1. CNS INFECTIONS

2. Done by: Areej Al Daur Aya Ferwana Bara’a Sheek Al Eed TO: Dr
Done by: Areej Al Daur Aya Ferwana Bara’a Sheek Al Eed TO: Dr.Ayham Abu Laila

3. Let’s begin with Bara’a

4. Infections of CNS
Bacterial
Viral
Fungal
Protozoal

5. Bacterial infection

6. Bacterial infection in CNS may cause:
meningitis,
brain abscess,
subdural and epidural abscesses
empyema

7. The diagnosis for the bacterial infection :
Basic observation:
fever
severe headaches
stiff neck

8. Blood test…. MRI scan… Spinal tap…..

9. Examination of the CSF typically reveals:
elevated protein concentration,
a depressed glucose concentration,
a moderate leukocytosis composed mainly of lymphocytes.

10. The exception is the cerebellar syndrome, in which the protein concentration is elevated but there is no leukocytosis.

11. Cultures of CNS tissue and fluid are frequently sterile; however, bacteria are occasionally recovered from the CSF and from the brain granuloma.

12. Transmission Through contaminated food
(e.g., L. monocytogenes, Salmonella, and Brucella spp.),

13. L. monocytogenes
a gram-positive, nonsporulating bacillus that is facultatively anaerobic and produces weak beta-hemolysis on blood agar.

14. Most human infection by L
Most human infection by L. monocytogenes is acquired by consumption of contaminated food.
L. monocytogenes, is able to enter the brain via a non hematogenous route by retrograde transport within cranial nerves.

15. Brucella Species
Brucellae are small, nonmotile, and non spore-forming gram-negative coccobacilli.
human disease is caused predominantly by B. abortus, B. melitensis, and B. suis

16. Human infection typically is acquired by ingestion of unpasteurized milk or cheese.
occupational exposure to infected animals, in particular sheep, goats, swine, camels, and cattle.

17. Brucella attacks the CNS and neurobrucellosis is found much less commonly in children than in adults.
permanent neurological deficits, particularly deafness, are common.

18. Salmonella Species
Salmonella spp. are gram-negative, facultative anaerobic, motile, non-lactose-fermenting, non-spore-forming bacilli.

19. In addition to headache,
CNS manifestations of enteric fever in the form of neuropsychiatric manifestations from encephalitis, including confusion and psychosis, occur in 5 to 10% of patients.

20. Through inhalation
(M. tuberculosis and C. burnetii).

21. M. tuberculosis
CNS infection by M. tuberculosis occurs in individuals of any age.
Most cases in children occurred between the ages of 6 months and 4 years, whereas adult cases clustered in patients aged 20 to 50 years.

22. Through the bite of infected arthropods
(R. rickettsii, R. prowazekii, and E. chaffeensis),

23. What is meningitis? What is encephalitis?
Infection of the meninges, the membranes that surround the brain and spinal cord, is called meningitis.
inflammation of the brain itself is called encephalitis.
Myelitis is an infection of the spinal cord.
When both the brain and the spinal cord become inflamed, the condition is called encephalomyelitis

25. Meningococcemia
Prominent rash Diffuse purpuric lesions principally involving the extremities.

26. Who is at risk for encephalitis and meningitis?
People with weakened immune systems, including
HIV patients:
Cancer,
diabetes,
alcoholism
substance abuse disorder
prolonged use of steroid

27. Bacterial meningitis upper respiratory tract infection.
bacteria invade the meninges directly.
penetrating wound (surgical procedure)

28. Streptococcus pneumoniae
Pneumococcal meningitis is the most common form of meningitis.
At particular risk are children under age 2 and adults with a weakened or depressed immune system.

29. streptococcus pneumoniae meningitis

30. Neisseria meningitidis
Meningococcal meningitis, is common in children ages 2-18.
Between 10 and 15 percent of cases are fatal.
with another percent causing brain damage and other serious side effects.

31. Haemophilus influenzae
Haemophilus meningitis was at one time the most common form of bacterial meningitis.
Fortunately, the Haemophilus influenzae b vaccine has greatly reduced the number of cases.

