Central Nervous System Infection

Central nervous system infection
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Jump to: navigation, search Central nervous system infections are those infections of the central nervous system (CNS) !here are four main causes of infections of the nervous system: "acterial, viral, fungal and proto#oal Bacterial infections can "e pyogenic infections (e.g., meningitis$ "rain a"scess$ su"dural and epidural a"scesses), tu"erculosis, neurosyphilis, or leprosy Viral infections may "e meningitis, encephalitis, poliomyelitis, slo% virus infections, ac&uired immune deficiency syndrome ('()S), and post*infectious syndromes Fungal infections may "e meningitis or meningoencephalitis, "rain a"scess, or spinal epidural infection Protozoal infections include to+oplasmosis, malaria or amoe"ic infection
Infection
Jump to: navigation, search For other uses, see Infection (disambiguation). 'n infection is the detrimental coloni#ation of a host organism "y a foreign species (n infection, the infecting organism seeks to utili#e the host,s resources in order to multiply (usually at the e+pense of the host) !he infecting organism, or pathogen, interferes %ith the normal functioning of the host and can lead to chronic %ounds, gangrene, loss of an infected lim", and even death !he host,s response to infection is inflammation Collo&uially, a pathogen is usually considered a microscopic organism though the definition is "roader, including "acteria, parasites, fungi, viruses, prions, and viroids ' sym"iosis "et%een parasite and host, %here"y the relationship is "eneficial for the former "ut detrimental to the latter, is characterised as parasitism !he "ranch of medicine that focuses on infections and pathogens is infectious disease -edit.
Colonization
Wound coloni#ation refers to nonreplicating microorganisms %ithin the %ound, %hile in infected %ounds replicating organisms e+ist and tissue is in/ured 'll multicellular organisms are coloni#ed to some degree "y e+trinsic organisms, and the vast ma/ority of these e+ist in either a mutualistic or commensal relationship %ith the host 'n e+ample of the former %ould "e the anaero"ic "acteria species %hich coloni#e the mammalian colon, and an e+ample of the latter %ould "e the various species of staphylococcus %hich e+ist on human skin Neither of these coloni#ations %ould "e considered infections !he difference "et%een an infection and a coloni#ation is often only a matter of circumstance 0rganisms %hich are normally non*pathogenic can "ecome pathogenic under the right conditions, and even the most virulent organism re&uires certain circumstances to cause a compromising infection Some coloni#ing "acteria, such as Corynebacteria sp. and viridans streptococci, prevent the adhesion and coloni#ation of pathogenic "acteria and thus have a sym"iotic relationship %ith the host, preventing infection and speeding %ound healing !he varia"les involved in the outcome of a host "ecoming inoculated "y a pathogen and the ultimate outcome include:

the route of entry of the pathogen and the access to host regions that it gains the intrinsic virulence of the particular organism the &uantity or load of the initial inoculant the immune status of the host "eing coloni#ed
's an e+ample, the staphylococcus species present on skin remain harmless on the skin, "ut, %hen present in a normally sterile space, such as in the capsule of a /oint or the peritoneum, %ill multiply %ithout resistance and create a huge "urden on the host
Central nervous system

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' 1. 2.
("rain
diagram Central
and
sho%ing nervous
spinal
the
CNS: 1rain system

cord)
3. Spinal cord !he central nervous system (CNS) represents the largest part of the nervous system !ogether %ith the peripheral nervous system, it has a fundamental role in the control of "ehavior Since the strong theoretical influence of cy"ernetics in the fifties, the CNS is conceived as a system devoted to information processing, %here an appropriate motor output is computed as a response to a sensory input 2et, many threads of research suggest that motor activity e+ists %ell "efore the maturation of the sensory systems and then, that the senses only influence "ehavior %ithout dictating it !his has "rought the conception of the CNS as an autonomous system !he CNS originates from the neural plate, a specialised region of the ectoderm, the most e+ternal of the three em"ryonic layers )uring em"ryonic development, the neural plate folds and forms the neural tu"e !he internal cavity of the neural tu"e %ill give rise to the ventricular system !he regions of the neural tu"e %ill differentiate progressively into transversal systems First, the %hole neural tu"e %ill differentiate into its t%o ma/or su"divisions: spinal cord (caudal) and "rain (rostral) Consecutively, the "rain %ill differentiate into "rainstem and prosencephalon 3ater, the "rainstem %ill su"divide into rhom"encephalon and mesencephalon, and the prosencephalon into diencephalon and telencephalon !he CNS is covered "y the meninges, the "rain is protected "y the skull and the spinal cord "y the verte"rae !he rhom"encephalon gives rise to the pons, the cere"ellum and
the medulla o"longata, its cavity "ecomes the fourth ventricle !he mesencephalon gives rise to the tectum, pretectum, cere"ral peduncle and its cavity develops into the mesencephalic duct or cere"ral a&ueduct !he diencephalon gives rise to the su"thalamus, hypothalamus, thalamus and epithalamus, its cavity to the third ventricle Finally, the telencephalon gives rise to the striatum (caudate nucleus and putamen), the hippocampus and the neocorte+, its cavity "ecomes the lateral (first and second) ventricles !he "asic pattern of the CNS is highly conserved throughout the different species of verte"rates and during evolution !he ma/or trend that can "e o"served is to%ards a progressive telencephalisation: %hile in the reptilian "rain that region is only an appendi+ to the large olfactory "ul", it represent most of the volume of the mammalian CNS (n the human "rain, the telencephalon covers most of the diencephalon and the mesencephalon (ndeed, the allometric study of "rain si#e among different species sho%s a striking continuity from rats to %hales, and allo%s us to complete the kno%ledge a"out the evolution of the CNS o"tained through cranial endocasts -edit.
Parts of the CNS

Spinal cord 5ons, 4hom"encephalon Cere"ellum, 6edulla o"longata 1rainstem 6esencephalon !ectum, Cere"ral peduncle, 5retectum, 6esencephalic duct 7pithalamus, !halamus, 8ypothalamus, Su"thalamus, 5ituitary 9land, 5ineal 9land, !hird ventricle 1asal ganglia, 4hinencephalon, 'mygdala,
1rain
)iencephalon 5rosencephalon
!elencephalon
8ippocampus, Neocorte+, 3ateral ventricles -edit.
See also

9lossary of anatomical terminology, definitions and a""reviations 3ist of regions in the human "rain Central nervous system infection
Brain (neural tube)

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Rhombencephalon (hindbrain)
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yelencephalon
medulla o"longata o medullary pyramids
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etencephalon

pons paramedian pontine reticular formation fourth ventricle cere"ellum o cere"ellar vermis o cere"ellar hemispheres anterior lo"e posterior lo"e flocculonodular lo"e o cere"ellar nuclei fastigial nucleus glo"ose nucleus em"oliform nucleus dentate nucleus
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esencephalon (midbrain)
tectum inferior colliculi superior colliculi mesencephalic duct (cere"ral a&ueduct, '&ueduct of Sylvius) cere"ral peduncle mid"rain tegmentum o ventral tegmental area o 4ed Nucleus o su"stantia nigra o crus cere"ri pretectum
o o
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!rosencephalon (forebrain)
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"iencephalon
epithalamus o pineal "ody o ha"enular nuclei o stria medullares o tenia thalami third ventricle thalamus o anterior nuclear group anteroventral nucleus anterodorsal nucleus anteromedial nucleus o medial nuclear group dorsomedial nucleus midline nuclear group paratenial nucleus paraventricular nucleus reuniens nucleus rhom"oidal nucleus intralaminar nuclear group centromedial nucleus parafascicular nucleus paracentral nucleus central lateral nucleus central medial nucleus o lateral nuclear group lateral dorsal nucleus
lateral posterior nucleus pulvinar o ventral nuclear group ventral anterior nucleus ventral lateral nucleus ventral posterior nucleus o metathalamus medial geniculate "ody lateral geniculate "ody o thalamic reticular nucleus hypothalamus (limbic system) ( P! a"is) o optic chiasm o arcuate nucleus o su"fornical organ o preoptic area o suprachiasmatic nucleus o supraoptic nucleus o periventricular nucleus o paraventricular nucleus o ventromedial nucleus o dorsomedial nucleus o lateral hypothalamus o infundi"ulum o tu"er cinereum o tu"eral region o mammillary "odies o mammillary nucleus su"thalamus( P! a"is) o thalamic nucleus o #ona incerta pituitary gland ( P! a"is) o neurohypophysis o intermediate pituitary o adenohypophysis

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red:frontal orange:parietal yello%:occipital green: "lue:cere"ellum "lack:"rainstem
temporal
lo"e lo"e lo"e lo"e
#elencephalon (cerebrum)
Cere"ral hemispheres o White matter Corona radiata (nternal capsule 7+ternal capsule 7+treme capsule 'rcuate fasciculus :ncinate fasciculus o Su"cortical 'mygdala (limbic system) (limbic lobe) (paleopallium) Central nucleus(autonomic ner#ous system) 6edial nucleus(accessory olfactory system) Cortical and "asomedial nuclei(main olfactory system) 3ateral and "asolateral nuclei(frontotemporal cortical system) 8ippocampus (limbic system) (limbic lobe) (archipallium) )entate gyrus Cornu ammonis (C' fields) 1asal ganglia Striatum(archipallium) Nucleus lentiformis 9lo"us pallidus 5utamen Nucleus caudatus Claustrum Corpus amygdaloideum o 4hinencephalon (paleopallium) 0lfactory "ul"
o o
5iriform corte+ 'nterior olfactory nucleus 0lfactory tract 'nterior commissure 3ateral ventricles Cere"ral corte+ (neopallium) Frontal lo"e Corte+ 5rimary motor corte+ (6;) 1rodmann area < (Primary motor corte") 5refrontal corte+ Supplementary motor corte+ 5remotor corte+ 9yrus Superior frontal gyrus 6iddle frontal gyrus (nferior frontal gyrus 1rodmann areas: =, >, ?, ;@, ;;, A<, AB, CA, CC, <<, <B, <=, <D !emporal lo"e Corte+ 5rimary somatosensory corte+ (S;) SA 5osterior parietal corte+ 9yrus Superior temporal gyrus 6iddle temporal gyrus (nferior temporal gyrus Fusiform gyrus 5arahippocampal gyrus 1rodmann areas: ?, A@, A;, AA, AD, C<, CB, C=, CD, C>, <;, <A 5arietal lo"e Corte+ 5rimary auditory corte+ (';) 'A (nferior temporal corte+ 5osterior inferior temproal corte+ 9yrus 5ostcentral gyrus (Primary somesthetic area) 0ther 5recuneus 1rodmann areas ;, A, C (Primary somesthetic area)$ B, D, AC, A=, A?, C;, C?, <@ 0ccipital lo"e Corte+

5rimary visual corte+ (E;) EA 3ateral occipital gyrus
9yrus
0ther
Cuneus 1rodmannFareas ;D (V$, primary #isual corte")$ ;>, ;?
(nsula Cingulate corte+ 'nterior cingulate 5osterior cingulate 1rodmannFareas AC, A<$ A=, A?, C@ (retrosplenial areas)$ C;, CA
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Neural path$ays

arcuate fasciculus cere"ral peduncle corpus callosum pyramidal or corticospinal tract 6a/or dopamine path%ays o mesocortical path%ay o mesolim"ic path%ay o nigrostriatal path%ay o tu"eroinfundi"ular path%ay Serotonin 5ath%ays o 4aphe Nuclei
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Cerebrospinal systems
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Neuronal systems

central nervous system peripheral nervous system o somatic nervous system o autonomic nervous system sympathetic nervous system parasympathetic nervous system enteric nervous system
o o
su"mucosal ple+us myenteric ple+us
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Co%nitive systems
senses and sensory systems o olfactory system primary olfactory corte+ o visual system o 'uditory system 6usic and the "rain
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&olitive systems
motor system o e+trapyramidal system o pyramidal tract o alpha system o gamma system
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Nerves

Spinal cord "rain stem o cranial nerves 0lfactory nerve, (() 0ptic nerve ((() 0culomotor nerve (((() !rochlear nerve((E) !rigeminal nerve (E) '"ducens nerve (E() Facial nerve (E(() Eesti"ulocochlear nerve (E((() 9lossopharyngeal nerve ((G) Eagus nerve (G) 'ccessory nerve (G() 8ypoglossal nerve (G(()
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Neurocrine systems
lim"ic system 85' a+is
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&ascular systems

venous systems circle of Willis (arterial system) "lood*"rain "arrier "lood*cere"rospinal fluid "arrier
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"ural menin%eal system

"rain*cere"rospinal fluid "arrier meningeal coverings o dura mater o pia mater epidural space su"dural space arachnoid septum ventricular system o cere"rospinal fluid su"arachnoid space third ventricle fourth ventricle lateral ventricles 'nterior horn 1ody of lateral ventricle (nferior horn 5osterior horn superior cistern cistern of lamina terminalis chaismatic cistern interpeduncular cistern pontine cistern cere"romedullary cistern spinal su"arachnoid space
enin%itis

enin%itis
IC"'1( IC"')
9@@*9@C CA@*CAA
enin%itis is the inflammation of the mem"ranes (meninges) covering the "rain and the spinal cord, usually due to "acterial or viral infections else%here in "ody that has spread into the "lood and into the cere"rospinal fluid (CSF) 0ther causes of meningitis such as fungal, proto#oal, or certain non*infectious etiologies are much rarer 6eningitis should "e distinguished from the condition encephalitis, the latter of %hich is the inflammation of the "rain itself 6eningitis can affect anyone in any age group, from the ne%"orn to the elderly, although the specific cause may "e different !ypical signs and symptoms of meningitis include fever, headache, stiff neck, photopho"ia, or vomiting 'lthough the most common cause of meningitis is viral (%hich may resolve %ithin a fe% days %ithout treatment), anyone suspected of having meningitis should "e evaluated promptly, "ecause "acterial meningitis can "e very serious and immediate treatment is necessary
Contents
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; Causes o ; ; (nfectious ; ; ; 4isk Factors o ; A Non*infectious A 5athophysiology C Symptoms o C ; Complications < )iagnosis o < ; CSF analysis in "acterial meningitis B !reatment o B ; Specific treatments B ; ; Eiral meningitis o B A (ncreased intracranial pressure = Eaccination D 8istory o D ; !he 'frican 6eningitis 1elt > See also ? 4eferences ;@ 7+ternal links
Causes
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Infectious
9@A@: &iruses are the most common cause of meningitis 7nterovirus accounts for the ma/ority (DB to ?@H) of all cases of viral meningitis Specific etiologies %ithin the family 5icornaviridae and other common viral causes of aseptic meningitis includes: o co+sackievirus o echovirus o poliovirus o human enteroviruses o ar"ovirus o lymphocytic choriomeningitis virus o 8(E o herpes simple+ virus type ((
3ess common and rare causes of viral meningitis includes herpes simple+ virus type (, varicella #oster virus, adenovirus, cytomegalovirus, 7pstein*1arr virus, influen#a virus ' or 1, parainfluen#a virus, mumps, ru"ella, and West Nile virus
9@@*9@;: *acterial menin%itis is the most common form of purulent CNS infection %ith incidence in the :nited States IA BJ;@@,@@@Jyr Currently, the most common organisms overall responsi"le for community*ac&uired meningitis are %treptococcus pneumoniae (KB@H), &eisseria meningitidis (KABH), %treptococcus agalactiae or 9roup 1 Streptococci (K;BH), and 'isteria monocytogenes (K;@H) aemophilus influenzae no% consists of L ;@H of all cases since the %idespread use of the 8i1 vaccine !he causes can also "e simplified "y the age of the patient affected (most common listed first): o less than 3 months *** %treptococcus agalactiae, (scherichia coli, 'isteria monocytogenes o 3 mo to + yrs *** &eisseria meningitidis, %treptococcus pneumoniae, aemophilus influenzae o 1+ to ,( yrs *** %treptococcus pneumoniae, &eisseria meningitidis o ,( yrs and older *** %treptococcus pneumoniae, 'isteria monocytogenes, 9ram*negative "acilli o Immunocompromised *** 'isteria monocytogenes, 9ram*negative "acilli, Cryptococcus neoformans o -ead trauma. post'neurosur%ery. CS/ shunt *** %taphylococcus spp, 9ram*negative "acilli, %treptococcus pneumoniae
!here is a geographic variation in the incidence of the "acteria, e g in rural !hailand the most common cause is %. suis )uberculous meningitis may also "e more prevalent in third*%orld countries -edit.
Ris0 /actors
!neumococcal menin%itis due to % pneumoniae can "e precipitated "y many factors, the most important of %hich is 5neumococcal pneumonia 'dditional risks include 5neumococcal sinusitis or otitis media, alcoholism, dia"etes mellitus, splenectomy, hypogammaglo"ulinemia, and head trauma 6ortality remains KA@H despite anti"iotic therapy enin%ococcal menin%itis due to & meningitidis after nasopharyngeal coloni#ation may "e either asymptomatic or "ecome systemically invasive, progressing to death %ithin hours of symptomatic onset !he main host capa"ility to eradicate & meningitidis is through production of anti"odies and lysis of the "acterium "y "oth the classic and alternative complement path%ay 5atients %ith impaired or deficient complement components, especially the CB*? lytic component, is highly suscepti"le to disseminated meningococcal infections 1roup * streptococci meningitis due to % agalactiae is an important cause of neonatal meningitis, the risk of %hich increases if the mother has positive vaginal coloni#ation during "irth and %as not given anti"iotics 2isteria infection is mainly ac&uired through ingestion of contaminated foods 4eported foods at risk for 'isteria contamination include milk, colesla%, soft cheeses, and several ready*to*eat foods such as deli meat and uncooked hot dogs 1ram ne%ative bacilli infection is more common in those %ith chronic conditions such as dia"etes mellitus, cirrhosis, alcoholism, or chronic urinary tract infections Staphyloccocus infections such as those due to % aureus is important in those %ho have had neurosurgery procedures such as shunting for hydrocephalus or the use of 0mmaya reservoir for intrathecal chemotherapy &iral menin%itis infections may e+press a higher incidence during certain seasona"le variations o %ummer*(arly fall ** ar"ovirus, enterovirus o Fall*+inter ** lymphocytic choriomeningitis virus o +inter*%pring ** mumps o nonseasonal ** 8SE, 8(E
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Non'infectious
Non*infectious causes are rare, and may include:

