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Micro. Semi. CNS


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Micro. Semi. CNS


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Cecylia Ambroży


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How dose a normal CSF and a CSF in meningitis look like
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normal - clear, colourless meningitis - milky, containing bacteria and neutrophils

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How dose a normal CSF and a CSF in meningitis look like
Normal - clear, colourless meningitis - milky, containing bacteria and neutrophils
How dose a normal CSF and a CSF in meningitis look like
Normal - clear, colourless meningitis - milky, containing bacteria and neutrophils
How dose a normal CSF and a CSF in meningitis look like
Normal - clear, colourless meningitis - milky, containing bacteria and neutrophils
How dose a normal CSF and a CSF in meningitis look like
Normal - clear, colourless meningitis - milky, containing bacteria and neutrophils
List bacteria that can cross blood-brain barrier transcellularily
Staphylococcus pneumoniae haemophilus influenzae neisseria meningitidis escherichia coli K1
Which bacteria use the trojan horse mechanism within white blood cells....
Mycobacterium tubuerculosis Listeria monocytogenes Epstein Barr virus Cytomegalovirus
List spieces that cause bacterial meningitis in neonates
Escherichia coli Group B streptococcus (Staphylococcus agalactiae) Listeria monocytogenes
List spieces that cause bacterial meningitis in young adults 15-35 years
Viruses Neisseria meningitidis Streptococcus pneumoniae
List the spiecies that cause bacterial meningitis in older people
Streptococcus pneumoniae Listeria monocytogenes gram negative bacteria Neisseria meningitidis Haemophilus influenzae
What is a prion and why is it important in brain infections
Prion - misfolded proteins with the ability to transmit their misfolded shape onto normal variants of the same protein. They characterize several fatal and transmissible neurodegenerative diseases.
What encephalopathys are caused by prions
Creutzfeldt-Jakob disease variant Creutzfeldt-Jakob disease Kuru
What are the CSF findings in bacterial meningitis
Low glucose raised protein polymorphs raised
What is septicaemia
Septicaemia is when bacteria enter the bloodstream, and cause blood poisoning which triggers sepsis.
Which spiecies can cause viral meningitis
Enterovirus mumps herpes simplex arboviruses
What are the CSF findings in viral meningitis
Glucose normal protein raised lyphocytosis raised
Which spiecies cause viral encephalitis
Herpes simplex arboviruses mumps measles
Which spieces cause brain abscesses
Anaerobic streptococcus bacteroides staphylococci gram negatives
How to store CSF collected from lumbar puncture
- delivery to th elab ASAP - temp. not lower than 30C - never refrigerate - if inoculated in media, then 37C - if incubation then 37C 5-10 porcent of CO2 24h
What can we do with the pellet and the supernatant after centrifugation of CSF
Pellet -gram staining -methylene blue staining -Ziehl Neelsen staining supernatant -latex test -PCR
List constitiuents of CSF, group them in those that are lower and higher than in blood plasma
LOWER -proteins -glucose -phosphorous -bicarbonate -potassium -sulfate -cholesterol -enzymes HIGHER -sodium -cholride
What is meningism
Group of symptoms and signs that accompany meningitis
How dose a normal CSF and a CSF in meningitis look like
Normal - clear, colourless meningitis - milky, containing bacteria and neutrophils
List spiecies that cause meningitis in infants and children up to 2 years
Group B streptococcus (streptococcus agalactiae) neisseria meningitidis haemophilus influenzae
List spieces that cause meningitis in children from 2-15 years
Viruses - coxackie A, coxackie B, Echo, Herpes, mumps virus haemophilus influenzae neisseria meningitidis streptococcus pneumoniae
List spiecies that cause meningitidis in adults older than 35 years
Streptococcus pneumoniae Neisseria meningitidis
What kind of diagnostics can you performe to diagnose meningitis
- CSF compositioin and colour - micrsocopy - culture - blood culture - nasopharyngeal swab - aspirate of purpuric spot from the skin - serology - PCR (blood and CSF)
How may you accuire meningitis...
Adult (neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae) - inhalation of respiratory droplets babies (Streptococcus agalactiae) - during passage through infected birth canal
In most cases bacteria spread to the meninges from...
Lungs sinusitis otitis media bacteremia
What is the leading cause of bacterial meningitis?
Streptococcus pneumoniae Neisseria meningitidis
List the preventive mesures for bacterial meningitis
-vaccination of children agains Streptococcus pneumoniae, Haemophilus influenzae type B, Neisseria meningitidis -penicillin to child whose mother is colonized with Streptococcus agalactiae -treatment of infected pregnant mothers with penicilin (ampicillin or vancomycin) to prevent spread of Streptococcus agalactiae -meningococcal vaccine for college freshmen and military recruits -people in contact with infected people should take rifampin, tetracyclines or sulfonamides - people at risk of listeriosis should avoid soft cheeses, unpasteurized milk etc
What can listeria monocytogenes cause?
Listeriosis, human-human transmission like mother-child can cause meningitis
Aseptic meningitis
