case12year old boy c/o fever 3daysVomitingRefusal of feedsCrying without any reasonHad fits last nightApproach?

Acute CNS infection

Dr.P.SoundararajanProfessor, Pediatrics

Terms to understandMeningitisEncephalitisMeningoencephalitisMyelitisPostinfectious polyneuritisCerebral abcess

History Described by hippocrates 1768; robert whytt described TBM in

autopsy 1805; epidemic in Geneva, Massachussets 1840-1905; major outbreaks in Africa 1884; vladimir kernig 1887; meningococcal link found 1891; use of csf analysis 1899; joseph brudzinski 1906; use of horse serum 1944; use of penicillin 2000; vaccine recommended 2002; steroids are useful

Burden 1.3million cases worldwide1.35 lakh deaths1.5% admissions in India16% mortality6/1 Lakh; encephalitis [10%

HSV]

Organisms

Pathogenesis Hematogenous spreadContiguousOther focusInjury ,post operative

Purulent exudate, cerebral edemaThrombosis, occlusion, ICT, CBF less

How to recognize?Usual nonspecific symptomsMeningeal signs ICT signs Focal deficitsHerniation

Workup

CSF; sugar less protein more,Gram stain +ve,Culture,

CSF; CRP latex agglutination PCR

Treatment of FeverShockCerebral edema; mannitol seizures Fluid imbalance

Treatment

<3m age;Cefatoxime+amikacin

>3m;/staph-aureusCeftrioxone+ vancomycin

Pseudomonos;ceftazidime

GBS,Listeria;ampicillin

Antibiotic therapy

Dexamethasone therapy

Outcome; 10-30% mortalitySequalae; cognitive, motor dysfunction, blindness

Prevention;Vaccination; HIB, PCV, meningococcal V.Rifampicin prophylaxis

Encephalitis Arbovirus;JBE, WNV, dengue

Herpes virus;HSV,EBV,CMV,VZV

Entero virus;Polio, echo, coxasckie

Mumps, measles, rabies,adeno

Incidence; 6 per lakh population

Pathogenesis neuronal, hematogenous, inhalation, feco oral,

Neuronophagia, demyelination, meningitis, vasculitis

Behavioral and personality changes, confusion, amnesia, seizures Focal findings ( hemiparesis, focal seizures, autonomic dysfunction)

AtaxiaMovement disorders ( St Louis encephalitis, equine encephalitis)Cranial nerve defects

Meningeal signs Dysphagia, particularly in rabiesFlaccid paralysis (10% of patients with WNE) sensorimotor dysfunction ( encephalomyelitis)

Workup

EEG in HSV

Substantia nigra involvement

Therapy Supportive careControl of seizuresAcyclovir

Meningitis Encephalitisage <2yrs School childrenseizures common Almost alwayssensorium irritable Mostly unconsciousCSF polymorphs lymphocytes

Gram stain, culture IGM, PCRcomplications Hydrocephalus,

deafness,Seizures, behavior problems, blindness

Q3 organisms causing meningitisVaccines preventing meningitisTest to prove meningitisTests to isolate/prove virus in

enceph....4 meningeal signsDrug for cerebral edema