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MCB 2010 22,24 Diseases of Nervous, Resp System

Nervous System Infections
Peripheral NS: botulism, tetanus, leprosy, polio, herpes simplex, varicella >>>> Central NS: meningitis, encephalitis, myelitis
C. botulinum
GPR, OA, endospores
C. botulinum toxin
AB exotoxin--neurotoxin. Blocks acetylcholine transmission in synapse
Botulism symptoms
FLACCID paralysis -- muscles do not contract, inhalation stops. Antitoxins from CDC bind the neurotoxin
C. tetani
GPR, OA, endospores, AB exotoxin neurotoxin tetanospasmin
Tetanus symptoms
SPASTIC paralysis, muscles contract and do not relax. Exhalation stops.
Opistho-tonos definition
extreme contraction
Tetanus vaccine contains
antibodies to bind toxin, stimulates formation of antibodies to neutralize any future toxin, booster every 10 yrs. 50% of population no antibodies
Mycobacterium leprae
GPR--acid fast. IDed in 1870
CNS portals of entry
Skull or vertebral fx: staph spp. >>> medical procedures: lumbar puncture, epideral >>> climbs along peripheral nerves: rabies, HSV >>> via cribriform foramina: amoebas >>> via sinuses >>> Hemato-logous spread [MOST COMMON] across blood-brain barrier
CNS infections testing
CT scan for abcesses, tumors, cysts >>> Lumbar puncture LP for cerebral spinal fluid tests
Cerebral Spinal Fluid CSF tests
gram, capsule and acid fast stains, low glucose [suggesting bacteria], neutrophils [suggesting bacteria], lymphocytes [suggesting virus, TB, cryptococcus or HIV]
CSF tests #2
Serology: for syphilis, HIV, Lyme >>> and cultures.
CSF test if immuno-compromised
test for atypical organisms
Bacterial meningitis symptoms
fever, headache, stiff neck [inflamed meninges causes pain so pt will not move neck], nausea >>> rapid progression to convulsions, coma
Acute Meningitis pathogens
Most common. [1] H. influenza [2] S. pnuemoniae [3] N. meningitidis >>> GNR, Listeria spp, and M. tuberculosis
H. influenza
GNR, capsule, aerobic: everyone has as normal nasopharyngeal flora, but if it crosses the blood-brain barrier ---> meningitis. Also otitis media, epiglottitis and pneumonia
HiB vaccine consists of
capsule antigen conjugated with a protein
"Meningococcal meningitis"
N. menigiditis: a GN cocci, aerobic, w/ a capsule. Very rapid endotoxin damage. college/military
S. pneumoniae
GP diplo-cocci capsule. 80% mortality elderly. Vaccination with capsule subunits from 7 strains
Cryptococcus neoformans
Meningitis mortality up to 30%. Systemic fungus with a thick capsule. IDed by CSF india ink stain. Pigeon droppings. Mild lung infection unless hematologous spread. Amphotericin B
Viral meningitis earmarks
Aseptic: meaning no growth in the usual cultures. CSF has elevated lymphocytes.
Non-polio enterovirus meningitis
mild, self-limited
Herpes simplex meningitis
Severe. Hematologous. Along cranial nerves. Treat with Ayclovir.
Arboviral encephaltis varieties
WEE, EEE, St. Louis, Calif., W Nile. All from mosquitos with bird-mammal reservoirs except Calif -- small mammal reservoir.
EEE mortality
> 30%
St. Louis E mortality
W Nile mortality rate
Polio is spread how?
fecal-oral route
What percentage of polio infections are enteric only?
99%. Only one percent gets to the CNS.
What route does it take to the CNS
Hemato-logous. Destroys the grey matter spinal cord motor horns.
What kind of paralysis?
FLACCID paralysis with limbs and respiratory muscles affected -- can't inhale.
Last known US wild case of polio?
