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33 Cards in this Set
- Front
- Back
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Which virus that causes a CNS infection will result in RBCs in the CSF?
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Herpes simplex virus
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What are some symptoms associated with encephalitis?
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Being unable to speak
Not being oriented to place |
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What are some symptoms associated with meningitis?
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Stiff neck
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What is the typical epidemiology of WNV infection in the US?
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WNV is usually seen in the late summer, early fall. It is carried in a mosquito vector and its reservoir is birds (esp. crows and blue jays). Humans and horses are incidental hosts.
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Who are the usual human hosts that develop CNS infections?
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Age is the most important factor when determining if someone will get a CNS infection. As your age increases you are at increased risk. People over 50 are at increased risk. Immunocompromised people are also at increased risk.
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If you are bitten by a mosquito carrying WNV are you immediately infected and have to worry about CNS infection?
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No, a very small percentage of people bitten by an infected mosquito will develop CNS infection.
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What is the normal response of a young, healthy individual infected with WNV?
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They usually have a fever for a few days, malaise, muscle aches, flu-like symptoms, rash, headache, backache, arthralgia, prolonged fatigure, etc... This is a self-limited disease though and will go away.
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What are some other ways besides a mosquito bite that WNV can be transmitted?
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Tranfusions
Organ transplants Breast feeding Transplacentally Needle Sharing |
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Can symptoms tell you that you the specific virus that is causing the encephalitis?
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NO
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If you suspect a young individual has West Nile Virus due to only flu-like symptoms should you send in a test to confirm your diagnosis?
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NO, labs will not do tests for WNV without the patient having CNS effects.
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How can you make the diagnosis of WNV encephalitis?
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PCR can be used (not in MI). IgM capture using an EIA on CSF or serology looking for single IgM in the serum against WNV can be used to diagnose it.
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What are the symptoms of poliomyelitis and what virus causes this?
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Poliomyelitis is when you have asymmetric flaccid paralysis without any sensory loss. It is caused by WNV attacking the anterior horn cells. This usually occurs in younger patients and can be temporary or have residual effects.
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What is the treatment for WNV encephalitis?
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Supportive treatment- ventilation, fluid balance, electrolytes, nutrition, maintain ICP
Antibodies are useless |
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What are 2 great symptomatic clues that can point you towards a diagnosis of rabies?
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Tingling progressing up an extremity and difficulty swallowing.
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What is an arboviral panel?
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It is a test that allows you to test for all the arboviruses at once.
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What should be done to diagnose rabies?
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Lumbar puncture and PCR on the CSF
Biopsy of neck or cornea and PCR or DFA on it PCR of the saliva Biopsy of the brain and looking for negri bodies Imaging- NOT USEFUL |
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Should you do an antibody test to diagnose rabies?
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No, the virus is not in the bloodstream and antibodies do not develop until really late in the infection.
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What are negri bodies?
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Rabies viral inclusions in the cytoplasm of neurons.
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What is the most likely exposure to rabies in the US? Other sources?
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BATS
Raccoons and mongoose can also transmit rabies |
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If a patient is bitten by an animal that they suspect has rabies is your only option to post-exposure prophylaxis them?
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No, if you have the animal you can send its brain in to get checked to see if the animal has rabies
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Does everyone who comes in with rabies live around animals or remember being bitten by an animal?
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No
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What are the 5 principle reservoirs of rabies in the US?
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Bats, skunks, raccoons, foxes and wolves (Sylvatic cycle)
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What is the principal reservoir of rabies in developing countries?
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Ferral dogs (urban cycle)
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Do animals show symptoms of rabies?
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YES
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What determines whether a patient infected with rabies can be treated and survives?
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It depends on the time between inoculation and post-exposure prophylaxis. Once you present with rabies symtpoms you are almost guaranteed to die.
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What is a random treatment used on the girl in Minnesota with rabies that saved her life?
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IV ribovirin and induced coma
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Is there a risk to healthcare workers caring for a patient with rabies?
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Yes, the patients saliva is infectious. Often the diagnosis of rabies takes some time so many healthcare workers are exposed. They all receive post-exposure prophylaxis.
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What do you do it someone shows up the ER after being bitten by a pet dog?
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You wait quarantine the dog for 10 days to see if they show signs of rabies. You also check to see if the dog has had their rabies vaccine. Finally you consider the events that lead up the bite (provoked or unprovoked). This is a low risk situation in the US and you do not need to start prophylaxis right away.
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What do you do if a patient shows up in the ER after being bitten by a raccoon?
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You give then prophylaxis right away. The status of the animal is unknown, you are dealing with a wild animal that has not been vaccinated, etc... You would inject the bite site with rabies immunoglobulin (passive immunity) and give them 4 doses of the active vaccine (at days 0, 3, 7 and 14).
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When do you give pre-exposure prophylaxis?
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The pre-exposure prophylaxis is the active vaccine. This is given to high risk individuals. It lasts for a few years and then patients need booster vaccines. If people who have had the pre-exposure prophylaxis and they get exposed to rabies they should be give 2 doses of the booster vaccine (same with patients who have received post-exposure prophylaxis following a previous encounter with rabies).
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What type of bacteria is P. aeruginosa and where would you see it growing in a deep agar tube?
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P. aeruginosa is an aerobe. It would grow only at the top of a deep agar tube.
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What type of bacteria is S. aureus and where would you see it growing in a deep agar tube?
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S. aureus is a facultative bacteria that would undergo very little, if any, gas exchange. You would see it within the agar and at the top of the deep agar tube.
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What type of bacteria is C. sporgenes and where would you see it growing in a deep agar tube?
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C. sporgenes is an anaerobe. You would see the media within the deep agar tube with a space between it due to gas production. The bacteria would ONLY grow within the agar.
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