Neuro - Blue - Viral And Fungal Infections Of Cns

Front 1

What causes viral meningitis?

Back 1

Enteroviruses for ex. polio, coxsackie, echo, Arbo (esp West Nile), Herpes virus, MMR

Front 2

What things cause Fungal meningitis

Back 2

Cryptococcus neoformans and a bunch of others but this is our main focus

Front 3

There's a spectrum of diseases associated with Polio, Cox A, Cox B and Echo. List some that are common to all 4 of these

Back 3

Paralytic disease, Meningitis-encephalitits, Myocarditis, respiratory infections, Undifferentiated fever

Front 4

Coxsackie A, B and echoviruses which cause aeptic meningitis primarily infects what population?

Back 4

Infants, and children 5-10 in late summer or early fall

Front 5

How are Coxsackie A, B and echoviruses transmitted?

Back 5

fecal-oral AND respiratory

Front 6

What can Herpes simplex virus cause? (note: its the most commonly associated STD)

Back 6

Encephalitis

Front 7

How is Herpes transmitted to eventually cause encephalitis?

Back 7

sexually or Mother to infant at birth

Can also be latent and cause infection via reactivation

Front 8

What can West Nile virus cause in CNS?

Back 8

Meningitis OR Encephalitis

Front 9

Which is more severe, bacterial or viral meningitis?

Back 9

BACTERIAL - so rule this out first, but start abx before ruling it out.

Viral meningitis usually has no residual effects upon recovery.

Front 10

How might a pt with viral meningitis present?

Back 10

fever, chills, H, Stiff neck, N, V, Photophobia, Mental dysfunction

If a pt. presents this way, begin antibiotic therapy immediately, b/c it may be bacterial in origin, and until you rule it out you need to treat the bacterial meningitis

Front 11

What are the most common Causes of viral meningitis?

Back 11

Coxsackie B and Echovirus

Note: initial infection often food-borne

Front 12

Pt presents with signs of meningitis (fever, chills, H, Stiff neck, N, V, Photophobia, Mental dysfunction) You do a CSF analysis after withdrawing fluid via spinal tap. What do you expect to see if the cause is viral? if Bacterial?

Back 12

Bacterial = more severe = look for Inc WBC count (mostly PMNs, neutrophils), Inc protein, Dec. glu b/c lymphocytes have used it up.

Viral = Much lower PMNs, lower protein, Lower glu

Front 13

When do we usually Dx Enteroviruses (polo, coxsackie, eccho) and ARBO vs herpes in meningitis?

Back 13

Enteroviruses and ARBO = late summer/early fall

Herpes = year round

*recent travel Hx and sexual history can give you a clue

Front 14

A pt comes in with positive Bubinski, Positive Kernig, nuchal rigidity and rubelliform/vessicular rash on trunk. Culture is negative for bacteria, but a viral ELISA shows IgM. We're still waiting of results from CSF. Dx?

Back 14

Meningitis if its coxsackie A, B, (look for recent travel Hx) encephalitis if its Herpes (look for sexual Hx)

Front 15

Treatment for Viral meningitis/encephalitis infections?

Back 15

Supportive, IVIG, anti-herpetics if its herpes

Front 16

Whats the most common fungal cause of meningits or meningoencephalitis?

Back 16

Cryptococcus neoformans - encapsulated yeast

Front 17

What are the pathogenic features of cryptococcus neoformans?

Back 17

Negatively charged capsule = inhibits phagocytosis
Melanin produced from conversion of brain catecholamines. DOPA acts as chemoattractant. Uses nitrogen from creatine, creatinine

Front 18

Why does cryptococcus neoformans produce melanin?

Back 18

Melanin protects it from oxidative compounds (free radicals) produced by macrophages

Front 19

How is Cryptococcus neoformans spread?

Back 19

Inhaled as a yeast from dried pigeon or blackbird droppings (which are nitrogen rich)

Front 20

Is there any person-person spread with cryptococcus neoformans?

Back 20

Nope

Front 21

Does cryptococcus neoformans cause disease in pigeons?

Back 21

No

Front 22

What population of individuals are most affected by cryptococcus neoformans?

Back 22

Immunocompromised. (Spreads in blood to CNS)

10-15% incidence in HIV pts.

Front 23

How will cryptococcus neoformans present in an HIV + pt?

Back 23

subacute pulmonary disease

In healthy individual, it can be seen only on x-ray...

Front 24

If untreated, what can cryptococcus progress to?

Back 24

Meningitis and meningoencephalitis = fatal if untreated.

Front 25

T/F: Cutaneous and mucocutaneous spread can also occur with cryptococcus neoformans

Back 25

TRUE

Front 26

How do we Dx Cryptococcus neoformans?

Back 26

India Ink stain of CSF or Cryptococcus antigen test - Ab coated latex particles

Front 27

How do we treat Cryptococcus neoformans?

Back 27

Amphoteracin B Plus flycytosine, fluconazole, itraconazole