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FEBRILE CONDITIONS OF CNS

FEBRILE CONDITIONS OF CNS. EtiologyViralBacterialProtozoalMetazoalFungalPostvaccinal reactionPostinfectional reaction . GROUPS OF INDIVIDUALS MORE SUSCEPTIBLE TO CNS INFECTIONS. patients with neural tube defectsvery young and very old individualsalcoholicspatients with CNS trauma or after neurosurgical interventionpatients who are immunocompromised for any reasonpatients with cardiac and pulmonary anomalies.

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FEBRILE CONDITIONS OF CNS

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    1. FEBRILE CONDITIONS OF CNS Jana Dαnovα Dept.of Epidemiology

    2. FEBRILE CONDITIONS OF CNS Etiology Viral Bacterial Protozoal Metazoal Fungal Postvaccinal reaction Postinfectional reaction

    3. GROUPS OF INDIVIDUALS MORE SUSCEPTIBLE TO CNS INFECTIONS patients with neural tube defects very young and very old individuals alcoholics patients with CNS trauma or after neurosurgical intervention patients who are immunocompromised for any reason patients with cardiac and pulmonary anomalies

    4. VIRAL MENINGITIS (SEROUS, ASEPTIC, NONBACTERIAL) Differential diagnosis: - some nonviral agents may mimic aseptic meningitis such as tuberculous and cryptococcal meningitis, meningitis coused by other fungi, cerbrovascular syphilis and lymhogranuloma venereum - postinfectious and postvaccinal reactions - leptospirosis, listeriosis, lymphocytic choriomeningitis Specific identification: - dg serologic and isolation techniques (half of cases) - viral agents may be isolated in early stages from throat wastings and stool, from CSF, blood

    5. VIRAL MENINGITIS + MENINGOENCEPHALITIS ETIOLOGY: Enteroviruses – Polio, Coxsackie, Echo, Enteroviruses 68 -71 Arboviruses – Togaviruses, Flaviviruses, Bunyaviruses Rhabdoviruses – Lyssavirus Herpesviruses – HSV1, HSV2, Varicella-zoster, Herpes simiae, EBV, Cytomegalovirus

    6. ENCEPHALITIS + ENCEPHALOMYELITIS ETIOLOGY: Viruses- important organisms - Polioviruses, Lyssavirus, viruses caused Tick-borne enc., Equine encephalitis, St.Louis encephalitis, West Nile encephalitis Rickettsia – Typhus exanthematicus, Rocky mountains spotted fever Protozoa – Toxoplasma gondii Bacterial invasion of CNS typically results in abscess formation not to encephalitis or encephalomyelitis

    7. ARTHROPOD-BORNE VIRAL DISEASES ARTHROPOD-BORNE VIRAL ENCEPHALITIS Mosquito-borne - Eastern equine enc., Western equine enc., Japanese enc., St.Louis enc., West Nile enc., Murray Valley enc. Tick-borne - Central european tick-borne enc., Spring-summer enc., Louping ill ARTHROPOD-BORNE VIRAL FEVERS Mosquito-borne Venezuelan equine enc., Chikungunya, O΄nyong-nyong Tick-borne - Colorado tick fever ARTHROPOD-BORNE VIRAL HEMORRHAGIC FEVERS Mosquito borne - dengue, yellow fever Tick-borne - omsk hemorrhagic fever

    8. CENTRAL EUROPEAN TICK-BORNE ENCEPHALITIS Clinical symptoms: diphasic meningoencephalitis first symptoms are not typical – influenza like second part after several days of recovery – meningeal symptoms Etiologic agent: virus of central european TBE (Flavivirus) Reservoir: rodents, ticks Mode of transmission: bite of infective tick, consumption of milk from certain infected animals Incubation period: 7 – 21 days, commonly 14 days

    9. TICK-BORNE ENCEPHALITIS source NIPH

    13. DENGUE FEVER Clinical symptoms: an acute febrile viral disease, headache, myalgia, arthralgia, retroorbital pain dengue hemorrhagic fever – bleeding manifestations and involvement of organs, maculopapular rash Etiologic agent: dengue virus types 1, 2, 3, 4 Reservoir: man, also mosquito Mode of transmission: by the bite of infective mosquitoes Aedes aegypti Incubation period: 3 – 14 days commonly 4 – 7 days

