NERVOUS SYSTEM

INFECTIONS
NICO ANGELO SOLON, RMT
DEFINITION OF TERMS

• Encephalitis: brain inflammation

• Encephamyelitis: brain and spinal inflammation
• Meningitis: inflammation of the meninges
• Meningoencephalitis: inflammation of brain and meninges
• Myelitis: inflammation of spinal cord.
• Bacterial infections • Viral Encephalitis
• Listeriosis • Fungal Infections:
• Tetanus • Cryptococcal Meningitis
• Viral Infections
• Lymphocytic choriomeningitis
• Poliomyelitis
• Rabies
• Viral Meningitis
BACTERIAL INFECTION

• Listeriosis
• Tetanus
LISTERIOSIS

• Generally a mild febrile illness in the healthy, immunocompetent

individuals but is manifested as meningoencephalitis and/or
septicemia in newborns and the elderly and/or
immunosuppressed adults with fever, intense headache, nausea,
vomiting, delirium, coma, occasionally collapse, shock and
death. Also causes spontaneous abortion in women.
• Pathogen: Listeria monocytogenes a gram positive coccobacillus
• Reservoir and Mode of Transmission: Ingestion of contaminated
milk, soft cheese or vegetables; may be transmitted from mother
to fetus in utero or during passage through an infected birth
canal. Found in oil, water, mud, silage, infected mammals,
humans and soft cheese.
TETANUS

• Acute neuromuscular disease induced by a bacterial exotoxin

called tetanospasmin with painful muscular contractions,
primarily of the masseter and neck muscles, spasms and rigid
paralysis.
• Pathogenic agent: Clostridium tetani (motile, Gram positive
anaerobic spore-forming bacillus)
• Reservoir and mode of transmission: Introduced by puncture
wound and needlestick contamination. Found in soild
contaminated with human, horse or other animal feces.
• Laboratory diagnosis: Diagnosis of tetanus is made on clinical
and epidemiological grounds. Attempts to isolate C. tetani from
wounds or demonstrate antibody production are successful.
VIRAL INFECTIONS

• Lymphocytic choriomeningitis
• Poliomyelitis
• Rabies
• Viral Meningitis
• Viral Encephalitis
LYMPHOCYTIC CHORIOMENINGITIS

• Rodent borne viral disease that presents as aseptic meningitis, encephalitis or

meningoencephalitis. Some patients develop fever, malaise, suppressed appetite, muscle
aches, headache, nausea, vomiting, sore throat, coughing, joint pain, chest pain and
salivary gland pain. Possible complications include deafness and temporary or permanent
neurological damage.
• Pathogen: Lymphocytic choriomeningitis virus (Arenaviridiae family)
• Reservoir and mode of transmission: Exposure to mouse urine, droppings, saliva.
• Lab diagnosis: Immunodiagnostic procedures and cell culture
POLIOMYELITIS

• In most patients has minor illness with fever, malaise,

headache, nausea and vomiting. 1% progresses to severe
muscle pain, stiffness in the neck and back with or without
paralysis. Major illness is likely to occur in older children and
adults. Vaccination is available since the 1950s.
• Pathogen: Poliovirus (RNA virus in the Picornaviridiae family)
• Reservoir and mode of transmission: infected humans by fecal-
oral route and by throat secretions.
• Laboratory diagnosis: Isolation of poliovirus from stool
sample, cerebrospinal fluid, oropharyngeal secretions using cell
culture techniques or by immunodiagnostic or molecular
diagnostic procedures.
RABIES

• Fatal acute viral encephalomyelitis of mammals with mental

depression, restlessness, headache, fever, malaise, paralysis,
salivation, spasms of throat muscles, induced by a slight breeze or
drinking water, convulsions and death caused by respiratory failure.
Paralysis usually starts from the lower legs moving upward through
the body.
• Pathogen: Rhabdovirus (bullet shaped enveloped RNA virus in the
family Rhabdoviridiae
• Mode of transmission: Bite of a rabid mammal (dogs, foxes, coyote,
wolves, jackals, skunks raccoons, mongooses and bats)
• Laboratory diagnosis: Diagnosis of rabies is made by cell culture,
antibody detection in serum or CSF, antigen detection in antigen
detection in tissue samples. Observation of Negri bodies in brain or
other tissues.
VIRAL MENINGITIS

