Central Nervous System Infections

2016 ◽  
Author(s):  
Nicholas J. Johnson ◽  
David F. Gaieski
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Bacterial Meningitis ◽  
Lumbar Puncture ◽  
Clinical Manifestations ◽  
Empirical Therapy ◽  
Cns Infection ◽  
Cns Infections ◽  
Associated Conditions

Infections of the central nervous system (CNS) are among the most devastating diseases that present to the emergency department (ED). Because of the great potential for morbidity, as well as the importance of prompt treatment, emergency physicians must remain vigilant of these diseases, which are also fraught with diagnostic challenges. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of CNS infections. Figures show causes of viral meningitis, an algorithm for the initial evaluation and management of patients with a suspected CNS infection, clinical manifestations of community-acquired meningitis in patients 16 years of age and older, assessment of nuchal rigidity, Kernig sign, and Brudzinski sign for meningeal irritation, proper positioning of the patient for lumbar puncture, and a sagittal view of the lumbar puncture needle as it is advanced into the subarachnoid space. Tables list CNS pathogens based on predisposing and associated conditions, cerebrospinal fluid diagnostic studies for meningitis, adult patients who should receive computed tomography prior to lumbar puncture, classic cerebrospinal fluid characteristics in meningitis, empirical therapy for bacterial meningitis based on predisposing and associated conditions, recommended doses for antibiotics commonly used in the treatment of bacterial meningitis, and antimicrobial therapy for selected CNS infections.   This review contains 8 highly rendered figures, 7 tables, and 94 references

scholarly journals When Ventricular Cerebrospinal Fluid Assessment Misleads: Basal Meningitis and the Importance of Lumbar Puncture Sampling

2019 ◽  
Vol 6 (7) ◽  
Author(s):  
Sadid F Khan ◽  
Thornton Macauley ◽  
Steven Y C Tong ◽  
Ouli Xie ◽  
Carly Hughes ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Lumbar Puncture ◽  
Cns Infection ◽  
Pathophysiological Mechanisms ◽  
Cns Infections ◽  
Fluid Assessment ◽  
Composition Gradients

Abstract The diagnosis of central nervous system (CNS) infection relies upon analysis of cerebrospinal fluid (CSF). We present 4 cases of CNS infections associated with basal meningitis and hydrocephalus with normal ventricular CSF but grossly abnormal lumbar CSF. We discuss CSF ventricular–lumbar composition gradients and putative pathophysiological mechanisms and highlight clinical clues for clinicians.

Acute Bacterial Meningitis

2015 ◽  
Author(s):  
Karen L. Roos
Keyword(s):  
Bacterial Meningitis ◽  
Lumbar Puncture ◽  
Antimicrobial Therapy ◽  
Subarachnoid Space ◽  
Cerebral Arteries ◽  
Clinical Manifestations ◽  
Empirical Therapy ◽  
Patient Positioning ◽  
Acute Bacterial Meningitis ◽  
Associated Conditions

Acute bacterial meningitis is a life-threatening infection. By definition, meningitis is an infection of the meninges and the subarachnoid space. Bacterial meningitis is associated with an inflammatory response that involves the meninges, the subarachnoid space, the brain parenchyma, and the cerebral arteries and veins. As such, bacterial meningoencephalitis is the more accurate descriptive term. This chapter discusses the epidemiology, etiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, complications, and prognosis of the disease. The discussion of diagnosis covers clinical manifestations, physical examination findings, laboratory tests, and imaging studies. The discussion of treatment covers empirical therapy, specific antimicrobial therapy, and dexamethasone therapy. Graphs compare causative organisms and clinical manifestations of community-acquired meningitis. Illustrations depict proper patient positioning for detecting nuchal rigidity, Kernig sign, Brudzinski sign, and lumbar puncture, as well as a sagittal view of a lumbar puncture needle as it is advanced into the subarachnoid space. An algorithm delineates the approach to the patient with symptoms and signs of bacterial meningitis. Tables outline bacterial pathogens based on predisposing and associated conditions, cerebrospinal fluid diagnostic studies for meningitis, the appearance of the organism on a Gram stain, empirical antimicrobial therapy based on predisposing and associated conditions, recommendations for specific antibiotic therapy in bacterial meningitis, and recommended doses for antibiotics commonly used in the treatment of bacterial meningitis.   This review contains 8 highly rendered figures, 6 tables, and 75 references.

