viral CNS inftn CSF lab values for viral meningitis 1. glucose 2. protein 3. total WBC

1. glucose = 10-45 mg/dL 2. protein = 50-250 mg/dL 3. total WBC = cells/microL

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viral CNS inftn

CSF lab values for viral meningitis

glucose
protein
total WBC

glucose = 10-45 mg/dL
protein = 50-250 mg/dL
total WBC = cells/microL

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viral CNS inftn

WNV meningeoencephalitis occurs in __% of WNV inftns (high risk popn = cancers, DM, htn, CKD)

hint: recovery in wks-mo’s; permanent neuro effects

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viral CNS inftn

Name the virus

transmitted by mosquito/ticks vectors
attenuated vax for yellow fever + japanese encephalitis
more common in summer

Flavivirus

hint: adesus = urban only; culex = forest, urban

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viral CNS inftn

3 points of entry for ____ in CNS include:

nasal vacity
retrograde axonal travel
intact transcytosis (endoth cells/leaky pores)

arborvirus

hint: humans= dead end, incidental host

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viral CNS inftn

____ (virus) is chrs by the following patho phys

fecal oral transmission
esophageal/skin entry
serum Abs block spread –> viral shedding in GI tract
high asympto inftn rate
no vax/licensed antivirals

Enterovirus (Picornavirus)

hint: fecal-oral; exposure to poor sanitation; common in summer

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viral CNS inftn

out 68, 70, 71 - which enterovirus causes:

severe resp dz?

enterovirus 68

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viral CNS inftn

out 68, 70, 71 - which enterovirus causes:

paralutics dz, acute hemorr conjunctivitis?

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viral CNS inftn

out 68, 70, 71 - which enterovirus causes:

paralytic dz, encephalitis, meningitis, hand-foot-mouth dz

enterovirus 71

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viral CNS inftn

____ (virus) chrs include:

replication in muscle
wk-mo’s of incubation deps on distance from CNS
retrograde travels from peripheral nerves
prevention = post exposure vax (dt long incubation)

Rabies (rhabdovirus)

hint: spreads to non human salivary glands

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viral CNS inftn

reproduction of _____ in the brain causes:

hydrophobia
seizures
hallucinations
paralysis
coma + death

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viral CNS inftn

____(virus) encephalitis is chr by

trigeminal N spread
unilateral temporal lobal abn’s (see pic)
most common cause of sporadic viral enceph

HSV1

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viral CNS inftn

Treat HSV + VZV aggressivley with _____

ayclovir

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viral CNS inftn

HSVV1, HSV2, VZV are _____ which are neurotropic

alphaherpesviruses

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viral CNS inftn

cytolytic enceph occurs ___ after inftn

1-2 weeks

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viral CNS inftn

ddx meningitis from enceph - 2

encephalitis has

intracerebral hemorrhage
altered mental status (incl personality + poor judgement)

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brudzinski sign (flexed knees when neck is flexed) is positive for

meningitis

hint: mental status intact

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Pneumonia

These are all prevention for what inftn?

Acellular vaccine
whole heat killed vax
prophx maroclide (erythromycin)

B. Pertussis

hint: both vax req 10 year boosters

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Pneumonia

toxigenisis of the B. pertussis - 4

PTX (AB toxin, 2˚ attachment, leukocytosis)
Adenylate Cyclase toxin (mø apop, IR evasion)
Tracheal cytotoxin (cough)
LPS (inflamm)

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Pneumonia

_____ is mainly responsible for atachment of B. pertussis to cilia (resp epith cells)

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Filamentous hemagglutinin

hint: others responsb = PTX, fimbriae, pertactin, trach colonizn factor

Pneumonia

Whats the bug?

highly contagious short G- rod with inadeq vax coverage
cultured on regan Lowe Media

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B pertussis

hint: abroad vax (killed cell) >> US vax (short lived, acellular)

Pneumonia

_____ causes

neonatal + p/partum sepsis
CF pneumonia
systemic complication p/local mucosal inftn (IMNS)

