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CNS infections guidelines

Lisa Van de Wijer, Arnt F A Schellekens, David M Burger, Judith R Homberg, Quirijn de Mast, Andre J A M van der Ven
The non-nucleoside reverse transcriptase inhibitor efavirenz is part of the WHO guidelines for preferred first-line treatment of HIV-1-infected adults, pregnant and lactating women, and children. Efavirenz is well known to cause CNS toxicity. Although good data for CNS toxicity are available for adults, the opposite is true for children. Paediatric studies on this topic frequently suffer from small sample sizes or absence of thorough neuropsychiatric assessments. In this Personal View, we focus on two knowledge gaps of CNS toxicity of efavirenz in children...
May 2016: Lancet Infectious Diseases
Heng Gee Lee, Timothy William, Jayaram Menon, Anna P Ralph, Eng Eong Ooi, Yan'an Hou, October Sessions, Tsin Wen Yeo
BACKGROUND: Central nervous system (CNS) infections are a significant contributor to morbidity and mortality globally. However, most published studies have been conducted in developed countries where the epidemiology and aetiology differ significantly from less developed areas. Additionally, there may be regional differences due to variation in the socio-economic levels, public health services and vaccination policies. Currently, no prospective studies have been conducted in Sabah, East Malaysia to define the epidemiology and aetiology of CNS infections...
2016: BMC Infectious Diseases
E Firlag-Burkacka, P Swiecki, I Cielniak, E Siwak, J Gizinska, E Bakowska, J Kubicka, P Pulik, J Kowalski, R Podlasin, A Horban
BACKGROUND: Syphilis is an infection frequently seen with HIV, and European guidelines on the management of syphilis suggest that HIV-infected patients may have an increased risk of early neurological involvement, sometimes asymptomatic. Recent study shows a relationship between neurosyphilis and cerebrospinal fluid (CSF) HIV viral load (VL), which in turn may be associated with subsequent neurocognitive decline. OBJECTIVES AND METHODS: The aim of the study was estimation of the frequency of neurosyphilis among HIV-positive patients with early syphilis...
May 2016: HIV Medicine
M Schmidt-Hieber, G Silling, E Schalk, W Heinz, J Panse, O Penack, M Christopeit, D Buchheidt, U Meyding-Lamadé, S Hähnel, H H Wolf, M Ruhnke, S Schwartz, G Maschmeyer
Infections of the central nervous system (CNS) are infrequently diagnosed in immunocompetent patients, but they do occur in a significant proportion of patients with hematological disorders. In particular, patients undergoing allogeneic hematopoietic stem-cell transplantation carry a high risk for CNS infections of up to 15%. Fungi and Toxoplasma gondii are the predominant causative agents. The diagnosis of CNS infections is based on neuroimaging, cerebrospinal fluid examination and biopsy of suspicious lesions in selected patients...
July 2016: Annals of Oncology: Official Journal of the European Society for Medical Oncology
Desiderio Passali, Anna Crisanti, Luisa Maria Bellussi
Acute rhinosinusitis (ARS) is a very common/disease faced more often by general practitioners than ear, nose and throat specialists, pneumologists or allergologists. In an outpatients setting, upper respiratory tract infection is the third most common cause of a primary care consultation, one third of which is attributable to ARS, diagnosed upon clinical presentation. In some cases however, signs and symptoms do not allow clear differentiation from viral, post-viral or bacterial infection. This compels GPs and family doctors to make a careful choice and first use the best antimicrobial treatment to avoid recurrences or complications and the rise of antibiotic resistance...
December 2015: Le Infezioni in Medicina
Sylviane Defres, Josephine Mayer, Ruth Backman, Rachel Kneen
Lumbar punctures are essential in the management of suspected CNS infections. However, despite clear guidelines their use can be haphazard. This survey investigated the training, knowledge and experience of UK doctors in training in relation to lumbar punctures.
November 2015: British Journal of Hospital Medicine
F Tissot, G Prod'hom, O Manuel, G Greub
The impact of round-the-clock cerebrospinal fluid (CSF) Gram stain on overnight empirical therapy for suspected central nervous system (CNS) infections was investigated. All consecutive overnight CSF Gram stains between 2006 and 2011 were included. The impact of a positive or a negative test on empirical therapy was evaluated and compared to other clinical and biological indications based on institutional guidelines. Bacterial CNS infection was documented in 51/241 suspected cases. Overnight CSF Gram stain was positive in 24/51...
September 2015: European Journal of Clinical Microbiology & Infectious Diseases
Kamga Hortense Gonsu, Etienne Guenou, Michel Toukam, Valantine Ngum Ndze, Calixte Didier Mbakop, Dongmo Norbert Tankeu, Francois Xavier Mbopi-Keou, Samuel Takongmo
INTRODUCTION: Many studies still show significant numbers of surgical patients contracting nosocomial infections each year globally with high morbidity and mortality. The aim of this study was to identify potential bacteria reservoirs that may be responsible for nosocomial infection in surgical services in the Yaoundé University Teaching Hospital (YUTH) and the Central Hospital Yaoundé (CHY). METHODS: A cross sectional descriptive study was conducted from June to August 2012...
2015: Pan African Medical Journal
Francesco Chiappelli, Silvana Maria Eloi Santos, Xenia Maria Caldeira Brant, Andre Bakhordarian, April D Thames, Carl A Maida, Angela M Du, Allison L Jan, Melissa Nahcivan, Mia T Nguyen, Nateli Sama
UNLABELLED: Dengue, a leading cause of illness and death in the tropics and subtropics since the 1950׳s, is fast spreading in the Western hemisphere. Over 30% of the world׳s population is at risk for the mosquitoes that transmit any one of four related Dengue viruses (DENV). Infection induces lifetime protection to a particular serotype, but successive exposure to a different DENV increases the likelihood of severe form of dengue fever (DF), dengue hemorrhagic fever (DHF), or dengue shock syndrome (DSS)...
2014: Bioinformation
Choi Younghwan, Song Changmin, Park Eunok, Hyunjin Oh
INTRODUCTION: Safe and reliable vascular access is essential for the treatment and care of burn patients. Peripherally inserted central catheters (PICCs) are widely used for various groups of critically and chronically ill patients. However, the information about PICC use and management for burn patients is limited. METHODS: The Institutional Review Board approved retrospective cohort chart review included all burn patients at a single center who received one or more PICCs (n=106)...
September 2015: Burns: Journal of the International Society for Burn Injuries
Jon F Watchko, M Jeffrey Maisels
Low bilirubin kernicterus in preterm neonates, though rare, remains an unpredictable and refractory form of brain injury. Hypoalbuminemia, co-morbid CNS insult(s), infection, and inflammation are contributing causes that, in many cases, appear to interact in potentiating bilirubin neurotoxicity. Despite compulsive attention to serum bilirubin levels, and clinical and laboratory indices of neurotoxicity risk, low bilirubin kernicterus continues to be seen in contemporary NICUs. While efforts to refine and improve current treatment guidelines are certainly needed, such revision(s) will also have to take into account the risks and benefits of any intervention, including phototherapy...
November 2014: Seminars in Perinatology
Rekha Mittal
Febrile seizures are the most common seizures of childhood. A family history of febrile seizures is common, and the disorder is genetically heterogenous. While guidelines are available for management of simple febrile seizures, the management of complex febrile seizures is individualised. After a febrile seizure, it is important to rule out CNS infection and the decision to perform a lumbar puncture should be based on the clinical condition of the child. Neuroimaging and EEG are not required immediately in workup for simple or complex febrile seizures...
September 2014: Indian Journal of Pediatrics
Kala Yadhav Ml
CONTEXT: Bacterial meningitis is one of the most serious infections seen in infants and children, which is associated with acute complications and chronic morbidity. Infections of Central Nervous System (CNS) still dominate the scene of childhood neurological disorders in most of the developing tropical countries. AIMS: To isolate, identify and determine the antibiotic susceptibility patterns of pathogens associated with bacterial meningitis. We also aimed to comparatively evaluate of Gram staining, culture and bacterial antigen detection in cerebrospinal fluid samples...
April 2014: Journal of Clinical and Diagnostic Research: JCDR
X Kostaras, F Cusano, G A Kline, W Roa, J Easaw
BACKGROUND: Dexamethasone is the corticosteroid most commonly used for the management of vasogenic edema and increased intracranial pressure in patients with brain tumours. It is also used after surgery (before embarking on radiotherapy), particularly in patients whose tumours exert significant mass effect. Few prospective clinical trials have set out to determine the optimal dose and schedule for dexamethasone in patients with primary brain tumours, and subsequently, fewer clinical practice guideline recommendations have been formulated...
