DAMS VISUAL TREAT-2020

INFECTIOUS DISEASES
(CVS AND CNS)
Dr. Mamta Jawa
#MJMICRO
MBBS, MD Microbiology
Infectious Diseases Specialist
DAMS FACULTY
 CASE-1
Within 2 weeks of eating bear meat in Uttarakhand, a man
develops intense vomiting and diarrhoea, followed shortly by
a fever of 103°F, throbbing headache and achy muscles. After
a few more days of these unrelenting symptoms, he seeks
medical attention. His white blood cell count at presentation
is 16,100/mm3, with 22% eosinophils. Creatine kinase level in
serum was elevated. What is the diagnosis?
 CASE-1
Within 2 weeks of eating bear meat in Uttarakhand, a man
develops intense vomiting and diarrhoea, followed shortly by
a fever of 103°F, throbbing headache and achy muscles. After
a few more days of these unrelenting symptoms, he seeks
medical attention. His white blood cell count at presentation
is 16,100/mm3, with 22% eosinophils. Creatine kinase level in
serum was elevated. What is the diagnosis?
 ANSWER
TRICHINELLA SPIRALIS
INFECTION
 OPTIMUM HOST AND
PRINCIPAL RESERVOIR
OTHER HOSTS
 CASE-2
A 67-year-old man developed an insidious onset of fever,
chills, and night sweats. Over the course of a week or so
he became increasingly weak and short of breath. A heart
murmur was heard on auscultation. Blood tests revealed
an elevated erythrocyte sedimentation rate. Valvular
vegetations were seen on transoesophageal
echocardiography. What is the diagnosis?
 CASE-2
A 67-year-old man developed an insidious onset of fever,
chills, and night sweats. Over the course of a week or so
he became increasingly weak and short of breath. A heart
murmur was heard on auscultation. Blood tests revealed
an elevated erythrocyte sedimentation rate. Valvular
vegetations were seen on transoesophageal
echocardiography. What is the diagnosis?
 ANSWER
Subacute endocarditis by Viridans
Streptococci
 Gram stain of cultured
blood from a patient with
enterococcal bacterAemia
 CASE-3
A 65-year-old man, a South American immigrant, presents with
biventricular heart failure with peripheral oedema,
hepatosplenomegaly, and pulmonary congestion. Global heart
enlargement is seen on chest radiography. Electrocardiography
reveals right bundle- branch block and left anterior fascicular
block. Serum collected from the patient and run on ELISA detects
antibodies to an agent transmitted by the bite of reduviid bugs.
What is the aetiology of this man’s disease?
 CASE-3
A 65-year-old man, a South American immigrant, presents with
biventricular heart failure with peripheral oedema,
hepatosplenomegaly, and pulmonary congestion. Global heart
enlargement is seen on chest radiography. Electrocardiography
reveals right bundle- branch block and left anterior fascicular block.
Serum collected from the patient and run on ELISA detects
antibodies to an agent transmitted by the bite of reduviid bugs. What
is the aetiology of this man’s disease?
 ANSWER
Trypanosoma cruzi infection
ROMANA’S SIGN
Scanning electron
micrograph of a
trypomastigote of
T. cruzi
 CASE-4

A wildlife photographer travels to a big game

park in East Africa and returns home with
intermittent fever and a painless chancre like
sore on his neck. A Giemsa-stained blood
smear is positive for a flagellated microbe
(shown in the image). What is the diagnosis?
 CASE-4

A wildlife photographer travels to a big game

park in East Africa and returns home with
intermittent fever and a painless chancre like
sore on his neck. A Giemsa-stained blood
smear is positive for a flagellated microbe
(shown in the image). What is the diagnosis?
 ANSWER

