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CNS & Cardiac Infections - Coggle Diagram
CNS & Cardiac Infections
Meningitis
Causes: bacteria, viruses, fungi, protozoa
Bacterial Meningitis:
Acute= onset of signs & symptoms over hours to days
Chronic= onset of signs & symptoms over weeks to months
Acute Bacterial Meningitis
Medical emergency
Mortality; Haemophilus influenzae 5%, Neisseria meningitidis 7-10%, Streptococcus pneumoniae 20-30%
Morbidity: abscesses, hydrocephalus, seizures, learning difficulties
Causes: Group B strep., Ecoli, s. aureus, klebsiella, proteus
Haematogenous spread: most common, foci in nasopharynx, lung, heart valves
Contiguous spread: septic foci in head
Direct implantation: trauma, neurosurgical procedures
Presentation: fever, headache, nausea, photophobia, neck stiffness, pyrexia, kernig's sign, brudzinski's sign, rash
Investigations: lumbar puncture with examination of CSF, blood culture, PCR
Treatment: neonate- 3months ampicillin + cefotaxime. 3months - 50 yrs vancomycin + cefotaxime.
Over 50 yrs vancomycin + ampicillin + cefotaxime
Normal CSF
protein 0.1 - 0.4
Glucose >60% blood glucose
Cell count <6, all lymphocytes, no RBC
CSF Acute Bacterial Meningitis
Protein >1.0 g/L
Glucose <50% blood glucose
Cell count 100-10,000 predominantly polymorphs
Encephalitis
Viruses: Herpes, Arboviruses, mumps, measles, rubella,
Protozoa & Fungi: Toxoplasma gondii, Cryptococcus neoformans
Bacteria: Treponema pallidum, Mycoplasma pneumoniae
Clinical features: disturbance in LOC, confusion, drowsiness, personality change, seizures
Investigations: Lumbar puncture, EEG, MRI, serology
Herpes Simplex Encephalitis: acute asymmetrical necrotising infection primarily of temporal or frontal lobes
Meningococcal Meningitis
Neisseria meningitidis
Highest risk <1 years old
Sporadic or outbreaks
Treatment: Cefotaxime, Benzylpenicillin
Chemoprophylaxis: eradicate nasopharyngeal colonization. Ciprofloxacin
Viral Meningitis
most common
Causative viruses: Echovirus, Mumps, Herpes, Poliovirus, Flu A or B
Enteroviruses: 80-85% of all cases
Infective endocarditis
Predisposing Factors:
1.Endocardial Disease- congenital/rheumatic/degenerative/ heart disease
2.Transient bacteraemia- mouth, genitourinary/gastrointestinal tract, skin.
Vegetation; continuous bacteraemia, valve destruction, embolization
Causes: Staph. aureus, Viridans strep., enterococci, gram - bacteria, fungi
Clinical Features:
1.Bacteraemia- fever, chills, loss of appetite
2.Valve/ local destruction- valvular incompetence, conduction abnormalities.
3.Embolisation- CNS, peripheral limb arteries
Subacute: indolent process
Acute: more aggressive
Diagnosis: blood cultures (before antibiotics), echocardiogram
Treatment: antimicrobial therapy after blood cultures, IV high dose, bactericidal, prolonged course 4-6weeks
Native valve 4 weeks
Prosthetic valve 6 weeks