This document provides an overview of central nervous system (CNS) infections, including: 1. CNS infections can be classified by the organ involved (e.g. meningitis, encephalitis) or by pathogen (e.g. bacteria, viruses, fungi). 2. Common causes of acute bacterial meningitis include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Viral meningitis is usually caused by enteroviruses. 3. Chronic CNS infections include tuberculosis (TB), neurosyphilis, fungal infections (e.g. cryptococcosis), and prion diseases (e.g. Cre

1. CNS Infections Dr Kamran Afzal Asst Prof Microbiology

4. Meningitis

5. Meninges

10. Hemophilus influenzae Neisseria meningitidis Streptococcus pneumoniae >1 months to 5 years

11. Mycobacterium tuberculosis >5 years and Adults Streptococcus pneumoniae Neisseria meningitidis Haemophilus influenzae

12. Immunocompromised Patients Enterobacteriaceae Hemophilus influenzae Pseudomonas aeruginosa

13. Post surgical procedures OR Post cranial/spinal trauma Enterobacteriaceae Pseudomonas aeruginosa Staphylococcus aureus Streptococcus pneumoniae Persistant CSF leak Streptococcus pneumoniae

14. Ventriculo - Peritoneal shunt Staphylococcus epidermidis Enterobacteriaceae Diphtheroids

19. Symptoms

20. Symptoms

27. CSF Routine Examination GRAM NEGATIVE COCCI GRAM POSITIVE COCCI GRAM NEGATIVE RODS GRAM POSITIVE RODS GRAM STAIN

28. CSF Evaluation Normal Bacterial Viral TB Cells 0-5 >1000 <1000 <500 Polymorphs 0 Predominate Early +/- increased Lymphocytes 5 Low Predominate Increased Glucose 60-80 Decreased ++ Normal Decreased+ CSF : plasma Glucose ratio 66% <40% Normal < 30% Protein 5-40 Increased+++ +/- Increased Increased+ Culture Negative Positive Negative Positive (MTB)

34. Encephalitis

40. Chronic CNS infections

47. Treatment Disease Dose Duration HIV neg. Amphotericin 0.7MKD +flucytosine 100MKD +fluconazole 400mg/d 2 wk 10 wk Amphotericin 0.7MKD +flucytosine 100MKD 10 wk HIV pos. induction Amphotericin 0.7MKD +flucytosine 100MKD +fluconazole 400mg/d 2 wk 10 wk maintanance Fluconazole 400 mg/d

48. Protozoa Protozoan Disease Toxoplasma gondii Associated with congenital defects and AIDS African Trypanosomes African Sleeping Sickness Plasmodium falciparum Cerebral Malaria Entamoeba histolytica Rare invasion of the brain Acanthamoeba Rare cases

49. Helminths