NEUROPATHOLOGY III

INFECTIONS OF THE CNSINFECTIONS OF THE CNS

DEPT. OF PATHOLOGYDEPT. OF PATHOLOGY

AMS07 AMS07

NEUROPATHOLOGY III INFECTIONS OF THE CNS. INFECTIONS OF THE CNS.

*Viral*Viral-acute-acute-latent-latent-slow virus infections-slow virus infections

*Bacterial*Bacterial-acute(pyogenic)-acute(pyogenic)-chronic(granulomatous):AIDS(atypical myco -chronic(granulomatous):AIDS(atypical myco

bacteria), non-AIDS(mycobacterium TB, sy bacteria), non-AIDS(mycobacterium TB, sy philis)philis)

*Fungal *Parasitic*Fungal *Parasitic

NEUROPATHOLOGY III INFECTIONS OF THE CNS...INFECTIONS OF THE CNS...

*Portal of entry.*Portal of entry.

NEUROPATHOLOGY III INFECTIONS OF THE CNS..INFECTIONS OF THE CNS.. Acute viral infections.Acute viral infections.

*Aseptic meningitis*Aseptic meningitis*Poliomyelitis/Polioencephalomyelitis*Poliomyelitis/Polioencephalomyelitis*Encephalitis:*Encephalitis:

-Herpes simplex encephalitis-Herpes simplex encephalitis-Neonatal HSV encephalitis-Neonatal HSV encephalitis-Varicella-zoster virus infections-Varicella-zoster virus infections-CMV infection-CMV infection-Rubella encephalitis -Rabies infection-Rubella encephalitis -Rabies infection-Arbovirus infection-Arbovirus infection

NEUROPATHOLOGY III INFECTIONS...INFECTIONS... ASEPTIC MENINGITIS.ASEPTIC MENINGITIS. *It is a benign, short-lived meningeal infla- *It is a benign, short-lived meningeal infla-

mmation *Viral mmation *Viral causes include:causes include:

-Enteroviruses(MOST common)-Echovi -Enteroviruses(MOST common)-Echovi ruses/Coxsackie A and Bruses/Coxsackie A and B

-Herpes simplex type 2-Herpes simplex type 2-Mumps, Measles and Adenovirus-Mumps, Measles and Adenovirus

*Scanty meningeal infiltrate*Scanty meningeal infiltrate*Death may be due to secondary systemic disease vgr.: viral *Death may be due to secondary systemic disease vgr.: viral myocarditismyocarditis

NEUROPATHOLOGY III

ASEPTIC MENINGITIS...ASEPTIC MENINGITIS...

NEUROPATHOLOGY III

ASEPTIC MENINGITIS...ASEPTIC MENINGITIS...

NEUROPATHOLOGY III

ASEPTIC MENINGITIS...ASEPTIC MENINGITIS...

NEUROPATHOLOGY III VIRAL ENCEPHALITIS....VIRAL ENCEPHALITIS....

NEUROPATHOLOGY III POLYOMYELITIS.POLYOMYELITIS. *Enteroviruses:*Enteroviruses:

-Poliovirus-small RNA viruses-Poliovirus-small RNA viruses-Infrequent since Salk vaccine(inactiva- -Infrequent since Salk vaccine(inactiva-

ted) or Sabin(attenuated)development ted) or Sabin(attenuated)development-Rare reversion to virulence in attenua- -Rare reversion to virulence in attenua- ted ted

virusvirus-Echovirus or Coxsackie A/B are rare causes -Echovirus or Coxsackie A/B are rare causes

in populations immunizated against poliovir. in populations immunizated against poliovir. --Fecal-oral transmissionFecal-oral transmission

-Lytic inf. of motor neurons in spinal -Lytic inf. of motor neurons in spinal cord/braincord/brainneuronophagia+microglia nodls.neuronophagia+microglia nodls.

NEUROPATHOLOGY III POLYOMYELITIS...POLYOMYELITIS...

