CNS  Infection:  

•   Acute  Bacterial  Meningitis  

o   Produces  increased  ICP  because  of  cerebral  edema,  obstruction  to  flow  and  absorption  of  CSF  and  impairing  venous  
flow  
o   Etiologic  agents:  
Newborn  to  3  months   3  months  to  6  years   >  6  years  
GBS   H.  influenza,  Type  B   N.  meningitides  
E.coli   S.  pneumonia   S.  pneumonia  
L.  monocytogenes   N.  meningitides  
Enterococci  
S.  pneumonia  

o   Complications:  
!   Seizures,  subdural  effusions,  SIADH,  prolonged  fever,  DIC  
o   Sequelae:  
!   Cerebral  atrophy  
!   Microcephaly  
o   Treatment:  
!   Uncomplicated  penicillin  sensitive  s.  pneumonia  mengitis:  10  -­14  days  
!   Resistant  strep:  vancomycin  
!   Uncomplicated  N.  meningitides:  IV  penicillin  5-­7  days  
!   Uncomplicated  h.  influenza  type  B:  7-­10  days  
!   Gram  (-­)  meningitis:  3rd  generation  cephalosporin  
•   Viral  Meningitis  
o   Aseptic  meningitis  
o   Usually  accompanying  the  viral  infection  as  diarrhea,  respiratory,  mumps,  measles,  varicella  
o   Treatment  is  supportive  as  the  course  is  self-­limiting  
•   TB  meningitis  
o   3  stages:  
!   Stage  1  –prodromal  (fever,  headache,  irritability)  
!   Stage  2  –neurologic  signs  (meningeal  signs,  decreased  level  of  sensorium)  
!   Stage  3  –coma,  irregular  respiration,  rigidity,  opisthotonus  
o   Diagnosis:  
!   Clinical:  subacute  course,  (+)  exposure  to  TB,  (+)  tuberculin  test  
!   CSF:  groundglass  apperance  with  tendency  to  coagulate,  increased  WBC  with  
lymphocytes,  extremely  high  protein,  low  sugar  
!   (+)  Acid  fast  staining,  PCR,  ELISA,  or  latex  agglutination  antigen  
 
 o   Treatment:  
!   Quadruple  anti-­TB  regimen:  
•   2  HRZES/  10  HR  
 
WBC   Protein   Sugar   Others  
Normal   0-­5  lymphocyte   15-­45   50-­75   Clear  
>50%  of  blood  sugar  

Abnormal   High  neutrophils   High   Low   Turbid  

(After  5  days  lymphocyte)  

Viral   Normal   N  or  slight  increase   Normal   Clear  

TB   High  lymphocyte   High   Low  <40   xanthochromic  

•   Encephalitis  
o   Usually  viral  
!   Herpes  Simplex  
!   Dengue  encephalopathy  
!   Subacute  sclerosing  paraencephalitis  (SSPE)  
•   Related  to  measles  
•   Subacute  and  degenerative  disease  of  the  entire  brain  
•   Symptoms:  behavioral  and  personality  change  
•   Diagnosis:  (+)  measles  antibody  in  the  CSF,  characteristic  EEG  findings  
•   Treatment:  no  treatment