CNS Infections

Question 1

Types of CNS infections

Answer 1

abscess
empyema
meningitis
encephalomyelitis

Question 2

sites of CNS infections

Answer 2

brain

cord

Question 3

etiology of CNS infxns

Answer 3

bacterial, viral, fungal

Question 4

oral sequence of CNS infxn

Answer 4

DIRECT extension of acute oral infection
-caries-pulpitis 
-apical periodontitis 
-phlegmon/abscess
-necrotizing ulcerative gingivitis 
bacteremia(uncommon)

Question 5

what is the most common CNS infection secondary to dental pathology/procedure?

Answer 5

CNS abscess

Question 6

symptoms of CNS abscess

Answer 6

changes in consciousness
-focal neurologic signs
speech
visual field defects
paresis
-vomiting
-fever

Question 7

risk factors for bacterial abscess

Answer 7

oral pathology
oral procedure
immunocompromised
chronic illness
chronic heart disease
skull facture
meningitis
sinus infxns

Question 8

diagnosing CNS abscess

Answer 8

symptoms
physical exam
IMAGING
lab results

Question 9

Tx of bacterial abscess

Answer 9

antibiotics and surgery

Question 10

pathology of bacterial abscess

Answer 10

liquefactive

Question 11

etiology of dental CNS infections

Answer 11

87% had intra-oral pathology(caries, gingivitis, periodontitis)
70% ipsilateral
most related to molar removal

Question 12

where do most abscess happen in the CNS that are related to dental procedures

Answer 12

frontal and parietal lobes

Question 13

organisms that cause CNS abscess

Answer 13

gram+ cocci (most)
anaerobes
Gram - bacillus
Gram + bacillus

Question 14

T/F oral cultures matched with 61% of CNS cultures for microbiology

Answer 14

True

Question 15

can you get a good blood culture of a CNS abscess

Answer 15

no 89% negative

*remember most are causes by direct advancement of microbes

Question 16

Order the microbiology of CNS abscess based on polymicrobial, monomicrobial, and negative.

Answer 16

monomicrobial 49%
polymicrobial 47%
negative 4%

Question 17

polymicrobial cultures

Answer 17

Actinomyces spp. dominant

• branching filamentous bacteria
• gram positive
• non acid fast
• normal flora
• aerobic/microaerophilic

Question 18

mycoses CNS infections

Answer 18

immunocompromised patients

• aspergillus
• zygomycetes
• candida spp
• cryptococcus neoformans
• dimorphic fungi

Question 19

aspergillus

Answer 19

• **most common fungal pathogen of CNS
• oral->sinus->CNS in immunocompromised host
• focal symptoms

Question 20

Pathology of aspergillus

Answer 20

septate hypae
single/multiple abscess
granulomata
infarcted brain

Question 21

tx of aspergillus

Answer 21

aggressive surgical excision

-amphotericin B + flucytosine (antifungals)

Question 22

Zygomycetes aka mucormycosis

Answer 22

*diabetes and immunocompromised

will have rapidly progressive facial swelling

Question 23

species that causes zygomycosis

Answer 23

mucor spp.
rhizomucor spp.
rhizopus spp.

Question 24

morphology of zygomycetes

Answer 24

wide/ ribbon-like aseptate

90 degree branching

Question 25

candidial infections

Answer 25

uncommon oral etiology unproven immunocompromised

Question 26

forms of candidal infxns

Answer 26

meningitis encephalitits absecess

Question 27

Tx of candidal CNS infections

Answer 27

multimodal antifungals

Question 28

parasitic CNS pathogens

Answer 28

``` Helminths -neurocystercercosis ---Taenia solum (pork tape worm) Protozoa -Toxoplasmosis ---Toxoplasma gondii ```

Question 29

Spirochetes CNS pathogens

Answer 29

``` uncommon Dental related CNS infection not known -Neurosyphilis ----Treponema pallidum -Lyme disease ---borrelia burgdoferi ---Gumma ```

Question 30

Viral CNS pathogens

Answer 30

``` Herpetic gingivostomatitis -HSV1 or HSV2 very common in 6 mos-5 yrs and 20yrs -Herpes simplex encephalitis rare ```

Question 31

Prion disease aka slow virus

Answer 31

``` misfolded protein types: -CJD -CJD new variant -Gerstmann-Straussler syndrome (GSS) -Kuru (extinct) ```