!umors (leukemia, lymphoma, primary "rain tumors, metastases) CNS Sarcoidosis Chemical compounds (lead poisoning) Eogt*Moyanagi*8arada syndrome (solated granulomatous angiitis Systemic lupus erythematosus 1ehcet,s syndrome
6ollaret,s meningitis )rug hypersensitivity (6ethotre+ate) Wegener,s granulomatosis
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Pathophysiology
*acterial menin%itis is usually caused "y %treptococcus pneumoniae and &eisseria meningitidis !hese organisms initially attach to the epithelial cells of the nasopharyn+ and are then transported via vacuoles into the "loodstream !hey are a"le to avoid phagocytosis "y neutrophils and complement*mediated "actericidal activity "ecause of their polysaccharide capsule !hey then reach the ventricles and directly infect the choroid ple+us and gain access to the CSF !here, they are a"le to rapidly divide "ecause of the a"sence of effective immune defenses since CSF contains relatively small amounts of %hite "lood cells, complement proteins, and immunoglo"ulins !he scarcity of the latter t%o components renders opsoni#ation of "acteria ineffective, leading to impaired phagocytosis "y neutrophils 7ventually, the "acteria are lysed, %ith release of cell %all products into the su"arachnoid space !hese su"stances *** including lipopolysaccharide (35S), teichoic acid, and peptidoglycan *** induce meningeal inflammation "y stimulating cytokine release (such as !NF and (3*;) "y CNS microglia, astrocytes, monocytes, endothelial cells, and leukocytes (n addition to meningeal inflammation, these cytokines are responsi"le for the fever, headache, and increased intracranial pressure present secondary to the formation of the purulent e+udate and o"struction of CSF flo% through the ventricular system as %ell as inhi"iting resorption of CSF "y the su"arachnoid granulations 1ecause much of the symptoms of meningitis is due to the host inflammatory response rather than direct "acterial damage, this e+plains %hy symptoms may persist even after ade&uate anti"iotic therapy
(nterior vie% of a "rain %ith meningitis caused "y 8aemophilus influen#ae Source: C)C Purulent (suppurati#e) leptomeningitis is a diffuse purulent inflammation !he leptomeninges (arachnoid and pia matter) contain purulent e+udate (pus): leukocytes (neutrophils), fi"rin, germs, proteins, necrotic de"ris 1lood vessels in the
su"arachnoidian space and those intracere"ral are congested and neutrophil margination is present -;. -edit.
Symptoms
Symptoms of meningitis may progressive either acutely, "ecoming fulminant %ithin a fe% hours, or present su"acutely over several days !he classical triad of meningitis are fever, headache, and nuchal rigidity (Nneck stiffnessN) *** each presents in I?@H of patients 5hotopho"ia (intolerance to light), chills, nausea, vomiting, may also occur Sei#ures may occur in a"out A@ to <@H of patients 0ther signs include Mernig,s sign and 1rud#inski,s sign 'lthough commonly tested, the sensitivity and specificity of Mernig,s and 1rud#inski,s tests are uncertain

Nuchal rigidity is the pathognomonic sign of meningeal irritation and is present %hen the neck is resistant to passive fle+ion Mernig,s sign is elicited %hen patient is lying supine, %ith "oth hips and knees fle+ed 6eningeal irritation is present if pain is elicited %hen the knees are passively e+tended 1rud#inski,s sign is elicited %hen the patient is lying supine, %ith "oth hips and knees fle+ed 6eningeal irritation is present if pain is elicited %hen the neck is passively fle+ed
'n important clue in meningococcal meningitis is diffuse petechial rash present on the trunk, lo%er e+tremities, mucous mem"ranes, con/unctiva, and occasionally on the palms and soles -edit.
Complications
'n increased intracranial pressure is a kno%n and a potentially fatal complication of "acterial meningitis !he main sign of an increased (C5 is an altered states of consciousness, %hich may vary from lethargy to confusion to coma 6ore than ?@H of cases %ill present %ith CSF opening pressure I ;>@ mm8g and some %ith I <@@ mm8g 0ther signs of increased (C5 in addition to headache and vomiting include papilledema, si+th cranial nerve palsies, decere"rate posturing, and Cushing,s refle+ ("radycardia, hypotension, and Cheyne*Stokes respiration) !he most fatal complication of (C5 is "rain herniation, %hich may present in ; to >H of cases ,ain article- intracranial pressure -edit.
Diagnosis
'lthough diagnosis of meningitis as %ell as its specific etiology is important, la"oratory testing takes time 1ecause "acterial meningitis is such an urgent issue, treatment is usually instituted "efore a definite diagnosis is made

When a patient is suspected of meningitis, "lood culture should "e dra%n and empiric anti"iotics started immediately )iagnosis of meningitis can then "e carried out %ith e+amination of CSF %ith a lum"ar puncture (35) 8o%ever, if the patient has had recent head trauma, is immunocompromised, have kno%n malignant or CNS neoplasm, or have focal neurologic deficits such as papilledema or altered consciousness, a C! or 64( should "e performed prior to the 35 in order to avoid a potentially fatal "rain herniation during the procedure 0ther%ise, the C! or 64( should "e performed after the 35, %ith 64( preferred over C! due to its superiority in demonstrating areas of cere"ral edema, ischemia, and meningeal enhancement
'nti"iotics started %ithin < hours of lum"ar puncture %ill not significantly affect la" results !he opening pressure is noted during the 35 and the CSF fluid sent for e+amination of %hite "lood cell, red "lood cell, glucose, protein, 9ram stain, culture, and possi"ly late+ agglutination test, limulus lysates, or 5C4 for "acterial )N' -edit.
CS/ analysis in bacterial menin%itis

0pening pressure: I ;>@ mm8A0 White "lood cell: ;@*;@,@@@Ju3 %ith neutrophil predominance 9lucose: L <@ mgJd3 CSF glucose to serum glucose ratio: L @ < 5rotein: I < B mgJd3 9ram stain: positive in I=@H Culture: positive in I>@H 3ate+ agglutination: may "e positive in meningitis due to %treptococcus pneumoniae, &eisseria meningitidis, aemophilus influenzae, (scherichia coli, 9roup 1 Streptococci 3imulus lysates: positive in 9ram*negative meningitis
CSF cultures are usually positive in C@ to D@H of patients %ith viral meningitis and those %ith negative cultures %ill usually have a positive CSF 5C4 test -edit.
Treatment
1acterial meningitis is a medical emergency and has a high mortality rate if untreated 'll suspected cases, ho%ever mild, need emergency medical attention 7mpiric anti"iotics should "e started immediately, even "efore the results of the lum"ar puncture and CSF are kno%n 1ecause the most common organisms involved are %treptococcus pneumoniae and &eisseria meningitidis, therapy usually "egins %ith a third*generation cephalosporin (such as ceftria+one or cefota+ime) plus vancomycin (n those L C years of age, I B@ years of age, and immunocompromised, ampicillin should "e added to cover 'isteria monocytogenes For hospital*ac&uired meningitis as %ell as those follo%ing neurosurgical procedures, staphyloccocci and gram*negative "acilli are common causative agents (n those patients, cefta#idime should "e su"stituted for ceftria+one or cefota+ime "ecause it is the only cephalosporin %ith activity against CNS infection %ith Pseudomonas aeruginosa -edit.
Specific treatments
0nce the results of the CSF analysis are kno%n along %ith the 9ram*stain and culture, empiric therapy may "e s%itched to therapy targeted to the specific causative organisms 1ecause anti"iotic*resistance is a prevalent pro"lem, information from drug suscepti"ility testing should also "e gathered
Neisseria meningitidis can usually "e treated %ith a D*day course of (E anti"iotics: o 5enicillin*sensitive ** penicillin 9 or ampicillin o 5enicillin*resistant ** ceftria+one or cefota+ime o 5rophyla+is for close contacts (contact %ith oral secretions) ** rifampin =@@ mg "id for A days (adults) or ;@ mgJkg "id (children) 4ifampin is not recommended in pregnancy and as such, these patients should "e treated %ith single doses of ciproflo+acin, a#ithromycin, or ceftria+one Streptococcus pneumoniae can usually "e treated %ith a A*%eek course of (E anti"iotics: o 5enicillin*sensitive ** penicillin 9 o 5enicillin*intermediate ** ceftria+one or cefota+ime o 5enicillin*resistant ** ceftria+one or cefota+ime O vancomycin Listeria monocytogenes is treated %ith a C*%eek course of (E ampicillin O gentamicin 9ram negative "acilli ** ceftria+one or cefota+ime Pseudomonas aeruginosa ** cefta#idime %taphylococcus aureus o 6ethicillin*sensitive ** nafcillin o 6ethicillin*resistant ** vancomycin %treptococcus agalactiae ** penicillin 9 or ampicillin aemophilus influenzae ** ceftria+one or cefota+ime
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&iral menin%itis
:nlike "acteria, viruses cannot "e killed "y anti"iotics 5atients %ith mild viral meningitis may "e allo%ed to stay at home, %hile those %ho have a more serious infection may "e hospitali#ed for supportive care 5atients %ith mild cases, %hich often cause only flu*like symptoms, may "e treated %ith fluids, "ed rest (prefera"ly in a &uiet, dark room), and analgesics for pain and fever !he physician may prescri"e anticonvulsants such as dilantin or phenytoin to prevent sei#ures and corticosteroids to reduce "rain inflammation (f inflammation is severe, pain medicine and sedatives may "e prescri"ed to make the patient more comforta"le -edit.
Increased intracranial pressure

!reatment of increased intracranial pressure include elevation of head to C@ to <B degrees, intu"ation and hyperventilation, and mannitol ,ain article- intracranial pressure -edit.
Vaccination
Eaccinations against aemophilus influenzae (8i") have decreased early childhood meningitis significantly Eaccines against type ' and C &eisseria meningitidis, the kind that causes most disease in preschool children and teenagers in the :nited States, have also "een around for a %hile !ype ' is also prevalent in su"*Sahara 'frica and W;CB out"reaks have affected those on the 8a// pilgrimage to 6ecca ' vaccine called ,e&.B for a specific strain of type 1 Neisseria meningitidis prevalent in Ne% Pealand has completed trials and is "eing given to many people in the country under the age of A@ !here is also a vaccine, 6en1Eac, for the specific strain of type 1 meningoccocal disease prevalent in Nor%ay, and another specific vaccine for the strain prevalent in Cu"a 5neumova+ against %treptococcus pneumoniae is recommended for all those I =B years of age as %ell as children %ith specific risk factors -edit.
History
!he symptoms of meningitis %ere recorded in the 6iddle 'ges along %ith those of tu"erculosis and the 1lack 5lague, "ut it %as first accurately identified "y the S%iss Eieusseu+ (a scientific*literary association,) during an out"reak in 9eneva, S%it#erland in ;>@B (n the ;?th Century meningitis %as a scourge of the Japanese (mperial family, playing the largest role in the horrendous pre*maturity death rate the family endured (n the mid*;>@@s, only the 7mperor Momei and t%o of his si"lings reached maturity out of fifteen total children surviving "irth Momei,s son, the 7mperor 6ei/i, %as one of t%o survivors out of Momei,s si+ children, including an elder "rother of 6ei/i %ho %ould have taken the throne had he lived to maturity Five of 6ei/i,s fifteen children survived, including only his third son, the !aisho 7mperor, %ho %as fee"le*minded, perhaps as a result of having contracted meningitis himself 1y 7mperor 8irohito,s generation the family %as receiving modern medical attention 's the focal point of tradition in Japan, during the !okuga%a Shogunate the family %as denied modern N)utchN medical treatment then in use among the upper caste$ despite e+tensive moderni#ation during the 6ei/i 4estoration the 7mperor insisted on traditional medical care for his children !he in"reeding produced among the very fe% families considered %orthy of marriage into the imperial line, most of %hom %ere descendents from that same line and therefore none too distant cousins of one another, also played an important role -edit.
#he 3frican
enin%itis *elt
!he N6eningitis 1eltN is an area in su"*Saharan 'frica %hich stretches from Senegal in the %est to 7thiopia in the east in %hich large epidemics of meningococcal meningitis occur (t contains an estimated total population of C@@ million people !he largest epidemic out"reak %as in ;??=, %hen over AB@,@@@ cases occurred and AB,@@@ people died as a conse&uence of the disease
*rain abscess
Jump to: navigation, search *rain abscess (or cere"ral a"scess) is an a"scess caused "y inflammation and collection of infected material coming from local (ear infection, infection of paranasal sinuses, infection of the mastoid air cells of the temporal "one, epidural a"scess) or remote (lung, heart, kidney etc ) infectious sources %ithin the "rain tissue !he infection may also "e introduced through a skull fracture follo%ing a head trauma or surgical procedures 1rain a"scess is usually associated %ith congenital heart disease in young children (t may occur at any age "ut is most fre&uent in the third decade of life
Contents
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; Features A 5athophysiology C )iagnosis
< !reatment -edit.
eatures
!he symptoms of "rain a"scess are caused "y a com"ination of increased intracranial pressure due to a space*occupying lesion (headache, vomiting, confusion, coma), infection (fever, fatigue etc ) and focal neurologic "rain tissue damage (hemiparesis, aphasia etc ) !he most fre&uent presenting symptoms are headache, dro%siness, confusion, sei#ures, hemiparesis or speech difficulties together %ith fever %ith a rapidly progressive course !he symptoms and findings depend largely on the specific location of the a"scess in the "rain 'n a"scess in the cere"ellum, for instance, may cause additional complaints as a result of "rain stem compression and hydrocephalus Neurologic e+amination may reveal a stiff neck in occasional cases (erroneously suggesting meningitis) !he famous triad of fever, headache and focal neurologic findings are highly suggestive of "rain a"scess "ut are o"served only in a minority of the patients -edit.
Pathophysiology
1rain a"scesses are usually polymicro"ial in nature !he most common organism recovered from cultures is the "acterium %treptococcus 8o%ever, a %ide variety of other "acteria ( Proteus, Pseudomonas, Pneumococcus, ,eningococcus, aemophilus), fungi and parasites may also cause the disease Fungi and parasites are especially associated %ith immunocompromised patients 0rganisms that are most fre&uently*associated %ith "rain a"scess in patients %ith '()S are !o+oplasma gondii and Cryptococcus neoformans, though in infection %ith the latter organism, symptoms of meningitis generally predominate -edit.
Diagnosis
!he diagnosis is esta"lished "y a computed tomography (C!) (%ith contrast) e+amination 't the initial phase of the inflammation (%hich is referred to as cere"ritis), the immature lesion does not have a capsule and it may "e difficult to distinguish it from other space*occupying lessions or infarcts of the "rain Within <*B days the inflammation
and the concomitant dead "rain tissue are surrounded %ith a capsule, %hich gives the lesion the famous ring*enhancing appearance on C! e+amination %ith contrast (since intravenously applied contrast material can not pass through the capsule, it is collected around the lesion and looks as a ring surrounding the relatively dark lesion) 3um"ar puncture procedure, %hich is performed in many infectious disorders of the central nervous system is contraindicated in this condition (as it is in all space*occupying lesions of the "rain) "ecause removing a certain portion of the cere"rospinal fluid may alter the concrete intracranial pressure "alances and cause a part of the "rain tissue to move out of the skull ("rain herniation) 4ing enhancement may also "e o"served in cere"ral hemorrhages ("leeding) and some "rain tumors 8o%ever, in the presence of the rapidly progressive course %ith fever, focal neurologic findings (hemiparesis, aphasia etc) and signs of increased intracranial pressure, the most likely diagnosis should "e the "rain a"scess -edit.
Treatment
!he treatment includes lo%ering the increased intracranial pressure and starting intravenous anti"iotics (and mean%hile identifying the causative organism mainly "y "lood culture studies) Surgical aspiration or removal of "rain a"scess are performed for patients that are resistant to medical treatments 4etrieved from Nhttp:JJen %ikipedia orgJ%ikiJ1rainFa"scessN
#uberculosis

