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Chronic Meningitis

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