Skip to main content

Infections of the Nervous System

  • Chapter
  • First Online:
Neurology

Abstract

Diagnosing and treating neurological infectious diseases are often difficult for both neurologists and infectious disease specialists. Treatment of neurological infectious diseases is frequently based on anecdotal or experiential evidence rather than on evidence from controlled trials. Although studies are lacking for many specific neurological infectious diseases, good evidence exists to support the treatment of bacterial meningitis, herpes encephalitis, neurocysticercosis, and fungal meningitis. This chapter evaluates the available literature and presents treatment options based on those data.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Pfister H-W, Roos KL. Bacterial Meningitis. In: Roos KL, editor. Principles of neurologic infectious diseases. New York: McGraw -Hill; 2005. p. 13–28.

    Google Scholar 

  2. Schuchat A, Robinson K, Wenger JD, et al. Bacterial meningitis in the United States in 1995. N Engl J Med. 1997;337:970–6.

    Article  PubMed  CAS  Google Scholar 

  3. Pizon AF, Bonner MR, Wang HE, Kaplan RM. Ten years of clinical experience with adult meningitis at an urban academic medical center. J Emerg Med. 2006;30:367–70.

    Article  PubMed  Google Scholar 

  4. Dawson KG, Emerson JC, Burns JL. Fifteen years of experience with bacterial meningitis. Pediatr Infect Dis J. 1999;18:816–22.

    Article  PubMed  CAS  Google Scholar 

  5. Nigrovic LE, Kuppermann N, Malley R. Children with bacterial meningitis presenting to the Emergency Department during the Pneumococcal conjugate vaccine era. Acad Emerg Med. 2008;15:522–8.

    Article  PubMed  Google Scholar 

  6. Hasbun R, Abrahams J, Jekel J, Quagliarello VJ. Computed tomography of the head before lumbar puncture in adults with suspected meningitis [see comment]. N Engl J Med. 2001;345:1727–33.

    Article  PubMed  CAS  Google Scholar 

  7. Greig PR, Goroszeniuk D. Role of computed tomography before lumbar puncture: a survey of clinical practice. Postgrad Med J. 2006;82:162–5.

    Article  PubMed  CAS  Google Scholar 

  8. van Crevel H, Hijdra A, de Gans J. Lumbar puncture and the risk of herniation: when should we first perform CT? J Neurol. 2002;249:129–37.

    Article  PubMed  Google Scholar 

  9. Ray P, Badarou-Acossi G, Viallon A, et al. Accuracy of the cerebrospinal fluid results to differentiate bacterial from non bacterial meningitis, in case of negative gram-stained smear. Am J Emerg Med. 2007;25:179–84.

    Article  PubMed  Google Scholar 

  10. Nigrovic LE, Malley R, Macias CG, et al. Effect of antibiotic pretreatment on cerebrospinal fluid profiles of children with bacterial meningitis. Pediatrics. 2008;122:726–30.

    Article  PubMed  Google Scholar 

  11. Roos KL, editor. Principles of neurologic infectious diseases. New York: McGraw-Hill; 2005.

    Google Scholar 

  12. Poppert S, Essig A, Stoehr B, et al. Rapid diagnosis of bacterial meningitis by real-time PCR and fluorescence in situ hybridization. J Clin Microbiol. 2005;43:3390–7.

    Article  PubMed  CAS  Google Scholar 

  13. Tunkel Allan R, Hartman Barry J, Kaplan Sheldon L, et al. Practice Guidelines for the Management of Bacterial Meningitis. Clin Infect Dis. 2004;39:1267–84.

    Article  PubMed  CAS  Google Scholar 

  14. Prasad K, Karlupia N, Kumar A. Treatment of bacterial meningitis: an overview of Cochrane systematic reviews. Respir Med. 2009;103:945–50.

    Article  PubMed  Google Scholar 

  15. de Gans J, van de Beek D. European dexamethasone in adulthood bacterial meningitis study I. Dexamethasone in adults with bacterial meningitis. N Engl J Med. 2002;347:1549–56.

