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medicine.Cns infections 2.(dr.muhamad tahir)
 

medicine.Cns infections 2.(dr.muhamad tahir)

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    medicine.Cns infections 2.(dr.muhamad tahir) medicine.Cns infections 2.(dr.muhamad tahir) Presentation Transcript

    • NERVOUS SYSTEM INFECTIONS MENINGITISAcute infection of the meninges presentswith the characteristic combination: pyrexia Headache Meningism
    • CAUSES OF MENINGITIS Infective BacteriaViruses: Enteroviruse,Mumps, Influenza Herpes simplex Protozoa & parasites:Toxoplasma Amoeba Fungi:Cryptococcus neoformans,
    • Fever,Headache,Nuchal rigidity Altered mental status Yes NoEncephalitis,ADEM,Abscess Meningitis Brain imaging CSF Imaging,CT or MRI. CSF
    • Bacterial causes of meningitis•Age of onset •Common •Less common• Neonate •G-negative •Listeria bacillia,Group B monocytogenes •streptococci•Pre-school child •H-influenzae •Mycobacterium •N-meningitidis •tuberculosis •St-pneumonia•Older child •N-Meningitidis •L –m,T.B,Crypto
    • NeonateG-negative bacilli Group B streptococci
    • Pre-school child Haemophillus ifluenza Neisseria meningitidis Streptococcus pneumonia
    • Older child adult & Neisseria Streptococcus Listeriameningitidis pneumoniae monocytogenes
    • CSF INDICES IN MENINGITISConditi CELl CELL Glucose protein -Gon Type Count stainNormal Lymp 0-4 Normal - >60% B-GViral Lymp 10-2000 normal - normalBacteri Poly 1000 Low /N +al 5000 IncreaseTB L/P,M 50-5000 Low Increase often
    • CHEMOTHERAPY OF BACTERIAL MENINGGITISN-meningitidis BenzylpenicillinStrep.pneumoniae CefotaximeSensitive to B-lactams CeftriaxoneResistant +VancomycinH.Influenzae Cefotaxime Ceftriaxone
    • Treatment of pyogenicmeningitis unknown cause of1-patients with a typical meningococcal rash Benzylpenicillin 2.4 gIV.6-hourly2-Adult aged 18-50 years without meningococcal rash Cefotaxime 2 g IV.6-hourly Ceftriaxone 2g IV.12-hourly3-Patient in whome pencillin-resistant pneumococcal infection is suspected As 2 but add-Vancomycin 1g Iv,12-hourly or Rifampicin 600 mg IV.12-hourly4-Adult aged over 50 years and those in whome Listeria monocytogees infection is suspected As for 2 but add Ampicillin 2g IV.4-jourly or Co-trimoxazole5-Patients with a clear history of anaphylaxis to B-lactams Chloramphenicol 25 mg/kg IV.6-hourly plus Vancomycin 1g IV.12-hourly
    • Recommendations for Empirical antimicrobial therapy in adult with community-acquired meningitisPredisposing factor pathogen Drugs16-50 yr N-St-pn Vancomycin + 3rd cephalosporin>50 yrٍ St-pn, N, List Van+3rd Ceph+ AmpicillinPresence of a risk St-pn, list, Van+3rd ceph+ H-infuenzae Ampicillinwww.NEJM.ORG ,N ENGL ,Jan-2006
    • Chemoprophylaxis for meningococcal infectionDose it reduce the incidence of clinical disease among contact?Observational data suggest that antibiotic reduce the risk of diseaseIn adults a single dose of 500 mg ciprofloxacin or oral rifampicin 600mg(12-hourly) for 2 days.Vaccines for groups A&C but not B menigococci.
    • COMPLICATIONSOF MININGOCOCCAL SEPTICEMIA• Menigitis• Rash• Shock• Intravascular coagulation• Renal failure• Gangrene• Arthritis• Pericarditis
    • Major intracranial complications in Bacterial meningitis in adult-----------------------------------------1-Transtentorial herniation2-Hydrocephalus3-Infarction4-Seizures
    • CLINICAL FEATURES OF TB MENINGITIS• Vomiting • Depression• Low-grade • Confusion fever • Behavior• lassitude changes
    • Signs Meningism (may be absent) Ocular palsies Papilloedema Depression of conscious level Focal hemispher signs
    • Viruses causing acute encephalitisCommonArbovirusesEnterovirsusesHSVLess commonCMVEBVHIVMumps
    • Viruses causing acute meningitis Enterviruses =75-90Echo 30% Coxsa-A 10% Coxsac-B 40%Mumpsvirus 15%
    • Practical points• The typical profile is lymphocytic pleocytosis(25-500 cells/uL.)• A normal or slightly elevated protein• A normal glucose concentration.• PMN pleocytosis should always promt an alternative diagnosis• In both enterovirus &HSV,PCR is the diagnostic procedure of choice
    • Differential diagnosisBacterial menigitis: Mycoplasma,lasteria,brucellaParameningeal infectionPartially treated bacterial meningitisTb,fungal, parasitic, Syphilitic diseaseNeoplastic meningitisSarcoid, Behcets disease
    • Chronic & recurrent meningitisCharacteristic neurological syndrome for>4weeks &Persistent inflammation in CSF (WBC>5/Ul)Causes:1-Meningeal infection 2-Malignancy 3-Noninfectious inflammatory disorder 4-Chemical meningitis 5-Parameningeal infections
    • Symptoms & signs of chronic meningitis Symptom SignChronic headache Sign of Meningeal irritationChange in personality Altered mental statusFacial weakness Crainal nerve palsyDouble visions Papilledema,optic atrophyWeakness Myelopathy,radiculopathySensory symptoms Frontal lobe dysfunctionSphincter dysfunction Ataxia