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NTHi (Unencaps H flu)

hint: not vax covered

Pneumonia

Hib and NTHi versions of H flu share what in common? - 3

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IgA protease
pili
adhesins

Pneumonia

G- pleomorphic (cocci + rod) microbe with rapid bacteremia that leads to celluliltus epilogttis, septic arthritis and lethal meningitis

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H. influenzae

Pneumonia

lab Dx for what organism?

cultured on chocolate agar (heated-blood) ± factors V (hemin) and X (NAD)
quelung rxn ddx’s serotype

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H. flu

# Pneumonia Surgical drainage + batrim/cerfuroxime, axetil, cefixime, macrolides, or fluoroquinolones are used to treat \_\_\_\_(manifestation) of Hib inftn

Cellulitis, Pericarditis, Septic Arthritis

# Pneumonia How would you tx the inftn below? - 3

Hib Meningitis 1. ceftriaxone 2. dexamethasone (if \> 2 mo) 3. supportive care hint: monitor for sensitivity

# Pneumonia Tx for upper resp Hib inftn? - 2 combos

1. amoxicillin + clavulanate 2. Bactrim (TMP-SMX)

# Pneumonia Describe tx for Hib manifestations below: 1. Epiglottitis 2. Otitis Media

1. inutbation/trach + ABx 2. amoxicillin

# Pneumonia Properties of what two bugs? - 2 * human restricted and fastidious to culture * required factors X + V in vitro * resp droplet transmission * pediatric contagious resp intn * vax, abx, and supp care

H flu + Bordetella

# Pneumonia Virulence factors that determine pathogenicity of \_\_\_\_\_? 1. LOS endotoxin 2. IgA protease 3. meningococcus capsule 4. gonococcus pilli 5. porins 6. Opa

Neisseria hint: capsule resistts phagocytosis; VIP vax component

# Pneumonia What should you use to culture Neisseria on mucosal sites vs sterile sites? -2

1. Thayer-Martin medium for mucosal (GU, nasal) 2. Blood agar for sterile (CSF, blood)

# Pneumonia G- diplococci, facultative aerobe, human-restricted, oxidase + catalase pos; ferments maltose (malt liquor)

Neisseria Meningitidis

# Pneumonia Host defenses against N. menigitidis? - 2

1. IgG enh complement 2. PMNs

# Pneumonia \_\_\_\_ predisposes pts to Neisseria complications

complement defc hint: C5-9 VIP for poking holes

# Pneumonia aysmpto/untreated ____ in women leads to PID

gonoccocus

# Pneumonia even tho are neonates are passibely protected from meningococc they still need prophx eye ointment for \_\_\_\_

gonococcus

# Pneumonia N. meningitidis treatment includes? -2

1. ceftriaxone/cefixime 2. rifampin (prophx) **DO NOT USE STEROIDS!!!!** hint: prevention = meningcocc vax + gonococc condoms

# Pneumonia meningococcemia with higher fever, shock, **widespread purpura, and DIC**

Waterhouse-Friderichen Syndrome

# Pneumonia G+, catalase⊖, diplococci that form chains in culture

Pneumococcus (Step pneumoniae)

# Pneumonia How would you treat? Strep pneumonia that sinusitis, otitis media, mild pneumonia

outpt amoxicillin

# Pneumonia how would you tx severe strep pneum w. rusty sputum, lobar consoldn, ↑procalcitonin (labs: xray and urine Ag⊕)? - 3

admit for 1. amoxicillin, 2. flouroquins, 3. a/o vanco (after sensitivity testing)

# Pneumonia risk factors fr invaseive pneumococc dz? - 2

1. ø vax coverage 2. ↓/ø spleen fx

# Pneumonia Gram stain + culture would be positive in spinal tap unless?

abx tx began \>4 hrs prior

# Pneumonia If pneumococc came back resisant (toxic MIC), and you couldnt tx with vanco + ceftriaoxne/cefotaxime, what would you use? - 3

1. rifampin 2. meropenem 3. chloramphenicol hint: use steroids sparingly

what vax prevents pneumococc invasive disease? Why did they step it up? - 2

1. Prevnar13 (formally7) 2. dt replacement dz after herd immunity established

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