    Article  PubMed  Google Scholar 

  16. Dzupova O, Rozsypal H, Prochazka B, Benes J. Acute bacterial meningitis in adults: predictors of outcome. Scand J Infect Dis. 2009;41:348–54.

    Article  PubMed  CAS  Google Scholar 

  17. Cabellos C, Verdaguer R, Olmo M, et al. Community-acquired bacterial meningitis in elderly patients: experience over 30 years. Medicine (Baltimore). 2009;88:115–9.

    Article  Google Scholar 

  18. Ishihara M, Kamei S, Taira N, et al. Hospital-based study of the prognostic factors in adult patients with acute community-acquired bacterial meningitis in Tokyo, Japan. Intern Med. 2009;48:295–300.

    Article  PubMed  Google Scholar 

  19. King NL, Roos KL. Herpesvirus Encephalitis. In: Halperin JJ, editor. Encephalitis: diagnosis and treatment. New York: Informa Healthcare; 2008.

    Google Scholar 

  20. Whitley RJ, Gnann JW. The incidence and severity of herpes simplex encephalitis in Sweden, 1990–2001. Clin Infect Dis. 2007;45:881–2.

    Article  PubMed  Google Scholar 

  21. Rantalaiho T, Farkkila M, Vaheri A, Koskiniemi M. Acute encephalitis from 1967 to 1991. J Neurol Sci. 2001;184:169–77.

    Article  PubMed  CAS  Google Scholar 

  22. Hjalmarsson A, Blomqvist P, Skoldenberg B. Herpes simplex encephalitis in Sweden, 1990–2001: incidence, morbidity, and mortality. Clin Infect Dis. 2007;45:875–80.

    Article  PubMed  Google Scholar 

  23. Kennedy PGE. Viral encephalitis. J Neurol. 2005;252:268–72.

    Article  PubMed  Google Scholar 

  24. Lakeman FD, Whitley RJ. Diagnosis of herpes simplex encephalitis: application of polymerase chain reaction to cerebrospinal fluid from brain-biopsied patients and correlation with disease. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. J Infect Dis. 1995;171:857–63.

    Article  PubMed  CAS  Google Scholar 

  25. McGrath N, Anderson NE, Croxson MC, Powell KF. Herpes simplex encephalitis treated with acyclovir: diagnosis and long term outcome. J Neurol Neurosurg Psychiatry. 1997;63:321–6.

    Article  PubMed  CAS  Google Scholar 

  26. Meyding-Lamade UK, Oberlinner C, Rau PR, et al. Experimental herpes simplex virus encephalitis: a combination therapy of acyclovir and glucocorticoids reduces long-term magnetic resonance imaging abnormalities. J Neurovirol. 2003;9:118–25.

    PubMed  CAS  Google Scholar 

  27. Nakano A, Yamasaki R, Miyazaki S, Horiuchi N, Kunishige M, Mitsui T. Beneficial effect of steroid pulse therapy on acute viral encephalitis. Eur Neurol. 2003;50:225–9.

    Article  PubMed  CAS  Google Scholar 

  28. Raschilas F, Wolff M, Delatour F, et al. Outcome of and prognostic factors for herpes simplex encephalitis in adult patients: results of a multicenter study. Clin Infect Dis. 2002;35:254–60.

    Article  PubMed  Google Scholar 

  29. Gaffo AL, Guillen-Pinto D, Campos-Olazabal P, Burneo JG. Cysticercosis as the main cause of partial seizures in children in Peru. Rev Neurol. 2004;39:924–6.

    PubMed  CAS  Google Scholar 

  30. Garcia HH, Gilman R, Martinez M, et al. Cysticercosis as the major cause of epilepsy in Peru. The Cysticercosis Working Group in Peru (CWG). Lancet. 1993;341:197–200.

