Neuro: Blue - Viral And Fungal Infections Of The Ns

Front 1

Last time we talked about encephalitirs.....

Back 1

this time we are talking about agents that are more likley to cause Meningitis

Front 2

What is the most common cause of Viral Meningitis aseptic?

Back 2

ENTEROVIRSUSES*****

Front 3

What are examples of enteroviruses?

Back 3

Polioviruses (3); Coxsackie A (23), B (6); Echo (32).

Front 4

What % and type of meningitis do enterviruses cause?

Back 4

90% of community-acquired viral meningitis.

Front 5

What % of all causes of meningitis do enteroviruses cause?

Back 5

70% of all causes

Front 6

If you had a hospital acquired meningitis what is the most likely cause?

Back 6

Fungal

Front 7

What is another virus that cause Meningitis?

Back 7

Herpes virus:

HSV 1-2, VZV, EBV, CMV, HHV-6, 7

HSV 2 really causes the most ~90%

Front 8

What are other viral causes of meningitis?

esp in 3rd world areas

Back 8

Measles, Mumps, Rubella

Esp: Mumps most significant

Front 9

What is the most significant fungal infection causing meningitis?

Back 9

Cryptococcus neoformans

Front 10

When it comes to meningitis is it more viral or fungal?

Back 10

always think viral first!

Front 11

Where else did we see coxsacchie virus?

Back 11

Cardio system

Front 12

Spectrum of disease associated with enteroviruses;

10-20 million symptomatic infections/year in U.S.

Back 12

polio
cox A
cox B
Echo

Front 13

What causes “Aseptic” meningitis (no longer a notifiable disease). 50,000+ cases/yr.

Back 13

Coxsackie A, B, echoviruses

Front 14

Who is primarily affected by Coxsackie A, B, echoviruses?

Back 14

Primarily infants (endemic serotypes, yearly);
then children, 5-10yrs (new serotypes entering a community, ). The latter may also affect older children, adults.

Front 15

When is coxsackie A,B,echovirus most common?

As in what season?

Back 15

Late summer or early fall (year around in tropical).

Small epidemics, variety of diseases (nervous, respiratory, skin systems).

Front 16

What is the transmission route of Coxsackie A,B,echoviruses?

Back 16

Both fecal-oral and respiratory transmission

Front 17

Do elderly or kids carry coxsackie diseases?

Back 17

More kids!!!!

Front 18

What virus is more sporadidic for causing meningitis?

Back 18

Herpes Simplex virus Type 1 and Type 2

Sporadic. 2000-4000 cases/year. Both can also cause encephalitis.

Front 19

What are some characteristics of HSV 1 and 2?

Back 19

Most commonly STD associated (type 2)
Uncommon, more severe in newborn.
Mother to infant at birth.
Latency/Reactivation.

Front 20

What virus can cause Meningitis and is most commonly due to mosquitoes?

Back 20

West Nile virus:
Summer/Fall,
mosquitoe-borne,
meningitis
and/or encephalitis.

Front 21

How does Meningitis most commonly occur with HSV?

Back 21

Reactivation!

Front 22

What are the effects of viral meningitis?

Back 22

Usually self-limited, with no residual effects upon recovery

usually less of a problem then bacterial and fungal!

Front 23

What are the symptoms of viral meningitis?

Back 23

Patients present with fever, chills, headache, stiff neck, nausea and vomiting, photophobia. May be signs of mental dysfunction

Front 24

EXAM****

Most meningitis is viral but what do you do if you suspect meningitis?

Back 24

May be concurrent with or follow URT infection.
Must differentiate from bacterial! Regardless, start antibacterial therapy immediately*******EXAM

Front 25

What viruses are the 2 most common to cause meningitis?

How do the viruses get access to the CNS?

How are you infected with the virus to cause meningitis?

Back 25

Coxsackie B and Echovirus most common.

Access to CNS via blood.

