Acute cns infection in children
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Transcript of Acute cns infection in children
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