Viral Meningitis and Encephalitis Microbiology

  1. T/F: Viral meningitis and viral encephalitis are both typically self-limiting illness
  2. T/F: Profound altered mental status and focal neurological deficits are symptoms found in viral meningitis
    False; these are symptoms for viral encephalitis, viral meningitis (like bacterial meningitis), presents frequently with nuchal rigidity and only variable degrees of altered mental status
  3. T/F: Viral cause of newborn meningitis is common
    False; it is really rare, newborn meningitis is typically caused by Group B strep, NMEC and/or listeria. Same thing goes for 60 year + adults too
  4. What are common causes of viral Encephalitis?
    • HSV-1
    • And arboviruses i.e EEE, WEE, StLouisE, LaCrosse, California encephalitis, WNV
  5. T/F: Treatment for all viral encephalitis is the use of IV Acyclovir
    False; acyclovir is only used for HSV-1 infections (because it is a DNA virus), other causes of viral encephalitis is supportive care
  6. Viral infection CSF: pressure _____, CSF appearance ____, cell counts ___, dominant cell type ____, glucose ____, protein ____
    • Normal pressure
    • Clear CSF
    • Normal cell count
    • Late lymphocytes
    • Normal glucose
    • Normal protein
  7. If blood is present in the CSF and traumatic spinal tap is ruled out, what does this suggest?
    HSV-1 encephalitis
  8. 80-85% of viral meningitis is caused by _____
    • Coxsackie A and B
    • Echovirus is the second most common
    • These are enteroviruses
  9. Enteroviruses: Coxsackie A/B and echovirus (and poliovirus)- genetic makeup:
    • Single-stranded RNA (+)
    • non-enveloped
    • Picornaviridae family
    • replicate in the cytoplasm
  10. Coxsackie ___ can cause hand-foot-mouth disease, hemorrhagic conjunctivitis and respiratory disease
    • A
    • While coxsackie B can cause pericarditis, pleurodynia
    • Both of them can cause paralytic, encephalitis and meningitis
  11. Enterovirus enter ____ route, and replicate in the ____ or in the ____. Later enter the bloodstream and infect other cell types
    • Fecal-oral/ ENT
    • Oropharynx
    • Intestines
  12. Which virus has biphasic virulent cycle?
    Enterovirus – first peak when the virus replicate in the intestinal mucosa, affected individual starts to feel a little better but then struck with next round of viremia that could possibly get to the CNS
  13. Diagnosing enteroviral, HSV, West Nile CNS infection:
  14. HSV is of the ____ family, and its genome is ______, (with/without) envelope and replicates in the _____
    • Herpesviridae
    • Double-stranded linear DNA
    • with envelope
    • replicates in the nucleus
  15. Herpesviridae virus gets their envelope from ____
    The nuclear membrane when it buds off
  16. Where does Herpesvirus establishes latency?
    • In the neuron, in trigeminal ganglia
    • Then it’s reactivated when there’s stress, fever, trauma, and spreads via peripheral nerves
  17. T/F: HSV-1 causes encephalitis, and HSV-2 usually meningitis
    True, though HSV-2 can also cause encephalitis but that’s seen more in neonates
  18. What is whitlow?
    Herpetic whitlow, hand/finger lesions seen in a lot of healthcare provider form having contact with the herpesvirus
  19. What is gingivostomatitis?
    Primary HSV-1 oral lesion that supposedly Honsa had and said that most of us have had it too as a child
  20. If adult gets exposed to oral HSV-1 for the first time, it can present as ___
    • Severe pharyngitis
    • This is why you should ideally get gingivostomatitis as a child so as an adult you won’t have to get this
  21. Cold sores is aka____
    • Herpes labilais
    • Primary infection can be asymptomatic and usually occurs in childhood
  22. When CSF shows _____, it is suggestive of HSV-1 encephalitis reactivation, which attacks what part of the brain?
    • Blood
    • Temporal lobe
  23. Most common cause of sporadic acute necrotizing encephalitis in the USA is _____, and there is a high mortality if untreated.
    • HSV-1 encephalitis
    • Treated pt will likely have neurological sequelae and 20% mortality
  24. Cowdry type A inclusions, think:
    Herpes; HSV-1
  25. What is Cowdry type A inclusions?
    Intranuclear eosinophilic bodies surrounded by a clear halo with margination of chromatin on the nuclear membrane, suggestive of the Herpesviridae family
  26. ______ shows Multinucleated giant cells of HSV or VZV
    Tzanck smear
  27. Which is the most common arboviral infection in the US?
    West nile virus
  28. T/F: Eastern Equine Encephalitis (EEE) and Western Equine Encephalitis (WEE) have horse as its reservoir
    • False; horses are dead-end HOSTS, not reservoir.
