are aedes mosquitoes found?

A

urban areas.

57
Q

culex mosquitoes found where?

A

urban areas and forest areas.

58
Q

the transmission of falviverdae is more common when?

A

when the vectors are outside and people are also outside. AKA summer.

59
Q

which of the flaviverdae have vaccines?

A

yellow-fever and JE. no antivirals.

60
Q

how are the flaviviruses disseminated?

A

mucosal surfaces > lymph > primary bactermia > various tissues (vascular endothelium, macrophages, liver, spleen, etc) > secondary bacteremia > encephalitis, yellow fever hepatitis, hemorrhagic fever.

61
Q

WNV meningoencephalitis symptoms

A

occurs in 1% of WNV infections. HA, fever, stiff neck, disorientation, coma, tremors, seizures, paralysis

62
Q

WNV meningoencephalitis high risk pops.

A

cancer, diabetes, HTN, kidney disease.

63
Q

WNV meningoencephalitis prognosis

A

recovery over weeks to months. some of the neurological effects are permanent. mortality is 10%

64
Q

summer/fall meningitis virus

A

enteroviruses: coxsackie, echovirus, polio.

65
Q

summer/fall encephalitis viruses.

A

WNV, SLE, EEE, WEE, california encephalitis

66
Q

winter/spring meningitis viruses

A

mumps, lymphocytic coriomeningitis virus.

67
Q

winter/spring encephalitis viruses

A

measles, mumps.

68
Q

any season meningitis viruses

A

HSV-2, HIV infection

69
Q

any season encephalitis viruses

A

HSV-1, HIV

micro unit 3 (2 decks)

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