    15. YELLOW FEVER Clinical symptoms: an acute viral disease, sudden onset, fever, chills, headache, muscle pain, nausea, vomiting, the pulse slows (Faget΄s sign), hemorrhagic symptoms – epistaxis, buccal bleading, hematemesis (vomito negro), melena, jaundice is present in the second part of disease Etiologic agent: virus of yellow fever (flavivirus) Reservoir: in urban areas – man and Aedes aegypti in forest areas mainly monkeys, forest mosquitoes Mode of transmission: bite of infective mosquitoes Incubation period: 3 – 6 days

    18. VIRAL MENINGITIS + MENINGOENCEPHALITIS accompaned some infectious diseases Measles Mumps Rubella Influenza Herpes simplex 1, 2 Varicella- zoster Adenoviruses diseases Lymphocytic choriomeningitis

    19. ENTEROVIRUSES Polioviruses 1, 2, 3 Coxsackie group A (23 serotypes) group B (6 serotypes) Echoviruses (30 serotypes) Enteroviruses 70, 71 Any of these types cause clinicaly encephalitis, meningitis, meningoencephalitis All 3 types polioviruses, coxsackie group B - 1 –6, group A – 2, 3, 4, 7, 9, 10, echoviruses – types 2, 5, 6, 7, 9, 10, 11, 14, 18, 30

    20. POLIOMYELITIS Acute viral infection, more than 90% is inapparent, paralysis occurs in less than 1%, aseptic meningitis in about 1% Reservoir – man only Mode of transmission – direct- person with apparent or inapparent infection indirect – fecally contaminated materials (watter, milk etc.) Incubation period – 7 – 14 days (3 – 35) Period of communicability – virus persist 1 week in throat and 3 – 6 weeks in feces Preventive measures - immunization

    21. COXSACKIEVIRUSES Clinical symptoms – serous meningitis, enteroviral vesicular pharyngitis (herpangina) vesicular stomatitis with exanthem, lymphonodular pharyngitis Serous meningitis - group B (types 1 – 6) caused one third of these diseases, group A (types 2, 3, 4, 7, 9, 10) Vesicular pharyngitis herpangina group A (1-6, 10 and 22) Vesicular stomatitis – group A 16(most) 4, 5, 9, 10 Lymphonodular pharyngitis – group A type 10

    22. ECHOVIRUSES 30 types Clinical manifestation similar as coxsackieviruses Echoviruses types 2, 5, 6, 7,9(most) 10, 11, 14, 18, 30 – caused about one half of serous menigitis Seasonal increase in late summer and early autumn Winter outbreaks – mainly due to mumps Myocarditis, pericarditis Encephalohepatomyocarditis (newborns) – Echovirus 11

    23. ASEPTIC –SEROUS MENINGITIS source NIPH

    27. AFRICAN HEMORRHAGIC FEVER MARBURG HEMORRHAGIC FEVER EBOLA HEMORRHAGIC FEVER systemic viral febrile disease, sudden onset with fever, headache, pharyngitis, followed by vomiting, diarrhea, maculopapular rash, renal and hepatic involvement, hemorrhagic diathesis case fatality rate Marburg 25% Ebola 50 – 90%

    28. AFRICAN HEMORRHAGIC FEVER Infectious agent: viruses members of Filoviridae Marburg + Ebola Occurence: Marburg in 1967 Germany and Yugoslavia 31 persons were infected following exposure to African green monkeys from Uganda Ebola first recognized in western equatorial province of Sudan and Zaire in 1976 Mode of transmission: person to person, contact with infected blood, secretion Incubation period: 9 days Marburg, 2 – 21 days Ebola

    29. LASSA FEVER an acute viral disease 1 – 4 weeks duration, onset is gradual with fever, headache, nausea, vomiting, diarrhea, myalgia, hypotension or shock, hemorrhage, encephalopathy Infectious agent: Lassa virus – Arenavirus Occurence: West Africa Reservoir: wild rodents Mode of transmission: direct or indirect contact with excreta of infected rodents, person to person and laboratory infection occurs in hospital environment Incubation period: 6 – 21 days