Acute Bacterial Meningitis

2015 ◽  
Author(s):  
Karen L. Roos
Keyword(s):  
Bacterial Meningitis ◽  
Lumbar Puncture ◽  
Antimicrobial Therapy ◽  
Subarachnoid Space ◽  
Cerebral Arteries ◽  
Clinical Manifestations ◽  
Empirical Therapy ◽  
Patient Positioning ◽  
Acute Bacterial Meningitis ◽  
Associated Conditions

Acute bacterial meningitis is a life-threatening infection. By definition, meningitis is an infection of the meninges and the subarachnoid space. Bacterial meningitis is associated with an inflammatory response that involves the meninges, the subarachnoid space, the brain parenchyma, and the cerebral arteries and veins. As such, bacterial meningoencephalitis is the more accurate descriptive term. This chapter discusses the epidemiology, etiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, complications, and prognosis of the disease. The discussion of diagnosis covers clinical manifestations, physical examination findings, laboratory tests, and imaging studies. The discussion of treatment covers empirical therapy, specific antimicrobial therapy, and dexamethasone therapy. Graphs compare causative organisms and clinical manifestations of community-acquired meningitis. Illustrations depict proper patient positioning for detecting nuchal rigidity, Kernig sign, Brudzinski sign, and lumbar puncture, as well as a sagittal view of a lumbar puncture needle as it is advanced into the subarachnoid space. An algorithm delineates the approach to the patient with symptoms and signs of bacterial meningitis. Tables outline bacterial pathogens based on predisposing and associated conditions, cerebrospinal fluid diagnostic studies for meningitis, the appearance of the organism on a Gram stain, empirical antimicrobial therapy based on predisposing and associated conditions, recommendations for specific antibiotic therapy in bacterial meningitis, and recommended doses for antibiotics commonly used in the treatment of bacterial meningitis.   This review contains 8 highly rendered figures, 6 tables, and 75 references.

Acute Bacterial Meningitis

2014 ◽  
Author(s):  
Karen L. Roos
Keyword(s):  
Bacterial Meningitis ◽  
Lumbar Puncture ◽  
Antimicrobial Therapy ◽  
Subarachnoid Space ◽  
Cerebral Arteries ◽  
Clinical Manifestations ◽  
Empirical Therapy ◽  
Patient Positioning ◽  
Acute Bacterial Meningitis ◽  
Associated Conditions

Acute bacterial meningitis is a life-threatening infection. By definition, meningitis is an infection of the meninges and the subarachnoid space. Bacterial meningitis is associated with an inflammatory response that involves the meninges, the subarachnoid space, the brain parenchyma, and the cerebral arteries and veins. As such, bacterial meningoencephalitis is the more accurate descriptive term. This chapter discusses the epidemiology, etiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, complications, and prognosis of the disease. The discussion of diagnosis covers clinical manifestations, physical examination findings, laboratory tests, and imaging studies. The discussion of treatment covers empirical therapy, specific antimicrobial therapy, and dexamethasone therapy. Graphs compare causative organisms and clinical manifestations of community-acquired meningitis. Illustrations depict proper patient positioning for detecting nuchal rigidity, Kernig sign, Brudzinski sign, and lumbar puncture, as well as a sagittal view of a lumbar puncture needle as it is advanced into the subarachnoid space. An algorithm delineates the approach to the patient with symptoms and signs of bacterial meningitis. Tables outline bacterial pathogens based on predisposing and associated conditions, cerebrospinal fluid diagnostic studies for meningitis, the appearance of the organism on a Gram stain, empirical antimicrobial therapy based on predisposing and associated conditions, recommendations for specific antibiotic therapy in bacterial meningitis, and recommended doses for antibiotics commonly used in the treatment of bacterial meningitis.   This review contains 8 highly rendered figures, 6 tables, and 75 references.

scholarly journals Diagnostic Cerebrospinal Fluid Biomarker Discovery and Validation in Patients with Central Nervous System Infections

2020 ◽  
Author(s):  
Tran Tan Thanh ◽  
Climent Casals-Pascual ◽  
Nguyen Thi Han Ny ◽  
Nghiem My Ngoc ◽  
Ronald Geskus ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Bacterial Meningitis ◽  
Diagnostic Performance ◽  
Biomarker Discovery ◽  
Characteristic Curve ◽  
Accurate Identification ◽  
Cns Infections ◽  
Potential Biomarker