• Also known as aseptic meningitis and nonbacterial or abacterial meningitis. It is a relatively

common disease but, fortunately, is less serious. Acute illness rarely exceeds 10 days duration.
Viral meningitis is characterized by sudden onset of febrile illness with the signs and symptoms
of meningeal involvement. CSF findings include the presence of mononuclear white blood cells,
increased protein levels, normal glucose levels and the absence of bacteria.
• Pathogen: Commonly enteroviruses (sometimes coxsackie virus, arbovirus, measles virus,
mumps virus, herpes simplex and varicella zoster)
• Laboratory diagnosis: in early stages, isolated from throat washings and stool and occasionally
from CSF and blood.
VIRAL ENCEPHALITIS

• Arthropod-borne viral encephalitis is an acute inflammatory iral disease. A patient with

this disease may be asymptomatic or have a mild fever or headache. Severe infection is
also possible with headache, high fever, stupor, disorientation, coma, tremors, occasional
convulsions, spastic paralysis and death.
• Pathogens: (West Nile Virus encephalitis, St. Louie encephalitis) Flaviviridiae, (Eastern
and Western Equine Encephalitis) Togaviridiae, (California Encephalitis) Bunyaviridiae
• Mode of transmission: Arthropod vectors (mosquitoes)
• Laboratory diagnosis: Molecular diagnosis/electron microscopy.
FUNGAL INFECTION: CRYPTOCOCCOSIS

• Starts as a lung infection but spreads via the bloodstream

to the brain. Usually presents as a subacute or chronic
meningitis. Infection of the lungs, kidneys, prostate, skin,
and bone may also occur. Common infection in AIDS
• Pathogen: Cryptococcus neoformans
• Reservoir/Mode of Transmission: Inhalation of yeasts
from pigeon nests, chicken, turkey, pigeon and bat
droppings. Stimulated by high pH and high nitrogen
content in bird droppings.
• Lab Diagnosis: Observing encapsulated budding yeasts by
India ink.
GASTROINTESTINAL
INFECTIONS
NICO ANGELO C. SOLON, RMT
DEFINITION OF TERMS

• Colitis: inflammation of the colon

• Diarrhea: abnormal discharge o semi solid or fluid fecal matter. Some laboratory specimens as stool
specimen that are fluid like.
• Dysentery: Frequent watery stools accompanied by abdominal pain, fever and dehydration.
• Enteritis: Inflammation of the intestines usually referring to the small intestine.
• Gastritis: Inflammation of the mucosal lining of the stomach.
• Gastroenteritis: Inflammation of the mucosal linings of the stomach and intestines.
• Hepatitis: Inflammation of the liver, usually the result of viral infections but can be caused by toxic agents.
• Bacterial Infections • Enterovirulent E. coli
• Bacterial Gastritis • Enterohemorrhagic E. coli (EHEC)
diarrhea
• Campylobacter enteritis
• Enterotoxigenic E. coli (ETEC) diarrhea
• Cholera
• Salomenellosis
• Viral Infections

• Typhoid Fever • Gastroenteritis

• Shigellosis (Bacillary Dysentery) • Viral Hepatitis

• Clostridium difficile-associated disease

BACTERIAL GASTRITIS

• Infection causing duodenal ulcers that may be suspected

when a person experiences upper abdominal pain with
nausea and heart burn. People usually experiences burning,
aching, mild to moderate pain just below the breastbone, an
empty feeling and hunger.
• Pathogen: Helicobacter pylori (curved, microaerophilic,
capnophilic, Gram negative bacillus that is found on the
mucus secreting epithelial cells of the stomach).
• Reservoir and Mode of Transmission: Ingestion or oral-oral
or oral-fecal transmission.
• Laboratory Diagnosis: urea breath test, NH4 excretion test,
molecular diagnostic procedure. In the urea breath test, the
patient ingests radioactively labeled urea and hi or her
breath is analyzed 60 minutes later for radioactively labeled
Co2.
• Principle: H. pylori splits the urea into Ammonia nad CO2.
 CAMPYLOBACTER ENTERITIS

• Acute bacterial enteric disease ranging from asymptomatic to severe,

with diarrgea, nausea, vomiting, fever, malaise and abdominal pain.
The disease is usually self limiting lasting 2-5 days. Stools may
contain gross or occult (hidden) blood, mucus and WBCs.
• Pathogen: Campylobacter jejuni and less commonly, Campylobacter
spp. are spp. S-shaped or spiral-shaped Gram-negative bacilli often
having a wing gull morphology.
• Reservoir and Mode of Transmission: Ingestion of contaminated food
or contaminated cutting boards, contact with infected pets and animals
including poultry, cattle, sheep, swine, rodents, birds, kittens, puppies
and other pets as well as ingesting contaminated holy water fonts.
• Laboratory diagnosis: Diagnosis depends on the recovery of
Campylobacter spp. from stool specimen using selective medium
(Campylo blood agar, which contains several antimicrobial agents to
suppress growth of other bacteria and Campy gas mixture: 5% O2,
10% CO2, 85% N2) and 42% incubation.
CHOLERA