Rabies types
"Furious" type: restless, excitable >>> "Paralytic" type: docile
Rabies virus vaccine is
killed virus or inactivated vaccine
How does rabies virus get to encephalitis
virus travels along PNS into the CNS at rate of approx. 1 cm./day. A month to a year until encephalitis. Immune systems are ineffective because the virus is not traveling via the blood or lymph system
Rabies symptoms
"Autonomic system instability" like fever, sweating, foaming. Delirium. Hydrophobia.
Post-exposure prophylaxis rabies
Rabies Immune Globulin RIG + a chick embryo vaccine called Human Diploid Cell Vaccine HDCV
Negri body
What you observe microscopically in brain of autopsied rabies victim
Rabies antibodies are found in serum and CSF
Rabies Antigens?
testing by direct fluorescent antibody of cerebellum and brain stem
RNA in saliva and neck nape skin biopsy of nerve around hair root
Sleeping Sickness
African Trypanosoma Encephalitis
Types of Sleeping Sickness
T. brucei gambiense: milder then brain damage >>> T. brucei rhodesiense: lethal
Sleeping sickness reservoirs
Medication for Trypanosoma
none. Rapidly evolving protein coat.
Creutzfeldt-Jakob disease
prions. Infectious "pieces of protein"
Prion transmission
ingestion, transplant, inherited
Pacific Islanders, eyeball ingestion
related to Italian family how
Familial Fatal Insomnia
Upper respiratory infections
symptoms all look the same whether bacteria or virus. Normal flora is potentially pathogenic. We are talking sinusitis, pharyngitis, tonsillitis, otitis media, epiglottitis
What pathogen causes epiglottitis?
Only one. H. influenzae. Nothing else.
the Common Cold is caused by:
50% Rhinoviruses, 15-20% Coronaviruses, and Mastadenoviruses. Altogether, there are over 200 causative viruses, and each one of those has multiple strains.
Otitis Media bacterial prevalence
S. pneumoniae [35%] >>> H. influenzae [20-30%] >>> M. catarrhalis [10-15%] >>> S. pyogenes [8-10%] >>> S. aureus [1-2%]
Otitis Media treatment
Broad-spectrum antiobiotics
Strep throat agent
Streptococcus pyogenes: GP cocci
Group A Streptococcus
GAS has extra goodies
Steptokinases: lyse clots to allow spread of infection >>>>> Streptolysins: cytoxins to kill tissue, RBCs and phagocytes
GAS lab tests
Indirect Agglutination tests take 10 minutes, and you need to culture the tissue to determine sensitivity
Untreated GAS
Can lead to rheumatic fever and heart valve destruction. Scarlet fever is another toxin -- an erythrogenic toxin -- that causes skin splotching.
Diphtherial upper respiratory infections
GP rod, non-endospore. Pharyngitis with gray membrane of fibrin, dead tissue and bacteria. Toxins: cardio and neuro
Diphtheria treatment
Antibiotics do not affect the toxin, only CDC approved administration of antitoxins
Cutaneous diptheria
slow healing ulcer
Lower Respiratory infections
Normally sterile environment, no potentially pathologic flora. Larynx, trachea, bronchus, bronchioles, alveoli. Pathogens are inhaled
Whooping cough
Bordetella pertussis: GN coccobacillus with a capsule. Tracheal cytotoxin damages ciliated cells -- Pertussis toxin enters the bloodstream and is assoc. w/ systemic symptoms.
Stages of pertussis
catarrhal stage: 1-2 weeks, like common cold ... violent coughing stage: 2-8 weeks ... convalescence: 1-2 weeks
Pertussis treatment
Erythro- or Azithro-mycin if given early can shorten the duration.
