CNS Infections - Columbia University

CNS Infections - Columbia University

CNS Infections Bacterial meningitis - Pathophysiology - general Specific organisms - Age Hosts Treatment/Prevention Distinguish from viral disease

Meningitis - Neonate Aspiration - colonization - lack of preformed Ab Organisms - GBS E.coli K1 (Enteric bacteria) Listeria monocytogenes Enterococci

Salmonella - fecal contamination Antibiotics - Cover gram negatives/Listeria/ GBS GBS pathogenesis: High grade bacteremia poor neonatal host defenses (PMN function, complement function, lack of Ab for

phagocytosis) Meningeal receptors endocytosis ? Intracellular ? Replication persistence Clinical relevance need for prolonged therapy ? GBS Streptococcus agalactiae

Common commensal flora childbearing women Lack of preformed Ab sepsis meningitis in neonate Early onset disease Sepsis pneumonia Late onset disease Sepsis MENINGITIS Vertical transmission most important - Preventable

E.coli K1 (not all E. coli - specific capsular type) Maternal fecal flora ascending infection CHO capsule lack of antibody High grade bacteremia meningitis specific receptors on meninges Problem with antibiotic resistance

Meningitis - neonate Listeria monocytogenes Gram positive bacillus - motile Found in animal feces - very common ! Contamination of unpasteurized animal products - organic produce - Mexican cheese

Epidemiology 2000 cases/year Associated with a flu-like illness in the mother Immunocompromised patients - T cell function Listeria - pathogenesis Maternal infection

Preterm delivery (not always) Pneumonia - sepsis - meningitis Intracellular pathogen - ? Lack of T cell function in the neonate Cell to cell spread - like Shigella breaks out of phagosome - avoids Ab Need T cell function- macrophage activation

Meningitis - neonate/young infant Greater incidence of sepsis - immature immune function Greater incidence of meningitis - Sepsis work-up includes LP - difficult to distinguish viral from bacterial disease Clinical clues high or low WBC irritability non specific sxs

Very small premature infants Complex congenital heart diseas Premature infants improved ventilatory support Coagulase negative staphylococci sepsis/meningitis Enterococci selection by antibiotics

Fungi Meningitis in infants and toddlers: Case - 4 month old - T- 104 - seen by M.D. - rxd with tylenol Still febrile the next day - seen again, said to have otitis media - prescribed amoxicillin Increasingly irritable Seen in CPMC E.R.(by clinical clerk)

chief complaint - lump on head which was a bulging fontanel S. pneumoniae in CSF - Arrow - exudate - pus PMNs

meninges Cortex - note edema Pathophysiology:

PMNs Inflammation Edema Elevated CSF protein

Increased intracranial pressure Breakdown of blood-brain barrier Loss of perfusion

Low glucose Loss of autoregulation - BP control SIADH Pneumococcal meningitis

Sporadic cases - NP colonization - bacteremia - meningeal seeding - Inflammation Worst prognosis Treatment - Achieve 20x MIC of the organism in the CSF Penicillin MIC = 1.0 - need level of 20 micrograms/ml only get 10% of the blood level What to do ???

S. pneumoniae 1999 S. pneumo - 1999 data Prevention of S. pneumoniae infections

Infants/children Prevnar Pneumococcal Vaccine 8 capsular types + protein conjugate vaccine Immunogenic Effective Adults 23-valent polysaccharide vaccine

Eradication of a common disease: H. influenzae non typeable otitis acquire type B capsule Poly ribose phosphate Bacteremia Meningitis Paradigms for the management of meningitis Universal vaccination of infants

HiB PRP-protein conjugate vaccine Disease gone in vaccinated children Meningitis - Haemophilus influenzae type B Antibody - polyribose phosphate capsule Allows efficient phagocytosis

Development of conjugate vaccines: PRP - Diphtheria toxin Meningococcal OMP Sporadic cases - adults who lack Ab Use of anti-inflammatory agents in

meningitis H. influenzae experience Give corticosteroids BEFORE antibiotics Decreases the secondary increase in TNF due to the release of bacterial cell wall fragments

Improved clinical outcome ? Other organisms ? Other ages Case - 20 year old college sophomore - goes to nurse with headache, T- 102. Diagnosed as having flu. Still feels unwell,nurse gives tyelenol with codeine spends night at dorm - collapses and is unarowsable. Sent to local hospital, T- 103 , WBC -2500

CSF - WBC- 120 - 100% PMNs; Glucose 20/96, Protein275. PE - Diffuse petecchiae, cold, clammy extremities, Poor air entry... N. meningitidis N. meningitidis - Epidemic strains/endemic strains meningitis belt in sub-Saharan Africa (type A) Sporadic cases types B, A, W135,

Gram negative (LPS) - Rapid uptake by theSepsis epithelial cells Receptor mediated endocytosis Encapsulated - requires IgG + complement to phagocytose Carriers in the population - increased carriage - disease in those lacking antibody

Gram stain of CSF - note PMNs and intracellular bacteria N. meningitidis - 1999 data N. meningitidis OUTBREAKS !

