Causes of Encephalitis

VIRAL

MEASLES

 (SSPE) Subacute Sclerosing PanEncephalitis

 Slow form encephalitis, occurs many yrs after child/adolescent’s measles infxn

 Slowly progressing CNS disease, mental deteriorxn, loss coordinxn

MUMPS

 Encephalitis: rare, but severe

 also can cause Meningitis

VARICELLA ZOSTER VIRUS (VZV)

 Encephalitis in ImmCo/ AIDS pts

HERPES SIMPLEX VIRUS/ HSV1

 common cause of severe viral Encephalitis in US

 Sudden onset of fever and focal neurological abnormalities

RABIES Virus

 Human bitten by rabid mammal, virus replicates locally for few days

 Then migrates slowly (weeks – 1yr) up nerve axons to CNS

 Prodrome: non-specific Sx of fever, headache, sore throat, fatigue, nausea, sensitivy around wound site

 Acute Encephalitis – hyperactive, agitation, confusion, MADNESS!!!

 Brainstem Encephalitis – CN dysfxn makes painful to swallow liquids (pharyngeal muscle contrxn)
“Hydrophobia” & “foaming of the mouth”
 Rapid progression to death over 1-2 wks once symptoms develop, no recovery from active rabies

 Death occurs after ultimate respiratory center dysfxn

*Pathognomonic NEGRI BODIES (cytoplasmic collections of virions) in brain cells . Upon autopsy.

THE ARBOVIRUSES: Arthropod Borne

FLAVIVIRIDAE
 MOSQUITO-vector (spread)

 Flaviviruses cause Japanese Encephalitis and Russian Encephalitis

 West Nile Virus → mild, flu-like illness or Encephalitis

BUNYAVIRUS

 California Encephalitis

TOGAVIRUS

 WEE! EEE! VEE! (Western-equine encephalitis, Eastern “ “, Venezualan “ “)

FUNGAL CAUSES

CRYPTOCOCCUS NEOFORMANS

 Meningoencephalitis; mainly in ImmCo/ AIDS pts

 Pigeon poops, inhalation, yeast

 subacute--> chronic meningitis --> cerebral edema --> brainstem compression

 Diagnose: lumbar puncture, test CSF

 India Ink Stain  yeast w/ surrounding halo (polysaccharide capsule)

PARASITIC

TOXOPLASMA GONDII

 Encephalitis in ImmCo/AIDS pts and Congenital Toxoplasmosis

ACANTHAMOEBA

 Chronic meningoencephalitis (granulomatous brain infxn) in ImmCo/AIDS pts

TRYPANASOMA CRUZI – American Trypanosome “Chaga’s Disease”

 Meningoencephalitis
Major Causes of Meningitis 12/31/2010
VIRAL
NEISSERIA MENINGITIDIS
 High risk group: infants (6mos-2yrs) and Army recruits
 Common cause in ADULTS in crowded living situations
 Spreads via resp. secretions and can live asymptomatically in nasopharynx, bacteremia = meningitis
 Petechial rash: classic sign of invasive meningococcal infxn

GROUP B – STREPTOCOCCUS - think Beta-hemolytic, baby

 Mother may carry these strep vaginally, perinatal infxn --> Baby meningitis, pneumonia, sepsis
 #1 common cause of NEONATAL MENINGITIS
 Babies don’t exhbit stiff neck like adults- non-specific Sx (fever, vomiting, poor feeding, irritability)
 Must diagnose by lumbar puncture and act quickly if suspect meningitis

E. COLI (with virulence factors)

 2nd most common cause of NEONATAL MENINGITIS

LISTERIA MONOCYTOGENES
 3rd most common cause of NEONATAL MENINGITIS
 neonates contract organism from asymptomatic mothers during delivery
 Also causes Meningitis in ImmCo pts (AIDS, Transplants, Cancer)

HAEMOPHILUS INFLUENZA (TYPE B) - “capsule b = bad”

 Was most common cause of Meningitis in toddlers (6mos-3yrs), now infants receive HiB vaccine
 Also causes Acute Epiglottitis, Septic arthritis, Sepsis
 organisms inhaled, enter thru nose/throat
 non-capsulated strains cause local infxn: otitis media, URT disease

STREPTOCOCCUS PNEUMONIAE
 Most common cause of Adult Meningitis
 Nuchal rigidity, stiff neck

3° SYPHILIS
 A Sx of Neurosyphilis: Subacute Meningitis. Pts present with fever, stiff neck, headache
 CSF lumbar puncture shows: predominance of lymphocytes and positive syphilis tests, (most Bact. Acute
meningitis – Hi neutrophil count)

MYCOBACTERIUM TUBERCULOSIS
 Subacute Meningitis
 CSF lumbar punct = predominance of lymphocytes (most Bact. Acute meningitis – high neutrophil count)

MUMPS
 Meningitis may occur (more commonly than encephalitis)

BORRELIA BURGDORFERI - Lyme Disease!

 Stage 2: Early Disseminated Stage – many Sx, but may invade CNS and cause:
 Aseptic Meningitis, CN Palsies (esp. CNVII – Bell’s Palsy), Peripheral neuropathies

STAPHYLOCOCCUS AUREUS
 Disease can result from DIRECT organ invasion.
 (Brain/Meninges) --> Meningitis, Brain abscess

POLIO VIRUS
 1 of the 3 disease manifestations: ASEPTIC MENINGITIS (complete recovery in 1 week)

COXSACKIE A&B, ECHOVIRUSES and ENTEROVIRUSES

 Can all cause ASEPTIC MENINGITIS
 (Entero- most common cause of Aseptic (non-bact) meningitis in US?)

AIDS/HIV
 Meningeal infxn results in Aseptic Meningitis

FUNGAL CAUSES
CRYPTOCOCCUS NEOFORMANS
 MENINGITIS; mainly in ImmCo/ AIDS pts
 Important! AIDS pts lack immune fxn so often don’t exhibit meningeal inflammation! Only sign may be fever,
vomiting, nausea. MUST Diagnose: lumbar puncture, test CSF
 Pigeon poops, inhalation, yeast spreads
 India Ink Stain  yeast w/ surrounding halo (polysaccharide capsule)

PARASITIC
NAEGLERIA FOWLERI - Free-living amoeba: in freshwater & moist soils. Lots exposed, infxn rare
 Infxn often occurs during summer, swimming in lakes, pools. Pts give history of swimming 1wk earlier
 Penetrate thru nasal mucosa --> cribriform plate --> brain
 Causes Meningoencephalitis (infxn of meninges and brain)
 FOWL PLAY – 95% of pts die within 1 week.

ACANTHAMOEBA - Free-living amoeba: in freshwater & moist soils. Lots exposed, infxn rare
 Chronic meningoencephalitis (granulomatous brain infxn) in ImmCo/AIDS pts

TAENA SOLIUM (Pork Tapeworm)

 Brain cysts – after 5-10 yrs cysts die and leak
12/31/2010