• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
medicine.Cns infections 2.(dr.muhamad tahir)

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






Total Views
Views on SlideShare
Embed Views



0 Embeds 0

No embeds



Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
Post Comment
Edit your comment

    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