Nervous System Infections In Patients Research Articles

Prevention of central nervous system infections in patients at risk

Infections of the central nervous system in patients at risk are relatively uncommon when compared with pneumonia, bacteremia, and soft tissue infection. However, they carry serious morbidity and are frequently fatal. Each of the diverse conditions that can place a patient at risk for central nervous system infection is associated with a fairly predictable spectrum of etiologic organisms. Various forms of trauma (including blunt and penetrating injuries and neurosurgery, especially when a cerebrospinal fluid shunt is implanted) predispose to infection with common pathogenic bacteria. Defects of cellular immunity including congenital immune deficiencies, immunosuppressive drug therapy, leukemia, lymphoma, and the acquired immune deficiency syndrome are more likely to give rise to infection with a distinctive spectrum of opportunistic viruses, fungi, and protozoa. Other underlying conditions include sinus, ear, and mastoid infections, congenital heart disease, intrathoracic suppuration, endocarditis, and bacteremia, hypogammaglobulinemia, and complement deficiencies. Some preventive measures including vaccines, antibiotics, and surgical procedures are available. However, for many of these central nervous system infections, preventive measures are lacking or less effective than those for infections in other organs. In the future, opportunistic central nervous system infections will increase in frequency as the number of patients at risk continues to grow.

Central Nervous System Infections as a Limiting Factor in the Intelligence of Children with Myelomeningocele

The expectation for intellectual performance of children born with myelomeningocele has often been reported to be significantly decreased due to the presence of hydrocephalus. This study examines the medical histories as well as psychological performance scores of 167 patients observed in our multidisciplinary clinic. Based only on medical histories, the subjects were placed into one of three groups: nonshunted, shunted, and shunted with a history of ventriculitis. Their IQ scores were then compiled and resulted in the following performance breakdown of mean IQs: nonshunted, IQ = 102; shunted, IQ = 95; shunted with a history of ventriculitis, IQ = 72, There were no cases of central nervous system infections in patients who did not have hydrocephalus. Visual motor integration scores were also categorized in the same manner, illustrating a similar trend for severely depressed scores in the group that was shunted and had a history of ventriculitis, while at the same time showing the two remaining groups to be statistically similar. These results have significant importance in the management of hydrocephalus and/or infection as well as indicating the nonpredictability of simple hydrocephalus in the ultimate outcome for intellectual function of those persons born with myelomeningocele.

Central nervous system infections in patients with cancer.Changing patterns

Central nervous system infections in patients with cancer at Memorial Sloan-Kettering Cancer Center from 1971 to 1974 were surveyed and compared with a previous survey from 1955 to 1970. The two periods were similar in that: 1) There was a high incidence of CNS infection in patients with lymphoma, leukemia, and head and spine tumors, 2) specific organisms tended to infect patients with certain primary neoplasms, and 3) fungal infections were common and difficult to diagnose. The two periods differed in that: 1) the overall incidence of CNS infection was lower in 1971 to 1974, 2) there was a decreased incidence of cryptococcal meningitis, and 3) there was an increase in Listeria monocytogenes meningitis. Early recognition of CNS infection and aggressive therapy appears to increase survival.