INFECTIOUS DISEASES

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 INFECTIOUS DISEASES OF THE CNS
Important ANATOMIC FEATURE of the CNS that affects the
pathophysiology of INFECTIONS is that:

The BRAIN is surrounded by

MENINGES & bathed in CSF

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 CNS INFECTIOUS DISEASES
CSF PROVIDES BOTH:
1. Culture Medium for the infecting organism
2. Rapid means of disseminating infection throughout the
system once the outer defenses have been breached

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 MENINGITIS
Inflammatory state of the:

leptomeninges

subarachnoid space

It is usually the result of infection

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 MENINGITIS
CHEMICAL MENINGITIS
caused by release or insertion of
irritative substance into the CSF
Pleocytosis (Increase # of PMNs)
Increased CHON
Normal sugar content
Organism can neither be seen nor
cultured

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 MENINGITIS
CARCINOMATOUS MENINGITIS

- Infiltration of the subarachnoid

space by tumor cells and eventually

spread to the entire neuraxis

- no inflammatory response

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 INFECTIOUS MENINGITIS
CLASSIFICATION

ACUTE PYOGENIC - Usually Bacterial

ACUTE LYMPHOCYTIC - Usually Viral

CHRONIC MENINGITIS - Bacterial or Fungal

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 ACUTE PYOGENIC MENINGITIS
CAUSATIVE ORGANISM

1. E. coli: Neonate w/ neural tube defect

2. H. influenza: Infants & Children

3. Neisseria meningitides
adolescents & young adults
most common cause: epidemic meningitis
Oral commensal & transmitted through the air

4. Pneumococcus:
very young or the very old and following trauma

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 ACUTE PYOGENIC MENINGITIS
GROSS:
cloudy or frankly purulent CSF
Location of the exudate varies:
H. influenza basal
Pneumococcal over the cerebral convexities near the sagittal
sinus
Fulminant meningitis extend into the ventricles

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 ACUTE PYOGENIC MENINGITIS
MICRO:
PMNs fill the entire subarachnoid space & around the
leptomeningeal blood vessels (less severe cases)

Fulminant inflammatory cells infiltrate the walls of the

leptomeningeal veins that can lead to venous occlusion
hemorrhagic infarction of the underlying brain

Arteritis uncommon unless meningitis is prolonged

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 ACUTE PYOGENIC MENINGITIS
CLINICAL MANIFESTATIONS:
1. General signs of infection
2. Signs of meningeal irritation
headache
photophobia
irritability
clouding of consciousness
neck stiffness

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 ACUTE PYOGENIC MENINGITIS

LABORATORY DIAGNOSIS:

SPINAL TAP
Cloudy or purulent CSF
Increased pressure
90,000 / mm3 PMNs
Increased CHON level
Markedly reduced sugar content

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 ACUTE PYOGENIC MENINGITIS

LAB DIAGNOSIS
CSF SMEAR Increase number of
WBC (smear)
CSF CULTURE ID causative org

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 ACUTE PYOGENIC MENINGITIS
FATAL
RECOVERY: Fibroblastic proliferation in
the meninges that produced adhesive
arachnoiditis
If obliteration sufficiently impede CSF
flow
HYDROCEPHALUS
Pneumococcal meningitis
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 ACUTE PYOGENIC MENINGITIS

HYDOCEPHALUS due to Pneumococcal Meningitis:

Large quantities of the capsular
polysaccharide of the organism produce
glutinous exudate that encourages
arachnoid fibrosis obliteration
impede CSF circulation

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 ACUTE PYOGENIC MENINGITIS

MENINGITIS IN IMMUNOSUPPRESSED
Klebsiella or anaerobic organism

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 ACUTE PYOGENIC MENINGITIS

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 ACUTE PYOGENIC MENINGITIS

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 ACUTE PYOGENIC MENINGITIS

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 BACTERIAL MENINGITIS

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 BACTERIAL MENINGITIS

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 BACTERIAL MENINGITIS

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 BACTERIAL MENINGITIS

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 ACUTE LYMPHOCYTIC MENINGITIS
CAUSATIVE AGENTS (viruses)
1. Mumps
2. ECHO viruses
3. Coxsackie virus
4. Epstein-Barr virus
5. Herpes simplex II

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 ACUTE LYMPHOCYTIC MENINGITIS

CLINICAL MANIFESTATION

- Same as bacterial meningitis with meningeal irritation but is

LESS FUMINANT & the CSF findings are markedly different

Self-limiting

No life-threatening complications

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 ACUTE LYMPHOCYTIC MENINGITIS

LABORATORY DIAGNOSIS
1. Lymphocytic Pleocytosis
2. CHON elevation is moderate
3. Sugar content is nearly always
normal

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 ACUTE LYMPHOCYTIC MENINGITIS
(VIRAL MENINGITIS)

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 ACUTE LYMPHOCYTIC MENINGITIS

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 ACUTE LYMPHOCYTIC MENINGITIS

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 VIRAL MENINGITIS

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 VIRAL MENINGITIS

Typical owl-eye intranuclear inclusions are seen in

cytomegalovirus encephalitis together with distention of the
Cytoplasm by viral particles
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 CHRONIC MENINGITIS
CAUSATIVE AGENTS
Mycobacterium TB
Treponema pallidum (Syphilis)
Brucella spp
Fungi
Coccidioisis
Candida
Cryptococcus neoformans

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 TB MENINGITIS
GROSS:

Subarachnoid space contains gelatinous or fibrinous

exudate that is most obvious around the base of the brain
extending to the lateral sulci

Focal densities visible along the course of the cerebral

vessels

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 TB MENINGITIS
MICRO:
Exudate consists of lymphocytes, plasma
cells, macrophages & fibroblasts

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 TB MENINGITIS
MICRO:
Focal densities are tubercles with giant cells &
caseation necrosis
Arteries in the subarachnoid space may show
obliterative endarteritis with inflammatory cells in their
walls and marked intimal thickening
Fibrous adhesive arachnoiditis around the base of the
brain

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 TB MENINGITIS
CLINICAL MANIFESTATION
headache
malaise
mental confusion
vomiting

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 TB MENINGITIS

COMPLICATIONS
Hydrocephalus
Obliterative endarteritis causing arterial occlusion
& infarction of the underlying brain
Cranial nerves may be affected

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 TB MENINGITIS
LABORATORY DIAGNOSIS
Moderate CSF either entire
mononuclear pleocytosis or mixture of
PMNs and mononuclears = 1000 cells
per mm3
CHON level is elevated
sugar is moderately reduced / normal

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 TB MENINGITIS

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 TB MENINGITIS

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 TB MENINGITIS

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 TB MENINGITIS

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 CRYPTOCOCCAL MENINGITIS
Frequent in debilitated or immunocompromised hosts

Trivial inflammatory response despite the large number of

organism
GROSS:
Found in the subarachnoid space
Distends the Virchow-Robin spaces producing characteristic
soap bubbles

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 CRYPTOCOCCAL MENINGITIS

CLINICAL MANIFESTATION
Course is fulminant & fatal in 2 weeks
indolent over months or years

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 CRYPTOCOCCAL MENINGITIS
LABORATORY DIAGNOSIS
Mucoid encapsulated yeasts can be visualized in the CSF by:
india ink

INDOLENT CASES:

- Few cells

- Very high CHON - > 500 mg/dl

- Pathognomonic cryptococcal antigen

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 CRYPTOCOCCAL MENINGITIS

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 CRYPTOCOCCAL MENINGITIS

anwar wardy w pspd fkk umj

 Wassalam, Wr Wbr,
HAVE A NICE DAY!

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