1. Microbiology: A Systems Approach, 2 nd ed. Chapter 19: Infectious Diseases Affecting the Nervous System

2. 19.1 The Nervous System and Its Defenses Two component parts to the nervous system – CNS – PNS Three important functions – Sensory – Integrative – Motor Brain and spinal cord: made up of neurons, both surrounded by bone, encased with meninges PNS: cranial and spinal nerves

3. Defenses of the Nervous System Mainly structural Bony casings Cushion of CSF Blood-brain barrier Immunologically privileged site

4. Figure 19.1

5. Figure 19.2

6. 19.2 Normal Biota of the Nervous System No normal biota Any microorganisms in the PNS or CNS is a deviation from the healthy state

8. 19.3 Nervous System Diseases Caused by Microorganisms Inflammation of the meninges Many different microorganisms can cause an infection More serious forms caused by bacteria If it is suspected, lumbar puncture is performed to obtain CSF Typical symptoms: headache, painful or stiff neck, fever, and usually an increased number of white blood cells in the CSF

9. Neisseria meningitides Gram-negative diplococcic lined up side by side Commonly known as meningococcus Often associated with epidemic forms of meningitis Causes the most serious form of acute meningitis

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13. Streptococcus pneumonia Referred to as the pneumococcus Most frequent cause of community-acquired meningitis Very severe Does not cause the petechiae associated with meningococcal meningitis- useful diagnostically Small gram-positive flattened coccus that appears in end-to-end pairs

14. Haemophilus influenza Tiny gram-negative pleomorphic rods Sensitive to drying, temperature extremes, and disinfectants Causes severe meningitis Symptoms: fever, stiff neck, vomiting, and neurological impairment

15. Listeria monocytogenes Gram-positive Ranges in morphology from coccobacilli to long filaments in palisades formation Resistant to cold, heat, salt, pH extremes, and bile In normal adults- mild infection with nonspecific symptoms of fever, diarrhea, and sore throat In elderly or immunocompromised patients, fetuses, or neonates- affects the brain and meninges and results in septicemia

16. Figure 19.6

17. Cryptococcus neoformans Fungus More chronic form of meningitis More gradual onset of symptoms Sometime classified as a meningoencephalitis Headache- most common symptom; also nausea and stiff neck Spherical to ovoid shape and a large capsule

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20. Coccidioides immitis At 25°C forms a moist white to brown colony with abundant, branching, septate hyphae Hyphae fragment into arthroconidia at maturity Usually begins with pulmonary infection

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23. Viruses Aseptic meningitis Majority of cases occur in children 90% caused by enteroviruses Generally milder than bacterial or fungal meningitis

25. Neonatal Meningitis Almost always a result of infection transmitted by the mother, either in utero or during passage through the birth canal Two most common causes – Streptococcus agalactiae Group B strep – Escherichia coli

27. Meningoencephalitis Encephalitis: inflammation of the brain Two microorganisms cause meningoencephalitis (both amoebas) – Naegleria fowleri – Acanthamoeba

28. Naegleria fowleri Small, flask-shaped amoeba Forms a rounded, thick-walled, uninucleate cyst Infection begins when amoebas are forced into human nasal passages as a result of swimming, diving, or other aquatic activities Amoeba burrows in to the nasal mucosa, multiplies, and migrates into the brain and surrounding structure Primary amoebic meningoencephalitis (PAM)

29. Figure 19.11

30. Acanthamoeba Large, amoeboid trophozoite with spiny pseudopods and a double-walled cyst Invades broken skin, the conjunctiva, and occasionally the lungs and urogenital epithelia Granulomatous amoebic meningoencephalitis (GAM)

32. Acute Encephalitis Encephalitis can present as acute or subacute Always a serious condition Acute: almost always caused by viral infection Signs and symptoms vary but may include behavior changes, confusion, decreased consciousness, seizures

33. Arborviruses Borne by insects; most feed on the blood of hosts Common outcome: acute fever, often accompanied by rash

34. Western Equine Encephalitis (WEE) Appears first in horses then in humans Carried by mosquito Extremely dangerous to infants and small children

35. Eastern Equine Encephalitis (EEE) Eastern coast of North American and Canada Usually appears first in horses and caged birds Very high case fatality rate

36. California Encephalitis May be caused by two different viral strains: California strain and the LaCrosse strain Children living in rural areas: primary target group

37. St. Louis Encephalitis (SLE) May be most common of all American viral encephalitides Epidemics in the US occur most often in the Midwest and South

38. West Nile Encephalitis Increasing in numbers in the United States

39. Herpes Simplex Virus Can cause encephalitis in newborns born to HSV-positive mothers Prognosis is poor

40. JC Virus Infection is common In patients with immune dysfunction, cause progressive multifocal leukoencephalopathy (PML)- uncommon but generally fatal

42. Subacute Encephalitis Symptoms take longer to show up and are less striking Most common cause: Toxoplasma

43. Toxoplasma gondii Flagellated parasite Most cases go unnoticed In the fetus and immunodeficient people, severe and often fatal Asymptomatic or marked by mild symptoms such as sore throat, lymph node enlargement, and low-grade fever

44. Figure 19.13

45. Measles Virus: Subacute Sclerosing Panencephalitis (SSPE) Occurs years after an initial measles episode Seems to be caused by direct viral invasion of neural tissue

46. Prions Transmissible spongiform encephalopathies (TSEs): neurodegenerative diseases with long incubation periods but rapid progression once they begin Human TSEs – Creutzfeldt-Jakob disease (CJD) – Gerstmann-Strussler-Scheinker disease – Fatal familial insomnia

47. Figure 19.14

49. Rabies Slow, progressive zoonotic disease Characterized by fatal encephalitis Average incubation time: 1-2 months or more Prodromal phase begins with fever, nausea, vomiting, headache, fatigue, and other nonspecific symptoms Furious rabies – Periods of agitation, disorientation, seizures, and twitching – Spasms in the neck and pharyngeal muscles lead to hydrophobia Dumb rabies – Patient is not hyperactive but is paralyzed, disoriented and stuporous Both forms progress to the coma phase, resulting in death

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53. Poliomyelitis Acute enteroviral infection of the spinal cord Can cause neuromuscular paralysis Often affects small children Most infections are contained as short-term, mild viremia Some develop mild nonspecific symptoms of fever, headache, nausea, sore throat, and myalgia Then spreads along specific pathways in the spinal cord and brain Neurotropic: the virus infiltrates the motor neurons of the anterior horn of the spinal cord Nonparalytic: invasion but not destruction of nervous tissue Paralytic: various degrees of flaccid paralysis Rare cases: bulbar poliomyelitis

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57. Tetanus Also known as lockjaw Clostridium tetani Gram-positive, spore-forming rod Releases a powerful neurotoxin, tetanospasmin, that binds to target sites on peripheral motor neurons, spinal cord and brain, and in the sympathetic nervous system Toxin blocks the inhibition of muscle contraction Results in spastic paralysis First symptoms : clenching of the jaw, followed in succession by extreme arching of the back, flexion of the arms, and extension of the legs Risus sardonicus

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62. Botulism Intoxication associated with eating poorly preserved foods Can also occur as a true infection Three major forms – Food-borne botulism Ingestion of preformed toxin – Infant botulism Entrance of botulinum toxin into the bloodstream – Wound botulism Entrance of botulinum toxin into the bloodstream

63. Symptoms: double vision, difficulty in swallowing, dizziness; later symptoms include descending muscular paralysis and respiratory compromise Clostridium botulinum – Spore forming anaerobe – Releases an exotoxin

64. Figure 19.23

66. African Sleeping Sickness Trypanosoma brucei Also called trypanosomiasis Affects the lymphatics and areas surrounding blood vessels Usually a long asymptomatic period precedes onset of symptoms Symptoms include intermittent fever, enlarged spleen, swollen lymph nodes, and joint pain Central nervous system is affected with personality and behavioral changes that progress to lassitude and sleep disturbances

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