Microbiology: An Introduction, 13e (Tortora et al.)
Chapter 22 Microbial Diseases of the Nervous System
22.1 Multiple-Choice Questions
1) All of the following are true regarding African trypanosomiasis EXCEPT
A) it is also known as “sleeping sickness.”
B) all subspecies of Trypanosoma brucei have multiple hosts.
C) it is transmitted by the tsetse fly.
D) death ultimately occurs without proper treatment.
E) Trypanosoma brucei gambiense is the more common cause of disease.
2) Bacterial encephalitis and meningitis are difficult to treat because
A) no medications exist for treatment of these infections.
B) antibiotics damage nervous tissue.
C) many antibiotics cannot penetrate the blood-brain barrier.
D) the infections move along peripheral nerves.
E) it is very difficult to determine the causative microbe.
3) All of the following organisms cause meningitis EXCEPT
A) Neisseria meningitidis.
B) Haemophilus influenzae.
C) Cryptococcus neoformans.
D) Streptococcus pneumoniae.
E) Mycobacterium leprae.
4) Which of the following statements about Neisseria meningitis is FALSE?
A) A healthy carrier state can exist.
B) It is encapsulated.
C) It is typically transmitted by droplet aerosols or direct contact with secretions.
D) Its most distinguishing feature is a unique rash.
E) It is a gram-positive anaerobe.
5) Which of the following pairs is mismatched?
A) Neisseria meningitidis – produces deadly endotoxins
B) Haemophilus influenzae – virulence due to capsule
C) Mycobacterium leprae – grows in armadillos
D) Cryptococcus neoformans – acid-fast rod
E) Naegleria fowleri – causes amoebic meningoencephalitis
6) All of the following organisms are correctly matched to the recommended treatment EXCEPT
A) Neisseria meningitidis – cephalosporins.
B) Haemophilus influenzae – cephalosporins.
C) Cryptococcus neoformans – amphotericin B.
D) Mycobacterium leprae – dapsone.
E) poliovirus – amphotericin B.
7) Which of the following statements about leprosy is FALSE?
A) It is rarely fatal.
B) Patients with leprosy must be isolated.
C) It is transmitted by direct contact.
D) Diagnosis is based on skin biopsy.
E) The etiologic agent is acid-fast.
8) All of the following organisms are transmitted via the respiratory route EXCEPT
A) Neisseria meningitidis.
B) Haemophilus influenzae.
C) Listeria monocytogenes.
D) Cryptococcus neoformans.
E) None of the answers is correct; all of these organisms are transmitted by the respiratory route.
9) Which of the following statements about rabies is FALSE?
A) It is caused by Lyssavirus.
B) Hydrophobia is associated with the disease.
C) Most infections in the U.S. are the result of bites from infected dogs.
D) Diagnosis is based on immunofluorescent techniques.
E) Average incubation period is 30 to 50 days after initial infection.
10) The symptoms of tetanus are due to
A) endospore formation.
B) systemic infection.
C) sustained relaxation of muscles.
D) tetanospasmin.
E) inflammation.
11) All of the following diseases are caused by arbovirus EXCEPT
A) St. Louis encephalitis.
B) eastern equine encephalitis.
C) West Nile encephalitis.
D) primary amebic meningoencephalitis (PAM).
E) None of the answers is correct; all of these diseases are caused by arbovirus.
12) A 30-year-old woman was hospitalized after she experienced convulsions. On examination,
she was alert and oriented and complained of a fever, headache, and stiff neck. Any of the
following organisms could be responsible for her symptoms EXCEPT
A) Clostridium botulinum.
B) Listeria monocytogenes.
C) Haemophilus influenza.
D) Streptococcus pneumoniae.
E) Any of these organisms could be the causative agent.
13) The most effective control of mosquito-borne disease is
A) treatment of infected humans.
B) treatment of infected wild animals.
C) elimination of the mosquito population.
D) avoidance of endemic areas.
