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Chronic Meningitis
| Question | Answer |
|---|---|
| Chronic meningitis is defined as ? | * meningeal inflammation that persists for more than 4 weeks |
| At most risk = ? | * immunocompromised patients (T-Cell deficit is key to this ) |
| Clues = ? | * travel to certain areas, HIV positive, preparing for a transplant to reduce his immune system, etc. |
| How to Dx = ? | * CSF analysis (atlest 10 - 20 mL to catch anything) , Gram Staining |
| Tuberculous Meningitis basics = ? | * Rod organisms that need to use Acid fast stain to get a positive (Ziehl Neelsen) ( Stain with carbol fuchsin ).... * VERY SLOW incubation/grower |
| TB epidemiology = ? | * 1/3 of pop. is effected and usu 1/2 are of foreign ppl |
| How TB survives = ? | * inhaled and ingested by Macros in the lungs, where it avoids destruction... * Granulomas = from Th cells walling off TB |
| TB CxSx = ? | * chronic cough, fatigue, weight loss, high temp., SOB w/chest pain, see Delayed type hypersensitivity reaction |
| Tuberculous Meningitis basics = ? | * From TB infection ... * rupture in subarachnoid space causing meningitis... * Cerebral vasculitis causes infarction or hemorrhage... * can see hydrocephalus and CN 6 impingement... * Tuberculomas may develop in advanced cases |
| Early and Late signs = ? | * Early = stiff neck, h/a, n/v.... * Late = alterations in consciousness, coma, seizures, Nerve issues |
| Lab Dx = ? | * Acid Fast CSF stain (need 10-20 ml) , PCR , or Imaging |
| Neurosyphilis basics = ? | * Most chronic, insideous meningeal inflammatory process known... * from trp. pallidum (2ndary Syphilis) ... * see an increase due to AIDs |
| Neurosyphilis, and how we get it today ? | * usu from HIV ppl, male to male sex |
| Early Neurosyphilis = ? | * CSF is invaded (+ VDRL) , Invasion of the meninges (stiff neck), and Meningovascular syphilis (arteritis of vessels in subarach. space) |
| Late Neurosyphilis = ? | * Tabes dorsalis – charaterized by demyelination of the nerves in dorsal columns of spinal cord... * loss of coordination and paralysis |
| Neurosyphilis Dx = ? | * Cx suspicion of HIV pt.... * CSF VDRL and FTA + test |
| TmT = ? | * Pen. G |
| Lyme Neurologic Disease = ? | * Caused by spirochete Borrelia burgdorferi, by lxodes ticks... * see multiple erythema migrans... * high prev. in NorthEast |
| Tmt = ? | * Doxycycline or Ceftriaxone |
| Post Lyme Disease Syndrome = ? | * Persistent musculoskeletal pain, cognitive problems, and fatigue.... * Weird thing is that pts. DO NOT have a chronic Bor. Burg. infection |
| Viral Causes of Meningitis/Encephalitis = ? | * HIV, CMV, EBV, HSV I and II (Mollaret’s syndrome – recurrent meningitis), and VZV |
| Dx of Viral Meningitis = ? | * Polymerase Chain Reaction (PCR) has been especially useful |
| (Fungal Meningitis) Cryptococcal Meningoencephalitis = ? | * Generally an infection of immunocompromised but can cause clinical disease in healthy people... * Cryptococcus neoformans... * get due to inhalation |
| Cryptococcus Epidemiology = ? | * C. neoformans associated with bird droppings (pigeons and chickens) ... * C. gatti associated with eucalyptus trees.... * See highly in Immunocomp. pts... * All usu cause CNS issues |
| Virulence of Cryptococcus = ? | * negatively charged capsule that causes resistance to chemotaxis and phagocytosis... * Melanin protects organism from oxidative killing by macrophages |
| CxSx = ? | * h/a, lethargy, personality change, mem. loss |
| Lab Diagnosis for Crypto. = ? | * India ink staining or Cryptococcal antigen test |
| Crypto. Tmt = ? | * Amphotericin B (plus flucytosine) |
| Coccidioidal Meningitis basics = ? | * Coccidioides immitis .... * See in Southwestern US.... *get from inhalation, and from spores (rain may assist in this) |
| How we actually get Coccidioidal Meningitis ? | * we inhale an arthrospore, a sphereule develops, and releases endospores |
| Coccidioidal CxSx = ? | * Persistence of headache -- Progressive worsening of headache -- Unusual severity of the headache -- Associated nausea and vomiting -- Blurring of vision -- Changes in mental status |
| Coccidioidal Lab Dx = ? | * Cerebrospinal fluid (CSF) or CT or MRI – hydrocephalus most common finding |
| Tmt = ? | * Fluconazole - or - Itraconazole - or - Amphotericin B (intrathecal) |
| Histoplasmosis basics = ? | * By Histoplasma capsulata... * Thermal dimorphic = Body temp (37oC) a yeast or at Room temp (25oC) mycelial with macroconidia.... * See Mississippi, Ohio, and St. Lawrence River valleys ... * in bird or bat poop... * usu asymptomatic |
| Histo. Brain imaging = ? | * see little white dots all over |
| Histo. Tmt = ? | * Amphotericin B or Fluconazole |
| The 2 Chronic Parasitic CNS Infections = ? | * Toxoplasma gondii and Taenia solium |
| Toxoplasmosis basics = ? | * get from Toxoplasma gondii (Cats or from Meats in Greece/S.Africa) .... * Nothing is immunocompetent ppl.... * Severe infections in immunocompetent (AIDS), pregnant females (congenital infections) |
| How we get Toxo. = ? | * Cat = oocyst….... * Pig/Cattle = sporulated oocyst ... * go to major organs = eye, heart, brain |
| Toxo. Life Cycle = ? | * They develop into tachyzoites..... * Eventually tachyzoites localize to muscle tissues and the CNS where they convert to tissue cysts, or bradyzoites |
| Diagnosis of Toxoplasma encephalitis = ? | * CSF or Imaging with MRI or CT for ring-enhancing lesions |
| Toxo. TmT = ? | * Pyrimethamine + sulfadiazine + Leucovorin ..... * Trimethoprim-sulfamethoxazole ..... * Pyrimethamine + azithromycin |
| Cysticercosis basics = ? | * Neurocysticercosis is most severe form of disease .... * From the Pork tapeworm Taneia Solium (has a scolex and 4 hooks that attach to the intestines) .... * Major cause of adult onset seizures in most low-income countries |
| Cysticercosis Epidemiology = ? | * Leading cause of epilepsy worldwide ..... * endemic in Central and South America and is 100% preventable disease |
| Patho. = ? | * Evade destruction and develop host immune tolerance ..... * Metacestodes elaborate taeniaestatin (a serine proteinase inhibitor), paramyosin, sulfated polysaccharides, and secretory proteases, that inhibit inflammatory responses |
| CxSx = ? | * Depend upon where cysts are localized in brain ..... * Cysticerci that lodge in the subarachnoid space lead to chronic arachoiditis which may result in hydrocephalus, meningitis, stroke, and vasculitis |
| Dx and TmT = ? | * Based on clinical presentation and Imaging with CT or MRI for cystic or calcified lesions ...... * TmT = Antiepileptics – phenytoin or carbamazepine or Antiparasitics – albendazole is preferred over praziquantel |
Created by:
thamrick800
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