#uberculosis
IC"'1( IC"')
';B*';? @;@*@;>
#uberculosis (commonly a""reviated as #*) is an infection caused "y the "acterium ,ycobacterium tuberculosis, %hich most commonly affects the lungs (pulmonary !1) "ut can also affect the central nervous system (meningitis), lymphatic system, circulatory system (6iliary tu"erculosis), genitourinary system, "ones and /oints !u"erculosis is one of the most deadly and common ma/or infectious diseases today 's of A@@<, ;< = million people have active !1 disease %ith nine million ne% cases of the disease and nearly t%o million deaths, -;. mostly in developing countries 8o%ever,
developing countries are not the only places %ith tu"erculosis !here is a rising num"er of people in the developed %orld %ho contract tu"erculosis "ecause they have compromised immune systems, typically as a result of immunosupressive drugs or 8(EJ'()S !hese people are at particular risk of tu"erculosis infection and active tu"erculosis disease 6ost of those infected (?@H) have asymptomatic latent !1 infection (3!1() !here is a ;@H lifetime chance that 3!1( %ill progress to !1 disease %hich, if left untreated, %ill kill more than B@H of its victims !1 is one of the top four infectious killing diseases in the %orld: !1 kills ; D million, and malaria kills A*C million 8(EJ'()S, the neglect of !1 control programs, and immigration have caused a resurgence of tu"erculosis 6ultidrug*resistant strains of !1 (6)4*!1) and 7+treme )rug*4esistance in !u"erculosis (G)4*!1) are emerging !he World 8ealth 0rgani#ation declared !1 a glo"al health emergency in ;??C, and the Stop !1 5artnership proposed a 9lo"al 5lan to Stop !u"erculosis %hich aims to save an additional ;< million lives "et%een A@@= and A@;B
The bacterium
'cid*fast "acilli ('F1) (sho%n in red) are tu"ercle "acilli ,ycobacterium tuberculosis !he cause of tu"erculosis, ,ycobacterium tuberculosis (6!1), is a slo%*gro%ing aero"ic "acterium that divides every ;= to A@ hours !his is e+tremely slo% compared to other "acteria (although not the slo%est), %hich tend to have division times measured in minutes (among the fastest gro%ing "acteria is a strain of (. coli that can divide roughly every A@ minutes$ "y contrast, ,ycobacterium leprae divides every A@ days) 6!1 is not classified as either 9ram*positive or 9ram*negative "ecause it does not have the chemical characteristics of either (f a 9ram stain is performed, it stains very %eakly 9ram*positive or not at all (ghost cells) (t is a small rod*like "acillus %hich can %ithstand %eak disinfectants and can survive in a dry state for %eeks "ut, spontaneously, can only gro% %ithin a host organism (in #itro culture of ,. tuberculosis took a long time to "e achieved, "ut is no%adays a routine la"oratory procedure) 6!1 is identified microscopically "y its staining characteristics: it retains certain stains after "eing treated %ith acidic solution, and is thus classified as an Nacid*fast "acillusN or 3/* (n the most common staining techni&ue, the Piehl*Neelsen stain, 'F1 are stained a "right red %hich stands out clearly against a "lue "ackground 'cid*fast "acilli can also "e visuali#ed "y fluorescent microscopy, and "y an auramine*rhodamine stain
!he ,. tuberculosis comple+ includes C other myco"acteria %hich can cause tu"erculosis: ,. bo#is, ,. africanum and ,. microti !he first t%o are very rare causes of disease and the last one does not cause human disease Nontu"erculous myco"acteria (N!6) are other myco"acteria ("esides ,. leprae %hich causes leprosy) %hich may cause pulmonary disease resem"ling !1, lymphadenitis, skin disease, or disseminated disease !hese include ,ycobacterium a#ium, ,. /ansasii, and others -edit.
The !isease
-edit.
4pidemiolo%y
0ne*third of the %orld population (A "illion people) have latent !1 infection$ in A@@<, around ;< = million people have active !1 disease %ith ? million ne% cases !he annual incidence rate varies enormously, from CB= per ;@@,@@@ in 'frica to <; per ;@@,@@@ in the 'mericas -;. (n the :M, incidence ranges from ?@ per ;@@,@@@ in the centre of 1irmingham to less than B per ;@@,@@@ in rural 8ertfordshire 'ppro+imately ; D million people died from !1 in A@@< -edit.
#ransmission
!1 is spread "y aerosol droplets e+pelled "y people %ith active !1 disease of the lungs %hen they cough, snee#e, speak, or spit 7ach droplet is B Qm in diameter and contains ; to C "acilli Close contacts (people %ith prolonged, fre&uent, or intense contact) are at highest risk of "ecoming infected (typically a AAH infection rate) ' person %ith untreated, active tu"erculosis can infect an estimated A@ other people per year 0thers at risk include foreign*"orn from areas %here !1 is common, immunocompromised patients (eg 8(EJ'()S), residents and employees of high*risk congregate settings, health care %orkers %ho serve high*risk clients, medically underserved, lo%*income populations, high*risk racial or ethnic minority populations, children e+posed to adults in high*risk categories, and people %ho in/ect illicit drugs !ransmission can only occur from people %ith active !1 disease (not latent !1 infection) !he pro"a"ility of transmission depends upon infectiousness of the person %ith !1 (&uantity e+pelled), environment of e+posure, duration of e+posure, and virulence of the organism !he chain of transmission can "e stopped "y isolating patients %ith active disease and starting effective anti*tu"erculous therapy
-edit.
!atho%enesis
While only ;@H of !1 infection progresses to !1 disease, if untreated the death rate is B;H !1 infection "egins %hen 6!1 "acilli reach the pulmonary alveoli, infecting alveolar macrophages, %here the myco"acteria replicate e+ponentially !he primary site of infection in the lungs is called the 9hon focus 1acteria are picked up "y dendritic cells, %hich can transport the "acilli to local (mediastinal) lymph nodes, and then through the "loodstream to the more distant tissues and organs %here !1 disease could potentially develop: lung apices, peripheral lymph nodes, kidneys, "rain, and "one !u"erculosis is classed as one of the granulomatous inflammatory conditions 6acrophages, ! lymphocytes, 1 lymphocytes and fi"ro"lasts are among the cells that aggregate to form a granuloma, %ith lymphocytes surrounding infected macrophages !he granuloma functions not only to prevent dissemination of the myco"acteria, "ut also provides a local environment for communication of cells of the immune system Within the granuloma, ! lymphocytes (C)<O) secrete a cytokine such as interferon gamma, %hich activates macrophages to destroy the "acteria %ith %hich they are infected, making them "etter a"le to fight infection ! lymphocytes (C)>O) can also directly kill infected cells (mportantly, "acteria are not eliminated %ith the granuloma, "ut can "ecome dormant, resulting in a latent infection 3atent infection can "e diagnosed only "y tu"erculin skin test, %hich yields a delayed hypersensitivity type response to purified protein derivatives of ,. tuberculosis in an infected person 'nother feature of the granulomas of human tu"erculosis is the development of cell death, also called necrosis, in the center of tu"ercles !o the naked eye this has the te+ture of soft %hite cheese and %as termed caseous necrosis (f !1 "acteria gain entry to the "lood stream from an area of tissue damage they spread through the "ody and set up myriad foci of infection, all appearing as tiny %hite tu"ercles in the tissues !his is called miliary tu"erculosis and has a high case fatality (n many patients the infection %a+es and %anes !issue destruction and necrosis are "alanced "y healing and fi"rosis 'ffected tissue is replaced "y scarring and cavities filled %ith cheese*like %hite necrotic material )uring active disease, some of these cavities are in continuity %ith the air passages "ronchi !his material may therefore "e coughed up (t contains living "acteria and can pass on infection !reatment %ith appropriate anti"iotics kills "acteria and allo%s healing to take place 'ffected areas are eventually replaced "y scar tissue
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!ro%ression
(n those people in %hom !1 "acilli overcome the immune system defenses and "egin to multiply, there is progression from !1 infection to !1 disease !his may occur soon after infection (primary !1 disease R ; to BH) or many years after infection (post primary !1, secondary !1, reactivation !1 disease of dormant "acilli R B to ?H) !he risk of reactivation increases %ith immune compromise, such as that caused "y infection %ith 8(E (n patients co*infected %ith 6 tu"erculosis and 8(E, the risk of reactivation increases to ;@H per year, %hile in immune competent individuals, the risk is "et%een B and ;@H in a lifetime '"out five percent of infected persons %ill develop !1 disease in the first t%o years, and another five percent %ill develop disease later in life (n other %ords, a"out ;@H of infected persons %ith normal immune systems %ill develop !1 disease in their lifetime Some medical conditions increase the risk of progression to !1 disease (n 8(E infected persons %ith !1 infection, the risk increases to ;@H each year instead of ;@H over a lifetime 0ther such conditions include drug in/ection (mainly "ecause of the life style of (E )rug users), su"stance a"use, recent !1 infection (%ithin t%o years) or history of inade&uately treated !1, chest G*ray suggestive of previous !1 (fi"rotic lesions and nodules), dia"etes mellitus, silicosis, prolonged corticosteroid therapy and other immunosuppressive therapy, head and neck cancers, hematologic and reticuloendothelial diseases (leukemia and 8odgkin,s disease), end*stage renal disease, intestinal "ypass or gastrectomy, chronic mala"sorption syndromes, or lo% "ody %eight (;@H or more "elo% the ideal) Some drugs, including rheumatoid arthritis drugs that %ork "y "locking tumor necrosis factor*alpha (an inflammation*causing cytokine), raise the risk of causing a latent infection to "ecome active due to the importance of this cytokine in the immune defense against !1 -edit.
Symptoms
!1 most commonly affects the lungs (DBH or more), %here it is called pulmonary !1 Symptoms may include a productive, prolonged cough of more than three %eeks duration, chest pain, and hemoptysis Systemic symptoms include fever, chills, night s%eats, appetite loss, %eight loss, and easy fatiga"ility !he term consumption arose "ecause sufferers appeared as if they %ere NconsumedN from %ithin "y the disease 5eople from 'sian and 'frican descent may have lymph node !1 more often than Caucasians 3ymph node !1 is not contagious
7+trapulmonary sites include the pleura, central nervous system (meningitis), lymphatic system (scrofula of the neck), genitourinary system, and "ones and /oints (5ott,s disease of the spine) 'n especially serious form is disseminated, or miliary !1, so named "ecause the lung lesions so*formed resem"le millet seeds on +*ray !hese are more common in immunosuppressed persons and in young children 5ulmonary !1 may co* e+ist %ith e+trapulmonary !1 -edit.
"ru% resistance
)rug*resistant !u"erculosis is transmitted in the same %ay as regular !1 5rimary resistance develops in persons initially infected %ith resistant organisms Secondary resistance (ac&uired resistance) may develop during !1 therapy due to inade&uate treatment regimen, i e not taking the prescri"ed regimen appropriately or using lo% &uality medication )rug*resistant !1 is an important pu"lic health issue in many developing countries, as treatment of drug*resistant !1 re&uires the use of more e+pensive drugs and treatment is longer 6ultidrug*resistant !1 is defined as resistance to the t%o most effective first line !1 drugs * 4ifampicin and (sonia#id ((N8) -edit.
Diagnosis
' complete medical evaluation for !1 includes a medical history, a physical e+amination, a tu"erculin skin test, a serological test, a chest G*ray, and micro"iologic smears and cultures !he measurement of a positive skin test depends upon the person,s risk factors for progression of !1 infection to !1 disease 1acteriophage*"ased assays are among a fe% ne% testing procedures that offer the hope of cheap, fast and accurate !1 testing for the impoverished countries that need it most %ee- tuberculosis diagnosis, tuberculosis radiology -edit.
Treatment
For all practical purposes, only patients %ith tu"erculosis of the lungs can spread !1 to other people 5eople may "ecome infected %ith !1 "ut not have active disease: such people are said to have latent !1 infection (3!1() and are not capa"le of passing the infection on to other people !he reason for treating people %ith 3!1( is to prevent them from progressing to active !1 disease later in life (appro+imately ;@H lifetime risk) !he distinction is important "ecause treatment options are different for the t%o groups
%ee- tuberculosis treatment -edit.
Pre"ention of Tuberculosis
5revention and control efforts include three priority strategies:

identifying and treating all people %ho have !1 finding and evaluating persons %ho have "een in contact %ith !1 patients to determine %hether they have !1 infection or disease, and treating them appropriately, and testing high*risk groups for !1 infection to identify candidates for treatment of latent infection and to ensure the completion of treatment
(n tropical areas %here the incidence of atypical myco"acteria is high, e+posure to nontu"erculous myco"acteria gives some protection against !1 -edit.
*C1 vaccine
6any countries use 1C9 vaccine as part of their !1 control programs, especially for infants !he protective efficacy of 1C9 for preventing serious forms of !1 (e g meningitis) in children is high (greater than >@H) 8o%ever, the protective efficacy for preventing pulmonary !1 in adolescents and adults is varia"le, from @ to >@H (n the :nited Mingdom, children aged ;@*;< %ere typically immuni#ed during school until A@@B (4outine 1C9 vaccination %as stopped as it %as no longer cost*effective !he incidence of !1 in people "orn in the :M, and %ith parents and grandparents %ho %ere "orn in the :M, %as at an all time lo%, and falling 0thers continue to "e offered 1C9 vaccination ) !he effectiveness of 1C9 is much lo%er in areas %here myco"acteria are less prevalent (n the :S', 1C9 vaccine is not routinely recommended e+cept for selected persons %ho meet specific criteria:
(nfants or children %ith negative skin*test result %ho are continually e+posed to untreated or ineffectively treated patients or %ill "e continually e+posed to multidrug*resistant !1 8ealthcare %orkers considered on individual "asis in settings in %hich high percentage of 6)4*!1 patients has "een found, transmission of 6)4*!1 is likely, and !1 control precautions have "een implemented and not successful
-edit.
#uberculosis vaccine
!he first recom"inant !u"erculosis vaccine entered clinical trials in the :nited States in A@@< sponsored "y the National (nstitute of 'llergy and (nfectious )iseases (N('()) -A. ' A@@B study sho%ed that a )N' !1 vaccine given %ith conventional chemotherapy can accelerate the disappearance of "acteria as %ell as protecting against re*infection in mice$ it may take four to five years to "e availa"le in humans -C. 1ecause of the limitations of current vaccines, researchers and policymakers are promoting ne% economic models of vaccine development including pri#es, ta+ incentives and advance market commitments -edit.
#nimals
!u"erculosis can "e carried "y many mammals )omesticated species, such as cats and dogs, are generally free of tu"erculosis, "ut %ild animals may "e carriers 's a result, many places have regulations restricting the o%nership of novelty pets, possi"ly including such partially domesticated species as pet skunks$ for e+ample, the 'merican state of California for"ids the o%nership of pet ger"ils !he strictness of such restrictions generally depends on the pu"lic health policies adopted for fighting tu"erculosis 'n effort to eradicate "ovine tu"erculosis from the cattle and deer herds of Ne% Pealand is under%ay (t has "een found that herd infection is more likely in areas %here infected vector species such as 'ustralian "rush*tailed possums come into contact %ith domestic livestock at farmJ"ush "orders Controlling the vectors through possum eradication and monitoring the level of disease in livestock herds through regular surveillance are seen as a Nt%o*prongedN approach to ridding Ne% Pealand of the disease (n "oth the 4epu"lic of (reland and Northern (reland, "adgers have "een identified as a vector species for the transmission of "ovine tu"erculosis 's a result, the government in "oth regions has mounted an active campaign of eradication of the species in an effort to reduce the incidence of the disease 1adgers have "een culled primarily "y snaring and gassing (t remains a contentious issue, %ith proponents and opponents of the scheme citing their o%n studies to support their position -<.-B.-=.
4ncephalitis

