Skip to main content
SpringerLink
Log in

Infections of the Central Nervous System (CNS) in the ICU

  • Chapter
  • First Online:
Infectious Diseases in the Intensive Care Unit

Abstract

Infections of the central nervous system (CNS) encompass a range of potentially life-threatening infections. They often require acute management and careful monitoring in an intensive care setup. The most common causes of ICU admission due to CNS infections include acute bacterial meningitis, acute viral encephalitis, tuberculous meningitis, fungal meningitis, neurocysticercosis, abscess, and myelitis. Problems necessitating ICU admission related to these infections include raised intracranial pressure, status epilepticus, neurological deficits, and coma necessitating ventilatory support. Acute CNS infections have mortality rates that range from 20 to 25% in acute bacterial meningitis (Mandell et al. 2009), 70% in herpes simplex encephalitis without treatment (30% with treatment) (Daroff et al. 2016), and up to 30–40% in Japanese encephalitis (Solomon et al. 2000).

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover 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

Similar content being viewed by others

References

  • Alvis Miranda H, Castellar-Leones SM, Elzain MA, Moscote-Salazar LR. Brain abscess: current management. J Neurosci Rural Pract. 2013;4(Suppl 1):S67–81.

    PubMed  PubMed Central  Google Scholar 

  • Bonadio WA. The cerebrospinal fluid: physiologic aspects and alterations associated with bacterial meningitis. Pediatr Infect Dis J. 1992;11(6):423–31.

    Article  CAS  PubMed  Google Scholar 

  • Bourgi K, Fiske C, Sterling TR. Tuberculosis meningitis. Curr Infect Dis Rep. 2017;19(11):39.

    Article  PubMed  Google Scholar 

  • Brabin B, Dorman E, Beales PF. Severe falciparum malaria. World Health Organization, Communicable Diseases Cluster. Trans R Soc Trop Med Hyg. 2000;94(Suppl 1):S1–90.

    Google Scholar 

  • Brouwer MC, McIntyre P, Prasad K, van de Beek D. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev∗. 2015;9:CD004405.

    Google Scholar 

  • Carpenter J, Stapleton S, Holliman R. Retrospective analysis of 49 cases of brain abscess and review of the literature. Eur J Clin Microbiol Infect Dis. 2007;26(1):1–11.

    Article  CAS  PubMed  Google Scholar 

  • CDC. Meningitis. Fungal meningitis. Atlanta: CDC. https://www.cdc.gov/meningitis/fungal.html.

  • Chaudhuri A, Kennedy P. Diagnosis and treatment of viral encephalitis. Postgrad Med J. 2002;78(924):575–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Dalmau J, Graus F. Antibody-mediated encephalitis. N Engl J Med. 2018;378(9):840–51.

    Article  PubMed  Google Scholar 

  • Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL. Bradley’s neurology in clinical practice. 7th ed. Philadelphia: Elsevier; 2016.

    Google Scholar 

  • Dastur DK, Manghani DK, Udani PM. Pathology and pathogenetic mechanisms in neurotuberculosis. Radiol Clin N Am. 1995;33(4):733–52.

    CAS  PubMed  Google Scholar 

  • de Gans J, van de Beek D. Dexamethasone in adults with bacterial meningitis. N Engl J Med. 2002;347(20):1549–56.

    Article  PubMed  Google Scholar 

  • Denkinger CM, Schumacher SG, Boehme CC, Dendukuri N, Pai M, Steingart KR. Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis. Eur Respir J. 2014;44(2):435–46.

    Article  PubMed  Google Scholar 

  • Desai BT, Vijayaraghavan A. Neurological intensive care in India. Natl Med J India. 1991;4(4):162–5.

    CAS  PubMed  Google Scholar 

  • Domingues RB, Lakeman FD, Pannuti CS, Fink MCD, Tsanaclis AMC. Advantage of polymerase chain reaction in the diagnosis of herpes simplex encephalitis: presentation of 5 atypical cases. Scand J Infect Dis. 1997;29(3):229–31.

