Blue: Viral And Fungal Menigitis

Front 1

Breaching of Tight Junctions

Back 1

how viruses enter the brain

Front 2

Prevents antibodies from entering brain

Back 2

Tight Junctions of BBB

Front 3

Carried by Leukocytes

Back 3

viruses across BBB

Front 4

May infect peripheral nerves and travel by retrograde axonal flow

Back 4

(HSV-1, 2, VZV, rabies; all utilize specific neuronal receptors for infection.)

Front 5

Albert was a building contractor. His symptoms started abruptly, and included vertigo, nausea, fatigue, fevers, chills, weakness, anorexia, poor concentration, agitated feelings, “electrical shock” feelings in his brain (right side only), depression, and anxiety. After 6 months, some of his symptoms resolved, but he still battles terrible fatigue, nausea, depression, and has a strange sensation he describes as his brain feeling “waterlogged”. He still gets intermittent electrical shocks in the right side of his brain

Back 5

HSV encephalitis

Front 6

Most common global Arbovirus encephalitis

Back 6

West Nile Virus (Flavivirus)

Front 7

Infected local bird populations, spread west, bird mosquito (Culex sp.).

Back 7

West Nile Virus (Flavivirus)

Front 8

Viral titers in horses,
dogs, other small
animals and humans
SHORT-lived, precluding
transmission to
mosquitoes.

Back 8

West Nile Virus (Flavivirus)

Front 9

Why are early MRI's and CSF panels for viral enephalitis not helpful?

Back 9

They don't really show much change until about 14 days later.

Front 10

MCC encephalitis in the midwest

Back 10

St. Louis Encephalcitis.

Front 11

Animal that dies of encephalitis more frequently than humans

Back 11

Horses

Front 12

Encephalitis in Asian Countries

Back 12

Japanese encephalitis

Most deaths worldwide from encephalitis

Front 13

Now most common U.S. cause
of encephalitis.

Back 13

West Nile Virus (Flavivirus):

Front 14

Summer-Fall. Local epidemics

Back 14

West Nile Virus (Flavivirus):

Need mosquitoes! Vaccinate horses.

Front 15

Who dies from West Nile encephlalitis?

Back 15

Elderly.

Front 16

Fever--90%
Weakness--56%
Nausea--53%
Vomiting--51%
Headache--47%
Change in Mental status--46%

Back 16

Symptoms of encephalitis.

Front 17

Rapid onset and severe headache are common to _____________encephalitides.

Back 17

Arbovirus

Front 18

What is the duration of viral encephalitis?

Back 18

3-6 Days.

Most full recovery. Sequelae include fatigue, memory loss, muscle weakness, depression (1+ year later).

Front 19

Forrested Areas

Back 19

LaCrosse Virus (Bunyavirus, California Encephalitis Virus)

Front 20

Aedes triseriatus

Back 20

LaCrosse Virus

Woodland Mosquito that breeds in treeholes.

Front 21

Lumbar jack that develops encephalitis.

Back 21

LaCrosse Virus

Front 22

Natural host: chipmunks, squirrels (no disease).

Back 22

LaCrosse Virus
Aedes triseriatus --mosquito

Front 23

Mosquito--> rodent cycle,
or mosquito-->mosquito cycle.

No human-to-human transmission

Back 23

LaCrosse Virus

Front 24

Spring and Fall Peak

Back 24

LaCrosse Virus

Front 25

Male, 1-19 years., camping or hiking. Stiff neck, fever, lethargy, seizures. Resolves spontaneously 7-10 days, 1% mortality. 10% develop epilepsy, 20% persistent paresis.

Back 25

LaCrosse Virus

Front 26

RX for Lacross encephalitis?

Back 26

No antiviral treatment (supportive).

Front 27

Geographic range - Midwest-Mideast (Minnesota-W.Virginia).

Back 27

Lacross virus

Front 28

Presumptive diagnosis -
(a) stable elevated antibody titer to an arbovirus, or
(b) specific Ig_____ antibody in serum by EIA
(c) Available: Arbovirus antibody panel: includes WNV, EEE, WEE, SLE, CEV

Back 28

M

Arbovirus (presumptive!)

Front 29

Confirmed diagnosis - same illness, with at least one of the following:
(a) 4-fold or greater rise in antibody titer, or
(b) virus isolation from tissue, blood or CSF, or
(c) PCR, blood, CSF (WNV); adjunctive
(d) ___________IgM in CSF

Back 29

specific

Arbovirus (confirmation)

Front 30

Bullet Shaped Virus

Back 30

Rabies virus (Lyssavirus/Rhabdovirus)

Front 31

Natural hosts BATS both
insectivorous and vampire. 30 of 39 known U.S. bat speciesreported as intermittent carriers

Back 31

Rabies virus (Lyssavirus/Rhabdovirus)

Front 32

4 different strains of rabies virus exists; how do they stop the spread?

Back 32

Strict import and export laws restrict geographic spread.

Four major viral strains - U.S.,
African, European, Asian.

Front 33

Near 100% fatality except in bats

Back 33

Rabies virus (Lyssavirus/Rhabdovirus)

Front 34

Most cases due to being bitten by wild animals-bats,
wolves, skunks, raccoons, coyotes, etc.

Back 34

Rabies virus (Lyssavirus/Rhabdovirus)

Front 35

Rabies Virus appears in _____________of animal 1 to 3 days before symptoms appear.

Back 35

saliva

Front 36

Incubation period of Rabies virus lasts several days to avg. 2-3 months depending on SITE of bite. Long incubation period allows for ___________ - infection vaccination.

Back 36

Post

bite in ankle = long time
bite in head = short time

Front 37

Rabies Virus Attaches to ____________receptors. Virus multiplies locally, travels to brain via nerves.

Back 37

Ach

Front 38

Negri bodies in brain tissue

Back 38

Rabies encephlitis

Front 39

RX for acute rabies bite?

Back 39

human rabies immune globulin (HRIG), begin vaccination.

clean wound, apply antiseptics!

Front 40

Vaccine for rabies?

Back 40

1. Tissue culture vaccine - 5 doses: days 0, 3, 7, 14, 28 (optional day 90).