Exam #7: Fungal & Parasitic Infections of the CNS Flashcards Preview

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Flashcards in Exam #7: Fungal & Parasitic Infections of the CNS Deck (52):
1

What is the leading cause of fungal meningitis?

Cryptococcal meningitis

2

What two systemic fungi most commonly cause meningitis?

Crytococcus neoformans
Coccidioidies

3

How are the systemic mycoses acquired?

Inhalation of fungal elements

4

What form of Coccidioides immitis infects man?

Filamentous mold infects man, which is then converted to yeast in tissues during infection

*Remember, "mold in the cold, yeast in the heat"

5

What form of crytococcus neoformans infections man?

Encapsulated yeast

Note that this is particular to cryptococcus neoforms, it is an encapsulated yeast BOTH in the environment & in infected individuals

6

Where is Coccidioidomyocsis endemic? When do most endemics occur?

- San Joaquin Valley of California & in Southern Arizona i.e. Southwestern US
- Drought-rain-drought pattern with large numbers of fungal elements present in blowing dust

7

What form of Coccidioides is found in man?

Spherule= a multinucleated structure that produces hundreds of single nucleated spores

8

What clinical syndromes are caused by Coccidiomycosis?

- Pulmonary disease= mild to moderate flu-like illness that largely resolves spontaneously
- Coccidial meningitis= chronically developing headache, fever, & stiff neck

*Note that in comparison to bacterial meningitis, fungal meningitis is has a SLOW onset

9

How is Coccidiomycosis diagnosed?

- Antigen detection in CSF
- Serology

10

How is Coccidiomycosis treated?

Amphotericin B

11

How is cioccidial meningitis diagnosed?

- Mainly based on history
- Antigen detection in CSF
- Serology i.e. antibody presence, which has limited utility in areas where coccidiomyocses is common

Note that cultivation is rarely successful

12

Where is cyrptococcus neoformans found?

Abundant in soil contaminated with bird droppings

13

What clinical syndromes are caused by Cryptococcus neoformans?

- Pulmonary Disease= asymptomatic to mild flu-like illness that is self-resolving
- Cryptococcal meningitis= *the most common cause of fungal meningitis

14

Describe the presentation of cryptococcal meningitis.

- Chronic onset of typical meningeal symptoms (weeks-->months)
- Intermittent headache, irritability, dizziness, & other CNS findings

15

How does the presentation of cryptococcal meningitis differ in AIDS & HIV+ patients?

Acute onset instead of chronic onset

16

How is Cryptococcosis diagnosed?

India ink i.e. stain that reveals encapsulated yeast

17

How is cryptococcal meningitis treated?

Amphotericin B & Flourocytosine

18

What additional therapy is needed following cryptococcal meningitis in AIDS patients?

Suppressive therapy

19

What causes rhinocerebral mucromycosis? What patient population is it most common in?

- Zygomycoses that begins as sinusitis that eventually spreads into the eye & CNS
- Most common in diabetic patients

20

What are the causative organisms of rhinocerebral mucromycosis?

Rhizopus
Absidia
Mucor

21

What are the features of the Zygomycetes? How is zygomycoses (mucormycosis) diagnosed?

- Observation of non-septate (aspetate) hyphae
- Observed in blood vessels branching at 90 degrees

22

What is Entamoeba histolytica?

Parasite that causes amoebic dysentery & brain abscesses

23

What is Trypanosoma brucei?

African trypanosome that causes sleeping sickness

24

What is plasmodium falciparum?

Causative organism of cerebral malaria

25

What are opportunistic amoeba?

Protozoa/ amoebas that are normally found in the environment & occasionally infect humans

26

What are the three genera of opportunistic amoeba?

Acanthamoeba
Naegleria
Balamuthia

- Thought to normally reside in fresh water & accidental parasites of man
- All cause fatal infections in man

27

What is PAM?

Primary emebic meningoencephalitis that causes:
- Fever
- Headache
- Vomiting
- Confusion
- Coma
- Death

28

What causes PAM?

Naegleria fowleri

29

What is PAM associated with?

Warm water*

Hot springs
Heated pools
Hot tubs
Neti Pots

30

How is PAM diagnosed?

Observation of trophozoite forms of amoeba in the CSF

31

How is PAM treated?

There has been some success in treatment with Amphotericin B, but infection is usually fatal

32

What is GAE? How does GAE compare to PAM?

Granulomatous amoebic encephalitis that causes a SLOWER onset of:
- Fever
- Headache
- Vomiting
- Confusion
- Coma
- Death

33

What causes GAE?

Acanthamoeba
Balamuthia

34

What is Acanthamoeba keratitis?

Chronic amoebic infection of the cornea that is associated with contact lens use

35

What is Toxoplasmosis?

- One of the most common parasitic infections in humans & animals
- Most infections are asymptomatic
- Becomes a problem in the immunosuppressed--> encephalitis

36

What causes Toxoplasmosis? What patient populations are at risk for Toxoplasmosis?

Toxoplasma gondii

- Congenital infection to child
- Immunosuppressed

37

Describe the lifecycle of Toxoplasma gondii. How is Toxoplasmosis transmitted to humans?

Humans acquire Toxoplasmosis by eating tissue cysts in undercooked meat or ingestion of oocysts in contaminated soil.
- A single tissue cyst is enough to cause disease, and these are readily found in pork and lamb in the US
- Soil contamination by cat feces is a major source of oocysts

*Thus, contaminated meat= tissue cyst. Cat feces= oocysts. This is why pregnant women are instructed to avoid cat litter boxes.

38

What are the outcomes of congenitally acquired Toxoplasmosis?

Miscarriage/stillbirth or:

- Blindness
- Mental retardation
- Neurological disorders

39

What are the recommendations for pregnant women because of Toxoplasmosis?

- Avoid cats/ cat liter

*Concern is about a woman having a newly acquired infection during the first trimester
- If maternal infection in 1st trimester= 15-25% chance of SEVERE disease
- If maternal infection in 3rd trimester= 65% chance of less severe disease

40

What are the symptoms of Toxoplasmosis?

- Asymptomatic mostly
- Symptoms are "flu-like"
- Eventually walls off & forms a bradyozite filled cyst

*If the immune system is weakened, reactivation can occur

41

How is Toxoplasmosis diagnosed?

- Serologic testing
- Congenital infection tested with PCR for amniotic fluid
- Maternal= IgM (new infection) or rising IgG titer

*ring-enhancing lesion on imaging studies*

42

What is the importance of rising IgM & IgG titers of toxoplasmosis?

Such titers indicate that an acute infection is likely

43

How is toxoplasmosis prevented?

- Cooking meat thoroughly
- Avoid contact with cat feces, especially if pregnant or immunosuppressed

44

How is toxoplasmosis treated?

Immunocompetent= rarely require treatment
Pregnant mother= early treatment to prevent transmission
Children= treatment for 1 year
Immunocompromised= prophylactic therapy

45

What is the name of the pork tapeworm?

Taenia solium

46

What form of Taenia solium causes disseminated infection in man?

- Ingestion of embyronated eggs from an infected individual
- Ingested eggs hatch in the intestine & release larvae that enter circulation & travel to site where they encyst
- Encysting causes space filling lesions that induce localized inflammation

47

What is the name of the infection of the brain caused by Taenia solium?

Neurocyticercosis

48

Who is at risk for Neurocyticercosis?

Endemic to South America; increasing prevalence in immigrant families in the US

49

How is Neurocyticercosis diagnosed?

- "Swiss cheese" morphology on imaging
- Serology

50

What is visceral larval migrans?

- Infection of man by ascarid worms that normally infect & cause intestinal disease in dogs & cats
- Transmission to man is by ingestion of eggs
- Eggs hatch and larvae migrate to numerous body sites, die, and then a granuloma forms

51

How is visceral larval migrans diagnosed?

- Eosinohpilia

*Note that eggs will NOT be in feces of humans

52

What are the most common symptoms of visceral larval migrans?

Symptoms are highly dependent on the location of granuloma formation but,
- Eye infections are most common
- Lesions in the brain result in epilepsy or encephalopathy

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