- caused by viruses - no bacteria in CNS - milder than bacterial meningitis - similar symptoms as bacterial meningitis
90% of viral meningitis is caused by...
Enteroviruses HSV mumps virus coxackie A virus coxackie B virus echoviruses poliovirus
How dose enterovirus spread?
Person-person fecal-oral respiratory secretions (only coxackie or enteroviruses)
How to diagnose viral meningitis?
Symptoms no bacteria in CSF
What is the treatment of viral meningitis?
Acyclovir gancyclovir (for HSV)
Encephalitis is caused by...
VIRUSES HSV (mostly) arboviruses (st.Louis virus, western equine virus, eastern equine virus, west nile virus) rabies virus
What is the pathogenesis of viruses causing encephalitis?
HSV - acute diffuse encephalitis Arboviruses - neuronal infection Rabies virus - peripheral nerves invasion
Brain abscesses can be caused by...
Parameningal suppuration foreign bodies haematogenous from distant sepsis
What aerobes and anaerobes can be found in brain abscesses?
Aerobes: staphylococcus aureus, staphylococci, streptococci, gram negative rods (enterobacteriacae) anaerobes: bacteroides, fusobacterium
What are the clinical features of brain abscesses?
Headache fever reduced consciousness neurological signs increased intracranlial pressure
How to diagnose brain abscesse?
CT scan culture from pus normal or low glucose in CSF high WBC in CSF
Poliomyelitis
Affects children fecal-oral route person-person can cause paralysis NO CURE (only vaccine)
Symptoms of poliomyelitis
Fever fatigue neck stifness pain in limbs vomiting headche
How to diagnose polio?
Virus present in throat or feces Chronic fatigue syndrome cell culture techniques
Treatment of polio
Pleconaril popocavir
Is rabies endemic?
Yes (not antarctica and hawaii)
Rabies treatment
Wash wound with soap and water as fast as possible begin post exposure prophylaxis (one dose of human rabies immune globulin, four doses of rabies vaccine over 1 month )
Rabies diagnosis
Cell culture and virus isolation immunodiagnostic procedures observation of negri bodies in animal brain
Tetanus is cause by...
Ingestion of exotoxin from clostridium tetani (spores get into tussue and tetanospasmin is produced)
Diagnosis of tetanus
Muscle spasms in guinea pigs that where injected with scrapings from the wound
Fungal CNSI, give examples of diseases with the spiecies
Chronic meningitis vasculitis (mucor, aspergillus) brain parenchyma invasion (cryptococcus, candida)
What is mycosis?
Infection cause by a fungus
What is the treatment for fungal CNSI?
Fluconazole and voriconazole against aspergillus amphoericin B against candida and cryptococcus
List some of the degenerative CNS diseases and their etiological factors
SSPE (subacute sclerosing panencephalitis) - measles virus PML (progressive multifocal leukoencephalopathy) - human plyoma virus 2 Kuru disease - prions Crteutzfeldt Jacob disease - prions
Variant creutzfeldt jakob disease
- encephalopathy - brain tissue destroyed - death in 12 months - caused by prions
Diagnosis Variant creutzfeldt jakob disease
Lab tests on samples from CNS to confirm presence of prions
What sample is need in diagnosis of meningococcal CNSI?
Pharyngeal swab from the person and all its relatives
Meningitis in newborns
Escherichia coli K1 Group B streptococci (Streptococcus agalctiae) Listeria monocytogenes Klebsiella pneumoniae
Meningitis in infants and little children
Group B streptococci (Streptococcus agalactiae) Neisseria meningitidis Haemophilus influenzae Streptococcus pneumoniae
Meningitis in children, teenagers and young adults
Viruses (Coxackie A & B, Echoviruses, Herpes viruses, mumps virus) Neisseria meningitidis Streptococcus pneumoniae
Meningitis in elderly people
Streptococcus pneumoniae Listeria monocytogenes Enterobacteriaceae Pseudomonas aeruginosa Acinetobacter baumannii
"Culture negative" meningitis (without paracites)
Mycobacterium tuberculosis Candida albicans Cryptococcus neoformans Aspergillus Mucor Treponema pallidum Borrelia burgdorferi Leptospira interrogans Rickettsia rickettsiae Rickettsia prowazeki Coxiella burnetii Chlamydia psittaci Mycoplasma pneumoniae
"Culture negative" meningitis (only paracites)
Toxoplasma gondii Plasmodium falciparum Naegleria fowlerii
Nosocomial meningitis
Staphylococcus aureus Staphylococcus epidermidis Gram-negative rods (Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter baumannii) Enterococcus spp. Candida spp
What are the basic specimens for bacteriological diagnostics in CNS infection?
Cerebrospinal fluid Blood (in 50-70% meningitis cases pathogen can be isolated from blood)
What are the additional specimens (depending on the case) for CNS infection
Skin rash scrapings (for Neisseria meningitidis )  Materials from a primal focus of infection (ear swab, sputum, urine, wound swab)  Nasopharyngeal swab (for carriage detection)  Swab of vagina (for colonization detection)
How do we collect CSF?
Cerebrospinal fluid is collected aseptically from lumbar puncture. After proper antiseptic treatment of skin in lumbar area, the CSF sample is collected to sterile tubes preheated to 37°C. One part of CSF should be sent for direct microscopy. CSF should be sent immediately to the lab (in time no longer than 15 min in 37°C). In case of prolongation of transport (in 2h) temperature 37°C should be kept and never lowered under 30°C. For bacteriological culture, CSF should be also additionally added to a transport medium (preheated to 37°C) and sent in 37°C.