tailieunhanh - Chapter 115. Approach to the Acutely Ill Infected Febrile Patient (Part 7)

Brain Abscess (See also Chap. 376) Brain abscess often occurs without systemic signs. Almost half of patients are afebrile, and presentations are more consistent with a space-occupying lesion in the brain; 70% of patients have headache, 50% have focal neurologic signs, and 25% have papilledema. Abscesses can present as single or multiple lesions resulting from contiguous foci or hematogenous infection, such as endocarditis. The infection progresses over several days from cerebritis to an abscess with a mature capsule. More than half of infections are polymicrobial, with an etiology consisting of aerobic bacteria (primarily streptococcal species) and anaerobes. Abscesses arising. | Chapter 115. Approach to the Acutely Ill Infected Febrile Patient Part 7 Brain Abscess See also Chap. 376 Brain abscess often occurs without systemic signs. Almost half of patients are afebrile and presentations are more consistent with a space-occupying lesion in the brain 70 of patients have headache 50 have focal neurologic signs and 25 have papilledema. Abscesses can present as single or multiple lesions resulting from contiguous foci or hematogenous infection such as endocarditis. The infection progresses over several days from cerebritis to an abscess with a mature capsule. More than half of infections are polymicrobial with an etiology consisting of aerobic bacteria primarily streptococcal species and anaerobes. Abscesses arising hematogenously are especially apt to rupture into the ventricular space causing a sudden and severe deterioration in clinical status and high mortality. Otherwise mortality is low but morbidity is high 30-55 . Patients presenting with stroke and a parameningeal infectious focus such as sinusitis or otitis may have a brain abscess and physicians must maintain a high level of suspicion. Prognosis worsens in patients with a fulminant course delayed diagnosis abscess rupture into the ventricles multiple abscesses or abnormal neurologic status at presentation. Cerebral Malaria See also Chap. 203 This entity should be urgently considered if patients who have recently traveled to areas endemic for malaria present with a febrile illness and lethargy or other neurologic signs. Fulminant malaria is caused by Plasmodium falciparum and is associated with temperatures of 40 C 104 F hypotension jaundice adult respiratory distress syndrome and bleeding. By definition any patient with a change in mental status or repeated seizure in the setting of fulminant malaria has cerebral malaria. In adults this nonspecific febrile illness progresses to coma over several days occasionally coma occurs within hours and death within 24 h. Nuchal rigidity and .