E) treatment of uninfected humans.
14) Initial treatment for tetanus in an unimmunized person with a puncture wound is
A) tetanus toxoid.
B) tetanus immune globulin.
C) penicillin.
D) none; no action is necessary.
E) debridement.
15) Initial treatment for tetanus in a fully immunized person with a puncture wound is
A) tetanus toxoid (inactivated tetanus toxin) booster.
B) tetanus immune globulin.
C) penicillin.
D) supportive rehydration therapy.
E) debridement.
16) The most common route of central nervous system invasion by pathogens is through
A) the skin.
B) the circulatory system.
C) the gastrointestinal system.
D) the parenteral route.
E) direct penetration into nerves.
17) The prodromal (i.e., pre-acute disease stage) symptoms of bacterial meningitis are
A) mild cold symptoms.
B) fever and headache.
C) stiff neck and back pains.
D) convulsions.
E) fever, headache, and stiff neck.
18) All of the following are associated with botulism outbreaks EXCEPT
A) type A toxin is most virulent.
B) endospores of C. botulinum have been recovered from honey.
C) type E toxin is associated with seafood.
D) Alaskan natives have the lowest rate of botulism in the world.
E) antibodies are not an effective method of treatment.
19) A pathologist detects Negri bodies while examining a brain section taken at autopsy. What
was the cause of death?
A) rabies
B) meningococcal meningitis
C) eastern equine encephalitis
D) Hansen’s disease
E) poliomyelitis
20) Encephalitis is more common in the summer months because
A) pathogens are present in swimming pools and lakes.
B) ameba populations increase in swimming pools.
C) ticks are encountered while hiking in the woods.
D) mosquito populations increase.
E) people encounter more bats during warm summer evenings.
21) Which of the following pairs is mismatched?
A) leprosy – direct contact
B) poliomyelitis – respiratory route
C) meningococcal meningitis – respiratory route
D) rabies – direct contact
E) listeriosis – ingestion
22) A 30-year-old woman was hospitalized after she experienced convulsions. On examination,
she was alert and oriented and complained of a fever, headache, and stiff neck. Which of the
following is most likely to provide rapid identification of the cause of her symptoms?
A) Gram stain of cerebrospinal fluid
B) Gram stain of throat culture
C) biopsy of brain tissue
D) check serum antibodies
E) None of these would provide rapid identification.
23) Each of the following is caused by prions EXCEPT
A) sheep scrapie.
B) kuru.
C) Creutzfeldt-Jakob disease.
D) bovine spongiform encephalopathy.
E) rabies.
24) Which of the following vaccine characteristics is (are) mismatched with their respective
vaccine type?
Salk Vaccine Sabin Vaccine 1. Consists
of a formalin-inactivated virus 4. Consists of a live, attenuated polio virus
2. Administered orally 5. Administered orally
3. Requires booster doses 6. Provides community immunity
A) 1, 3, and 5
B) 4, 5, and 6
C) 1 and 3 only
D) 2 only
E) None of the answers are correct; all these characteristics are correctly matched.
25) An eight-year-old girl in rural Wisconsin has chills, headache, and fever and reports having
been bitten by mosquitoes. How would you confirm your diagnosis of arboviral encephalitis?
A) ELISA test for IgM antibodies
B) brain biopsy for Negri bodies
C) Gram stain of cerebrospinal fluid
D) examination of local mosquitoes
E) complement fixation test for IgG antibodies
26) All of the following are true of chronic fatigue syndrome EXCEPT
A) it may have a genetic component.
B) it is also known as myalgic encephalomyelitis.
C) it is a psychological disorder.
D) it often begins with flu-like symptoms that do not go away.
E) it may be triggered by a viral infection.
27) A physician diagnoses a patient with lepromatous Hansen’s disease. All of the following
pertain to the patient EXCEPT
A) disfiguring nodules form all over the body.
B) the disease has progressed from the tuberculoid stage.
C) a skin biopsy will be taken to aid diagnosis.
D) treatment will include injections of penicillin.
E) infection probably occurred as a result of prolonged contact with another infected individual.
28) Arboviruses cause ________ and are transmitted by ________.
A) meningitis; bee stings
B) meningitis; mosquitoes
C) encephalitis; dog bites
D) encephalitis; mosquitoes
E) both meningitis and encephalitis; mosquitoes
29) Naegleria fowleri meningoencephalitis is commonly acquired by
A) exposure to bird droppings.
B) mosquito bites.
C) swimming in warm ponds or streams.
D) ingestion of water contaminated with fecal material.
E) exposure to body fluids of a contaminated individual.
30) Diagnosis of rabies is confirmed by
A) Gram stain.
B) direct fluorescent-antibody test.
C) patient’s symptoms.
D) passive agglutination.
E) patient’s death.
31) Which of the following is treated with antibiotics?
A) botulism
B) tetanus
C) streptococcal pneumonia
D) polio
E) All of these diseases can be successfully treated with antibiotics.
32) Which one of the following causes the most severe illness in humans, with a mortality rate of
30 percent?
A) western equine encephalitis
B) eastern equine encephalitis
C) St. Louis encephalitis
D) California encephalitis
E) West Nile encephalitis
33) Which of the following is/are a free-living amoeba that can cause encephalitis?
A) Acanthamoeba
B) Naegleria
C) Entamoeba
D) Naegleria and Acanthamoeba
E) Entamoeba and Naegleria
34) Microscopic examination of cerebrospinal fluid reveals gram-positive rods. What is the
organism?
A) Haemophilus
B) Listeria
C) Naegleria
D) Neisseria
E) Streptococcus
35) On June 30, a 47-year-old man was hospitalized with dizziness, blurred vision, slurred
speech, difficulty swallowing, and nausea. Examination revealed facial paralysis. He reported
eating home-canned green beans and stew containing roast beef and potatoes 24 hours before
onset of symptoms. The patient should be treated with
A) antibiotics.
B) toxin.
C) surgery.
D) vaccination.
E) supportive care, including respiratory assistance.
36) On October 5, a pet store sold a kitten that subsequently died. On October 22, rabies was
diagnosed in the kitten. Between September 19 and October 23, the pet store had sold 34 kittens.
Approximately 1000 people responded to health care providers following local media alerts.
These people were given
A) antibiotics.
B) human diploid cell vaccine.
C) immune globulin injections.
D) antiviral medications.
E) postexposure prophylaxis.
37) Vaccination is available for all the following EXCEPT
A) Haemophilus meningitis.
B) Neisseria meningitis.
C) tetanus.
D) rabies.
E) botulism.
38) Patients with leprosy usually die from complications such as
A) brain damage.
B) loss of nerve function.
C) tuberculosis.
D) pneumonia.
E) cardiac arrest.
39) All of the following are acquired by ingestion EXCEPT
A) botulism.
B) cryptococcosis.
C) listeriosis.
D) poliomyelitis.
E) Creutzfeldt-Jakob disease.
40) A one-year-old boy was listless, irritable, and sleepy. Encapsulated Gram-negative rods were
cultured from his cerebrospinal fluid. His symptoms were caused by
A) Neisseria meningitidis.
B) rabies.
C) Clostridium tetani.
D) Haemophilus influenzae.
E) a prion.
41) Which of the following pairs is mismatched?
A) tetanus – releases potent neurotoxin
B) botulism – stimulates transmission of nerve impulse
C) poliomyelitis – multiplication of virus occurs in throat and small intestine
D) rabies virus – destroys cells of the CNS
E) leprosy – deformation of nose and hands can occur
42) All of the following microorganisms can directly cause meningitis EXCEPT
A) protozoa.
B) virus.
C) fungi.
D) bacteria.
E) mosquitoes.
43) Which of the following vaccines can cause the disease it is designed to prevent?
