Central Nervous System Infections: Meningitis and Brain Abscess
Section snippets
Bacterial meningitis
Bacterial meningitis can be divided into community-onset and nosocomial infections. The development of effective vaccines against Hemophilus influenzae type-b and Streptococcus pneumoniae resulted in a profound decline in the incidence of community-acquired bacterial mening itis among children in the United States since the 1980s.1, 2 However, among adults, the annual incidence of community-onset bacterial meningitis (three to six cases per 100,000 persons) has not changed over the past decade.3
Epidemiology and Etiology
Because of improvements in the treatment of ear, sinus, and orofacial infections over the last half century, brain abscesses are rare, with only 1,500 to 2,500 infections each year in the United States.81 Delays in hospitalization, focal neurologic deficits at admission, impaired host immunity, uncontrolled diabetes, and Glasgow Coma Scale less than 12 are associated with death and permanent neurologic deficits because of brain abscesses.82, 83, 84, 85 Understanding the pathogenesis of brain
Subdural empyema
Subdural empyema, which is defined as a purulent infection of the space between the cranial dura and arachnoid membrane, is a neurosurgical emergency, with approximately 10% to 13% mortality, despite aggressive neurosurgical management.95, 96 The pathogenesis of subdural empyema is similar to those of brain abscess: direct extension from a contiguous foci (eg, paranasal sinus diseases, cranial osteomyelitis, or cranial trauma), or hematogenous spread from distant foci. The microbiology of
Summary
Meningitis and brain abscess are life-threatening infectious diseases requiring the highest medical attention. A multidisciplinary approach, including emergency medicine, infectious diseases, neurology, and neurosurgery facilitates prompt diagnosis and treatment. Acknowledgment of treatment strategy will lead to improving the outcome of central nervous system infection.
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