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Published on: May 12, 2013
Principles of Management of Central Nervous System Infections
Sunit Singhi1, Suresh Kumar Angurana2
1Division of Pediatrics, Medanta- The Medicity, Sector 38, Gurugram, Haryana, 122001, India. sunit.singhi@gmail.com.
Insights
Central nervous system (CNS) infections in children are emergencies requiring prompt diagnosis and management. Early recognition, laboratory tests, and swift antimicrobial therapy are crucial for better outcomes and reduced mortality.
Area of Science:
- Pediatric infectious diseases
- Pediatric neurology
- Critical care medicine
Background:
- Central nervous system (CNS) infections in children represent a critical medical emergency.
- These infections are associated with significant mortality and morbidity.
- A high index of suspicion is essential for timely diagnosis.
Purpose of the Study:
- To outline the diagnostic approach for CNS infections in children.
- To detail the immediate management strategies for pediatric CNS infections.
- To emphasize the importance of protocolized care for improved outcomes.
Main Methods:
- Clinical assessment supplemented by laboratory investigations including CSF Gram stain and cultures, blood culture, PCR on CSF, serological tests, and imaging.
- Immediate management addressing airway, breathing, and circulation.
- Protocolized management of raised intracranial pressure (ICP) and status epilepticus.
Main Results:
- Common life-threatening complications include coma, seizure, raised ICP, focal deficits, shock, respiratory failure, and fluid/electrolyte abnormalities.
- Prompt administration of appropriate antimicrobial agents based on suspected pathogens is vital.
- Close monitoring for early detection of complications is necessary.
Conclusions:
- Integrated clinical evaluation, laboratory workup, specific antimicrobial therapy, and supportive treatment are essential.
- Protocolized management of CNS infections in children leads to better outcomes.
- Multifaceted and prompt intervention is key to reducing mortality and morbidity.
Abstract:
CNS infections in children are medical emergency and are associated with high mortality and morbidity. For diagnosis, a high index of suspicion is required. Clinical assessment should be supplemented by laboratory investigations including CSF Gram stain and cultures, blood culture, PCR on CSF, serological tests, and imaging. Commonly associated life threatening complications include coma, seizure, raised intracranial pressure (ICP), focal deficits, shock, respiratory failure, and fluid and electrolyte abnormalities. Immediate management should first address control of airway, breathing and circulation; protocolized management of raised ICP and status epilepticus; maintaining adequate intravascular volume; and close monitoring for early detection of complications. Appropriate antimicrobial agents should be administered promptly according to the suspected pathogen. Clinical evaluation, laboratory workup, specific antimicrobial therapy, supportive treatment, and management of associated complications should go hand in hand in a protocolized way for better outcome.
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