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42 Cards in this Set
- Front
- Back
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What is aseptic meningitis?
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Any non-bacterial meningitis or inflammation of the meninges (normally means viral meningitis). There is often some involvement of the brain (encephalitis) as well
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What is encephalitis?
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Inflammation of the brain. Often, there is also inflammation of the meninges, but it is predominantly the brain
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Which enteroviruses cause meningoencephalitis?
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Coxsachie virus
Echovirus Poliovirus |
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Are the enteroviruses that cause meningoencephalitis acid-resistant or acid-sensitive?
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Acid-resistant
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Who is generally infected with enteroviral meningoencephalitis?
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Healthy kids
Rare cases of immunoglobulin deficiency |
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Describe the disease process of enteroviral meningoencephalitis.
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Entry into the host - generally from ingestion (fecal-oral spread)
Replication in GI tract Spread to blood - viremia Spread to the CNS |
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When do symptoms generally first appear?
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Often not until the virus gets to the CNS
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What are the non-specific and specific symptoms of viral meningitis? (7)
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Sudden onset of symptoms
NS: fever, malaise, anorexia S: headache, neck pain, photophobia |
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What are the non-specific and specific signs of viral meningitis?
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NS: fever
S: photophobia, nuchal rigidity, lethargic, confused |
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Which diagnostic tests are helpful and which are not?
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Most important: lumbar puncture
Helpful: PCR of CSF, perhaps serology (acute and convalescent antibody) Not helpful: CT/MRI (only useful for ruling other diseases out), culture |
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What are the typical findings from a lumbar puncture for viral meningitis?
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Opening pressure: normal
WBC: 50-300 (high, less than bacterial) RBC: 0 Protein: 50-100 (high) Glucose: normal (very helpful distinguishing factor from bacteria) |
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How do you treat viral meningitis?
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Supportive only
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What is the typical outcome?
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Person normally recovers on their own
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How do you prevent this?
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Hand washing
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What are the differences between viral and bacterial meningitis?
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Viral is less acute and is a less dramatic illness
Different CSF findings (cells, protein, glucose) |
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Which arboviruses cause meningoencephalitis? (6)
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Eastern equine
Western equine St. Louis LaCrosse West Nile Japanese B |
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Who is the typical host?
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Healthy kids and adults
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How long is the incubation for arboviral meningoencephalitis?
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3-14 days
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Do arboviruses more often cause meningitis or encephalitis?
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Encephalitis
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What is the typical reservoir for arboviruses?
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Birds
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How could arboviruses be spread from human-to-human? (4)
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Blood donation
Organ donation Placental Breast milk |
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What are the specific symptoms for viral encephalitis? (5)
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Sudden onset
headache confused (according to family) personality change seizures |
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What are the specific signs of viral encephalitis?
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Mental status changes (MSC)
seizing - this definitely points to the brain |
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What syndrome is associated only with west nile virus?
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Poliomyelitis syndrome, which is marked by acute flaccid paralysis
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How do you diagnose viral encephalitis?
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Lumbar puncture: similar results to viral meningitis
Serology: important for WNV - look for IgM to WNV in CSF CT/MRI: not useful early on and not specific Culture: rarely helpful PCR: would work, but would need to take brain biopsy, so it is not done |
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What is the treatment for viral encephalitis?
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Supportive only
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Which virus has the worst outcome for viral encephalitis?
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Eastern equine encephalitis
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What is the most comon non-epidemic cause of encephalitis in the US?
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Herpes
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Who generally gets herpes encephalitis?
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Healthy adults
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What is the pathogenesis of herpes encephalitis?
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Reactivation of latent virus - probably from trigeminal ganglion
Reason for reactivation is unknown Retrograde spread into CNS, especially to the temporal lobes Direct neuronal death with extensive necrosis |
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What are the differences between herpes encephalitis and other encephalitides?
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It is necrotizing and targets the temporal lobes
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How do you diagnose herpes encephalitis?
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Lumbar puncture: same as the rest, perhaps some RBC
CT/MRI: helpful after a few days to show temporal lobe focus Serology: no benefit, most people have antibodies PCR for herpes in CSF: Gold Standard |
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How do you treat herpes encephalitis?
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Acyclovir IV
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What is the outcome of herpes encephalitis?
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Depends on how quickly the diagnosis is made
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What is the incubation period for rabies?
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Weeks to months
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What is the pathogenesis of the rabies virus?
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Inoculated with a bite
Multiplies locally in the muscle Moves proximally along axon into the CNS (NOT THROUGH BLOOD) Multiplies in neurons and causes cell death with minimal host response Moves back out along autonomic nerves from CNS to salivary glands, cornea, and skin |
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What is the most common way to acquire rabies in the US? In the world?
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US - bats
World - feral dogs |
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What are specific symptoms for rabies? (6)
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Headache
Fever Parasthesia Pain MSC Seizures |
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What are specific signs for rabies? (8)
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Fever
Tremors Gait problems (if bite was in the leg) seizures obtunded (less than full mental capacity) hypersalivation can't swallow hydrophobia |
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How do you diagnose rabies?
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Biopsy the neck or cornea and identify virus by PCR - best test
Brain biopsy (Negri bodies) Serology: helpful but slow CSF: normal but PCR for rabies is helpful |
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How do you treat rabies?
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None, but there is prevention
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How do you prevent rabies after exposure but before symptoms?
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Passive vaccine that contains immunoglobulin that can protect you before the virus starts traveling to your CNS
You also administer a vaccination so that the person can develop their own antibodies |
