Viral Meningitis Flashcards
is the brain the POE for viral infections?
NO
Why isn’t viral meningitis as common as in the past?
vaccination against mumps
how does the severity of viral meningitis differ from bacterial
viral is usually benign with rapid resolutions to disease process with little to no sequelae
what are the most common viral agents in meningitis
ECHO and Cocksackie
HHV 6 and 7
what age group dies HHV 6 and 7 target
6 months to 2 years
what age group does Non-polio enterovirus affect
2 yo and older
what are the signs and symptoms of viral meningitis
irratibility
lethargy
fever
HA, Nuchal rigid, vomit, opisthotonos, eyeball pressure, and photophobia
what is the major cause of acute febrile illness in infants and young children
HHV 6 and 7
What infection cause children 6mo-12mo to many ER visits (20%)
HHV-6
what is the cause of many first time febrile seizures among ages <2yo
HHV 6 and 7
Primary HHV6/7 infection in children with functional immune system results in
asymptomatic infection
exanthem subitum/roseola infantum
With symptomatic or asymptomatic HH-6 causes what types of infections
latent persistent infection
Chronic persistent infection (salivary glad)
what are the manifestation of HHV 6 and 7 meningitis and how long does it last
high fever, lethargy, irritability, malaise, no rash until fever disappears then rash appears
usually lasts 4-6 days
Diagnosis of aseptic meningitis
spinal tap is aseptic
Treatment of aseptic meningitis
treat otherwise healthy infants supportively, if therapy is done depends on viral resistance and sensitivity
what is HSV 2 aseptic meningitis
patient has genital herpes, fever and aseptic meningitis
what type a virus is a LCM virus
arenavirus
?what is LCM virus resistant to
Drying- important for transmission
what is the the morphology of LCM virus
enveloped nucleocapsid containing RNA
how many arena virus infect humans
7
what are the most important arena viruses
LCM
lassa virus
which arena virus is passed by inhalation of infected rat urine and causes hemorrhagic fever in humans
Whitewater arroyo virus
what is important about animals who are LCM virus reservior
the have life long viremia and shed virus in feces and urine
what are the major animal reservoir for LCM virus
house mouse- primary
hamsters
other rodents
how does LCM virus spread from rodent to human
direct wit infected animal
inhalation of aerosols or dust with virus
food
when is the peak seasonality of LCM virus
winter- when rodents come inside house
what is the consequence of LCM viral disease in immunocomprimised
systemic infection and death
what is LCM virus pathogenesis
perivascular infiltration of meninges and all parts of the brain with macrophages and lympcytes
What is grippe
a flu-like illness of variable duration is the most common manifestation of LCM virus
What happens after defervescence of fever in LCM virus
a subacute meningitis with classic triad
what are the possible outcomes of prenatal LCM virus infection
1st/2nd trimester
spontaneous abortion, chorioretinitis, microcephaly, macrocephaly, hydrocephalus
what percentage of children have severe neurological sequelae in LCM virus
75%
how do you diagnose LCM virus
history of rodent contact, CSF+Fluorescent AB test, acute & convalescent sera,
what is the treatment for LCM virus
supportive can take up to 3 months
what is the prevention for LCM virus
rodent control
what are 4 types of non-polio enterovirus
- ECHOvirus
- Coxsackie
- Entervius 68-71
- HpeV 1-3
What is non-polio enterovirus common for
important viral pathogen causing febrile illness with or without rash
what ratio of febrile illness and young children during summer and fall months is non-polio enterovirus responsible for
1/2
what is the most common known cause of aseptic meningitis in countries that vaccinate against mumps
non-polio enterovirus
What is the transmission of non-polio enterovirus
fecal oral (water), inhalation, direct contact, hand to eye, in utero
what is the reservoir for non-polio enterovirus
humans are sole host
environment and humans can be reservoir
what is the gender relationship in non-polio enterovirus
males manifest with disease although equal m/f infected
what is the age relationship in non-polio enterovirus
both incidence and severity are inversely related with patient age
1yo highest attack rate, severe disease in older
what is the seasonality of non-polio enterovirus
temperate climate, peak in summer and fall months but sporadic can occur year round
what are RF for non-polio enterovirus
neonates, immunocompromised
what non-polio enterovirus can cause neonatal sepsis
ECHO virus
how is Neonatal sepsis transmitted
vertically
what is the POE of neonatal sepsis
POE to CNS via viremia
what are predisposing factors for neonatal sepsis
male, premature, maternal infection 2 weeks before birth
what is the acute febrile symptoms in non-polio enterovirus
fever, headache, malaise, +/-vomitting/diahhrea, +/- maculopapular rash
what can non-polio enterovirus acute febrile disease develop into
classic: fever + rash, HFMD, herpangia. pleurodynia, pharyngitis, conjunctivitis or severe: meningitis ,viremia, encephalitis,myocarditis, hepatitis
what are the age related signs of aspetic meningitis in non-polio enterovirus
young child- fever, irritability
older child- fever, headache, and nuchal rigidity
adult- fever, nuchal rigidity, and HA needing narcotics to manage
which specific non-polio enterovirus causes regional and world epidemics of undifferentiated febrile illness that sometimes progresses to encephalitis?
enterovirus 71
what are the 3 different encephalits syndoromes based n geographic location in non-polio enterovirus
acute flaccid paralysis (US, Europe, South America)
HFMD- meningoencephalitis (japan, China)
HFMD-encephalitis (Malaysia, Taiwan)
how do you diagnose non-polio enterovirus
PCR for enteroviral agents, Tissue culture (rare but gold standard), PMNs predominate early then shift to leukocytosis
what is the treatment for non-polio enterovirus
symptomatic
Pleconaril
What is the prevention of non-polio enterovirus
none
