Central Nervous System Infections: Meningitis and Brain Abscess

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Despite advances in antimicrobial and antiviral therapy, meningitis and brain abscess are infections that result in significant morbidity and mortality. A multidisciplinary approach, including intensive care, is often required in the treatment of these infections. Meningitis is defined by the presence of the inflammation of the meninges, with characteristic changes in cerebrospinal fluid. Brain abscess is a focal infection of the brain parenchyma, commonly caused by bacterial, fungal, and parasitic pathogens. This article reviews the common infectious etiologies of central nervous system infections, especially bacterial meningitis and brain abscess, and their subsequent management in the intensive care unit.

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.

References (98)

  • S. Kumarvelu et al.

    Randomized controlled trial of dexamethasone in tuberculous meningitis

    Tuber Lung Dis

    (1994)
  • U.B. Schaad et al.

    Dexamethasone therapy for bacterial meningitis in children. Swiss Meningitis Study Group

    Lancet

    (1993)
  • D. van de Beek et al.

    Steroids in adults with acute bacterial meningitis: a systematic review

    Lancet Infect Dis

    (2004)
  • F. Xiao et al.

    Brain abscess: clinical experience and analysis of prognostic factors

    Surg Neurol

    (2005)
  • J.H. Tseng et al.

    Brain abscess in 142 patients: factors influencing outcome and mortality

    Surg Neurol

    (2006)
  • E. Tonon et al.

    Brain abscess: clinical aspects of 100 patients

    Int J Infect Dis

    (2006)
  • K.L. Heilpern et al.

    Focal intracranial infections

    Infect Dis Clin North Am

    (1996)
  • D.J. Farrar et al.

    Tuberculous brain abscess in a patient with HIV infection: case report and review

    Am J Med

    (1997)
  • T. Hakan et al.

    Bacterial brain abscesses: an evaluation of 96 cases

    J Infect

    (2006)
  • M.K. Osborn et al.

    Subdural empyema and other suppurative complications of paranasal sinusitis

    Lancet Infect Dis

    (Jan 2007)
  • W.G. Adams et al.

    Decline of childhood Haemophilus influenzae type b (Hib) disease in the Hib vaccine era

    JAMA

    (1993)
  • Centers for Disease Control and Prevention

    Direct and indirect effects of routine vaccination of children with 7-valent pneumococcal conjugate vaccine on incidence of invasive pneumococcal disease–United States, 1998–2003

    Morb Mortal Wkly Rep

    (2005)
  • C. Choi

    Bacterial meningitis in aging adults

    Clin Infect Dis

    (2001)
  • W.R. Short et al.

    Changing epidemiology of bacterial meningitis in the United States

    Curr Infect Dis Rep

    (2000)
  • M. Weisfelt et al.

    Community-acquired bacterial meningitis in older people

    J Am Geriatr Soc

    (2006)
  • A. Schuchat et al.

    Bacterial meningitis in the United States in 1995. Active Surveillance Team

    N Engl J Med

    (1997)
  • D. van de Beek et al.

    Clinical features and prognostic factors in adults with bacterial meningitis

    N Engl J Med

    (2004)
  • G.D. Overturf

    Indications for the immunological evaluation of patients with meningitis

    Clin Infect Dis

    (2003)
  • N.E. Rosenstein et al.

    Meningococcal disease

    N Engl J Med

    (2001)
  • F.S. Southwick et al.

    Intracellular pathogenesis of listeriosis

    N Engl J Med

    (1996)
  • M.C. Brouwer et al.

    Community-acquired Listeria monocytogenes meningitis in adults

    Clin Infect Dis

    (2006)
  • M. Zuniga et al.

    Listeria monocytogenes meningitis in previously healthy adults: long-term follow-up

    QJM

    (1992)
  • M.A. Samuels et al.

    Case records of the Massachusetts General Hospital. Case 34–2007. A 77-year-old man with ear pain, difficulty speaking, and altered mental status

    N Engl J Med

    (2007)
  • L.A. Jackson et al.

    Risk factors for group B streptococcal disease in adults

    Ann Intern Med

    (1995)
  • G. Le Moal et al.

    Meningitis due to Capnocytophaga canimorsus after receipt of a dog bite: case report and review of the literature

    Clin Infect Dis

    (2003)
  • K.E. Lyke et al.

    Ventriculitis complicating use of intraventricular catheters in adult neurosurgical patients

    Clin Infect Dis

    (2001)
  • A.M. Korinek et al.

    Risk factors for adult nosocomial meningitis after craniotomy: role of antibiotic prophylaxis

    Neurosurgery

    (2006)
  • I.S. Kourbeti et al.

    Risk factors associated with postcraniotomy meningitis

    Neurosurgery

    (2007)
  • M.L. Durand et al.

    Acute bacterial meningitis in adults. A review of 493 episodes

    N Engl J Med

    (1993)
  • K.L. Tyler

    Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's

    Herpes

    (2004)
  • L. Kupila et al.

    Etiology of aseptic meningitis and encephalitis in an adult population

    Neurology

    (2006)
  • Y. Schlesinger et al.

    Herpes simplex virus type 2 meningitis in the absence of genital lesions: improved recognition with use of the polymerase chain reaction

    Clin Infect Dis

    (1995)
  • D. Nash et al.

    The outbreak of West Nile virus infection in the New York City area in 1999

    N Engl J Med

    (2001)
  • D.J. Gubler

    The continuing spread of West Nile virus in the Western hemisphere

    Clin Infect Dis

    (2007)
  • T. Solomon

    Flavivirus encephalitis

    N Engl J Med

    (2004)
  • Center for Disease Control and Prevention. West Nile virus activity–United States, 2007

    Morb Mortal Wkly Rep

    (2008)
  • Center for Disease Control and Prevention

    West Nile virus

  • Center for Disease Control and Prevention

    Update: multistate outbreak of mumps–United States, January 1–May 2, 2006

    Morb Mortal Wkly Rep

    (2006)
  • S.A. Fischer et al.

    Transmission of lymphocytic choriomeningitis virus by organ transplantation

    N Engl J Med

    (2006)
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