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CMED 311 > WEEK 4: NEUROLOGY CNS INFECTIONS > Flashcards

WEEK 4: NEUROLOGY CNS INFECTIONS Flashcards

1
Q

Etiology of CNS infections in neonates

A

E Coli, Group B Strep, Listeria, Strep agalactiae

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2
Q

Etiology if CNS infections in Children

A

N. meningitidis, H. influenza if unvaccinated, Strep pneumoniae

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3
Q

Etiology if CNS infections in young adult

A

N. Meningitidis, Strep pneumoniae

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4
Q

Etiology if CNS infections in older people

A

S. pneumoniae, Listeria monocytogenes

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5
Q

Etiology if CNS infections in immunosuppressed

A

M. Tuberculosis, Cryptococcus

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6
Q

Etiology if CNS infections if there is a shunt?

A

Staphylococcus

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7
Q

CSF Findings in Bacterial Meningitis?

A

Glucose Low, Protein Raised, Polymorphs raised

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8
Q

Route for brain abcess?

A

Hematogenous
local spread
Foreign body

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9
Q

Organisms for brain abcess? (4)

A

Anaerobic strep
Bacteroides
Staphylococci
Gram Negatives

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10
Q

Viral encephalitis agents?

A

Herpes Simplex, Arboviruses, Mumps, Measles

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11
Q

Viral meningitis agents?

A

enterovirus, mumps, herpes simplex, arboviruses

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12
Q

CSF findings in viral meningitis?

A

Glucose normal, protein raised, lymphocytes raised

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13
Q

most cases of meningitis result from what route?>

A

hematogenous dissemination

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14
Q

sources of infections in the CNS?

A

Contiguous spread: sinusitis, otitis media, birth defects
Hematogenous:
Direct inoculation: Trauma, neurosurgical complications
Reactivation of latent disease: TB, HSV

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15
Q

The clinical factors noted to be associated with adverse outcomes in bacterial meningitis included

A 
Streptococcal pneumonia as the etiology,
focal neurological deficits, 
and hyponatremia (serum sodium concentration <130mmol/L)
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16
Q

the most common acute neurological complications observed in bacterial meningitis

A

Subdural effusion, seizures and hydrocephalus

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17
Q

Distinction between the gray matter and white matter is gone. This means to say

A

Cerebral edema

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18
Q

Finger-like appearance of white matter

A

perilesional edema

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19
Q

most common agents of bacterial meningitis

A

most common are H.

influenzae, N. meningitidis, and S. pneumoniae,

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20
Q

associated condition in patients who had meningitis with HIB

A

hearing loss, seizures most often here too

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21
Q

Hib reamain sensitive to what drug?

A

third gen cephalosporins (

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22
Q

In neonatal period, GBS infection is

associated usually in

A

vaginally born child or in the birth canal.

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23
Q

Infection with Neisseria meningitidis most commonly

manifests as

A

asymptomatic colonization in the

nasopharynx of healthy adolescents and adults

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24
Q

is a gram-negative aerobic intracellular diplococcus that
colonizes humans only and that causes disease after
transmission to a susceptible individual

A

N. meningitidis

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25
Q

N meningitidis incubation period

A

Incubation period of 2-7 days

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26
Q

When the onset is attended by a
petechial or purpuric rash or by large
ecchymoses and lividity of the skin of
the lower parts of the body. what agent?

A

N. Meningitidis

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27
Q

Along the spectrum of presentations of meningococcal disease, the most common clinical syndromes are

A

meningitis and meningococcal septicemia

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28
Q

Tuberculous Meningitis and Tuberculoma TB of the central nervous system is seen most often in

A

young children but also develops in adults, especially those infected with HIV.

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29
Q

Tuberculous meningitis results from the hematogenous spread of

A

primary or post primary pulmonary TB or from the rupture of a sub-ependymal tubercle into the subarachnoid space.

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30
Q

evidence of old pulmonary lesions or a miliary pattern is found on chest radiography

A

Tuberculous Meningitis

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31
Q

Acute Bacterial meningitis vs TB meningitis in terms of exudation

A

In Acute Bacterial meningitis, exudates can be found in the subarachnoid space, specifically, in the convexity, causing subdural effusion, and communicating hydrocephalus due to obstruction on the absorption of the CSF in the subarachnoid space.

 In TB meningitis, suppuration can be found in the base of the brain and cisterns, and it’s called Basal meningitis – has a ‘star-shaped’ appearance (

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32
Q

Gold standard in the dx of TB meningitis?

A

Culture of CSF is diagnostic in up to 80% of cases and remains the gold standard.

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33
Q

This is a preferred INITIAL diagnostic, but this is NOT the GOLD STANDARD in TB meningitis

A

Realtime automated nucleic acid amplification (the Xpert MTB/RIF assay)

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34
Q

pathognomonic of patients with chronic meningitis or TB meningitis in imaging?

A

Imaging studies (CT and MRI) may show hydrocephalus and abnormal enhancement of basal cisterns or ependyma.

