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160 Cards in this Set
- Front
- Back
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By what route do fungal infections infect the CNS?
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Hematogenous route
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T/F Fungal infections of the CNS cause multiple areas of infection
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True
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T/F Fungal infections cannot cause abscesses.
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False (Fungal infections can cause abscesses)
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What are secondary conditions which arise from fungal infection of the CNS?[3]
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Thrombosis
Cerebral infarction Hemorrhage |
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What are the common fungal organisms to cause fungal infection of the CNS?
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Aspergillus
Candidia Albicans Cryptococcus Neoformans |
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Branching hyphae
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Aspergillus
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Describe Aspergillus
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Branching hyphae
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Exists only in the yeast form in humans
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Candidia Albicans
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What is the morphology of candidia albicans when it has invaded the body
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Yeast
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Capsulated spheres
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Cryptococcus neoformans
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T/F Capsule of the cryptococcus neoformans is seen with H&E stain
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False
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What preparation is required to observe the capsule of cryptococcus neoformans?[2]
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PAS
Mucicarmine |
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What is the significance of Mucicarmine?
What other stain can have a similar action? |
Stains the capsule of Cryptococcus neoformans
PAS |
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Where is cryptococcus found?
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In the soil
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What is the geographic distribution of cryptococcus?
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Worldwide
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Who are at greatest risk for CNS infection by Cryptococcus neoformans?
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Immunocompramised
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What percentage of meningioecephalitis patients with AIDS are infected with Cryptococcus neoformans?
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85%
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What is the mortality rate of patients with cryptococcal meningitis?
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12%
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T/F Sequeleae of cryptococcal meningitis can be permanent neurological damage
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True
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Where is the site of initial Cryptococcus neoformans infection?
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Lungs
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What are the symptoms of the initial pulmonary infection of Cryptococcus neoformans?
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The initial infection is asymptomatic
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How is Cryptococcus neoformans acquired?
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Inhaled
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What are the symptoms of cryptococcal meningitis?[4]
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Fever
Headache Nuchal rigidity Confusion |
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What stain would be used to observe cryptococcus neoformans from a CSF sample?
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India Ink
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What is the "gold standard" for the detection and diagnosis of cryptococcus neoformans
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Detection fo the cryptococcal polysaccharide antigen using immunologic methods
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Which is more sensitive for the detection of Cryptococcus neoformans:
CSF satin with india ink Immunologic detection of the cryptococcal polysaccharide antigen |
Immunologic detection of the cryptococcal polysaccharide antigen
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What is the treatment for meningitis caused by Cryptococcus neoformans?[2]
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Amphotericin B
5-flucytosine |
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What is the geographic location of Histoplasmosis capsulatum?
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Eastern United States
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What percentage of adults that live in regions where Histoplasmosis is located test positive for the organism
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80%
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What demographics are at increased risk for severe disease?[3]
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Infants
Young children Older persons |
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What conditions are usually presented in the events of dissemination of Histoplasmosis capsulatum?[3]
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Cancer
AIDS Immunosuppresion other than AIDS |
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Where is Histoplasmosis capsulatum found?
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Soil and water contaminated with bat and bird droppings
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In what form does Histoplasmosis capsulatum infect the human?
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Spore
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How does Histoplasmosis capsulatum infect humans
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Airborne spores from the soil
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T/F Histoplasmosis capsulatum infection of one patient can be transmittied to another patient
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False (Histoplasmosis capsulatum is acquired through the inhalation of spores)
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Is Hisptoplasmosis capsulatum infection more common in men or women?
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Men
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What is the mortality rate of patients who show neurological signs of infections from Hispoplasmosis capsulatum?
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7-23%
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What is the incubation period of Histoplasmosis capsulatum?
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3-17 days
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What are the symptoms of acute resipatory syndrome caused by Histoplasmosis capsulatum?[4]
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Fever
Cough Productive sputum Erythema multiform |
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What is the course of the infection of Histoplasmosis capsulatum following acute respiratory sydrome if the the patient is not treated?
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Dissemination of Histoplasmosis capsulatum to deeper tissues
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Constitutional symptom
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A symptom indicating that a disease or disorder is affecting the whole body
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A symptom indicating that a disease or disorder is affecting the whole body
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Constitutional symptom
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What symptom occurs in the case of chronic Histoplasmosis capsulatum infection?
