Bacterial infections of the nervous system
In few areas of medicine is a presumptive etiologic diagnosis more likely to be accurate than in bacterial infections of the nervous system. Given the location of the infection; the patient’s age; the presence or absence of underlying disease, particularly malignant or pleuropulmonary; sinus or middle ear infection; and the presence or absence of trauma, accidental or surgical; “bacteriologic statistics” permit one to focus on a relatively small number of possible pathogens in any given patient.
Most physicians recognize the well-known predominance of Hemophilus influenzae, the pneumococcus, and the meningococcus as the major causes of nonhospital acquired bacterial meningitis following the neonatal period, but they are not equally aware of the predictability of organisms involved in other bacterial infections of the nervous system. For example, in brain abscess the recovery of anaerobic pathogens is the rule. Failure to examine a Gram stain and transport the specimen promptly for proper anaerobic culture may completely misdirect the physician. When trauma results in a simple dural leak, the pneumococcus is most commonly responsible for meningitis. However, trauma which penetrates the dura permits contaminating organisms, such as the staphylococcus and gram-negative enteric bacilli to enter the picture.
This paper will approach the topic of antimicrobial selection by emphasizing the bacteriology of meningitis, brain abscess, and subdural empyema. Circumstances in which unusual organisms are found will be stressed. Advantages and limitations of the newer antimicrobial agents will be discussed.Bacterial meningitis
Neonates and children. The pediatrician is constantly challenged by the shifting pattern of neonatal. . .