tailieunhanh - CURRENT ESSENTIALS OF CRITICAL CARE (PART 6)

Khởi phát cấp tính của nhức đầu, cứng cổ nhẹ, sốt (virus viêm màng não); triệu chứng mãn tính tăng dần mức độ nghiêm trọng hơn ngày để tuần (viêm màng não do nấm hoặc lao) Có thể có các tính năng của các bệnh tiềm ẩn | 148 Current Essentials of Critical Care Nonbacterial Meningitis Essentials of Diagnosis Acute onset of headache mild neck stiffness fever viral meningitis chronic symptoms with gradual increase in severity over days to weeks tuberculous or fungal meningitis May have features of underlying disease viral syndrome or pulmonary or disseminated tuberculosis or fungal infection Viral meningitis acute onset resolves within days cerebrospinal fluid with predominance of lymphocytes normal glucose enteroviruses most commonly implicated Tuberculous meningitis subacute or chronic onset of symptoms cerebrospinal fluid with predominance of lymphocytes low glucose high protein Fungal meningitis subacute or chronic onset of symptoms cerebrospinal fluid has predominance of lymphocytes variably low glucose and high protein Coccidioides immitis in Cryptococcus neoformans meningitis symptoms signs often unremarkable may have high CSF opening pressure and positive CSF India ink stain but normal glucose protein cell counts Differential Diagnosis Carcinomatous meningitis Partially treated bacterial meningitis Drug-induced meningitis Treatment No specific treatment for viral meningitis Tuberculous meningitis begin empiric therapy with 3-4 antituberculous drugs Cryptococcal meningitis amphotericin B plus 5-flucytosine followed by fluconazole Coccidioides meningitis high dose fluconazole or fluconazole amphotericin B Pearl Mumps Herpes simplex and lymphochoriomeningitis LCM meningoencephalitis may cause low CSF glucose levels. Reference Beaman MH Acute community-acquired meningitis and encephalitis. Med J Aust 2002 176 389. PMID 12o41637 Chapter 10 Infectious Disease 149 Nosocomial Pneumonia Essentials of Diagnosis Common nosocomial infection with mortality rate up to 70 Aspiration of oropharyngeal material most common route of acquisition oropharynx often colonized with gram-negative hospital-acquired organisms 20-40 polymicrobial Risk factors neurologic impairment mechanical ventilation .