Your SlideShare is downloading. ×
Cns infections
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Introducing the official SlideShare app

Stunning, full-screen experience for iPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Cns infections

225
views

Published on

Published in: Health & Medicine

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
225
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
35
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. CNS INFECTIONSCNS INFECTIONS PROF. DR. SHAHENAZ M. HUSSEINPROF. DR. SHAHENAZ M. HUSSEIN
  • 2. OBJECTIVES By the end of this lecture you will be able to understand the followings: • Etiology, clinical manifestations, investigations, and treatment of acute bacterial meningitis. • Etiology, clinical manifestations, laboratory findings, diagnosis and management of encephalitis. • Slide and video demonstration of some neurological manifestations.
  • 3. Acute Bacterial MeningitisAcute Bacterial Meningitis Etiology: First 2 months of life: Group B Streptococcus, gram negative bacilli, S. pneumoniae, Neisseria meningitides, Haemophilus influenzae type b. and L. monocytogenes. Children 2 mo-12yr of age 1- S. pneumoniae 2- N. meningitides Alterations of host defense: Pseudomonas aeruginosa, Staphylococcus aureus, Salmonella spp., and L. monocytogenes. Mode of infection: Bacterial meningitis most commonly results from hematogenous dissemination of microorganisms from a distant site of infection. Etiology: First 2 months of life: Group B Streptococcus, gram negative bacilli, S. pneumoniae, Neisseria meningitides, Haemophilus influenzae type b. and L. monocytogenes. Children 2 mo-12yr of age 1- S. pneumoniae 2- N. meningitides Alterations of host defense: Pseudomonas aeruginosa, Staphylococcus aureus, Salmonella spp., and L. monocytogenes. Mode of infection: Bacterial meningitis most commonly results from hematogenous dissemination of microorganisms from a distant site of infection.
  • 4. Clinical Manifestations: The onset of acute bacterial meningitis has two predominant patterns: 1- The more dramatic less common presentation is sudden onset with rapidly progressive manifestations of shock, purpura, DIC, unconsciousness, and frequently resulting in death within 24 hours. 2- More often, meningitis: is preceded by several days of fever with upper respiratory or GIT symptoms followed by nonspecific signs of CNS infection such as lethargy or irritability. Non specific findings: Fever, anorexia, poor feeding, myalgia, arthralgia, tachycardia, hypotension, and petechiae,or an erythematous macular rash.
  • 5. Untitled7.WMV
  • 6. Untitled12.WMV
  • 7. Signs of meningeal irritation: • Nuchal rigidity and back pain • Kernig’s sign: flexion of the hip 90 degrees with subsequent pain and limitation with extension of the leg. • Brudzinski sign: involuntary flexion of the knees and hips after passive flexion of the neck while the patient in supine position. Symptoms and Signs of increased ICP: 1- Headache, and vomiting 2- Bulging fontanel or widening of the sutures 3- Cranial nerve neuropathies. 4- Hypertension with bradycardia 5- Apnea or hyperventilation, stupor and coma. Signs of meningeal irritation: • Nuchal rigidity and back pain • Kernig’s sign: flexion of the hip 90 degrees with subsequent pain and limitation with extension of the leg. • Brudzinski sign: involuntary flexion of the knees and hips after passive flexion of the neck while the patient in supine position. Symptoms and Signs of increased ICP: 1- Headache, and vomiting 2- Bulging fontanel or widening of the sutures 3- Cranial nerve neuropathies. 4- Hypertension with bradycardia 5- Apnea or hyperventilation, stupor and coma.
  • 8. Untitled15.WMV
  • 9. Untitled16.WMV
  • 10. Seizures (focal or generalized) due to, cerebritis, infarction or electrolyte disturbances. Seizures that occur on presentation or within the first 4 days of onset are usually of no prognostic significance. Diagnosis: Lumbar puncture for CSF analysis should be performed: 1- Microorganisms on gram stain and culture. 2- Neutrophil pleocytosis (300-2000/mm3 ). 3- Elevated protein (100-500mg/dL) 4- Reduced glucose concentration (<50% of S. glucose) 5- Physical appearance:Turbid with elevated pressure (100-300 mm H2O). Normal CSF shows: Normal pressure (50-80 mm H2O), leucocytes (<5/mm3 ), proteins (20-45 mg/dl) and glucose (75% of the level of serum glucose). Seizures (focal or generalized) due to, cerebritis, infarction or electrolyte disturbances. Seizures that occur on presentation or within the first 4 days of onset are usually of no prognostic significance. Diagnosis: Lumbar puncture for CSF analysis should be performed: 1- Microorganisms on gram stain and culture. 2- Neutrophil pleocytosis (300-2000/mm3 ). 3- Elevated protein (100-500mg/dL) 4- Reduced glucose concentration (<50% of S. glucose) 5- Physical appearance:Turbid with elevated pressure (100-300 mm H2O). Normal CSF shows: Normal pressure (50-80 mm H2O), leucocytes (<5/mm3 ), proteins (20-45 mg/dl) and glucose (75% of the level of serum glucose).
