Viral Meningitis

Question 1

is the brain the POE for viral infections?

Answer 1

NO

Question 2

Why isn’t viral meningitis as common as in the past?

Answer 2

vaccination against mumps

Question 3

how does the severity of viral meningitis differ from bacterial

Answer 3

viral is usually benign with rapid resolutions to disease process with little to no sequelae

Question 4

what are the most common viral agents in meningitis

Answer 4

ECHO and Cocksackie

HHV 6 and 7

Question 5

what age group dies HHV 6 and 7 target

Answer 5

6 months to 2 years

Question 6

what age group does Non-polio enterovirus affect

Answer 6

2 yo and older

Question 7

what are the signs and symptoms of viral meningitis

Answer 7

irratibility
lethargy
fever
HA, Nuchal rigid, vomit, opisthotonos, eyeball pressure, and photophobia

Question 8

what is the major cause of acute febrile illness in infants and young children

Answer 8

HHV 6 and 7

Question 9

What infection cause children 6mo-12mo to many ER visits (20%)

Answer 9

HHV-6

Question 10

what is the cause of many first time febrile seizures among ages <2yo

Answer 10

HHV 6 and 7

Question 11

Primary HHV6/7 infection in children with functional immune system results in

Answer 11

asymptomatic infection

exanthem subitum/roseola infantum

Question 12

With symptomatic or asymptomatic HH-6 causes what types of infections

Answer 12

latent persistent infection

Chronic persistent infection (salivary glad)

Question 13

what are the manifestation of HHV 6 and 7 meningitis and how long does it last

Answer 13

high fever, lethargy, irritability, malaise, no rash until fever disappears then rash appears
usually lasts 4-6 days

Question 14

Diagnosis of aseptic meningitis

Answer 14

spinal tap is aseptic

Question 15

Treatment of aseptic meningitis

Answer 15

treat otherwise healthy infants supportively, if therapy is done depends on viral resistance and sensitivity

Question 16

what is HSV 2 aseptic meningitis

Answer 16

patient has genital herpes, fever and aseptic meningitis

Question 17

what type a virus is a LCM virus

Answer 17

arenavirus

Question 18

?what is LCM virus resistant to

Answer 18

Drying- important for transmission

Question 19

what is the the morphology of LCM virus

Answer 19

enveloped nucleocapsid containing RNA

Question 20

how many arena virus infect humans

Answer 20

7

Question 21

what are the most important arena viruses

Answer 21

LCM

lassa virus

Question 22

which arena virus is passed by inhalation of infected rat urine and causes hemorrhagic fever in humans

Answer 22

Whitewater arroyo virus

Question 23

what is important about animals who are LCM virus reservior

Answer 23

the have life long viremia and shed virus in feces and urine

Question 24

what are the major animal reservoir for LCM virus

Answer 24

house mouse- primary
hamsters
other rodents

Question 25

how does LCM virus spread from rodent to human

Answer 25

direct wit infected animal inhalation of aerosols or dust with virus food

Question 26

when is the peak seasonality of LCM virus

Answer 26

winter- when rodents come inside house

Question 27

what is the consequence of LCM viral disease in immunocomprimised

Answer 27

systemic infection and death

Question 28

what is LCM virus pathogenesis

Answer 28

perivascular infiltration of meninges and all parts of the brain with macrophages and lympcytes

Question 29

What is grippe

Answer 29

a flu-like illness of variable duration is the most common manifestation of LCM virus

Question 30

What happens after defervescence of fever in LCM virus

Answer 30

a subacute meningitis with classic triad

Question 31

what are the possible outcomes of prenatal LCM virus infection

Answer 31

1st/2nd trimester | spontaneous abortion, chorioretinitis, microcephaly, macrocephaly, hydrocephalus

Question 32

what percentage of children have severe neurological sequelae in LCM virus

Answer 32

75%

Question 33

how do you diagnose LCM virus

Answer 33

history of rodent contact, CSF+Fluorescent AB test, acute & convalescent sera,

Question 34

what is the treatment for LCM virus

Answer 34

supportive can take up to 3 months

Question 35

what is the prevention for LCM virus

Answer 35

rodent control

Question 36

what are 4 types of non-polio enterovirus

Answer 36

1. ECHOvirus 2. Coxsackie 3. Entervius 68-71 4. HpeV 1-3

Question 37

What is non-polio enterovirus common for

Answer 37

important viral pathogen causing febrile illness with or without rash

Question 38

what ratio of febrile illness and young children during summer and fall months is non-polio enterovirus responsible for

Answer 38

1/2

Question 39

what is the most common known cause of aseptic meningitis in countries that vaccinate against mumps

Answer 39

non-polio enterovirus

Question 40

What is the transmission of non-polio enterovirus

Answer 40

fecal oral (water), inhalation, direct contact, hand to eye, in utero

Question 41

what is the reservoir for non-polio enterovirus

Answer 41

humans are sole host | environment and humans can be reservoir

Question 42

what is the gender relationship in non-polio enterovirus

Answer 42

males manifest with disease although equal m/f infected

Question 43

what is the age relationship in non-polio enterovirus

Answer 43

both incidence and severity are inversely related with patient age 1yo highest attack rate, severe disease in older

Question 44

what is the seasonality of non-polio enterovirus

Answer 44

temperate climate, peak in summer and fall months but sporadic can occur year round

Question 45

what are RF for non-polio enterovirus

Answer 45

neonates, immunocompromised

Question 46

what non-polio enterovirus can cause neonatal sepsis

Answer 46

ECHO virus

Question 47

how is Neonatal sepsis transmitted

Answer 47

vertically

Question 48

what is the POE of neonatal sepsis

Answer 48

POE to CNS via viremia

Question 49

what are predisposing factors for neonatal sepsis

Answer 49

male, premature, maternal infection 2 weeks before birth

Question 50

what is the acute febrile symptoms in non-polio enterovirus

Answer 50

fever, headache, malaise, +/-vomitting/diahhrea, +/- maculopapular rash

Question 51

what can non-polio enterovirus acute febrile disease develop into

Answer 51

classic: fever + rash, HFMD, herpangia. pleurodynia, pharyngitis, conjunctivitis or severe: meningitis ,viremia, encephalitis,myocarditis, hepatitis

Question 52

what are the age related signs of aspetic meningitis in non-polio enterovirus

Answer 52

young child- fever, irritability older child- fever, headache, and nuchal rigidity adult- fever, nuchal rigidity, and HA needing narcotics to manage

Question 53

which specific non-polio enterovirus causes regional and world epidemics of undifferentiated febrile illness that sometimes progresses to encephalitis?

Answer 53

enterovirus 71

Question 54

what are the 3 different encephalits syndoromes based n geographic location in non-polio enterovirus

Answer 54

acute flaccid paralysis (US, Europe, South America) HFMD- meningoencephalitis (japan, China) HFMD-encephalitis (Malaysia, Taiwan)

Question 55

how do you diagnose non-polio enterovirus

Answer 55

PCR for enteroviral agents, Tissue culture (rare but gold standard), PMNs predominate early then shift to leukocytosis

Question 56

what is the treatment for non-polio enterovirus

Answer 56

symptomatic | Pleconaril

Question 57

What is the prevention of non-polio enterovirus

Answer 57

none