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Unformatted text preview: Lecture 21 - CNS Viral I nfections including Rabies and Arboviruses M I-44a. Describe the clinical syndromes associated with CNS viral infection. Three often overlapping syndromes Aseptic meningitis : usually a benign syndrome characterized by headache, stiff neck, fever and CSF changes of pleocytosis with lymphocytic predominance (usually), increased protein, normal sugar (usually) and negative bacterial cultures. Encephalitis : Instead of or in addition to meningitis, there is involvement in the parenchyma of the brain . This can result in depressed consciousness , seizures , focal neurologic signs, increased intracranial pressure. Poliomyelitis : (polio=gray, myel=spinal cord): acute inflammation of the gray matter acute febrile illness usually with meningitis with the additional presentation of flaccid paralysis without objective evidence of a sensory defect or cortical damage. Different virus are likely to cause one of the three acute syndrome (but there is no gaurantee in any patients) Enteroviruses & Mumps -- aseptic meningitis (except polio) Polio - Poliomyelitis Herpes simplex virus - encephalitis Subacute and Chronic Viral Infection of the CNS HIV encephalopathy o most prevalent o most H IV patient has H IV in their CNS Subacute sclerosing pan-encephalitis (SSPE): rare complication of measles o disappearing with measles immunization Progressive multifocal leukoencephalopathy (PML): o subacute focal complication of polyomavirus (JC) o 2/3 of us have JC in our brain immunosuppression result in reaction of CNS disease Cytomegalovirus polyradicalopathy and ventriculitis HTLV-1: TSP/HAM (tropical spastic paraparesis/HTLV-associated myelopathy) Chronic enteroviral meningitis Subacute spongiform encephalopathies o i.e. Mad Cow (not discussed) Post-infectious Viral Syndromes of the CNS probably immunological immediated Post-infectious encephalitis: perhaps 1:1000 cases of measles; vaccinia, others Reye syndrome: o non-inflammatory metabolic (mitochondrial) disease of liver and brain: o follows influenza A and B, varicella, adeno, others o ASA for fever in youngsters Guillian-Barre syndrome: o an acute inflammatory demyelinating polyneuropathy often following one of many antecedent viral (and non-viral) illnesses Post-poliomyelitis neuromuscular syndrome o late complications of polio skin lesions Aseptic meningitis (Aseptic you cant grow in a day or two) - Patient present with it and you wont find the bacteria if its viral - You have to be aware of the bacterial that causes it- The fungi that causes it- The drug toxicity M I-44b. Describe the pathogenesis of CNS viral infections....
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This note was uploaded on 09/14/2011 for the course PHARM mb taught by Professor Staff during the Spring '11 term at UCSD.
- Spring '11