Osteomyelitis
- Same bacterial species as epidural abscesses and occurs with sinusitis
- Mechanisms
- After craniotomy
- Hematologic spread.
- Characterized by moth-eaten cortical bone with poor margins and soft tissue swelling.
- X-ray films may appear similar to metastatic lesions.
- Gradenigo's syndrome
- Petrous apex osteomyelitis with CN VI palsy and retroorbital pain
- May occur in children from extension of severe otitis.
Human Prion disease (CJD)
- Neruosurgical pts high risk of CJD
- All neurosurgical procedure are high risk
- Growth hormone 1985
- Neurosurgical procedure before 1992
- Separate sets should be used for patients born after 1997
Immunodeficiency related infections
- Toxoplasmosis
- Aspergillosis
- Candida
- Nocardia
- Mycobacterium
Neurocysterosis
- Custerus cellulosae
- Cystercus
Bacterial infections
- Mycobacterial infections
- Mycobacterium tuberculosis: TB
- General
- CSF
- Inc. lymphocystes
- Dec glucose
- Inc. prot (200mg/dl)
- Acid fast bascilli seen in the CSF in <25% cases
- Culture require 4 wks
- Dx by
- Positive purified protein derivative (PPD) skin test and
- TB lesions in other parts of body
- 2/3 of cases have active TB infections elsewhere in the body.
- Treatment
- 24 months of triple antibiotics
- TB meningitis
- Characterized by
- Thick basilar exudate
- Small miliary granulomas on the convexities,
- Frequent vascular occlusions.
- Morbidity is 80% and mortality is 30%.
- Morbidity is 80% and mortality is 30%.
- Mechanisms
- Hematogenous spread
- Pathologic
- Granulomas with
- Caseating necrosis
- Lymphocytes
- Langerhans giant cells
- Tuberculomas within brain parenchyma
- Rare in western world, common in India and Mexico.
- May be solid or cystic
- 30% are multiple
- Paeds: mainly (2/3) infratentorial
- Miliary TB
- Multiple small lesions
- Rare
- More frequently seen in children
- Mycobacterium leprae: Leprosy
- General
- It most frequently occurs in tropical climates,
- Primarily brought in by travellers.
- There are two types
- Lepromatous form
- Patient with low host resistance
- Has lepra cells that are plump histiocytes filled with organisms.
- Lesions are located in the skin on cooler parts of the body (i.e., hands, feet, head, peripheral nerves, anterior eyes, upper airways, and testes).
- Lepromatous = Lethal
- The lepromin skin test is negative.
- Th2 reponse
- Tuberculoid form
- Maximal host resistance
- Has areas of hypesthetic skin, inflamed swollen nerves, caseating granulomas, and occasional gram-negative bacilli seen on histologic examination.
- The lepromin skin test is positive
- Th1 reponse
- Treatment: dapsone and rifampin for tuberculoid form; clofazimine is added for lepromatous form.
Nocardia vs Actinomyces
- Both are Gram positive and form long, branching filaments resembling fungi.
- Treatment is a SNAP
- Sulfonamides - Nocardia
- Actinomyces - Penicillin
Nocardia
Actinomyces
Oxygen
Aerobe
Anaerobe
Acid fast
Acid fast (weak)
Not acid fast
Habitat
Found in soil
Normal oral, reproductive, and GI flora
Clinical features
Causes pulmonary infections in immunocompromised (can mimic TB but with ⊖ PPD); cutaneous infections after trauma in immunocompetent; can spread to CNS
Causes oral/facial abscesses that drain through sinus tracts; often associated with dental caries/extraction and other maxillofacial trauma; forms yellow "sulfur granules"; can also cause PID with IUDs
Treatment
Treat with sulfonamides (TMP-SMX)
Treat with penicillin
Images
Q&A
- Which organism is associated with Sydenham chorea?
Answer: Group A β-hemolytic streptococcus. Sydenham chorea is one of the main criteria of rheumatic fever. Other features include arthritis, erythema marginatum, and endocarditis.
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