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Clinical Pathology > CNS Infections - Viral Meningitis and Encephalitis (26) > Flashcards

CNS Infections - Viral Meningitis and Encephalitis (26) Flashcards

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1
Q

Meningitis

A

Inflammation of meninges

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2
Q

Encephalitis

A

Inflammation of the brain

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3
Q

Meningo-encephalitis

A

Inflammation of brain and meninges

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4
Q

Aseptic meningitis WBC

A

Above 5X10^6/L in CSF (negative bacterial culture)

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5
Q

Common causes of aseptic meningitis

A

Viruses, partially treated bacterial meningitis, Listeria, TB, syphilis, malignancy, autoimmune conditions, drugs

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6
Q

Virion

A

Basic infectious particle of virus

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7
Q

Virus structure

A

Nucleic acid (DNA/RNA), capsid, lipid envelope (derived from host cell membrane), some contain other proteins/enzymes

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8
Q

What is a capsid?

A

Protein coat, made up of capsomeres (subunits)

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9
Q

Epidemiology of viral meningitis

A

Common neonates and under 5,

5-15 cases per 100,000

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10
Q

Aetiology of viral meningitis

A
  • Enteroviruses (echoviruses, coxsackie, parch, enteroviruses 70 and 71, polio)
  • Herpes virus (HSV 2), VZV, CMV, EBV, HHV6, HHV7
  • Arboviruses
  • Mumps
  • HIV
  • Adenovirus
  • Measles
  • Influenza
  • Parainfluenza type 3
  • Lymphocytic choriomeningitis virus (LCMV)
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11
Q

What’s the lead cause of viral meningitis?

A

Enteroviruses

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12
Q

What are common causes of viral meningitis?

A

Enterovirus, HSV 2, VZV, Mumps, HIV

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13
Q

What percentage of viral meningitis cause unknown?

A

35%

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14
Q

Pathogenesis of viral meningitis

A

Colonisation of mucosal surfaces, invasion of epithelial surface, replication in cells, dissemination and CNS invasion

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15
Q

How does viral meningitis dissemination into CNS?

A

Via cerebral microvascular endothelial cells, via choroid plexus epithelium, spread along olfactory nerve

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16
Q

What are symptoms in VM mainly due to?

A

Inflammatory response in CNS

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17
Q

Clinical presentation of viral meningitis

A

Fever, Meningism (headache, neck stiffness, photophobia), lethargy, myalgia, arthralgia, sore throat, rash, diarrhoea and vomiting

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18
Q

Children clinical presentation of viral meningitis

A

Neonates/infants meningeal signs absent, nuchal rigidity/neck stiffness and bulging anterior fontanelle

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19
Q

Kernig’s sign

A

Hip and knee flexed to 90 degrees, knee cannot be extended due to pain/stiffness in hamstrings

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20
Q

Brudzinski’s sign

A

Flexing the neck causes hip and knees to flex

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21
Q

Nuchal rigidity

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A

Resistance to flexion of the neck

22
Q

Investigations

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A
  • Bloods (FBC, U&E, CRP, clotting, blood culture)
  • CT (raised ICP, SAH, mass lesion)
  • Indicated before LP
  • LP (MC&S, protein, glucose, viral PCR)
  • Throat swab/stool sample (enterovirus PCR)
  • Serology (Mumps, EBV/CMV, HIV)
23
Q

LP contraindications

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A

If raised ICP removing CSF can cause coning (brain though the foramen magnum)

24
Q

CSF findings in viral meningitis/encephalitis

25
Pleocytosis
WBC in CSF
26
Treatment for viral meningitis
IV antibiotics (cefotaxime) if risk of bacterial, supportive therapy, notify public health
27
When do you get epidemics of enteroviral meningitis?
Summer/autumn epidemics
28
Symptoms of enteroviral meningitis
Fever, vomiting, anorexia, rash, upper resp tract symptoms
29
HSV 1 causes
Cold sores and viral encephalitis
30
HSV2 causes
Genital herpes and meningitis
31
Mollaret's meningitis
Recurrent aseptic meningitis, common cause HSV2
32
Primary VZV
Varicella - chickenpox
33
Secondary VZV
Zoster - shingles
34
Is meningitis common with VZV?
No, it's unusual, can occur during/on its own/after vaccination - rash
35
Mumps meningitis
10-30% mumps cases
36
Symptoms of mumps meningitis
CNS symptoms 5 days after onset of parotitis (parotid gland inflammation), ab pain, orchitis
37
HIV and meningitis
Can occur as part of primary infection
38
HIV and meningitis symptoms
(Glandular fever), fever, lymphadenopathy, pharyngitis, rash (self-limiting)
39
Aetiology of viral encephalitis
- HSV 1, VZV, EBV, CMV - Adenovirus - Measles - Mumps - Enterovirus (polio) - Arboviruses (West Nile, Japanese B, St Louis, Eastern and Western Equine Encephalitis) - Influenza - Rubella - HIV - Rabies - Bacteria (Step pneumonia, Neisseria meningitidis, TB) - Malignancy (paraneoplastic) - Autoimmune - Acute disseminated encephalomyopathy (ADEM)
40
What are the common causes of viral encephalitis?
HSV1, VZV, EBV, Measles, Mumps, Enterovirus, Bacteria, ADEM
41
What is the most common cause of viral encephalitis?
HSV1
42
What percentage is aetiology unknown in viral encephalitis?
37%
43
Clinical presentation of viral encephalitis
Altered mental state (confusion/bizarre behaviour/coma), fever, headache, meningism?, seizures, weakness, dysphasia/aphasia, cranial nerve palsy, ataxia
44
Investigations
- Bloods (FBC, U&E, CRP, clotting, cultures, serology) - CT (before LP) - MRI (HSV changes) - LP (M, C&S, protein/glucose, viral PCR) - EEG (HSV abnormal temporal lobe activity)
45
Treatment of viral encephalitis
High dose IV aciclovir
46
HSE epidemiology
Rare, 50yrs, male=female
47
HSE pathogenesis
Primary infection vs reaction (direct transmission of the virus along neural/olfactory pathways, reactivation in trigeminal ganglia), acute focal necrotising encephalitis, inflammation/swelling of brain tissue
48
Herpes Simplex Encephalitis outcome
Untreated 70% mortality, treated remains high 28% at 18 months, Paralysis, speech loss, personality change
49
Acute disseminated encephalomyelopathy
Immune-mediated CNS demyelination, can follow viral illness/vaccination, CSF findings= viral meningitis, MRI helpful, treatment - steroids/immunosuppressants
50
If an doubt on diagnosis
Treat as bacteria - antibiotics!

Clinical Pathology (60 decks)

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