1 / 36

Subacute/Chronic meningitis

Subacute/Chronic meningitis. Reşat ÖZARAS, MD , Prof. Infection Dept. rozaras@yahoo.com. Admission A cute ( 1 day-1 week ) Suba c ute ( 1 week-1 mo.) Ch ronic (> 1 mo. ). Subacute/Chronic meningitis. W ithin weeks or months

adina
Download Presentation

Subacute/Chronic meningitis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Subacute/Chronic meningitis Reşat ÖZARAS, MD, Prof. Infection Dept. rozaras@yahoo.com

  2. Admission Acute (1 day-1 week) Subacute (1 week-1 mo.) Chronic (> 1 mo. )

  3. Subacute/Chronic meningitis • Within weeks or months • Headache, fever, neck rigidity, mental changes • Focal neurological signs are more frequent • Needs specific treatment • A diagnostic challenge

  4. A Case Study • A 48-year-old female was admitted with headache, myalgia, nausea, vomiting, fatigue, anorexia and fever for 6 weeks • Biochemistry normal • CBC normal • C-RP: 5 Xnormal, ESR 100 mm/h

  5. No previous and family history • Immunosuppressive disorders/drugs • No similar signs & symptoms in the family • No focal neurological sign • Neck rigidity +/-, Kernig and Brudzinski + • MRI showed mild contrast enhancement at basal cranial meninges

  6. CSF • Clear • Cell count: 250 /mm3, 80% lymphocytes • Glucose 10 mg/dl (blood glucose 98) • Protein 280 mg/L • Gram and EZN staining: negative

  7. What is your diagnosis?

  8. 2 days later • CSF TB-PCR: positive

  9. 25 days later • CSF cultures Mycobacterium tuberculosis

  10. Subacute/chronic meningitis • Infections: • TB

  11. TB • May follow a slow progress • Exposure, TST/PPD(+), immune suppression • Prodrome 2-4 weeks

  12. Not only menengitis, • Vasculitis, space-occupying lesion (brain tuberculoma) • Fever • Change in mental status • Hemiplegia, paraplegia • Ocular nerve involvement

  13. CSF

  14. neuropathology.neoucom.edu

  15. Clinical Presentation • Most common clinical findings: • Fever • Headache • Vomiting • Nuchal Rigidity

  16. Diagnosis • CSF Examination • Usually lymphocytic pleocytosis • Elevated protein with severely depressed glucose • AFB • Culture • PCR

  17. Diagnosis • Other Studies • Brain imaging – demonstrates hydrocephalus, basilar exudates and inflammation, tuberculoma, cerebral edema, cerebral infarction • CXR • Abnormal, sometimes miliary pattern

  18. seattlechildren.org

  19. Treatment: Antimicrobial Therapy • Start as soon as there is suspicion for TB meningitis • Same Guidelines as those for pulmonary TB • Intensive Phase: 4 drug regimen of Isoniazid, Rifampin, Pyrazinamide, and Ethambutol for 2 months • Continuation Phase: Isoniazid and Rifampin for another 7 – 10 months

  20. Treatment: Adjunctive Therapy • Glucocorticoids Indicated with: • rapid progression from one stage to the next • CT evidence of cerebral edema • worsening clinical signs after starting antiTb meds • increased basilar enhancement, or moderate to advancing hydrocephalus on head CT

  21. Outcomes • Overall Poor • Only 1/3 - 1/2 of patients demonstrate complete neurologic recovery • Up to 1/3 of patients have residual severe neurologic deficits such as hemiparesis, blindness, seizure DO

  22. Another Case Study • A 30-year-old male farmer was admitted with headache, newly-onset seizures, and fever for 1 month • Biochemistry normal • CBC normal • C-RP: 5 Xnormal, ESR 50 mm/h

  23. A 30-year-old male was admitted with headache, newly-onset seizures, and fever for 1 month… • Blood cultures were obtained • MRI: normal • Diagnosed by a serology!...

  24. Rose-Bengal test positive • Wright test positive • 2 bottles of blood culture yielded Brucella melitensis

  25. Rx • Rifampin+Doxycycline

  26. Subacute/chronic meningitis • Infections: • TB • Spirochetal diseases (syphilis, Lyme’s disease) • Brucellosis • Fungal • Cryptococcus neoformans, Aspergillus, Candida Toxoplasmosis,

  27. Neurosyphilis • Infection of the central nervous system by Treponema pallidum • Neurosyphilis can occur at any time after initial infection.

  28. utdol.com

  29. Early NS • Asymptomatic • Symptomatic • Meningovascular • Late NS • General paresis • Tabes dorsalis

  30. A) Focal meningeal enhancement in the left frontal lobe with surrounding edema. B) Significant edema in the left posterior frontal lobe. Cerebral gumma in an HIV-infected patient with recent secondary syphilis. utdol.com

  31. Diagnosis • EIA: syphilis enzyme immunoassay • FTA-ABS: fluorescent treponemal antibody-absorbed test • TPPA: Treponema pallidum particle agglutination test

  32. Rx • Penicillin G benzathine 2.4 million units IM once

More Related