MPL11: MD of Nervous System

• Bacterial Meningitis

  Common pathogens: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae
• Pathophysiology of Bacterial Meningitis

  Caused by bacterial infection of the meninges (protective layer of the brain parenchyma)
• Ways of acquiring Bacterial Meningitis

  Swimming, eating contaminated, blood transfusion
• Clinical symptoms of Bacterial Meningitis

  • Sudden fever, severe headache, neck stiffness, nausea, sensitivity to light, seizures may occur in severe cases
• Never use white light in the hospital, it causes seizures. Only use yellow or orange light.
• Diagnostic Tools for Bacterial Meningitis

  • Lumbar Puncture, CSF Analysis results: increased white blood cell count, elevated protein, decreased glucose levels
• Treatment for Bacterial Meningitis

  IV Antibiotics: Penicillin G, Ceftriaxone (immunocompromised), Meropenem, Vancomycin (last line of defense)
• Tetanus

  Common pathogen: Clostridium tetani
• Pathophysiology of Tetanus

  The bacteria produces toxins that affect the nervous system, leading to muscle stiffness and spasms
• Clinical symptoms of Tetanus

  • Right trismus - lockjaw, neck and abdomen stiffness, difficulty swallowing, severe muscles spasms, seizures, autonomic system disorders
• Diagnostic Tools for Tetanus

  • History of wound exposure; laboratory tests are not useful
• Management Strategies for Tetanus

  Wound care, TIG (Human Tetanus Immunoglobulin) 3 months after the shot, immunity is valid. 5-6 months, need a booster, Antibiotics: Metronidazole
• Botulism


  Common Pathogen: Clostridium botulinum
• Pathophysiology of Botulism


  Botulinum toxin blocks the neurotransmitter release, leading to muscle paralysis
• Cause of infant botulism

  Ingestion of honey
• Clinical Symptoms of Botulism

  • Blurred vision, slurred speech, difficulty swallowing, muscle weakness, severe case: respiratory failure
• Diagnostic Tools for Botulism

  • Clinical evaluation, identification of toxin in serum, stool, or food samples
• Treatment for Botulism

  Antitoxin, supportive care in ICU to manage respiratory and autonomic dysfunction
• Leprosy - Hansen's Disease


  Common pathogen: Mycobacterium leprae
• Pathophysiology of Leprosy

  Leads to nerve damage and sensory loss, which affects the skin and peripheral nerves
• Clinical symptoms of Leprosy

  • Skin lesions caused by nerve damage, numbness in hands and feet, muscle weakness
• Routes of Transmission for Leprosy

  Droplets, contact transmission, inhalation/airborne, blood to blood transfusion
• Diagnostic Tools for Leprosy

  • Lepromin Skin Test
• Treatment for Leprosy


  Multiple Drug Treatment (MDT): Dapsone, Rifampicin, Clofazimine. MDT for 2-3 days, the patient will no longer be contagious.
• Poliomyelitis


  Common pathogen: Poliovirus
• Pathophysiology of Poliomyelitis

  The virus infects the gastrointestinal tract but can invade the CNS, leading to nerve destruction and paralysis
• Clinical Symptoms of Poliomyelitis

  • Mostly asymptomatic, in symptomatic: fever, headache, vomiting, stiffness, pain in the limbs, paralytic polio can lead to severe muscle weakness and paralysis
• Treatment for Poliomyelitis

  No cure exists, supportive care: physical therapy & orthopedic interventions, prevention relies on vaccination
• Rabies

  Common pathogen: Rabies virus
• Pathophysiology of Rabies

  Transmitted through the saliva of infected animals, the virus travels from peripheral nerves to the brain, causing encephalitis
• Signs of Rabies in Animals

  • Salivating frequently, eyes are red, chasing their tails, aggression
• Incubation period of Rabies

  10-90 days
• Clinical symptoms of Rabies

  • Fever, headache, general weakness, neurological symptoms: anxiety, confusion, hallucinations, hydrophobia
• Diagnostic Tools for Rabies

  • Post-mortem, ante-serum tests include saliva, serum, or cerebrospinal fluid analysis
• Management of Rabies

  No effective treatment, pre-exposure vaccination and immediate post exposure prophylaxis (PEP) with rabies vaccine and immunoglobulin
• Cryptococcus neoformans Meningitis (Cryptococcosis)


  Common pathogen: Cryptococcus neoformans
• Pathophysiology of Cryptococcosis


  Caused by a fungus that primarily affects immunocompromised individuals, invades the CNS leading to meningitis
• Clinical Symptoms of Cryptococcosis

  • Severe headache, fever, neck stiffness, photophobia, nausea, progresses to confusion, reduced consciousness, and coma in severe cases
• Diagnosis of Cryptococcosis

  • India ink staining, culture or, cryptococcal antigen testing
• Management of Cryptococcosis

  Prolonged antifungal therapy: amphotericin B flucytosine, Fluconazole. Side effects: resistance to antibiotic drugs