FEBRILE CONDITIONS OF CNS

1
FEBRILE CONDITIONS OF CNS

• Jana Dánová
• 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,
• Onyong-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 ENCEPHALITISsource NIPH
10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
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

14
(No Transcript)
15
YELLOW FEVER

• Clinical symptoms an acute viral disease, sudden
  onset, fever, chills, headache, muscle pain,
  nausea, vomiting, the pulse slows (Fagets 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

16
(No Transcript)
17
(No Transcript)
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 MENINGITISsource NIPH
24
(No Transcript)
25
(No Transcript)
26
(No Transcript)
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

36
(No Transcript)
37
MENINGOCOCCAL MENINGITISsource 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

39
(No Transcript)
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