Chapter 23: Central Nervous System Infections

1. A one-and-a-half-year-old non-vaccinated child presented with signs of meningitis; her

CSF showed pleomorphic gram-negative bacilli. On blood agar, the organisms showed
enhanced growth in the presence of X and V factors. What is the likely organism associated
with this case?
a) M. tuberculosis
b) E. coli
c) B. pertussis
d) H. influenzae

2. A regular swimmer was admitted with diminished vision and neck stiffness. On
examination, she was found to have keratitis and meningitis. She gave a history of using
semisoft contact lenses. Her CSF culture on axenic media showed microbial growth. Which
organism is commonly associated with such a condition?
a) S. pneumoniae
b) M. tuberculosis
c) Acanthamoeba spp.
d) T. gondii

3. A 23-year-old wrestler with a habit of consuming raw milk was admitted with signs of
meningitis for the past three days. His CSF reveals gram-positive bacilli. Which organism is
likely to be associated in this case?
a) M. tuberculosis
b) E. coli
c) L. monocytogenes
d) B. cereus

4. A 56-year-old HIV seropositive patient presented with gradually increasing photophobia

and impaired consciousness with oculo-facial palsy. CSF grew acid-fast bacilli with trehalose
6, 6’-dimycolate. Name the organism associated with this disease.
a) M. avium-intracellulare
b) M. tuberculosis
c) M. kansasii
d) M. scrofulaceum

5. A child with trigeminal neuralgia and vesicular painful ulcer around the mouth was
admitted to the hospital. Her CSF sample inoculated on cell culture showed syncytia
formation and ballooning. What is the likely organism associated with this condition?
a) Adenovirus
b) Herpes virus
c) Cytomegalovirus
d) Varicella zoster virus
6. A 20-year-old presented with projectile vomiting, headache and fever. He was hospitalised
and diagnosed with meningitis. The gram-stain of CSF showed intracellular gram-negative
diplococci. Which organism is responsible for this condition?
a) N. meningitidis
b) E. coli
c) S. pneumoniae
d) Klebsiella spp.

7. Meningococci are:
a) Non-capsulated
c) Gram-positive diplococci
b) Oxidase-negative
d) Gram-negative diplococci

8. Which serogroup of meningococci causes both epidemics and outbreaks?

a) A
b) B
c) W-135
d) Y

9. Which of the following is NOT a virulence determinant in N. meningitidis?

a) Capsule
b) IgA protease
c) Exotoxin
d) Endotoxin

10. One of the important risk factors in meningococcal disease is complement deficiency.
Which complement deficiency favours the disease?
a) C1 deficiency
b) C1 inhibitor deficiency
c) C9 deficiency
d) C5-C8 deficiency

11. Primary agents of pyogenic meningitis include all the following EXCEPT:
a) Streptococcus pneumoniae
b) H. influenzae
c) N. meningitidis
d) Moraxella catarrhalis

12. The selective medium used for meningococci is:

a) Thayer-Martin medium
b) Neomycin blood agar
c) Mannitol salt agar
d) MYPA agar

13. The specimen that is NOT indicated for diagnosis of severe meningococcemia is:
a) Blood
b) Sputum
c) Skin lesions
d) CSF
14. Treatment of meningococcal carriers is by:
a) Penicillin
b) Erythromycin
c) Ciprofloxacin
d) Tetracycline

15. A seven-year-old boy presented to the emergency department with high-grade fever and
headache for two days and a single episode of convulsion and projectile vomiting the
previous day. On examination, he was found to be disoriented, and his neck rigid; Kernig’s
sign was positive. On Gram stain, gram-negative cocci were seen in pairs, most of them
intracellular with plenty of polymorphs. Which organism is suggested by this Gram stain?
a) Neisseria meningitidis
b) Streptococcus pneumoniae
c) H. influenzae
d) Streptococcus pyogenes

16. Which selective medium is used to isolate meningococci from carriers during epidemics?
a) Chocolate agar
b) Cetrimide agar
c) Modified Thayer–Martin medium
d) Mueller Hinton agar

17. Modified Thayer-Martin medium contains:

a) Vancomycin, colistin and nystatin
b) Vancomycin, imipenem and nystatin
c) Erythromycin, colistin and nystatin
d) Erythromycin, colistin and nalidixic acid

18. Which of the following is used in the identification of Streptococcus agalactiae?

a) Bile solubility
b) PYR test
c) CAMP test
d) Inulin fermentation

19. The blood sample from a neonate suffering from fever grew beta-hemolytic colonies on
blood agar. On Gram stain, gram-positive cocci in chains were seen under the microscope.
Cervical swab from the mother also showed the same organism. Which is the likely causative
agent?
a) S. pyogenes
b) S. pneumoniae
c) S. agalactiae
d) S. viridans

