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NERVOUS SYSTEM          INFECTIONS             MENINGITISAcute infection of the meninges presentswith the characteristic c...
CAUSES OF MENINGITIS         Infective  BacteriaViruses: Enteroviruse,Mumps,          Influenza Herpes simplex   Protozoa ...
Fever,Headache,Nuchal rigidity           Altered mental status          Yes                          NoEncephalitis,ADEM,A...
Bacterial causes of meningitis•Age of onset       •Common            •Less common• Neonate           •G-negative        •L...
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                        st...
CHEMOTHERAPY OF BACTERIAL          MENINGGITISN-meningitidis        BenzylpenicillinStrep.pneumoniae       CefotaximeSensi...
Treatment of pyogenicmeningitis            unknown cause of1-patients with a typical meningococcal rash  Benzylpenicillin ...
Recommendations for Empirical        antimicrobial therapy in adult with        community-acquired meningitisPredisposing ...
Chemoprophylaxis for meningococcal           infectionDose it reduce the incidence of clinical disease  among contact?Obse...
COMPLICATIONSOF MININGOCOCCAL SEPTICEMIA• Menigitis• Rash• Shock• Intravascular coagulation• Renal failure• Gangrene• Arth...
Major intracranial complications in   Bacterial meningitis in adult-----------------------------------------1-Transtentori...
CLINICAL FEATURES OF TB MENINGITIS• Vomiting         • Depression• Low-grade        • Confusion  fever            • Behavi...
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...
Differential diagnosisBacterial menigitis:           Mycoplasma,lasteria,brucellaParameningeal infectionPartially treated ...
Chronic & recurrent meningitisCharacteristic neurological syndrome for>4weeks                       &Persistent inflammati...
Symptoms & signs of chronic                   meningitis Symptom                        SignChronic headache        Sign o...
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medicine.Cns infections 2.(dr.muhamad tahir)

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Transcript of "medicine.Cns infections 2.(dr.muhamad tahir)"

  1. 1. NERVOUS SYSTEM INFECTIONS MENINGITISAcute infection of the meninges presentswith the characteristic combination: pyrexia Headache Meningism
  2. 2. CAUSES OF MENINGITIS Infective BacteriaViruses: Enteroviruse,Mumps, Influenza Herpes simplex Protozoa & parasites:Toxoplasma Amoeba Fungi:Cryptococcus neoformans,
  3. 3. Fever,Headache,Nuchal rigidity Altered mental status Yes NoEncephalitis,ADEM,Abscess Meningitis Brain imaging CSF Imaging,CT or MRI. CSF
  4. 4. 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
  5. 5. NeonateG-negative bacilli Group B streptococci
  6. 6. Pre-school child Haemophillus ifluenza Neisseria meningitidis Streptococcus pneumonia
  7. 7. Older child adult & Neisseria Streptococcus Listeriameningitidis pneumoniae monocytogenes
  8. 8. 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
  9. 9. CHEMOTHERAPY OF BACTERIAL MENINGGITISN-meningitidis BenzylpenicillinStrep.pneumoniae CefotaximeSensitive to B-lactams CeftriaxoneResistant +VancomycinH.Influenzae Cefotaxime Ceftriaxone
  10. 10. 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
  11. 11. 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
  12. 12. 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.
  13. 13. COMPLICATIONSOF MININGOCOCCAL SEPTICEMIA• Menigitis• Rash• Shock• Intravascular coagulation• Renal failure• Gangrene• Arthritis• Pericarditis
  14. 14. Major intracranial complications in Bacterial meningitis in adult-----------------------------------------1-Transtentorial herniation2-Hydrocephalus3-Infarction4-Seizures
  15. 15. CLINICAL FEATURES OF TB MENINGITIS• Vomiting • Depression• Low-grade • Confusion fever • Behavior• lassitude changes
  16. 16. Signs Meningism (may be absent) Ocular palsies Papilloedema Depression of conscious level Focal hemispher signs
  17. 17. Viruses causing acute encephalitisCommonArbovirusesEnterovirsusesHSVLess commonCMVEBVHIVMumps
  18. 18. Viruses causing acute meningitis Enterviruses =75-90Echo 30% Coxsa-A 10% Coxsac-B 40%Mumpsvirus 15%
  19. 19. 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
  20. 20. Differential diagnosisBacterial menigitis: Mycoplasma,lasteria,brucellaParameningeal infectionPartially treated bacterial meningitisTb,fungal, parasitic, Syphilitic diseaseNeoplastic meningitisSarcoid, Behcets disease
  21. 21. 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
  22. 22. 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
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