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Ulcers of the mucosa of the mouth and gums
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What percentage of cultures of CNS from a patient infected with Histoplamosis capsulatum will be positive?
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30% to 60%
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What is expected to be found in serum studies of a patient who is infected with Histoplasmosis capsulatum?[5]
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Anemia
Pancytopenia(70-90%) Alkaline Phosphatase 1:32complemnet fixing antibodies Culture positive for microbe |
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Anemia, Pancytopenia, Alkaline phosphatase, 1:32 complement fixing antibody and culture positive serum analysis suggests what infection?
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Histoplasmosis capsulatum
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What are the findings to expect with chest X-ray of a patient infected with Histoplasmosis capsulatum?[2]
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Hilar lymphadenopathy
Nodular infiltrates |
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T/F Chest X-ray may be within normal limits in a patient infected with Histoplasmosis capsulatum?
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True
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What investigation can be used to detect cerebral histoplasmosis before performing an LP?
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CT scan
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What is the most frequent CNS manifestation of candidia infection?
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Meninigitis
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What patient population is candidiaisis more common in?
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Neonates
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What is a common finding for 18% to 52% of patient who die from invasive candidiasis?
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Scattered Brain Microabscesses
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What are the symptoms of CNS infection with Candidia albicans?[6]
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Fever
Headache Nuchal rigidity Altered mental status Confusion Disorientation |
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Fever, headache, nuchal rigidity, altered mental status, confusion, disorientation are all symptoms of what condition?
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Meningitis due to Candidia albicans
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What are two prominent CNS features of neonatal invasive candidiasis?
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Bulging frontonelle
Splitting sutures |
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Bulging frontonelle and splitting sutures are two CNS features of what condition?
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Neonatal invasive candidiasis
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What are the finding in the CSF of a patient with candidiasis?[4]
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Pleocytosis
Lymphocyte or PMN preponderance Moderatly low glucose Mild increase in protein |
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What is the treatment which is used for invasive candidiasis?[3]
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Amphotercin B
5-fluorocytosine Fluconazole |
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What geographical area is Coccidiodes immitis located?
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Only in the Americas
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What is the CNS manifestation of Coccidiodes immitis?
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Chronic meningitis
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How is Coccidioides immitis contracted?
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Inhalation of arthroconidia after disturbance
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What fungal agent is transmitted after a disturbance (such as an earthquake) allows for the inhalation of arthroconidia?
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Coccidioides immitis
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Anthroconidia
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An asexual spore which is the product of separation and fragmentation of true fungal hyphae.
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An asexual spore which is the product of separation and fragmentation of true fungal hyphae.
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Antroconidia
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What demographic is at risk for contacting Coccidioides immitis?[3]
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Construction workers
Agricultural workers Archeologists |
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Inhaled arthroconidia reach alveoli; convert to spherule that gives rise to endospores; endospores phagocytosed but survive; large (60-100 μm) spherules escape phagocytosis; alkaline environment allows survival within phagosome. What is the organism
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Coccidioides immitis
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What is the pathogenisis of Coccidioides immitis infection?
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Inhaled arthroconidia reach alveoli; convert to spherule that gives rise to endospores; endospores phagocytosed but survive; large (60-100 μm) spherules escape phagocytosis; alkaline environment allows survival within phagosome
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What are the symptoms associated with infection with Coccidioides immitis?[3]
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Flu-like symptoms
Chronic pulmonary infection Dissemination |
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What are the areas of disseminiation with infection with Coccidioides immitis?[5]
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Meningitis
Bone and joints Genitourinary tract Cutaneous Ophthalmic |
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What is the treatment for Coccidioides immitis infection?[2]
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Amphotericin B
Miconazole |
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How is Apergillosis fumigatus acquired?
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Inhalation of airborne conidia
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Where is Aspergillosis fumigatus usually found?
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Soil
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What is the initial presentation of an infection with Aspergillosis fumigatus?
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Invasive pulmonary infection
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What are the symptoms of invasive pulmonary infection that is found with Aspergillosis fumigatus infection?[3]
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Fever
Cough Chest pain |
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What is the progression seen after invasive pulmonary infection in an infection with Aspergillosis fumigatus?
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Dissemination
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What are the sties of dissemination with an infection with Aspergillosis fumigatus?[3]
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Brain
Skin Bone |
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This fungal organism disseminates to the brain skin and bone.
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Aspergillosis fumigatus
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This fungal organism disseminates to the meninges, soft tissue, and joints.
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Coccidioides immitis
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What condition seen with infection with Aspegillosis fumigatus will result in high mortality?
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Persistent granulocytopenia
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What condition seen with infection with Aspegillosis fumigatus will result in 100% mortality?
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Formation of a brain abscess
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What is the treatment for Aspergillosis fumigatus infection?
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IV Amphotericin B
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What supplemental antibiotics can be administered in the case of Aspergillosis fumigatus infection in conjunction with IV ampotercin B?[2]
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Itraconazole
Voriconazole |
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What species are included in the group Hyalohyphomycoses?[7]
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Penicillium
Paecilomyces Acremonium Beauvaria Fusarium Pseudallescheria |
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Penicillium, Paecilomyces, Acremonium, Beauvaria, Fusarium Scapulariopsis and Pseudallescheria are all part of ...
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Hyalohyphomycoses
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What is the patient at risk Hyalohyphomycoses infection?
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Immunocompramised patients
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Besides in the immunocompramised what other situation can there be infection of the brain be Hyalohyphomycoses?
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Traumatic injury
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What is the most common phaeohyphomycosis?
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Cladosporiosis
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What organism is associated with decaying plants and trees?
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Cladosporiosis
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What are the areas of deep systemic infection by cladosporiosis?[3]
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Skin
Muscle CNS |
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What are two risk factors for CNS infection by cladosporiosis?
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Peritoneal Dialysis
Head trauma |
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Describe the morphology of Cladosperiosis.[3]
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Dermatiaceous (Dark walled) septate hyphae
Yeast Combination of both ing the tissue |
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What is the prognosis of CNS infection with Cladosporiosis?
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Poor prognosis
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Used in cultivating fungi; promotes sporulation and pigmentation.
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Potato dextrose agar
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Potato dextrose agar
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Used in cultivating fungi; promotes sporulation and pigmentation.
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What medium is used to cultivate Cladosporiosis?
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Potato dextrose agar
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Zoonotic protozoa found in mammals and birds
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Toxoplasma gondii
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T/F Toxoplasma gondii can be transmitted vertically via trans placental route
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True
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What is the method of diagnosis for Toxoplasmosis gondii?
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Examine the anti-toxoplasma IgG in the serum
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What is the most common site of infection and necrosis with Toxoplasma gondii infection?
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Brain
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At what stage does a treponema pallidum infection infection begin to exhibit symptoms of CNS involvement?
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Tertiary syphilis
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T/F Treponema pallidum is in the serum in high titers in the event of CNS involvement.
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False (T. pallidum is in low titers in tertiary syphilis)
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What is the main mechanism of tissue damage seen in tertiary syphilis?
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Delayed type hypersensitivtiy
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What are the common lesions found in tissues in tertiary syphilis?
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Granulomatous lesion
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What are the symptoms seen in tertiary syphilis that affects the CNS?[3]
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Mental changes
Frank psychosis Tabes dorsalis |
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What are the CSF finding in a treponema pallidum infection?
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Venareal Disease Research Laboratory(VDRL) postitive
Elevated WBC's Elevated protein |
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What is VDRL?
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Venereal Disease Reasearch Laboratory test - A blood test for syphilis
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What antibiotic is used for the treatment of an infection with treponema pallidum?
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Penicillin
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What antibiotic would be administered to a patient with infection of treponema pallidum and who is allegic to penicillin?
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Doxycycline
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How is Leptospira interrogans transmitted?
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Contamination of water by the urine of infected animals
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What can kill Leptospira interrogans?[3]
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Acid solutions
Soap Drying |
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What demographic is at risk for infection with Leptospira interrogans?[4]
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Sewer workers
Miners Veterinarians Meat packers |
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What is the incubation period of Leptospira interrogans?
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7 to 13 days
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What are the symptoms of Bacteremic phase of Leptspira interrogans infection?
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Influenza-like symptoms
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How long after infection is the 2nd phase encountered in Leptospira interrogans infection?
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3+ weeks
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What are the symptoms of the 2nd phase of Leptospira interrogans infection?[3]
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MS symptoms
Headache with aseptic meningitis Hemodynamic collapse (occasionally) |
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At what point does treatment need to be started with Leptospira interrogans?
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4 days into bacteremic phase
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What treatment is administered in the event of an infection with Leptospira interrogans?[2]
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Penicillin
Tetracycline |
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What condition is caused by infection with Borrelia burgdorferi?
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Lymes Disease
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What organsim causes Lymes disease?
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Borelia burgdorferi
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What is the mode of transmission of Borrelia burgdorferi?
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Zoonotic(Tick bite)
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What complication is seen in 15% of cases of Lymes disease?
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Neurological abnormalities
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What are the symptoms of Borrelia burgdorferi?[5]
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"Bull's Eye" rash
Constitutional symptoms Fever MS and joint pains Meningeal irritation |
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What are the 2nd stage symptoms of Lymes disease?
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Dissemination system wide
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What are the 3rd stage symptoms of Lymes disease?[2]
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Mild neurologic symptoms
Frank encephalitis |
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T/F Cultured is readily used to clinically diagnose Lymes disease.
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False (Culture is difficult and not often used)
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What test is used to diagnose Lymes disease?
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Silver and immunoflorecent stains
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What treatment should be administered for early stage Lymes disease?
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Doxycycline daily for 14 to 28 days
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What treatment should be administered for late stage Lymes disease?[2]
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Parenteral Penicillin
Ceftriaxone |
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What substance should be avoided when deciding the treatment for Lymes disease?
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Bismacine
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Why should Bismacine be avoided as a treatment of choice for lymes disease?
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May cause heart and renal failure
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What is a prion
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An infectious protein
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Any of a family of spiral- or coil-shaped bacteria known as Spirochetae
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Spirochetes
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What are the pathogenic spirochetes that affect the CNS?[3]
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Treponema pallidum
Leptospira interrogans Borrelia burgdorferi |
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T/F Prions have no nucleic acid.
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True (Prions are misfolded infectious proteins)
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What are two virulence factors which allow prions to evade the immunde system?
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Replicate without activating the antibody response
Resistant to conventional activation methods that are used for bacteria and viruses |
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What effect do prions have on the brain?
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Attack to brain leaving vacuolated areas in the cerebellum and cortex
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What secondary structure is found in normal prions(PrPc)
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Alpha Helices
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What secondary structure is prominent on PrPSc prions?
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Beta Sheets
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When is PrPc changed into PrPSc?
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when PrPc comes into contact with PrPSc
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How are vaculoated areas formed in prion disease?
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Aggregates of PrPSc accumulate
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What are the routes of spread of prion disease?[4]
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Sporadic
Inherited Ingestion Medical innoculation |
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Any of a family of spiral- or coil-shaped bacteria known as Spirochetae
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Spirochetes
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What are the pathogenic spirochetes that affect the CNS?[3]
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Treponema pallidum
Leptospira interrogans Borrelia burgdorferi |
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T/F Prions have no nucleic acid.
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True (Prions are misfolded infectious proteins)
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What are two virulence factors which allow prions to evade the immunde system?
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Replicate without activating the antibody response
Resistant to conventional activation methods that are used for bacteria and viruses |
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What effect do prions have on the brain?
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Attack to brain leaving vacuolated areas in the cerebellum and cortex
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What secondary structure is found in normal prions(PrPc)
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Alpha Helices
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What secondary structure is prominent on PrPSc prions?
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Beta Sheets
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When is PrPc changed into PrPSc?
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when PrPc comes into contact with PrPSc
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How are vaculoated areas formed in prion disease?
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Aggregates of PrPSc accumulate
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What are the routes of spread of prion disease?[4]
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Sporadic
Inherited Ingestion Medical innoculation |
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What pattern of inheritance is seen in the incidents of inherited prion disease?
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Autosomal dominant
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What is the most common prion in humans?
|
Creutzfeldt-Jakob Disease
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What is the peak age of onset?
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55 years to 65 years
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What is the treatment for Creutzfeldt-Jakob disease?
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There is no treatment
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What are the symptoms of Creutzfedt-Jakob disease?[4]
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Insidious mental deterioration
Cerebellar problems Vision problems Severe dementia |
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What are some of the causes of Creutsfedt-Jakob disease?[4]
|
Corneal transplant
Unsterilized brain equipment Pituitary hormone injections from cadavers Cuts during autopsy/surgery |
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How Was mad cow caused?
|
Feeding cows protein rich feed which was not processed properly
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What are the tests to diagnose Bovine variant CJD?[2]
|
Brain Biopsy
Identify specific protein in the CSF |
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What is the treatment for vCJD?
|
No treatment
|
