1. CNSINFECTIONS

2. Done by: Areej Al DaurAyaFerwanaBara’aSheek Al Eed TO: Dr.Ayham Abu Laila

3. Let’s begin with Bara’a

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-hemolysison blood agar.

14. 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 CNSand 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 rashDiffuse 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. Neisseriameningitidis • Meningococcal meningitis, is common in children ages 2-18. • Between 10 and 15 percent of cases are fatal. • with another 10-15 percent causing brain damage and other serious side effects.

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

32. Other forms….. • Listeriamonocytogenesmeningitis, 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. 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 arborviralencephalitis 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