CNS Infections- Viral Encephalitis Flashcards Preview

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Flashcards in CNS Infections- Viral Encephalitis Deck (35):
1

During encephalitis, viral replication occurs in ______, leading to severe CNS dysfunction which causes manifestations.

brain parenchyma

2

The brain is not a ____ for viral infection. Infections in the CNS are usually a secondary infections, occurring weeks, months, years after the initial infection.

POE

3

Few survive viral encephalitis, and those who do have ___________

serious emotional disorders and learning deficits

4

The most frequent etiologic agents are

1. Arboviruses
2. Herpes simplex virus-1 (HSV-1)

5

The etiologic agents that can cause BOTH focal and diffuse encephalitis:

1. Non-polio enterovirus
2. Herpes simplex virus 1 (HSV-1)
3. Arbovirus

6

The etiologic agents of FOCAL encephalitis only:

rarely polio virus or rabies

7

Describe Arbovirus

1. Arthropod-borne viruses (arboviruses)
2. Zoonotic agents
3. Association with chronic infection in the reservoir host.
4. Humans are generally the dead end host.
5. Disease in the reservoir, if it occurs, is similar to human disease if POE is same

8

Togaviridae group comprises most arthropod-borne viruses and Rubella, also includes:

Alphavirus and Flavivirus

9

Alphavirus includes

1. Eastern equine encephalitis (EEE) is caused by EEEVirus.
2. Western equine encephalitis (WEE) is caused by WEEVirus.
3. Venezuelan equine encephalitis (VEE) is caused by VEEVirus.
**equine viruses**

10

Flavivirus (flavi = Latin for yellow, includes yellow fever, dengue, hepatitis C agents, also Japanese encephalitis virus and Nipah virus which are an important disease agents in Asia; includes:

1. St. Louis encephalitis (SLE) is caused by SLEVirus.
2. West Nile Encephalitis (WNE) is caused by WNVirus.
3. Powassan encephalitis (POW) is caused by POWVirus

11

Bunyaviridae - bunyavirus includes:

1. California virus
2. Jamestown canyon virus
3. La Cross viruses (LAC) virus

(called the California encephalitis group, highest incidence in California, Midwest and southeast US)

12

Reoviridae group (respiratory, enteric orphans) includes:

1. Rotaviruses
2. Coltiviruses--> Colorado tick fever is caused by CTFVirus (rare in US)

13

Arboviruses cause two primary syndromes in humans:

1. hemorrhagic fever
2. encephalitis/meningitis

14

Arboviruses are the primary cause of _________, but also cause _________.

epidemic encephalitis

benign, aseptic meningitis

15

Seasonality

summer months when humans are outdoors.

16

Vectors are primarily

mosquitoes and ticks

-Colorado tick fever and Powassan fever virus are spread by ticks
-The rest of the arboviruses are spread by mosquitoes

17

Reservoir

Zoonosis (many animals, but primarily birds and small mammals in US)

**Survival of virus by alternating between vertebrate host (reservoir) and arthropod host (vector)**

18

Primary virus replication (viremia) occurs with each arbovirus having specific target cells, such as endothelial cells of the capillaries, macrophages, monocytes, erythrocytes, and the reticuloendothelial system (liver, spleen, lymph nodes) → symptoms are _________

either no or mild symptoms

19

A second round of replication in reticuloendothelial cells can occur immediately after the primary round, producing a second viremia, which may yield sufficient virus to attack___________, depending upon the specific virus → symptoms are __________

brain, liver, skin, vasculature, kidney

symptoms are severe

20

In humans, during the first and second rounds of replication, the viremia is usually low, resulting in mostly ______________

asymptomatic infections and humans being incidental hosts.

**Asymptomatic infections are the most common***

21

S/S

Mild, self-limiting flu-like illness (1 of 5 persons infected) lasting about 1 week, URT symptoms (coryza), fever, chills, sore throat, headache, nausea, vomiting, muscle weakness &/or myalgias, arthralgias, maculopapular rash.

22

CNS disease may manifest as

1. Mild, self-limiting aseptic meningitis.
2. acute, fulminant, diffuse, encephalitis (can be focal) and death.
3. +/- acute flaccid paralysis

will see signs of meningoencephalitis: lethargy, irritability, drowsiness, acute flaccid paralysis, seizures, may evolve into coma, then death due to immunopathology (brain edema) and/or myocarditis

23

Differential

1. Arboviruses
2. enteroviruses
3. herpes viruses.
4. rabies virus (dumb rabies)

24

CSF sample will show

protein and glucose levels as per viral infection and mononuclear pleocytosis.

25

Treatment/Prevention

Treatment is supportive

Prevention goal: limiting the vector population
US military has human vaccines for Eastern Equine Encephalitis and Western Equine Encephalitis

26

Eastern Equine Encephalitis (EEE):

-vectors are mosquitos
-This disease has worst mortality rate; survivors are more likely to manifest with serious neurological sequelae
**Of all arbovirus agents of encephalitis, EEEV is unique in that infection often (not always) causes EEE. Asymptomatic infection is NOT the norm!!**

27

Western Equine Encephalitis (WEE):

-vectors are mosquitos
-rural residence is highest risk factor
***Most benign form of encephalitis***

28

St. Louis Encephalitis (SEE):

-vectors are mosquitos
-Midwest
-Leading cause of epidemic arboviral encephalitis in US before West Nile Virus epidemic in 2002

29

West Nile Encephalitis (WNE):
IMPORTANT

-Closely related to St. Louis encephalitis (cross-reacts serologically with SLE)
**Most common arbovirus infection in the US today**

30

Transmission of west nile besides mosquitoes

1. Transfusions (4 cases)
2. in utero
3. case of a women with WNE passed infection to child via breast milk
4. Organ transplants

31

S&S of WNE

-flu-like symptoms (moderate to high fever or chills, anorexia, malaise, muscle aches, joint pain, respiratory symptoms)
-nausea, vomiting, diarrhea
-maculopapular rash spreading from the trunk to head and limbs
-frontal headaches of >7days duration
-eye pain

32

West Nile Encephalitis is West Nile fever with S/S of one or more of the following

1. meningitis
2. encephalitis
3. parkinsonism – tremors (obviously not in limb(s) with flaccid paralysis)
4. Focal symptoms of muscle weakness/ascending, asymmetrical diffuse flaccid paralysis:
-diminished deep-tendon reflexes/areflexic leg weakness,
-EMG velocity studies demonstrate axonal-type polyneuropathy affecting anterior horn cells or their axons vs. demyelination
-No muscle or sensory pain/loss is noted

33

Treatment for WNE

Ribavirin is efficacious in vitro (in cell culture) studies

34

During WNE in CSF you'll see

plasma cells

35

California (CAL) Encephalitis Serogroup

-La Cross (LAC; Midwestern, Southeastern US) is the most important cause of arboviral pediatric encephalitis in the USA
-Jamestown canyon and other CAL groups rarely cause disease in humans
-Seizures may occur during illness, some patients who recover from illness will experience seizures as sequelae