4ncephalitis
IC"'1( IC"')
'>C*'>=, 1?< ;, 9@B CAC
4ncephalitis is an acute inflammation of the "rain, commonly caused "y a viral infection Sometimes, encephalitis can result from a "acterial infection, such as "acterial meningitis, or it may "e a complication of other infectious diseases like ra"ies (viral) or syphilis ("acterial) Certain parasitic proto#oal infestations, like "y to+oplasma, can also cause encephalitis in people %ith compromised immune systems 1rain damage occurs as the inflamed "rain pushes against the skull, and can lead to death
Contents
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; Features A 'etiology C )iagnosis < !reatment B 7ncephalitis lethargica
= 7+ternal links -edit.
eatures
5atients %ith encephalitis suffer from fever, headache, vomiting, confusion, dro%siness and photopho"ia !he patients could also suffer from %eakness, sei#ure, and less commonly, stiffness of the neck 4arely, the patients may have lim" stiffness, slo%ness in movement and clumsiness, depending on the specific part of the "rain involved !he symptoms of encephalitis are caused "y the "rain,s defense mechanisms activating to get rid of the infection, including s%elling, small "leedings and cell death -edit.
#etiology
Eictims are usually e+posed to viruses resulting in encephalitis "y insect "ites or food and drink !he most fre&uently encountered agents are ar"oviruses (carried "y mos&uitoes or ticks, see also tick*"orne meningoencephalitis) and enteroviruses (co+sackievirus, poliovirus and echovirus) Some of the less fre&uent agents are measles, ra"ies, mumps, varicella and herpes simple+ viruses (ncidentally type C 3yssavirus (6okola virus), found in 'ustralia, causes a lethal encephalitis %hich hardly resem"les ra"ies Numerically, the most important cause of encephalitis %orld%ide is pro"a"ly Japanese encephalitis, as it causes up to B@ @@@ cases a year, %ith a"out ;B @@@ deaths Japanese encephalitis affects 7ast and Southeast China, Morea, Japan, !ai%an, Southeast 'sia, 5apua Ne% 9uinea, South 'sia and even Northern 'ustralia !he most %idespread cause of encephalitis %orld%ide, ho%ever, is 8erpes Simple+ encephalitis !he herpes
simple+ virus causes inflammation on the temporal lo"e of the "rain, and if not treated, half to three &uarters of the patients succum" (n very young children, ho%ever, the virus could affect any part of the "rain, even sparing the temporal lo"e 'n interesting cause of viral encephalitis is the Nipah virus (t %as first discovered in 6alaysia in ;??> ' virus from the same genus, the 8endra virus, %as discovered in Septem"er ;??< in northern 'ustralia %hen ;C horses and their o%ner died -edit.
Diagnosis
'dult patients %ith encephalitis present %ith acute onset of fever, headache, confusion, and sometimes sei#ures 2ounger children or infants may present %ith irrita"ility, anore+ia and fever Neurologic e+amination usually reveal a dro%sy or confused patients Stiff neck, due to the irritation of the meninges covering the "rain, indicates that the patient has either meningitis or meningoencephalitis 7+amination of the cere"rospinal fluid o"tained "y a lum"ar puncture procedure usually reveals increased amounts of protein and %hite "lood cells %ith normal glucose, though in a significant percentage of patients, the cere"rospinal fluid may "e normal C! scan often is not helpful, as cere"ral a"scess is uncommon Cere"ral a"scess is more common in patients %ith meningitis than encephalitis 1leeding is also uncommon e+cept in patients %ith herpes simple+ type ; encephalitis 6agnetic resonance imaging offers "etter resolution (n patients %ith herpes simple+ encephalitis, electroencephalograph may sho%ed sharp %aves in one or "oth of the temporal lo"es 3um"ar puncture procedure is performed only after the possi"ility of prominent "rain s%elling is e+cluded "y a C! scan e+amination )iagnosis is often made %ith detection of anti"odies against specific viral agent (such as herpes simple+ virus) or "y polymerase chain reaction that amplifies the 4N' or )N' of the virus responsi"le -edit.
Treatment
!reatment is usually symptomatic 4elia"ly tested specific antiviral agents are availa"le only for a fe% viral agents (e g aciclovir for herpes encephalitis) and are used %ith limited success for most infection e+cept herpes simple+ encephalitis (n patients %ho are very sick, supportive treatment, such as mechanical ventilation, is e&ually important -edit.
$ncephalitis lethargica
7ncephalitis lethargica is an atypical form of encephalitis %hich caused an epidemic from ;?;D to ;?A> !here have only "een a small num"er of isolated cases since, though in
recent years a fe% patients have sho%n very similar symptoms !he cause is no% thought to "e a "acterial agent or an autoimmune response follo%ing infection 's depicted in the "ook !0a/enings "y doctor 0liver Sacks, %hich %as made into the film starring 4o"in Williams and 4o"ert )e Niro, the disease sometimes caused catatonia %hich could persist for decades
#o5oplasma %ondii
(4edirected from !o+oplasma) Jump to: navigation, search 6Toxoplasma gondii
). gondii tachy#oites
Scientific classification Mingdom: 5hylum: Class: 0rder: Family: 9enus: Species: 5rotista 'picomple+a Conoidasida 7ucoccidiorida Sarcocystidae Toxoplasma T. gondii
*inomial name ,,,Toxoplasma gondii'''

(Nicolle S 6anceau+), ;?@>
Toxoplasma gondii is a species of parasitic proto#oa %hose definitive host is cats "ut can also "e carried "y the vast ma/ority of other %arm*"looded animals including humans (t
causes the disease to+oplasmosis %hich is usually minor and self*limiting "ut can have serious or even fatal effects, particularly in cats, or for a foetus %hen first contracted during pregnancy (t "elongs to the 'picomple+a and is the only kno%n mem"er of the genus Toxoplasma
Contents
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; 3ife cycle A 1ehavioral modifications of the host C 8uman prevalence < 8o% to prevent infection B Fiction = 4eferences
D 7+ternal links -edit.
%ife cycle
!he life cycle of )o"oplasma gondii has t%o phases !he se+ual part of the lifecycle takes place only in mem"ers of the Felidae family (domestic and %ild cats), the definitive host of )o"oplasma gondii !he ase+ual life cycle can take place in any %arm*"looded animal, like other mammals (including felines) and "irds
). gondii constructing daughter scaffolds %ithin the mother cell (n these intermediate hosts, the parasite invades cells, forming intracellular so*called parasitophorous vacuoles containing "rady#oites, the slo%ly replicating form of the parasite-;. Eacuoles form tissue cysts mainly %ithin the muscles and "rain Since they are %ithin cells the host,s immune system does not detect these cysts 4esistance to anti"iotics varies, "ut the cysts are very difficult to eradicate entirely Within these vacuoles ). gondii propagates "y a series of "inary fissions until the infected cell eventually "ursts and tachy#oites are released !achy#oites are the motile, fast ase+ually
reproducing form of the parasite :nlike the "rady#oites, the free tachy#oites are usually efficiently cleared "y the host,s immune response, although some manage to infect cells and form "rady#oites thus maintaining the infection !issue cysts can "e ingested "y a cat, e g "y feeding on an infected mouse !he cysts survive passage through the digestive system of the cat and the parasites infect epithelial cells of the small intestine %here they undergo se+ual reproduction and oocyst formation 0ocysts are shed %ith the feces 'nimals and humans that ingest oocysts (e g , "y eating un%ashed vegeta"les etc ) or tissue cysts in improperly cooked meat "ecome infected !he parasite enters macrophages in the intestinal lining and is distri"uted via the "lood stream throughout the "ody 'cute stage to+oplasma infections can "e asymptomatic, "ut often gives ,flu*like symptoms in the early acute stages, and like ,flu can "ecome, in very rare cases, fatal !he acute stage fades in a fe% days to months leading to the latent stage 3atent infection is normally asymptomatic$ 8o%ever, in the case of immunocompromised patients (such as those infected %ith 8(E, or transplant recipients on immunosuppressive therapy) to+oplasmosis can develop !he most nota"le manifestation of to+oplasmosis in immunocompromised patients is to+oplasmic encephalitis, %hich can "e deadly (f infection %ith ). gondii occurs for the first time during pregnancy, the parasite can cross the placenta, possi"ly leading to hydrocephalus, intracranial calcification and chorioretinitis, %ith the possi"ility of spontaneous a"ortion or intrauterine death -edit.
Beha"ioral mo!ifications of the host

,ain article- )o"oplasmosis (t has "een found that the parasite has the a"ility to change the "ehavior of its host: infected rats and mice are less fearful of cats$ in fact, some of the infected rats actually seek out cat urine*marked areas again and again !he parasite alters the mind, and thus the "ehavior, of the rat for its o%n "enefit, leading to a propagation of the lifecycle -A. !he mechanism for this change is not completely understood, "ut there is evidence that to+oplasmosis infection raises dopamine levels in infected mice 9iven the close "iological similarities and common inheritance "et%een mice and humans, it has "een suggested that human "ehaviour could also "e affected in some %ay, and some epidemiological links may have "een found "et%een latent )o"oplasma infections and car crashes, slo%er reactions, an increase in risk*taking "ehaviors, and possi"ly some forms of schi#ophrenia Several independent pieces of evidence point to%ards a role of )o"oplasma infection in some cases of schi#ophrenia-C.:
'cute )o"oplasma infection sometimes leads to psychotic symptoms not unlike schi#ophrenia
Some anti*psychotic medications that are used to treat schi#ophrenia, such as 8aloperidol, also stop the gro%th of )o"oplasma in cell cultures Several studies have found significantly higher levels of )o"oplasma anti"odies in schi#ophrenia patients, compared to the general population -<. )o"oplasma infection causes damage to astrocytes in the "rain, and such damage is also seen in schi#ophrenia
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Human pre"alence
!he : S N8'N7S (;???*A@@@) national pro"a"ility sample found that ;B >H of : S persons a"ove ;A years of age had !o+oplasma*specific (g9 anti"odies, indicating that they had "een infected %ith the organism !his prevalence had not significantly changed from the ;?>>*;??< data -B. (t is estimated that up to B@H of all people %orld%ide are infected %ith )o"oplasma gondii !he incidence of infection is highly specific to each nationality %ith ranges such as AAH infected in the :M to over >>H in France -=. -edit.
Ho& to pre"ent infection

See to+oplasmosis
#o5oplasmosis

#o5oplasmosis
IC"'1( IC"')
1B> ;C@
#o5oplasmosis is a parasitic disease caused "y the parasite )o"oplasma gondii (t infects most animals and causes human parasitic diseases, "ut the primary host is the felid (cat) family Cats get infected "y eating infected rats 4ats get infected "y accidentally a"sor"ing cat faeces !he parasite su"tly alters the rat,s "ehavior Whereas healthy rats avoid areas that smell like cat urine, infected rats may actually seek these areas out 5eople usually get infected "y eating ra% or undercooked meat, or more rarely, "y contact %ith cat faeces
't least one third of the %orld population may have contracted a to+oplasmosis infection in their lifetime "ut, after the acute infection has passed, the parasite rarely causes any symptoms in other%ise healthy adults 8o%ever, people %ith a %eakened immune system are particularly suscepti"le, such as people infected %ith 8(E !he parasite can cause encephalitis (inflammation of the "rain) and neurologic diseases and can affect the heart, liver, and eyes (chorioretinitis)
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; !ransmission o ; ; 5regnancy precautions A Symptoms o A ; 'cute to+oplasmosis A ; ; !reatment o A A 3atent to+oplasmosis A A ; !reatment C 4isk factors < 5ossi"le effects on human "ehavior B 8uman prevalence = 'nimal prevalence D Footnotes
> 7+ternal links -edit.
Transmission
!ransmission may occur through:
(ngestion of ra% or partly cooked meat, especially pork, lam", or venison, or "y hand to mouth contact after handling undercooked meat (nfection prevalence is higher in countries that traditionally eat undercooked meat, such as France !his seems to "e "y far the most common route of infection -citation needed. (ngestion, accidental or other%ise, of contaminated cat faeces !his can occur through hand to mouth contact follo%ing gardening, cleaning a cat,s litter "o+, children,s sandpits, or touching anything that has come into contact %ith cat feces Contamination of knives, utensils, cutting "oards and other foods that have had contact %ith ra% meat )rinking %ater contaminated %ith !o+oplasma (ngestion of ra% or unpasteuri#ed milk and milk products, particularly those containing goat,s milk !he reception of an infected organ transplant or "lood transfusion, although this is e+tremely rare
!he cyst form of the parasite is e+tremely hardy, capa"le of surviving e+posure to cooling do%n to su"#ero temperatures and chemical disinfectants such as "leach and can survive in the environment for over a year (t is, ho%ever, suscepti"le to high temperatures, and is killed "y cooking 'lthough the pathogen has "een detected on the fur of cats, the pathogen has not "een found in a ,ripe, form, and direct infection from handling cats is generally "elieved to "e very rare Cats e+crete the pathogen in their faeces for a num"er of %eeks or months after contracting or recontracting the disease, generally "y eating an infected rodent 7ven then, cat faeces are not generally contagious for the first day or t%o after e+cretion, after %hich the cyst ,ripens, and "ecomes potentially pathogenic Studies have sho%n that only a"out AH of cats are shedding at any one time -edit.
!re%nancy precautions
Congenital to+oplasmosis is a special form in %hich an un"orn child is infected via the placenta !his is the reason that pregnant %omen should "e checked to see if they have a titer to to+oplasmosis ' titer indicates previous e+posure and largely ensures the un"orn "a"y,s safety (f a %oman receives her first e+posure to !o+oplasma %hile pregnant then the "a"y is at particular risk ' %oman %ith no previous e+posure should avoid handling ra% meat, e+posure to cat faeces, and gardening (a common place to find cat feces) 6ost cats are not actively shedding oocysts and so are not a danger, "ut the risk may "e reduced further "y having the litter"o+ emptied daily (oocysts re&uire longer than a single day to "ecome infective), andJor "y having someone else empty the litter"o+ !reatment is very important for recently infected pregnant %omen, to prevent infection of the foetus Since a "a"y,s immune system does not develop fully for the first year of life, and the resilient cysts that form throughout the "ody are very difficult to eradicate %ith antiproto#oans, an infection can "e very serious in the very young -edit.
Symptoms
(nfection has t%o stages: -edit.
3cute to5oplasmosis
)uring acute to+oplasmosis, symptoms are often flu*like: s%ollen lymph nodes, or muscle aches and pains that last for a month or more 4arely, a patient %ith a fully functioning immune system may develop eye damage from to+oplasmosis 2oung children and immunocompromised patients, such as those %ith 8(EJ'()S, those taking
certain types of chemotherapy, or persons %ho have recently received an organ transplant, may develop severe to+oplasmosis !his can cause damage to the "rain or the eyes 0nly a small percentage of infected ne%"orns have serious eye or "rain damage at "irth -edit.
#reatment
' com"ination of sulfadia#ine and pyrimethamine should "e given -edit.
2atent to5oplasmosis
6ost patients %ho "ecome infected %ith )o"oplasma gondii and develop to+oplasmosis do not kno% it (n most non*immunodeficient patients, the infection enters a latent phase, during %hich only "rady#oites are present, forming cysts in nervous and muscle tissue 6ost infants %ho are infected %hile in the %om" have no symptoms at "irth "ut may develop symptoms later in life -edit.
#reatment
!he cysts are immune to the standard acute treatments !he anti"iotic atova&uone has "een used to kill !o+oplasma cysts in situ in '()S patients -;A. (n mice, a com"ination of atova&uone %ith clindamycin seemed to optimally kill cysts-;C. -edit.
'is( factors

(nfants "orn to mothers %ho "ecame infected %ith )o"oplasma for the first time during or /ust "efore pregnancy 5ersons %ith severely %eakened immune systems, such as persons %ith '()S !his results from an acute !o+oplasma infection or an infection that occurred earlier in life that reactivates and causes damage to the "rain, eyes, or other organs
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Possible effects on human beha"ior

!he findings of "ehavioral alteration in rats and mice have lead some scientists to speculate that to+oplasma may have similar effects in humans, even in the latent phase that had previously "een considered asymptomatic !o+oplasma is one of a num"er of parasites that re&uire alteration of host,s "ehaviour for their life cycle-;. !he changes o"served are likely due to the presence of cysts in the "rain, %hich produce or induce production of a neurotransmitter, possi"ly dopamine-A., therefore acting similarly to dopamine reuptake inhi"itor type antidepressants !he evidence for "ehavioral effects on humans, although intriguing, is relatively %eak !here have "een no randomi#ed clinical trials studying the effects of to+oplasma on human "ehavior 'lthough some researchers have found potentially important associations %ith to+oplasma, it is possi"le that these associations merely reflect factors that predispose certain types of people to infection Studies have found that to+oplasmosis is associated %ith an increased car accident rate, roughly dou"ling or tripling the chance of an accident relative to uninfected people -C.-<. !his may "e due to the decreased reaction times that are associated %ith infection -<. N(f our data are true then a"out a million people a year die /ust "ecause they are infected %ith to+oplasma,N the researcher Jaroslav Flegr told )he 1uardian -B. !he data sho%s that the risk decreases %ith time after infection, "ut is not due to age -=. 4uth 9il"ert, medical coordinator of the 7uropean 6ulticentre Study on Congenital !o+oplasmosis, told BBC &e0s 2nline these findings could "e due to chance, or due to social and cultural factors associated %ith to+oplasma infection -D. 0ther studies suggest that the parasite may influence personality !here are claims of to+oplasma causing antisocial attitudes in men and promiscuity->. (or even Nsigns of higher intelligenceN-?.) in %omen, and greater suscepti"ility to schi#ophrenia and manic depression->. in all infected persons ' A@@< study found that to+oplasma Npro"a"ly induce-s. a decrease of novelty seeking N-;@. !he possi"ility that to+oplasmosis is one cause of schi#ophrenia has "een studied "y scientists at least since ;?BC !hese studies, many %ritten in languages other than 7nglish, had attracted little attention from : S researchers until they %ere pu"lici#ed through the %ork of prominent psychiatrist and advocate 7 Fuller !orrey (n A@@C, !orrey pu"lished a revie% of this literature, reporting that almost all the studies had found that schi#ophrenics suffer from elevated rates of to+oplasmosis infection !hese types of studies are suggestive "ut cannot confirm a causal relationship ("ecause of the possi"ility that schi#ophrenia increases the likelihood of to+oplasmosis infection, rather than the other %ay around) -;;. -edit.
Human pre"alence
(n the : S N8'N7S ((( national pro"a"ility sample, AA BH of ;D,=B> persons I;A years of age had !o+oplasma*specific (g9 anti"odies, indicating that they had "een infected %ith the organism (t is thought that "et%een C@H and =@H of the %orld,s population are infected 8o%ever, there is large variation countries: in France, for e+ample, a"out >BH of the population are carriers, pro"a"ly due to a high consumption of ra% and lightly cooked meat -edit.
#nimal pre"alence
' :niversity of California )avis study of dead Sea 0tters collected from ;??> to A@@< found that to+oplasmosis %as the cause of death for ;CH of the animals 5ro+imity to fresh%ater outflo%s into the ocean %ere a ma/or risk factor (ngestion of oocysts from cat faeces is considered to "e the most likely ultimate source -;A.
Immune system
Jump to: navigation, search !he (mmune System (also kno%n as the (mmunlological System) is made up of all the mechanisms through %hich a multicellular organism defends itself from internal invaders such as "acteria, virus or parasites !here are t%o types of defense mechanisms: the innate or non*specific, such as skin, gastric acid, phagocytes or tear secretion$ and the adaptive immune system, %ith directed action "y lymphocytes and specific anti"ody production !he immune system is often divided into four sections:

Natural passive immunity7 8ereditary immunity, ac&uired from the mother, and lasting the first si+ months of a child,s life 3c8uired passive immunity7 Non*permanent immunity gained from vaccines, such as 4a"ies or !etanus Natural active immunity7 8aving suffered a disease and its symptoms, one has natural active immunity, also kno%n as a secondary response, %here 1*Cells fire off anti"odies to com"at a recognised antigen 3c8uired active immunity7 5ermanent immunity as a result of vaccine
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; (nnate Non*specific 6echanisms o ; ; 5hysical 1arriers o ; A 5hagocytes o ; C Complement System o ; < (nflammatory 4esponse A Specific or 'daptive (mmune System o A ; 1 3ymphocytes and 'nti"ody 5roduction o A A !> 3ymphocytes and Cytoto+icity o A C 5hagocytes o A < !< 3ymphocytes and 4esponse Supervision C )isorders of the human immune system < 0ther factors that affect immune response B 5harmacology = See also D Further reading
> 7+ternal links -edit.
)nnate Non*specific +echanisms

!he innate system is comprised of all the mechanisms that defend an organism in non* specific form, against an invader, responding in the same fashion, regardless of %hat it is (t constitutes older defense strategies, some of these "eing found in primitive multicellular forms, in plant and fungi -edit.
!hysical *arriers
!he skin is the first and main line of defense !he surface is made up of dead skin cells rich in keratin, %hich impedes microorganisms from entering the "ody 3ightly acidic and lipidic secretions from se"aceous gland and s%eat glands create a hostile cutaneous environment impeding the e+cessive gro%th of "acteria 9astric acid is a po%erful defense against invading "acteria from the intestines Fe% species are a"le to survive the lo% p8 and destructive en#ymes that e+ist in the stomach Saliva and tears contain anti"acterial en#ymes, such as 3yso#yme, %hich destroy the cellular %alls of "acteria (n the intestines, the "acterial flora, using po%erful pathogens, compete %ith one another for food and space, diminishing the pro"a"ility of these "acteria multiplying in sufficient num"ers to cause illness For this reason the e+cessive
ingestion of oral anti"iotics can lead to the depletion of "enign "acteria in the intestine :pon ending treatment, dangerous species can multiply %ithout any competition, there"y causing many illnesses 6ucus is another defense, coating the mucous mem"ranes (t catches and immo"ili#es invading "odies, its compostion deadly to many microorganisms (t also contains !ype (ga anti"odies
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!ha%ocytes
5hagocytes are cells, such as neutrophiles and macrophages, that have the capacity to directionally e+tend cellular portions (pseudopod), englo"ing and overtaking a foreign particle or microorganism !his microorganism is contained inside a vacuole %hich is then "athed in lysosomes, vacuoles rich in en#ymes and acids, %hich digest the particle or organism 5hagocytes react to cytokines produced "y lymphocytes, "ut also patrol the "ody autonomously , %ithout stimulus, al"eit in a less eficient manner Naturally this form of defense is important against "acterial infections, as viruses are too small and the ma/ority of parasites too large to "e consumed 5hagocytosis is also an important part of the cleaning process after cellular destruction follo%ing infection or any other process that leads to cellular death in "ody tissues Should many phagocytes die after phagocytosis, or if the num"er of invaders and casualties is large, "oth phagocytes and "acteria can "e trapped in a pasty li&uid rich in stuctural proteins, kno%n as pus Some "acteria, such as 6yco"acterium tu"erculosis, %hich causes tu"erculosis, have defense mechanisms against digestion after phagocytosis, and survive %ithin the phagocyte parasitically and hiding itself from lymphocytes 5hagocytes and related cells:
Neutrophil granulocyte: the most a"undant type of phagocyte and is al%ays the first to arrive at the scene of infection 6acrophages: a gigantic cell, the mature form of a monocyte, has the capacity to consume many more "acteria than a neutrophil )ifferentiation is stimulated through cytokine (t is more efficient in destroying "acteria than neutrophils, "ut lives for a shorter amount of time, having to "e reformed through monocytes during each infection 1asophil granulocyte and 6ast Cells: consuming very little, these cells release histamine and are important in some allergic reactions (such as asthma) and also defending against parasites !hey are mo"ili#ed "y the anti"ody !ype (g7 7osinophil granulocyte: a non*consuming cell related to the neutrophil 'n important part of defense against parasites
Neutrophils, eosinophils and "asophils are also kno%n as polymorphonuclear leukocytes (due to their lo"ed nuclei) or granulocytes -edit.
Complement System
!he complement system is a "iochemical cascade of the immune system that helps clear pathogens from an organism (t is derived from many small plasma proteins %orking together to form the primary end result of cytolysis "y disrupting the target cell,s plasma mem"rane !he proteins are sythesi#ed in the liver, mainly "y hepatocytes 0ther non*specific proteins include 5rotease CC*convertase, %hich is also sythesi#ed in the liver and connects to other molecules that are commonly found in "acteria "ut non* e+istant in humans, stimulating the complement system and phagocytosis -edit.
Inflammatory Response
!he inflammatory response is fundamentally a non*specific reaction, despite in practice controlled "y specific mechanisms (lymphocytes) (t is characteri#ed "y the follo%ing &uintet, defined in 9reco*4oman anti&uity: redness (ru"or), heat (calor), s%elling (tumor), pain (dolor) and dysfunction of the organs involved (functio laesa) (nflammation is stimulated "y factors released "y in/ured cells !hese factors (histamine, "radicine) sensiti#e pain receptors and cause dilation of the "lood vessels at the scene (rubor and tumor), and also attract phagocytes, especially neutrophils 5hagocytosis causes the neutrophils to release other factors that call lymphocytes and other phagocytes -edit.
Specific or #!apti"e )mmune System

!he "asis of all specific systems lies in the capacity of immune cells to distinguish "et%een proteins produced "y the "ody,s o%n cells (NselfN antigen * those of the original organism), and proteins produced "y invaders or cells under control of a virus (Nnon*selfN antigen * or, %hat is not recogni#ed as the original organism) !his distinction is made via !*Cell 4eceptors (!C4) or 1*Cell 4eceptors (1C4) For these receptors to "e efficient they must "e produced in thousands of configurations, this %ay they are a"le to distinguish "et%een many different invader proteins !his immense diversity of receptors %ould not fit in the genome of a cell, and millions of genes, one for each type of possi"le receptor, %ould "e impractical What happens is that there are a fe% families of genes, each one having a slightly different modification !hrough a special process, uni&ue to human cells, the genes in these lymphocytes recom"ine, one from each family, ar"itrarily into a single gene
!his %ay, for e+ample, each anti"ody or 1C4 of 1 lymphocytes has si+ portions, and is created from t%o genes uni&ue to this lymphocyte, created "y the recomniation (union) of a random gene from each family (f there are = families, %ith B@, C@, ?, <@, and B mem"ers, the total possi"le num"er of anti"odies is B@+C@+=+?+<@+B T ;= million 0n top of this there are other comple+ processes that increase the diversity of 1C4 or !C4 even more, "y mutation of the genes in &uestion !he varia"ility of anti"odies is practically limitless, and the immune system creates anti"odies for any molecule, even artificial molecules that do not e+ist in nature 6any !C4 and 1C4 created this %ay %ill react %ith their o%n peptides 0ne of the functions of the thymus and "one marro% is to hold young lymphocytes until it is possi"le to determine %hich ones react to molecules of the organism itself !his is done "y speciali#ed cells in these organs that present the young lymphocytes %ith molecules produced "y them (and effectively the "ody) 'll the lymphocytes that react to them are destroyed, and only those that sho% themselves to "e indifferent to the "ody are released into the "loodstream !he lymphocytes that do not react to the "ody num"er in the millions, each %ith millions of possi"le configurations of receptors, each %ith a receptor for different parts of each micro"ial protein possi"le !he vast ma/ority of lymphocytes never find a protein that its receptor is specified for, those fe% that do find one are stimulated to reproduce 7ffective cells are generated %ith the specific receptor and memory cells !hese memory cells are &uiescent, they have long lives and are capa"le of identifying this antigen some time later, multiplying themselves &uickly and rapidly responding to future infections !he specific immune system is controlled directed largely "y lymphocytes !here are various types of lymphocytes: -edit.
* 2ymphocytes and 3ntibody !roduction

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#+ 2ymphocytes and Cytoto5icity

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!ha%ocytes
!hough phagocytes are an innate mechanism, since they respond to any foreign "ody, they are also the first line decision makers for lymphocytes 5hagocytes, especially macrophages, respond to cytokines generated "y lymphocytes 6onocytes are the precursors to macrophages and they transform into macrophages %hen
stimulated "y !< cytokines !hey are also attracted "y other cytokines and factors emitted "y cells in areas of active infection (f properly stimulated "y cytokines emitted in a locali#ed and controlled manner "y !< lymphocytes, the macrophages release sufficient &uantities of en#ymes and free radicals to completely destroy a locali#ed area, killing "oth invaders and human cells 0n top of this, under control of lymphocytes, macrophages are responsi"le for some specific immunological reactions such as granuloma and a"scesses 9ranuloma occurs during an invasion of micro"acteria and fungi, the most %ell*kno%n e+ample "eing tu"erculosis (t is a reaction commanded "y !< cytokines, %hen there is intracellular infection of the phagocytes themselves (n order to stop the invader from entering the "loodstream and spreading throughout the "ody in these mo"ile cells, the !< lymphocytes secrete cytokines that call more macrophages, and make them more resistant to infection Cytokines also provoke an adaptation in macrophages of epithelial morphology around the area of invasion, %ith numerous layers of immo"ili#ed cells connected "y %ater*resistant links as to close off the invader !he tu"erculosis micro"acteria cannot propagate and remains stagnant !oday hundereds of millions of healthy people have micro"acteria controlled in this form %ithin their lungs (visi"le in +* rays) 0nly in those that have severely de"ilitated immunities do these pathogens escape and cause tu"erculosis !he a"scess is similar, surrounded "y a cyst of pus (t is important to se&uester pathogenic "acteria %hose to+icity kills phagocytes (forming the pus) and does not permit efficient cleaning -edit.
#9 2ymphocytes and Response Supervision

!< 3ymphocytes, or helpers, are immune response controllers !hey NdecideN %hich actions to take during an invasion, promoting or inhi"iting all other immune cells via cytokines 8(E, "eing a virus that directly attacks the !< cells, causes a collapse of the entire system "y attacking the root !< lymphocytes are a"le to decide of there is an invasion due to the fact that each cell contains a randomly created !C4 'll phagocytes and some other cells, such as dendrites, after digesting the proteins of an invader retain some of the peptides in a protein mem"rane, 68C !he !C4 of the !< lymphocytes attach to the 68C (( via the peptide and if the connection is effective, li"erates cytokines No !< lymphocytes contain "ody proteins, these %ere destroyed during the cell development in the thymus (f the levels of these cytokines are sufficiently high, and if other, less kno%n factors e+ist in the "lood, the !< lymphocytes NdecideN that there is an invasion and %hat sort, "eginning the specific immune response !he !< lymphocytes then produce other cytokines activating other cells for the appropriate response 's %ith other lymphocytes, stimulated !< lymphocytes multiply and some serve as memory cells to speed up future responses
!here are essentially t%o types of !< helpers, corresponding to t%o types of responses What e+actly selects each type !he !8; response is characteri#ed "y the production of cytokines such as (3*A, (FN*gamma and !NF*"eta 6acrophages are activated, and through cytoto+ic mechanisms (! lymphocytes), the infected areas are e+tensively destroyed (t is efficient in elimination of intracellular pathogens (intracellular viruses and "acteria) (n the !8A response there is a release of (3*< and (3*B (t is characteri#ed "y the production of anti"odies from 1 lymphocytes (t is effective against organisms in the "lood, such as e+tra*cellular "acteria and parasites Which response (!8; or !8A) is produced is important to the progression of the infection For e+ample, in leprosy, an infection caused "y the intracellular ,ycobacterium leprae, the !8; response is e+tremely effective and the infection is kept to minimum (lepra tuberculoide) $ "ut if a response !8A is activated, ineffective against intracellular organisms, common leprosy occurs causing e+tensive damage and loosening of the skin (lepra lepromatosa) !here is a third type of ! lymphocyte regulator, the lymphocyte suppressors, %hich limit and suppress the immune reaction, an important mechanisms considering the e+treme destruction the immune system can cause -edit.
Disor!ers of the human immune system

!he most important function of the human immune system occurs at the cellular level of the "lood and tissues !he lymphatic and "lood circulation systems are paths for speciali#ed %hite "lood cells to travel around the "ody White "lood cells include 1 cells, ! cells, natural killer cells, macrophages, and dendritic cells 7ach has a different responsi"ility, "ut all function together %ith the primary o"/ective of recogni#ing, attacking and destroying "acteria, viruses, cancer cells, and all other pathogens Without this coordinated effort, a person %ould not "e a"le to survive more than a fe% days "efore succum"ing to an over%helming infection When a pathogen has entered the "ody, it sets off a chain reaction that starts %ith the activation of macrophages and natural killer cells that reach the site of infection and destroy as much of the pathogen as possi"le While this is happening, it is the /o" of the dendritic cells to take Usnap*shotsV of the "attle* ground to take to the lymph nodes in order to activate ! cells %hich then activate 1 cells to produce anti"odies against the pathogen 6any disorders of the human immune system fall into t%o "road categories that are characteri#ed "y:
Weakened immune response: !here are ,congenital, (in"orn) and ,ac&uired, forms of immunodeficiency, characteri#ed "y an attenuated response Chronic granulomatous disease, in %hich phagocytes have trou"le destroying pathogens, is an e+ample of the former, %hile '()S (N'c&uired (mmune )eficiency
SyndromeN), an infectious disease caused "y the 8(E virus that destroys C)<O ! cells, is an e+ample of the latter (mmunosuppressive medication intentionally induces an immunodeficiency in order to prevent re/ection of transplanted organs
0ver#ealous immune response: 0n the other end of the scale, an overactive immune system figures in a num"er of other disorders, particularly autoimmune disorders such as lupus erythematosus, type ( dia"etes (sometimes called N/uvenile onset dia"etesN), multiple sclerosis, psoriasis, and rheumatoid arthritis (n these, the immune system fails to properly distinguish "et%een self and non*self, and attacks a part of the patient,s o%n "ody 0ther e+amples of over#ealous immune responses in disease include hypersensitivities, such as allergies and asthma
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,ther factors that affect immune response

)his section is a stub. 3ou can help by adding to it. 6any factors can also contri"ute to the general %eakening of the immune system:

