This document discusses a case of acute meningoencephalitis in a 23-year-old patient from Karnataka with fever, headache, vomiting, and altered mental status. Initial CSF analysis showed lymphocytic predominance, which could indicate viral or partially treated bacterial meningitis. Further investigations including MRI, repeat CSF analysis, and PCR ruled out conditions like tuberculosis, cerebral malaria, and bacterial meningitis. The patient was ultimately diagnosed with viral meningoencephalitis. The document also provides an overview of acute meningitis causes, presentations, diagnostic tests and interpretations.
Meningitis is an inflammation of the meninges that can be caused by bacteria, viruses, fungi or other pathogens. Bacterial meningitis requires urgent treatment and has the highest risk of complications. Common bacterial causes include streptococcus pneumoniae, neisseria meningitidis, and haemophilus influenzae. Viral meningitis is generally milder and self-limiting. Tubercular meningitis has a subacute onset and causes thick basal exudates. Fungal meningitis occurs more often in immunocompromised individuals. Diagnosis involves CSF analysis showing pleocytosis and characteristic findings depending on the cause. Treatment involves antibiotics, antivirals or antitubercular drugs depending on the
This document discusses meningitis, including the anatomy of the meninges and cerebrospinal fluid. It describes different types of meningitis such as septic, chronic, and aseptic meningitis. Common causes and symptoms are provided for each type. The laboratory diagnosis and examination of cerebrospinal fluid samples is explained. Important causative organisms like Neisseria meningitidis and Streptococcus pneumoniae are discussed. Treatment focuses on correcting electrolyte imbalances and managing patients in the intensive care unit.
This document summarizes various neurological complications of HIV/AIDS, including:
- Acute retroviral syndrome occurring in the majority after initial HIV exposure, potentially causing meningitis.
- HIV-associated encephalopathy, the most common HIV-related brain disease, presenting as cognitive and motor slowing.
- Myelopathy, characterized by vacuolar changes in the thoracic spinal cord causing spasticity and sensory symptoms.
- Several types of infections are described like toxoplasmosis, cryptococcus, CMV, and various types of mycobacteria.
- Primary central nervous system lymphoma is an AIDS-defining cancer that can involve the brain, eyes and spinal fluid.
- Neurotoxic
The document discusses meningitis, including:
1. It defines meningitis as inflammation of the meninges covering the brain and spinal cord. Meningitis can be caused by viruses, bacteria, fungi or other microorganisms.
2. It classifies meningitis based on etiology, including bacterial, viral, fungal and parasitic meningitis. The most common bacterial causes are S. pneumoniae, N. meningitidis and H. influenzae.
3. It notes that while viral meningitis is more common, bacterial meningitis requires urgent treatment due to high mortality and morbidity. Prompt diagnosis and treatment are critical for improving prognosis.
The document discusses various neurological complications that can occur in HIV infected individuals. It covers topics like neuropathogenesis of HIV, meningitis (aseptic and cryptococcal), focal brain conditions like cerebral toxoplasmosis, and treatment approaches. Cryptococcal meningitis is described as the most common fungal meningitis in AIDS patients. Clinical features, diagnosis, antifungal therapy, monitoring and management of increased intracranial pressure are discussed for cryptococcal meningitis.
This document provides information on acute encephalitis syndrome, including its definition, epidemiology, etiology, pathogenesis, clinical manifestations, laboratory diagnosis, differential diagnosis, and management. Acute encephalitis syndrome is defined as an acute onset fever with changes in mental status or seizures. It is commonly caused by viruses and can involve inflammation of the brain tissue. Diagnosis involves examination of CSF and imaging studies. Treatment focuses on supportive care and antiviral medications like acyclovir.
Meningitis is an inflammation of the meninges that can be caused by bacteria, viruses, fungi or other pathogens. Bacterial meningitis requires urgent treatment and has the highest risk of complications. Common bacterial causes include streptococcus pneumoniae, neisseria meningitidis, and haemophilus influenzae. Viral meningitis is generally milder and self-limiting. Tubercular meningitis has a subacute onset and causes thick basal exudates. Fungal meningitis occurs more often in immunocompromised individuals. Diagnosis involves CSF analysis showing pleocytosis and characteristic findings depending on the cause. Treatment involves antibiotics, antivirals or antitubercular drugs depending on the
This document discusses meningitis, including the anatomy of the meninges and cerebrospinal fluid. It describes different types of meningitis such as septic, chronic, and aseptic meningitis. Common causes and symptoms are provided for each type. The laboratory diagnosis and examination of cerebrospinal fluid samples is explained. Important causative organisms like Neisseria meningitidis and Streptococcus pneumoniae are discussed. Treatment focuses on correcting electrolyte imbalances and managing patients in the intensive care unit.
This document summarizes various neurological complications of HIV/AIDS, including:
- Acute retroviral syndrome occurring in the majority after initial HIV exposure, potentially causing meningitis.
