Exam 4.docx - Exam 4 Nervous System Infections CNS CSF blood brain barrier Abscess Encephalitis Meningitis PNS Meningitis Hemophilus infuenzae

Exam 4.docx - Exam 4 Nervous System Infections CNS CSF...

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Exam 4 Nervous System Infections 10/21/2013 CNS CSF: blood brain barrier Abscess Encephalitis Meningitis PNS Meningitis Hemophilus infuenzae b (Hib) (preschool) C: gram- coccobacillus S: adult triad: fever, stiff neck, neurological signs (headache, photophobia, nausea and vomiting) P: Antiphagocytic (polyribosylribitol phosphate) PRP capsure, serotype b D: CSF: cloudy, culture-ID, serology; culture requires X (hemin), V (NAD) chocolate agar is required T: Ceph 3 rd until antibiotic susceptibility test (AST), then switch antibiotics (ampicillin). Materinal IgG lasts for 3m. HipTITIER (2,4,6m) is a PRP conjugate with diphtheria toxoid E: URT: 1-4% child carriers: #2 cause worldwide; in U.S. 1.3/100,000 sincle 1990; 6% will be fatal; 20% permanent hearing loss or other long-term sequalae Meningococcal Meningitis Neisseria meningitidis (teen) C: gram- diplococcus S: adult triad, rash, permanent neurological damage, disseminated intravascular coagulation (DIC); high mortality even if treated P: polysaccharide capsule, pili. 5 serotypes; IgA1 protease cleaves IgA1 into Fab and Fc. D: CSF: cloudy, culture-ID, serology T: 3 rd generation cephalosporin; prophylactic antibiotics (rifampin or ciprofloxacin) & vaccines for epidemics; polyvalent capsular vaccine (A,C,Y,W135) for high risk groups ages 11-55 (Menactra) E: URT (airborn): institutional carriers; #1 worldwide; WVU May 2005, November 2006- January 2007, Spring 2009, Fall 2009, Fall 2010 Meningitis Streptococcus pneumonia C: gram+ diplococcus, big capsule S: adult triad, otitis media P: 85 SSS (Specific Soluble Substance) capsule serotypes D: CSF: cloudy, culture, a-hemolytic, sensitive to optochin, Quellung test T: chephalosporins; even so, mortality 30%; Pneumovax for 2y and up is polyvalent 23 SSS capsular vaccine E: URT; carriers; #1 USA; mortality about 30% Viral Meningitis Meningoencephalitis Enterovirus: 40% Mumps Virus: 15% Misc. Virus: 30% ^^^Low mortality; no specific therapy Polyomavirus HSV-1 ^^^ High mortality 1
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Exam 4 Cryptococcal Meningitis Cryptococcus neoformans C: yeast with budding capsule S: chronic meningitis P: capsule is virulence factor D: encapsulated yeast found in CSF with India Ink stain or ELISA, latex aggulutination test for antigen T: amphotericin B + fluconazole for weeks/months E: via respiratory route from bird feces; not communicable 10/25/2013 Rabies/Rabies Virus C: ss(-) RNA, large bullet shaped virus S: salivation, hydrophobia, 100% mortality P: wound incubation PNS CNS Brain D: fluorescent AB test of biopsy of nape of neck, Negri bodies (inclusions in animal brain, RT- PCR in saliva) T: post-exposure RIG (y-globulin), and HDCV (human diploid cell vaccine), 4-6 inj. IM (1 dose of RIG and 5 doses HCDB (0,3,7,14 and 28 days); treatment should begin within 2 days of bite/exposure T: preexposure HDCV, 3 IM (0,7 and 21 days) for high risk E: zoonoses for all mammals; inhalation by spelunkers, corneal grafts; 2009: 6690 cases reported (40% raccoons, 6.8% domestic), highest incidence in summer E:
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