Viral-Neurological-Syndromes.pdf

Viral Neurological Syndromes  Viral CNS infections Acute Chronic (slow infections  Meningitis.  SSPE.  Encephalitis.  Progressive multifocal leucoencephalopathy.  Post infectious...

Viral Neurological Syndromes  Viral CNS infections Acute Chronic (slow infections  Meningitis.  SSPE.  Encephalitis.  Progressive multifocal leucoencephalopathy.  Post infectious Spongiform encephalomyelitis.  encephalopathy.  Acute flaccid  HIV encephalopathy paralysis. Acute CNS infections:  Menngitis: › Enteroviruses. CSF: › Mumps.  › Lymphocytosis. › HSV-2. › =/↑ protein. › =/↓ glucose. › HIV. › Lymphocytic choriomengitis virus (LCMV).  Acute CNS infections: Encephalitis:  HSV-1.  Rabies.  Enterovirus 71.  Arboviruses: › West Nile virus. › Tick born EV. › Western Equine Encephalitis. › Eastern Equine Encephalitis. › California Encephalitis. › La Cross Encephalitis. Select this paragraph to edit Rabies Rabies  “Rabies” is derived from Latin word “to rage”.  Acute “fatal” zoonotic viral infection of the central nervous system (CNS).  Main modes of transmission is bite from rabid Carnivores (dogs, cats) and bats.  The fatality rate is near to 100% after development of symptoms.  Rabies virus: Classification  Family: Rhabdoviridae.  Genus: Lyssa virus.  Host: › Man. › Dogs. › Raccoons. › Bats. › others  Rabies virus: Structure  Bullet shape.  75 width – 180 Length nanometer.  Enveloped with envelop.  Nuleocapsid with helical symmetry.  Linear SS-RNA of -ve sense non segmented. Rabies virus:Transmission  Bite of rabid animal.  Other proposed ways:  Rarely: corneal › Contact the infected transplantation obtained saliva with open wound. from patient died of rabies. › Exposure to aerosolized secretion from rabid bats in caves. Rabies: Pathogenesis  No viremic stage.  Rabies Encephalomylelitis: pathology Select this paragraph  Mononuclear infiltration to edit › Perivascular cuffing of lymphocytes or polymorphonuclear cells or inflammation around a blood vessel Rabies Encephalomylelitis: pathology  Neurons: cytoplasmic eosinophilic inclusions. Select this paragraph to edit NEGRI BODIES Rabies: stages of the illness INCUBATION PERIOD PRODROMAL PHASE NEUROLOGIC PHASE COMA DEATH  Rabies: stages of the illness INCUBATION PERIOD  Long incubation period varies between 20-90 days to several months.  Depending on: › Size of the bite. › Depth of the bite. › Number of the bites. › Amount of saliva inoculated. › Proximity from the CNS. › Age.  Rabies: stages of the illness PRODROMAL PHASE  10-20 days: › Fever. › Pharyngitis. › Malaise and anorexia. › Nausea, vomiting and diarrhea. › Insomnia and depression. › Pain at the site of the bite.  Rabies: stages of the illness NEUROLOGIC PHASE  Furious stage:  Paralytic stage › Hyper excitation. (dumb): › Hallucination. › Local or diffused › Confusion. paralysis. › Bizarre behavior. › Excessive salivation, lacrimation. › Hydrophobia. › Aerophobia:  Severe laryngeal spasm Rabies: Lab diagnosis  Ante mortem;  Post mortem; › Antigen detection: IF: › Brain histopathology ( skin biopsy, corneal Negri bodies: impression. pathognomonic) › Viral isolation: saliva, CSF, animal inoculation. › RT-PCR for saliva and CSF. › Antibody detection. Serum, CSF: Rabies: Management and Prevention 1. Wound cleaning and debridement: 1. Pre-exposure prophylaxis. › More 20 minutes. › Vaccination for high risk › Antibiotic prophylaxis individuals e.g. Amoxicillin +clavulnic acid veterinarians, lab (Amoclan) workers , zookeepers. 2. Post exposure prophylaxis: 2. Animal control: › Human Rabies › Vaccination of domestic Immunoglobulin: animals. › Observation and killing of the  Infiltrate around the suspected rabid animal wound.  The remaining is injected intramuscular › Rabies Vaccine:  Doses: for HDCV: 0,3, 7, 14 day. may add at 21-28 96.day. Rabies vaccine  Inactivated cell  Inactivated Neural culture tissue vaccine: Human diploid cell vaccine (HDCV). › Rabies vaccine absorbed from rhesus monkeys. › Vero-cell vaccine. West Nile Encephalitis  An “arboviral” infection affecting the CNS caused by West Nile virus.  The disease was first recognized in West Nile province in Uganda.  The disease is Endemic in Middle East (including Sudan) ,Africa and Asia.  The disease took large attention when resulted in a drastic outbreak in USA in 1999.  West Nile encephalitis:  Clinical manifestations: › 3 patterns:  Asymptomatic.  West Nile fever.  West Nile encephalitis.  Family: flaviviridae.  Other manifestations:  Genus: flavivirus. › Aseptic meningitis  Transmission: › Chorioretinitis. › Bite of culex › Hepatitis. pipiens. › Pancreatitis. › Other hosts: birds › Nephritis. (crows), horses › Guillain Barre Syndrome. › Extrapyramedal symptoms. Post infectious encephalomyelitis.  Measles.  Pathology: › Immune-mediated.  Mumps. › Demyelination.  Rubella. › Occur at  Primary VZV. convalescence.  Rabies neural tissue vaccine. Acute flaccid paralysis  Guillain-Barre syndrome.  Poliomyelitis:  VZV. › Poliovirus.  EBV.  HIV. › Anterior horn cells.  CMV.  Asymmetrical flaccid  WNV. › Postinfectious paralysis. Demyelination polyneuropathy. › Symmetrical ascending flaccid paralysis. Chronic CNS infection  Transmissable Spongiform encephalopathy. ( Prion diseases). › A group of fatal neurodegenerative disorders in humans and animals  Bovine Spongiform Encephalopathy (BSE) Mad cow disease.  Creutzfeldt Jakob Disease (CJD).  Gerstmann Strausler Scheinker syndrome (GSS).  Famlial Fata Insomnia (FFI).  Kuru.