This document discusses meningitis and brain abscess. It defines meningitis as inflammation of the meninges due to infection, which can be caused by bacteria, viruses, fungi or protozoa. Common bacterial causes include Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae type b. Symptoms vary depending on age but include fever, headache, neck stiffness, vomiting, and confusion. Treatment involves antibiotics, steroids, and supportive care. Brain abscesses are usually secondary to infections elsewhere, like sinusitis or otitis media. Common causative agents are streptococci, staphylococci, and anaerobic bacteria. Diagnosis involves imaging and treatment
Parvovirus B-19 in Pregnancy Parvovirus is a member of the family Parvoviridae. The virus contains a single-stranded DNA. It can only infect humans. 50% of all adults have been infected sometime during childhood or adolescence.
Parvovirus B-19 in Pregnancy Epidemiology Congenital infection rates vary depending on the prevalence in the community. Approximately 50 to 75% of adult women are immune. 20% to 30% of susceptible adults in school settings will become infected. Day-care workers have a 20% to 50% risk of seroconversion. The risk of infection among susceptible adults following household exposure to an infected person is approximately 50%.
congenital cytomegalovirus infection is a major problem in children. severe morbidity also in some cases mortality can occur due to this infection. this presentation has highlighted updates on this topic in short.
Parvovirus B-19 in Pregnancy Parvovirus is a member of the family Parvoviridae. The virus contains a single-stranded DNA. It can only infect humans. 50% of all adults have been infected sometime during childhood or adolescence.
Parvovirus B-19 in Pregnancy Epidemiology Congenital infection rates vary depending on the prevalence in the community. Approximately 50 to 75% of adult women are immune. 20% to 30% of susceptible adults in school settings will become infected. Day-care workers have a 20% to 50% risk of seroconversion. The risk of infection among susceptible adults following household exposure to an infected person is approximately 50%.
congenital cytomegalovirus infection is a major problem in children. severe morbidity also in some cases mortality can occur due to this infection. this presentation has highlighted updates on this topic in short.
An infection of the central nervous system can be a life-threatening condition, especially for children with weakened immune systems. These infections need ...
Infections and salivary gland disease in pediatric age: how to manage - Slide...WAidid
The slideset by Professor Susanna Esposito aims at explaining how to manage the salivary gland infections in pediatric age, from pathogenesis, to transmission, treatments and vaccination coverage, that should be urgently increased in Italy as well as in EU Countries.
Central nervous system (CNS) infections are extremely serious group of diseases.
The cerebral cortex and spinal cord are confined within the restricted boundaries of the skull and bony spinal canal.
Infection, inflammation and oedema therefore have serious consequences, often leading to tissue infarction that in turn results in permanent neurologic damage or death.
Therefor, early diagnosis and prompt treatment is very important
Pediatrics notes about "Tuberculosis". These notes were published in 2018.