    Article  PubMed  CAS  Google Scholar 

  31. Roman G, Sotelo J, Del Brutto O, et al. A proposal to declare neurocysticercosis an international reportable disease. Bull World Health Organ. 2000;78:399–406.

    PubMed  CAS  Google Scholar 

  32. Wallin MT, Kurtzke JF. Neurocysticercosis in the United States. Neurology. 2004;63:1559–64.

    PubMed  Google Scholar 

  33. Burneo JG, Plener I. Neurocysticercosis and Epilepsy Research Network. Neurocysticercosis in a patient in Canada. CMAJ. 2009;180:639–42.

    Article  PubMed  Google Scholar 

  34. Del Brutto OH, Roos KL, Coffey CS, Garcia HH. Meta-analysis: cysticidal drugs for neurocysticercosis: albendazole and praziquantel. Ann Intern Med. 2006;145:43–51.

    PubMed  Google Scholar 

  35. Murthy JMK, Reddy YVS. Prognosis of epilepsy associated with single CT enhancing lesion: a long term follow up study. J Neurol Sci. 1998;159:151–5.

    Article  PubMed  CAS  Google Scholar 

  36. Del Brutto OH, Rajsekhar B, White AC, et al. Proposed diagnostic criteria for neurocysticercosis. Neurology. 2001;57:177–88.

    PubMed  Google Scholar 

  37. Garcia HH, Pretell EJ, Gilman RH, et al. A trial of antiparasitic treatment to reduce the rate of seizures due to cerebral cysticercosis. N Engl J Med. 2004;350:249–58.

    Article  PubMed  CAS  Google Scholar 

  38. Kalra V, Dua T, Kumar V. Efficacy of albendazole and short-course dexamethasone treatment in children with 1 or 2 ring-enhancing lesions of neurocysticercosis: a randomized controlled trial. J Pediatr. 2003;143:111–4.

    PubMed  CAS  Google Scholar 

  39. Miller LG, Choi C. Meningitis in older patients: how to diagnose and treat a deadly infection. Geriatrics. 1997;52:43–4.

    PubMed  CAS  Google Scholar 

  40. Safdieh JE, Mead PA, Sepkowitz KA, Kiehn TE, Abrey LE. Bacterial and fungal meningitis in patients with cancer. Neurology. 2008;70:943–7.

    Article  PubMed  CAS  Google Scholar 

  41. Bicanic T, Harrison TS. Cryptococcal meningitis. Br Med Bull. 2004;72:99–118.

    Article  PubMed  Google Scholar 

  42. Drake KW, Adam RD. Coccidioidal meningitis and brain abscesses: analysis of 71 cases at a referral center. Neurology. 2009;73:1780–6.

    Article  PubMed  Google Scholar 

  43. Offiah CE, Turnbull IW. The imaging appearances of intracranial CNS infections in adult HIV and AIDS patients. Clin Radiol. 2006;61:393–401.

    Article  PubMed  CAS  Google Scholar 

  44. King NL, Roos KL. Therapy of central nervous system infections. In: Johnston MV, Gross RA, editors. Principles of drug therapy in neurology. Oxford: Oxford University Press; 2008.

    Google Scholar 

  45. Arsura EL, Johnson R, Penrose J, et al. Neuroimaging as a guide to predict outcomes for patients with coccidioidal meningitis. Clin Infect Dis. 2005;40:624–7.

    Article  PubMed  Google Scholar 

  46. van Driel JJ, Bekker V, Spanjaard L, van der Ende A, Kuijpers TW. Epidemiologic and microbiologic characteristics of recurrent bacterial and fungal meningitis in the Netherlands, 1988–2005. Clin Infect Dis. 2008;47:e42–51.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nicholas L. King MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

King, N.L., Burneo, J.G. (2012). Infections of the Nervous System. In: Burneo, J., Demaerschalk, B., Jenkins, M. (eds) Neurology. Springer, New York, NY. https://doi.org/10.1007/978-0-387-88555-1_12

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-88555-1_12

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-88554-4

  • Online ISBN: 978-0-387-88555-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics