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166 Cards in this Set
- Front
- Back
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what is the most common route of CNS infection?
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blood
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what 3 pathogens will infect along the nerves?
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rabes
herpes tetanus |
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what is the most common cause of meinigitis in newborns?
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group B strep (agalectiae)
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what is the 2nd most common cause of meinigitis in newborns?
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e. coli
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what is the 3rd most common cause of meinigitis in newborns?
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listeria monocytogenes
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what is the most common cause of meinigitis in infants and children?
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strep pneumonia
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what is the 2nd most common cause of meinigitis in infants and children?
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neisseria meningitis
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what is the 3rd most common cause of meinigitis in infants and children?
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haemophilis
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what is the most common cause of meinigitis in adults?
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strep pneumonia
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what is the 2nd most common cause of meinigitis in adults?
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neisseria meningitis
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what 3 pathogens are associated with a brain abscess from trauma/surgery?
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staph auereus
staph epidermidis strep pneumo |
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what pathogen is associated with a nontraumatic brain abscess?
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pepto strep
must be microaerophilic or anaerobic |
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how can encephalitis be differentiated from meingitis?
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encephalitis will not have nausea, vomiting, or fever
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what are 2 viral causes of epidemic CNS infections?
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arbovirus
lacrosse |
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what is a sporadic cause of viral CNS infections?
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herpes
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what are 4 common viral causes of acute CNS infection?
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enterovirus (MC)
HIV HSV EBV |
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what are 4 causes of chronic granulomatous infection?
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M TB
coccidodes immitus crypto histoplasmosus |
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what will be the number 1 and 2 causes of chronic granulomatous infection in HIV?
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crypto
toxo |
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what cell type will be high in purulent meningitis?
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neutrophils
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what are 2 of the MC causes of chronic meningitis?
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mycobacteria
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what is usually the cause of aseptic meningitis?
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viral
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what will you see in primary syphillis?
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dark filled elimination
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what will you see with secondary syphilis? (2)
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non-specific serology
maculo-papular rash (copper colored) |
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what 3 additional symptoms will encephalitis have?
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seizures
paralysis disordered mentation |
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where does polio have a predilection for?
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anterior horn motor cells
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what type of paralysis will polio have?
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asymmetric flaccid paralysis
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what type of paralysis will acute polio have?
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symmetric flaccid paralysis
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what will happen to the CNS in Reyes?
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cerebral edema with fatty infiltration of different organs with increased ammonia in the blood
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how many cells should there normally be in CSF?
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0-5
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what will the glucose level usually be?
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66%
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if glucose is decreased and protein is increased, what does it indicate?
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bacteria
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what type of diagnosis will seldom be done?
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biopsy
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what 3 diseases have commercially available kits for latex agglutination tests?
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neisseria
strep haemophilis |
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what do neisseria, strep, haemophilis, and crypto all have?
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polysaccharide capsule
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what 4 pathogens will have a polysaccharide capsule?
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neisseria, strep, haemophilis, and crypto
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what will bacterial CSF look like?
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turbid
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what should you give if a patient has cerebral edema?
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isoosmotic diuretic (mannitol)
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what are the top 5 causes of bacetrial meningitis?
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group B strep
listeria meningitis strep pneumonia haemophilis influenza neisseria meningitis |
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what is the #1 gram-negative cause of meningitis?
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neisseria meningitidis
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is neisseria meningitidis motile?
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no
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is neisseria meningitidis spore forming?
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no
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is neisseria meningitidis acid fast?
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no
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is neisseria meningitidis oxidase postive?
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yes
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what must neisseria meningitidis be distinguished from?
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venorella, another gram-negative diplococcus
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when you see a diplococcus within a neutrophil, what is it?
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neisseria meningitidis
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what is the only cell that does not die to release LPS and instead releases it during replication?
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neisseria meningitidis
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what is the most common age for neisseria meningitidis?
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6-24 months because this is when babies are forming their own antibodies
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which neisseria meningitidis serotype is associated with epidemics?
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A
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where will neisseria meningitidis enter from?
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nasopharynx (normal flora there)
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what are the 3 virulence factors of neisseria meningitidis?
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polysaccharide capsule
IgA protease LPS |
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what is the most toxic moeity of LPS?
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lipid A
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what will neisseria meningitidis cause first?
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large amount of pro-inflammatory cytokines (Il-1 and TNF-alpha)
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what will TNF-alpha do in neisseria meningitidis? (5)
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vasodilation
increased permeability leaky vessels hypovolemia DIC |
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where will the inflammatory response be in the CNS in neisseria meningitidis?
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sub-arachnoid space
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what will be found on PE in neisseria meningitidis?
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petechial hemorrhage
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what allows for meningiococcemia without meningitis and how will it present?
