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Central Nervous System Infections in the Elderly

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Brain and Spine Surgery in the Elderly

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Abstract

Elderly patients with central nervous system (CNS) infections suffer from higher rates of neurological morbidity and mortality. Community-acquired meningitis, healthcare-associated meningitis, and encephalitis have distinct clinical presentations and diagnostic challenges, with some etiologies requiring urgent empirical treatment for cure and survival. In elderly patients with suspected bacterial meningitis, empiric antimicrobial therapy with vancomycin, ampicillin, and a third-generation cephalosporin (either cefotaxime or ceftriaxone) with adjunctive dexamethasone is recommended. In patients with healthcare-associated meningitis, empirical therapy with vancomycin plus an antipseudomonal beta-lactam agent (e.g., ceftazidime, cefepime, or meropenem) should be initiated. In those patients with suspected viral encephalitis, a cerebrospinal fluid (CSF) polymerase chain reaction for herpes simplex virus types 1 and 2 and, in endemic areas, a CSF West Nile IgM should be ordered; empiric acyclovir therapy should be started as soon as possible in patients with suspected herpes simplex encephalitis to avoid substantial morbidity and mortality.

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Authors and Affiliations

  1. UT Health McGovern Medical School, 6431 Fannin St. 2.112 MSB, Houston, TX, 77030, USA

    Rodrigo Hasbun MD, MPH

  2. Warren Alpert Medical School of Brown University, 222 Richmond Street, Room G-M143, Providence, RI, 02912, USA

    Allan R. Tunkel MD, PhD

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  1. Rodrigo Hasbun MD, MPH
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  2. Allan R. Tunkel MD, PhD
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Correspondence to Rodrigo Hasbun MD, MPH .

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Editors and Affiliations

  1. Department of Neurosurgery, University Hospital of Lyon, Lyon, France

    Moncef Berhouma

  2. Hôpital des Charpennes, Hospices civils de Lyon, Villeurbanne, France

    Pierre Krolak-Salmon

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Hasbun, R., Tunkel, A.R. (2017). Central Nervous System Infections in the Elderly. In: Berhouma, M., Krolak-Salmon, P. (eds) Brain and Spine Surgery in the Elderly. Springer, Cham. https://doi.org/10.1007/978-3-319-40232-1_6

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  • DOI: https://doi.org/10.1007/978-3-319-40232-1_6

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