Ch 22

Microbial
Diseases of
the Nervous
System
 Student Learning Outcomes
Review anatomy of CNS, PNS, meninges, BBB
Differentiate meningitis from encephalitis including diagnosis and
treatment.
Discuss mode of transmission, etiology, disease symptoms,
treatment, and preventive measures of
 Bacterial meningitis caused by H. influenzae, S. pneumoniae, N.
meningitidis, and L. monocytogenes
 Tetanus
 Botulism
 Leprosy
 Rabies
 Arboviral encephalitis,
 Cryptococcosis.
 African trypanosomiasis
 Prion diseases
Compare and contrast the Salk and Sabin vaccines
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Anatomy and Physiology Review

Fig 22.1

How do microbes enter the

CNS ?

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 The Meninges and Cerebrospinal Fluid

Fig 22.2
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 Bacterial Diseases of the CNS

Bacteria can grow in CSF in subarachnoid

space.
The BBB prevents passage of some materials
(such as antimicrobial drugs) into CNS.
Meningitis vs. encephalitis
Meningitis can be caused by viruses, bacteria,
fungi, and protozoa.
BACTERIAL MENINGITIS: Much more serious
than viral. Can cause severe disease resulting
in brain damage and death.
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 Bacterial Meningitis
 The three major causes:
 Haemophilus influenzae
 Neisseria meningitidis
 S. pneumoniae
 Nearly 50 species of opportunistic bacteria can
cause meningitis (L. monocytogenes, S. pyogenes,
S. aureus)
 Symptoms: Fever, headache, stiff neck, followed by
nausea and vomiting  may progress to
convulsions, coma, shock, and death
 Diagnosis by Gram stain or latex agglutination of
CSF
 Cephalosporins before identification of pathogen!
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 Epidemiology of Bacterial Meningitis
Not very contagious  spreads by direct close
contact with discharges from nose/throat of infected
person.
Vaccines:
1988: Hib
2000: PCV7
(Prevnar®) new for use
in children < 2 y old.
2005: MCV4
(MenactraT®) vaccine of Fig 22.3
choice for 11 to 55 y old
(old vaccine since 1982)
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Spinal Tap (Lumbar Puncture)

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 Haemophilus influenzae Meningitis (Hib)
 Gram-negative,
pleomorphic
coccobacilli,
capsule
 Common part of
normal throat
microbiota
 Fastidious  needs factors in blood (genus
name!). Species name is misnomer.
 Mostly in children under age 4 (especially around
6 month of age. Why?)
 Also causes pneumonia, otitis media, epiglottitis
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 Neisseria Meningitis: Meningococcal
Meningitis
Gram-neg cocci,
capsule
~ 10% of people are
healthy naso-
pharyngeal carriers
Begins as throat infection,
typical rash  death may occur within a few hours
of onset.
Continuing threat in day-care centers and schools.
Mostly in children < 2 y of age.
Sporadic outbreaks among young adults.
Vaccination recommended for college students
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 Meningococcal Rash
About half the children or adults with meningococcal
meningitis have rash that does not fade

Exotoxins
damage blood
vessel walls 
blood leaks into
skin

Glass test, or pressure test –

septicaemic rash usually does not
fade under pressure. (Not 100%
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 Pneumococcal Meningitis – S.
pneumoniae
 Gram-positive diplococci
 Typically associated with
pneumonia, but may cause
pneumococcal meningitis and
pneumococcal septicemia.
 70% of people are healthy nasopharyngeal
carriers
 Most common in children (1 month to 4
years)
 Mortality: 30% in children, 80% in elderly
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 Listeriosis
 Listeria monocytogenes
 Gram-positive
 Reproduce in Fig 22.5
phagocytes.
 Acquired by ingestion of contaminated food -
psychrophil!
 May be asymptomatic in healthy adults.
 Causes meningitis in newborns, immunosuppressed,
pregnant women, and cancer patients.
 Can cross placenta and cause spontaneous abortion
and stillbirth
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Diseases in Focus:
Meningitis and Encephalitis
 A worker in a day-care
center in eastern North
Dakota became ill with
fever, rash, headache, and
abdominal pain. The
patient had a precipitous
clinical decline and died on
the first day of
hospitalization. Diagnosis
was confirmed by Gram
staining of cerebrospinal
fluid.
 Can you identify infections
that could cause these
symptoms?
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 Tetanus (Lockjaw)
 Clostridium tetani
 Gram-positive, endospore-forming, obligate
anaerobe
 Grows in deep wounds.
 Tetanospasmin (exotoxin / neurotoxin)
released from dead cells blocks relaxation
pathway in muscles. Tetanospasmin action.
 Prevention by vaccination with tetanus toxoid
(DTaP) and booster (dT).
 Treatment with tetanus immune globulin.
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 Tetanospasmin Action
Blockage of
inhibitory NT release
in CNS (glycine and
GABA – gamma-
animobutyric acid)
Result ?

