CNS

INFECTIONS

INFECTION-SITE
Parenchyma: encephalitis
Meninges: meningitis
Both of parenchyma and meninges :
meningoencephalitis

INFECTIONS PATHWAY
Infection through circulation

Direct infection : trauma ,otitis media, sinusitis

Meningitis

Three organisms responsible for acute

meningitis in childhood or adult life

Meningococcus

Haemophilus influenza
Pneumococcus

THE PATIENT WITH ACUTE CNS

INFECTION
Overall Goals in Management

To promptly recognize the patient with an acute CNS

infection syndrome
To rapidly initiate appropriate empiric therapy
To rapidly and specifically identify the etiologic agent,
adjusting therapies as indicated
To optimize management of complicating features

APPROACH TO THE PATIENT WITH

SUSPECTED MENINGITIS
Clinical Assessment
Historical/physical exam clues
Clinical status of the patient
Integrity of host defenses

TO LP OR NOT TO LP
Single most important diagnostic test
Mandatory, especially if bacterial meningitis suspected
If LP contraindicated, obtain BCs (+ in 50-60%), then
begin empirical Rx

Contraindications to LP
Skin infection over site
Papilledema
focal neurological signs
GCS
Bleeding diathesis

CSF STUDIES
Color/Clarity
Cell counts/WBC dif
Chemistries (protein, glucose)
Stains/Smears (Gram)
Cultures (routine)
+/- Antigen screens

CSF SMEARS & STAINS

GmS + in 60-90% of pts with untreated bacterial
meningitis
With prior ATB Rx, positivity of GmS decreases to 4060%
REMEMBER: + GmS = Heavy organism burden & worse
prognosis

CSF ANTIGEN SCREENS

Bacterial antigen screens detect S. pneumoniae, N.
meningitidis, Hib; + in 50-100% of pts (esp. useful in pts
with prior ATB Rx)

CEREBROSPINAL FLUID PROFILES

Neutrophilic/Low glucose (purulent)
Lymphocytic/Normal glucose
Lymphocytic/Low glucose

THE THERAPY OF MENINGITIS

Desirable Antimicrobic Properties
Good Difusion
Penicillins
3rd& 4th Gen Cephs

Poor Difusion
Early Gen Cephs

Chloramphenicol

Clindamycin

Rifampin

Tetracyclines

AMGs

Macrolides

Role of Steroids
The addition of anti-inflammatory agents has been
attempted as an adjuvant in the treatment of meningitis
Early administration of corticosteroids resulted in
reduction in the incidence of severe neurologic
complications and deafness and reduce the mortality

Encephalitis
It is inflammation of the brain parenchyma
Commonly caused byviruses

Clinical manifestation
Mental symptom
Convulsion
Disturbance of consciousness
Focal symptom:
Meningeal irritation

Investigation
EEG
CT or MRI
CSF
1) antigen
2) antibody
3) HSV DNA

Treatment
Empiric therapy with acyclovir should be started
immediately
Stander Rx course is IV acyclovir 10mg/kg Q8h in adults
Duration 14-21 days

THANK
YOU