Infections of CNS

Clinical forms of CNS infections:

• Acute bacterial meningitis

• Acute viral meningitis

• Encephalitis

• Local infections:

• Brain abscess

• Cerebellitis

• Subdural empyema

• Infectious thrombophlebitis of brain vessels

Etiology of meningitis in different age groups:

Age	Causative agent
0 – 3 months	Listeria monocytogenes, Group B streptococci, E. Coli and other Gram- bacteria
3 – 36 months	Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, Listeria monocytogenes, Enterobacteriaceae, HSV-1, 2 Group B streptococci
Older than 3 years	Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, Enteroviruses

Etiotropic therapy of meningitis depending on age:

Under 1 month	Listeria monocytogenes, Group B streptococci, E. Coli	Ampicillin + cefotaxim (or gentamycin)
1 – 3 months	Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, Enterobacteriaceae, HSV, Group B streptococci	Ampicillin + cefotaxim
Older 3 months	Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, Enteroviruses	Ceftriaxon (or cefotaxim)

Bacterial causes of meningitis and encephalitis:

Aerobic bacteria

Neisseria meningitidis* Haemophilus influenzae* Streptococcus pneumoniae* Streptococcus gr. "B" Streptococcus viridans Staphylococcus aureus Enterococcus Escherichia coli Bacteroides fragilis Bacteroides spp. Peptostreptococcus Fusobacterium meningosepticum, etc.

Salmonella spp., S.typhi, S.enteritidis Klebsiella pneumoniae Serratia marcescens Proteus spp. Pseudomonas aeruginosa Citrobacter diversus Listeria monocytogenes

Clinical classification of meningitis and encephalitis:

Morphology	Purulent Serous
Character of appearance	Primary Secondary
Etiology	Bacteria Viruses	Fungi Protozoa Mixed
Course	Acute Chronic	Fulminant Recurrent
Predominating clinics	Basal Convexital	Total Spinal

Primary purulent meningitis:

• Meningococcus

• Pneumococcus (Strep. Pneumonia)

• Haemophylus Influenza type B

Primary serous meningitis:

• Acute lymphocytic choriomeningitis

• Enteroviral

• Poliomyelitis

• Parotitis

Secondary purulent meningitis:

Bacterial • Staphylococcus • Streptococcus • E. coli • Salmonella • Proteus • Klebsiella • Pseudomonas • Anthrax • Listeria

• Pasterilia • Micoplasma • Acinetobacter Fungi • Candida • Aspergillus Protozoa • Ameba • Toxoplasma

Bacterial serous meningitis:

• Tuberculosis

• Syphilis

• Leptospirosis

• Ornithosis

• Brucellosis

Ways of infection penetration into CNS:

Hematogenous (systemic septicemia)

Axonal (HSV-1, 2)

Contact

(mastoiditis, epitympanitis, sinusitis)

Along perineural spaces of craniocerebral nerves (otits, mastoiditis)

Pathogenesis of viral neuroinfections – neuronal transmission (HSV, VZV):

Hematologic spread of bacteria into CNS:

Aseptic meningitis:

Viral meningitis

Fungi meningitis

Bacterial meningitis (caused by bacteria which can not be seen on Gram staining)

Toxic meningitis (drugs, toxins)

Meningitis at systemic diseases

Meningitis at neoplastic diseases

Parameningeal processes

Дата добавления: 2015-10-29