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Chronic Meningitis

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Answer
Chronic meningitis is defined as ?   * meningeal inflammation that persists for more than 4 weeks  
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At most risk = ?   * immunocompromised patients (T-Cell deficit is key to this )  
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Clues = ?   * travel to certain areas, HIV positive, preparing for a transplant to reduce his immune system, etc.  
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How to Dx = ?   * CSF analysis (atlest 10 - 20 mL to catch anything) , Gram Staining  
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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  
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TB epidemiology = ?   * 1/3 of pop. is effected and usu 1/2 are of foreign ppl  
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How TB survives = ?   * inhaled and ingested by Macros in the lungs, where it avoids destruction... * Granulomas = from Th cells walling off TB  
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TB CxSx = ?   * chronic cough, fatigue, weight loss, high temp., SOB w/chest pain, see Delayed type hypersensitivity reaction  
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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  
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Early and Late signs = ?   * Early = stiff neck, h/a, n/v.... * Late = alterations in consciousness, coma, seizures, Nerve issues  
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Lab Dx = ?   * Acid Fast CSF stain (need 10-20 ml) , PCR , or Imaging  
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Neurosyphilis basics = ?   * Most chronic, insideous meningeal inflammatory process known... * from trp. pallidum (2ndary Syphilis) ... * see an increase due to AIDs  
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Neurosyphilis, and how we get it today ?   * usu from HIV ppl, male to male sex  
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Early Neurosyphilis = ?   * CSF is invaded (+ VDRL) , Invasion of the meninges (stiff neck), and Meningovascular syphilis (arteritis of vessels in subarach. space)  
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Late Neurosyphilis = ?   * Tabes dorsalis – charaterized by demyelination of the nerves in dorsal columns of spinal cord... * loss of coordination and paralysis  
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Neurosyphilis Dx = ?   * Cx suspicion of HIV pt.... * CSF VDRL and FTA + test  
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TmT = ?   * Pen. G  
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Lyme Neurologic Disease = ?   * Caused by spirochete Borrelia burgdorferi, by lxodes ticks... * see multiple erythema migrans... * high prev. in NorthEast  
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Tmt = ?   * Doxycycline or Ceftriaxone  
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Post Lyme Disease Syndrome = ?   * Persistent musculoskeletal pain, cognitive problems, and fatigue.... * Weird thing is that pts. DO NOT have a chronic Bor. Burg. infection  
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Viral Causes of Meningitis/Encephalitis = ?   * HIV, CMV, EBV, HSV I and II (Mollaret’s syndrome – recurrent meningitis), and VZV  
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Dx of Viral Meningitis = ?   * Polymerase Chain Reaction (PCR) has been especially useful  
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(Fungal Meningitis) Cryptococcal Meningoencephalitis = ?   * Generally an infection of immunocompromised but can cause clinical disease in healthy people... * Cryptococcus neoformans... * get due to inhalation  
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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  
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Virulence of Cryptococcus = ?   * negatively charged capsule that causes resistance to chemotaxis and phagocytosis... * Melanin protects organism from oxidative killing by macrophages  
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CxSx = ?   * h/a, lethargy, personality change, mem. loss  
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Lab Diagnosis for Crypto. = ?   * India ink staining or Cryptococcal antigen test  
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Crypto. Tmt = ?   * Amphotericin B (plus flucytosine)  
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Coccidioidal Meningitis basics = ?   * Coccidioides immitis .... * See in Southwestern US.... *get from inhalation, and from spores (rain may assist in this)  
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How we actually get Coccidioidal Meningitis ?   * we inhale an arthrospore, a sphereule develops, and releases endospores  
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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  
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Coccidioidal Lab Dx = ?   * Cerebrospinal fluid (CSF) or CT or MRI – hydrocephalus most common finding  
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Tmt = ?   * Fluconazole - or - Itraconazole - or - Amphotericin B (intrathecal)  
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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  
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Histo. Brain imaging = ?   * see little white dots all over  
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Histo. Tmt = ?   * Amphotericin B or Fluconazole  
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The 2 Chronic Parasitic CNS Infections = ?   * Toxoplasma gondii and Taenia solium  
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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)  
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How we get Toxo. = ?   * Cat = oocyst….... * Pig/Cattle = sporulated oocyst ... * go to major organs = eye, heart, brain  
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Toxo. Life Cycle = ?   * They develop into tachyzoites..... * Eventually tachyzoites localize to muscle tissues and the CNS where they convert to tissue cysts, or bradyzoites  
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Diagnosis of Toxoplasma encephalitis = ?   * CSF or Imaging with MRI or CT for ring-enhancing lesions  
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Toxo. TmT = ?   * Pyrimethamine + sulfadiazine + Leucovorin ..... * Trimethoprim-sulfamethoxazole ..... * Pyrimethamine + azithromycin  
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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  
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Cysticercosis Epidemiology = ?   * Leading cause of epilepsy worldwide ..... * endemic in Central and South America and is 100% preventable disease  
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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  
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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  
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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  
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