• Acute bacterial diarrheal disease with profuse watery

stools, occasional vomiting and rapid dehydration. If
untreated, circulatory collapse, renal failure and death
may occur. More than 50% of untreated people with
severe cholera die.
• Pathogens: Vibrio cholerae serogroup 01 (Curved,
comma-shaped Gram negative bacilli that secrete an
enterotoxin: a toxin adversely affects cells in the intestinal
tract called choleragen) Vibrio parahaemolyticus and
Vibrio vulnificus also cause diarrheal diseases.
• Reservoirs and Mode of Transmission: Infected humans
and aquatic reservoirs by fecal-oral route
• Laboratory diagnosis: Rectal swab or stool specimens
should be inoculated into thiosulfate-citrate-bile-sucrose-
agar.
SALMONELLOSIS

• Gastroenteritis with sudden onset of headache, abdominal pain,

diarrhea, nausea and sometimes vomiting. Dehydration may be
severe. Salmonellosis may develop into septicemia or localized
infection in any tissue of the body.
• Pathogen: Caused by the Enterobacterecieae family currently
named Salmonella enterica. Gram negative bacilli invade
intestinal cells, release endotoxin and produce cytotoxins and
enterotoxins. Commonly reported Salmonella enterica subsp.
Enterica serovar typhimirium
• Reservoir and mode of transmission: Ingestion of contaminated
foo/ fecal-oral transmission from person to person, food
handlers or contaminated water supplies.
• Laboratory diagnosis: MacConkey agar culture growth and
biochemical tests.
TYPHOID FEVER

• Typhoid fever is a systemic bacterial disease with fever, severe

headache, malaise, anorexia, a rash on the trunk in about 25% of
patients, non productive cough and constipation. Bacteremia;
pneumonia gall bladder, liver and bone infection; endocarditis;
meningitis and other complications may occur.
• Pathogen: Salmonella typhi (Gram negative bacillus that releases
endotoxin and produces exotoxins). Similar but less severe
infection is caused by Salmonella typhi.
• Reservoirs and Mode of Transmission: Infected humans serve as
reservoirs for typhoid and paratyphoid; rarely domestic animals
for paratyphoid. Some people become carriers following infection
shedding the pathogen in their feces or urine. Transmission is by
fecal-oral route, food or water contaminated by feces or urine of
patients or carriers, oysters and flies.
• Laboratory diagnosis: Isolation of S. typhi from blood, urine, feces
or bone marrow, followed by identification by biochemical tests
SHIGELLOSIS (BACILLARY DYSENTERY)

• Acute bacterial infection of the lining of the small and large intestine producing diarrhea. Other symptoms
include: nausea, vomiting, cramps and fever. Sometimes toxemia (toxins in the blood) and convulsions (in
children) occur. Other serious complications such as hemolytic-uremic syndrome may occur.
• Pathogen: Shigella dysenteriae, Shigella flexneri, Shigella boydii and Shigella soneii (Non-motile Gram-
negative bacilli that are members of the Enterobacteriaceae family.
• Reservoir and Mode of Transmission: Fecal-oral transmission by unwashed hands.
• Laboratory diagnosis: Leukocytes will be present in stool specimens. Fresh fecal or rectal swabs should be
immediately inoculated into Gram-negative enrichment broth and onto a solid medium. (Xylose Lysine
Deoxycholate or Hektoen Enteric Agar; produces colorless colonies in MacConkey agar and identified in
biochemical tests.
CLOSTRIDIUM DIFFICILE- ASSOCIATED
DISEASES
• Major cause of conditions known as antibiotic associated diarrhea and
pseudomembranous colitis which frequently occur in patients following antibiotic
therapy.
• Pathogen: Clostridium difficile (spore forming anerobic Gram positive bacillus)
• Reservoir and mode of transmission: Nosocomial bacteria and acquired thru presence of
organism in a hospital environment.
ENTEROVIRULENT ESCHERICHIA COLI

• Escherichia coli is a Gram negative bacillus that is found in the GI tract of all humans.
There are strains and serotypes of E. coli that are part of the indigenous microbiota of the
GI tract that are opportunistic pathogens. Usually causes no harm but has the potential to
cause serious infections if they gain access to the blood stream, urinary bladder or wound.
E. coli is the major cause of septicemia, urinary tract infections and health care
associated infections.
• Enterohemorrhagic E. coli (EHEC) diarrhea
• Enterotoxigenic E. coli (ETEC) diarrhea
ENTEROHEMORRHAGIC E. COLI DIARRHEA

