NEW TREND IN DIAGNOSIS AND MANAGEMENT OF DENGUE SHOCK SYNDROME

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NEW TREND IN DIAGNOSIS AND MANAGEMENT OF DENGUE SHOCK SYNDROME Powered By Docstoc
					ACUTE CNS INFECTION


                           ิ
       ผศ.นพ.โอฬาร พรหมาลิขต
                 ื้
    หน่วยโรคติดเชอ ภาควิชากุมารเวชศาสตร์
  คณะแพทยศาสตร์ มหาวิทยาลัยศรีนครินทรวิโรฒ
           CNS INFECTION

 Meningitis               Bacteria
 Encephalitis             M. tuberculosis
 Meningoencephalitis    Virus
 Brain abscess          Fungus
 Myelitis               Parasite
 Medullary abscess      Protozoa
           CNS INFECTION

   Viral meningitis / encephalitis
     - enteroviruses     - HSV
     - arboviruses       - adenovirus
     - mumps             - measles
     - rubella
   Bacterial meningitis
    Bacterial meningitis

   Hematogenous spreading
   Adjacent organs
   Direct penetration
   Iatrogenic
    Clinical manifestations

   Fever
   Convulsion
   Headache
   Nausea/ Vomiting
   Bulging anterior fontanelle
   Meningeal irritation
              CSF FINDING
               CELL      SUGAR   PROTEIN

Bacterial    I (PMN)       L       H
meningitis
   TB        I (Lymph)     L       H
meningitis
 Aseptic     I (Lymph)    N        N/H
meningitis
  Brain         N/I       N        H
 abscess
    BACTERIAL MENINGITIS
   New born (0-30 days)
      - GBS
      - E. coli
      - P. aeruginosa
      - K. pneumoniae
      - Enterobacter spp.
      - Salmonella spp.
    BACTERIAL MENINGITIS
   Beyond neonatal period

       -   S. pneumoniae
       -   H. influenza
       -   Salmonella spp.
       -   N. meningitidis
           Empirical antibiotic


     AGE            CHOICE         ALTERNATIVE
 NB – 2 mo.       Cefotaxime or    Ampicillin (PGS)
                  Ceftriaxone +                +
                 Aminoglycosides   Aminoglycosides
>2 mo. – 14 y.     Cefotaxime      Ampicillin (PGS)
                       or                      +
                   Cetriaxone      Chloramphenicol
Drug Resistant
S.pneumoniae
Drug Resistant S.pneumoniae

Vancomycin 60 mg/kg/day +
Cefotaxime 225-300 mg/kg/day or
Ceftriaxone 100 mg/kg/day
             Susceptibility Testing

       Antibiotic   Susceptible        Non-susceptible
                     (μg/ml)              (μg/ml)
                                  Intermediate Resistance
Penicillin            < 0.06        0.1-1.0       >2


Ceftriaxone OR
Cefotaxime
  - Non-Meningeal      <1.0           2.0         >4.0
  - Meningeal          <0.5           1.0         >2.0

                                                  Red Book 2006
    Drug Resistant S.pneumoniae

 Susceptible to penicillin
   - penicillin
   - continue cefotaxime or ceftriaxone
 Nonsusceptible to penicillin but
  susceptible to cefotaxime & ceftriaxone
   - continue cefotaxime or ceftriaxone
    Drug Resistant S.pneumoniae


   Nonsusceptible to penicillin, cefotaxime,
    and ceftriaxone

      - continue vancomycin and cefotaxime
        or ceftriaxone
    Drug Resistant S.pneumoniae

   Allergic to beta-lactam antibiotics
      - vancomycin + rifampicin
      - meropenem
      - chloramphenicol (MBC < 4 μg/ml)
 Duration of antibiotic use in
    bacterial meningitis

   GBS                   14-21   days
   L. monocytogenes      14-21   days
 Gram negative bacilli    » 21   days
 Hib                     10-14   days
 S. pneumoniae             14    days
 N. meningitidis          7-10   days
      COMPLICATIONS

   Seizure
   Subdural effusion/ empyema
   Ventriculitis
   Brain abscess
   Hydrocephalus
   Deafness/ visual field defect
   SIADH
       COMPLICATIONS

   Relapse meningitis
   Recrudescence meningitis
   Recurrent meningitis

				
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posted:5/24/2012
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