Term
| Name 3 ways in which viruses cross the blood brain barrier: |
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Definition
Growing across it
Being passively transported across it in intracellular vacuoles
Being carried across by WBCs |
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Term
| What is the receptor for measles? |
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Definition
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Term
| What is the receptor for polio? |
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Definition
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Term
| What is the receptor for HSV? |
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Definition
| Heparin sulfate, TNF receptor |
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Term
| What is the receptor for rabies? |
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Definition
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Term
| What is the receptor for HIV? |
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Definition
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Term
| What is hematogenous entry and what two types of viruses can do this? |
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Definition
Directly into blood stream
Arboviruses- mosquito injection
Rabies- from a bite |
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Term
| What is neural entry into the CNS, and what viruses do this? |
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Definition
Spread from distal neural structures to CNS-
Rabies, HSV, VZV
Travel up ganglia |
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Term
| What are the symptoms of frontal lobe abscess? |
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Definition
Frontal sinusitis
Headache
Memory defects
Attention loss
Diminished intelligence |
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Term
| What are the symptoms of temporal lobe encephalitis? |
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Definition
| Personality changes, visual field defects, hemiparesis (with large lesion), focal seizures |
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Term
| What are the symptoms of basilar meningitis? |
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Definition
Headache- suboccipital
Neck stiffness
Diplopia
Cranial Nerve palsy |
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Term
| What are 3 important aspects of the immune response to CNS pathogens? |
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Definition
-inflammation->edema->tissue death
-decreased capillary perfusion to brain
-neurological symptoms |
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Term
| What is the main class of enteroviruses, and how are they spread? |
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Definition
| Picornaviridae- SMALL RNA VIRUSES- fecal-oral transmission without symptoms of diarrhea |
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Term
| What changes do we see in CSF in bacterial infection? |
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Definition
Highly elevated PMNs
Protein above 100
Glucose less than 45 |
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Term
| What changes do we see in CSF in viral infection? |
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Definition
Presence of lymphocytes/monocytes
Protein 50-100
Normal Glucose (Esper said differently) |
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Term
| What are the classic symptoms of viral meningitis? |
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Definition
Fever, nuchal rigidity, photophobia, headache
-irritability, nausea/vomiting, rash, weakness x 18-36 hours |
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Term
| How long does viral meningitis usually take to clear? |
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Definition
| Self limiting withing 7-10 days |
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Term
| What virus causes Hand Foot and Mouth disease? |
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Definition
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Term
| What virus causes viral myocarditis? |
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Definition
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Term
| What class of virus is polio? Describe it? |
|
Definition
Enterovirus
+ stranded RNA, non-enveloped
Spread fecal-oral |
|
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Term
What viruses are estimated to cause >85% of all meningitis?
When are we more likely to see these cases? |
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Definition
Non-polio enteroviruses
Warmer months
Think coxsackie A and B |
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Term
| What are some symptoms associated with enterovirus meningitis (besides the main meningitis symptoms)? |
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Definition
| Pharyngitis, pleurodyna (pain in pleura), rash, pericarditis |
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Term
| Describe Arboviruses generally and what they cause: |
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Definition
Postive stranded enveloped RNA viruses
Mosquito vector borne
Cause ENCEPHALITIS (and sometimes meningitis) |
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Term
| What is the most common arbovirus in the US? |
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Definition
| Saint Louis Encephalitis (SLE) |
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Term
| What is the most common arbovirus worldwide? |
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Definition
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Term
| What is the most common clinical manifestation of arbovirus infection? |
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Definition
| Meningoencephalitis instead of pure aseptic meningitis |
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Term
| Why are seizures more common in arbovirus infection? |
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Definition
| Because they cause encephalitis too |
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Term
| Describe mumps and its most important permanent effect: |
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Definition
Mumps- negative stranded RNA virus- helical- ENVELOPED
Meningitis is a common complication
Causes Bilateral Parotitis (chipmunk cheeks)
CAN CAUSE STERILITY IN MALES (orchitis) |
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Term
| What virus is the leading cause of encephalitis? |
|
Definition
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Term
| Which herpes is responsible for genital infections and neonatal meningitis? |
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Definition
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Term
| Describe the structure of herpes viridae: |
|
Definition
| DNA virus; Icosahedral; ENVELOPED |
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Term
| When is VZV CNS infection most common? |
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Definition
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Term
| What drug should be given immediately upon suspicion of herpes viral infection? |
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Definition
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Term
| What are two ways in which viral encephalitis can be prevented? |
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Definition
Mosquito eradication
Sanitation |
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Term
| Your patient presents with obvious infectious lesions of the temporal lobes and obvious visible vesicular outbreak on their face. What is your best guess for the causative agent? |
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Definition
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Term
| Your patient presents with a rash and encephalitis. You notice the rash covers a distinctive/definable region. What is your best guess for the causative agent? |
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Definition
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|
Term
Your patient presents with a bite and neurological symptoms. What is your best guess for a causative agent?