    Article  CAS  PubMed  Google Scholar 

  • Domingues RB, Fink MC, Tsanaclis AM, de Castro CC, Cerri GG, Mayo MS, et al. Diagnosis of herpes simplex encephalitis by magnetic resonance imaging and polymerase chain reaction assay of cerebrospinal fluid. J Neurol Sci. 1998;157(2):148–53.

    Article  CAS  PubMed  Google Scholar 

  • Dorovini-Zis K, Schmidt K, Huynh H, Fu W, Whitten RO, Milner D, et al. The neuropathology of fatal cerebral malaria in malawian children. Am J Pathol. 2011;178(5):2146–58.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gilden DH, Mahalingam R, Cohrs RJ, Tyler KL. Herpesvirus infections of the nervous system. Nat Clin Pract Neurol. 2007;3(2):82–94.

    Article  CAS  PubMed  Google Scholar 

  • Heckenberg SGB, Brouwer MC, van der Ende A, van de Beek D. Adjunctive dexamethasone in adults with meningococcal meningitis. Neurology. 2012;79(15):1563–9.

    Article  CAS  PubMed  Google Scholar 

  • Idro R, Jenkins NE, Newton CRJC. Pathogenesis, clinical features, and neurological outcome of cerebral malaria. Lancet Neurol. 2005;4(12):827–40.

    Article  PubMed  Google Scholar 

  • Kamei S, Sekizawa T, Shiota H, Mizutani T, Itoyama Y, Takasu T, et al. Evaluation of combination therapy using aciclovir and corticosteroid in adult patients with herpes simplex virus encephalitis. J Neurol Neurosurg Psychiatry. 2005;76(11):1544–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kennedy DH, Fallon RJ. Tuberculous meningitis. JAMA. 1979;241(3):264–8.

    Article  CAS  PubMed  Google Scholar 

  • Korinek A-M, Baugnon T, Golmard J-L, van Effenterre R, Coriat P, Puybasset L. Risk factors for adult nosocomial meningitis after craniotomy: role of antibiotic prophylaxis. Neurosurgery. 2006;59(1):126–33; discussion 126–33.

    Article  PubMed  Google Scholar 

  • 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(4):857–63.

    Article  CAS  PubMed  Google Scholar 

  • Lu C-H, Chang W-N, Lui C-C. Strategies for the management of bacterial brain abscess. J Clin Neurosci. 2006;13(10):979–85.

    Article  PubMed  Google Scholar 

  • Mandell G, Bennett J, Dolin R. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 7th ed. London: Churchill Livingstone; 2009.

    Google Scholar 

  • Marin SE, Callen DJA. The magnetic resonance imaging appearance of monophasic acute disseminated encephalomyelitis. Neuroimaging Clin N Am. 2013;23(2):245–66.

    Article  PubMed  PubMed Central  Google Scholar 

  • Marion DW. Complications of head injury and their therapy. Neurosurg Clin N Am. 1991;2(2):411–24.

    Article  CAS  PubMed  Google Scholar 

  • McIntyre PB, Berkey CS, King SM, Schaad UB, Kilpi T, Kanra GY, et al. Dexamethasone as adjunctive therapy in bacterial meningitis. A meta-analysis of randomized clinical trials since 1988. JAMA. 1997;278(11):925–31.

    Article  CAS  PubMed  Google Scholar 

  • Meena AK, Prasad VS, Murthy JM. Neurological intensive care in India--disease spectrum and outcome. Neurol India. 2001;49(Suppl 1):S1–7.

    PubMed  Google Scholar 

  • Miner JR, Heegaard W, Mapes A, Biros M. Presentation, time to antibiotics, and mortality of patients with bacterial meningitis at an urban county medical center. J Emerg Med. 2001;21(4):387–92.

    Article  CAS  PubMed  Google Scholar 

  • Misra UK, Kalita J, Bhoi SK. Spectrum and outcome predictors of central nervous system infections in a neurological critical care unit in India: a retrospective review. Trans R Soc Trop Med Hyg. 2014;108(3):141–6.

    Article  PubMed  Google Scholar 

  • Mollman HD, Haines SJ. Risk factors for postoperative neurosurgical wound infection. A case-control study. J Neurosurg. 1986;64(6):902–6.

    Article  CAS  PubMed  Google Scholar 

  • Nathoo N, Nadvi SS, van Dellen JR. Cranial extradural empyema in the era of computed tomography: a review of 82 cases. Neurosurgery. 1999a;44(4):748–53; discussion 753–4.

    Article  CAS  PubMed  Google Scholar 

  • Nathoo N, Nadvi SS, van Dellen JR, Gouws E. Intracranial subdural empyemas in the era of computed tomography: a review of 699 cases. Neurosurgery. 1999b;44(3):529–35; discussion 535–6.

    Article  CAS  PubMed  Google Scholar 

  • Newton CRJC, Hien TT, White N. Cerebral malaria. J Neurol Neurosurg Psychiatry. 2000;69(4):433–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Nguyen THM, Tran THC, Thwaites G, Ly VC, Dinh XS, Ho Dang TN, et al. Dexamethasone in Vietnamese adolescents and adults with bacterial meningitis. N Engl J Med. 2007;357(24):2431–40.

    Article  CAS  PubMed  Google Scholar 

  • Nigrovic LE, Malley R, Macias CG, Kanegaye JT, Moro-Sutherland DM, Schremmer RD, et al. Effect of antibiotic pretreatment on cerebrospinal fluid profiles of children with bacterial meningitis. Pediatrics. 2008;122(4):726–30.

    Article  PubMed  Google Scholar 

  • Patir R, Mahapatra AK, Banerji AK. Risk factors in postoperative neurosurgical infection. A prospective study. Acta Neurochir. 1992;119(1–4):80–4.

    Article  CAS  PubMed  Google Scholar 

  • Porter SB, Sande MA. Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome. N Engl J Med. 1992;327(23):1643–8.

    Article  CAS  PubMed  Google Scholar 

  • Prasad KN, Mishra AM, Gupta D, Husain N, Husain M, Gupta RK. Analysis of microbial etiology and mortality in patients with brain abscess. J Infect. 2006;53(4):221–7.

    Article  PubMed  Google Scholar 

  • Prasad K, Singh MB, Ryan H. Corticosteroids for managing tuberculous meningitis. Cochrane Database Syst Rev. 2016;4:1–64.

    CAS  Google Scholar 

  • Raggueneau JL, Cophignon J, Kind A, Rey A, Goldstein A, Thurel C, et al. Analysis of infectious sequelae of 1000 neurosurgical operations. Effects of prophylactic antibiotherapy. Neurochirurgie. 1983;29(4):229–33.

    CAS  PubMed  Google Scholar 

  • Rich AR, McCordock HA. Bull. Johns Hopkins Hosp. 1933;52:5–37.

    Google Scholar 

  • Saravolatz LD, Manzor O, VanderVelde N, Pawlak J, Belian B. Broad-range bacterial polymerase chain reaction for early detection of bacterial meningitis. Clin Infect Dis. 2003;36(1):40–5.

    Article  CAS  PubMed  Google Scholar 

  • Scarborough M, Gordon SB, Whitty CJM, French N, Njalale Y, Chitani A, et al. Corticosteroids for bacterial meningitis in adults in sub-Saharan Africa. N Engl J Med. 2007;357(24):2441–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Sethi PK, Khanna L, Batra A, Anand I, Sethi NK, Torgovnick J, Arsura E. Central nervous system fungal infections: observations from a large tertiary hospital in northern India. Clin Neurol Neurosurg. 2012;114(9):1232–7.

    Article  PubMed  Google Scholar 

  • Solomon T, Dung NM, Kneen R, Gainsborough M, Vaughn D, Khanh VT. Japanese encephalitis. J Neurol Neurosurg Psychiatry. 2000;68(4):405–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Solomon T, Hart IJ, Beeching NJ. Viral encephalitis: a clinician’s guide. Pract Neurol. 2007;7(5):288–305.