Initial infection often food-borne (GI, fecal-oral).

Front 26

Newborns, infants: can still easily differentiate from bacterial

Look at the CSF:

Back 26

Bacterial CSF:
200 to 100,000 WBCs
80-100% Neutrophils
<40% of serum glucose
100-500 Protein

Viral meningitis - CSF
25-1,000 WBCs
<50% Neurtophils
>40% of serum glucose
Protein: 50 to 100

Front 27

More ways to Dx:

Time of year/season. Enteroviruses, ARBO?

Back 27

late summer
early fall

Front 28

Time of year/season. HSV?

Back 28

year round

start acyclovir

Front 29

What are clinical symptoms of Meningitis due to viral causes?

Back 29

Clinical symptoms :
fever
nuchal rigidity
positive Kernig, Brudzinski signs
rubelliform or vesicular rash
possibly: confusion, delirium, coma

Front 30

What are Diagnostic tests you can do for viral meningitis?

Back 30

Negative bacterial culture.

Viral ELISA’s (IgM).

PCR’s for selected enteroviruses (~60) & HSV 1, 2, West Nile

Front 31

what do you again do to the CSF to Dx viral meningitis?

Back 31

Isolation/identification of virus (from CSF)

Front 32

What is the Tx for viral meningitis?

Back 32

Treatment: Supportive; IVIG; anti-herpetics (acyclovir)

Front 33

What is the most common hospital aquired fungus meningitis?

Back 33

Cryptococcosis - Cryptococcus neoformans

Front 34

What is a dangerous fungus that has just recently been seen in the US to cause meningitis?

Back 34

C. gattii (tropical)

Front 35

Where are most initial infections occur for fungal infections?

Back 35

lungs

Front 36

What are the pathological factors

Back 36

there are a couple...

Front 37

What is Negatively charged capsule for?

Back 37

inhibits phagocytosis

Front 38

What is excess production of capsular material for?

Back 38

inhibits chemotaxis

Front 39

What is Melanin production for?

Back 39

from conversion of brain catecholamines (e.g., DOPA, acts as a chemoattractant);

Also utilizes nitrogen from creatine, creatinine.

Front 40

What does melanin protect?

Back 40

melanin protects organism from oxidative compounds (free radicals) produced by macrophages.

Front 41

What is the host for Cryptococcus neoformans?

Back 41

Inhaled as a yeast:

From dried pigeon or blackbird droppings (nitrogen rich).

No person-person spread.

Does not cause disease in pigeon:

Front 42

Where do we see fungal infections most commonly?

Back 42

Primarily in immunocompromised, spread via blood to CNS

Front 43

How is Cryptococcus neoformans distributed?

Back 43

Worldwide distribution. In Western countries, incidence 10-15%,

in HIV patients. (Zimbabwe, 88% of HIV patients)

Front 44

What does Cryptococcus cause in a nl healthy person?

Back 44

Usually subacute pulmonary disease.

In normal, healthy person, lung infection is resolved, only revealed by x-ray

Front 45

What happens if a person does have Cryptococcus meningitis?

Back 45

Meningitis, meningoencephalitis.

Fatal if untreated. Cutaneous and mucocutaneous spread also occurs

Front 46

MRI/Meningitis often nedgative

Back 46

Brain biopsy rarely done

SKin lesion not distinctive

Front 47

Crystococcoma rare and fatal

Back 47

Traditional stain done to Dx Crytociccus?

EXAM**** and COMLEX****

Traditional:
India Ink Stain (of CSF)

Front 48

What are the newer tests we have to look for crytococcus?

Back 48

CRYPTOCOCCUS ANTIGEN (Capsular Polysaccharide)
TEST - antibody-coated latex particles.
99% sensitivity with CSF, 86% w/serum.

Front 49

What is the treatment for Cryptococcus?

Back 49

Treatment:
Amphotericin B (plus flucytosine)*******,

fluconazole, itraconazole