INFECTIOUS DISEASE OF THE NERVIOUS SYSTEM

I) OVERVIEW
→ CNS & PNS
–

→ Meninges
–

→ Cerebrospinal Fluid (CSF)

– Derived from blood, circulates around brain and meninges
– Contents are selected from blood by blood-
brain barrier, other materials not allowed in
– Brain is an immuno- privileged site
→ Synapse Structure
–

– A junction b/w neurons is called a synapse

* These are points of continuing communication
II) MENINGITIS
→ What is it?
– Meningitis is inflammation of the meninges that can be caused by several different microbes
* Bacteria
* Viruses
* Fungi
* Even some eukaryotic single-celled organisms!
→ Many things cause meningitis.
– Bacteria
* Neisseria meningitits
* Streptococcus pneumoniae
* Listeria monocytogenes
– Fungi
– Viruses
→ Vaccine:
– Most common vaccine is against Neisseria meningitidis
– Another vaccine, given mostly to at-risk groups, also covers a range of similar bacteria called a
serogroup
 *Serogroup: A group of bacteria that are closely related; there are 6 serogroups of Neisseria
meningitidis that cause most meningococcal disease in the world — A, B, C, W, X, and Y
→ Movement
 –Getting in:
* Through the blood
» Pathogen generally:
› Particularly virulent
› Around for a long time
› Has already caused blood vessel damage
* Through damage to the bones of the face/skull
* Through a breach in the meninges (injection)
→ Commonalities of meningitis diseases:
– Often fatal
– Always serious
– Always induces fever, headache and neck stiffness
– CSF is a normally sterile site; induction of an inflammatory response here puts pressure on the
brain and can have long-lasting consequences
– Diagnosis by CSF sampling
→ Listeria monocytogenes
– Causes mild or asymptomatic food poisoning
– Bacteria live inside cells and can pass from one cell to the next
– We all probably eat Listeria on a regular basis
* Found in:10-15% of all ground beef
* Found in: 25-30% of all chicken and turkey *most important for pregnant women to avoid
eating raw*
* Found in: 5-10% of all deli meats, hot dogs and cheese
– In elderly, immunocompromised, pregnant women, and babies L. monocytogenes can pass into
meninges and cause meningitis.
* As a result, it is recommended that pregnant women avoid deli-meats and cold-cuts for the
duration of their pregnancy
III)ENCEPHALITIS
→ What is it?
– Inflammation of the brain
– Can be extremely dangerous or fatal
– Symptoms include behavior changes, confusion, seizures, paralysis, etc.
→ Vector-Borne Encephalitis
– Eastern Equine Encephalitis and West Nile Virus (there are actually 5, but these 2 are found in
Mass)
* Carried by mosquitos
* No treatment, prevent mosquito bites
* There are an average of 4 EEE cases in the US each year. The states with most cases are
Florida, Georgia, Massachusetts, and New Jersey.
* West Nile-1% of people have past infection, introduced to US in 1999, spreading rapidly
* No vaccine, but lifelong immunity if you survive infection
* 4-5% of infections result in disease, but 30-70% of disease cases are fatal
– Eastern Equine Encephalitis

– West Nile Virus

* 20% infections result in symptoms
* 1% of infections result in serious, sometimes fatal disease
* Fever, headache, fatigue, & weakness that can last for weeks
IV) PARALYSIS-INDUCING DOSEASES
→ Tetanus
– Overview
 * Caused by Clostridium tetani
* Spores are often found in soil
* Releases a toxin that interferes with the neurotransmitters that inhibit muscle contraction
* Causes “spastic paralysis” sometimes called “lockjaw”
* Part of the “Tdap” vaccine in childhood and booster
» Tetanus, Diphtheria, and Pertussis
* Risk factors: accidental puncture wounds, cultural practices of applying mud to wounds, IV
drug users
– TeNT
* The final target of TeNT is the cleavage of synaptobrevin and, even in low doses, has the
effect of interfering with exocytosis of neurotransmitters from inhibitory interneurons.
» The blockage of the neurotransmitters γ-aminobutyric acid (GABA) and glycine is the
direct cause of the physiological effects that TeNT induces
› GABA inhibits motor neurons, so by blocking GABA,
tetanus toxin causes violent spastic paralysis
– The Neuromuscular Junction
* Nerve impulse stimulates the release of the
neurotransmitter acetylcholine (ACh) into the synaptic
cleft
* This stimulates the release of calcium, which in turn
causes the muscle to contract
» Misleading about this diagram, Ca++ is coming from the SARCOPLASMIC RETICULUM, NOT
t-tubule
* The tetanus toxin interferes with the action of “GABA”, a protein that would usually stop this
process, resulting in “spastic paralysis”
*
→ Botulism
– Overview
* Caused by Clostridium botulinum
* Spores are often found in soil, on vegetables, in
canned foods
* Releases a toxin that interferes with the neuromuscular
junction
* Causes “flaccid paralysis”
* No vaccine
– 3 sources of infection:
* Food poisoning: inadequate canning procedures, more
common in home-canning
* Infant: From honey or vegetables, infant GI tract is
more vulnerable to infection
* Wound: Like tetanus, can spread among IV users
– Botox in the Clinic
* Used to treat migraines and muscle spasms
* Beauty/recreational use for wrinkles and sweating
* Botox can spread from injection site, few cases of serious
side effects