    Article  PubMed  Google Scholar 

  • Srinivas D, Kumari HV, Somanna S, Bhagavatula I, Anandappa CB. The incidence of postoperative meningitis in neurosurgery: an institutional experience. Neurol India. 2011;59(2):195.

    Article  PubMed  Google Scholar 

  • Streptomycin in Tuberculosis Trials Committee, Medical Research Council. Streptomycin treatment of tuberculous meningitis. Lancet. 1948;251(6503):582–96.

    Google Scholar 

  • Taylor TE, Wirima JJ, Molyneun ME, Davis TME, Brewster D, Hill AS, et al. Hypoglycaemia and cerebral malaria. Lancet. 1990;336(8720):950–1.

    Article  Google Scholar 

  • Tenter AM, Heckeroth AR, Weiss LM. Toxoplasma gondii: from animals to humans. Int J Parasitol. 2000;30(12–13):1217–58.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Thigpen MC, Whitney CG, Messonnier NE, Zell ER, Lynfield R, Hadler JL, et al. Bacterial meningitis in the United States, 1998-2007. N Engl J Med. 2011;364(21):2016–25.

    Article  CAS  PubMed  Google Scholar 

  • Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267–84.

    Article  PubMed  Google Scholar 

  • Tyler KL. Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret’s. Herpes. 2004;11(Suppl 2):57A–64A.

    PubMed  Google Scholar 

  • Tyler KL, Pape J, Goody RJ, Corkill M, Kleinschmidt-DeMasters BK. CSF findings in 250 patients with serologically confirmed West Nile virus meningitis and encephalitis. Neurology. 2006;66(3):361–5.

    Article  CAS  PubMed  Google Scholar 

  • Udwadia FE, Guntupalli KK, Vidyasagar D. Critical care in India. Crit Care Clin. 1997;13(2):317–29.

    Article  CAS  PubMed  Google Scholar 

  • van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med. 2004;351(18):1849–59.

    Article  PubMed  Google Scholar 

  • van de Beek D, de Gans J, Tunkel AR, Wijdicks EFM. Community-acquired bacterial meningitis in adults. N Engl J Med. 2006;354(1):44–53.

    Article  PubMed  Google Scholar 

  • Weisfelt M, de Gans J, van der Ende A, van de Beek D. Community-acquired bacterial meningitis in alcoholic patients. PLoS One. 2010;5(2):e9102.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Whitley RJ, Soong SJ, Linneman C, Liu C, Pazin G, Alford CA. Herpes simplex encephalitis. Clinical assessment. JAMA. 1982;247(3):317–20.

    Article  CAS  PubMed  Google Scholar 

  • WHO. WHO meeting report of a technical expert consultation. Geneva: WHO; 2017.

    Google Scholar 

  • Xiong C-H, Yan Y, Liao Z, Peng S-H, Wen H-R, Zhang Y-X, et al. Epidemiological characteristics of acute disseminated encephalomyelitis in Nanchang, China: a retrospective study. BMC Public Health. 2014;14:111.

    Article  PubMed  PubMed Central  Google Scholar 

  • Xu H-B, Jiang R-H, Li L, Sha W, Xiao H-P. Diagnostic value of adenosine deaminase in cerebrospinal fluid for tuberculous meningitis: a meta-analysis. Int J Tuberc Lung Dis. 2010;14(11):1382–7.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, All India Institute of Medical Sciences, New Delhi, India

    Deepti Vibha & Divyani Garg

Authors
  1. Deepti Vibha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Divyani Garg
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Medicine, All India Institute of Medical Sciences, New Delhi, India

    Manish Soneja

  2. Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India

    Puneet Khanna

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Vibha, D., Garg, D. (2020). Infections of the Central Nervous System (CNS) in the ICU. In: Soneja, M., Khanna, P. (eds) Infectious Diseases in the Intensive Care Unit. Springer, Singapore. https://doi.org/10.1007/978-981-15-4039-4_8

Download citation

  • DOI: https://doi.org/10.1007/978-981-15-4039-4_8

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-4038-7

  • Online ISBN: 978-981-15-4039-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation