cns infection dr. v.p.c.rajakaruna mbbs(colombo)
TRANSCRIPT
![Page 1: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/1.jpg)
CNS infection
Dr. V.P.C.Rajakaruna MBBS(COLOMBO)
![Page 2: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/2.jpg)
Content
• Types of infections
• Causative agents
• Symptoms and signs
![Page 3: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/3.jpg)
Infections – Terminology
• Meningitis • Encephalitis• Myelitis• Meningoencephalitis• Meningomyelitis• Encephalomyelitis• Meningo-encephalomyelitis• Brain abscess
![Page 4: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/4.jpg)
Meningitis
![Page 5: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/5.jpg)
Meningitis
• Purulent meningitis
- polymorphonuclear cell
- WBC > 1000 celss/mm3
- pyogenic bacteria• Lymphocytic meningitis• Eosinophillic meningitis
- eosinophil > 5%
- parasite• Carcinomatous meningitis
![Page 6: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/6.jpg)
Pathogenic organism• Virus• Bacteria• Mycobacterium• Fungus – Cryptococcus neoformans• Parasite – Angiostrongylus cantonensis, Gnathostomiasis,
Cysticercosis• Actinomycosis • Protozoa• Rickettsia• Spirochete• Mycoplasma
![Page 7: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/7.jpg)
Pathogenesis
• Hematogenous spreading• Parameningeal structures – sinusitis, mastoiditis,
otitis media, dental carries• Direct infection to the subarachnoid space –
fracture base of skull, dermal sinus tract, ruptured meningoceal abscess
• Direct infection – surgery, lumbar puncture• Cranial nerve and peripheral nerve – rabies
encephalitis, herpes simplex encephalitis
![Page 8: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/8.jpg)
Symptoms and signs
• Fever, Headache, Nausea and vomitting• Period
- acute period: within 1 week
bacteria, virus, amoeba, parasite,
systemic infection
- subacute period: 1- 4 weeks
tuberculosis, fungus, parasite,
spirochete, systemic infection
- chronic period: > 4 weeks
![Page 9: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/9.jpg)
Chronic meningitisInfectious causes
M.Tuberculosis
Cryptococus neoformans
Cysticercosis
Angiostrongylus cantonensis
Treponema pallidum
Nocardia asteroides
Actinomycosis
Acanthamoeba
![Page 10: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/10.jpg)
Noninfectious causes
Neoplasm
SLE
Vasculitis
Behcet’s disease
lymphocytic meningitis
Sjogren’s syndrome
![Page 11: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/11.jpg)
Symptoms
![Page 12: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/12.jpg)
Symptoms (children)
![Page 13: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/13.jpg)
Kernig’s sign
![Page 14: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/14.jpg)
Brudzinski’s sign
![Page 15: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/15.jpg)
Symptoms
• Alteration of consciousness
• Seizure
• Localizing signs: hemiparesis, paraplegia
• Cranial nerve palsy
• Autonomic hyperactivity
![Page 16: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/16.jpg)
Investigations
![Page 17: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/17.jpg)
Lumbar puncture
![Page 18: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/18.jpg)
Lumbar puncture
![Page 19: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/19.jpg)
CSF analysis• The characteristics of normal CSF
- open pressure: 50-200 mmCSF
- clear color
- cells: RBC
WBC- lymphocyte < 5 cells
- protein 20-45 mg/dl
- CSF sugar/ Serum sugar > 50%
- fresh smear, Gram stain, India ink,
AFB, modified AFB
- culture
![Page 20: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/20.jpg)
CSF analysis for differential diagnosis (acute onset)
![Page 21: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/21.jpg)
Pathogen Virus Bacteria
Open pressure Normal Normal, increased
Appearance Clear Turbid
WBC + (+)
Lymphocyte
+++
PMN
Protein + ++
CSF sugar/ Serum sugar
Normal Decreased
Others Special lab Gram stain, culture, CIE, latex agglutination
![Page 22: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/22.jpg)
CSF analysis for differential diagnosis (acute onset)
![Page 23: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/23.jpg)
Pathogens Parasite Protozoa (Naegleria)
Systemic infection
Open pressure
Normal, increased
Normal, increased
Normal
Appearance Angio: coconut juice
Gnatho: xanthochrome
Turbid Clear
WBC ++
eosinophil
+++
PMN
+Lymphocyte
Protein ++ ++ +
CSF sugar/ Serum sugar
Normal Decreased Normal
Others - Fresh smear, culture
-
![Page 24: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/24.jpg)
CSF analysis for differential diagnosis (subacute onset)
![Page 25: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/25.jpg)
Pathogen Tuberculosis Cryptococcosis
Open pressure Normal, increased
Normal, increased
Appearance Straw color
Xanthochrome
Clear
WBC + +
Lymphocyte
++
Lymphocyte
Protein +++(+) ++
CSF sugar/ Serum sugar
Decreased Decreased
Others AFB, culture, cobweb, PCR
India ink, culture, Crypto Ag
![Page 26: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/26.jpg)
Viral Encephalitis
![Page 27: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/27.jpg)
HSV encephalitis
• In adult most caused by HSV-1• Primary infection in oropharyngeal or intranasal
mucosa• Latent ganglionic infection• Reactivation leads to encephalitis • Headache, fever, alteration of consciousness
![Page 28: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/28.jpg)
VZV encephalitis
• After varicella develop, VZV remain within the ganglia
• Reactivation, spread to spinal cord & brain
![Page 29: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/29.jpg)
Japanese encephalitis
• Flavivirus, Culex- borne, Southeast Asia /China• Symptoms: headache and alteration of
consciousness• Clinical signs (post encephalitis): tremor, dystonia,
rigidity, mask-like face• Mortality rate 30%• Vaccine available – inactivated virus, age should be
more than one year to get the vaccine
![Page 30: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/30.jpg)
Rabies encephalitis
• Rhabdovirus family, transmission through dog bites
• Encephalitic form involve cerebrum, brainstem
• Late state involve basal ganglia and thalamus coma
• Paralytic form involve medulla, spinal cord
![Page 31: CNS infection Dr. V.P.C.Rajakaruna MBBS(COLOMBO)](https://reader036.vdocuments.net/reader036/viewer/2022062314/56649f205503460f94c38e92/html5/thumbnails/31.jpg)
CMV encephalitis
• Opportunistic infection in organ transplant, HIV
• Brainstem encephalitis, cranial nerve palsy, associated retinitis visual pathway