June 2014: Current Oncology
Rajeev Desai, James Neuberger
Cancers in solid organ recipients may be classified as donor transmitted, donor derived, de novo or recurrent. The risk of donor-transmitted cancer is very low and can be reduced by careful screening of the donor but cannot be abolished and, in the United Kingdom series is less than 0.03%. For donors with a known history of cancer, the risks will depend on the nature of the cancer, the interventions given and the interval between diagnosis and organ donation. The risks of cancer transmission must be balanced against the risks of death awaiting a new graft and strict adherence to current guidelines may result increased patient death...
May 28, 2014: World Journal of Gastroenterology: WJG
Penney Letsos, Lynda Ryall-Henke, Jennifer Beal, Gina Tomaszewski
Suboptimal oral care is well documented in the literature and is linked to increased nosocomial pneumonia rates and prolonged hospitalization, negatively affecting patients' quality of life (Terezakis et al. 2011). A standardized approach to oral care can change these adverse outcomes. This project used best practice guidelines and evidence in the literature to guide the development of oral care best practice within an acute care inpatient unit. Based on the work of the interprofessional Clinical Neurological Sciences (CNS) Continuous Quality Improvement (CQI) Council at London Health Sciences Centre-University Hospital (LHSC-UH), an oral care policy and bedside assessment tool were implemented in line with Stroke Best Practice Recommendations (Heart and Stroke Foundation of Canada 2010)...
2013: Nursing Leadership
Ferdinand K Hui, Mark Bain, Nancy A Obuchowski, Steven Gordon, Alejandro M Spiotta, Shaye Moskowitz, Gabor Toth, Shazam Hussain
BACKGROUND: Cerebral angiography remains the gold standard for the detection of mycotic aneurysms, and it has been estimated that ruptured mycotic aneurysms result in 5% of the neurological complications of patients with infective endocarditis (IE). OBJECTIVE: To determine the diagnostic yield of cerebral angiography in the above patient population and to assess patient factors that might suggest greater or lesser utility. METHODS: We retrospectively reviewed 168 patients who underwent cerebral angiography with a diagnosis of IE or infected left ventricular assist device at the Cleveland Clinic between January 2003 and March 2010 in accordance with institutional review board guidelines...
June 2015: Journal of Neurointerventional Surgery
Carlos Henrique Camargo, Maria de Lourdes Ribeiro de Souza da Cunha, Jacqueline Costa Teixeira Caramori, Alessandro Lia Mondelli, Augusto Cezar Montelli, Pasqual Barretti
BACKGROUND AND OBJECTIVES: Coagulase-negative Staphylococcus (CNS) is the most frequent cause of peritoneal dialysis (PD)-related peritonitis in many centers. This study aimed to describe clinical and microbiologic characteristics of 115 CNS episodes and to determine factors influencing the outcome. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study reviewed the records of 115 CNS peritonitis episodes that occurred in 74 patients between 1994 and 2011 at a single university center...
June 6, 2014: Clinical Journal of the American Society of Nephrology: CJASN
Emmi Broenen, Annelies Mavinkurve-Groothuis, Karin Kamphuis-van Ulzen, Roger Brüggemann, Paul Verweij, Adilia Warris
The existing guidelines regarding the management of invasive pulmonary aspergillosis do not recommend screening of the extra-pulmonary sites. Due to the fact that the presence of central nervous system (CNS) aspergillosis will influence treatment decisions regarding which antifungal to use and the aimed target concentrations of azoles in plasma, to be informed about dissemination of the infection to the CNS is absolutely necessary. We demonstrate the need for a structured approach to screening of pediatric patients for CNS aspergillosis...
April 2014: Medical Mycology Case Reports
Rachel M Smith, Adamma Mba-Jonas, Mathieu Tourdjman, Trisha Schimek, Emilio DeBess, Nicola Marsden-Haug, Julie R Harris
BACKGROUND: Cryptococcus gattii is a fungal pathogen causing an emerging outbreak in the United States Pacific Northwest (PNW). Treatment guidelines for cryptococcosis are primarily based on data from C. neoformans infections; applicability to PNW C. gattii infection is unknown. We evaluated the relationship between initial antifungal treatment and outcomes for PNW C. gattii patients. METHODS: Cases were defined as culture-confirmed invasive C. gattii infections among residents of Oregon and Washington States during 2004-2011...
2014: PloS One
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