acute cns infection in children
TRANSCRIPT
![Page 1: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/1.jpg)
case12year old boy c/o fever 3daysVomitingRefusal of feedsCrying without any reasonHad fits last nightApproach?
![Page 2: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/2.jpg)
Acute CNS infection
Dr.P.SoundararajanProfessor, Pediatrics
![Page 3: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/3.jpg)
Terms to understandMeningitisEncephalitisMeningoencephalitisMyelitisPostinfectious polyneuritisCerebral abcess
![Page 4: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/4.jpg)
![Page 5: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/5.jpg)
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
![Page 6: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/6.jpg)
Burden 1.3million cases worldwide1.35 lakh deaths1.5% admissions in India16% mortality6/1 Lakh; encephalitis [10%
HSV]
![Page 7: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/7.jpg)
Organisms
![Page 8: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/8.jpg)
Pathogenesis Hematogenous spreadContiguousOther focusInjury ,post operative
Purulent exudate, cerebral edemaThrombosis, occlusion, ICT, CBF less
![Page 9: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/9.jpg)
![Page 10: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/10.jpg)
![Page 11: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/11.jpg)
How to recognize?Usual nonspecific symptomsMeningeal signs ICT signs Focal deficitsHerniation
![Page 12: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/12.jpg)
![Page 13: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/13.jpg)
![Page 14: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/14.jpg)
Workup
CSF; sugar less protein more,Gram stain +ve,Culture,
![Page 15: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/15.jpg)
CSF; CRP latex agglutination PCR
![Page 16: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/16.jpg)
Treatment of FeverShockCerebral edema; mannitol seizures Fluid imbalance
![Page 17: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/17.jpg)
Treatment
<3m age;Cefatoxime+amikacin
>3m;/staph-aureusCeftrioxone+ vancomycin
Pseudomonos;ceftazidime
GBS,Listeria;ampicillin
Antibiotic therapy
Dexamethasone therapy
![Page 18: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/18.jpg)
Outcome; 10-30% mortalitySequalae; cognitive, motor dysfunction, blindness
Prevention;Vaccination; HIB, PCV, meningococcal V.Rifampicin prophylaxis
![Page 19: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/19.jpg)
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
![Page 20: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/20.jpg)
![Page 21: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/21.jpg)
![Page 22: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/22.jpg)
Pathogenesis neuronal, hematogenous, inhalation, feco oral,
Neuronophagia, demyelination, meningitis, vasculitis
![Page 23: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/23.jpg)
![Page 24: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/24.jpg)
![Page 25: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/25.jpg)
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)
![Page 26: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/26.jpg)
Workup
![Page 27: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/27.jpg)
![Page 28: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/28.jpg)
EEG in HSV
![Page 29: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/29.jpg)
![Page 30: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/30.jpg)
![Page 32: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/32.jpg)
![Page 33: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/33.jpg)
![Page 34: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/34.jpg)
![Page 35: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/35.jpg)
![Page 36: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/36.jpg)
![Page 37: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/37.jpg)
Therapy Supportive careControl of seizuresAcyclovir
![Page 38: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/38.jpg)
![Page 39: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/39.jpg)
Meningitis Encephalitisage <2yrs School childrenseizures common Almost alwayssensorium irritable Mostly unconsciousCSF polymorphs lymphocytes
Gram stain, culture IGM, PCRcomplications Hydrocephalus,
deafness,Seizures, behavior problems, blindness
![Page 40: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/40.jpg)
Q3 organisms causing meningitisVaccines preventing meningitisTest to prove meningitisTests to isolate/prove virus in
enceph....4 meningeal signsDrug for cerebral edema
![Page 41: Acute cns infection in children](https://reader036.vdocument.in/reader036/viewer/2022062522/58a2bf881a28ab217a8b48d1/html5/thumbnails/41.jpg)