- HIV-associated encephalopathy, the most common HIV-related brain disease, presenting as cognitive and motor slowing.
- Myelopathy, characterized by vacuolar changes in the thoracic spinal cord causing spasticity and sensory symptoms.
- Several types of infections are described like toxoplasmosis, cryptococcus, CMV, and various types of mycobacteria.
- Primary central nervous system lymphoma is an AIDS-defining cancer that can involve the brain, eyes and spinal fluid.
- Neurotoxic
The document discusses meningitis, including:
1. It defines meningitis as inflammation of the meninges covering the brain and spinal cord. Meningitis can be caused by viruses, bacteria, fungi or other microorganisms.
2. It classifies meningitis based on etiology, including bacterial, viral, fungal and parasitic meningitis. The most common bacterial causes are S. pneumoniae, N. meningitidis and H. influenzae.
3. It notes that while viral meningitis is more common, bacterial meningitis requires urgent treatment due to high mortality and morbidity. Prompt diagnosis and treatment are critical for improving prognosis.
The document discusses various neurological complications that can occur in HIV infected individuals. It covers topics like neuropathogenesis of HIV, meningitis (aseptic and cryptococcal), focal brain conditions like cerebral toxoplasmosis, and treatment approaches. Cryptococcal meningitis is described as the most common fungal meningitis in AIDS patients. Clinical features, diagnosis, antifungal therapy, monitoring and management of increased intracranial pressure are discussed for cryptococcal meningitis.
This document provides information on acute encephalitis syndrome, including its definition, epidemiology, etiology, pathogenesis, clinical manifestations, laboratory diagnosis, differential diagnosis, and management. Acute encephalitis syndrome is defined as an acute onset fever with changes in mental status or seizures. It is commonly caused by viruses and can involve inflammation of the brain tissue. Diagnosis involves examination of CSF and imaging studies. Treatment focuses on supportive care and antiviral medications like acyclovir.
This document provides information on acute bacterial meningitis, including:
- The most common causative organisms are Streptococcus pneumoniae, Neisseria meningitidis, and Group B streptococci.
- Clinical presentation typically includes the classic triad of fever, headache, and nuchal rigidity, along with decreased consciousness.
- Diagnosis involves examination of CSF which shows pleocytosis, low glucose, and high protein. Blood cultures and neuroimaging may also be used.
- Treatment involves prompt empiric administration of antibiotics like ceftriaxone, vancomycin, and dexamethasone, with specific therapy guided by diagnostic testing.
Central nervous system infections can cause fever and signs of neurological dysfunction. The most common types are meningitis (inflammation of the meninges) and encephalitis (inflammation of the brain). Acute bacterial meningitis is commonly caused by Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b. Clinical manifestations include fever, headache, neck stiffness, and altered mental status. Diagnosis involves lumbar puncture and CSF analysis. Treatment involves supportive care, antibiotics, and management of increased intracranial pressure. Complications can include hearing loss, seizures, and intellectual disability. Prevention is through vaccination and chemoprophylaxis of close contacts for certain bacteria.
Central nervous system infections can cause meningitis or encephalitis. Bacterial meningitis is commonly caused by Streptococcus pneumoniae, Neisseria meningitidis, or Haemophilus influenzae type b. It presents with fever, headache, neck stiffness, and altered mental status. Diagnosis involves lumbar puncture showing pleocytosis and low glucose in CSF. Treatment involves antibiotics, corticosteroids, and supportive care to prevent increased intracranial pressure complications.
Tuberculous meningitis is a serious form of tuberculosis infection that affects the membranes surrounding the brain and spinal cord. It is more common in developing countries and in young children. Clinical features progress from vague symptoms to signs of meningeal irritation and eventually cerebral involvement. Diagnosis involves examination of cerebrospinal fluid showing lymphocytic predominance, low glucose and high protein levels. Imaging shows diffuse brain edema, basal cistern enhancement and infarcts. Treatment involves a combination of antitubercular drugs for at least 10 months along with corticosteroids to reduce inflammation and intracranial pressure.
MENINGITIS IN CHILDREN-1.pptx by John wambugu clinical officer paediatricsJohnMainaWambugu
This document provides an overview of meningitis, including its definition, causes, pathogenesis, clinical manifestations, diagnosis, treatment, and prevention. Key points include:
- Meningitis is an inflammation of the meninges that surround the brain and spinal cord. It can be caused by bacterial, viral, or fungal infections.
- Bacterial meningitis requires urgent treatment with antibiotics as it can be fatal if untreated. Common bacterial causes include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b.
- Symptoms may include fever, headache, stiff neck, nausea, confusion, and seizures. Diagnosis involves examination of cerebrospinal fluid
This document discusses meningitis, specifically focusing on bacterial meningitis. It defines meningitis as an inflammation of the membranes covering the brain and spinal cord. The most common causes are bacteria and viruses. Bacterial meningitis requires immediate treatment to prevent complications like brain damage, coma, or death. The document outlines the types, symptoms, diagnostic tests, treatment including antibiotics, and management of bacterial meningitis.