32. Other forms…..
Listeria monocytogenes meningitis, which can cross the placental barrier and cause a baby to be stillborn or die shortly after birth.
Mycobacterium tuberculosis meningitis

33. Escherichia coli meningitis, which is most common in elderly adults and newborns and may be transmitted to a baby through the birth canal,

34. How are these disorders transmitted?
saliva,
nasal discharge,
feces,
respiratory and throat secretions (often spread through kissing, coughing, or sharing drinking glasses or cigarettes).

35. Brain abscess
inflammation and collection of infected material, within the Brain.
Brain abscess is relatively rare, accounting for 1 in 10,000 hospital admissions.
Single abscess occurs in 75% of cases, and the remainder of cases involve multiple abscesses.

36. Causes: spread of bacteria from a nearby infection. Otitis media.
sinusitis
an abscessed tooth.
Other sources of bacteria include:
abdominal infection .
Endocarditis.
penetrating head wounds.

37. Empyema…………
Collection of purulent material confined within epidural or subdural space
Subdural empyema usually occurs in association with:
sinusitis.
a severe ear infection,
a head injury, or a blood infection.

38. Jaya suffers from cerebral empyema, a brain infection
Jaya suffers from cerebral empyema, a brain infection. She has already undergone a number of operations and continues to be treated

39. symptoms The most common symptoms are: headache altered mental status
seizures
Fever and stiff neck.
vomiting, eye tremor, and uncoordinated movements.

40. bacteria that cause brain abscesses can cause subdural empyemas.
streptococci,
staphylococci,
pseudomonas,
bacteroides,
enterobacter,
klebsiella,
H. influenzae, and E. coli.

41. Go with Areej…

42. Viral infections of the CNS

43. Viral Encephalitis Infection of brain parenchyma
Presents of neurological abnormalities distinguish it from meningitis

44. California encephalitis
California encephalitis is an arbovirus-induced, arthropod-borne encephalitis or encephalomeningitis.
The virus is transmitted to humans through a mosquito bite.

45. arborviral encephalitis
Five types of arborviral encephalitis are found in the United States, including:
eastern equine encephalitis (EEE)
western equine encephalitis
St Louis encephalitis
La Crosse encephalitis
West Nile encephalitis.

46. Eastern Equine Encephalitis
This infection is caused by an arthropod-borne alphavirus of the Togaviridae family

48. Herpes Simplex Encephalitis
HSV remains dormant in the nervous system; rarely, it presents as encephalitis.
This encephalitis is a neurologic emergency and the most important neurologic sequela of HSV.

50. The infection of neonates may occur:
intrauterine
during parturition
breast- feeding

51. Prognosis is poor as

52. hydranencephaly

53. porencephalic cysts

54. HSE in other age groups causes
necrotizing encephalitis in the temporal and orbitofrontal lobes of the brain

55. Japanese encephalitis
Japanese encephalitis is a neurologic infection closely related to St. Louis encephalitis and West Nile encephalitis.

56. Viral meningitis
more than 85% of viral meningitis cases are caused by nonpolio enteroviruses.
Mumps, polio, and lymphocytic choriomeningitis viruses (LCMVs) are now rare offenders in developed countries.
However, polio remains a major cause of debilitating myelitis in some regions of the world.

57. Enteroviruses
Enteroviruses account for more than 85% of all cases of viral meningitis
include echoviruses, coxsackieviruses A and B, polioviruses, and the numbered enteroviruses.
majority of meningitis cases are caused by serotypes of coxsackievirus and echovirus

58. Arboviruses
5% of cases
Some of the important arboviruses include the eastern and western equine encephalitis viruses, from the Togavirus family; St. Louis encephalitis’ West Nile, Japanese B, and Murray Valley viruses, from the Flavivirus family; and California group and Jamestown Canyon viruses, from the Bunyaviridae family.

59. The most common clinical manifestation is meningoencephalitis rather than pure meningitis
Seizures are more common with arboviral meningitis than with any other group of viruses.