    • Reservoir: wild birds; Vector: mosquitoes
  29. T/F: California encephalitis is commonly seen in Kern County, Central California
    False; instead it is found in northcentral states, think Illinois, Minnesota and Iowa
  30. Reservoir and vector for California Encephalitis/ La Crosse Virus
    • Reservoir: rodents
    • Vector: mosquito
  31. T/F: Colorado tick fever virus (reovirus), is commonly found in the northcentral states
    False; Colorado tick fever virus is aptly named, unlike California Encephalitis, in that this virus is actually found in the Rocky Mountains region, and clinical vignette may often involve a hiker
  32. Dermacentor tick is the vector for which virus causing viral encephalitis?
    • Colorado tick fever virus
    • (this tick is also a vector in the Gr negative coccobacilli bacteria Franciscella tularensis!)
  33. T/F: all the arboviruses causing viral encephalitis have mosquito as their vectors and wild birds as their reservoir
    • False; while it is ALMOST true, but Colorado Tick fever virus as Dermacentor tick as vector
    • And both California Encephalitis and Colorado Tick fever have “small mammals” as their reservoir instead of wild birds
  34. Which viruses are part of the Flaviviridae family?
    • West Nile Virus
    • St. Louis encephalitis Virus (and Japanese encephalitis virus but we didn’t really learn that)
    • (from hemorrhagic fever lecture: also Dengue and Yellow fever)
  35. Which viruses are part of Togaviridae family?
    • Eastern Equine Encephalitis virus
    • Western Equine Encephalitis virus
  36. Which viruses are part of bunyaviridae family?
    • California encephalitis virus, including La crosse virus
    • (also from hemorrhagic fever: Hantavirus)
  37. Which viruses are part of reoviridiae family?
    Colorado tick fever virus
  38. Which viruses are part of arenaviridae family?
    • Lymphocytic choriomeningitis virus (not an arbovirus!)
    • (from hemorrhagic fever: Lassa fever virus)
  39. T/F: All of the viral encephalitis viruses are ssRNA, enveloped virus
    False; almost all are ssRNA enveloped, except for Reoviridae (Colorado tick fever) it is not enveloped and it is actually dsRNA
  40. Which two family have segmented enveloped ambisense ssRNA?
    • Bunyaviridae (somehow this was not specified in the hemorrhagic fever lecture though)
    • Arenaviridae
  41. T/F: both Flaviviridae and togaviridae families have positive-sense ssRNA, enveloped genome
  42. Which mosquito-borne viral encephalitis can be found in California?
    • Western Equine Encephalitis virus
    • St. Louis Encephalitis
    • West Nile Virus
  43. Culex mosquito is a vector for _____ virus
    • West Nile
    • St. Louis Encephalitis vrus
  44. West Nile virus most often cause encephalitis in which age group?
    Over 60 years
  45. Which family of virus has 3 circular segments of RNA?
    Bunyaviridae – California encephalitis virus, La crosse virus, hantavirus
  46. Aedes mosquitoes are vector for ____ virus
    California encephalitis and La Crosse
  47. Chipmunks, squirrels are reservoirs for ____ virus
    California Encephalitis virus and La crosse
  48. California encephalitis and La crosse virus most often affect which age group?
    Children 5 to 18 years old
  49. A squirrel-chasing teenager from rural Iowa presents with altered mental status and multiple mosquito bites, think:
    California Encephalitis and La Crosse virus
  50. T/F: St. Louis Encephalitis virus is seen more in urban setting, while California encephalitis/ La Crosse is seen more in suburban and rural environments
  51. What is robovirus? Does it have an insect vector?
    • Rodent-borne virus – Lymphocytic Choriomeningitis Virus
    • NOT an arbovirus, no insect vector
  52. Lymphocytic Choriomeningitis virus is a ______ virus, of the _____ family.
    • Rodent-borne
    • Arenaviridae
  53. In Lymphocytic choriomeningitis virus, there is ____ WBC and ____ platelet count
    • Decreased
    • Decreased
  54. Vertical transmission can be seen in this virus:
    LCMV (lymphocytic choriomeningitis virus)
Card Set
Viral Meningitis and Encephalitis Microbiology
HemeOnc Final