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Viral meningitis | vaya a nuestro tema completo sobre Viral meningitis Viral meningitis is one of the most common infections of the central nervous system (CNS), and is the most common cause of aseptic meningitis. Causative agents include non-polio human enteroviruses (most commonly), herpes simplex virus, mumps, varicella zoster virus, arboviruses such as West Nile, HIV, and (rarely) influenza.[2] Viral meningitis must be distinguished from bacterial meningitis, which is associated with significant morbidity and mortality. Common symptoms include headache, photophobia, neck stiffness, fever, nausea, and vomiting. Key risk factors include age (most commonly seen in infants and young children, but also young adults and older people) and exposure to insect vectors. |
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Bacterial meningitis in adults | vaya a nuestro tema completo sobre Bacterial meningitis in adults Bacterial meningitis is a serious inflammation of the meninges caused by various bacteria. Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b (Hib) are the predominant causative pathogens.[3] It commonly affects extremes of age because of impaired or waning immunity. Common symptoms include headache, neck stiffness, fever, vomiting/nausea, and altered level of consciousness or cognition. Key risk factors include crowding, exposure to pathogens, cranial anatomical defects, cochlear implants, sickle cell disease, and immunocompromising conditions. |
Bacterial meningitis in children | go to our full topic on Bacterial meningitis in children Bacterial meningitis is a life-threatening inflammation of the meninges caused by various bacteria. It commonly affects children aged <2 years because of a less developed immune system. Red flag symptoms include headache, neck stiffness, fever, and altered level of consciousness or cognition. Symptoms and signs may be difficult to identify in young people, who may appear well at presentation. Key risk factors include incomplete immunisation, immunocompromising conditions, cranial structural defects, medical devices, perinatal period, exposure to pathogens, and contiguous infection. |
Meningococcal disease | go to our full topic on Meningococcal disease Meningococcal infections are caused by N meningitidis, a gram-negative diplococcus that colonises the nasopharynx. The highest rates of invasive meningococcal disease are in children under aged 5 years, especially those under aged 1 year, with a second peak occurring in 11-24 years olds and a third peak in people aged >65 years.[4] Meningococcal infection may progress rapidly to septic shock with hypotension, acidosis, and disseminated intravascular coagulation. Common symptoms include fever, vomiting or nausea, irritable/unsettled, and headache. Key risk factors include young age, complement deficiency, use of eculizumab and ravulizumab, and immunoglobulin deficiency. |
Fungal meningitis | go to our full topic on Fungal meningitis Fungal meningitis presents as a progressive, life-threatening, chronic or subacute meningitis that is most commonly caused by Cryptococcus neoformans. Occurs most commonly in immunosuppressed individuals and is often accompanied by systemic involvement. The incidence of fungal meningitis is increasing worldwide due to the increasing number of patients immunosuppressed by pharmacological agents and the ongoing burden of HIV-associated cryptococcal meningitis in resource-limited countries.[5] Common symptoms include progressive and/or severe headache, meningismus, symptoms of hydrocephalus, behavioural or personality change, and reduced visual acuity and papilloedema. Key risk factors include immunosuppression; exposure to disturbed soil, chicken guano, or bat caves; neutropenia; impaired phagocytic function; and neurosurgery. |
Assessment of rash in children | go to our full topic on Assessment of rash in children Rash in children is common. The differential diagnoses are extensive, ranging from self-limiting conditions to life-threatening illnesses such as meningococcal disease. Meningococcal disease classically presents with abrupt onset of fever and malaise, progressing rapidly (within 24 hours) to signs and symptoms of septicaemia and/or meningitis. A generalised macular rash may be the initial presenting feature of meningococcal disease, although this progresses to a more purpuric rash. Initial considerations in evaluating a rash in children include its morphology, duration, and distribution. Age, sex, family history, drugs, known allergies, and exposures are also of primary importance. |
Extrapulmonary tuberculosis | go to our full topic on Extrapulmonary tuberculosis An infectious disease caused by Mycobacterium tuberculosis that occurs in organ systems other than the lungs. Almost any organ system may be affected by extrapulmonary tuberculosis, including the lymph nodes, CNS, bones/joints, genitourinary tract, abdomen (intra-abdominal organs, peritoneum), and pericardium. Epidemiological risk factors include birth in high tuberculosis-prevalent countries, exposure at place of residence/work in an institutional setting, and homelessness.Tuberculous meningitis results from haematogenous spread of M tuberculosis with the development of submeningeal or intrameningeal foci called Rich foci. With rupture of a Rich focus into the subarachnoid space, meningitis develops. Common symptoms include enlarged lymph nodes, pleuritic chest pain, skeletal pain, urinary symptoms, abdominal swelling and pain. Key risk factors include exposure to tuberculosis; born in Asia, Latin America, or Africa; HIV infection; immunosuppressive drugs; haematological or head/neck malignancy; end-stage renal disease; apical fibrosis; and very young age. |
Rabies | go to our full topic on Rabies An acute viral encephalomyelitis caused by negative-sense RNA viruses of the Lyssavirus genus, which is transmitted by animal bites, mainly dogs in developing countries and bats in other countries including the US. The main burden of disease is located in developing countries in Asia and Africa.[6] Clinically, rabies has two forms: encephalitic (furious) and paralytic. Both forms have a prodrome of fever, chills, malaise, sore throat, vomiting, headaches, and paraesthesias. In encephalitic rabies, this is followed by early-onset behavioural changes and late-onset paralysis. In the paralytic form, the behavioural changes are absent. Key risk factors include a recent scratch or bite from a known vector in a rabies-endemic country, recent contact with a bat, and occupational or recreational exposure. |
Syphilis infection | go to our full topic on Syphilis infection A common sexually transmitted infection caused by the spirochete bacteriumTreponema pallidum, subspecies pallidum. Neurosyphilis is characterised by a chronic, insidious inflammation of the meninges, and is caused by CNS invasion by the T pallidum bacteria, which may occur at any stage of infection. Infection is typically acquired through direct person-to-person sexual contact with an individual who has early (primary or secondary) syphilis.[7] Early neurosyphilis syndromes are usually the result of meningovascular involvement; late neurosyphilis may occur due to meningovascular involvement or direct infection of the brain and spinal cord parenchyma. Clinical presentation is often asymptomatic, but can manifest in a number of ways. Symptoms of headache, meningismus, hearing loss, seizures, or neuropathy suggest neurological involvement. |
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