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 Why characteristic
backward arc?

Characteristic
condition:
Opistothonos
Neonatal tetanus with severe muscle
90% fatality rate contractions.
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 Botulism
 Clostridium botulinum
 Gram-positive, endospore-forming, obligate
anaerobe, ubiquitous in soil and H2O
 Intoxication (ingestion of botulinum toxin): 7
different Neurotoxins (exotoxins, A, B and E cause
most human illness)
 Type A
 60-70% fatality
 Found in CA, WA, CO, OR, NM.
 Type B
 25% fatality
 Europe and eastern United States
 Type E
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 Botulinum Toxin: Most Potent Toxin on Earth
 Mechanism of action: Irreversible
inhibition of ACh release from motor neuron
 ________
 Treatment: ?

 Prevention
 Proper canning
 Nitrites prevent endospore germination in
sausages

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 3 Forms of Botulism
1. Foodborne botulism: Intoxication not
infection! Endospores survive improper
canning procedures.
2. Wound botulism: ~ symptoms as
above, start ~ 4 days after wound
infection
3. Infant botulism: due to ingestion
of endospores  C. botulinum
growing in intestines.
In animals: limberneck
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 Botulinum Toxin: Killer and Healer
Botox (Botulinum toxin type A)
Medical uses: blephrospasms,
strabismus, torticollis . . . . . etc.
Under investigation: migraine
headaches, hyperhidrosis
Cosmetic purposes

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 Spastic
torticollis:
neck in a
twisted or
bent position

Blepharospasm is a focal
dystonia characterized by
increased blinking and
involuntary closing of the eyes.
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 Leprosy or Hansen’s Disease

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 Mycobacterium leprae (acid-fast rod)
 Grows best at 30°C  cooler body regions
(peripheral nerves and skin cells)
 Transmission requires prolonged contact with an
infected person. Mostly via nasal secretions of
lepromatous leprosy patients
Incubation time: Months to 10 years
Two forms depending on immune response
1. Tuberculoid (neural) form: Loss of sensation in
skin areas; positive lepromin test
2. Lepromatous (progressive) form: in case of cell
mediated IS failure) Disfiguring nodules over body;
negative lepromin test
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Tuberculoid leprosy in a 24-year-old Samoan woman with seven-
month history of expanding plaque on cheek. Note the thickened
accessory nerve coursing over the sternomastoid muscle.
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 Patient with active,
neglected nodulous
lepromatous
leprosy. With
treatment, all
nodules could be
reversed.
©WHO/TDR/McDou
gall

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 Azadegan Clinic,
Teheran: The foot of
a woman that has
been grossly
disfigured through
leprosy infection. ©
World Health
Organization/TDR/C
rump

Deformity due to nerve damage with its consequent ulcers and

resorption of bone. Such deformities can be worsened by careless
use of the hands. © WHO/TDR
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 Viral Diseases of the Nervous System

VIRAL MENINGITIS:
Usually mild. Clears up
within a week or two
without specific Poliomyelitis
treatment. Also called
aseptic meningitis.
Rabies

Viral meningitis

Viral encephalitis
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 Poliomyelitis – Infantile Paralysis
Poliovirus (Enteroviruses of picornaviridae)
Transmitted by ingestion. 3 strains of polio virus
(1,2,3)
90% of cases asymptomatic
Initial symptoms: Sore throat and nausea
Viremia may occur; if persistent, virus can enter the
CNS; Selective destruction of motor neurons and
paralysis occurs in <1% of cases.
Prevention: vaccination (enhanced IPV)
Post-polio syndrome 30 y later: Crippling deterioration
of originally affected muscles due to aging process
of “replacement neurons”.
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 Worldwide Annual Incidence of
Poliomyelitis

Fig 22.11
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 Prevention and Treatment
 1955: Salk vaccine
(Inactivated – IPV)
FDR, President from
1932 to 1945  1961: Sabine vaccine
(Live, attenuated, oral –
OPV). Advantages ?
 OPV has caused all the
polio cases in the US
between 1980 and 1999
 2000: CDC recommends
new IPV (E_IPV) for
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 Rabies Virus (of Rhabdoviridae)
 Zoonosis – Transmission from saliva of rabid animal
 Virus multiplies in skeletal muscles, then retrograde
axonal transport to CNS (encephalitis), then back out
to periphery (salivary glands etc.)
 Initial symptoms may include muscle spasms of the
mouth and pharynx and hydrophobia.

