tailieunhanh - Neurologic Disease in Women - part 9

Điều trị với liều kháng sinh tiêu chuẩn ngay khi có thể bắt đầu điều trị kháng nấm ngay sau khi tác nhân gây bệnh được xác định Điều trị như được chỉ ra ngay sau khi dùng thuốc có thể sử dụng IV cho tất cả các hình thức nhiễm trùng lan tỏa (bao gồm cả viêm não) | 382 NEUROLOGIC DISEASE IN WOMEN TABLE Treatment Considerations for Common Neurologic Infections during and Immediately after Pregnancy Disease Drug of Choice Teratogenicity Breast-feeding Ok t Recommendations Tuberculous meningitis Isoniazid No Treat with multidrug regimen at Rifampicin Pyrazinamide and or Ethambutol No No No all stages of pregnancy Listerial meningitis Ampicillin - Yes Treat with standard antibiotic doses as soon as possible Coccidioidal meningitis Amphotericin B - Unknown Begin antifungal therapy as soon as pathogen is identified Cerebral malaria Quinidine gluconate - Yes Treat as indicated as soon as possible Disseminated HSV Acyclovir - Yes Use IV dosing for all forms of disseminated infection including encephalitis - No adverse effects demonstrated or no adverse effects known Class A or B adverse effects in animals and no studies in women Class C significant fetal risk Class D or X . t Yes absent or low concentrations of the drug excreted into breast milk No systemic or concentrated levels found in milk proceed with caution or avoid breast-feeding altogether. system and the pathogen itself are responsible for the spread of infection during pregnancy 1-7 23 . Coccidioidal meningitis is subtle in its presentation with lethargy confusion headache low-grade fever and generalized weight loss developing gradually. Diagnosis may be further delayed when meningitis occurs without any apparent pulmonary disease a pattern of presentation that occurs in almost two-thirds of cases involving the CNS 24 . The CSF is always abnormal in patients with coccidioidal meningitis and the diagnosis is made either by detecting anticoccidioidal complement fixing CF antibodies or by growing C. immitis from the CSF. Because it is invariably fatal when left untreated aggressive therapy for all patients is indicated Table . The main therapeutic regimen requires intravenous followed by intraventricular amphotericin B at least until the CSF anticoccidioidal CF .