This document provides an overview of meningitis including:
- It is an inflammation of the meninges that can be caused by bacteria, viruses, fungi or tuberculosis. Common bacterial causes are Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae type b.
- An outbreak in Nigeria from 2016-2017 saw over 1,400 suspected cases mostly in children ages 5-14 in certain states. Risk factors include young age, close contacts, crowding and poverty.
- Symptoms can include fever, headache, nausea, and signs of meningeal irritation like neck stiffness. Diagnosis involves CSF and blood tests. Treatment depends on the suspected cause but may include
This document discusses AIDS and its ocular manifestations. It begins with an introduction to AIDS, noting that eye involvement occurs in 90% of autopsy cases and ocular complications are present in 75% of patients with AIDS. It then covers the global prevalence of HIV/AIDS, modes of transmission, pathophysiology involving destruction of CD4+ cells, common signs and symptoms affecting multiple organ systems, diagnosis including CD4+ cell counts and WHO staging, and various ocular manifestations such as CMV retinitis, toxoplasmosis retinochoroiditis, HIV retinopathy, progressive outer retinal necrosis, herpes zoster ophthalmicus, and Kaposi's sarcoma.
Meningitis can be caused by bacterial, viral, fungal or opportunistic infections. Common bacterial causes include streptococcus pneumoniae, neisseria meningitidis and haemophilus influenzae. Viral causes include EBV, HSV, CMV and HIV. Fungal and opportunistic infections like cryptococcosis and tuberculosis are more common in immunocompromised individuals. Clinical presentation includes fever, headache, neck stiffness and altered mental status. Investigations include CSF analysis, blood tests and imaging. Treatment involves antimicrobials targeted against the suspected pathogen. Complications can include seizures, cerebral edema and cognitive impairment.
Central nervous system tuberculosis (CNS TB) is a severe form of TB infection that can affect the brain and spinal cord. It is most common in children under 5 years old. Left untreated, CNS TB has an almost 100% fatality rate and can cause permanent neurological damage even with treatment. Diagnosis involves examination of cerebrospinal fluid which shows increased white blood cells and protein with low glucose. Brain imaging also helps with diagnosis. Treatment requires a multi-drug regimen administered over 9-12 months. Adjunctive steroids are also often used to reduce inflammation and complications. Even with treatment, CNS TB has poor outcomes with only one third of patients fully recovering neurologically.
Fever with Fits 22.1.2016 (to print), update.pptxKyawMyoHtet10
This document discusses various causes of fever with fits in children including febrile convulsions, central nervous system infections like meningitis, encephalitis, brain abscess, and cerebral malaria. It provides details on the clinical presentation, investigations, and management of these conditions. Common causes of meningitis in children are discussed along with signs of meningism on examination. Diagnosis of meningitis involves lumbar puncture and analysis of cerebrospinal fluid. Tuberculous meningitis has distinct cerebrospinal fluid findings and requires prolonged antibiotic treatment. Viral encephalitis is usually self-limiting and treatment focuses on controlling symptoms. Brain abscesses require imaging studies for diagnosis and may necessitate
Intracranial infection diagnosis and managementShaheer Anwar
This document discusses the diagnosis and management of various types of intracranial infections. It covers topics such as acute bacterial meningitis, viral meningitis, tuberculous meningitis, post-neurosurgical procedure meningitis, post-cranial trauma meningitis, brain abscesses, and more. For each topic, it discusses causes, clinical presentation, diagnosis, and treatment approaches. The goal is to provide an overview of different intracranial infections and guidelines for clinicians on evaluating and managing these conditions.
This case presentation discusses a 24-year-old female patient admitted with complaints of fever, altered sensorium, headache, and body pains. Examination found increased white blood cell count in cerebrospinal fluid analysis consistent with viral meningitis. The patient was treated with acyclovir and other supportive medications and showed improvement over time. The document then reviews causes, presentation, diagnostic testing, and treatment approaches for viral and bacterial meningitis.
Meningitis is a severe CNS pathology and early and appropriate intervention is needed to prevent adverse outcome including mortality and long term complications. This presentation focuses on the different types of meningitis and the appropriate management options
This document provides an overview of meningitis and encephalitis. It discusses the different types of bacterial, viral and fungal meningitis including their causes, symptoms, diagnosis and treatment. Key points include that bacterial meningitis can be caused by organisms like pneumococcus, meningococcus and haemophilus influenza. Viral meningitis causes aseptic meningitis while encephalitis involves brain inflammation. Diagnosis involves lumbar puncture and CSF analysis. Treatment depends on the identified organism and may involve antibiotics, antivirals or antifungals.
This document outlines a case study and provides information on meningitis and encephalitis, including their definitions, causes, clinical presentations, investigations, management, and complications. It discusses the classic triad seen in bacterial meningitis and notes that altered mental status is more common in bacterial versus viral meningitis. The top 5 causes of bacterial meningitis are mentioned. Diagnostic tests, treatment including the role of steroids and prophylaxis, and potential radiological findings are summarized. Encephalitis is also defined and its causes, presentations, and investigations are briefly covered.
Meningitis is an inflammation of the meninges, which are the protective membranes that cover the brain and spinal cord. Bacteria can reach the meninges through the bloodstream, direct contact from a site of infection like the sinuses or ears, or iatrogenically through procedures like lumbar puncture. Symptoms include fever, headache, neck stiffness, and altered mental status. Diagnosis involves analyzing cerebrospinal fluid obtained via lumbar puncture for signs of infection like increased white blood cells. The most common causes of bacterial meningitis are Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
This document provides information on acute bacterial meningitis, including:
- The most common causative organisms are Streptococcus pneumoniae, Neisseria meningitidis, and Group B streptococci.
- Clinical presentation typically includes the classic triad of fever, headache, and nuchal rigidity, along with decreased consciousness.
- Diagnosis involves examination of CSF which shows pleocytosis, low glucose, and high protein. Blood cultures and neuroimaging may also be used.
- Treatment involves prompt empiric administration of antibiotics like ceftriaxone, vancomycin, and dexamethasone, with specific therapy guided by diagnostic testing.
Central nervous system infections can cause fever and signs of neurological dysfunction. The most common types are meningitis (inflammation of the meninges) and encephalitis (inflammation of the brain). Acute bacterial meningitis is commonly caused by Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b. Clinical manifestations include fever, headache, neck stiffness, and altered mental status. Diagnosis involves lumbar puncture and CSF analysis. Treatment involves supportive care, antibiotics, and management of increased intracranial pressure. Complications can include hearing loss, seizures, and intellectual disability. Prevention is through vaccination and chemoprophylaxis of close contacts for certain bacteria.
Central nervous system infections can cause meningitis or encephalitis. Bacterial meningitis is commonly caused by Streptococcus pneumoniae, Neisseria meningitidis, or Haemophilus influenzae type b. It presents with fever, headache, neck stiffness, and altered mental status. Diagnosis involves lumbar puncture showing pleocytosis and low glucose in CSF. Treatment involves antibiotics, corticosteroids, and supportive care to prevent increased intracranial pressure complications.
Tuberculous meningitis is a serious form of tuberculosis infection that affects the membranes surrounding the brain and spinal cord. It is more common in developing countries and in young children. Clinical features progress from vague symptoms to signs of meningeal irritation and eventually cerebral involvement. Diagnosis involves examination of cerebrospinal fluid showing lymphocytic predominance, low glucose and high protein levels. Imaging shows diffuse brain edema, basal cistern enhancement and infarcts. Treatment involves a combination of antitubercular drugs for at least 10 months along with corticosteroids to reduce inflammation and intracranial pressure.
MENINGITIS IN CHILDREN-1.pptx by John wambugu clinical officer paediatricsJohnMainaWambugu
This document provides an overview of meningitis, including its definition, causes, pathogenesis, clinical manifestations, diagnosis, treatment, and prevention. Key points include:
- Meningitis is an inflammation of the meninges that surround the brain and spinal cord. It can be caused by bacterial, viral, or fungal infections.
- Bacterial meningitis requires urgent treatment with antibiotics as it can be fatal if untreated. Common bacterial causes include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b.
- Symptoms may include fever, headache, stiff neck, nausea, confusion, and seizures. Diagnosis involves examination of cerebrospinal fluid
This document discusses meningitis, specifically focusing on bacterial meningitis. It defines meningitis as an inflammation of the membranes covering the brain and spinal cord. The most common causes are bacteria and viruses. Bacterial meningitis requires immediate treatment to prevent complications like brain damage, coma, or death. The document outlines the types, symptoms, diagnostic tests, treatment including antibiotics, and management of bacterial meningitis.
This document provides an overview of meningitis including:
- It is an inflammation of the meninges that can be caused by bacteria, viruses, fungi or tuberculosis. Common bacterial causes are Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae type b.
- An outbreak in Nigeria from 2016-2017 saw over 1,400 suspected cases mostly in children ages 5-14 in certain states. Risk factors include young age, close contacts, crowding and poverty.
- Symptoms can include fever, headache, nausea, and signs of meningeal irritation like neck stiffness. Diagnosis involves CSF and blood tests. Treatment depends on the suspected cause but may include
This document discusses AIDS and its ocular manifestations. It begins with an introduction to AIDS, noting that eye involvement occurs in 90% of autopsy cases and ocular complications are present in 75% of patients with AIDS. It then covers the global prevalence of HIV/AIDS, modes of transmission, pathophysiology involving destruction of CD4+ cells, common signs and symptoms affecting multiple organ systems, diagnosis including CD4+ cell counts and WHO staging, and various ocular manifestations such as CMV retinitis, toxoplasmosis retinochoroiditis, HIV retinopathy, progressive outer retinal necrosis, herpes zoster ophthalmicus, and Kaposi's sarcoma.
Meningitis can be caused by bacterial, viral, fungal or opportunistic infections. Common bacterial causes include streptococcus pneumoniae, neisseria meningitidis and haemophilus influenzae. Viral causes include EBV, HSV, CMV and HIV. Fungal and opportunistic infections like cryptococcosis and tuberculosis are more common in immunocompromised individuals. Clinical presentation includes fever, headache, neck stiffness and altered mental status. Investigations include CSF analysis, blood tests and imaging. Treatment involves antimicrobials targeted against the suspected pathogen. Complications can include seizures, cerebral edema and cognitive impairment.
Central nervous system tuberculosis (CNS TB) is a severe form of TB infection that can affect the brain and spinal cord. It is most common in children under 5 years old. Left untreated, CNS TB has an almost 100% fatality rate and can cause permanent neurological damage even with treatment. Diagnosis involves examination of cerebrospinal fluid which shows increased white blood cells and protein with low glucose. Brain imaging also helps with diagnosis. Treatment requires a multi-drug regimen administered over 9-12 months. Adjunctive steroids are also often used to reduce inflammation and complications. Even with treatment, CNS TB has poor outcomes with only one third of patients fully recovering neurologically.
Fever with Fits 22.1.2016 (to print), update.pptxKyawMyoHtet10
This document discusses various causes of fever with fits in children including febrile convulsions, central nervous system infections like meningitis, encephalitis, brain abscess, and cerebral malaria. It provides details on the clinical presentation, investigations, and management of these conditions. Common causes of meningitis in children are discussed along with signs of meningism on examination. Diagnosis of meningitis involves lumbar puncture and analysis of cerebrospinal fluid. Tuberculous meningitis has distinct cerebrospinal fluid findings and requires prolonged antibiotic treatment. Viral encephalitis is usually self-limiting and treatment focuses on controlling symptoms. Brain abscesses require imaging studies for diagnosis and may necessitate
Intracranial infection diagnosis and managementShaheer Anwar
This document discusses the diagnosis and management of various types of intracranial infections. It covers topics such as acute bacterial meningitis, viral meningitis, tuberculous meningitis, post-neurosurgical procedure meningitis, post-cranial trauma meningitis, brain abscesses, and more. For each topic, it discusses causes, clinical presentation, diagnosis, and treatment approaches. The goal is to provide an overview of different intracranial infections and guidelines for clinicians on evaluating and managing these conditions.
This case presentation discusses a 24-year-old female patient admitted with complaints of fever, altered sensorium, headache, and body pains. Examination found increased white blood cell count in cerebrospinal fluid analysis consistent with viral meningitis. The patient was treated with acyclovir and other supportive medications and showed improvement over time. The document then reviews causes, presentation, diagnostic testing, and treatment approaches for viral and bacterial meningitis.
Meningitis is a severe CNS pathology and early and appropriate intervention is needed to prevent adverse outcome including mortality and long term complications. This presentation focuses on the different types of meningitis and the appropriate management options
This document provides an overview of meningitis and encephalitis. It discusses the different types of bacterial, viral and fungal meningitis including their causes, symptoms, diagnosis and treatment. Key points include that bacterial meningitis can be caused by organisms like pneumococcus, meningococcus and haemophilus influenza. Viral meningitis causes aseptic meningitis while encephalitis involves brain inflammation. Diagnosis involves lumbar puncture and CSF analysis. Treatment depends on the identified organism and may involve antibiotics, antivirals or antifungals.
This document outlines a case study and provides information on meningitis and encephalitis, including their definitions, causes, clinical presentations, investigations, management, and complications. It discusses the classic triad seen in bacterial meningitis and notes that altered mental status is more common in bacterial versus viral meningitis. The top 5 causes of bacterial meningitis are mentioned. Diagnostic tests, treatment including the role of steroids and prophylaxis, and potential radiological findings are summarized. Encephalitis is also defined and its causes, presentations, and investigations are briefly covered.
Meningitis is an inflammation of the meninges, which are the protective membranes that cover the brain and spinal cord. Bacteria can reach the meninges through the bloodstream, direct contact from a site of infection like the sinuses or ears, or iatrogenically through procedures like lumbar puncture. Symptoms include fever, headache, neck stiffness, and altered mental status. Diagnosis involves analyzing cerebrospinal fluid obtained via lumbar puncture for signs of infection like increased white blood cells. The most common causes of bacterial meningitis are Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
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).
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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.
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
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. Bed side clinical approach to meningitis case scenarios
1.brief introduction
3.Typcal cases
4.Atypical cases
5.Take home message
15.2.2023 white army
3. Introduction
• Infections of the nervous system are a global problem.
• Once infection is suspected it is an emergency as time is brain in all situations.
• Suspicion by a physician who has examined and assessed the patient sincerely is the indication to initiate
treatment based on the prevalence pattern in that region.
• CNS infections can be meningitis , Encephalitis, abscess, subdural empyema ,ventriculitis etc .
• Noso comial infections are complications of surgical & other interventions procedures .
• Head injury related infections
• They leave sequelae usually and therefore reducing morbidity and mortality is dependent on timely initiation
of appropriate therapy
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4. What is meningitis ?
• Lepto-meningitis when the inflamed structure is Pia & Arachnoid,
pachymeningitis if it is Dura.
• IgA proteases, compliment regulatory proteins, capsular
polysaccharides help organisms to attach to nasopharyngeal
epithelium & later cross BBB.
• CNS has low immunoglobulins and compliment mediated host
defences.
• Injury happens due to endo and exotoxins, proinflammatory
cytokines, vascular invasion, and abscess formation.
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5. Acute meningitis
• Meningitis
• Fever
• Headache
• Altered sensorium
• Neck stiffness
• Encephalitis
• Seizures
• Focal deficits
Only upto 40%
patients have all
these features
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6. Bacterial meningitis: clinical features
• Clinical features develop over 24-48 hrs
• Triad – fever, altered mental state and neck stiffness (44%) .
• Symptoms
• Fever (75–95%)
• Headache (80–95%)
• Photophobia (30–50%)
• Vomiting (90% of children; 10% of adults)
• Signs
• Neck stiffness (50–90%) ; absent in comatose pts
• Confusion (75–85%)
• Kernig’s sign (5%)
• Brudzinski’s signs (5%)
• Focal neurological deficit (20–30%)
• Seizures (15–30%)
• Rash (10–15%)
15.2.2023 white army
7. Repeat CSF after 24 to 48 hours
Viral
• Lymphocytes
• < 1000 cells
• CRP not inreased
• CSF lactate < 35 mg
• Proinflammatory cytokines not increased
• CSF protein < than 250 mg
• Sugar decreases < 3.7 %
Bacterial
• Poly morphs
• > 1000 cells
• CRP increased
• CSF lactate > 35 mg
• Proinflammatory cytokines increased
• CSF protein > than 35 mg
• Sugar decreases > 95 %
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8. CNS Infections
15.2.2023 white army
Bacterial Spirocheate
HIV -
Related
Parasitic
Fungal
Viral
Tuberculosis
Pneumococcal
Meningococcal
Hemophilus
Listeria
Nosocomial
Abscess
Empyema
Treponema
Borrelia
Leptospira
Herpes Virus
Arbovirus
Rabies
Measles
HIV
Japanese
Encephalitis
Cryptococcus
Aspergillus
Mucor
Candida
Histoplasma
Toxoplasma
Cysticercosis
Echinococcosis
Amoebiasis
Malaria
HIV
encephalopathy
PCNSL
PML
CMV encephalitis
IRIS
9. Broad classification of meningitis
• 1. Acute pyogenic meningitis
• 2. Acute lymphocytic meningitis
• 3. Chronic progressive meningitis
• 4. Chronic recurrent meningitis
• 5. Iatrogenic meningitis
• 6. Non microbial meningitis
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10. Case history-1
• A 23 year old person from Karnataka
• Fever & Head ache: 5 days.
• Admitted in a local hospital & treated with injections
• Vomiting: 2 days
• Irrelevant talk,
• and restlessness
2 days
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11. Case history
• Investigation 1:
• Blood: TLC: 10500/cmm: DC: Polys- 65%, lymph: 35%
• ESR: 45mm/1st hour
• CSF:
TC: 80 cells/cmm, Polys:32%, Lymph: 68%
Protein: 60mg/dL.,
Sugar : 46 mg% against a blood sugar of 102 mg%(normal CSF has
60 to 70%of blood sugar)
Gram stain: negative.
Culture: result: awaited
• CT Scan: Normal;
• X-ray chest: Normal
• Serum HIV test: negative
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12. Lumbar puncture before or after imaging? Beware of these
situations
Clinical risk factors for herniation Imaging risk factors
Stupor or coma Lateral shift of cerebral midline structures
Dilated or fixed pupils Loss of suprachiasmatic and basilar cisterns
Fixed deviation of eyes or absent
oculocephalic reflex
Obliteration or shift of the fourth ventricle
Papilledema Obliteration of the superior cerebellar and
quadrigeminal plate cisterns
Recent seizures Masses in the cerebral hemisphere or
cerebellum
Decorticate or decerebrate posturing Infarction or occlusion of the superior
sagittal sinus or draining veins
Hemiparesis
Hypertension with bradycardia
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13. Case history based diagnosis
• Level 1:
• Viral meningoencephalitis
• Patient was put on Inj.Acyclovir ? The spectrum of acyclovir ?
• Level 2:
• Possibility of partially treated pyogenic meningitis:
• Put on Inj.Ceftriaxine & ampicillin
• Level 3:
• Possibility of acute presentation of TBM
• In addition to viral encephalitis & bacterial meningitis
• ?? Cerebral malaria
• Advised:
• MRI Scan, EEG ,
• repeat CSF for TB-PCR, PCR for HSE
• Z-N stain for mycobacteria.
• Peripheral smear for MP
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14. Investigations2:
• EEG: Diffuse slowing in theta to delta
range. NO PLEDS
• MRI: Patient could not afford.
• Repeat CSF:
• Traumatic.
• RBC: 16000/cmm; (CSF cells =every 500 RBC 1 WBC)
• WBC: 64 cells, Polys: 28%, Lymphs: 72%
• Protein : 80mg/dL.
• Sugar: 56mg%
• CSF for HSV-PCR & TB-PCR: Negative
• AFB-smear- negative
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15. Grand rounds
• In acute meningitis time is brain
: Treated elsewhere, with antibiotics; partially treated pyogenic meningitis possible
• .Neurologist discussion.
• Rarely TBM can have acute presentation.
• In 15% of cases CSF sugar can be normal.
• CSF protein may only be mildly elevated in early phase of illness
• Higher the hierarchy more the uncertainty – current case most likely Viral
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16. Acute meningoencephalitis
• How to diagnose viral encephalitis?
• Can bacterial meningitis mimic viral meningo -
encephalitis?
• Can previous antibiotic treatment affect CSF
interpretation?
• How to differentiate viral encephalitis from partially
treated bacterial meningitis.?
• If CSF becomes traumatic, how to interpret the CSF
findings?
• How to rule out TBM in such cases?
• When to suspect and fungal and syphilitic meningitis &
how to rule out these conditions
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17. Laboratory investigations in acute bacterial
meningitis
• Blood:(The3 Cs)
• Culture
• Cell count
• C-reactive protein (CRP)
• Cerebrospinal fluid (CSF)
• Opening pressure (always raised in ABM)
• Appearance
• Cell count
• Glucose and the ratio of blood glucose
• (obtained before lumbar puncture)
• Protein
• Gram stain, culture
• Optional: lactate, ferritin, LDH
• Others: CIE, RIA, LPA ,ELISA, PCR
• Body fluid culture
• Petechial fluid, sputum, secretions from oro-pharynx, nose and ear
WBC reduces by 32 % in 1 hr and
50% by 2hrs.
Never refrigerate
Organisms die if transit time is
more than few minutes.
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19. Some clues 1
• Meningococcal meningitis is suspected when there is rapid evolution
of symptoms with delirium , stupor , purpuric rash , ecchymosis
patches and lividity of the skin esp lower limbs. There can be
associated circulatory shock described as Waterhouse Friderichsen
syndrome.
• Rashes can be also seen in ECHO viruses and Staph aureus infection
• Pneumococcal meningitis is usually associated with upper and lower
respiratory infection or artificial heart valves , splenectomy, auto
splenoctomy conditions like Sickle cell anaemia and alcoholism.
• It can produce cranial nerve palsy like TBM.
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20. Some clues 2
• Influenzas meningitis is seen in children following ENT or upper respiratory infection.it
can produce seizures.
• H.influenza and Pneumococcus can produce focal deficits due to sub dural effusion.
• If furunculosis ,coagulase positive Staphylococcus is suspected .
• patients with Ventriculo atrial shunts are prone for Coagulase negative Staphylococcus
infection.
• Rare infections are common in immune compromised patients like HIV or non HIV
related immunosuppression.
• Adams RD, Kubik CS, Bonner FJ : The clinical and pathological aspects of influenza
meningitis. Arch Pediatr 65:354, 1948. [PMID 18883966]
•
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21. Clues in CSF
• Clear CSF in only 2% of ABM but 57% of TBM.
• In bacterial meningitis, WBC count > 1,000 per mm3 (87%), > 100 per mm3 (99%)
• < 100 WBCs per mm3 is more common in patients with viral meningitis
• Beware
• Lower counts in children, immunocompromised
• Can be acellular CSF in pneumococcal & meningococcal meningitis
• > 10 % of bacterial meningitis - lymphocytic predominance, early in
the clinical course and when < 1,000 WBCs per mm3
• Early stages of tubercular or fungal meningitis and few viral meningitis
can have a neutrophilic pleocytosis
• Partial treatment effect. Does not alter Total WBC count,CSF protein
,CSF glucose,but culture and polymorphs can change
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22. CSF Proteins & sugar
• Proteins
• Values <220 mg/dl – strong predictor with respect to viral meningitis
(Spanos et al.,1989).
• In bacterial meningitis usually 100-500 mg/dl
• sugar
• Acute bacterial meningitis <40mg/dl most often
• CSF: Blood glucose ratio <0.23 high predictive value (Spanos et al.,
1989)
• Can be normal in 24 - 50% of patients with bacterial meningitis
(Geisler et al., 1980, Dougherty et al., 1986)
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23. Gram stain & culture
• “All patients evaluated for suspected meningitis should undergo a
Gram stain examination of CSF”. (Class A-III, Practice guideline for bacterial
meningitis, Clin Infect Dis 2004)
• Sensitivity - 90 % S.pneumoniae, 86% H.influenza, N.meningitides 75%, gram-
negative bacilli 50% and <50% Listeria (Greenlee, 1990)
• CSF culture
• 70-90% in non-treated cases of bacterial meningitis
• <50% after administration of antibiotics
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24. Bacterial meningitis : extended tests
• Newer tests
• Latex agglutination test – sensitivity 70-100% for S.pneumoniae, 60-100% for
H.influenzae and 33-70% for N.meningitidis; Specificity – 95-100%
• IDSA (infectious disease society of America)practice guideline does not recommend
routine use (Class D-II); may be most useful who has received pre-treatment and
other tests are negative (Class B-III)
• Limulus amoebocyte lysate – gram-negative meningitis, Sensitivity approaching
100%; Specificity 85-100% (Class D-II)
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25. • PCR for simultaneous detection of N.meningitidis, H.influenzae, and
streptococcii in 304 clinical CSF sample - sensitivity 94% & specificity 96%
• A broad-range PCR can detect small numbers of viable and nonviable organisms
in CSF
• Who have been pretreated with oral or parenteral antibiotics
• In whom Gram’s stain and CSF culture are negative
• “may be useful for excluding the diagnosis of bacterial meningitis, with the potential for
influencing decisions to initiate or discontinue antimicrobial therapy” ( Class B-II IDSA
Practice guideline 2004).
Bacterial meningitis : extended tests
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26. • Other techniques
• Bacterial genomes
• Broad range rRNA PCR
• Nucleic acid hybridization and Restriction fragment length polymorphism
• Serological markers
• Lactate
• C-Reactive protein
• Procalcitonin
• Cytokines
• Rapid culture method
Bacterial meningitis. extended tests
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27. • Procalcitonin
• 59 consecutive children sensitivity Serum procalcitonin concentration (using a cut off
of 15.0mcg/L) - 94%,and the specificity-100%.
• In adults, serum concentrations 10.2ng/mL had a sensitivity and specificity of upto
100%
• According to a metanalysis CRP
• For diagnosing ABM sensitivity that ranged from 69% to 99% and a specificity ranged
from 28% to 99%
• In Gram stain negative bacterial meningitis - sensitivity 96%, specificity - 93%, and a
negative predictive value - 99%
Bacterial meningitis : extended tests
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28. Lab tests helpful in special and difficult situations to diagnose or exclude
Bacterial meningitis
• CSF Lactate
• Not recommended for community acquired bacterial meningitis (Class D-III)
• Superior to CSF:Blood glucose ratio in post-op neurosurgical patients.
>4.0mmol/L suggestive of bacterial meningitis (Class B-II recommendation)
• CRP
• A normal CRP has a high negative predictive value (Class B-II
recommendation)
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29. EFNS(European federation of neurological societies)
guidelines - 2008
• Three other helpful and indirect diagnostic markers of ABM
• (a) elevated serum C reactive protein (quantified) in children
(sensitivity:96%,specificity:93%,negative predictive value:99%);
• (b) increased CSF lactate (sensitivity:86–90%,specificity:55–98%, positive predictive
value:19–96%,negative predictive value:94–98%)
• (c) high CSF ferritin (sensitivity:92–96%, specificity:81–100%)
• Bacterial antigen detection- LPA, ELISA, counter-immuno
electrophoresis, co-agglutination - sensitivity: 60–90%, specificity: 90-
100%, predictive positive value: 60–85%, predictive negative value: 80–95%
• Currently available PCR methods – sensitivity 87–100%,and specificity 98–
100%.
• Fluorescence in situ hybridization (FISH) less sensitive but may be
useful for identification of bacteria in CSF samples in some cases.
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30. Ventricular CSF Vs Lumbar CSF
• Normally – gradient of rising cell count and protein and falling glucose from
ventricle to lumbar
• In ABM – gradient for cell count and protein but not for glucose; no
difference in differential count
• Cell count & protein normal in 12% of pts with ABM
• But all three were normal in 0-5%
• Has a higher yield for bacterial culture
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Lateral shift of cerebral midline structures indicating unequal supratentorial intracranialpressure◆Loss of suprachiasmatic and basilar cisterns indicating the supratentorial pressure is greaterthan infratentorial; the lateral ventricles may be either large or small◆Obliteration or shift of the fourth ventricle indicating increased posterior fossa pressure◆Obliteration of the superior cerebellar and quadrigeminal plate cisterns with sparing of theambient cisterns indicating upward cerebellar transtentorial herniation◆Masses in the cerebral hemisphere or cerebellum◆Infarction or occlusion of the superior sagittal sinus or draining veins