InstituteInstitute forfor Microbiology, Medical Faculty of Masaryk UniversityMicrobiology, Medical Faculty of Masaryk University
and St. Anna Faculty Hospitaland St. Anna Faculty Hospital in Brnoin Brno
Agents ofAgents of neuroinfectionsneuroinfections
Central nervous system infectionsCentral nervous system infections
• relativelyrelatively rarerare
• can have a verycan have a very serious courseserious course
• IncidenceIncidence
bacterial meningitis: 2/100.000/yearbacterial meningitis: 2/100.000/year
viral meningitis: 10/100.000/yearviral meningitis: 10/100.000/year
• LethalityLethality
bacterial meningitisbacterial meningitis,, non-treated:non-treated: >70 %>70 %
treated: ~10 %treated: ~10 %
Penetration into CNSPenetration into CNS
• From a peripheral focus:From a peripheral focus:
by means of bloodby means of blood (meningococci)(meningococci)
per continuitatemper continuitatem (pneumococci or(pneumococci or
haemophili from the middle ear)haemophili from the middle ear)
along nervesalong nerves (HSV, rabies virus)(HSV, rabies virus)
• Directly:Directly:
after an injuryafter an injury (pneumococci,(pneumococci,
staphylococci, nocardiae, aspergilli)staphylococci, nocardiae, aspergilli)
http://www.dcu.iehttp://www.dcu.ie
EEtiology of CNS infectionstiology of CNS infections
...depends on the...depends on the typetype and theand the durationduration ofof
the disease, different in....the disease, different in....
1.1. meningitismeningitis
- acute bacterial (purulent)/viral (aseptic)- acute bacterial (purulent)/viral (aseptic)
- chronic- chronic
2.2. encephalitisencephalitis
3. brain3. brain abscessabscess – acute or chronic– acute or chronic
Cytology and biochemistry of CSFCytology and biochemistry of CSF
marker norm
purulent
meningitis
aseptic
meningitis
cells 0-6/μl ↑↑↑ (>1000) ↑↑(100-500)
proteins
20-50
mg/100 ml ↑↑ (>100) ↑ (50-100)
glucose
40-80
mg/100 ml ↓ (<30) ~ (30-40)
Etiology ofEtiology of acute meningitisacute meningitis – I– I
Etiology of purulent meningitis by the age in %Etiology of purulent meningitis by the age in %
ageage GBSGBS
0-1 m.0-1 m. 5050
1-4 y.1-4 y.
5-295-29
30-5930-59
≥≥6060
www.bakteriologieatlas.de
Etiology ofEtiology of acute meningitis – IIacute meningitis – II
Etiology of purulent meningitis by the age in %Etiology of purulent meningitis by the age in %
ageage GBSGBS Haem.Haem.
infl. binfl. b
0-1 m.0-1 m. 5050
1-4 y.1-4 y. 7070
5-295-29
30-5930-59
Etiology of acute meningitis – IIIEtiology of acute meningitis – III
Etiology of purulent meningitis by the age in %Etiology of purulent meningitis by the age in %
ageage GBSGBS Haem.Haem.
infl. binfl. b
Neiss.Neiss.
men.men.
0-1 m.0-1 m. 5050
1-4 y.1-4 y. 7070
5-295-29 4545
30-5930-59
Etiology of acute meningitis – IVEtiology of acute meningitis – IV
Etiology of purulent meningitis by the age in %Etiology of purulent meningitis by the age in %
ageage GBSGBS Haem.Haem.
infl. binfl. b
Neiss.Neiss.
men.men. otherother
0-1 m.0-1 m. 5050
1-4 y.1-4 y. 7070
5-295-29 4545
30-5930-59 4040
Etiology of acute meningitis – VEtiology of acute meningitis – V
Etiology of purulent meningitis by the age in %Etiology of purulent meningitis by the age in %
ageage GBSGBS Haem.Haem.
infl. binfl. b
Neiss.Neiss.
men.men. otherother Str.Str.
pneu.pneu.
0-1 m.0-1 m. 5050
1-4 y.1-4 y. 7070
5-295-29 4545
30-5930-59 4040
http://bioinfo.bact.wisc.eduhttp://bioinfo.bact.wisc.edu
http://images.google.czhttp://images.google.cz
Etiology of acute meningitis – VIEtiology of acute meningitis – VI
Etiology of purulent meningitis by the age in %Etiology of purulent meningitis by the age in %
ageage GBSGBS Haem.Haem.
infl. binfl. b
Neiss.Neiss.
men.men. otherother Str.Str.
pneu.pneu.