ABSTRACTBackgroundCentral nervous system (CNS) infections are common causes of morbidity and mortality worldwide. Rapid, accurate identification of the likely cause is essential for clinical management and the early initiation of antimicrobial therapy, which potentially improves clinical outcome.MethodsWe applied liquid chromatography tandem mass-spectrometry on 45 cerebrospinal fluid (CSF) samples from a cohort of adults with/without CNS infections to discover potential diagnostic protein biomarkers. We then validated the diagnostic performance of a selected biomarker candidate in an independent cohort of 364 consecutively treated adults with CNS infections admitted to a referral hospital in southern Vietnam.ResultsIn the discovery cohort, we identified lipocalin 2 (LCN2) as a potential biomarker of bacterial meningitis. The analysis of the validation cohort showed that LCN2 could discriminate bacterial meningitis from other CNS infections, including tuberculous meningitis, cryptococcal meningitis and viral/antibody-mediated encephalitis (sensitivity: 0.88 (95% confident interval (CI): 0.77–0.94), specificity: 0.91 (95%CI: 0.88–0.94) and diagnostic odd ratio: 73.8 (95%CI: 31.8–171.4)). LCN2 outperformed other CSF markers (leukocytes, glucose, protein and lactate) commonly used in routine care worldwide. The combination of LCN2 and these four routine CSF markers resulted in the highest diagnostic performance for bacterial meningitis (area under receiver-operating-characteristic-curve 0.96; 95%CI: 0.93–0.99).ConclusionsOur results suggest that LCN2 is a sensitive and specific biomarker for discriminating bacterial meningitis from a broad spectrum of CNS infections. A prospective study is needed to further assess the diagnostic utility of LCN2 in the diagnosis and management of CNS infections.

Nghiên cứu đặc điểm lâm sàng và cận lâm sàng nhiễm trùng thần kinh trung ương ở trẻ em

2021 ◽  
Author(s):  
Vinh Phu Tran
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Central Nervous System Infection ◽  
Clinical Manifestations ◽  
Inverse Correlation ◽  
Altered Mental Status ◽  
Cns Infection ◽  
Common Disease ◽  
Psychological Consequences ◽  
Cns Infections

Đặt vấn đề: Nhiễm trùng thần kinh trung ương (NTTKTW) là bệnh lý thường gặp, để lại nhiều hậu quả về sức khỏe cũng như tâm lý nặng nề cho từng gia đình cũng như toàn xã hội. Bệnh có tỉ lệ tử vong cao, đặc biệt là trẻ em. Biểu hiện lâm sàng nhiễm trùng thần kinh trung ương ở trẻ em rất đa dạng và thay đổi theo lứa tuổi. Việc phát hiện triệu chứng nghi ngờ để chẩn đoán sớm có ý nghĩa quan trọng, góp phần cải thiện tiên lượng bệnh qua việc quyết định điều trị sớm. Đối tượng: 61 trường hợp bệnh nhi được chẩn đoán và điều trị NTTKTW tại Trung tâm Nhi khoa Bệnh viện Trung ương Huế. Phương pháp nghiên cứu: Mô tả cắt ngang. Kết quả: NTTKTW hay gặp nhất ở nhóm trẻ > 5 tuổi (chiếm 52,5%); Các triệu chứng cơ năng thường gặp là ăn, bú kém (62,8% VMN, 98,9% viêm não), đau đầu (34,9% VMN, 61,1% viêm não), nôn (48,8% VMN, 38,9% viêm não); Các dấu hiêu thực thể thường gặp là sốt (79,1% VMN, 73,3% viêm não), rối loạn tri giác (79% VMN, 22,7% viêm não), hội chứng tăng áp lực nội sọ (65,1% VMN, 72,2% viêm não), hội chứng kích thích màng não (36,6% VMN, 22,2% viêm não), co giật (14% VMN, 44,4% viêm não, p < 0,05). Có mối tương quan nghịch giữa sự biến đổi tri giác ban đầu của bệnh nhi (đánh giá bằng thang điểm glasgow) với tần số tim (r = -0,412), tần số thở (r = -0,33), thời gian nằm viện (r = -0,612) và số lượng tế bào trong dịch não tủy (VMNM r = -0,575); VMN tăng lympho r = -0,686, VN r = -0,804). Kết luận: Biểu hiện lâm sàng của các nhóm bệnh lý nhiễm trùng thần kinh khá đa dạng, biến đổi tri giác ban đầu bệnh nhi là yếu tố tiên lượng bệnh. Từ khóa: Lâm sàng, cận lâm sàng, nhiễm trùng thần kinh trung ương trẻ em. ABSTRACT CLINICAL AND SUBCLINICAL CHARACTERISTICS OF CENTRAL NERVOUS SYSTEM INFECTION IN CHILDREN Background: Central nervous system infection (CNS) is a common disease, leading to many serious health and psychological consequences for each family’s patient as well as the whole society. The disease has a high mortality rate, especially in children. Clinical manifestations of CNS infections in children are variable, depending on age.Detecting suspicious symptoms for early diagnosis is important, contributing to improving prognosis through early treatment decisions. Subjects: 61 cases of patients diagnosed and treated at Pediatrics Center in Hue Central Hospital. Methods: Prospective observational study. Results:It showed that CNS infections are most common in children > 5 years old (52.5%); Commonsymptoms were poor feeding (62.8% meningitis, 98.9% encephalitis), headache (34.9% meningitis, 61.1% encephalitis), vomiting (48.8% meningitis, 38.9% encephalitis); Commonsigns are fever (79.1% meningitis, 73.3% encephalitis), altered mental status (79% meningitis, 22.7% encephalitis), increased intracranial pressure syndrome (65.1% meningitis,72.2% encephalitis), convulsions (14% meningitis, 44.4% encephalitis, p < 0.05). There is an inverse correlation between the change in the patient’s initial consciousness (assessed by the glasgow scale) with heart rate (r = -0.412), respiratory rate (r = -0.33), duration of hospitalization(r = -0.612) and the number of cells in the cerebrospinal fluid. Conclusions: Clinical manifestations of CNS infection are variable, the initial change in the patient’s consciousness is a predictor of the disease. Key words: Clinical, subclinical, Central Nervous System Infections.

