INFECTIOUS

DISEASES

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 INFECTIOUS DISEASES OF
THE CNS
Important ANATOMIC FEATURE of the CNS that
affects the pathophysiology of INFECTIONS is
that:

The BRAIN is surrounded by

MENINGES & bathed in CSF

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 CNS INFECTIOUS DISEASES
CSF PROVIDES BOTH:
1. Culture Medium for the infecting organism
2. Rapid means of disseminating infection
throughout the system once the outer
defenses have been breached

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 MENINGITIS
Inflammatory state of the:

leptomeninges

subarachnoid space

It is usually the result of infection

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 MENINGITIS
CHEMICAL MENINGITIS
caused by release or insertion
of irritative substance into the
CSF
Pleocytosis (Increase # of
PMNs)
Increased CHON
Normal sugar content
Organism can neither be seen
nor cultured
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 MENINGITIS
CARCINOMATOUS MENINGITIS

- Infiltration of the subarachnoid

space by tumor cells and eventually

spread to the entire neuraxis

- no inflammatory response

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 INFECTIOUS MENINGITIS
CLASSIFICATION

ACUTE PYOGENIC - Usually Bacterial

ACUTE LYMPHOCYTIC - Usually Viral

CHRONIC MENINGITIS - Bacterial or Fungal

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 ACUTE PYOGENIC MENINGITIS
CAUSATIVE ORGANISM

1. E. coli: Neonate w/ neural tube defect

2. H. influenza: Infants & Children

3. Neisseria meningitides
adolescents & young adults
most common cause: epidemic meningitis
Oral commensal & transmitted through the air

4. Pneumococcus:
very young or the very old and following trauma

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 ACUTE PYOGENIC MENINGITIS
GROSS:
cloudy or frankly purulent CSF
Location of the exudate varies:
H. influenza basal
Pneumococcal over the cerebral
convexities near the sagittal sinus
Fulminant meningitis extend into the
ventricles

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 ACUTE PYOGENIC MENINGITIS
MICRO:
PMNs fill the entire subarachnoid space & around
the leptomeningeal blood vessels (less severe
cases)

Fulminant inflammatory cells infiltrate the walls

of the leptomeningeal veins that can lead to
venous occlusion hemorrhagic infarction of the
underlying brain

Arteritis uncommon unless meningitis is

prolonged
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 ACUTE PYOGENIC MENINGITIS
CLINICAL MANIFESTATIONS:
1. General signs of infection
2. Signs of meningeal irritation
headache
photophobia
irritability
clouding of consciousness
neck stiffness

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 ACUTE PYOGENIC MENINGITIS

LABORATORY DIAGNOSIS:

SPINAL TAP
Cloudy or purulent CSF
Increased pressure
90,000 / mm3 PMNs
Increased CHON level
Markedly reduced sugar
content
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 ACUTE PYOGENIC MENINGITIS
LAB DIAGNOSIS
CSF SMEAR Increase
number of WBC (smear)
CSF CULTURE ID causative
org

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 ACUTE PYOGENIC MENINGITIS
FATAL
RECOVERY: Fibroblastic
proliferation in the meninges that
produced adhesive arachnoiditis
If obliteration sufficiently impede
CSF flow
HYDROCEPHALUS
Pneumococcal meningitis

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 ACUTE PYOGENIC MENINGITIS

HYDOCEPHALUS due to Pneumococcal

Meningitis:
Large quantities of the capsular
polysaccharide of the organism
produce glutinous exudate that
encourages arachnoid fibrosis
obliteration impede CSF
circulation

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 ACUTE PYOGENIC MENINGITIS

MENINGITIS IN IMMUNOSUPPRESSED
Klebsiella or anaerobic organism

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 ACUTE PYOGENIC MENINGITIS

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 ACUTE PYOGENIC MENINGITIS

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 ACUTE PYOGENIC MENINGITIS

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 BACTERIAL MENINGITIS

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 BACTERIAL MENINGITIS

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 BACTERIAL MENINGITIS

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 BACTERIAL MENINGITIS

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 ACUTE LYMPHOCYTIC
MENINGITIS
CAUSATIVE AGENTS (viruses)
1. Mumps
2. ECHO viruses
3. Coxsackie virus
4. Epstein-Barr virus
5. Herpes simplex II

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 ACUTE LYMPHOCYTIC
MENINGITIS

CLINICAL MANIFESTATION

- Same as bacterial meningitis with meningeal

irritation but is LESS FUMINANT & the CSF
findings are markedly different
Self-limiting

No life-threatening complications

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 ACUTE LYMPHOCYTIC MENINGITIS

LABORATORY DIAGNOSIS
1. Lymphocytic Pleocytosis
2. CHON elevation is
moderate
3. Sugar content is nearly
always normal

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 ACUTE LYMPHOCYTIC MENINGITIS
(VIRAL MENINGITIS)

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 ACUTE LYMPHOCYTIC MENINGITIS

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 ACUTE LYMPHOCYTIC
MENINGITIS

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 VIRAL MENINGITIS

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 VIRAL MENINGITIS

Typical owl-eye intranuclear inclusions are seen in

cytomegalovirus encephalitis together with distention
of the
Cytoplasm
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 CHRONIC
MENINGITIS
CAUSATIVE AGENTS
Mycobacterium TB
Treponema pallidum (Syphilis)
Brucella spp
Fungi
Coccidioisis
Candida
Cryptococcus neoformans

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 TB MENINGITIS
GROSS:
Subarachnoid space contains gelatinous or
fibrinous exudate that is most obvious
around the base of the brain extending to
the lateral sulci
Focal densities visible along the course of
the cerebral vessels

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 TB MENINGITIS
MICRO:
Exudate consists of
lymphocytes, plasma cells,
macrophages & fibroblasts

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 TB MENINGITIS
MICRO:
Focal densities are tubercles with giant
cells & caseation necrosis
Arteries in the subarachnoid space may
show obliterative endarteritis with
inflammatory cells in their walls and
marked intimal thickening
Fibrous adhesive arachnoiditis around the
base of the brain

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 TB MENINGITIS
CLINICAL MANIFESTATION
headache
malaise
mental confusion
vomiting

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 TB MENINGITIS

COMPLICATIONS
Hydrocephalus
Obliterative endarteritis causing
arterial occlusion & infarction of the
underlying brain
Cranial nerves may be affected

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 TB MENINGITIS
LABORATORY DIAGNOSIS
Moderate CSF either entire
mononuclear pleocytosis or
mixture of PMNs and
mononuclears = 1000 cells per
mm3
CHON level is elevated
sugar is moderately reduced /
normal
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 TB MENINGITIS

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 TB MENINGITIS

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 TB MENINGITIS

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 TB MENINGITIS

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 CRYPTOCOCCAL MENINGITIS
Frequent in debilitated or immunocompromised
hosts

Trivial inflammatory response despite the large

number of organism
GROSS:
Found in the subarachnoid space
Distends the Virchow-Robin spaces producing
characteristic soap bubbles

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 CRYPTOCOCCAL MENINGITIS

CLINICAL MANIFESTATION
Course is fulminant & fatal in 2
weeks
indolent over months or years

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 CRYPTOCOCCAL MENINGITIS
LABORATORY DIAGNOSIS
Mucoid encapsulated yeasts can be
visualized in the CSF by: india ink

INDOLENT CASES:

- Few cells

- Very high CHON - > 500 mg/dl

- Pathognomonic cryptococcal antigen

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 CRYPTOCOCCAL MENINGITIS

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 CRYPTOCOCCAL MENINGITIS

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 Wassalam, Wr Wbr,
HAVE A NICE DAY!

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