You can download them also from
- Telegram: https://t.me/pediatric_notes_2018
- Mediafire: http://www.mediafire.com/folder/u5u60m184t9z7/Pediatric_Notes_2018
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Meningitis and brain abscess
1. Meningitis and Brain Abscess
1
SG5®
Definition of meningitis: Inflammation of the meninges due to infection
Causes of meningitis:
1) Bacteria (more severe)
2) Viruses
-Mild
-Enteroviruses and Mumps (common)
3) Fungi (very occasionally) – Cryptococcus neoformans meningitis in
immunocompromised patients
4) Protozoa – Toxoplasma gondii (also causing brain abscess and encephalitis)
Route of infection:
1) Haematogenous
2) Direct (particularly from an open skull fracture or from paranasal sinuses and middle
ear infection)
3) Iatrogenic (from lumbar puncture procedure)
Symptoms:
Infant and young child (<5y/o) – non
specific symptoms
i. Low grade fever
ii. Vomiting
iii. Reluctance to feed
iv. Irritability
v. Rash (purpural or petechial)
Older child and adult
i. Fever
ii. Vomiting
iii. Headache
iv. Neck stiffness
v. Photophobia
vi. Confusion
vii. Rash (purpural or petechial)
2. Meningitis and Brain Abscess
2
SG5®
Risk factors:
i. Splenectomy – infection with Haemophilus influenza type b
ii. Diabetes Mellitus – infection with S. pneumoniae
iii. Alcoholism – infection with S. pneumoniae
iv. Immunosuppressed – infection with Listeria monocytogenes
v. Fractured skull- infection with S. pneumoniae
vi. Inherited defects in late complement components – infection with Neisseria
meningitidis
vii. Pregnant woman – infection with Neisseria meningitidis
A. BACTERIAL MENINGITIS
Most common in infants and young child
Pattern of infection:
i. Colonisation
ii. Carriers
iii. Invasive
iv. Post-infection sequelae – post-infectious autoimmune disease and CNS
abscess
Causative agents depends on geography and age-related differences
TYPICAL pathogens:
All ages
i. N.meningitidis
ii. S.pneumoniae
iii. H.influenzae type b, in
pre-school child who are
not vaccinated
Neonate
i. Group B strep
ii. E.coli and aerobic GNB
iii. Listeria monotcytogenes
Teenagers and children
i. N.meningitidis
Elderly
i. S.pneumoniae
Immunocompromised
i. Listeria monocytogenes
WORLDWIDE!!
A. Neisseria Meningitidis
B. Streptococcus pneumoniae
3. Meningitis and Brain Abscess
3
SG5®
Investigations:
a) Clinical – assess vaccine Hx + symptoms and signs of meningitis
b) Lab (sample: blood , CSF and rash)
i. Blood
-Culture
-PCR
-EDTA blood sample for peripheral WCC
-Blood sugar level (to compare with CSF sugar level; normal CSF sugar is
>60% of blood sugar!!!)
ii. CSF
-Physical appearance of fluid, i.e color! Bacterial infection: turbid or cloudy
fluid and NORMAL fluid is colourless
-Microscopy: Gram stain, cell count and differential
-Culture
-PCR for N.meningitidis, S. pneumonia, Haemophilus influenza
-Biochemistry: glucose and protein level (high in meningitis!)
iii. Rash
-Microscopy: presence of INTRACELLULAR gram –ve diplococcic will
confirm a diagnosis of meningococaemia (BSI of meningococcus)
-Sample of skin rash is indicated IF lumbar puncture is contraindicated, i.e
in RIP patient
iv. Nasopharyngeal swab will indicate colonisation not diagnostic of infection
v. Antigen detection for N.meningtidis, S.pneumoniae, Hib, E.coli and group
B strep
Mx of bacterial meningitis:
1) Airway: ventilation may be required if patient is interrupted
2) Intensive care: organ support IF bloodstream infection is indicated
3) Steroids: administer before antibiotic or with first dose antibiotic to
reduce inflammation
-Hib meningitis: steroids reduce overall mortality
-Pneumococcal meningitis: steroids may reduce mortality in adults
-TB meningitis: steroids is used to reduce fibrosis and risk of
hydrocephalus
-Meningococcal meningitis: NO DATA!
4) Antibiotics: empirical and quickly (before blood or CSF cultures)
-Empirical:
0-3mths: ampicillin + cefotaxime +gentamicin
>3 mths: cefotaxime +/- vancomycin
-Definitive:
Strep pneumoniae: cefotaxime + vancomycin IF penicillin
resistant
N.meningitidis: benzyl penicillin
TB: RIPE initially
5) Fluid: Fluid resuscitation for shock patient and fluid restriction for RIP
4. Meningitis and Brain Abscess
4
SG5®
Prevention of meningitis: by chemoprophylaxis
-Rifampicin oral (first choice) and alternatives: ceftriaxone IM or
ciprofloxacin oral
I. Invasive meningococcal meningitis: close contacts of index case
II. Invasive Hib meningitis: close contacts IF there is an at-risk child
(<48mths @ <2y/o) in the contact network
III. Invasive pneumococcal meningitis: NO PROPHYLAXIS
By immunisation:
I. Hib vaccine for infants
II. MenC vaccine added for infant routine immunisation
III. Pneumococcal vaccine for at-risk groups (CSF leak, skull fracture,
elderly)
IV. No vaccines for neonatal bacterial meningitis (Listeria
monocytogenes, E.coli, Group B strep)
Complications of bacterial meningitis:
I. Subdural abscess
II. Ventriculitis
III. Cranial nerve palsies especially the 6th
IV. Secondary vasculitis
V. Hydrocephalus (due to obstructed CSF drainage)
VI. Intellectual handicap
VII. RIP
VIII. Cerebral oedema
IX. Seizure and blindness
X. Herniation!
5. Meningitis and Brain Abscess
5
SG5®
Type of
Bacterial
Meningitis
Listeria monocytogenes Leptospira canicola
or Leptospira
icterhaemorrhagica
(Weil’s disease)
TB
Zoonosis Zoonosis TB meningitis usually secondary
haematogenous spread from a
focus elsewhere and the onset is
stealthy
In infants, the onset may be
acute
May occur during primary
haematogenous spread (miliary
TB) in infancy in particular
Route of
transmission
I. Ingestion of contaminated
meat, vegetables or dairy
products
II. Direct contact with infected
animals
I. Direct contact
with skin
openings such
as wounds
and mucous
membranes
I. Inhalation
Individuals at
risk?
I. Foetus
II. Neonate
III. Pregnant women
IV. Elderly
V. Immunocompromised
(due to neoplasia, high
steroids, transplant)
VI. Occupational Xposure
I. Farmer
II. Water
sports
Clues for diagnosis
-Jaundice
-Conjunctival
injection
I. Immigrants from areas
with TB endemic (Africa)
II. Child with malnutrition
III. Immunocompromised
IV. Non-vaccinated with BCG
V. Fever for mths or wks
Tx Ampicilin + gentamicin (resistant
to cephalosporin)
Benzyl penicillin RIPE tx
Investigation CSF with high
lymphocytes;
consider CSF if
renal/ hepatic
failure and
meningism
CSF clear
CSF with high protein and low
glucose and high lymhocytes
A fibrin clot may occur after a
short time of standing
ZN/Auramine stain and culture
Biopsy of meninges
--------------------------------------------------------------------------------------------------------------------------------------
6. Meningitis and Brain Abscess
6
SG5®
B. BRAIN ABSCESS
a) Clinical presentations: (can also be seen in encephalitis, meningitis, head trauma, stroke,
tumour)
i. Headache
ii. Seizure
iii. Nausea and vomiting
iv. Altered mental status
b) Sites:
i. Frontal lobe
ii. Temporal lobe
iii. Parietal lobe
c) Pathogenesis:
i. Secondary to a focus elsewhere
Sinusitis
Otitis media
Penetrating head wound
Fractured skull
Post-op surgical sepsis
Metastatic spread; S.aureus BSI with endocarditis
IV drug use
Immunosuppresion
DM
d) Causative agents:
i. Bacterial
Strep + anaerobes (commonest!!), polymicrobial
Streptococcus (Str. Milleri or Str. Anginosus) 35%
Staphylococcus (including MRSA) 20%
Aerobic GN bacilli (E.coli) 23%
Anaerobes (Bacteroides spp) 14%
ii. Fungal
Aspergillus (in immunocompromised patients, eg neutropenia)
iii. Protozoa
Toxoplasma gondii (in poorly controlled HIV infection)
e) Investigations:
i. Clinical:
-Signs and symptoms of underlying condition (eg sinusitis)
-Signs of RIP
ii. Imaging:
-CT
-MRI
f) Tx:
i. Craniotomy
ii. Burr hole aspiration + antibiotics (>2 types) , eg cefotaxime + metronidazole +
flucloxacillin
LESS COMMON