Who is at risk ? How is the organisms spread - carriers? How can disease be prevented N. meningitidis Development of protective immunity - cross reactive CHOs

commensal flora (Neisseria lactamica) Vaccines - (epidemic types) - A and C, Y, W 135 Not B - associated with sporadic cases Sialic acid epitopes - look like self Who to vaccinate? College students? Military, travellers to endemic areas

Prophylaxis - Rifampin, ciprofloxacin, ceftriaxone achieve levels in naso-pharyngeal secretions Diagnosis of meningitis - When to do an L.P. Interpretation of results

ONE ANGRY POLY.. CSF - gram stain Culture Antigen- detection - latex agglutination tests Chemistries

LOW GLUCOSE Deranged blood Brain barrier not bacteria eating lunch HIGH PROTEIN Treatment of meningitis: Decrease inflammation

Antimicrobial agents that get into the CSF Fluid CNS pressure management Septic shock management Public health considerations Sequellae of meningitis

Hearing loss Seizure disorder Major neurological dysfunction Hydrocephalus - obstructed ventricular drainage Soft neurological dysfunction Attention deficit disorder

Behavioral abnormalities

Recently Viewed Presentations

  • Services Marketing Chapter 2: Consumer Behavior in a

    Services Marketing Chapter 2: Consumer Behavior in a

    Richard Normann Service Encounters Range from High-Contact to Low-Contact Distinctions between High-Contact and Low-Contact Services The Servuction System Source: Adapted and expanded from an original concept by Eric Langeard and Pierre Eiglier The Servuction System: Service Production and Delivery Servuction...
  • Using Gender Statistics: a toolkit for training data

    Using Gender Statistics: a toolkit for training data

    The public audience is made up of all members of society who want information in a personal capacity or on behalf of another organisation. The professional audience is made up of professionals in the public, private and educational sectors who...
  • Teorya ng multiple intelligences

    Teorya ng multiple intelligences

    Pagtukoysakanyangmgakatangian, talento, kakayahangamitang Multiple Intelligences Survey Form ni Walter Mckenzie. ... Magiging masaya sila kung magiging musician , kompositor o "Disk Jockey". IntrapersonalIntelligence.
  • What Quantity is Measured in an Excess Quantum Noise Measurement?

    What Quantity is Measured in an Excess Quantum Noise Measurement?

    FDT: NET absorption from classical field. (Valid also in steady nonequilibrium States) Nothing is emitted from a T = 0 sample, but it may absorb… Noise power depends on final state filling. Exp confirmation: deBlock et al, Science 2003, (TLS...
  • Pilnas pamokos apraymas  Pamokos apvalga Mokymosi sritis Amius

    Pilnas pamokos apraymas Pamokos apvalga Mokymosi sritis Amius

    Anglų kalba Pamokos apžvalga Mokymosi sritis Amžius 7 klasė Gilinti žinias apie senovės Egipto kultūrą, religiją ir papročius. Plėsti aktyvųjį ir pasyvųjį anglų kalbos žodyną istorine tematika.
  • Key Stage 2 SATs - Victoria Dock Primary School

    Key Stage 2 SATs - Victoria Dock Primary School

    Key Stage 2 SATs Changes. In 2014/15 a new national curriculum framework was introduced by the government for Years 1, 3, 4 and 5. From 2015/16 children in all years at Key Stage 1 and 2 are expected to study...
  • Presentation heading - Warwickshire LDC

    Presentation heading - Warwickshire LDC

    Area Team Structure Arden, Herefordshire and Worcestershire June 2013 Arden, Herefordshire and Worcestershire Local Area Team * Business Office Jane Gordijn Jenny McGill Jo Clode Medical Director Martin Lee Director of Nursing Sue Doheny Director of Finance Brian Hanford Director...
  • 没有幻灯片标题 - Fudan University

    没有幻灯片标题 - Fudan University

    Sexually transmitted diseases(2) Lianjun Chen Huashan Hospital