You slay the offending animal and look at its brains. What do you find? |
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Definition
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|
Term
| When is a patient most likely to acquire herpes encephalitis? |
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Definition
|
|
Term
| Where does HSV-1 reactivate and where does it infect? |
|
Definition
Usually reactivation in the trigeminal ganglia
Infects temporal lobe |
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Term
| What characterizes an "intermediate" host? |
|
Definition
Lower viral titers, difficult to spread
A "dead end" for the virus |
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|
Term
Where on earth would you find arboviruses in their highest titre form?
(tricky question) |
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Definition
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|
Term
| What aspect of a patient history is super important in cases of encephalitis? |
|
Definition
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|
Term
| Describe the structure of the rabies virus: |
|
Definition
Negative stranded RNA virus
HELICAL, ENVELOPED
BULLET SHAPED |
|
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Term
|
Definition
| Acute, progressive, incurable and DEADLY encephalitis |
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|
Term
| What 4 animals most commonly transmit rabies in the US? Worldwide? |
|
Definition
Racoons, bats, foxes, skunks
Worldwide= dogs |
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|
Term
| How long is the incubation period for rabies? |
|
Definition
|
|
Term
| How does rabies travel in the CNS? |
|
Definition
|
|
Term
| Describe the path of travel of the rabies virus in an infected person: |
|
Definition
| From the brain, the virus returns to the periphery, to the salivary glands (which are highly innervated) |
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|
Term
| What are the symptoms of rabies? |
|
Definition
Fever, chills, headache, difficulty swallowing, HYDROPHOBIA
Hallucination, disorientation, paralysis, coma, death |
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|
Term
| Describe the prodrome of rabies: |
|
Definition
|
|
Term
| How does rabies eventually kill the patient? |
|
Definition
| Cardiac or respiratory arrest |
|
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Term
|
Definition
Perivascular cuffing
Skin biopsy, corneal impression, brain biopsy with PCR/IF
NEGRI BODIES |
|
|
Term
|
Definition
Clean the wound, VACCINATION (only time we vaccinate after exposure)
Half in the wound, half IM
Confirm if animal is rabid |
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|
Term
| Describe the structure of HIV: |
|
Definition
Positive stranded RNA RETROVIRUS
Enveloped |
|
|
Term
| Describe the course of HIV encephalitis |
|
Definition
Invades CNS shortly after initial infection- pleocytosis in CSF, mild meningitis like illness
Later subacute encephalitis with dementia |
|
|
Term
| Describe the pathology of HIV related dementia: |
|
Definition
Brain shrunken with enlarged ventricles
Vacuolization of myelin tracts
Virus infects the macrophages (microglia) in the CNS |
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|
Term
| What does mumps encephalitis usually follow? |
|
Definition
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|
Term
| What virus causes subacute sclerosing pan encephalitis (SSPE)? |
|
Definition
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|
Term
| What characterizes the pathology of subacute sclerosing pan encephalitis? |
|
Definition
| Progressive neurological deterioration due to brain inflammation and nerve cell death |
|
|
Term
| What are some symptoms of SSPE? |
|
Definition
| Behavior changes, intellect/memory issues, movement issues, gait problems, seizures, speech difficulty, dysphagia |
|
|
Term
|
Definition
POLIO- replication in neurons of gray matter of brain and spinal cord
FLACCID PARALYSIS without sensory loss |
|
|
Term
| What is affected in bulbar polio? |
|
Definition
| Respiratory muscles, medulla oblongata |
|
|
Term
| What are the two types of polio vaccine and which can revert to virulent strain? |
|
Definition
Salk- Killed
Sabin- Live- can revert
Not used in US anymore |
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Term
| What viruses that cause encephalitis can be revealed by a Tzanck test? |
|
Definition
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|
Term
| What virus causes Progressive Multifocal Leukoencephalopathy, and in what patient population? |
|
Definition
| JC Virus- immunocompromised patients |
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