Section 17. Infectious Diseases >
Part 2. Infections of Organ Systems >
Chapter 231. Bacterial Infections of the Central Nervous SystemThomas S. Murray and Robert S. Baltimore
Topics Discussed: antibiotic therapy, empirical; central nervous system bacterial infections; infectious diseases; meningitis, bacterial; meningitis, haemophilus; meningitis, pneumococcal; meningococcal meningitis; neurology.
Sections: Brain Abscess, Spinal Abscess, Intervertebral Disc Infection, References.
Excerpt:"Meningitis, an infection of the subarachnoid space and leptomeninges
caused by a variety of pathogenic organisms, continues to be an
important source of mortality and morbidity. Despite the introduction
of new vaccines that prevent the most severe causes, bacterial, or purulent,
meningitis remains the most important form in the United
States in terms of incidence, sequelae, and ultimate loss of productive life. Aseptic
meningitis, usually caused by viruses, especially enteroviruses
(see Chapter 306) is more common; however,
significant sequelae are uncommon and the disease is usually self-limited. Granulomatous
meningitis, caused either by M tuberculosis or
fungi, is a major cause of neurologic injury and death in the developing
world (See Chapter 269).The first month after birth represents the period of highest
attack rate for meningitis, with likely pathogens including group
B streptococci (Streptococcus agalactiae), Escherichia coli, other
gram-negative enteric organisms, and less commonly, Listeria
monocytogenes (Table 231-1). Beyond
the neonatal period, the most important pathogens are Streptococcus
pneumoniae and Neisseria meningitidis. Formerly, Haemophilus
influenzae type b (Hib) was the most common
pathogen causing meningitis in infants and children, but the incidence
has been reduced substantially by immunization with conjugate vaccines
in developed countries.1,2 Recent studies of conjugate..."
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