Acute Bacterial Meningitis

2015 ◽  
Author(s):  
Karen L. Roos
Keyword(s):  
Bacterial Meningitis ◽  
Lumbar Puncture ◽  
Antimicrobial Therapy ◽  
Subarachnoid Space ◽  
Cerebral Arteries ◽  
Clinical Manifestations ◽  
Empirical Therapy ◽  
Patient Positioning ◽  
Acute Bacterial Meningitis ◽  
Associated Conditions

Acute bacterial meningitis is a life-threatening infection. By definition, meningitis is an infection of the meninges and the subarachnoid space. Bacterial meningitis is associated with an inflammatory response that involves the meninges, the subarachnoid space, the brain parenchyma, and the cerebral arteries and veins. As such, bacterial meningoencephalitis is the more accurate descriptive term. This chapter discusses the epidemiology, etiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, complications, and prognosis of the disease. The discussion of diagnosis covers clinical manifestations, physical examination findings, laboratory tests, and imaging studies. The discussion of treatment covers empirical therapy, specific antimicrobial therapy, and dexamethasone therapy. Graphs compare causative organisms and clinical manifestations of community-acquired meningitis. Illustrations depict proper patient positioning for detecting nuchal rigidity, Kernig sign, Brudzinski sign, and lumbar puncture, as well as a sagittal view of a lumbar puncture needle as it is advanced into the subarachnoid space. An algorithm delineates the approach to the patient with symptoms and signs of bacterial meningitis. Tables outline bacterial pathogens based on predisposing and associated conditions, cerebrospinal fluid diagnostic studies for meningitis, the appearance of the organism on a Gram stain, empirical antimicrobial therapy based on predisposing and associated conditions, recommendations for specific antibiotic therapy in bacterial meningitis, and recommended doses for antibiotics commonly used in the treatment of bacterial meningitis.   This chapter contains 8 highly rendered figures, 6 tables, 75 references, 1 teaching slide set, and 5 MCQs.

scholarly journals Metagenomic Next-Generation Sequencing for Pathogen Detection and Transcriptomic Analysis in Pediatric Central Nervous System Infections