• Consists of hemorrhagic, watery diarrhea with abdominal cramping. Usually, patients have no fever or only
a light fever. About 5% of the infected develop hemolytic uremic syndrome with anemia, low platelet count
and kidney failure. The first recognized outbreak occurred in 1982 due to contaminated hamburger meat.
• Pathogen: E. coli O157:H7 (serotype that possesses a cell wall antigen “O157” and flagellar antigen “H7”)
Other serotypes include O26:H11 O111:H8 and O104:H21. All producing Shiga like toxin.
• Reservoir and Mode of Transmission: Inadequately cooked meat, fecal oral route, unpasteurized milk,
person to person contact or fecally contaminated water.
• Laboratory diagnosis: Stool samples inoculated in sorbitol-MacConkey agar yielding colorless, sorbitol
negative colonies which should then be assayed for O157 antigen using commercially available antiserum
ENTEROTOXIGENIC E. COLI (TRAVELER’S
DIARRHEA)
• Consists of watery diarrhea with or without mucus or blood, vomiting and abdominal
cramping. Dehydration and low-grade fever may occur.
• Pathogen: Caused by different serotypes of diarrhea producing heat-labile or heat-stable
toxins or both.
• Reservoir and Mode of Transmission: Fecal oral route and ingestion of fecally
contaminated food or water.
• Laboratory diagnosis: isolation from stool specimen followed by demonstration of
enterotoxin production, molecular diagnostic procedures or immunodiagnostic procedures.
VIRAL INFECTIONS OF THE GI TRACT

• Gastroenteritis
• Viral Hepatitis
VIRAL GASTROENTERITIS

• May be and endemic or epidemic illness in infants, children and adults. Symptoms include nausea, vomiting,
diarrhea, malaise, abdominal pain myalgia, headache and low grade fever. Although a self-limiting disease,
lasting for 24-48 hours, viral gastroenteritis can be fatal in an infant or young child.
• Pathogen:
• Children in first few years of life: enteric adenoviruses, astroviruses, caliciviruses (including noroviruses) and
rotavirus
• Children and adults: Norovirus and Rotavirus

• Reservoir and Mode of Transmission: Fecal oral route, ingestion of contaminated water and shell fish.
Airborne infections may cause endemic.
• Diagnosis: electron microscopy
VIRAL HEPATITIS

• Hepatitis or inflammation of the liver can have many causes including alcohol, drugs and
viruses. Viral hepatitis refers to hepatitis caused by one of the dozen different viruses
including Hepatitis A, B, C, D and E.
GENITOURINARY
INFECTIONS
NICO ANGELO C. SOLON, RMT
• Bacterial Infections: • Fungal Infections
• Genital Chlamydia • Yeast Vaginitis
• Gonorrhea
• Syphilis

• Viral Infections:
• Anogenital Herpes
• Genital Warts
• AIDS
BACTERIAL INFECTIONS

• Genital Chlamydia
• Gonorrhea
• Syphilis
GENITAL CHLAMYDIA

• Most commonly transmitted sexually transmitted pathogen.

Different serovars of Chlamydia trachomatis cause different
diseases. Serovars D through K are major causes of
nongonococcal utheritis (NGU) and epididymitis in men and
cervicitis, utheritis, endometritis in women.
• Pathogen: Chlamydia trachomatis (tiny obligate intracellular
Gram-negative bacteria), Ureaplasma ureolyticum, Herpes
Simplex Virus and Trichomonas vaginalis
• Reservoirs and Mode of Transmission: Infected humans thru
sexual intercourse or mother to neonate during birth.
• Laboratory diagnosis: Cell culture, staining and
immunodiagnostic techniques.
GONNORHEA

• May present as asymptomatic mucosal infection, ophthalmia

neonatorum, utheritis, proctitis, pharyngitis, epididymitis, cervicitis.
Bartholin gland infection, pelvic inflammatory disease, endometritis,
salpingitis, peritonitis and disseminated gonococcal infection. Patients
with disseminated gonococcal infection have myalgia, arthralgia,
polyarthritis and a dermatitis. Urethral discharge and painful urination
are common in infected men, usually starting 2-7 days after infection.
• Pathogen: Neisseria gonorrhea (Gram negative diplococcus) Some
strains are multidrug resistant.
• Reservoirs and Mode of Transmission: Sexual contact, transplacental
and membrane to mucous membrane contact.
• Laboratory diagnosis: Typical appearance of Gram stained urethral
discharge containing numerous WBC’s and intracellular and
extracellular Gram Negative diplococci inoculated in Chocolate Agar
Plate or modified chocolate agar (Thayer-Martin, Martin-Lewis or
Transgrow medium)
SYPHILIS

• Treponemal disease that occurs in four stages:

• Primary stage: presence of painless lesion known as a chancre
• Secondary stage: skin rash (4-6 weeks) known as condyloma
lata
• Latent stage: asymptomatic
• Tertiary: damage to CNS (neurosyphilis) cardiovascular and
other sites. Dead tissues known as gumma start to be seen.