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TCR mutation
fulminant DIC and shock |
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what is the immunity for neisseria meningitidis?
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naturally acquired through infection or colonization
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how can neisseria meningitidis be prevented?
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vaccine against A, C, and W125 but not B which is most common
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what is the post exposure prophylaxis with neisseria meningitidis?
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rifampin for close contacts
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what is the drug of choice for neisseria meningitidis and why?
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penicillin bc of good CNS penetration
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what should you use for PCN resistant cases of neisseria meningitidis?
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cephalosporins
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what type of bacteria is strep agalatiae? (3)
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GBS
cocci in short chains beta hemolytic |
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how will strep agalatiae respire?
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facultative anaerobe
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why is strep agalatiae more common in neonates?
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it is normal flora in the vagina
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what increases the risk for strep agalatiae transmission? (4)
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prematurity
prolonged membrane rupture interpartum fever recent history of strep agalatiae infection |
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what strep agalatiae are seen in neonates?
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1, 3, and 5
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how does strep agalatiae cause damage?
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sialic acid binds to the H factor to enhance degradation of C3b used for opsonization
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what will be destroyed and what will remain intact after strep agalatiae?
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alternate complement pathway will be destroyed
classical pathway intact |
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how will strep agalatiae manifest in monthers?
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chorioretinitis and bacteremia during labor
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which test should be used to diagnose strep agalatiae and what will it show?
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CAMP test
will show a triangular zone of hemolysis on blood agar |
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what type of immunity in strep agalatiae?
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antibody mediated
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how should strep agalatiae be treated?
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beta lactams
add aminoglycoside in severe infections |
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how can strep agalatiae be prevented?
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screen expectant mothers
prophylaxis PCN in genitourinary procedure in an older adult |
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what type of bacteria is strep pneumo? (3)
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gram-positive
diplococcus alpha hemolysis |
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what is strep pneumo sensitive/positive for? (3)
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optochin sensitive
bile solubility positive quelling reaction positive |
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how can strep pneumo be prevented? (2)
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conjugated vaccine for children (strain 15)
capsular, polysaccharide vaccine for adults |
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why does strep pneumo require a conjugated vaccine?
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to create memory because polysaccharides and lipopolysaccharides are t-independent
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how is strep pneumo treated?
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PCN
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what type of bacteria is listeria?
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gram positive rod
beta hemolytic |
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what temp will listeria grow at?
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40C
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is listeria motile?
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in liquid media
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is listeria catalase positive or negative?
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positive
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where is listeria typically seen?
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soft cheese and deli meat
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why are pregnant women taught to avoid soft cheese?
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because listeria is commonly found there and it can cross the placenta
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what will look like a comet moving through the evening sky?
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listeria
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what type of pathogen is listeria?
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intracellular
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what will listeria produce?
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LLO
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how will neonates with listeria present early on?
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disseminated granulomatosis via in-utero transmission
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how will neonates with listeria present later on? (2)
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meningitis
septicemia |
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how will immunocompromised with listeria present? (2)
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meningitis
septicemia |
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what type of immunity in listeria?
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cell mediated (bc antibodies cant reach inside the cell)
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how is listeria treated?
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ampicillin and gentamycin
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what type of bacteria is haemophilis influenza? (2)
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gram-negative coccobacilli/rod
capsulated |
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why does haemophilis influenza need to grow on chocolate agar?
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it requires factor C and V for growth
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how will haemophilis influenza present? (3)
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patient will not have had vaccine
satellite colonies may be seen of staph younger than 2 more susceptible to CNS |
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where does haemophilis influenza pathogenesis come from?
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mostly the capsule
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what is the classic example of why we need a conjugated vaccine?
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haemophilis influenza
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what type of immunity is involved in haemophilis influenza?
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mostly humoral
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how is haemophilis influenza treated?
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third generation cephalosporins (don't want to risk resistance)
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what is hansens disease?
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leprosy
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if the temproal lobe is involved, what should you think?
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herpes
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how is mycobacterium leprae different from bacteria?
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it uses mycolic acid which is a lipid and prevents gram staining (therefore use AFB)
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what type of bacteria is mycobacterium leprae? (3)
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aerobic
acid fact rod shaped |
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how must mycobacterium leprae be grown?
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on live cells from animal foot pads
use carbofuschin stain then wash with alcohol/acetone add methylene blue, red indicates its positive |
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where is mycobacterium leprae seen?
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mostly asia, africa, and latin america
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how is mycobacterium leprae transmitted? (3)
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close contact for a significant length of time
nasal secretions armadillos and mangabey monkeys |
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what will mycobacterium leprae infect first?
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macrophages and schwann cells
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what are the virulence factors of mycobacterium leprae? (2)
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PGL-1 and LAM
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what significant does "DTH intact" have with mycobacterium leprae?