60. Mumps
A member of the Paramyxovirus family, mumps virus was one of the first known causative agents of meningitis and meningoencephalitis

61. Prion-Related Diseases
Kuru
Creutzfeldt-Jacob Diease.

62. spongiform degeneration and astrocytosis but no inflammatory reaction
KURU
spongiform degeneration and astrocytosis but no inflammatory reaction

63. random laughing

64. headaches

65. trembling

66. joint pains

67. The victims present with cerebellar ataxia

68. CREUTZFELDT - JACOB DISEASE (CJD)
The clinical manifestations include:
spasticity

69. ataxia

70. visual loss

71. CREUTZFELDT - JACOB DISEASE (CJD)
involuntary movements
mental changes
speech problems
personality changes

72. cytomegalovirus
The congenital infection with this virus is associated with:
microcephaly
hydrocephalus
seizures
optic atrophy
deafness

73. Acquired infections have been associated with:
transverse myelitis
brachial plexitis
Guillain-Barré syndrome
adult encephalitis

74. H I V several neurological manifestations
At the stage of seroconversion
the patient may experience, general signs and symptoms of any viral illness
mild meningitis
Encephalitis
myelitis

75. Go with Aya…

76. Fungal infections of the CNS

77. Fungal Meningitis
Cryptococcosis - most common fungal infection in CNS diagnosed in live patients
Cryptococcoma (mucinous pseudocyst) - occurs almost entirely in the HIV population
3-10mm, most commonly in the basal ganglia

78. Cryptococcosis

79. Coccidiomycosis - normally causes meningitis
Fungal Meningitis
Candidiasis - most common fungal infection in CNS diagnosed in dead patients
rare in healthy individuals
Aspergillosis
Coccidiomycosis - normally causes meningitis

80. Aspergillosis – Abscess in the centrum ovale
Aspergillosis – Abscess in the centrum ovale. Note many satellite lesions common among fungal infections.

81. Mucor – aggressive and locally destructive infection.

82. Fungal Meningitis
Insidious onset with progressive headache, fever, lethargy, mild neck stiffness
Complications: abcess, neuro deficits, ocular nerve damage (especially cryptococcus)
Usually pulmonary source, usually immunocompromised
Presents similar to TB meningitis

83. Protozoal infections of the CNS

84. Cysticercosis Most common parasitic infection in CNS
Caused by larval stage of Taenia solium- pork tapeworm
Incubation period from months to decades
83% of cases show symptoms within 7 years of exposure

85. Common routes of infection
Cysticercosis
Common routes of infection
Food (usually vegetables) or water containing eggs from human feces
Fecal - Oral autoinfection (poor sanitation habits)
Autoinfection from reverse peristalsis

86. Cysticercosis Location: meningeal 27-56% parenchymal 30-63%
ventricular 12-18% (may cause hydrocephalus)
mixed - 23%
Clinical
symptoms of increased intracranial pressure

87. serology CT scan Cysticercosis
antibody titers significant if 1:64 in the serum and 1:8 in the CSF
CT scan
ring enhancing / calcified lesions, multiple

88. Cystercercus cellulosae - (3-20 mm) regular round thin walled cyst, produces only mild inflammation larva in cyst

89. Echinococcosis
“Hydatid Cyst” - caused by ingestion of the dog tapeworm
Treatment - Surgical excision without cyst rupture
Cyst is full of worms
Adjunctive treatment
Albendazole

90. Echinococcus Cyst – intraoperative

91. Toxoplasmosis CNS manifestations Mass lesion (most common)
Meningoencephalitis
Encephalopathy

92. Toxoplasmosis CT findings
Mass lesion - comprises 70-80% of cerebral masses in AIDS patients
large low density area with mild to moderate edema
most commonly in the basal ganglia
Often multiple
Most patients with CT diagnosed toxoplasmosis also have evidence of cerebral atrophy

93. Toxoplasmosis

94. Toxoplasmosis

95. Amoeba Naegleria fowleri "the brain-eating amoeba")
Invade the central nervous system via the nose
Cause primary amoebic meningoencephalitis (PAM)

96. Amoeba
PAM usually occurs in healthy children or young adults with no prior history of immune compromise who have recently been exposed to bodies of fresh water.

97. Symptoms Onset 1 to 14 days after exposure.
The initial symptoms include:
changes in taste and smell
headache, fever, nausea, vomiting, and stiff neck.
Secondary symptoms include:
confusion, hallucinations, lack of attention, ataxia, and seizures.
The disease progresses rapidly 3 to 7 days, with death occurring from 7 to 14 days