SLEEPING SICKNESS
 CASE-5
A 45-year-old woman complains that her right arm has become
increasingly weak during the past few days. This morning, she
had a generalized seizure. She recently finished a course of cancer
chemotherapy. Magnetic resonance imaging (MRI) of the brain
reveals a lesion resembling an abscess. Brain biopsy shows gram-
positive rods in long filaments. Organism is weakly acid-fast.
 CASE-5
A 45-year-old woman complains that her right arm has become
increasingly weak during the past few days. This morning, she had a
generalized seizure. She recently finished a course of cancer
chemotherapy. Magnetic resonance imaging (MRI) of the brain
reveals a lesion resembling an abscess. Brain biopsy shows gram-
positive rods in long filaments. Organism is weakly acid-fast.
GRAM STAIN OF ACID FAST STAIN OF
NOCARDIA NOCARDIA
COLONIES OF NOCARDIA
 CASE-6
A 34-year-old woman in her third trimester of pregnancy delivers a
stillborn infant. Her history is significant for a febrile illness with
headache, back pain, and diarrhoea prior to going into premature
labour. A Gram-positive motile coccobacillus was isolated from
blood of the mother and the infant cultured at 4 °C. How did the
mother acquire this infection?
 CASE-6
A 34-year-old woman in her third trimester of pregnancy delivers a
stillborn infant. Her history is significant for a febrile illness with
headache, back pain, and diarrhoea prior to going into premature
labour. A Gram-positive motile coccobacillus was isolated from
blood of the mother and the infant cultured at 4 °C. How did the
mother acquire this infection?
 ANSWER
Intake of contaminated food
 CASE-7
A 14-year-old female medical student presented with a
febrile headache, vomiting. Physical examination revealed a
petechial rash on the skin. Gram stain of the CSF revealed
the presence of Gram-negative diplococci and culture
suggested a strict aerobe that fermented glucose and
maltose. Capsule antigens were also detected by serology.
Which is most likely the causative agent of the disease?
 CASE-7
A 14-year-old female medical student presented with a
febrile headache, vomiting. Physical examination revealed a
petechial rash on the skin. Gram stain of the CSF revealed
the presence of Gram-negative diplococci and culture
suggested a strict aerobe that fermented glucose and
maltose. Capsule antigens were also detected by serology.
Which is most likely the causative agent of the disease?
 ANSWER
Meningitis by Neisseria
meningitidis
Neisseria meningitidis in
cerebrospinal fluid
COLONIES OF MENINGOCOCCUS ON
CHOCOLATE AGAR
Skin lesions in a patient with
meningococcaemia
 CASE-8
A 47-year-old AIDS patient with a CD4 cell count of 95/cmm presents
with an insidious onset of severe headache and fever for the past 3
weeks. In the past few days, he had become mildly confused and
developed diplopia. Papilledema is seen on physical exam. Dilated
Virchow robin spaces are seen on MRI. Cerebral spinal fluid (CSF)
showed 150 mononuclear cells/cmm, mild elevation of protein, and
decreased glucose. An India ink stain of the CSF was negative;
however, capsular polysaccharide antigens, found in the CSF, allowed
for a definitive diagnosis. What is the aetiology of this man’s infection?
 CASE-8
A 47-year-old AIDS patient with a CD4 cell count of 95/cmm presents
with an insidious onset of severe headache and fever for the past 3
weeks. In the past few days, he had become mildly confused and
developed diplopia. Papilledema is seen on physical exam. Dilated
Virchow-robin spaces are seen on MRI. Cerebral spinal fluid (CSF)
showed 150 mononuclear cells/cmm, mild elevation of protein, and
decreased glucose. An India ink stain of the CSF was negative;
however, capsular polysaccharide antigens, found in the CSF, allowed
for a definitive diagnosis. What is the aetiology of this man’s infection?
 ANSWER
Cryptococcal Meningitis
 CASE-9
In July, a previously healthy 12-year-old girl from Bihar, who enjoys swimming
in farm ponds is evaluated for meningitis. Gram stain of the CSF
demonstrates no bacteria or yeast; however, there are indications of a PMN
leucocytosis. A wet mount shows motile cells that resemble WBCs.
Intravenous ceftriaxone therapy is initiated, but within 24 hours she slips into
a coma. CT shows brain swelling or oedema. Unfortunately, she is
unresponsive to anticonvulsant drugs and dies the following day. Based on the
available information, which diagnosis is the most plausible?
 CASE-9
In July, a previously healthy 12-year-old girl from Bihar, who enjoys
swimming in farm ponds is evaluated for meningitis. Gram stain of
the CSF demonstrates no bacteria or yeast; however, there are
indications of a PMN leucocytosis. A wet mount shows motile cells
that resemble WBCs. Intravenous ceftriaxone therapy is initiated, but
within 24 hours she slips into a coma. CT shows brain swelling or
oedema. Unfortunately, she is unresponsive to anticonvulsant drugs
and dies the following day. Based on the available information, which
diagnosis is the most plausible?
 ANSWER
Primary Amoebic
Meningoencephalitis (PAM) by
Naegleria fowleri
 Naegleria fowleri under
Phase Contrast Microscope
GIEMSA-WRIGHT STAIN OF CSF
 Scanning electronic
micrograph (SEM) of N. fowleri
 CASE-10
A 9-year-old patient—a daughter of a farm labourer—experiences
onset of epileptic seizures. A few pea-sized lipoma like lesions are
undeniably palpable in her subcutaneous tissue of her torso and
limbs. Excision of two of these lesions reveals parasites (shown in
the image). These parasites are active when placed in warm saline.
MRI demonstrates similar lesions in the CNS, and an immunoblot
assay is positive for the suspected parasitic disease. Of interest is
the discovery of taeniid ova in the stool of her father. Which
parasite is most likely the cause of the child’s illness?
 CASE-10
A 9-year-old patient—a daughter of a farm labourer—
experiences onset of epileptic seizures. A few pea-sized lipoma
like lesions are undeniably palpable in her subcutaneous tissue
of her torso and limbs. Excision of two of these lesions reveals
parasites (shown in the image). These parasites are active when
placed in warm saline. MRI demonstrates similar lesions in the
CNS, and an immunoblot assay is positive for the suspected
parasitic disease. Of interest is the discovery of taeniid ova in
the stool of her father. Which parasite is most likely the cause
of the child’s illness?
 ANSWER

Taenia solium
 Scolex of
Taenia solium
Egg of Taenia spp. in
saline mount
 Scolex of
Taenia saginata
Cysticercus cellulosae
(surgically removed)
Cysticercus in the eye
Gravid proglottid of
Taenia solium