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if its absent, the patient will get the lepromatous form
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what type of response will the tuberculoid form of mycobacterium leprae have?
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Th1 response (IL-2, IFN-gamma, lymphotoxin (TNF-beta))
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how will the tuberculoid form of mycobacterium leprae present? (3)
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macuoles or large flattened plaques on the face
margin will be raised and red while center is dry will eventually lose sensation |
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what happens to the nerves in the tuberculoid form of mycobacterium leprae?
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thickening of peripheral nerves, usually the ulnar N
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what will a biopsy of a tuberculoid leprosy lesion show?
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central necrosis and surrounding epitheliod cells
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what will the lepromatous form of leprosy not show?
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macrophage activation
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what cell type will be attacked in the lepromatous form of leprosy?
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schwann cells
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what cell type will be seen in the lepromatous form of leprosy? where else is this cell see?
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foam cells
chlamydia pneumonia |
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what type of response will be seen in the lepromatous form of leprosy?
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Th2
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what is a characteristic of lepromatous leprosy?
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leonine faces due to necrosis of the nasal bone and septum
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what will a positive lepromin test be?
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means patient has a cell mediated response intact and therefore has the tuberculoid test
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what will a negative lepromin test be?
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patient is lacking in immune response and therefore will have the lepromatous form
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what will close contacts of leprosy need to be treated with?
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dapsone
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how should tuberculoid leprosy be treated?
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dapsone and rifampin for 6 months
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how should lepromatous leprosy be treated?
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dapsone, rifampin, and clofaimine for 2 years
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who is commonly affected in TB?
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young children
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what is common with TB?
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hydrocephalus
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how does TB grow?
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acid fast
on LJ media for 4 weeks |
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what is a very sensitive test for TB and how will it appear?
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auramine-rhodamine stain
will produce apple green colonies |
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what is unique about TB?
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has only a thin peptidoglycan layer
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what 2 CNS lesions can TB cause?
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tuberculoma - center of lesion will have amorphorous necrosis and caseastion
meningeal reaction (much larger, space occupying) |
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what are 3 complications of TB?
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motor paralysis
convusion mental impairment |
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what will create a cob-web appearance in CSF?
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TB
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what cell type will be high in TB?
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lymphocytes
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what will AFB be positive for only 20% of the time?
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TB
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what must always be admined with B6 to prevent peripheral neuropathy?
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INH
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what will cause retrobulbar neuritis?
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ethambutol
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what will cause orange urine?
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rifampin
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what will cause hepatitis?
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pyranizamide
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what will cause ototoxicity?
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streptomycin
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what should be given to reduce the inflammatory response and ICP in TB?
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prednisolone
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what type of immunity in TB?
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innate immunity initially
cell mediated later on |
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how will norcardia typically present?
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pulmonary lesion that goes to brain (cavitary lesion)
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what family does norcardia belong to?
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actinomycosis
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what will actinomycosis cause?
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lumpy jaw and sinus discharge with sulfur granules
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what type of bacteria is norcardia?
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gram positive branching rod
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how does norcardia stain?
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weakly acid fast
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how will norcardia look on culture?
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dry, wrinkled appearance
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where is norcardia found?
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ubiquitous in the soil
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what is a gram-negative rod with gram-positive beads inside?
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norcardia
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which norcardia species will be primarily skin manifestations?
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brasilences
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which norcardia species will be primarily pulmonary and CNS lesions?
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asteroids
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how is norcardia transmitted?
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not person to person
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what does norcardia have an inherent ability for?
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withstand phagocytosis
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how can norcardia and actinomycosis be distinguished?
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norcardia will cause multiple lesions, actinomycosis will cause a solitary cavitary lesion
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what will norcardia cavitary lesions look like? (3)
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TB
MAC HIV |
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what type of stain should norcardia use? what else uses this stain? (2)
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silver stain
pneumocytsits and legionella |
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what is norcardia sensitve to?
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sulfonamides
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how should norcardia be treated?
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amikacin, imipenim, and broad spectrum cephalosporins for 6 weeks
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what are the widest spectrum beat-lactams?
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carbapenems
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anytime you see a GI manifestation with flaccid paralysis, what should you think?
|
botulism
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what is botulin?
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gram positive anaerobe
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what is unique about botulin spores?
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they are heat resistent and do not germinate until they find an aerobic condition
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how many toxins does botulin have?
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7
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what is intestinal borne botulin?
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when food is contaminated by spores, not preformed toxin
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how does botulin cause paralysis?
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inhibits Ach
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why should infants avoid honey for the first year?
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honey is a common source of intestinal botulin
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how should intestinal botulism be treated?
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stomach wash and enema
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