This document discusses acute CNS infections such as acute pyogenic meningitis, meningoencephalitis, and tuberculous meningitis (TBM). It covers the etiology, pathogenesis, clinical features, diagnosis, and treatment of these conditions. Common causes of acute pyogenic meningitis in children include Group B streptococcus, pneumococcus, meningococcus, and HIB. Meningoencephalitis can be caused by enteroviruses, arboviruses, or herpes viruses. TBM most often affects children ages 6 months to 4 years and has distinct prodromal, abrupt, and coma stages. Lumbar puncture and CSF analysis are important for diagnosing these infections
2. • What is it?
• What causes it?
• What happens in the system?
• How to recognize it?
• How to prove it?
• How to treat it?
• How to prevent?
3. Significance
• Significant morbidity & mortality in
children [1.2m cases worldwide]
• Diagnosis, challenging in young children
• High incidence of sequalae
4. • Fever with altered sensorium
• Virus > bacteria > fungi & parasite
• Meningitis
• Meningoencephalitis
• Brain abscess
• Common symptoms
photophobia,neckpain/rigidity,stupor,fits
• Diagnosis by CSF
8. Reasons for infection
• Less immunity
• Contact with people with invasive disease
• Occult bacteremia [infants]
• Immunodeficiency
• Splenic dysfunction
• CSF leak ,Meningomyelocele
• CSF shunt infection
9. Risk of infection
• Pneumococci
OM, sinusitis, pneumonia, CSF rhinorrhea.
• Meningococci
contact with adults, nasopharyngeal carriage
• HIB
Contact in daycare centre
36. Prognosis
• Mortality >10% [more in pneumococci]
• Prognosis poor in
– Infants
– Fits >4days
– Coma, FND on presentation
• Neurological sequalae 20%
– Behavior changes 50%
– Deafness [pneumo,HIB],visual loss
– MR,fits,
37. Prevention
• Meningococci
– Rifampacin for close contacts [10mg/kg/day q12h for
2days]
– Quadrivalent vaccine for high risk children
• HIB
– Rifampacin for contacts for 4days
– Conjugate vaccine
• Pneumococci
– Heptavalent conjugate vaccine
38. TBM
• Subacute / ?chronic meningitis
• From lymphohematogenous dissemination
• Caseous lesion in cortex / meninges
• Discharge of TB bacilli in CSF
• Thick exudate infiltrate blood vessels
• Inflammation,obstruction,infarct.