Pertussis vaccine
Acellular, cell fragments in TDP, adult booster with tetanus shot
Community Acquired Pneumonias
VEHICLES MF ... Varicella pneumonia virus, H. influenza GN coccobacillus, Chlamydiphila psittaci: GN intracellular, Legionella pneumophila GN, Strep pneumoniae, GP diplococci, Mycoplasma pneumo: GP pleo, Fungal pneumonias
Community Acquired Pneumonias Diagnosis model
Chest x-ray, culture, serology
"Pneumo-coccal pneumonia"
Streptococcus pneumoniae: otitis media and menigitis along with pneumonia. Bleeding into aveoli, rust-colored sputum, 20% mortality in elderly, vaccination w capsular antigens
S. pneumonia serotypes, how many?
90 capsule types
"Psittacosis pneumonia"
Chlamydophila psittaci: GN obligate intracellular. Bird droppings. Diagnosis via cell culture, Tx: Tetracycline
Fungal Pneumonias
BACH: Blastomyces dermatitidis -- Miss Valley, extensive tissue destruction ... Aspergillus fumigatus: compost ... Coccidio-oido-mycosis immitis: Valley Fever, spores SW dust storms ... Histoplasma capsulatum: bird, bat droppings Miss Valley
Fungal pneumonias treatment
Amphotericin B
Myco-bacterium tuberculosis Acid-Fast Rod. Resistant to drying, sunlight and disinfectants
Incidence in FL
5 to 10/100k ... in 1948, it was 100/100k nationwide
Most ethnic US TB
TB skin test
PPD, or Purified Protein Derivative [coat of bacterium]. Definitive Diagnosis: chest x-ray and culture.
TB diagnosis
Positive x-ray with positive Acid Fast Bacterium sputum. X-ray looking for cavitating lesion called Ghon complex
TB process
Alveolar macrophages ingest bacilli, which are either destroyed or they start multiplying faster, immune response brings more macrophages. A tubercle with a cavity. Enlarges, invading bronchioles, capillaries
Systemic TB
Attacks bones that have lots of marrow causing Pott's Disease -- a disabling scoliosis. Attacks all the organs causing Miliary TB -- named for millet seed-sized tubercles. Attacks testes. Attacks meniges and causes brain abcesses
Orthomyxo-virus Influenza A ... spreads from respiratory system to a systemic disease ... 16 subtypes of Hemagglutinin spikes ... 9 subtypes of Neuraminidase spikes or 144 in toto.
Asian flu --- not spread person to person
Seasonal flu comes from ...
SE Asia.
Current flu
H2N2, H3N2
Antigenic DRIFT
Influenza variation with gene changes to H or N surface proteins ... subtypes of strains in which virus avoids antibodies. "Expected Routine"
Antigenic SHIFT
Influenza variation with changes to H and N combinations. Not different subtypes of strains, but different strains altogether. "Big Deal"
Major flu strains
1918 H1N1 Spanish evolved in pigs and humans ... 1957 H2N2 Asian replaced H1N1 ... 1968 H3N2 Hong Kong flu replaces H2N2 ... 2009 H1N1 Swine replaces H3N2
Many flu strains infect
humans, birds, and pigs. An animal can be infected with several strains at once -- the viruses can re-assort and maybe produce an entirely new strain
Will a new animal strain infect a human?
Will a human with a new strain infect another human?
Reassortment can cause
What is stomach flu?
No such thing. There are no intestinal symptoms with influenza.
Diagnosis of flu ...
from antibodies.
What percent die from secondary infections?
Who is likely to die with seasonal flu?
ill and elderly
Who is likely to die with pandemic flu?
Za-nami-vir ---> Relenza® inhalation ... Osel-tami-vir --->Tamiflu® for H1N1 not H3N2
"Pneumocystis pneumonia"
Fungus: Pneumocystis joroveci ... affects infants, immuno-suppressed, AIDs.
Bactrim® [Trimethoprim-sulfamethoxazole TMP-SMZ] and pen-tam-idine ise-thio-nate
"Pneumoncystis pneumonia" diagnosis
characteristic chest x-ray: alveoli filled with froth