Chronic meningitis
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Chronic meningitis is defined as meningitis symptoms lasting 4 or more weeks. It can have various causes including infectious, malignant, or autoimmune etiologies. Common infectious causes are bacterial, mycobacterial, spirochetal, or viral agents. Evaluation involves examination of cerebrospinal fluid and serological testing to identify the specific etiology. Empiric treatment with antitubercular therapy or antivirals may help in cases where an etiology cannot be identified.
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This document discusses fever of unknown origin (FUO). It categorizes FUO into classical, nosocomial, neutropenic, and HIV-associated types. The most common etiologies of FUO are infections (30-60%), collagen vascular diseases (20-35%), and malignancies (10-20%). The diagnostic approach involves a careful history, physical exam, and diagnostic testing including blood tests, imaging, and biopsy. Empirical therapeutic drug trials may be used for suspected conditions like tuberculosis or culture-negative endocarditis, but have limitations and risks. The goal is to reach a specific diagnosis to guide appropriate treatment.
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Approach to acute febrile illness in Tropical regions
1. Acute undifferentiated febrile illness (AUFI) refers to fever without localizing signs for less than 14 days, which is common in tropical regions and can be caused by various infections.
2. A rational approach to evaluating AUFI involves collecting epidemiological information, clinical examination, and sequential laboratory testing to identify the cause.
3. Common etiologies of AUFI in tropical regions include malaria, dengue, enteric fever, leptospirosis, scrub typhus, and rickettsioses. Clinical features and complications can overlap between these illnesses.
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Pyrexia of unknown origin (puo)
1. Pyrexia of unknown origin (PUO) is defined as a fever that persists for at least 3 weeks with an unknown source despite 1 week of inpatient investigations or 3 outpatient visits. (2) Common causes of PUO include infections (especially tuberculosis), malignancies, and collagen vascular diseases.
2. A thorough history, physical exam, and initial laboratory and imaging tests are used to identify potential sources and guide further testing. Additional tests may include lumbar puncture, bone marrow biopsy, liver biopsy, or exploratory laparotomy.
3. When the source remains unknown after extensive evaluation, infectious disease, rheumatology, or oncology consultations may help identify less common causes or guide further
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2. A thorough history, physical exam, and initial laboratory and imaging tests are used to identify potential sources and guide further testing. Additional tests may include lumbar puncture, bone marrow biopsy, liver biopsy, or exploratory laparotomy.
3. When the source remains unknown after extensive evaluation, infectious disease, rheumatology, or oncology consultations may help identify less common causes or guide further
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- 13. CSF ANALYSIS Test Bacterial Viral Fungal Parasitic Opening Pressure Elevated Usually normal Variable Variable White blood cell count >1000 <100 Variable Variable Cell differential PMN Lymphs Lymphs Eosinophilia Protein Mild to Marked Elevation Normal to Elevated Elevated Elevated Glucose Normal to Low Normal Low Low
- 14. CSF ANALYSIS PMN predominate/ Low Glucose Lymph predominate/ Normal Glucose Lymph predominate/ Low Glucose Bacteria -Actinomyces, Listeria, Brucellosis Mumps LCM NSAIDS Sulfa Behcet’s Early Viral Viral CNS Malignancy Endocarditis Early Mycobacterium Early Fungal Mycobacterium Fungi