By Juan Carlos García-Moncó
This clinically orientated publication covers chosen infections of the critical frightened method that are of substantial present curiosity. elements which are much less good documented, reminiscent of spinal wire infections, crucial apprehensive approach infections in sufferers with melanoma, tropical infections, healthcare-associated ventriculitis or meningitis and immunological difficulties within the overseas vacationer also are mentioned, as those are all difficulties proper to day-by-day practice.
CNS Infections: A scientific Approach is of worth to the busy clinician; the neurological overseas group in addition to all basic care medical professionals, inner medication experts and citizens who look after sufferers with suspected neurological infections.
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Extra info for CNS Infections: A Clinical Approach
4 with a positive CSF culture and attributable symptoms. The reason for using such a low cutoff for WBC count is because most often indolent organisms cause minimal inflammation, but the decision to treat based on this should be individualized. Another instance would be when the WBC count and glucose values are normal, but there are multiple positive CSF cultures (from multiple shunt tap or explanted proximal shunt components) and attributable symptoms. CSF shunt infections can present as shunt blockage due to biofilms formed by organism without significant inflammation.
References 1. Swartz MN. Bacterial meningitis – a view of the past 90 years. N Engl J Med. 2004;351(18):1826–8. 2. Thigpen MC, Whitney CG, Messonnier NE, et al. Bacterial meningitis in the United States, 1998-2007. N Engl J Med. 2011;364(21):2016–25. 26 A. Bhimraj 3. van de Beek D, Farrar JJ, de Gans J, et al. Adjunctive dexamethasone in bacterial meningitis: a meta-analysis of individual patient data. Lancet Neurol. 2010;9(3):254–63. 4. Holmquist L, Russo CA, Elixhauser A. Meningitis-related hospitalizations in the United States, 2006: Statistical Brief #57.
The most common causative organisms are Streptococcus pneumoniae and Neisseria meningitidis. The incidence of Listeria monocytogenes infection increases over age 50 years and in those with compromised cell-mediated immunity. Symptoms and signs are not sensitive or specific enough to diagnose community-acquired bacterial meningitis. A lumbar puncture for cerebrospinal fluid is needed to reach the diagnosis, to identify the organism, and to determine antimicrobial susceptibilities. Computed tomography of the head is not necessary in all patients prior to a lumbar puncture, only in immunocompromised patients and in those who have features suggestive of or who are at risk of increased intracranial pressure.