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Microbiology: A Systems
Approach, 2nd ed.
Chapter 19: Infectious Diseases
Affecting the Nervous System
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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
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Defenses of the Nervous System
• Mainly structural
• Bony casings
• Cushion of CSF
• Blood-brain barrier
• Immunologically privileged site
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Figure 19.1
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Figure 19.2
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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
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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
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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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Figure 19.3
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Figure 19.4
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Figure 19.5
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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
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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
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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
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Figure 19.6
J7
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Slide 16
J7 Insert Figure 19.6 HereJennifer, 2/17/2008
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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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Figure 19.7
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Figure 19.8
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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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Figure 19.9
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Figure 19.10
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Viruses
• Aseptic meningitis
• Majority of cases occur in children
• 90% caused by enteroviruses
• Generally milder than bacterial or fungal
meningitis
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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
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Meningoencephalitis
• Encephalitis: inflammation of the brain
• Two microorganisms cause
meningoencephalitis (both amoebas)
– Naegleria fowleri
– Acanthamoeba
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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)
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Figure 19.11
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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)
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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
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Arborviruses
• Borne by insects; most feed on the blood of
hosts
• Common outcome: acute fever, often
accompanied by rash
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Western Equine Encephalitis (WEE)
• Appears first in horses then in humans
• Carried by mosquito
• Extremely dangerous to infants and small
children
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Eastern Equine Encephalitis (EEE)
• Eastern coast of North American and Canada
• Usually appears first in horses and caged birds
• Very high case fatality rate
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California Encephalitis
• May be caused by two different viral strains:
California strain and the LaCrosse strain
• Children living in rural areas: primary target
group
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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
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West Nile Encephalitis
• Increasing in numbers in the United States
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Herpes Simplex Virus
• Can cause encephalitis in newborns born to
HSV-positive mothers
• Prognosis is poor
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JC Virus
• Infection is common
• In patients with immune dysfunction, cause
progressive multifocal leukoencephalopathy
(PML)- uncommon but generally fatal
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Subacute Encephalitis
• Symptoms take longer to show up and are less
striking
• Most common cause: Toxoplasma
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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
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Figure 19.13
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Measles Virus: Subacute Sclerosing
Panencephalitis (SSPE)
• Occurs years after an initial measles episode
• Seems to be caused by direct viral invasion of
neural tissue
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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
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Figure 19.14
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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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Figure 19.15
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Figure 19.16
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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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Figure 19.17
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Figure 19.18
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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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Figure 19.20
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Figure 19.21
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Figure 19.22
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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
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• Symptoms: double vision, difficulty in
swallowing, dizziness; later symptoms include
descending muscular paralysis and respiratory
compromise
• Clostridium botulinum
– Spore forming anaerobe
– Releases an exotoxin
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Figure 19.23
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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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Figure 19.24
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Figure 19.25
J34
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Slide 69
J34 Insert Figure 19.25 HereJennifer, 2/17/2008