Microbiology

CNS Infection
Dr-Khaleel Abujhesha
Lara Masri / 180053

1442 / 4 / 10
The central nervous system (CNS) is the part of the body’s nervous system that
comprises the brain and spinal cord. It regulates most aspects of the body and mind.

CNS infection is an infectious process that affects the brain and/or spinal cord. A central
nervous system infection, particularly for children with compromised immune systems,
may be a life-threatening disease. This infections require prompt diagnosis and urgent
care by a specialist in infectious diseases. The most prevalent causes of CNS infections
include bacteria, fungi and viruses.
Bacterial Infection:

1. Bacterial Meningitis
2. Tuberculosis
3. Brain Abscess
4. Lysteriosis
5. Neurosyphilis

Viral Infection:

1. Viral Meningitis
2. Herpes simplex encephalitis
3. Rabies

Vungal Infection:

1. Cryptococcal meningitis

Parasitic Infection:

1. Neurocysticercosis
2. Toxoplasmosis

Bacterial meningitis

The most extreme form of meningitis is bacterial meningitis. It may contribute to death or
lifelong injury. There is an emergency for medical attention.
Meningitis, along with the cerebrospinal fluid, affects the meninges, the membranes
which surround the brain and spinal cord and protect the central nervous system (CNS).
Bacterial meningitis can be caused by a range of bacteria, including:

 Haemophilus influenzae (H. Influenzae) type B (Hib)

 Neisseria meningitides (N. Meningitides)
 Streptococcus pneumoniae (S. Pneumonia)
 Listeria monocytogenes (L. Monocytogenes
 Group B Streptococcus
Early symptoms

 Nausea and vomiting

 Fever
 Headache and a stiff neck
 Muscle pain
 Sensitivity to light
 Confusion
 Cold hands or feet and mottled skin
 In some cases, a rash that does not fade under pressure

Tuberculosis

Tuberculosis (TB) is a bacterial infection spread through inhaling tiny droplets from the
coughs or sneezes of an infected person.
It mainly affects the lungs, but it can affect any part of the body, including the tummy
(abdomen), glands, bones and nervous system.
Symptoms of TB

 a persistent cough that lasts more than 3 weeks and usually brings up phlegm,
which may be bloody
 weight loss
 night sweats
 high temperature
 tiredness and fatigue
 loss of appetite
 swellings in the neck
Tuberculosis Transmission
When someone who has TB coughs, sneezes, talks, laughs, or sings, they release tiny
droplets that contain the germs. If you breathe in these germs, you can get it.
TB isn’t easy to catch. You usually have to spend a long time around someone who has a
lot of the bacteria in their lungs. You’re most likely to catch it from co-workers, friends,
and family members.

Tuberculosis germs don’t thrive on surfaces. You can’t get it from shaking hands with
someone who has it or by sharing their food or drink.
Treatment
Many bacterial infections are treated with antibiotics for a week
or two, but TB is different. People diagnosed with active TB
disease generally have to take a combination of medications for
six to nine months. The full treatment course must be completed. Otherwise, it’s highly
likely a TB infection could come back. If TB does recur, it may be resistant to previous
medications and be much more difficult to treat .

Brain Abscess

Brain abscess is caused by intracranial inflammation with subsequent abscess formation.

In at least 15% of cases, the source of the infection is unknown.
Causes
Anaerobic and microaerophilic cocci and gram-negative and gram-
positive anaerobic bacilli are the predominate bacterial isolates. The predominant
organisms include: Staphylococcus aureus, aerobic and anaerobic streptococci
(especially Streptococcus intermedius)…
The symptoms and signs include the following:

 Low-grade or high-grade fever

 Persistent headache (often localized)
 Drowsiness
 Confusion
 Stupor
 General or focal seizures
 Nausea and vomiting
 Focal motor or sensory impairments
 Papilledema
 Ataxia
 Hemiparesis
 Neck stiffness

Lysteriosis

A severe infection caused by the germ Listeria monocytogenes is listeriosis. Since eating
infected food, people usually get sick with listeriosis. Pregnant
mothers, newborns, older adults and individuals with compromised
immune systems are mainly affected by the disease. It's unusual for
persons to get infected with Listeria infection in other classes.
Severe bloodstream (causing sepsis) or brain
(causing meningitis or encephalitis)
infections develop in some people with Listeria infections. Other
areas of the body, including muscles, joints, and locations in the
chest and abdomen, may also be infected by listeria infections.
Listeriosis is treated with antibiotics.
Neurosyphilis

Neurosyphilis refers to infection of the central nervous system in a patient

with syphilis. Meningitis is the most common neurological presentation in early
syphilis. Tertiary syphilis symptoms are exclusively
neurosyphilis, though neurosyphilis may occur at any
stage of infection.

Neurosyphilis causes and risk factors

Treponema pallidum is the bacterium that causes
syphilis and, subsequently, neurosyphilis.
Neurosyphilis tends to develop about 10 to 20 years
after the initial infection with the bacterium. Having
HIV and untreated syphilis are major risk factors for
neurosyphilis.
Treatment options for neurosyphilis

The antibiotic penicillin is used to treat syphilis and neurosyphilis. It may be injected or
taken orally. The usual regimen lasts 10 to 14 days. The antibiotics probenecid and
ceftriaxone are often used along with penicillin. Depending on your case, you may need
to stay in the hospital while being treated.