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35
Q

3 pathognomonic findings in the enhance CT or CT with contrast of patients with TB meningitis, and these are:

A

Presence of basal enhancement
Hydrocephalus
Presence of infarct

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36
Q

There is rapid killing of TB bacilli. what phase in the the TB regimen?

A

Initial phase

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37
Q

Fewer drugs are necessary (usually 2), but longer time

• These drugs eliminate the remaining bacilli. what phase in the TB regimen?

A

Continuation phase

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38
Q

Symptoms of Bacterial Meningitis?

A

Fever, Headache, Neck Stiffness, changes in mental funciton

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39
Q

Rashes typical of patients with meningococcemia?

A

Violaceous Purpurous Rashes

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40
Q

Causative agent that presents with General paresis and tabes dorsalis

A

Neurosyphilis (Treponema pallidum)

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41
Q

Neurosyphilis is more frequently symptomatic in patients who are co-infected with HIV, particularly in the setting of a low CD4+ T lymphocyte count T or F?

A

T

42
Q

Major clinical categories of symptomatic neurosyphilis include

A

meningeal, meningovascular, and parenchymatous syphilis

 Meaning to say, it can be presenting with meningitis, infarction, or encephalitis

43
Q

These symptoms reflect widespread late parenchymal damage

A

“PARESIS”

> Personality
o Affect
o Reflexes (Hyperactive)
o Eye (ex: Argyll Robertson pupils)
o Sensorium (illusion, delusion, hallucinations)
o Intellect (a decrease in recent memory and in the capacity for orientation, calculations, judgment and insight)
o Speech

44
Q

presents as symptoms and signs of demyelination of the posterior columns, dorsal roots and dorsal root ganglia

A

Tabes Dorsalis

45
Q

Tabes Dorsalis Symptoms?

A 
Symptoms include:
o Ataxic Wide-based gait and foot drop
o Paresthesia
o Bladder Disturbances
o Impotence
o Areflexia
o Loss of positional, deep-pain and temperature sensations
46
Q

Botulinum toxin is produced by 4 recognized species of clostridia:

A

o Clostridium Botulinum
o Clostridium Argentinense
o Clostridium Baratii
o Clostridium Butyricum

47
Q

T or F. All species of clostirdia are anaerobic gram-positive organisms that form subterminal spores; C. Botulinum and C. Argentinense spores have been recovered from the environment. The spores survive environmental conditions and ordinary cooking procedures

A

T

48
Q

Toxin production however requires a rare confluence of product storage conditions:

A

o An aerobic environment
o pH of > 4.6
o Low salt and sugar concentration
o Temp of > 4o C

49
Q

The distinctive clinical syndrome of botulism consists of

A

symmetrical cranial-nerve palsies, followed by Bilateral descending flaccid paralysis that may progress to Respiratory failure and death.

50
Q

Incubation period from ingestion of contaminated food to onset of symptoms in food-borne botulism is

A

usually 8-36hrs but can be as long as 10 days and is dose dependent.

51
Q

Incubation periods of _____ days have been documented in wound botulism associated with accidental injury.

A

4 - 17 days

52
Q

It is most commonly caused by mumps virus, polio virus and the non-polio enterovirus. Acute encephalitis is much less common, with very limited available data on long-term prognosis.

A

Herpes Simplex Encephalitis

53
Q

drug for Herpes Simplex Encephalitis?

A

Acyclovir

54
Q

Dengue viruses 1–4 (DENV 1–4) principal reservoir?

A

Non Human Primates and Mosquitos ( Aedes Aegypti, A. albopictus

55
Q

Japanese Encephalitis Virus reservoir?

A 
Principal reservoir: Ardeid wading birds (in particular herons), horses, pigs
o Mosquitoes (Culex spp., in particular C. tritaeniorhynchus)
56
Q

Zika Virus carrier?

A

Ae. Aegypti & Ae. Albopictus (also carries Dengue Virus)

57
Q

transfusion, and in utero.
 If a pregnant woman is infected with Zika virus, the baby may have congenital malformation, the most common of which is

A

Microcephaly

58
Q

What does the zika virus infects that impairs mitosis and survival?

A

NES (neuroepithelial stem cells) and radial glial cells

59
Q

Poliomyelitis is acquired via what route?

A

oral fecal route usually from contaminated food or water.

60
Q

what is AFP surveillance in Polio

A

o A-cute
o F-laccid
o P-aralysis
 All children < 15 years of age presenting with ACUTE, FLACCID PARALYSIS of any cause should be reported to the DOH, and stool is collected. This is AFP Surveillance so that we can always stop the transmission of polio virus.

61
Q

is polio an anterior or posterior horn cell disease?

A

anterior horn cell

62
Q

a small RNA virus that is a member of the enterovirus group of the picornavirus family.

A

poliomyelitis agent (polio virus)

63
Q

The main reservoir of infection of polio is the

A

human intestinal tract

64
Q

normal opening pressure in CSF?

A

<180 mm H20

65
Q

WBC count in CSF normal?

A

0-5;
increased in Bacterial Meningitis, Fungal and TB Meningitis.