    30. RABIES = LYSSA an acute fatal viral encephalomyelitis - case fatality rate 100% death is due to respiratory paralysis Infectious agent: Rabies virus, Rhabdovirus genus Lyssavirus Occurence: worldwide, estimated 40 000 deaths a year, almost in developing countries Reservoir: foxes, dogs, coyotes, wolves, bats Mode of transmission: by a bite or scratch of animal (organ transplants) Incubation period: usually 2-8 weeks (5 days – 1 year or more)

    31. HANTAVIRAL DISEASES Hantaviruses infect rodents worldwide, several species have been known for some time to infect humans with varying severity – increased vascular permeability, hypotensive shock, hemorrhagic manifestations HEMORRHAGIC FEVER WITH RENAL SYNDROME HEMORRHAGIC FEVER WITH PULMONARY SYNDROM

    32. HANTAVIRAL HAEMORRHAGIC FEVER WITH PULMONARY SYNDROM an acute zoonotic viral disease- fever, myalgia, GI complaints respiratory distress, hypotension Infectious agent: multiple Hantaviruses (Sin Nombre, Bayou) Occurence: first described summer 1993 North and South America Reservoir: deer mouse and other rodents Mode of transmission: aerosol transmission from rodents excreta, indoor exposure in poorly ventilated homes Incubation period: 2 weeks ( few days – 6 weeks)

    33. HANTAVIRAL HEMORRHAGIC FEVER WITH RENAL SYNDROME an acute zoonotic viral disese characterized by fever, back pain, hemorrhagic manifestations and renal involvement Infectious agent: Hantanviruses, Hantaan virus(Asia), Dobrava (former Yugosl.) Puumala (Europe) Occurence: worldwide, more comon among rural population, spring, early summer Reservoir: field rodents Mode of transmission: aerosol transmission from rodents, humans are accidental host Incubation period: few days – 2 months, aver. 2 – 4 weeks

    34. BACTERIAL MENINGITIS NEONATE E.coli MONTHS to 5 YEARS H.influenzae (30-40%) N.meningitidis (30%) Str.pneumoniae (10%) 5 to 50 YEARS H.influenzae (10%) N.meningitidis (30%) Str.pneumoniae (10%) Over 50 YEARS N.meningitidis (10%) Str.pneumoniae (40 -60%)

    35. MENINGOCOCCAL MENINGITIS acute bacterial disease, sudden onset, fever, headache, nausea, vomiting, petechial rash case fatality 5 – 15% up to 5-10% of population asymptomatic carriers Infection agent - Neisseria meningitidis (serol.groups A, B, C, D, X, Y, W135 etc.) 80% of dis. caused by type A, B, C higher incidence occurs during winter and spring Mode of transmission – direct contact, including respiratory droplets from nose and throat of infected people (asymptomatic carriage) Preventive measures – meningococcal vaccine

    37. MENINGOCOCCAL MENINGITIS source NIPH

    38. HAEMOPHILUS MENINGITIS The most common bacterial meningitis in children 2 months to 5 years of age, occurence worldwide Infection agent – Haemophilus influenzae type b Mode of transmission – droplet infection Incubation period – 2 – 4 days Period of communicabilty as long as the organisms are present, 24 –48 hours after ATB therapy com.stops Preventive measures – vaccination

    40. PNEUMOCOCCAL MENINGITIS High case- fatality rate The onset is usually sudden with high fever, lethargy, meningeal irritation Occurence - young children and elderly population Infection agent - Streptococcus pneumoniae more than 80 serotypes Clinical picture caused by Streptococcus pneumoniae sinusitis, otitis, mastoiditis

    41. TETANUS an acute disease inducted by an exotoxin of the tetanus bacilus, which grows anaerobically at the site of an injury Infectious agent: Clostridium tetani Occurence: worldwide, sporadic in industrial countries Reservoir: intestines of horses and other animals Mode of transmission: tetanus spores come in to the human body through a puncture wound (soil, street dust, animal and human feces) Incubation period: 3 – 21 days, average 10 days

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