 Furious rabies: Animals

restless then highly
excitable.
 Paralytic rabies: Animals
unaware of surroundings.
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Pathology of Rabies Infection

Fig 22.12
 Treatment and Prevention

 Highly fatal – only handful of people survived

 Preexposure prophylaxis: Human diploid cells
vaccine (HDCV) applied i.m.
 Postexposure prophylaxis (PEP):
 Vaccine (HDCV, applied i.m. on days 0, 3, 7, 14,
and 28)
 Human rabies immune globulin (RIG)
 Rodents and rabbits seldom get rabies. Dogs,
cats, cattle, skunks, raccoons, bats, etc. do 
Vaccination of pets! If necessary vaccination of
wild populations
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genetically engineered, ORV
vaccinia-rabies
glycoprotein (V-RG) virus
has proven to be orally
effective in raccoons.

Copyright © 2010 Pearson Education, Inc. CDC rabies prevention

Reported Cases of Rabies in Animals

Fig 22.13

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Arboviral Encephalitis
 Arboviruses are arthropod-
borne viruses that belong to
several families.
 Prevention by mosquito
control.
 Horses and humans affected.
 Incidence of arboviral encephalitis  in summer, when
mosquitoes are most numerous.
 Sentinel animals, e.g.: caged chickens
 Diagnosis based on serological tests.
 Symptoms from subclinical to coma and death
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 Notifiable Arboviral Encephalitis Infections
Mosquito U.S.
Encephalitis Reservoir
vector distribution
Western
Birds, horses Culex
equine

Eastern Aedes,
Birds, horses
equine Culiseta

St. Louis Birds Culex

Small
California Aedes
mammals
Birds,
West Nile Culex, Aedes
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Diseases in Focus:
Types of Arboviral Encephalitis (p. 628)
 An 8-year-old girl in
rural Wisconsin has
chills, headache,
and fever and
reports having been
bitten by
mosquitoes.
 Which type of
encephalitis is most
likely?

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 Fungal Disease of Nervous System

Cryptococcus neoformans Meningitis

 Also called cryptococcosis
 Soil fungus associated with pigeon and chicken
(aerosolization of dried up contaminated droppings)
 Transmitted by the respiratory route; spreads
through blood to the CNS
 Mortality up to 30% – Primarily affects AIDS patients
( .4%)
 Diagnosis: Serology to detect cryptococcal antigens
in serum or CSF
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Cryptococcus neoformans

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Figure 22.15
 Protozoan Disease of Nervous System
African Trypanosomiasis (Sleeping Sickness)
Caused by Trypanosoma brucei; vector: tsetse fly
(day-biting)
 T.b. gambiense infection is chronic (2 to 4 years).
 T.b. rhodesiense infection is more acute (few months).
Symptoms: chancre - intermittent fever – CNS invasion.
Without treatment: death

Treatment: Eflornithine
blocks an enzyme
necessary for the parasite
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Antigenic variation allows for persistent evasion of the
immune system  Cyclic parasitemia (7-10 days)

Fig
22.16
 Nervous System Diseases Caused by
Prions
Transmissible Spongiform Encephalopathies
Prions convert normal proteins into abnormal proteins
Post mortem sponge-like appearance of brain tissue
large vacuoles in cortex and cerebellum due to loss of neurons
Chronic and fatal
Transmitted by ingestion or transplant or inherited.
 Typical diseases
 Sheep scrapie
 Creutzfeldt-Jakob disease
 Kuru
 Bovine spongiform encephalopathy
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Prions
How can a protein be infectious?

Fig 13.22 / Fig 22.18

Preventing Prion Diseases Fig 7.11

 Surgical instruments
sterilized by
 NaOH
 + extended autoclaving
at 134°C

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