Infections & HIV Flashcards Preview

ABPP > Infections & HIV > Flashcards

Flashcards in Infections & HIV Deck (52):
1

Meningitis is usually caused by

Spread of an infectious agent via bloodstream from an infective focus elsewhere in the body

2

Clinical manifestations of meningitis

Rapid onset over several days; generalized HA, fever, vomiting, lethargy, stiff neck, confusion

3

Neurologic complications of meningitis

Seizures, focal cerebral signs, acute cerebral edema, CN dysfx (3, 4, 6, 7), hearing loss, HP, dysphagia, hemianopsia

4

Brain abscess can be caused by

Infection spread from middle ear or sinus
In assoc. w/ congenital heart disease
Spread of infection from distant site
Direct intro of bacteria following PHI

5

Cardinal symptom of brain abscess

Relentless & progressive HA, usually followed by focal neurological signs

6

Pott's disease

TB in spinal column

7

Early symptoms of neurosyphilis

Fatigue, irritability, personality changes, forgetfulness, tremor

8

Symptoms of late stage neurosyphilis

Impaired memory & judgment, confusion, disorientation, seizures, dysarthria, myoclonus, poor motor control

9

General paresis

Accumulation of neurosyphilis lesions causes dementia, behavioral changes, delusions of grandeur, psychosis, & diffuse UMN-type weakness

10

Tabes dorsalis

In neurosyphilis, there is involvement of the spinal cord dorsal roots resulting in degeneration of dorsal columns

11

Lyme disease

Neuro manifestations after a delay of several weeks; untreated cases eventually show WM abnormalities; may involve memory impairment & difficulty with complex cognitive fx, irritability, depressed mood

12

Tetanus

Affects the motor unit of the PNS

Tonic contractions eventually appear secondary to continuous activity of multiple muscle groups

Also see nuchal rigidity, lockjaw, risus sardonicus, dysphagia

13

Herpes simplex affects which area of the brain most?

Limbic cortex/temporal lobe

14

Presentation of CNS involvement of herpes simplex

Bizarre psychotic behavior, confusion, lethargy, HA, fever, meningeal signs, seizures, focal signs

15

Subacute sclerosing panencephalitis is caused by

persistent infection of genetically mutated forms of the measles virus that escape immune clearance; latent period of 6-8 yrs

16

Initial symptoms of subacute sclerosing panencephalitis

mild mental deterioration followed by myoclonic jerks, seizures, vision loss

17

Advanced state of subacute sclerosing panencephalitis

muscle spasms/rigidity, progressive deterioration to comatose & then persistent vegetative state

18

Progressive multifocal leukoencephalopathy

Demyelination of CNS due to destruction of oligodendrocytes by the JC polyoma virus (JCV)

Mostly seen in immunocompromised individuals

19

How does toxoplasmosis present on neuroimaging?

Ring-enhancing lesions

20

Common presenting features of toxoplasmosis

seizures, HA, fever, lymphocytic predominant meningitis, focal signs; general subacute encephalopathy & language impairment

21

Varicella-zoster

Herpes virus that causes chickenpox, becomes latent in CN & dorsal-root ganglia, & frequently reactivates decades later to produce shingles & postherpetic neuralgia

22

Varicella-zoster affects which cranial nerves?

5, 7, 3

23

Neurological complications of rabies

Delirium, seizures, nuchal rigidity, paralysis, excitabilty

24

Cysticercosis

Caused by ingestion of eggs of pork tapeworm, forms multiple cysts in muscles, eyes, & CNS

Seizures, HA, nausea, vomiting, lymphocytic meningitis, focal deficits

25

Kuru

Chronic, rapidly progressing, fatal nervous system disease caused by prions & characterized by prominent ataxia, dysarthria, tremulousness, dementia in late stages

Shows severe cerebellar loss, spongiform changes, & prion-amyloid plaques

26

Guillain-Barre syndrome

Post-infectious disease of peripheral myelin assoc. w/ paresthesias in the distal extremities & leg weakness

27

How does sarcoidosis affect the CNS?

takes form of a granulomatous infiltration of the meninges & underlying parenchyma, most frequent at base of brain

Lesions - focal collections of epithelioid cells surrounded by rim of lymphocytes

28

Retrovirus

Stores genetic info as RNA, releases RNA & an enzyme, making DNA using the viral RNA as a pattern; viral DNA is incorporated into host cell DNA

29

CDC classification of HIV/AIDS

Category A: pts who have remained medically asymptomatic or have had only a transient illness
Category B: pts w/ more serious HIV-related conditions
Category C: pts who have more serious AIDS-defining illnesses

AIDS is diagnosed in those w/ CD4<200 and/or a category C complication

30

What is the most common cause of CNS mass lesions in AIDS patients?