Sa Viral Normal to Slight elev

66
Q

WBC differential predominance in bacterial, viral etc?

A

Bacterial - PMN

Viral, Fungal and TB: Lymphocytes

67
Q

normal protein in CSF? bacterial? viral?>

A

15 to 50

Bacterial - INCCC
Viral Fungal
TB - slightly increased

68
Q

Glucose in CSF normally?

A

45 - 100 (2/3 of serum)
decreased in bacterial and TB
normal in fungal and viral

69
Q

Rabies virus is a member of the family

A

Rhabdoviridae

70
Q

2 genera in family Rhabdoviridae?

A

Lyssavirus and Vesiculovirus

71
Q

a lyssavirus that infects a broad range of
animals and causes serious neurologic disease when
transmitted to humans.

A

Rabies

72
Q

Rabies incubation period

A

20-90 days

73
Q

Clinical Stages of Rabies?

A 
Incubation Period
Prodrome
Encephalitic
Paralytic
Coma, Death
74
Q

member of the Togaviridae family and the
only member of the genus Rubivirus. This single-stranded
RNA enveloped virus measures 50–70 nm in diameter.

A

Rubella Virus

75
Q

Its core protein is surrounded by a single-layer lipoprotein
envelope with spike-like projections containing two
glycoproteins:

A

E1 and E2

76
Q

only known reservoir of rubella virus?

A

Human

77
Q

The most serious consequence of rubella virus infection can

develop when

A

a woman becomes infected during pregnancy,

particularly during the first trimester.

78
Q

Congenital rubella syndrome

A

Microcephaly,

cataract, and cardiac anomalies

79
Q

caused by persistent measles virus infection that would lead to complications

A

MIBE (measles inclusion body encephalitis)

SSPE (subacute sclerosing panencephalitis)

80
Q

a slowly progressive disease characterized by seizures and progressive deterioration of cognitive and motor functions, with death occurring 5–15 years after measles virus infection.

A

SSPE

81
Q

is often transmitted sexually, and asymptomatic carriage in semen or cervical secretions is common.

A

CMV

82
Q

HSV 1/ HSV 2 causes focal encephalitis common in older population;

HSV 1/ HSV 2 is more common in the neonatal period

A

HSV 1

HSV 2

83
Q

The clinical hallmark of HSV encephalitis has been

A

the acute onset of fever and focal neurologic symptoms and signs, especially in the temporal lobe.

84
Q

Coma is a characteristic and ominous feature of

A

falciparum malaria

85
Q

manifests as diffuse symmetric encephalopathy; focal neurologic signs are unusual. Although some passive resistance to head flexion may be detected, signs of meningeal irritation are absent

A

Cerebral Malaria

86
Q

Species of the genus plasmodium

A

P. falciparum
o P. vivax
o 2 morphologically identical sympatric species of P. ovale
(as suggested by recent evidence)
o P. malariae
o P. knowlesi – Southeast Asia, monkey amalria

87
Q

All deaths from malaria are coming from what speci?

A

P. Falciparum

88
Q

Schistosomiasis is caused by?

A

S. Mansoni; S. haematobium, S. Japonicum

89
Q

If shcistosomiasis is caught early, what drug is adequate?

A

praziquantel

90
Q

what is the parasitological diagnosis of S. mansoni and japonicum?

A

Stool Kato Katz

91
Q

what is the parasitological diagnosis of S. haematobium?

A

Urine Filtration

92
Q

Concern is heightened by history of headache and neurologic symptoms in a patient with underlying immunosuppressive disorders such as advanced HIV infection or solid organ transplantation

A

Cryptococcal infections

93
Q

dimorphic, existing in the asexual yeast form characterized by oval to spherical cells with a polysaccharide capsule, and in the sexual or prefect state characterized by the presence of basidiospores

A

Cryptococcus neoformans

94
Q

Colonies of Cryptococcus

A

white to cream in color, but characteristic dark brown colonies are formed when grown on birdseed agar

95
Q

Meningeal cryptococcosis can lead to sudden catastrophic

A

Vision Loss

96
Q

Prion category of infections includes a quartet of human diseases

A

Creutzfeldt-Jakob disease (and a variant that infects cows and may be rarely transmitted to humans), the Gerstmann-Sträussler-Scheinker syndrome, kuru, and fatal familial insomnia.

97
Q

Transmissible pathogen is a proteinaceous infectious particle that is devoid of nucleic acid, resists the action of enzymes that destroy RNA and DNA, fails to produce an immune response, and electron microscopically does not have the structure of a virus.

A

Prion

98
Q

Meningeal Triad

A

o Fever
o Headache
o Vomiting

99
Q

Gold standard in diagnosing CNS infection

A

CSF analysis

100
Q

Lumbar puncture is contraindicated in the following situations:

A

o Presence of signs of increased ICP
o Presence of infection at the site for puncture
o Presence of focal neurologic findings* ( with caution for signs of inc. ICP)

101
Q

Site of lumbar puncture in adults

A

L3 to L4

102
Q

When to do CT scan with contrast?

A

Hydrocephalus and pleural effusion

CMED 311 (47 decks)

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