6alnutrition (un"alanced diet J poor eating ha"its that cause a lack of vitamins, minerals and 5olyphenol antio+idants) 'lcohol a"use )rug a"use either intravenous or other ('ppears related to associated factors i e poor diet, use of infectedJdirty needles, poor e+ercise, stressJdepression) 6edications (particularly the use of anti*cancer drugs, corticosteroids, and anti"iotics)$ 4adiation 7+posure to certain environmental to+ins, %hether naturally occurring or from pollution !hese include: o Cigarette smoke StressJ)epression * 4esearch sho%s that psychological stress can greatly increase your suscepti"ility to colds and other viral diseases, namely through an increase in serum corticosteroid levels 'ge * '"ility of the immune system to respond is decreased at early and old age )ecreased a"ility to heal due to disease or medications (i e )ia"etes, corticosteroids, immune suppressant drugs), causing constant e+posure to infectious agents %ithout natural defense (intact skin) (nade&uate sleep at the )elta "rain %ave level 'ccording to a sleep study, %e need < hours of )elta sleep every night 3ack of e+ercise as %ell as e+cessive e+ercise resulting in physiological stress 3ong*term %eightlessness )iseases either infectious or other causing more depression on the immune system like: o Cancer, and hematological malignancy (such as leukemia, lymphoma and myeloma) in particular
o o o o o o o o o o o o o
)ia"etes 6ellitus Cystic fi"rosis 3upus 7rythematosus Nephrotic syndrome Eiral infections i e viral respiratory infections then allo%ing for "acterial pneumonia to develop 8(E :lcerative colitis 1ulimia (due to malnutrition, stress, depression) Sickle*cell disease 3iver disease J cirrhosis Cushing,s syndrome 5rotects 8untington,s Chorea
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Pharmacology
)espite high hopes, there are no medications that directly increase the activity of the immune system Earious forms of medication that activate the immune system may cause autoimmune disorders 'd/uvants (often 'luminium 8ydro+ide) can "e used in con/uction %ith a vaccine to provoke a &uicker immunological reaction Suppression of the immune system is often used to control autoimmune disorders or inflammation %hen this causes e+cessive tissue damage, and to prevent transplant re/ection after an organ transplant Commonly used immunosuppressants include glucocorticoids, a#athioprine, methotre+ate, ciclosporin, cyclophosphamide and mercaptopurine (n organ transplants, ciclosporin, tacrolimus, mycophenolic acid and various others are used to prevent organ re/ection through selective ! cell inhi"ition -edit.
See also

antigenJantigenic determinantJepitopeJhaptenJmemory cell autoimmune disorders C)< receptorJC)> receptorJperforinJapoptosisJclonal selection (mmunostimulator immunosuppression immunosuppressive drug immunotherapy lymphatic systemJlymphocyte macrophage ma/or histocompati"ility comple+Jclass ( 68CJclass (( 68C monoclonal anti"odyJpolyclonal anti"ody
3I"S

3c8uired immunodeficiency syndrome (3I"S)
IC"'1( IC"')
1A< @<A
!he 4ed ri""on is a sym"ol for solidarity %ith 8(E*positive people and those living %ith '()S 3c8uired immunodeficiency syndrome or 3c8uired immune deficiency syndrome (3I"S or 3ids) is a collection of symptoms and infections in humans resulting from the specific damage to the immune system caused "y infection %ith the human immunodeficiency virus (8(E) -;. !he late stage of the condition leaves individuals prone to opportunistic infections and tumors 'lthough treatments for '()S and 8(E e+ist to slo% the virus,s progression, there is no kno%n cure 8(E is transmitted through direct contact of a mucous mem"rane or the "loodstream %ith a "odily fluid containing 8(E, such as "lood, semen, vaginal fluid, preseminal fluid, and "reast milk -A.-C. !his transmission can come in the form of anal, vaginal or oral se+, "lood transfusion, contaminated needles, e+change "et%een mother and "a"y during pregnancy, child"irth, or "reastfeeding, or other e+posure to one of the a"ove "odily fluids 6ost researchers "elieve that 8(E originated in su"*Saharan 'frica during the t%entieth century$-<. it is no% a pandemic, %ith an estimated C> = million people no% living %ith the disease %orld%ide -B. 's of January A@@=, the Joint :nited Nations 5rogramme on 8(EJ'()S (:N'()S) and the World 8ealth 0rgani#ation (W80) estimate that '()S has killed more than AB million people since it %as first recogni#ed on June B, ;?>;, making it one of the most destructive epidemics in recorded history (n A@@B alone, '()S claimed an estimated A < * C C million lives, of %hich more than BD@,@@@ %ere children -B. ' third of these deaths are occurring in su"*Saharan 'frica, retarding economic gro%th and destroying human capital 'ntiretroviral treatment reduces "oth the mortality and the mor"idity of 8(E infection, "ut routine access to antiretroviral medication is not
availa"le in all countries -=. 8(EJ'()S stigma is more severe than that associated %ith other life*threatening conditions and e+tends "eyond the disease itself to providers and even volunteers involved %ith the care of people living %ith 8(E
Contents
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; (nfection "y 8(E A )iagnosis o A ; W80 disease staging system for 8(E infection and disease o A A C)C classification system for 8(E infection o A C 8(E test C Symptoms and complications o C ; 6a/or pulmonary illnesses o C A 6a/or gastro*intestinal illnesses o C C 6a/or neurological illnesses o C < 6a/or 8(E*associated malignancies o C B 0ther opportunistic infections < !ransmission and prevention o < ; Se+ual contact o < A 7+posure to infected "ody fluids o < C 6other*to*child transmission (6!C!) B !reatment = 7pidemiology D 7conomic impact > Stigma ? 0rigin of 8(E ;@ 'lternative theories ;; Common misconceptions ;A Notes and references
;C 7+ternal links -edit.
)nfection by H)V
For more details on this topic, see IV.
Scanning electron micrograph of 8(E*; "udding from cultured lymphocyte '()S is the most severe manifestation of infection %ith 8(E 8(E is a retrovirus that primarily infects vital components of the human immune system such as C)<O ! cells (a su"set of ! cells), macrophages and dendritic cells (t directly and indirectly destroys C)<O ! cells C)<O ! cells are re&uired for the proper functioning of the immune system When 8(E kills C)<O ! cells so that there are fe%er than A@@ C)<O ! cells per microliter (Q3) of "lood, cellular immunity is lost, leading to '()S 'cute 8(E infection progresses over time to clinical latent 8(E infection and then to early symptomatic 8(E infection and later, to '()S, %hich is identified on the "asis of the amount of C)<O ! cells in the "lood and the presence of certain infections (n the a"sence of antiretroviral therapy, the median time of progression from 8(E infection to '()S is nine to ten years, and the median survival time after developing '()S is only ? A months -D. 8o%ever, the rate of clinical disease progression varies %idely "et%een individuals, from t%o %eeks up to A@ years 6any factors affect the rate of progression !hese include factors that influence the "ody,s a"ility to defend against 8(E such as the infected person,s general immune function ->.-?. 0lder people have %eaker immune systems, and therefore have a greater risk of rapid disease progression than younger people 5oor access to health care and the e+istence of coe+isting infections such as tu"erculosis also may predispose people to faster disease progression -D.-;@.-;;. !he infected person,s genetic inheritance plays an important role and some people are resistant to certain strains of 8(E -;A. 'n e+ample of this is people %ith the CC4B*WCA mutation are resistant to infection %ith certain strains of 8(E 8(E is genetically varia"le and e+ists as different strains, %hich cause different rates of clinical disease progression -;C.-;<.-;B. !he use of highly active antiretroviral therapy prolongs "oth the median time of progression to '()S and the median survival time -edit.
Diagnosis
Since June B, ;?>;, many definitions have "een developed for epidemiological surveillance such as the 1angui definition and the ;??< e+panded World 8ealth 0rgani#ation '()S case definition 8o%ever, clinical staging of patients %as not an
intended use for these systems as they are neither sensitive, nor specific (n developing countries, the World 8ealth 0rgani#ation (W80) staging system for 8(E infection and disease, using clinical and la"oratory data, is used and in developed countries, the Centers for )isease Control (C)C) Classification System is used -edit.
:-; disease sta%in% system for -I& infection and disease

,ain article- + 2 4isease %taging %ystem for IV Infection and 4isease (n ;??@, the World 8ealth 0rgani#ation (W80) grouped these infections and conditions together "y introducing a staging system for patients infected %ith 8(E*; -;=. 'n update took place in Septem"er A@@B 6ost of these conditions are opportunistic infections that are easily treata"le in healthy people %tage I- 8(E disease is asymptomatic and not categori#ed as '()S %tage II- includes minor mucocutaneous manifestations and recurrent upper respiratory tract infections %tage III- includes une+plained chronic diarrhea for longer than a month, severe "acterial infections and pulmonary tu"erculosis %tage IV- includes to+oplasmosis of the "rain, candidiasis of the esophagus, trachea, "ronchi or lungs and Maposi,s sarcoma$ these diseases are indicators of '()S -edit.
C"C classification system for -I& infection

,ain article- C4C Classification %ystem for IV Infection !he Centers for )isease Control and 5revention (C)C) originally classified '()S as 94() %hich stood for 9ay 4elated (mmune )isease 8o%ever, after determining that '()S is not isolated to homose+ual people the name %as changed to the neutral '()S (n ;??C, the C)C e+panded their definition of '()S to include all 8(E positive people %ith a C)<O ! cell count "elo% A@@ per Q3 of "lood or ;<H of all lymphocytes -;D. !he ma/ority of ne% '()S cases in developed countries use either this definition or the pre* ;??C C)C definition !he '()S diagnosis still stands even if, after treatment, the C)<O ! cell count rises to a"ove A@@ per Q3 of "lood or other '()S*defining illnesses are cured -edit.
-I& test
,ain article- IV test
'ppro+imately half of those infected %ith 8(E do not kno% their 8(E status until an '()S diagnosis is made %ith an 8(E test )onor "lood and "lood products used in medicine and medical research are screened for 8(E using such a test !ypical 8(E tests, including the 8(E en#yme immunoassay and the Western "lot assay, detect 8(E anti"odies in serum, plasma, oral fluid, dried "lood spot or urine of patients 8o%ever, the %indo% period (the time "et%een initial infection and the development of detecta"le anti"odies against the infection) can vary !his is %hy it can take =*;A months to seroconvert and test positive Commercially availa"le tests to detect other 8(E antigens, 8(E*4N', and 8(E*)N' in order to detect 8(E infection prior to the development of detecta"le anti"odies are availa"le For the diagnosis of 8(E infection these assays are not specifically approved, "ut are nonetheless routinely used in developed countries -edit.
Symptoms an! complications
' generali#ed graph of the relationship "et%een 8(E copies (viral load) and C)< counts over the average course of untreated 8(E infection$ any particular individual,s disease course may vary considera"ly C)<O ! 3ymphocyte count (cellsJmmC) 8(E 4N' copies per m3 of plasma !he symptoms of '()S are primarily the result of conditions that do not normally develop in individuals %ith healthy immune systems 6ost of these conditions are infections caused "y "acteria, viruses, fungi and parasites that are normally controlled "y the elements of the immune system that 8(E damages 0pportunistic infections are common in people %ith '()S -;>. 8(E affects nearly every organ system 5eople %ith '()S also have an increased risk of developing various cancers such as Maposi sarcoma, cervical cancer and cancers of the immune system kno%n as lymphomas 'dditionally, people %ith '()S often have systemic symptoms of infection like fevers, s%eats (particularly at night), s%ollen glands, chills, %eakness, and %eight loss -;?.-A@. 'fter the diagnosis of '()S is made, the current average survival time %ith antiretroviral therapy is estimated to "e no% more than B years,-A;. "ut "ecause ne% treatments continue
to "e developed and "ecause 8(E continues to evolve resistance to treatments, estimates of survival time are likely to continue to change Without antiretroviral therapy, death normally occurs %ithin a year -D. 6ost patients die from opportunistic infections or malignancies associated %ith the progressive failure of the immune system -AA. !he rate of clinical disease progression varies %idely "et%een individuals and has "een sho%n to "e affected "y many factors such as host suscepti"ility and immune function->.-?. -;A. health care and co*infections,-D.-AA. as %ell as factors relating to the viral strain -;<.-AC.-A<. !he specific opportunistic infections that '()S patients develop depend in part on the prevalence of these infections in the geographic area in %hich the patient lives -edit.
a<or pulmonary illnesses
Pneumocystis 5iro#eci pneumonia (originally kno%n as Pneumocystis carinii pneumonia, often*a""reviated 5C5) is relatively rare in healthy, immunocompetent people "ut common among 8(E*infected individuals 1efore the advent of effective diagnosis, treatment and routine prophyla+is in Western countries, it %as a common immediate cause of death (n developing countries, it is still one of the first indications of '()S in untested individuals, although it does not generally occur unless the C)< count is less than A@@ per Q3 -AB. !u"erculosis (!1) is uni&ue among infections associated %ith 8(E "ecause it is transmissi"le to immunocompetent people via the respiratory route, is easily treata"le once identified, may occur in early*stage 8(E disease, and is preventa"le %ith drug therapy 8o%ever, multi*drug resistance is a potentially serious pro"lem 7ven though its incidence has declined "ecause of the use of directly o"served therapy and other improved practices in Western countries, this is not the case in developing countries %here 8(E is most prevalent (n early*stage 8(E infection (C)< count IC@@ cells per Q3), !1 typically presents as a pulmonary disease (n advanced 8(E infection, !1 often presents atypically %ith e+trapulmonary disease a common feature Symptoms are usually constitutional and are not locali#ed to one particular site, often affecting "one marro%, "one, urinary and gastrointestinal tracts, liver, regional lymph nodes, and the central nervous system -A=. 'lternatively, symptoms may relate more to the site of e+trapulmonary involvement
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a<or %astro'intestinal illnesses
7sophagitis is an inflammation of the lining of the lo%er end of the esophagus (gullet or s%allo%ing tu"e leading to the stomach) (n 8(E infected individuals, this is normally due to fungal (candidiasis) or viral (herpes simple+*; or cytomegalovirus) infections (n rare cases, it could "e due to myco"acteria -AD.
:ne+plained chronic diarrhea in 8(E infection is due to many possi"le causes, including common "acterial (%almonella, %higella, 'isteria, Campylobacter, or (scherichia coli) and parasitic infections, and uncommon opportunistic infections such as cryptosporidiosis, microsporidiosis, ,ycobacterium a#ium comple+ (6'C) and cytomegalovirus (C6E) colitis (n some cases, diarrhea may "e a side effect of several drugs used to treat 8(E, or it may simply accompany 8(E infection, particularly during primary 8(E infection (t may also "e a side effect of anti"iotics used to treat "acterial causes of diarrhea (common for Clostridium difficile) (n the later stages of 8(E infection, diarrhea is thought to "e a reflection of changes in the %ay the intestinal tract a"sor"s nutrients, and may "e an important component of 8(E*related %asting -A>.
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a<or neurolo%ical illnesses
!o+oplasmosis is a disease caused "y the single*celled parasite called )o"oplasma gondii$ it usually infects the "rain causing to+oplasma encephalitis "ut it can infect and cause disease in the eyes and lungs -A?. 5rogressive multifocal leukoencephalopathy (563) is a demyelinating disease, in %hich the gradual destruction of the myelin sheath covering the a+ons of nerve cells impairs the transmission of nerve impulses (t is caused "y a virus called JC virus %hich occurs in D@H of the population in latent form, causing disease only %hen the immune system has "een severely %eakened, as is the case for '()S patients (t progresses rapidly, usually causing death %ithin months of diagnosis
-C@.
'()S dementia comple+ (')C) is a meta"olic encephalopathy induced "y 8(E infection and fuelled "y immune activation of 8(E infected "rain macrophages and microglia %hich secrete neuroto+ins of "oth host and viral origin -C;. Specific neurological impairments are manifested "y cognitive, "ehavioral, and motor a"normalities that occur after years of 8(E infection and is associated %ith lo% C)<O ! cell levels and high plasma viral loads 5revalence is ;@*A@H in Western countries-CA. "ut only ;*AH of 8(E infections in (ndia -CC.-C<. !his difference is possi"ly due to the 8(E su"type in (ndia Cryptococcal meningitis is an infection of the menin+ (the mem"rane covering the "rain and spinal cord) "y the fungus Cryptococcus neoformans (t can cause fevers, headache, fatigue, nausea, and vomiting 5atients may also develop sei#ures and confusion$ left untreated, it can "e lethal
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a<or -I&'associated mali%nancies

5atients %ith 8(E infection have su"stantially increased incidence of several malignant cancers !his is primarily due to co*infection %ith an oncogenic )N' virus, especially 7pstein*1arr virus (71E), Maposi,s sarcoma*associated herpesvirus (MS8E), and human
papillomavirus (85E) -CB.-C=. !he follo%ing confer a diagnosis of '()S %hen they occur in an 8(E*infected person
Maposi,s sarcoma (MS) is the most common tumor in 8(E*infected patients !he appearance of this tumor in young homose+ual men in ;?>; %as one of the first signals of the '()S epidemic Caused "y a gammaherpes virus called Maposi,s sarcoma*associated herpes virus (MS8E), it often appears as purplish nodules on the skin, "ut can affect other organs, especially the mouth, gastrointestinal tract, and lungs 8igh*grade 1 cell lymphomas such as 1urkitt,s lymphoma, 1urkitt,s*like lymphoma, diffuse large 1*cell lymphoma ()31C3), and primary central nervous system lymphoma present more often in 8(E*infected patients !hese particular cancers often foreshado% a poor prognosis (n some cases these lymphomas are '()S*defining 7pstein*1arr virus (71E) or MS8E cause many of these lymphomas Cervical cancer in 8(E*infected %omen is considered '()S*defining (t is caused "y human papillomavirus (85E)
(n addition to the '()S*defining tumors listed a"ove, 8(E*infected patients are at increased risk of certain other tumors, such as 8odgkin,s disease and anal and rectal carcinomas 8o%ever, the incidence of many common tumors, such as "reast cancer or colon cancer, does not increase in 8(E*infected patients (n areas %here 8''4! is e+tensively used to treat '()S, the incidence of many '()S*related malignancies has decreased, "ut at the same time malignant cancers overall have "ecome the most common cause of death of 8(E*infected patients -CD. -edit.
;ther opportunistic infections

'()S patients often develop opportunistic infections that present %ith non*specific symptoms, especially lo%*grade fevers and %eight loss !hese include infection %ith ,ycobacterium a#ium6intracellulare and cytomegalovirus (C6E) C6E can cause colitis, as descri"ed a"ove, and C6E retinitis can cause "lindness 5enicilliosis due to Penicillium marneffei is no% the third most common opportunistic infection (after e+trapulmonary tu"erculosis and cryptococcosis) in 8(E*positive individuals %ithin the endemic area of Southeast 'sia -C>. -edit.
Transmission an! pre"ention

7stimated per act risk for ac&uisition of 8(E "y e+posure route-C?.
45posure Route
4stimated infections per
1(.((( e5posures to an infected source
*lood #ransfusion
?,@@@-<@.
Childbirth
A,B@@-<;.
Needle'sharin% in<ection dru% use
=D-<A.
Receptive anal intercourse=
B@-<C.-<<.
!ercutaneous needle stic0
C@-<B.
Receptive penile'va%inal intercourse= ;@-<C.-<<.-<=.
Insertive anal intercourse=
= B-<C.-<<.
Insertive penile'va%inal intercourse= B-<C.-<<.
Receptive oral intercourse=
;-<<.X
Insertive oral intercourse=
@ B-<<.X
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= assumin% no condom use Source refers to oral intercourse performed on a man
!he three main transmission routes of 8(E are se+ual contact, e+posure to infected "ody fluids or tissues and from mother to fetus or child during perinatal period (t is possi"le to find 8(E in the saliva, tears, and urine of infected individuals, "ut due to the lo% concentration of virus in these "iological li&uids, the risk is negligi"le -edit.
Se5ual contact
!he ma/ority of 8(E infections are ac&uired through unprotected se+ual relations "et%een partners, one of %hom has 8(E Se+ual transmission occurs %ith the contact "et%een se+ual secretions of one partner %ith the rectal, genital or oral mucous mem"ranes of another :nprotected receptive se+ual acts are riskier than unprotected insertive se+ual acts, %ith the risk for transmitting 8(E from an infected partner to an uninfected partner through unprotected insertive anal intercourse greater than the risk for transmission through vaginal intercourse or oral se+ 0ral se+ is not %ithout its risks as 8(E is transmissi"le through "oth insertive and receptive oral se+ -<D. !he risk of 8(E transmission from e+posure to saliva is considera"ly smaller than the risk from e+posure to semen$ contrary to popular "elief, one %ould have to s%allo% gallons of saliva from a carrier to run a significant risk of "ecoming infected -<>. Se+ually transmitted infections (S!() increase the risk of 8(E transmission and infection "ecause they cause the disruption of the normal epithelial "arrier "y genital ulceration andJor microulceration$ and "y accumulation of pools of 8(E*suscepti"le or 8(E* infected cells (lymphocytes and macrophages) in semen and vaginal secretions 7pidemiological studies from su"*Saharan 'frica, 7urope and North 'merica have suggested that there is appro+imately a four times greater risk of "ecoming infected %ith 8(E in the presence of a genital ulcer such as those caused "y syphilis andJor chancroid !here is also a significant though lesser increased risk in the presence of S!)s such as gonorrhea, Chlamydial infection and trichomoniasis %hich cause local accumulations of lymphocytes and macrophages -<?. !ransmission of 8(E depends on the infectiousness of the inde+ case and the suscepti"ility of the uninfected partner (nfectivity seems to vary during the course of illness and is not constant "et%een individuals 'n undetecta"le plasma viral load does not necessarily indicate a lo% viral load in the seminal li&uid or genital secretions 7ach ;@*fold increment of seminal 8(E 4N' is associated %ith an >;H increased rate of 8(E transmission -<?.-B@. Women are more suscepti"le to 8(E*; infection due to hormonal changes, vaginal micro"ial ecology and physiology, and a higher prevalence of se+ually transmitted diseases -B;.-BA. 5eople %ho are infected %ith 8(E can still "e infected "y other, more virulent strains )uring a se+ual act, only male or female condoms can reduce the chances of infection %ith 8(E and other S!)s and the chances of "ecoming pregnant !he "est evidence to date indicates that typical condom use reduces the risk of heterose+ual 8(E transmission "y appro+imately >@H over the long*term, though the "enefit is likely to "e higher if condoms are used correctly on every occasion -BC. !he effective use of condoms and screening of "lood transfusion in North 'merica, Western and Central 7urope is credited %ith contri"uting to the lo% rates of '()S in these regions 5romoting condom use, ho%ever, has often proved controversial and difficult 6any religious groups, most visi"ly the Catholic Church, have opposed the use of condoms on religious grounds, and have sometimes seen condom promotion as an affront to the promotion of marriage, monogamy and se+ual morality !his attitude is found among some health care providers and policy makers in su"*Saharan 'frican nations, %here 8(E
and '()S prevalence is e+tremely high -B<. !hey also "elieve that the distri"ution and promotion of condoms is tantamount to promoting se+ amongst the youth and sending the %rong message to uninfected individuals 8o%ever, no evidence has "een produced that promotion of condom use increases se+ual promiscuity 5ope 1enedict GE( commissioned a report on %hether it might "e accepta"le for Catholics to use condoms to protect life inside a marriage %hen one partner is infected %ith 8(E, or is sick %ith '()S -BB. )efenders of the Catholic Church,s role in '()S and general S!) prevention state that, %hile they may "e against the use of contraception, they are strong advocates of a"stinence outside marriage -B=. For this reason the Catholic Church is al%ays &uick to defend itself against allegations that it played a role in the spread of the disease !he Church argues that it goes to great lengths to push a very good prevention measure in a"stinence, and also that an analysis of its teaching demonstrates clearly that it cannot "e held responsi"le for the lack of condom use !he latter point arises from the fact that the principle of dou"le effect allo%s married couples to use contraception if the prime reason for doing so is the prevention of infection 's for unmarried couples, the Church,s a"stinence rule is a far more serious consideration than the use of contraception (t is therefore unlikely that couples engaging in pre*marital se+ are failing to use contraception out of respect to the Catholic Church if they are happy to commit a much greater sin Conversely, some religious groups have argued that preventing 8(E infection is a moral task in itself and that condoms are therefore accepta"le or even praise%orthy from a religious point of vie%
Condoms in many colors !he male late+ condom, if used correctly %ithout oil*"ased lu"ricants, is the single most efficient availa"le technology to reduce the se+ual transmission of 8(E and other se+ually transmitted infections 6anufacturers recommend that oil*"ased lu"ricants such as petroleum /elly, "utter, and lard not "e used %ith late+ condoms as they %eaken the late+, making the condoms porous (f necessary, manufacturers recommend using %ater* "ased lu"ricants 0il*"ased lu"ricants can ho%ever "e used %ith polyurethane condoms -BD. 3ate+ degrades over time, making them porous, %hich is %hy condoms have e+piration dates (n 7urope and the :nited States, condoms have to conform to 7uropean (7C =@@) or 'merican ()C<?A) standards to "e considered protective against 8(E transmission
!he female condom is an alternative to the male condom and is made from polyurethane, %hich allo%s it to "e used in the presence of oil*"ased lu"ricants !hey are larger than male condoms and have a stiffened ring*shaped opening, and are designed to "e inserted into the vagina !he female condom contains an inner ring, %hich keeps the condom in place inside the vagina R inserting the female condom re&uires s&uee#ing this ring With consistent and correct use of condoms, there is a very lo% risk of 8(E infection Studies on couples %here one partner is infected sho% that %ith consistent condom use, 8(E infection rates for the uninfected partner are "elo% ;H per year -B>. !he :nited States government and health organi#ations "oth endorse the !BC !pproach to lo%er the risk of ac&uiring '()S during se+: 3"stinence or delay of se+ual activity, especially for youth, *eing faithful, especially for those in committed relationships, Condom use, for those %ho engage in risky "ehavior !his approach has "een very successful in :ganda, %here 8(E prevalence has decreased from ;BH to BH 8o%ever, more has "een done than implementing the '1C 'pproach as 7d%ard 9reen, a 8arvard medical anthropologist put it, N7ganda has pioneered approaches to0ards reducing stigma, bringing discussion of se"ual beha#ior out into the open, in#ol#ing IV6infected people in public education, persuading indi#iduals and couples to be tested and counseled, impro#ing the status of 0omen, in#ol#ing religious organizations, enlisting traditional healers, and much more.N 0ther programs and initiatives promote condom use more heavily Condom use is an integral part of the C&& !pproach !his is: Condom use, for those %ho engage in risky "ehavior, Needles, use clean ones, Negotiating skills$ negotiating safer se+ %ith a partner and empo%ering %omen to make smart choices Criticism of the '1C approach is %idespread "ecause a faithful partner of an unfaithful partner is at risk of contracting 8(E -B?. Current research is clarifying the relationship "et%een male circumcision and 8(E in differing social and cultural conte+ts -=@. :N'()S "elieves that it is premature to recommend male circumcision services as part of 8(E prevention programs-=;. even though male circumcision may lead to a reduction of infection risk in heterose+ual men "y up to =@H -=A. 6oreover, South 'frican medical e+perts are concerned that the repeated use of unsterili#ed "lades in the ritual circumcision of adolescent "oys may "e spreading 8(E -=C. -edit.
45posure to infected body fluids
!his transmission route is particularly important for intravenous drug users, hemophiliacs and recipients of "lood transfusions and "lood products Sharing and reusing syringes contaminated %ith 8(E*infected "lood represents a ma/or risk for infection %ith not only 8(E, "ut also hepatitis 1 and hepatitis C Needle sharing is the cause of one third of all ne% 8(E*infections and B@H of hepatitis C infections in Northern 'merica, China, and 7astern 7urope !he risk of "eing infected %ith 8(E from a single prick %ith a needle that has "een used on an 8(E infected person though is thought to "e a"out ; in ;B@ (see ta"le a"ove) 5ost*e+posure prophyla+is %ith anti*8(E drugs can further reduce that small risk -=<. 8ealth care %orkers (nurses, la"oratory %orkers, doctors etc) are also concerned, although more rarely !his route can affect people %ho give and receive tattoos and piercings :niversal precautions are fre&uently not follo%ed in "oth su"* Saharan 'frica and much of 'sia "ecause of "oth a shortage of supplies and inade&uate training !he W80 estimates that appro+imately A BH of all 8(E infections in su"* Saharan 'frica are transmitted through unsafe healthcare in/ections -=B. 1ecause of this, the :nited Nations 9eneral 'ssem"ly, supported "y universal medical opinion on the matter, has urged the nations of the %orld to implement universal precautions to prevent 8(E transmission in health care settings -==.-=D. !he risk of transmitting 8(E to "lood transfusion recipients is e+tremely lo% in developed countries %here improved donor selection and 8(E screening is performed 8o%ever, according to the W80, the over%helming ma/ority of the %orld,s population does not have access to safe "lood and N"et%een BH and ;@H of 8(E infections %orld%ide are transmitted through the transfusion of infected "lood and "lood productsN
-=>.
6edical %orkers %ho follo% universal precautions or "ody su"stance isolation such as %earing late+ gloves %hen giving in/ections and %ashing the hands fre&uently can help prevent infection of 8(E 'll '()S*prevention organi#ations advise drug*users not to share needles and other material re&uired to prepare and take drugs (including syringes, cotton "alls, the spoons, %ater for diluting the drug, stra%s, crack pipes, etc) (t is important that people use ne% or properly sterili#ed needles for each in/ection (nformation on cleaning needles using "leach is availa"le from health care and addiction professionals and from needle e+changes (n some developed countries, clean needles are availa"le free in some cities, at needle e+changes or safe in/ection sites 'dditionally, many nations have decriminali#ed needle possession and made it possi"le to "uy in/ection e&uipment from pharmacists %ithout a prescription -edit.
other'to'child transmission ( #C#)

!he transmission of the virus from the mother to the child can occur in utero during the last %eeks of pregnancy and at child"irth (n the a"sence of treatment, the transmission rate "et%een the mother to the child during pregnancy, la"or and delivery is ABH
8o%ever, %hen the mother has access to antiretroviral therapy and gives "irth "y caesarean section, the rate of transmission is /ust ;H -<;. ' num"er of factors influence the risk of infection, particularly the viral load of the mother at "irth (the higher the load, the higher the risk) 1reastfeeding increases the risk of transmission "y ;@R;BH !his risk depends on clinical factors and may vary according to the pattern and duration of "reast*feeding Studies have sho%n that antiretroviral drugs, caesarean delivery and formula feeding reduce the chance of transmission of 8(E from mother to child -=?. Current recommendations state that %hen replacement feeding is accepta"le, feasi"le, afforda"le, sustaina"le and safe, 8(E*infected mothers should avoid "reast*feeding their infant 8o%ever, if this is not the case, e+clusive "reast*feeding is recommended during the first months of life and discontinued as soon as possi"le -B. (n A@@B, around D@@,@@@ children under ;B contracted 8(E, mainly through 6!C!, %ith =C@,@@@ of these infections occurring in 'frica -D@. 0f the estimated A C million -; D*C B million. children currently living %ith 8(E, A million (almost ?@H) live in su"*Saharan 'frica -B. 5revention strategies are %ell kno%n in developed countries, ho%ever, recent epidemiological and "ehavioral studies in 7urope and North 'merica have suggested that a su"stantial minority of young people continue to engage in high*risk practices and that despite 8(EJ'()S kno%ledge, young people underestimate their o%n risk of "ecoming infected %ith 8(E -D;. 8o%ever, transmission of 8(E "et%een intravenous drug users has clearly decreased, and 8(E transmission "y "lood transfusion has "ecome &uite rare in developed countries -edit.
Treatment
!here is currently no vaccine against 8(E or '()S !he only kno%n methods of prevention are "ased on avoiding e+posure to the virus or, failing that, on an antiviral treatment directly after a highly significant e+posure 'lso, not a single case has "een documented in %hich systemic 8(E infection has "een cured and even on the theoretical level, no plausi"le %ay of eradicating 8(E infection has so far "een found !reatment for 8(E can suppress viral replication to a degree sufficient to apparently stop disease progression, "ut success is critically dependent on the patients a"ility to keep perfect adherence to their drug schedule, %hich many people %ill fail to achieve 'lso, modern com"ination therapy has "een around for merely ten years, so it is not presently kno%n %hether treatment failure or inaccepta"le long*term side effects can "e avoided in the ma/ority even of perfectly compliant patients over a time*span of potentially many decades 8o%ever, it is kno%n that %ithout ma/or medical and scientific "reakthroughs, 8(E %ill not have any pro"lem surviving com"ination therapy for said decades Still, in %estern countries, most patients survive many years follo%ing diagnosis "ecause of the availa"ility of the highly active antiretroviral therapy (8''4!) -A;. (n the a"sence of 8''4!, progression from 8(E infection to '()S occurs at a median of "et%een nine to ten years and the median survival time after developing '()S is only ? A months -D.
8''4! dramatically increases the time from diagnosis to death, and treatment research continues Current optimal 8''4! options consist of com"inations (or NcocktailsN) consisting of at least three drugs "elonging to at least t%o types, or Nclasses,N of anti*retroviral agents !ypical regimens consist of t%o nucleoside analogue reverse transcriptase inhi"itors (N4!(s) plus either a protease inhi"itor or a non*nucleoside reverse transcriptase inhi"itor (NN4!() !his treatment is fre&uently referred to as 8''4! (highly*active anti*retroviral therapy) -DA. 'nti*retroviral treatments, along %ith medications intended to prevent '()S*related opportunistic infections, have played a part in delaying complications associated %ith '()S, reducing the symptoms of 8(E infection, and e+tending patients, life spans 0ver the past decade the success of these treatments in prolonging and improving the &uality of life for people %ith '()S has improved dramatically -DC.-D<. 1ecause 8(E disease progression in children is more rapid than in adults, and la"oratory parameters are less predictive of risk for disease progression, particularly for young infants, treatment recommendations are more aggressive for children than for adults -DB. (n developed countries %here 8''4! is availa"le, doctors assess the viral load, rapidity in C)< decline, and patient readiness %hile deciding %hen to recommend initiating treatment -D=. !here are several concerns a"out antiretroviral regimens, as side effects of these antiretrovirals have caused pro"lems such as lipodystrophy, dyslipidaemia, insulin resistance, an increase in cardiovascular risks and "irth defects -DD.-D>. 4egimens can "e complicated, re&uiring patients to take several pills at various times during the day, although treatment regimens have "een greatly simplified in recent years (f patients miss doses, drug resistance can develop contri"uting to the rise of viral escape -D?.->@. 'nti* retroviral drugs are e+pensive, and the ma/ority of the %orld,s infected individuals do not have access to medications and treatments for 8(E and '()S 4esearch to improve current treatments includes decreasing side effects of current drugs, further simplifying drug regimens to improve adherence, and determining the "est se&uence of regimens to manage drug resistance ' num"er of studies have sho%n that measures to prevent opportunistic infections can "e "eneficial %hen treating patients %ith 8(E infection or '()S Eaccination against hepatitis ' and 1 is advised for patients %ho are not infected %ith these viruses and are at risk of getting infected (n addition, '()S patients should receive vaccination against Streptococcus pneumoniae and should receive yearly vaccination against influen#a virus 5atients %ith su"stantial immunosuppression are generally advised to receive prophylactic therapy for 5neumocystis /iroveci pneumonia (5C5), and many patients may "enefit from prophylactic therapy for to+oplasmosis and Cryptococcus meningitis Earious forms of alternative medicine have "een used to try to treat symptoms or to try to affect the course of the disease itself, although none is a su"stitute for conventional treatment ->;. (n the first decade of the epidemic %hen no useful conventional treatment
%as availa"le, a large num"er of people %ith '()S e+perimented %ith alternative therapies !he definition of Nalternative therapiesN in '()S has changed since that time !hen, the phrase often referred to community*driven treatments, untested "y government or pharmaceutical company research, that some hoped %ould directly suppress the virus or stimulate immunity against it !hese kinds of approaches have "ecome less common over time as the "enefits of '()S drugs have "ecome more apparent 7+amples of alternative medicine that people hoped %ould improve their symptoms or their &uality of life include massage, her"al and flo%er remedies and acupuncture$->;. %hen used %ith conventional treatment, many no% refer to these as NcomplementaryN approaches None of these treatments has "een proven in controlled trials to have any effect in treating 8(E or '()S directly ->A. 8o%ever, some may improve feelings of %ell* "eing in people %ho "elieve in their value 'dditionally, people %ith '()S, like people %ith other illnesses such as cancer, sometimes use mari/uana to treat pain, com"at nausea and stimulate appetite -edit.
$pi!emiology
,ain article- !I4% pandemic
5revalence of 8(E among adults per country at the end of A@@B YY ;B*B@H YY B*;BH
YY ;*BH YY @ B*; @H YY @ ;*@ BH YY L@ ;H YY no data
:N'()S and the W80 estimate that '()S has killed more than AB million people since it %as first recogni#ed in ;?>;, making it one of the most destructive epidemics in recorded history )espite recent, improved access to antiretroviral treatment and care in many regions of the %orld, the '()S epidemic claimed an estimated A > million ("et%een A < and C C million) lives in A@@B of %hich more than half a million (BD@,@@@) %ere children -B. 9lo"ally, "et%een CC < and <= million people currently live %ith 8(E -B. (n A@@B, "et%een C < and = A million people %ere ne%ly infected and "et%een A < and C C million people %ith '()S died, an increase from A@@C and the highest num"er since ;?>; -B. Su"*Saharan 'frica remains "y far the %orst affected region, %ith an estimated A; = to AD < million people currently living %ith 8(E !%o million -; BRC @ million. of them are children younger than ;B years of age 6ore than =<H of all people living %ith 8(E are in su"*Saharan 'frica, as are more than three &uarters (D=H) of all %omen living %ith
8(E (n A@@B, there %ere ;A @ million -;@ =R;C = million. '()S orphans living in su"* Saharan 'frica A@@B -B. South S South 7ast 'sia are second %orst affected %ith ;BH '()S accounts for the deaths of B@@,@@@ children in this region !%o*thirds of 8(EJ'()S infections in 'sia occur in (ndia, %ith an estimated B D million infections (estimated C < * ? < million) (@ ?H of population), surpassing South 'frica,s estimated B B million (< ?*= ; million) (;; ?H of population) infections, making it the country %ith the highest num"er of 8(E infections in the %orld ->C. (n the CB 'frican nations %ith the highest prevalence, average life e+pectancy is <> C yearsZ = B years less than it %ould "e %ithout the disease -><. !he latest evaluation report of the World 1ank,s 0perations 7valuation )epartment assesses the effectiveness of the World 1ank,s country*level 8(EJ'()S assistance, defined as policy dialogue, analytic %ork, and lending, %ith the e+plicit o"/ective of reducing the scope or impact of the '()S epidemic ->B. !his is the first comprehensive evaluation of the World 1ank,s 8(EJ'()S support to countries, from the "eginning of the epidemic through mid*A@@< 1ecause the 1ank,s assistance is for implementation of government programs "y government, it provides important insights on ho% national '()S programs can "e made more effective !he development of 8''4! as effective therapy for 8(E infection and '()S has su"stantially reduced the death rate from this disease in those areas %here it is %idely availa"le !his has created the misperception that the disease has gone a%ay (n fact, as the life e+pectancy of persons %ith '()S has increased in countries %here 8''4! is %idely used, the num"er of persons living %ith '()S has increased su"stantially (n the :nited States, the num"er of persons %ith '()S increased from a"out CB,@@@ in ;?>> to over AA@,@@@ in ;??= ->=. (n 'frica, the num"er of 6!C! and the prevalence of '()S is "eginning to reverse decades of steady progress in child survival Countries such as :ganda are attempting to cur" the 6!C! epidemic "y offering EC! (voluntary counseling and testing), 56!C! (prevention of mother*to*child transmission) and 'NC (ante*natal care) services, %hich include the distri"ution of antiretroviral therapy -edit.
$conomic impact
Changes in life e+pectancy in several 'frican countries 1ots%ana Pim"a"%e Menya South 'frica :ganda 8(E and '()S retard economic gro%th "y destroying human capital :N'()S has predicted outcomes for su"*Saharan 'frica to the year A@AB !hese range from a plateau and eventual decline in deaths "eginning around A@;A to a catastrophic continual gro%th in the death rate %ith potentially ?@ million cases of infection -B. Without proper nutrition, health care and medicine that is availa"le in developed countries, large num"ers of people in these countries are falling victim to '()S !hey %ill not only "e una"le to %ork, "ut %ill also re&uire significant medical care !he forecast is that this %ill likely cause a collapse of economies and societies in the region (n some heavily infected areas, the epidemic has left "ehind many orphans cared for "y elderly grandparents !he increased mortality in this region %ill result in a smaller skilled population and la"or force ->D. !his smaller la"or force %ill "e predominantly young people, %ith reduced kno%ledge and %ork e+perience leading to reduced productivity 'n increase in %orkers[ time off to look after sick family mem"ers or for sick leave %ill also lo%er productivity (ncreased mortality %ill also %eaken the mechanisms that generate human capital and investment in people, through loss of income and the death of parents ->D. 1y killing off mainly young adults, '()S seriously %eakens the ta+a"le population, reducing the resources availa"le for pu"lic e+penditures such as education and health services not related to '()S resulting in increasing pressure for the state,s finances and slo%er gro%th of the economy !his then results in slo%er gro%th of the ta+ "ase, an effect that %ill "e reinforced if there are gro%ing e+penditures on treating the sick, training (to replace sick %orkers) and sick pay and caring for '()S orphans, especially if the sharp increase in
adult mortality shifts the onus from the family to the government in caring for these orphans 0n the level of the household, '()S results in "oth the loss of income and increased spending on healthcare "y the household !he income effects of this lead to spending reduction as %ell as a su"stitution effect a%ay from education and to%ards healthcare and funeral spending ' study in C\te d,(voire sho%ed that households %ith an 8(EJ'()S patient spent t%ice as much on medical e+penses as other households ->>. :N'()S, W80 and the :nited Nations )evelopment 5rogramme have documented a correlation "et%een the decreasing life e+pectancies and the lo%ering of gross national product in many 'frican countries %ith prevalence rates of ;@H or more (ndeed, since ;??A predictions that '()S %ould slo% economic gro%th in these countries have "een pu"lished !he degree of impact depended on assumptions a"out the e+tent to %hich illness %ould "e funded "y savings and %ho %ould "e infected ->?. Conclusions reached from models of the gro%th tra/ectories of C@ su"*Saharan economies over the period ;??@RA@AB %ere that the economic gro%th rates of these countries %ould "e "et%een @ B= and ; <DH lo%er !he impact on gross domestic product (9)5) per capita %as less conclusive 8o%ever, in A@@@, the rate of gro%th of 'frica,s per capita 9)5 %as in fact reduced "y @ DH per year from ;??@R;??D %ith a further @ CH per year lo%er in countries also affected "y malaria -?@. !he forecast no% is that the gro%th of 9)5 for these countries %ill undergo a further reduction of "et%een @ B and A =H per annum ->D. 8o%ever, these estimates may "e an underestimate, as they do not look at the effects on output per capita -?;. 6any governments in su"*Saharan 'frica denied that there %as a pro"lem for years, and are only no% starting to %ork to%ards solutions :nderfunding is a pro"lem in all areas of 8(E prevention %hen compared to even conservative estimates of the pro"lems -edit.
Stigma
'()S stigma e+ists around the %orld in a variety of %ays, including ostracism, re/ection, discrimination and avoidance of 8(E infected people$ compulsory 8(E testing %ithout prior consent or protection of confidentiality$ violence against 8(E infected individuals or people %ho are perceived to "e infected %ith 8(E$ and the &uarantine of 8(E infected individuals -?A. '()S stigma has "een further divided into the follo%ing three categories: ; A (nstrumental '()S stigmaZa reflection of the fear and apprehension that are likely to "e associated %ith any deadly and transmissi"le illness -?C. Sym"olic '()S stigmaZthe use of 8(EJ'()S to e+press attitudes to%ard the social groups or UlifestylesV perceived to "e associated %ith the disease -?C.
Courtesy '()S stigmaZstigmati#ation of people connected to the issue of 8(EJ'()S or 8(E* positive people -?<.
0ften, '()S stigma is e+pressed in con/unction %ith one or more other stigmas, particularly those associated %ith homose+uality, "ise+uality, and intravenous drug use (n many developed countries, there is an association "et%een '()S and homose+uality or "ise+uality, and this association is correlated %ith higher levels of se+ual pre/udice such as anti*homose+ual attitudes -?B. !here is also a perceived association "et%een all male* male se+ual "ehavior and '()S -?C.-?=. For more details on this topic, see %tigma and IV6!I4%, ! re#ie0 of the literature -?D. -edit.
,rigin of H)V
,ain article- !I4% origin !he '()S epidemic %as discovered June B, ;?>;, %hen the : S Centers for )isease Control and 5revention reported a cluster of Pneumocystis carinii pneumonia (no% classified as 5neumocystis /iroveci pneumonia) in five homose+ual men in 3os 'ngeles -?>. 0riginally du""ed 94(), or 9ay*4elated (mmune )eficiency, health authorities soon reali#ed that nearly half of the people identified %ith the syndrome %ere not homose+ual men (n ;?>A, the C)C introduced the term '()S to descri"e the ne%ly recogni#ed syndrome !hree of the earliest kno%n instances of 8(E infection are as follo%s: ; A C ' plasma sample taken in ;?B? from an adult male living in %hat is no% the )emocratic 4epu"lic of Congo -??. 8(E found in tissue samples from a ;B year old 'frican*'merican teenager %ho died in St 3ouis in ;?=? -;@@. 8(E found in tissue samples from a Nor%egian sailor %ho died around ;?D= -;@;.
!%o species of 8(E infect humans: 8(E*; and 8(E*A 8(E*; is more virulent and more easily transmitted 8(E*; is the source of the ma/ority of 8(E infections throughout the %orld, %hile 8(E*A is not as easily transmitted and is largely confined to West 'frica -;@A. 1oth 8(E*; and 8(E*A are of primate origin !he origin of 8(E*; is the Central Common Chimpan#ee (Pan troglodytes troglodytes) found in southern Cameroon -;@C. (t is esta"lished that 8(E*A originated from the Sooty 6anga"ey (Cercocebus atys), an 0ld World monkey of 9uinea 1issau, 9a"on, and Cameroon 'lthough a variety of theories e+ist e+plaining the transfer of 8(E to humans, there is no %idely accepted scientific consensus of any single hypothesis and the topic remains controversial Freelance /ournalist !om Curtis discussed one currently controversial possi"ility for the origin of 8(EJ'()S in a ;??A 4olling Stone maga#ine article 8e put
for%ard %hat is no% kno%n as the 05E '()S hypothesis, %hich suggests that '()S %as inadvertently caused in the late ;?B@s in the 1elgian Congo "y 8ilary Mopro%ski,s research into a polio vaccine -;@<. 'lthough su"se&uently retracted due to li"el issues surrounding its claims, the 4olling Stone article motivated another freelance /ournalist, 7d%ard 8ooper, to pro"e more deeply into this su"/ect 8ooper,s research resulted in his pu"lishing a ;??? "ook, !he 4iver, in %hich he alleged that an e+perimental oral polio vaccine prepared using chimpan#ee kidney tissue %as the route through %hich simian immunodeficiency virus (S(E) crossed into humans to "ecome 8(E, thus starting the human '()S pandemic -;@B. Su"se&uently, this hypothesis has "een refuted "y e+amination of these original polio vaccine stocks and esta"lishing that they do not contain material of chimpan#ee origin -;@=. -edit.
#lternati"e theories
,ain article- !I4% reappraisal ' minority of scientists and activists &uestion the connection "et%een 8(E and '()S,-;@D. or the e+istence of 8(E,-;@>. or the validity of current testing methods !hese claims are met %ith resistance "y, and often evoke frustration and hostility from most of the scientific community, %ho accuse the dissenters of ignoring evidence in favor of 8(E,s role in '()S, and irresponsi"ly posing a dangerous threat to pu"lic health "y their continued activities -;@?. Some assert that the current mainstream approach to '()S, "ased on 8(E causation, has resulted in inaccurate diagnoses, psychological terror, to+ic treatments, and a s&uandering of pu"lic funds -;;@. !he de"ate and controversy regarding this issue from the early ;?>@s to the present has provoked heated emotions and passions from "oth sides -edit.
Common misconceptions
,ain article- Common misconceptions about IV and !I4% ' num"er of misconceptions have arisen surrounding 8(EJ'()S !hree of the most common are that '()S can spread through casual contact, that se+ual intercourse %ith a virgin %ill cure '()S, and that 8(E can infect only homose+ual men and drug users 0ne possi"ility for the misconception that '()S infects only homose+ual men is that '()S %as termed 9ay 4elated (mmune )eficiency Syndrome %hen it %as first recogni#ed in ;?>; (it %as su"se&uently renamed after it %as recognised that there %ere methods of transmission other than male*male intercourse) 8(E appears to have entered the :nited States around the late ;?=@s and seems to have then "een unkno%ingly spread "y homose+uals throughout the : S and 7urope (n a survey on '()S conducted in ;?>C in 1elgium, )enmark, Finland, France, 9ermany, (taly, the Netherlands, Nor%ay,
S%eden, S%it#erland, and the :nited Mingdom a slight ma/ority of those infected %ith 8(E %ere male homose+uals (B>H of all cases) -;;;.

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Central nervous system infection

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Central nervous system

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CNS: 1rain system

Parts of the CNS

8ippocampus, Neocorte+, 3ateral ventricles -edit.

Brain (neural tube)

medulla o"longata o medullary pyramids

red:frontal orange:parietal yello%:occipital green: "lue:cere"ellum "lack:"rainstem

lo"e lo"e lo"e lo"e

5rimary visual corte+ (E;) EA 3ateral occipital gyrus

su"mucosal ple+us myenteric ple+us

lim"ic system 85' a+is

"ural menin%eal system

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6ollaret,s meningitis )rug hypersensitivity (6ethotre+ate) Wegener,s granulomatosis

CS/ analysis in bacterial menin%itis

Increased intracranial pressure

; Features A 5athophysiology C )iagnosis

< !reatment -edit.

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%ee- tuberculosis treatment -edit.

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'>C*'>=, 1?< ;, 9@B CAC

; Features A 'etiology C )iagnosis < !reatment B 7ncephalitis lethargica

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(4edirected from !o+oplasma) Jump to: navigation, search 6Toxoplasma gondii

*inomial name ,,,Toxoplasma gondii'''

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Beha"ioral mo!ifications of the host

Ho& to pre"ent infection

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Possible effects on human beha"ior

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)nnate Non*specific +echanisms

Specific or #!apti"e )mmune System

* 2ymphocytes and 3ntibody !roduction

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#9 2ymphocytes and Response Supervision

Disor!ers of the human immune system

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:-; disease sta%in% system for -I& infection and disease

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Symptoms an! complications

a<or pulmonary illnesses

a<or %astro'intestinal illnesses

a<or neurolo%ical illnesses

a<or -I&'associated mali%nancies

;ther opportunistic infections

Transmission an! pre"ention

4stimated infections per

1(.((( e5posures to an infected source

Needle'sharin% in<ection dru% use

Receptive anal intercourse=

!ercutaneous needle stic0

Receptive penile'va%inal intercourse= ;@-<C.-<<.-<=.

Insertive anal intercourse=

Insertive penile'va%inal intercourse= B-<C.-<<.

Receptive oral intercourse=