Toxoplasmosis

31

Common opportunistic infections in HIV/AIDS patients

Yeast infections, crytococcal meningitis, mycobacterium avium complex, cryptosporidium, PML, cytomegalovirus encephalitis, Kaposi's sarcoma, lymphomas, toxoplasmosis

32

What percentage of AIDS patients may develop some form of CNS disease?

50-66%

33

HIV-related mild neurocognitive disorder/minor cognitive motor disorder

-Difficulty in concentrating, unusual fatigability, subjectively slowed down, mild memory
-May be seen as anxiety, depression, or hypochondriasis
-Difficulties w/ info processing speed, divided attention, sustained effortful processing, deficiencies in learning & recalling new info
-Verbal skills less affected

34

Diagnostic criteria for HIV-Associated dementia (HAD)

-Acquired impairment in 2 domains of cognitive fx, w/ focus in learning, slowed info processing, distractibility/inattention
-Verified by neurological, NP, or clinical eval
-Marked interference w/ daily fx
-Present for 1 mo or more
-No alteration in consciousness
-Ruling out other causative etiology

35

AIDS dementia complex staging scheme (Sidtis & Price)

-Stage 0 (normal)
-Stage 0.5 (equivocal/subclinical): no impairment of work or ADL performance
-Stage 1 (mild): able to perform all but more demanding asepcts of work or ADLs, can walk w/o assistance
-Stage 2 (moderate): cannot work or maintain more demanding aspects of daily life, can perform basic self-care
-Stage 3 (severe): major intellectual incapacity or motor disability
-Stage 4 (end stage): nearly vegetative

36

What are some psychosocial factors that should be considered with HIV/AIDS patients?

Stigmatism, may affect immediate social support, adjustment d/o, anxiety d/o, mood disorders, psychosis, substance use disorders (may/may not be pre-existing)

37

Asceptic meningitis

Nonbacterial meningitis, can be inflammatory, idiopathic, or viral infection

38

Cryptococcal meningitis

Meningitis caused by cryptococcus (yeast) infection; often result of opportunistic infection

Often presents with headache, CN involvement, & CSF obstruction

39

Mollaret meningitis

Recurrent asceptic meningitis of unclear origin

40

Mental status changes are more often associated with bacterial or viral meningitis?

Bacterial

41

Meningismus

Meningeal irritation often caused by meningitis or SAH, carcinomatous meningitis, or chemical sensitivity

42

6 common signs of meningismus

HA, lethargy, photo & phonophobia, fever, nuchal rigidity

43

Common symptoms of brain abscess

HA, lethargy, fever, nuchal rigidity, nausea, vomiting, seizures, focal signs

44

Where do epidural abcesses most often occur?

Spinal canal

45

Neurological symptoms of Lyme disease

Often delayed by weeks; meningeal signs, emotional changes, impaired memory & cognition

46

What is the most common cause of viral encephalitis?

HIV-1

47

Cerebritis

Focal bacterial invasion of the brain parenchyma with no associated capsule or pus

48

Granuloma

Focal, more or less encapsulated, chronic inflammatory lesion (e.g., sarcoidosis, syphilis, TB, fungi, larvae of intestinal parasites)

49

Progressive multifocal leukoencephalopathy

Demyelinating viral infection of the brain

50

Kaposi's sarcoma

Tumor that appears as painless, red to purple, raised patches on skin

51

Lymphomas

Tumors of the immune system which may 1st appear in brain or other internal organs; pts typically present with slowly progressive neuro deterioration & may die within 3 months

52

The most common neurologic manifestation of HIV is

Emotional lability & delirium associated with HIV-associated dementia