A) tetanus toxoid vaccine
B) oral polio vaccine
C) inactivated polio vaccine
D) Haemophilus influenzae capsule vaccine
E) meningococcal capsule vaccine
44) All of the following are true of M. leprae EXCEPT
A) it grows best at temperatures below 37°C.
B) it survives ingestion by macrophages.
C) it invades cells of the PNS.
D) it can be cultured in armadillos.
E) it has a very short generation time of approximately twelve hours.
45) All of the following are true of poliomyelitis EXCEPT
A) infection is due to ingestion of contaminated water.
B) initial sites of viral replication are the throat and small intestine.
C) most cases result in muscle paralysis.
D) the majority of cases are asymptomatic.
E) the oral polio vaccine contains attenuated strains of the virus.
46) Which one of the following diseases may cause a polio-like paralysis in older adults?
A) West Nile virus infection
B) cryptococcosis
C) Bell’s palsy
D) chronic fatigue syndrome
47) Which one of the following statements about West Nile virus is FALSE?
A) The disease is maintained in a horse-human-horse cycle.
B) The disease is maintained in a bird-mosquito-bird cycle.
C) Most human cases are subclinical or mild.
D) The disease caused by the virus can sometimes cause a fatal encephalitis.
E) The virus was introduced to the United States in 1999 in the New York City area.
48) Which one of the following diseases causes symptoms in fewer than 1% of infected
individuals, but has a mortality rate in symptomatic patients of about 20%?
A) Eastern equine encephalitis
B) Western equine encephalitis
C) St. Louis encephalitis
D) California encephalitis
E) West Nile virus encephalitis
49) Which one of the following statements on Zika virus is FALSE?
A) It is a member of the Flaviviridae.
B) It is transmitted primarily through the bite of infected Aedes spp. Mosquitoes.
C) It causes temporary and self-resolving facial muscle paralysis.
D) It greatly increases the risks of a fetus developing microcephaly if the mother contracts the
virus while pregnant.
E) The virus was first discovered in 1947 in the Zika forest in Uganda.
50) Which disease listed below, results in symptoms of a drooping eyelid or mouth on one side
of the face, and is caused when a facial muscle nerve becomes inflamed?
A) St. Louis encephalitis
B) Eastern equine encephalitis
C) Bell’s palsy
D) chronic fatigue syndrome
E) bovine spongiform encephalopathy
22.2 True/False Questions
1) CSF contains high levels of complement and circulating antibodies, as well as a patrolling
group of specialized T lymphocytes, to prevent infection of the brain and spinal cord.
2) Bacterial meningitis is much more common than viral meningitis and tends to cause a milder
form of disease.
3) Lifelong immunity is conferred once an individual has had botulism and recovered.
4) Poliomyelitis is caused by a virus and usually leads to paralysis in those affected.
5) If a normal protein typically found on the surface of nervous tissue cells comes into contact
with an abnormally folded protein, it can lead to prion-related disease.
6) The most common host of the virus causing eastern equine encephalitis is horses.
7) The number of leprosy cases in the United States is around 100 reported cases each year.
8) Autopsy of a stillborn fetus reveals the cause of death to be meningitis. Cultures show the
presence of a gram-positive rod. The likely pathogen is Haemophilus influenza.
9) Botulism and tetanus are directly caused by bacterial endospores commonly found in the soil.
10) Cryptococcus neoformans is a gram-negative cocci with a thick capsule.
22.3 Essay Questions
1) There is an antitoxin for botulism. Why, then, is the outcome of botulism often fatal?
2) Discuss the advantages and disadvantages of the Salk and Sabin vaccines.
3) Explain the transmission and etiology of meningococcal meningitis.
4) Describe the challenges produced by prion diseases in herds of animals used for human food
supplies.
5) What is chronic fatigue syndrome, and how is it diagnosed? What are some of the challenges
facing clinicians trying to help CFS patients?