  • 11. COMPLICATIONS • Deafness • Hydrocephalus • Brain abscess • Subdural effusion • Motor disabilities
  • 12. Treatment: 1- Initial Antibiotic Therapy: -Ampicillin 200mg/kg with either cefotaxime or ceftriaxone100mg/kg, if gram-ve bacilli present give Ampicillin with Gentamycin for neonatal meningitis. -Vancomycin 60mg/kg/24hr given every 6 hr in combination With either cefotaxime (200mg/kg/24hr given every 6 hours) or ceftriaxone (100mg/kg/24hr once or twice daily) in older infants and children. -Patients allergic to β- Lactam antibiotics can be treated with chloramphenicol, 100mg/kg/d, given every 6 hr. Duration of therapy: At least for 7-14 days I.V. -Corticosteroids: I.V dexamethasone 0.15 mg/kg/dose given every 6hr for 2 days for children older than 6wk with acute bacterial meningitis caused by H. influenzae type b to decrease the permanent auditory nerve damage.
  • 13. 2-Supportive and symptomatic therapy: A-Good evaluation and monitoring are essential. B-Correction of dehydration and electrolyte disturbances and proper nutrition. C-Control of seizures D- Management of neurological complications Prevention: - Vaccination and antibiotic prophylaxis for susceptible at –risk contacts. Close contact should be treated with Rifampin 10mg/kg/dose every 12hr, for 2 days (in N. meningitides) and 20mg/kg/day for 4 days in H. influenzae type b. 2-Supportive and symptomatic therapy: A-Good evaluation and monitoring are essential. B-Correction of dehydration and electrolyte disturbances and proper nutrition. C-Control of seizures D- Management of neurological complications Prevention: - Vaccination and antibiotic prophylaxis for susceptible at –risk contacts. Close contact should be treated with Rifampin 10mg/kg/dose every 12hr, for 2 days (in N. meningitides) and 20mg/kg/day for 4 days in H. influenzae type b.
  • 14. ENCEPHALITIS Definition: Infection involving cerebral parenchyma, in some patients the meninges involved with the parenchyma causing meningoencephalitis. Etiology: 1- Arthropod born virus: Arbovirus; Flavivirus: -St. Louis encephalitis. Birds (culex mosquitoes).West-Nile virus. - Western equine encephalitis.Birds (Colisata mosquitoes). - Eastern equine encephalitis. Birds ( Culisata mosquitoes). - Venezuelan equine encephalitis. Hoarses ( 10 species mosquitoes). - California encephalitis (Bunya virus). Chipmunks (Aedes mosquitoes). - Clorado tick fever (Wood tick). ENCEPHALITIS Definition: Infection involving cerebral parenchyma, in some patients the meninges involved with the parenchyma causing meningoencephalitis. Etiology: 1- Arthropod born virus: Arbovirus; Flavivirus: -St. Louis encephalitis. Birds (culex mosquitoes).West-Nile virus. - Western equine encephalitis.Birds (Colisata mosquitoes). - Eastern equine encephalitis. Birds ( Culisata mosquitoes). - Venezuelan equine encephalitis. Hoarses ( 10 species mosquitoes). - California encephalitis (Bunya virus). Chipmunks (Aedes mosquitoes). - Clorado tick fever (Wood tick).
  • 15. Etiology: continue 2-Herpes simplex virus. 3- Varicella or vaccine. 4- Measles or vaccine 5-Influenza . 6- Poliomyelitis. 7- Congenital infections: Cytomegalovirus, Rubella. 8-HIV 9-Rabies 10-Rubella 11-E.B.V. 12-Mycoplasma pneumonia
  • 16. Untitled13.WMV
  • 17. Clinical manifestations: - Duration of illness: 2-5 days ----------up 3 weeks. - Abrupt onset of fever, chills, headache, nausia, vomiting. - Generalized weakness, seizures, coma, ataxia, cranial nerve palsies. - Meningeal signs in some cases; (Meningoencephalitis). Laboratory findings: - Lymphocytosis in blood picture. - CSF: 100-500 WBCs/ul pleocytosis (lymphocytes). - Serology: Specific antibodies( IgM) in the 1st week. - PCR for viral antigens. - Neuroimaging CT or MRI for brain. - EEG for temporal lobe lesion of herpes simplex. - Brain biopsy for undiagnosed cases. Clinical manifestations: - Duration of illness: 2-5 days ----------up 3 weeks. - Abrupt onset of fever, chills, headache, nausia, vomiting. - Generalized weakness, seizures, coma, ataxia, cranial nerve palsies. - Meningeal signs in some cases; (Meningoencephalitis). Laboratory findings: - Lymphocytosis in blood picture. - CSF: 100-500 WBCs/ul pleocytosis (lymphocytes). - Serology: Specific antibodies( IgM) in the 1st week. - PCR for viral antigens. - Neuroimaging CT or MRI for brain. - EEG for temporal lobe lesion of herpes simplex. - Brain biopsy for undiagnosed cases.
  • 18. Complications: *Acute disseminated encephalomyelitis ADEM usually follow measles or varicella diseases or vacination. *Mortality is variable according to the type of encephalitis 2- 5% in St. Louis and 20% in Venezuelan equine. And 50% in Eastern equine. *Neurological sequelea ranging from 1% to more than 50% in Eastern equine encephalitis. Therapy: Supportive except in Herpes Simplex;and varicella-zoster infections, Acyclovir is used.