NEUROPATHOLOGY III POLYOMYELITIS....POLYOMYELITIS....

NEUROPATHOLOGY III POLYOMYELITIS...POLYOMYELITIS...

NEUROPATHOLOGY III

NEUROPATHOLOGY III

NEUROPATHOLOGY III

POLYOMYELITIS...POLYOMYELITIS...

NEUROPATHOLOGY III HERPES VIRUSES – routes of infectionHERPES VIRUSES – routes of infection

*HSV type 1.*HSV type 1.-Direct contact w/infect.secretions from -Direct contact w/infect.secretions from mouth vesicles(“cold sore”) mouth vesicles(“cold sore”) --Involvement of olphactory tract after na Involvement of olphactory tract after na sopharyngeal infection sopharyngeal infection --Reactivation of latent infection(trigem. Reactivation of latent infection(trigem. ganglia, temporal lobe or other areas of ganglia, temporal lobe or other areas of CNS.CNS. *HSV type 2.*HSV type 2.-General mucocutaneous infection -General mucocutaneous infection --React. of latent infect. in sacral dorsal root React. of latent infect. in sacral dorsal root ganglion ganglion

NEUROPATHOLOGY III

HERPES VIRUS....HERPES VIRUS....

NEUROPATHOLOGY III HERPES VIRUS...HERPES VIRUS...

NEUROPATHOLOGY III HERPES ENCEPHALITIS.HERPES ENCEPHALITIS.

*Hemorrhagic ncrosis of temporal lobes, *Hemorrhagic ncrosis of temporal lobes, insula, cingulate gyri and posterior orbital insula, cingulate gyri and posterior orbital frontal lobefrontal lobe

*Intense perivascular inflammation, micro- *Intense perivascular inflammation, micro- glial nodules, glial nodules, eosinophilic inclusions and necrosiseosinophilic inclusions and necrosis

NEUROPATHOLOGY III HERPES ENCEPHALITISHERPES ENCEPHALITIS

NEUROPATHOLOGY III HERPES ENCEPHALITIS...HERPES ENCEPHALITIS...

NEUROPATHOLOGY III HERPES ENCEPHALITIS...HERPES ENCEPHALITIS...

NEUROPATHOLOGY III

NEONATAL HSV ENCEPHALITIS.NEONATAL HSV ENCEPHALITIS.*Etiologic agent is commonly HSV – 2*Etiologic agent is commonly HSV – 2*Acquired during delivery or by feto-mater *Acquired during delivery or by feto-mater nal transmission nal transmission in uteroin utero during early during early preg nancypreg nancy

-15-20% of cases caused by HSV-1infec -15-20% of cases caused by HSV-1infec tion tion*Diffuse necrotizing encephalitis*Diffuse necrotizing encephalitis

-May occur as part of a systemic HSV-2 -May occur as part of a systemic HSV-2 infection infection

NEUROPATHOLOGY III

VARICELLA-ZOSTER INFECTION.VARICELLA-ZOSTER INFECTION.

*Due to reactivation of latent infection in dorsal *Due to reactivation of latent infection in dorsal root or trigeminal gangliaroot or trigeminal gangliashinglesshingles

*Risk factors for reactivation:*Risk factors for reactivation:

-Cancer-Cancer

-Lymphoma-Lymphoma

-Ionizing radiation-Ionizing radiation

-Immunosuppresion-Immunosuppresion

NEUROPATHOLOGY III VARICELLA – ZOSTER INFECTION....VARICELLA – ZOSTER INFECTION....

*Adult infections include:*Adult infections include:-Zoster encephalitis/myeloradiculitis-Zoster encephalitis/myeloradiculitis-Zoster intracranial vasculopathy/vasculi -Zoster intracranial vasculopathy/vasculi

tis(autoimmune process) tis(autoimmune process) * Childhood infections include:* Childhood infections include:

-Varicella cerebellitis-Varicella cerebellitis-Varicella meningoencephalitis-Varicella meningoencephalitis-Intrauterine VZ infection-Intrauterine VZ infection-Neonantal VZ infection-Neonantal VZ infection

NEUROPATHOLOGY III VARICELLA – ZOSTER INFECTION...VARICELLA – ZOSTER INFECTION...

NEUROPATHOLOGY III VARICELLA-ZOSTER....VARICELLA-ZOSTER....

NEUROPATHOLOGY III VARICELLA.ZOSTER....VARICELLA.ZOSTER....

NEUROPATHOLOGY III VARICELLA – ZOSTER...VARICELLA – ZOSTER...

NEUROPATHOLOGY III CYTOMEGALOVIRUS INFECTION.CYTOMEGALOVIRUS INFECTION.

*Congenital CMV infection.*Congenital CMV infection. -Is the commonest intrauterine viral infect. (0.2 – -Is the commonest intrauterine viral infect. (0.2 – 2% of live births)2% of live births) -Fetomaternal transplacental transmission-Fetomaternal transplacental transmission -About 20% risk of transmission during pri -About 20% risk of transmission during pri mary maternal infection(2% during recrudes cence)mary maternal infection(2% during recrudes cence) -Necrotizing encephalitis-Necrotizing encephalitis -Ventriculoencephalitis-Ventriculoencephalitis -Complications: microcephaly, microgyria,poren cephaly, -Complications: microcephaly, microgyria,poren cephaly, hydrocephaly, periventricular calcific.hydrocephaly, periventricular calcific.

NEUROPATHOLOGY III CMV INFECTION...CMV INFECTION...

NEUROPATHOLOGY III CMV INFECTION...CMV INFECTION...

NEUROPATHOLOGY III

CMV INFECTION...CMV INFECTION...*CMV encephalitis and myeloradiculitis is *CMV encephalitis and myeloradiculitis is common in AIDS patientscommon in AIDS patients*Patterns of CNS infection:*Patterns of CNS infection:

-Low grade encephalitis-Low grade encephalitis-Necrotizing encephalitis w/large cysts -Necrotizing encephalitis w/large cysts -Ventriculoencephalitis w/hemorrhagic -Ventriculoencephalitis w/hemorrhagic

necrosis necrosis-Lumbosacral myeloradiculitis-Lumbosacral myeloradiculitis

NEUROPATHOLOGY III CMV INFECTION...CMV INFECTION...

NEUROPATHOLOGY III ARBOVIRUS INFECTIONS.ARBOVIRUS INFECTIONS.

*Small enveloped RNA v iruses transmitted by arthropod vectors *Small enveloped RNA v iruses transmitted by arthropod vectors from birds/rodents to man/horses, often in summer and fallfrom birds/rodents to man/horses, often in summer and fall*Mosquito borne encephalitis: *Mosquito borne encephalitis: TOGAVIRIDAE.TOGAVIRIDAE.

-Eastern equine encephalitis-Eastern equine encephalitis-Western equine encephalitis-Western equine encephalitis-Venezuelan equine encephalitis-Venezuelan equine encephalitisFLAVIVIRIDAE. -St.Louis encephalitisFLAVIVIRIDAE. -St.Louis encephalitisBUNYAVIRIDAE. La crosse(California sero BUNYAVIRIDAE. La crosse(California sero

group)group)|| *Tick-borne encephalitis: Colorado tick fever *Tick-borne encephalitis: Colorado tick fever

NEUROPATHOLOGY III ARBOVIRUS INFECTION...ARBOVIRUS INFECTION...

NEUROPATHOLOGY III ARBOVIRUS....ARBOVIRUS....

NEUROPATHOLOGY III ARBOVIRUS...ARBOVIRUS...

NEUROPATHOLOGY III ARBOVIRUS...ARBOVIRUS...

NEUROPATHOLGOY III PROGRESS.MULTIF.LEUKOENCEPHALOP.PROGRESS.MULTIF.LEUKOENCEPHALOP.

*JC virus detectable in tonsilar tissue of 1/3 of children and adults*JC virus detectable in tonsilar tissue of 1/3 of children and adults*50% of adolescents and 75% of adults have serological evidence of *50% of adolescents and 75% of adults have serological evidence of JC virus infect. (JC virus infect. (The The JC virusJC virus (JCV) is a type of human (JCV) is a type of human polyomaviruspolyomavirus (formerly known as (formerly known as papovaviruspapovavirus) and is ) and is genetically similar to genetically similar to BK virusBK virus and and SV40SV40. It was . It was discovered in 1971 and named after the two initials of a discovered in 1971 and named after the two initials of a patient with patient with progressive multifocal progressive multifocal leukoencephalopathyleukoencephalopathy (PML).(PML).[1][1] The virus causes PML and other diseases only The virus causes PML and other diseases only in cases of in cases of immunodeficiencyimmunodeficiency, as in , as in AIDSAIDS or during or during treatment with drugs intended to induce a state of treatment with drugs intended to induce a state of immunosuppressionimmunosuppression (e.g. (e.g. organ transplantorgan transplant patients). patients). *Oligodendroglia support productive infect.*Oligodendroglia support productive infect. cell cell lysislysisdemyelinationdemyelination*Astrocytes produce infect.*Astrocytes produce infect.morphological transformation and morphological transformation and bizarre appearancebizarre appearance

NEUROPATHOLOGY III PROGRESSIVE MULTIFOCAL.....PROGRESSIVE MULTIFOCAL.....

NEUROPATHOLOGY III PROGRESSIVE MULTIFOCAL..PROGRESSIVE MULTIFOCAL..

NEUROPATHOLOGY III PROGRESSIVE MULTIFOCAL... PROGRESSIVE MULTIFOCAL...

*Result from reactivation of latent JC virus *Result from reactivation of latent JC virus infection due to impaired cell-mediated immunity:infection due to impaired cell-mediated immunity:

-Post-renal transplants-Post-renal transplants-Lymphoma/leukemia patients-Lymphoma/leukemia patients-Acquired immune deficiency syndrome -Acquired immune deficiency syndrome

(accounts for 89% of PML cases) (accounts for 89% of PML cases)*Clinical:*Clinical:

-Focal neurologic deficits – dysartria,paresis, -Focal neurologic deficits – dysartria,paresis, ataxia, visual deficits, personality changes ataxia, visual deficits, personality changes and and occasionally seizures.occasionally seizures.

NEUROPATHOLOGY III PROGRESSIVE MULTIFOCAL...PROGRESSIVE MULTIFOCAL...

*Pathology:*Pathology:-Multifocal white matter demyelination-Multifocal white matter demyelination-Scanty perivascular lymphocytic infiltr.-Scanty perivascular lymphocytic infiltr.-Bizarre pleomorphic,hyperchromatic -Bizarre pleomorphic,hyperchromatic astrocytesastrocytes-Enlarged oligodendroglia w/intranucl. -Enlarged oligodendroglia w/intranucl. inclusionsinclusions-CSF + for JC viral nucleic acid-CSF + for JC viral nucleic acid*Progression of relentless w/increasing neurologic *Progression of relentless w/increasing neurologic deficits, dementia and death.deficits, dementia and death.

NEUROPATHOLOGY III PROGRESSIVE MULTIFOCAL...PROGRESSIVE MULTIFOCAL...

NEUROPATHOLOGY III PROGRESSIVE MULTIFOCAL...PROGRESSIVE MULTIFOCAL...

NEUROPATHOLOGY III PROGRESSIVE MULTIFOCAL...PROGRESSIVE MULTIFOCAL...

NEUROPATHOLOGY III PROGRESSIVE MULTIFOCAL....PROGRESSIVE MULTIFOCAL....

NEUROPATHOLOGY III CHRONIC/SUBACUTE VIRAL INFECT.CHRONIC/SUBACUTE VIRAL INFECT.

*Subacute Measles encephalitis.*Subacute Measles encephalitis.-Measles inclusion encephalitis:-Measles inclusion encephalitis: Develops several months after infect.Develops several months after infect. Most are immunosuppressedMost are immunosuppressed*Subacute sclerosing panencephalitis:*Subacute sclerosing panencephalitis: Chronic progressive encephalitis that Chronic progressive encephalitis that follows exposure to measles virus by follows exposure to measles virus by several yrs. several yrs.*Progressive Rubella panencephalitis*Progressive Rubella panencephalitis Delayed complication of intrauterine or Delayed complication of intrauterine or chilhood infection chilhood infection

NEUROPATHOLOGY III

SUBACUTE SCLEROSING PANENCEPHSUBACUTE SCLEROSING PANENCEPH

*Refers to viral persistence related to hyper- *Refers to viral persistence related to hyper- mutation of susceptible regions of mutation of susceptible regions of virus encoding M,H and F proteinsvirus encoding M,H and F proteins

*Non-production of altered proteins*Non-production of altered proteinseffective effective evasion of immune responseevasion of immune response

*Persistent cell fusion ability results in persistent in-*Persistent cell fusion ability results in persistent in-

fectionfection

NEUROPATHOLOGY III

SUBACUTE SCLEROSING PANENCEPHSUBACUTE SCLEROSING PANENCEPH (SSPE)...(SSPE)...*Is an uncommon clinical syndrome characte *Is an uncommon clinical syndrome characte

rized by: cognitive rized by: cognitive decline, spasticity of limbs and seizuresdecline, spasticity of limbs and seizures

*It occurs in children or young adults, months *It occurs in children or young adults, months or years after an initial, early age or years after an initial, early age acute infec tion w/measles acute infec tion w/measles

NEUROPATHOLOGY III

NEUROPATHOLOGY III SSPE....SSPE....

NEUROPATHOLOGY III

PROGRESSIVE RUBELLA PANENCEPHALITIS.PROGRESSIVE RUBELLA PANENCEPHALITIS.

*Clinical presentation is between ages of 8 tand 20 yrs. *Clinical presentation is between ages of 8 tand 20 yrs. with insidious onset of dementia and ataxia with insidious onset of dementia and ataxia

*Other features:*Other features:

-Seizures, spasticity, choreoathetosis and myo--Seizures, spasticity, choreoathetosis and myo-

clonus clonus

NEUROPATHOLOGY III RETROVIRAL INFECTIONS OF CNS.RETROVIRAL INFECTIONS OF CNS.

*Human T cell leukemia/lymphotropic virus – *Human T cell leukemia/lymphotropic virus – 1(HTLV –1).1(HTLV –1).

Tropical spastic paraparesisTropical spastic paraparesis -progressive spastic paraparesis-progressive spastic paraparesis -demyelination+gliosis of lateral columns-demyelination+gliosis of lateral columns

and less often anterior and posterior cols. and less often anterior and posterior cols. -HTLV-1 is endemic in Caribbean, South-HTLV-1 is endemic in Caribbean, South America, Japan, Seychelles, etc.America, Japan, Seychelles, etc.

NEUROPATHOLOGY III

RETROVIRAL INFECTIONS...RETROVIRAL INFECTIONS...

*Human Immunodeficiency Virus(HIV)*Human Immunodeficiency Virus(HIV)

-Direct HIV infection of CNS+AIDS -Direct HIV infection of CNS+AIDS de- de- mentia mentia complexcomplex

-Vacuolar myelopathy-Vacuolar myelopathy

-Opportunistic infections of -Opportunistic infections of CNS(CMV)CNS(CMV)

NEUROPATHOLOGY III RETROVIRAL INFECTIONS....RETROVIRAL INFECTIONS....

NEUROPATHOLOGY III

RETROVIRAL INFECTIONS...RETROVIRAL INFECTIONS...

NEUROPATHOLOGY III HIV INFECTION...HIV INFECTION...

NEUROPATHOLOGY III HIV INFECTION...HIV INFECTION...

NEUROPATHOLOGY III

BACTERIAL INFECTIONS .BACTERIAL INFECTIONS .

NEUROPATHOLOGY III MENINGITIS, SUBDURAL EMPYEMA, MENINGITIS, SUBDURAL EMPYEMA,

ABSCESS, VENTRICULITIS.ABSCESS, VENTRICULITIS.*Etiology:*Etiology:

-Neonate –Group B Streptococci, E.coli -Neonate –Group B Streptococci, E.coli -1-10 yrs – H.influenza(most common), -1-10 yrs – H.influenza(most common), N.meningitides,Streptococcus pneumon. N.meningitides,Streptococcus pneumon. -11-20 yrs – N.meningitides(most common), -11-20 yrs – N.meningitides(most common), S. pneumoniae S. pneumoniae

->30 yrs – S. pneumoniae, N. Meningitides, ->30 yrs – S. pneumoniae, N. Meningitides, gram negative bacilli gram negative bacilli -Mycobacteria-Mycobacteriameningitis, tuberculomameningitis, tuberculoma

NEUROPATHOLOGY III

BACTERIAL MENIGITIS.BACTERIAL MENIGITIS.*Sporadic – aprox.15,000 children/year, *Sporadic – aprox.15,000 children/year, 6-9 months old 6-9 months old -Epidemic -Epidemic

*Mode of entry to CNS *Mode of entry to CNS -Hematogenous -Hematogenous -Compound Fx -Compound Fx -Otitis media -Otitis media -Sinusitis -Sinusitis -Bacterial endocarditis -Bacterial endocarditis

NEUROPATHOLOGY III

BACTERIAL MENINGITIS....BACTERIAL MENINGITIS....

*Factors influencing outcome: *Factors influencing outcome: -Age, immune status(AIDS),sickle-cell -Age, immune status(AIDS),sickle-cell ane- mia ane- mia -Virulence of agent, vgr. -Virulence of agent, vgr. meningococcus - skin meningococcus - skin rash,septicemia,adrenal hemorrhagerash,septicemia,adrenal hemorrhageshock(W-F shock(W-F syndrome) -Duration of syndrome) -Duration of infection before Tx.infection before Tx.

NEUROPATHOLOGY III

BACTERIAL MENINGITIS... BACTERIAL MENINGITIS... *Complications: *Complications: -Cerebral edema -Cerebral edemaraised raised intracranial press. intracranial press. herniation herniation - -Angiitis/obliterative endarteritisAngiitis/obliterative endarteritisbrain in- brain in- farction(TB) farction(TB) -Inappropiate ADH -Inappropiate ADH secretion secretion -Cranial nerve palsy(e.g.sensori-neural deafness)-Cranial nerve palsy(e.g.sensori-neural deafness)

NEUROPATHOLOGY III

BACTERIAL MENINGITIS.... BACTERIAL MENINGITIS.... *Complications... *Complications... -Subdural -Subdural effusion(empyema) effusion(empyema) -Hydrocephalus -Hydrocephalus -Motor deficits -Motor deficits -Seizures -Seizures -Mental -Mental retardationretardation

NEUROPATHOLOGY III

BACTERIAL MENINGITIS.... BACTERIAL MENINGITIS.... *Dx.: *Dx.: -Headache, malaise, mental confusion, -Headache, malaise, mental confusion, fever, vomiting,convulsions or seizures(TB) fever, vomiting,convulsions or seizures(TB) -Physical examination showing neck stiff- -Physical examination showing neck stiff- ness, Kernig´s sign ness, Kernig´s sign -Lab.: CSF examination -Lab.: CSF examination w/Gram stain, w/Gram stain, culture. culture. PCR for HSVPCR for HSV

NEUROPATHOLOGY III CSF . CSF .

-Normal. Meningitis -Normal. Meningitis pressurepressure pyogenicpyogenic TBTB 60- 60-120mm >200 mm >200mmH2O 120mm >200 mm >200mmH2O appearance appearance crystal clear turbid crystal clear turbid opalescent opalescent cell contentcell content 0-4mononucl. >1000PMN´s lymphos. 0-4mononucl. >1000PMN´s lymphos. proteins proteins 0.2-0.4g/l 1-10 g/l 1-3g/l 0.2-0.4g/l 1-10 g/l 1-3g/l glucose glucose 50-80 mg/100ml 50-80 mg/100ml decreaseddecreased low low

NEUROPATHOLOGY III SYPHILIS.SYPHILIS.

*Asymptomatic.*Asymptomatic.-CSF pleocytosis,increased Igs+serology -CSF pleocytosis,increased Igs+serology *Meningitis. -1-2 yrs after *Meningitis. -1-2 yrs after initial infection *Meningovascular initial infection *Meningovascular syphilis -Arteritis syphilis -Arteritis *General paresis *General paresis -Chronic meningoencephalitis -Chronic meningoencephalitis -10-20 yrs after initial infection -10-20 yrs after initial infection -Psychiatric disord.,seizures,intellectual -Psychiatric disord.,seizures,intellectual decline, loss of motor control, incontinence decline, loss of motor control, incontinence *Tabes dorsalis-chronic inflamm. of *Tabes dorsalis-chronic inflamm. of dorsal roots+ gangliadorsal roots+ gangliacolumn degenerationcolumn degeneration

NEUROPATHOLOGY III

FUNGAL INFECTIONS.FUNGAL INFECTIONS.

NEUROPATHOLOGY III

FUNGAL INFECTIONS.FUNGAL INFECTIONS.*Most fungal infections occur as opportunistic *Most fungal infections occur as opportunistic infectionsinfections*Predisposing factors for opportunistic infections:*Predisposing factors for opportunistic infections: -Immunosuppresive therapy, HIV infect., -Immunosuppresive therapy, HIV infect., diabetes mellitus,neutropenia,alcoholism, diabetes mellitus,neutropenia,alcoholism, IV drug abuser,malnutrition,etc. IV drug abuser,malnutrition,etc. *Most common: Candidosis, *Most common: Candidosis, Cryptococcosis,As- pergillosis, Cryptococcosis,As- pergillosis, Mucormycosis.Mucormycosis.

NEUROPATHOLOGY III FUNGAL....FUNGAL....

NEUROPATHOLOGY III FUNGAL...FUNGAL...

NEUROPATHOLOGY III

BRAIN ABSCESS.BRAIN ABSCESS. Etiology. Etiology.

*Streptococci milleri(most common) gram- *Streptococci milleri(most common) gram- bacilli, Staph.aureus,bacteriodes bacilli, Staph.aureus,bacteriodes -Direct spread from paranasal sinuses(50%) -Direct spread from paranasal sinuses(50%) -Hematogenous(25%)from lung -Hematogenous(25%)from lung abscess,sub acute abscess,sub acute endocarditis, bronchiectasis,etc. -endocarditis, bronchiectasis,etc. -Mortality – 20% Mortality – 20% -Morbidity w/focal neurologic deficits or epilepsy -Morbidity w/focal neurologic deficits or epilepsy (50%) (50%)

NEUROPATHOLOGY III

PARASITIC INFECTIONSPARASITIC INFECTIONS

NEUROPATHOLOGY III

AMEBIASIS.AMEBIASIS.

*Primary – Naegleria fowleri- acute hemorrhagic *Primary – Naegleria fowleri- acute hemorrhagic necrotizing encephalitis in healthy necrotizing encephalitis in healthy individuals w/recent past individuals w/recent past history of swimming on fresh waters history of swimming on fresh waters

*Granulomatous-Acanthameba sp.-immune com *Granulomatous-Acanthameba sp.-immune com promised patients promised patients

*Cerebral amebic abscess-disseminated E.hystoly- *Cerebral amebic abscess-disseminated E.hystoly- tica infectiontica infection

NEUROPATHOLOGY III

TOXOPLASMOSIS.TOXOPLASMOSIS.

*CNS infections seen in:*CNS infections seen in:

-Defective cell immunity such as in AIDS -Defective cell immunity such as in AIDS and is secondary to reactivation of dormant and is secondary to reactivation of dormant infection. infection.

-Congenital infection following transplacen -Congenital infection following transplacen tal spread tal spread

NEUROPATHOLOGY III

CYSTICERCOSIS.CYSTICERCOSIS.*Epidemiology. *Epidemiology.

-Endemic in all countries except in -Endemic in all countries except in Australia Australia-Very common in L.A.-1.4-3.6% in auto -Very common in L.A.-1.4-3.6% in auto

psies(México)psies(México)-Caused by Tenia solium(pig tapeworm) -Caused by Tenia solium(pig tapeworm)

-Man is definitive host-adult parasite -Man is definitive host-adult parasite in in small intestinesmall intestine

NEUROPATHOLOGY III

CYSTICERCOSIS...CYSTICERCOSIS...

-Acquired after ingestion of larval stage in -Acquired after ingestion of larval stage in unhygienic pork meat unhygienic pork meat

-Pig is intermediate host-Pig is intermediate host

-Infection after ingestion of eggs(fecal cont) -Infection after ingestion of eggs(fecal cont) -Human cysticercosis when -Human cysticercosis when man is interme- diate host man is interme- diate host w/ingestion of eggs.w/ingestion of eggs.

NEUROPATHOLOGY III

CYSTICERCOSIS... CYSTICERCOSIS... *Clinical: *Clinical: -Parenchymal cysts-seizures, focal signs -Parenchymal cysts-seizures, focal signs without increased ICPwithout increased ICP

-Meningeal cysts(often basal)-hydrocephal., -Meningeal cysts(often basal)-hydrocephal., vascular occlusion vascular occlusion

-Ventricular cysts-most commonly in 4th ventricle-Ventricular cysts-most commonly in 4th ventricle

-Spinal cord cysts-uncommon-Spinal cord cysts-uncommon

NEUROPATHOLOGY III

CYSTICERCOSIS...CYSTICERCOSIS...

*Dx.:*Dx.:

-CT and MRI scans-cystic lesions+calcifica -CT and MRI scans-cystic lesions+calcifica tions in chronic tions in chronic casescases

-CSF serology-ELISA-CSF serology-ELISA90% sensitivity90% sensitivity

NEUROPATHOLOGY III PRION DISEASES.PRION DISEASES.

*Creutzfeldt-Jakob disease(CJD)*Creutzfeldt-Jakob disease(CJD)*Gerstmann-Strausler-Scheinker dis.(GSS)*Gerstmann-Strausler-Scheinker dis.(GSS)*Fatal familial insomnia(FFI)*Fatal familial insomnia(FFI)*Kuru*KuruCOMMON FEATURES.COMMON FEATURES.-Accumulation of abnormal cellular protein-Accumulation of abnormal cellular protein-Transmission: sporadic(85%),familial(15%),iatrogenic CJD(ino- -Transmission: sporadic(85%),familial(15%),iatrogenic CJD(ino- culation, tissue transplant),endocannibalism(kuru) culation, tissue transplant),endocannibalism(kuru) -Epidemiology: CJD incidence 1-2/million -Epidemiology: CJD incidence 1-2/million

age of onset 55-75 M=Fage of onset 55-75 M=F

NEUROPATHOLOGY III PRION DISEASES....PRION DISEASES....

NEUROPATHOLOGY III PRION DISEASES...PRION DISEASES...