Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e
Chapter 168. Central Nervous System and Spinal Infections
Sections: Bacterial Meningitis, Viral Meningitis, Viral Encephalitis, Brain Abscess, References.
Topics Discussed: central nervous system infection; spinal cord infection.
Excerpt:"The most common causes of bacterial meningitis
in the U.S. are Streptococcuspneumoniae (61%), Neisseria
meningitidis (16%), group B streptococcus (14%), Haemophilus
influenzae (7%), and Listeria monocytogenes (2%).
The median age of illness has risen to 39 years of age, and the
incidence of bacterial meningitis has declined.1 Changes
in epidemiology have mirrored vaccination practices in adults and
children against H. influenzae, S. pneumoniae,
and N. meningitidis. The incidence of penicillin-resistant S.
pneumoniae has increased, so that in some areas it accounts
for approximately one third of cases.1 These facts
are important because they affect the ED selection of empiric antibiotics
for presumptive bacterial meningitis.S. pneumoniae, H. influenzae type
b, and N. meningitidis are encapsulated organisms
that invade the host through the upper airway, survive dissemination
through the blood stream, and then gain access to the subarachnoid
space. The subcapsular constituents of these organisms trigger inflammatory
cascades. The brain and meninges, encased in the fixed-volume skull,
become edematous. Cerebrospinal..."
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