2021 ◽  
Author(s):  
Nanda Ramchandar ◽  
Nicole G Coufal ◽  
Anna S Warden ◽  
Benjamin Briggs ◽  
Toni Schwarz ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Next Generation Sequencing ◽  
Usual Care ◽  
Transcriptomic Analysis ◽  
Cns Infection ◽  
Metagenomic Sequencing ◽  
Next Generation ◽  
Cns Infections ◽  
Generation Sequencing

Abstract Background Pediatric central nervous system (CNS) infections are potentially life-threatening and may incur significant morbidity. Identifying a pathogen is important, both in terms of guiding therapeutic management, but also in characterizing prognosis. Usual care testing by culture and PCR is often unable to identify a pathogen. We examined the systematic application of metagenomic next-generation sequencing (mNGS) for detecting organisms and transcriptomic analysis of cerebrospinal fluid (CSF) in children with CNS infections. Methods We conducted a prospective multi-site study that aimed to enroll all children with a CSF pleocytosis and suspected CNS infection admitted to one of three tertiary pediatric hospitals during the study timeframe. After usual care testing had been performed, the remaining CSF was sent for mNGS and transcriptomic analysis. Results We screened 221 and enrolled 70 subjects over a 12-month recruitment period. A putative organism was isolated from CSF in 25 (35.7%) subjects by any diagnostic modality. mNGS of the CSF samples identified a pathogen in 20 (28.6%) subjects, which were also all identified by usual care testing. The median time to result was 38 hours. Conclusion Metagenomic sequencing of CSF has the potential to rapidly identify pathogens in children with CNS infections.

scholarly journals 1417. Detection of Human Herpesviruses DNA in Cerebrospinal Fluids of Patients Suspected with Central Nervous System Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S516-S516
Author(s):  
Yuki Higashimoto ◽  
Soichiro Ishimaru ◽  
Hiroki Miura ◽  
Kei Kozawa ◽  
Masaru Ihira ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Brain Mri ◽  
Central Nervous System Infection ◽  
Clinical Manifestations ◽  
Rflp Analysis ◽  
Cns Infection ◽  
Characteristic Change ◽  
Human Herpesviruses ◽  
Hsv 1

Abstract Background Of the nine human herpesviruses (HHVs), most viruses have neurovirulence. Clinical manifestations of central nervous system (CNS) complications caused by some of the HHVs are well examined in children and immunocompromised adults; however, information of EBV and β-herpesviruses in an immunocompetent adult is limited. Methods Between April 2013 and March 2018, 322 patients (median age; 51.6 years old, male/female; 196/126) suspected to CNS infection were enrolled in this study. Patients with unconsciousness or characteristic change lasting more than 24 hours and abnormal brain MRI or EEG were defined as encephalitis. Real-time PCRs for detection of the 7 HHVs DNA including HSV-1, HSV-2, VZV, CMV, EBV, HHV-6, and HHV-7 were carried out in DNA extracted from 200 μL CSF. HHV-6 was discriminated between HHV-6A and HHV-6B using RFLP analysis. Results Herpesviruses DNA was detected in 33 (10.2%) of the 322 patients. The most frequently detected HHVs was VZV (19 cases) and followed by HHV-6B (4 cases), HSV-1 (3 cases), HSV-2 (3 cases), and EBV (2 cases). Multiple HHVs DNAs were detected from the 2 patients (case A; HSV-2, HHV-6, and EBV, case B; EBV and HHV-6B). No CMV and HHV-7 DNAs were detected in any of the samples. Eleven cases were assigned as encephalitis, and other 22 cases were non-encephalitis. Although all 3 patients with positive HSV-1 DNA were encephalitis, all 3 patients with positive HSV-2 DNA were meningitis. Fourteen (13 patients had zoster) of the 19 patients with positive VZV DNA were meningitis, and the remaining 5 patients (4 patients had zoster) were encephalitis. Two of the 4 HHV-6B-positive patients were non-encephalitis, one patient was diagnosed Orbital apex syndrome and another patient was myelitis. One of the 2 encephalitis patient was chromosomally integrated (ci) HHV-6. Additionally, case B was also ciHHV-6. Conclusion Approximately 10% of the samples were positive of HHVs DNA. VZV was the most frequently detected viral DNA in this cohort. Thirty-three percent of the patients were encephalitis, remaining patients were non-encephalitis such as meningitis and myelitis. As suggested, ciHHV-6 can cause miss-diagnosis of patients suspected with CNS infection. Disclosures All authors: No reported disclosures.

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