Miscellaneous Quiz / CNS Pathogens

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Can you name the CNS Pathogens?

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Group VF: Blood invasion from lungs -> brain
VF: pneumolysin
Reservoir: Cat = definitive host
Free living amoebae
VF: Capsule, peptidase, lytic enzymes
Group s/s: Sudden onset: fever, stiff neck, severe HA (migraine-like); also n/v, photophobia, confusion, sleepiness, malaise…
Tx/Prev: Amphotericin B + flucytosine
Dx: Gram(+) cocci in pair + WBCs; Culture: blood agar -> α-hemolytic, optochin (S), bacitracin (R)
VF: Infective form: trophozoite
Reservoir: Soil-desert sand
Gram (-) rods, Enterobacteriacea family, lactose (+)
Tx/Prev: Empirical tx: antiviral (acyclovir) + antibacterial (ampicillin + cefotaxime)
Dz: Pneumococcal meningitis
Tx: Ampicillin + gentamicin
Most common pathogens (3) for bacterial meningitis in children and adults
Pathogen causing parastitic infection in immunocompromised persons
VF: K1 capsule, pili, cytotoxins, endotoxin (LPS)
Small gram(+) rods, non-spore forming, growth at 1°C to 45°C, motile at 25°C
Dx: Gram(-) diplococci inside polymorphonuclear cells; Culture: Thayer-Martin agar
Reservoir: Warm fresh water
S/s: Rapid onset, severe HA, fever, nausea, altered sense of smell. Progresses rapidly, death in a few days
Dz: toxoplasmosis
S/s: Febrile gastroenteritis (immunocompetant pts); Bacteremia (fever, malaise, spread to placenta); Granulomatosis infantiseptica (stillbirth, abscesses or granulomas in neonates)
Opportunistic free-living amoebae
Pathogen causing parastitic infection not otherwise specified
Prevention: Hib conjugate vaccine
VF: Endotoxin (LPS); Capsule = poly-ribitol-phosphate (PRP)
Dx: Gram(-) coccobacilli + WBCs; Cx: Chocolate agar (X &V factors)
Group dx: CSF: high protein, low glucose, neutrophils
Dz: Meningococcal meningitis, Meningococcemia (Waterhouse-Friderichsen syndrome)
HintAnswer
Dx: From CSF: capsulated yeasts, cx, capsular antigen detection
Group S/s: Slow onset, HA, visual disturbances, abnormal mental status, seizure
Most common pathogens (2) for bacterial meningitis in neonates
Dx: Cysts and trophozoites in tissue
S/s: May follow respiratory or ear infections, head trauma...
S/s: Often follows sinusitis or otittis media
Pathogen causing parastitic infection in immunocompetent persons
Pathogens causing fungal infections in immunocompromised host
VF: Infective form: cyst, oocyst; Intermediate host: other animal + humans; Oocyst -> tachyzoites -> invade macrophages -> spread to all organ systems: cyst
Transmission: Ingestion (uncooked meat w/ cyst, oocyst from fecal contamination), transplacental, blood & organ tpx
Group Dz: subacute to chronic meningitis
Reservoir: Asymptomatic carrier
Prevention: 7-valent conjugate vaccine; 23-valent polysaccharide vaccine
Dz: Primary meningoencephalitis
Group transmission: person to person via respiratory droplets
Most common pathogen (1) for bacterial meningitis in pregnant women, neonates, and immunocompromised patients
Dx: CSF: wet mount (motile trophozoites); Giemsa (trophozoites)
Dx: From blood or CSF: microscopy, cx (blood agar), motility test
S/s: CNS (meningitis, encephalitis in immunocompromised patients)
Dx: Complement fixing antibodies in serum
Tx: Amphotericin B + Ketoconazole
Dx: PCR (urine or CSF), Latex particle agglutination (urine), Cx (CSF, blood), CAMP test for GBS
VF: Endotoxins (LPS, LOS): diffuse vascular damage
Tx: Sulfadiazine + pyrimethamine (immunocompromised host); clindamycin & spiramycin (pregnant women)
Reservoir: Soil; fresh, brackish, sea water; sewage, swimming pool. Contact lens equipment
Gram(+) cocci, in chain or pairs, lancet shaped, a-hemolytic
Transmission: Enter body via lower resp. tract, ulcerated or broken skin
VF: Infective form: trophozoite & flagellated forms -> purulent, hemorrhagic inflammatory rxn
Group VF: Capsule, IgA protease, pili; Invasion into blood stream ->meninges -> inflammation
Reservoir: Intestine of animals and humans
HintAnswer
Encapsulated yeast
Transmission: From colonized mother (delivery, infected amniotic fluid); or nosocomial transmission
Group reservoir: human nasopharynx
Reservoir: normal flora GI tract -> secondary spread to vagina
Gram(-) diplococci (kidney-shaped); serogroups: A, B, C, Y, W 135
Group Dx: CSF: blood, neutrophils, high protein, low glucose
S/s: HA, altered mental status. Progresses slowly (several weeks)
Prevention: education for high-risk consumers
Group dx: From CSF, blood or skin lesions (meningococcus)
Reservoid: Soil enriched w/ brid droppings
Intracellular parasite
Dx: Serologic testing; biopsy (cyst, tachyzoites)
Reservoir: normal flora
Dz: Listeriosis
S/s: Hemorrhagic skin rash (petechiae)
S/s: Self limited flu-like illness (immunocompetent host); toxoplasmic encephalitis (imminocompromised host); Maternal infxn (stillbirth, neurologic problems)
S/s: Non specific: fever, poor feeding, vomiting, irritability alternating w/ lethargy…
Dz: Granulomatous amebic encephalitis
Transmission: Ingestion of contaminated food, transplacentally, or during delivery
Transmission: Enter body via olfactory neuroepithelium
Dimorphic fungus: mold in environment, spherules filled w/ endospores in tissue
Tx: Amphotericin B
Prevention: MPSV4; MCV4
Group tx/prev: Empirical tx: vancomycin + 3rd gen cephalosporin; Chemoprophylaxis: Rifampin
Group Transmission: inhalation
VF: Facultative intracellular pathogen, cell to cell spread
Gram(+) cocci in chains, B-hemolytic, bile resistant
Gram (-) coccobacilli; capsule serovar b

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