Viral Meningitis

The inflammation of the membranes (linings) that protect the brain and spinal cord is
viral meningitis. Meningitis can be caused by a number of viruses, including those which
cause gastroenteritis, measles, mumps, chicken pox and herpes.
Through breathing in virus particles that another contaminated human has sneezed or
coughed into the air, you will get viral meningitis. You can have get infected by handling
virus-contaminated surfaces or by contact with faeces). Viral meningitis can quickly
spread to the mouth from dirty hands, so good hand washing is very crucial for
protection.

Signs and symptoms

 fever
 severe headache
 drowsiness or confusion
 nausea (feeling sick) and vomiting
 neck stiffness
 sensitivity to light.
Herpes simplex encephalitis

Herpes simplex encephalitis (HSE) is a rare neurological disorder characterized by

inflammation of the brain. Herpes simplex encephalitis is caused by a virus known as
herpes simplex virus (HSV).

Signs & Symptoms

Symptoms associated with herpes simplex encephalitis

usually develop over several days, often without warning.

Early symptoms include headaches, fevers, and seizures.

Additional symptoms include drowsiness with general
weakness (stupor), and confusion or disorientation.

After the initial symptoms appear, affected individuals may develop speech abnormalities
such as a diminished ability to communicate by speech, writing, and/or signs (aphasia),
absence of the sense of smell (anosmia), and memory loss. In some cases, behavioral
changes such as hyperactivity or psychotic episodes occur. Some symptoms of herpes
simplex encephalitis may mimic meningitis. These symptoms may include a stiff neck,
altered reflexes, confusion, convulsions, and paralysis.

Rabies

Rabies is a deadly virus spread to people from the saliva of

infected animals. The rabies virus is usually transmitted
through a bite.

Once a person begins showing signs and symptoms of rabies,

the disease nearly always causes death. For this reason,
anyone who may have a risk of contracting rabies should
receive rabies vaccinations for protection.
Cryptococcal meningitis

Cryptococcal meningitis is a serious infection of the lining of the

brain and spinal cord caused by this fungus. It is rare for a healthy
person to develop cryptococcal meningitis. Most people who
develop cryptococcal meningitis have a weakened immune system
caused by an underlying illness, for example, HIV or cirrhosis of
the liver.

Symptoms
Symptoms of cryptococcal meningitis often develop gradually, within a few days to
weeks of exposure to the fungus.
 headache
 nausea and vomiting
 fatigue
 confusion or hallucinations
 personality changes
 sensitivity to light
 fever
 stiff neck
 blurred vision

It may be difficult for someone to tell if they have symptoms of cryptococcal meningitis.
Many of the symptoms may be similar to the side effects of a medication they may be
taking to treat an underlying condition.
If left untreated, cryptococcal meningitis can lead to more serious symptoms, including:
fluid on the brain
coma
hearing loss

Neurocysticercosis

Neurocysticercosis is a specific form of the infectious parasitic disease cysticercosis that

is caused by the infection with Taenia solium, a tapeworm found in pigs.
Neurocysticercosis occurs when cysts formed by the infection take hold within the brain,
causing neurologic syndromes such as epileptic seizures. It is a common cause of seizures
worldwide.
symptoms
1. seizures
2. headaches
3. blindness
4. meningitis
 5. dementia
Diagnosis
Neurocysticerosis is diagnosed by computed tomography
(CT) scan. Diagnosis may be confirmed by detection of antibodies
against cysticerci in CSF or serum through ELISA or imunoblotting
techniques.
Treatment
Treatment of neurocysticerosis includes
o epileptic therapy
o a long-course medication of praziquantel (PZQ) and/or albendazole
o Steroid therapy may be necessary to minimize the inflammatory reaction to dying
cysticerci
o Surgical removal of brain cysts may be necessary e.g. in cases of large
parenchymal cysts, intraventricular cysts or hydrocephalus

Toxoplasmosis

Toxoplasmosis is a disease that results from infection with the Toxoplasma gondii
parasite, one of the world's most common parasites. Infection usually occurs by eating
undercooked contaminated meat, exposure from infected cat feces, or mother-to-child
transmission during pregnancy.
Toxoplasmosis may cause flu-like symptoms in some people, but most people affected
never develop signs and symptoms. For infants born to infected mothers and for people
with weakened immune systems, toxoplasmosis may cause serious complications.

Symptoms

Most healthy people who are infected with toxoplasmosis have no signs or symptoms and
aren't aware that they're infected. Some people, however, develop signs and symptoms
similar to those of the flu, including:

 Body aches
 Swollen lymph nodes
 Headache
 Fever
 Fatigue

References

1. Healthline
2. Wikipedia
3. Medscape
4. Schuchat, A., Robinson, K., Wenger, J. D., Harrison, L. H., Farley, M., Reingold, A. L.,
... & Perkins, B. A. (1997). Bacterial meningitis in the United States in 1995. New
England journal of medicine, 337(14), 970-976.
5. Kennedy, P. G. E., and A. Chaudhuri. "Herpes simplex encephalitis." (2002): 237-238.
6. Rupprecht, Charles E., Cathleen A. Hanlon, and Thiravat Hemachudha. "Rabies re-
examined." The Lancet infectious diseases 2.6 (2002): 327-343.