List.List.
mono.mono.
0-1 m.0-1 m. 5050 3333 1010
1-4 y.1-4 y. 7070 1515 1010
5-295-29 4545 2525 2020
30-5930-59 1010 4040 3333
LLethality and sequelae of purulent meningitisethality and sequelae of purulent meningitis
....according to etiology....according to etiology
impor-impor-
tancetance
GBSGBS Haem.Haem.
infl. binfl. b
Neiss.Neiss.
men.men. otherother Str.Str.
pneu.pneu.
List.List.
mono.mono.
letha-lethalitylity
†† ††
seque-sequelaelae
++++++ ++ ++ ++
Aseptic (viral) meningitisAseptic (viral) meningitis
mumps virusmumps virus (CNS infection is clinically silent)(CNS infection is clinically silent)
enteroviruses: echovirusesenteroviruses: echoviruses (30 serotypes)(30 serotypes)
coxsackievirusescoxsackieviruses (23 + 6 serotypes)(23 + 6 serotypes)
tick-borne encephalitis virustick-borne encephalitis virus (TBEV)(TBEV)
rarelyrarely HSVHSV and VZV and other neurovirusesand VZV and other neuroviruses
rarely some bacteriararely some bacteria
leptospirae, borreliae, M. tuberculosisleptospirae, borreliae, M. tuberculosis
Etiology of chronic meningitisEtiology of chronic meningitis
Bacteria:Bacteria: Mycobacterium tuberculosisMycobacterium tuberculosis
(meningitis basilaris)(meningitis basilaris)
Moulds and yeasts:Moulds and yeasts:
aspergilliaspergilli
Cryptococcus neoformansCryptococcus neoformans
http://www.icu.cnhttp://www.icu.cn
Etiology of encephalitisEtiology of encephalitis
Encephalitis – onlyEncephalitis – only acuteacute, of, of viralviral origin:origin:
- tick-borne encephalitis- tick-borne encephalitis
- HSV- HSV
- enteroviruses- enteroviruses
- mumps- mumps
Mumps parotitis with cervical and presternal edema and erythemaMumps parotitis with cervical and presternal edema and erythema
Cystic lesions resulting from accumulation of organisms in perivascular spacesCystic lesions resulting from accumulation of organisms in perivascular spaces
aapredbook.aappublications.orgaapredbook.aappublications.org
Etiology of acute brain abscessEtiology of acute brain abscess
........always........always bacterial:bacterial:
- mixed- mixed anaerobic and aerobicanaerobic and aerobic floraflora
- staphylococci- staphylococci (both(both S. aureusS. aureus and coagulaseand coagulase
negative staphylococci)negative staphylococci)
- group A and D- group A and D streptococcistreptococci
Etiology of chronic brain abscessEtiology of chronic brain abscess
Bacteria:Bacteria:
Mycobacterium tuberculosisMycobacterium tuberculosis
Nocardia asteroidesNocardia asteroides
Mycotic organisms:Mycotic organisms:
Cryptococcus neoformansCryptococcus neoformans (yeast)(yeast)
Parasites:Parasites:
Cysticercus cellulosaeCysticercus cellulosae (tissue form of pork(tissue form of pork
tapewormtapeworm Taenia soliumTaenia solium))
http://www.medicine.cmu.ac.th
Top: Taenia solium cysticerci in the brain of a nine-yearold
girl who died during cerebrospinal fluid extraction to
diagnose her headaches.
This was in the 1970s - if it had happened 10 years later,
noninvasive computerized tomography would have given
an accurate diagnosis, and the parasites could have been
killed with drugs.
(Image courtesy of Dr. Ana Flisser, National Autonomous University of Mexico.)
Left: A pork tapeworm (T.solium) cysticercus,
the form in which the tapeworm is found in an infected
brain.
(Colorized image by P. W. Pappas and S. M. Wardrop, courtesy of P. W. Pappas,
Ohio State University.)
http://eands.caltech.edu/articles/LXVI4/brainworms.html
Leonardo da Vinci (1452-1519): Fetus in the WombLeonardo da Vinci (1452-1519): Fetus in the Womb
(between 1510-1512)(between 1510-1512)