• Pathogen: Treponema pallidum

• Reservoir and Mode of Transmission: sexual contact, direct
contact from body secretions, lesions, blood transfusion and
transplacental.
• Laboratory diagnosis: Darkfield microscopy, fluorescence,
Venereal Disease Reference Laboratory, Rapid Plasma
Reagin
VIRAL INFECTIONS

• Anogenital Herpes
• Genital Warts
• AIDS
ANOGENITAL HERPES

• In general, herpes simplex infections are characterized by a local

primary lesion, latency and a tendency to localized recurrence. In
women, the principal sites of primary anogenital herpes virus
infection are the cervix and vulva with current disease affecting the
vulva, perineal skin, legs and buttocks. In men, lesions appear on
the penis and in the anus and rectumof those engaging in anal sex.
• Pathogen: Herpes Simplex Virus 2 (commonly) and Herpes
simplex virus 1
• Reservoir and Mode of Transmission: Direct sexual contact or oral-
genital, oral-anal or anal-genital contact during the presence of
lesions. Mother to fetus or mother to neonate transmission.
• Laboratory diagnosis: Genital herpes is diagnosed by observation
of characteristic cytologic changes in tissue scrapings or biopsy
specimens and the presence of multinucleated giant cells with
intranuclear inclusions.
GENITAL WARTS

• Starts as tiny, soft, moist, pink or red swellings which grow

rapidly and may develop stalk. Their rough surfaces give
them the appearance of small cauliflowers. Multiple warts
often grow in the same area, most often in the penis of men
and the vulva, vaginal wall, cervix and skin surrounding in
the vaginal wall of women.
• Pathogen: Caused by 30-40 types of Papovaviridiae family
of DNA viruses (HPV)
• Reservoirs and Mode of Transmission: Sexual transmission
through humans or breaks of skin or mucous membrane or
from mother to neonate through birth.
• Laboratory diagnosis: Molecular diagnosis.
HUMAN IMMUNEDEFICIENCY VIRUS INFECTION

• Usually occurs within several weeks to several months after

infection.
• Initial symptoms: acute, self limited, mononucleosis-like
illness lasting 1-2 weeks
• There are cases of misdiagnosis due to the lack of sufficient
antibodies.
• Other signs and symptoms: fever, rash, headache,
lymphadenopathy, pharyngitis, myalgia, arthralgia, aspectic
meningitis, retroorbital pain, weight loss, depression, GI
distress, night sweats, and oral or genital ulcers.
• Approximately 90% of HIV cases proceeds to Acquired
Immune Deficiency Syndrome
ACQUIRED IMMUNE DEFICIENCY SYNDROME

• Severe life threatening late stage of HIV infection.

• Invasion and destruction of helper T-cells leads to
immune suppression of the patient’s immune
system.
• Secondary infections: other microbes
(Cytomegalovirus, herpes simplex, Cryptosporidium,
Toxoplasma, Mycoplasma tuberculosis, Candida,
Cryptococcus, Pneumocystis)
• Kaposi’s sarcoma: rare type of cancer is frequent in
AIDS complication.
HUMAN IMMUNEDEFICIENCY VIRUS INFECTION/
ACQUIRED IMMUNE DEFICIENCY SYNDROME
• Pathogen: Human Immunodeficiency Virus (retrovirus) Type 1 (common incident).
• Reservoirs and mode of transmission: Sexual intercourse, blood transfusion,
transplacental, contaminated needle sticks.
• Laboratory Diagnosis: Enzyme Linked Immunosorbent Assay confirmed by Western
Blot.
FUNGAL INFECTION: YEAST VAGINITIS

• Typical symptoms include: vulvar pruritis (itching),

a burning sensation, dysuria and a white discharge.
Vulvar erythema and rash sometimes occur.
• Pathogen: Candida albicans (common),
Trichomonas vaginalis
• Mode of Transmission: Contact with secretions or
excretions of mouth, skin, vagina or feces.
• Laboratory diagnosis: microscopic infection by
KOH method. May be cultured in Sabroud dextrose
agar.
NEXT MEETING: PARASITOLOGY PART 1