20. Which is TRUE about Listeria monocytogenes?

a) Is non-motile at 250C
b) Major virulence factor is capsule
c) Serovars associated with human infections are½2a,1/2b and 4b
d) Infection is transmitted by respiratory droplets
21. Tumbling motility is shown by:
a) S. pneumoniae
b) Legionella pneumophilla
c) Listeria monocytogenes
d) Neisseria meningitidis

22. Which organism shows drumstick appearance on Gram stain?

a) C. perfringens
b) C. botulinum
c) C. septicum
d) C. tetani

23. Which toxin (s) is responsible for pathogenicity of tetanus?

a) Tetanolysin
b) Tetanospasmin
c) Peripherally acting neurotoxin
d) All of the above

24. Tetanospasmin acts by:

a) Inhibition of neurotransmitters such as GABA
b) Blocking the production or release of acetylcholine
c) Degeneration of Nissl bodies
d) Combination of all of the above

25. The method used for isolating C. tetani from mixed cultures is:
a) Filde’s technique
c) Castaneda’s method
b) Deep agar shake
d) Dienes method

26. A 28-year-old male was brought to the hospital with an altered mental status. He soon
progressed to coma and respiratory paralysis. His family members stated that he had
consumed preserved meat the previous day. Smear from the suspected meat showed gram-
positive sporing bacilli. What is the agent likely associated with these symptoms?
a) Enterotoxigenic E. coli
b) Clostridium botulinum
c) Campylobacter jejuni
d) Yersinia enterocolitica

27. All the following bacteria produce neurotoxins EXCEPT:

a) Clostridium perfringens
b) Clostridium botulinum
c) Bacillus cereus
d) Vibrio cholerae
28. The FALSE statement about botulism is:
a) Wound botulism resembles food-borne botulism
b) In infant botulism, spores are ingested and not the pre-formed toxin
c) Type E strains are associated with fish and other seafood
d) All the eight toxins produced by C. botulinum are neurotoxins

29. Which of the following statements correctly describes tetanospasmin?

a) It is a heat-labile and oxygen-labile toxin
b) It is responsible for causing haemolysis on blood agar
c) It is a plasmid-encoded toxin responsible for tetanus
d) It is similar to the toxins produced by C. perfringens, C. novyi and S. pyogenes

30. A 25-year-old man is brought to the emergency department after a road traffic accident in
a state of altered sensorium. He has a contaminated lacerated wound on his legs. His
vaccination status cannot be ascertained. What is the action to be undertaken immediately to
provide him with tetanus prophylaxis?
a) Intramuscular injection of tetanus toxoid
b) Intramuscular injection of tetanus toxoid with antibiotics
c) Intramuscular injection of tetanus toxoid with antitetanus immunoglobulin and antibiotic
d) Subcutaneous injection of tetanus toxoid with antibiotics

31. Which of the following statements is NOT CORRECT regarding the toxin produced by
C. botulinum
a) The toxin is not released during the life of the organism
b) It acts by inhibition of neurotransmitters such as GABA
c) It is produced intracellularly as a non-toxic protoxin or progenitor toxin
d) Toxin production is regulated by the presence of bacteriophages

32. Aseptic meningitis is commonly caused by:

a) Enterovirus
b) Adenovirus
c) Poliovirus
d) Echovirus

33. All the following are members of Enterovirus EXCEPT:

a) Echovirus
b) Coxsackievirus
c) Poliovirus
d) Orf virus

34. Which one of the following is FALSE regarding the oral polio vaccine?
a) Induces only systemic antibody response
b) Protects the individual and the community
c) Induces long-lasting immunity
d) Early administration can prevent an epidemic
35. Degeneration of Nissl bodies is the characteristic feature of:
a) Poliovirus
b) Rabies virus
c) Adenovirus
d) Vaccinia virus

36. The pulse polio programme induces:

a) Active immunity
b) Passive immunity
c) Herd immunity
d) Active and herd immunity

37. Failure of the oral polio vaccine occurs because of all of the following EXCEPT:
a) Interference with other enteroviruses
b) Frequent diarrhea preventing colonisation
c) Intestinal enzymes
d) Immediate breastfeeding after vaccination

38. Sabin polio vaccine stimulates the production of all of the following immunoglobulins
EXCEPT:
a) IgM
b) IgG
c) IgA
d) IgD

39. Which of the following is CORRECT regarding poliovirus?

a) Poliovirus type 3 is responsible for most epidemics of paralytic poliomyelitis
b) In India, poliovirus type 1 commonly causes paralysis
c) Immunity is not type-specific
d) The virus is destroyed by 0.1 ppm chlorine but higher concentrations are required to kill
the virus in sewage water

40. Which statement is NOT true regarding the epidemiology of poliomyelitis?

a) Paralysis is seen in more than 90% of infections
b) Natural infection occurs only in humans as there are no animal reservoirs
c) The virus after entry colonises the nasopharynx and multiplies there
d) Primary viremia occurs when the virus enters the bloodstream from the regional lymph
nodes of the intestine

41. A 5-year-old boy presents with neck stiffness and fever for past 2 days. His CSF is sent to
the laboratory, with the results revealing lymphocytic pleocytosis, normal glucose and
slightly elevated protein. No organisms is seen on Gram stain. The most likely diagnosis in
this patient is:
a) Pyogenic bacterial meningitis
b) Viral meningitis
c) Tubercular meningitis
d) Cannot be ascertained
42. Coxsackieviruses have the characteristic ability to infect:
a) Suckling mice
b) Adult mice
c) Gnotobiotic mice
d) Guinea pigs

43. Coxsackie B viruses are associated with all of the following EXCEPT:
a) Myocarditis
b) Encephalitis
c) Bornholm disease
d) Hand, foot and mouth disease

44. Group A coxsackie virus is associated with all of the following EXCEPT:
a) Bornholm disease
b) Hand, foot and mouth disease
c) Aseptic meningitis
d) Herpangina

45. Orchitis is a complication of which one of the following viral infections?

a) Varicella
b) Herpes
c) Coxsackie
d) Polio

46. Herpangina (vesicular pharyngitis) is caused by:

a) Coxsackie group A
b) Coxsackie group B
c) ECHO virus
d) Poliovirus

47. Which of the following virus is associated with hand, foot and mouth disease?
a) Enterovirus 71
b) Coxsackie virus type 5,10
c) Coxsackie type 23
d) All of the above

48. A 25-year-old man reports to casualty with complaints of being bitten by a stray dog on
the left leg. The dog cannot be traced. On examination, the leg shows lacerations with
multiple bites. The nurse washes the wound with soap and water. What is the immediate
action required in casualty?
a) Take a swab from the wound and send for culture
b) Administer rabies vaccine after proper wound toilet
c) Administer rabies immunoglobulin and vaccine immediately after proper wound toilet
d) Send the patient home

49. The staining technique used for the demonstration of Negri bodies is:
a) Giemsa stain
b) Wright’s stain
c) Field’s stain
d) Seller’s stain
50. Which part of the brain tissue has Negri bodies in abundance?
a) Cerebrum
b) Brainstem
c) Hippocampus
d) Corpus callosum

51. Which vaccines are safe and effective for pre-exposure prophylaxis of rabies?
a) Semple vaccine
b) Beta-propiolactone (BPL)
c) Duck egg vaccine
d) Human diploid cell vaccine (HDC)

52. Post-exposure prophylaxis in rabies is recommended in all of the following cases

EXCEPT:
a) Minor abrasions without bleeding
b) Licks on the intact skin
c) Single, transdermal bite
d) Exposure to bats

53. Which one of the following is FALSE regarding post-exposure prophylaxis of rabies?
a) Five-six doses of the vaccine at 3, 7, 14, 30 and 90 days after exposure
b) The suspected animal needs observation for two days
c) Stop treatment if the animal dies during the observation period
d) Stop treatment if the animal tests rabies-positive in a laboratory

54. All the following statements are TRUE regarding passive immunisation for rabies
EXCEPT:
a) It should be given after one to two days of the first dose of the vaccine
b) Dose of human rabies immune globulin is 20 IU/kg body weight
c) There is risk of anaphylaxis with equine rabies immune globulin
d) Both active and passive immunisation are preferred in high-risk cases

55. Which one of the following is FALSE regarding rabid dogs?

a) Bite without provocation and indiscriminately
b) Usually die after 2 weeks
c) Lie huddled, unable to feed
d) 60% of them shed virus in saliva

56. Which of the following is FALSE regarding Negri bodies?

a) Smears are fixed and stained by Seller’s technique
b) Have round to oval intranuclear bodies
c) Possess basophilic inner granules
d) Measure 3–27 microns
57. All of the following are TRUE with regards to the treatment of an animal bite wound
EXCEPT:
a) Wash the wound thoroughly with soap and water
b) Treat with Cetavlon/tincture iodine
c) Infiltrate with anti-rabies serum
d) Suture the wound immediately

58. All of the following are examples of slow viral diseases EXCEPT:
a) Eastern equine encephalitis
b) Subacute sclerosing panencephalitis (SSPE)
c) Progressive multifocal50eukoencephalopathyy (PML)
d) Subacute spongiform viral encephalopathies

59. Which of the following is NOT true regarding slow virus disease?
a) Course of illness lasts for months or years, with remissions and exacerbations
b) There is predilection for the involvement of the central nervous system
c) The immune response is exaggerated
d) There is a genetic predisposition and the disease usually has a fatal outcome

60. Prions are:

a) Protein-containing particles containing either DNA and RNA
b) Viruses that are easily destroyed by physical and chemical agents such as heat, irradiation
and formalin
c) Particles that can be transmitted to experimental animals by parenteral and oral challenge
d) All of the above

61. The only specific method of diagnosing human prion diseases is:
a) Measuring an abnormal prion protein (PrPsc).
b) CSF examination
c) CT scan
d) None of the above

62. Progressive multifocal leukoencephalopathyy (PML) is caused by:

a) Sindbis virus
b) Lassa virus
c) Polyomavirus
d) West Nile virus

63. Which one of the following is FALSE with regard to prions?

a) They are proteinaceous infectious particles
b) Cause chronic progressive degenerative diseases of the CNS
c) They possess either DNA or RNA
d) Resistant to heat, irradiation and formalin

64. The reservoir host for Japanese encephalitis is:

a) Monkey
b) Bird
c) Rodent
d) Sheep
65. The transmitting vector of Japanese encephalitis is:
a) Tick
b) Mosquito
c) Sandfly
d) Rodent

66. All of the following viruses belong to the genus Alphavirus EXCEPT:
a) O’nyong‘nyong
b) Chikungunya virus
c) Hantavirus
d) Semliki forest virus

67. Japanese encephalitis is transmitted by:

a) Culex tarsalis
b) Culex annulirostris
c) Culex tritaeniorhynchus
d) Aedes aegypti

68. Which statement is NOT TRUE regarding neurocysticercosis?

a) Stool microscopy has no diagnostic role
b) Medical treatment is effective only for parenchymal cysts
c) 60–80% of cases of cysticercosis show neural involvement
d) Meningitis is the most common presenting symptom

69. Primary amoebic encephalitis is caused by:

a) Entamoeba histolytica
b) Entamoeba coli
c) N. fowleri
d) Acantheamoeba castelleni

70. Which of the following is an example of Trojan horses in microbiology?

a) Acanthameba species
b) Entamoeba histolytica
c) Leishmania donovani
d) Trypanosoma cruzi

71. Acanthameba species can cause

a) Parasitic meningitis
b) Primary amoebic encephalitis
c) Amoebic keratitis
d) All of the above

72. Which of the following is true regarding the treatment of CNS infections caused by
free-living amoeba?
a) It can be treated successfully with metronidazole
b) Surgical treatment is often successful
c) The condition is almost fatal
d) All of the above
 73. Which of the following is a NOT a morphological form seen in toxoplasmosis?
a) Tachyzoites
b) Bradyzoites
c) Sporocyst
d) Oocyst

74. Which of the following statements is true regarding toxoplasmosis?

a) The definitive host is cat while the intermediate host is man
b) The definitive host is rodent while cats are the accidental host
c) The definitive host is cat and man is the accidental host
d) The intermediate host is cat while man is the definitive host

75. Avidity testing of IgG against toxoplasmosis is a good indicator to:

a) Differentiate recent from past infections
b) Diagnose past infections
c) Diagnose recent infection
d) Detect only congenital infections

76. The Sabin-Feldman test has been used to diagnose:

a) Toxoplasmosis
b) Leishmaniasis
c) Trypanosomiasis
d) Neurocysticercosis

77. HIV patients should be started on trimethoprim sulphamethoxazole prophylaxis to

prevent toxoplasmosis in:
a) All patients
b) Case of CD4 below 100/μL
c) Case of CD4 below 500/μL
d) Cases with high IgG

78. Which of the following is a diagnostic criterion of toxoplasmosis in a newborn?

a) Detection of IgA at 10 days after birth
b) Detection of IgE and IgM in newborn blood
c) Level of IgG >1,000 mg/dL in neonates
d) All of the above

79. Winterbottom’s sign is seen in:

a) Toxoplasmosis
b) Sleeping sickness
c) Cryptococcosis
d) Histoplasmosis

80. The vector responsible for transmission of African sleeping sickness is:
a) Tsetse fly
b) Culex mosquito
c) Aedes mosquito
d) Rat flea
81. A 38-year-old smoker developed a severe pneumonia-like syndrome and was
hospitalised. In the next two days, he developed meningitis. He was seropositive for HIV and
was on antiretroviral therapy. His CD4 counts were less than 50 per mm3. His CSF sample
was positive for capsular polysaccharide antigen by serology. What is the likely causative
agent?
a) MTB
b) Cryptococcus
c) Pneumococci
d) Candida spp.

82. Fatal fungal meningitis in patients with AIDS is commonly caused by:
a) Cryptococcosis
b) Blastomycosis
c) Sporotrichosis
d) Chromoblastomycosis

83. Encephalitozoon species have been identified as agents causing:

a) Renal failure and pneumonitis in HIV-infected persons
b) Neurological disease only in immunocompetent persons
c) Hemorrhagic fever in HIV-positive patients
d) No infections in humans