Serebral Enfeksiyon Süreci
Özet
Serebral enfeksiyon süreçlerini ele alan bu çalışma; menenjit, beyin apsesi, ampiyem ve ensefalit gibi merkezi sinir sistemi (MSS) enfeksiyonlarının tanı, klinik seyir ve tedavi yöntemlerini kapsamlı bir şekilde incelemektedir. MSS enfeksiyonları, yüksek mortalite ve morbidite oranları nedeniyle tıbbi acil durumlar olarak kabul edilir. Bakteriyel menenjitlerde en sık görülen etkenler S. pneumoniae ve N. meningitidis iken; ateş, ense sertliği ve mental durum değişikliği klasik klinik belirtilerdir. Tanıda Lomber Ponksiyon (LP) ve BOS bulguları (düşük glukoz, yüksek protein ve nötrofil hakimiyeti) belirleyicidir. Viral menenjitler ve ensefalitlerde ise genellikle sistemik enfeksiyonlar rol oynar ve tanı için PCR altın standarttır. Beyin apseleri, lokalize serebrit ile başlayıp kapsüllü nekrotik alanlara dönüşen fokal enfeksiyonlardır. Tanıda MRG ve BT görüntüleme kritik öneme sahipken, tedavi süreci genellikle uzun süreli antibiyoterapi ve gerekli durumlarda cerrahi aspirasyon veya eksizyonu içerir. Subdural ampiyem ve epidural apseler ise sıklıkla sinüzit veya cerrahi müdahaleler sonrası gelişen, hızlı müdahale gerektiren durumlardır. Sonuç olarak, MSS enfeksiyonlarının yönetiminde enfeksiyon hastalıkları, nöroloji ve nöroşirurjiyi kapsayan multidisipliner bir yaklaşım hayati önem taşımaktadır.
This study on cerebral infection processes comprehensively examines the diagnosis, clinical course, and treatment methods of central nervous system (CNS) infections such as meningitis, brain abscess, empyema, and encephalitis. CNS infections are considered medical emergencies due to their high mortality and morbidity rates. While the most common agents in bacterial meningitis are S. pneumoniae and N. meningitidis, the classic clinical triad consists of fever, neck stiffness, and altered mental status. Lumbar puncture (LP) and CSF findings (low glucose, high protein, and neutrophil dominance) are decisive in diagnosis. In viral meningitis and encephalitis, systemic infections usually play a role, and PCR is the gold standard for diagnosis. Brain abscesses are focal infections that begin as localized cerebritis and progress into encapsulated necrotic areas. While MRI and CT imaging are critical for diagnosis, the treatment process generally involves long-term antibiotic therapy and, when necessary, surgical aspiration or excision. Subdural empyema and epidural abscesses are conditions that often develop after sinusitis or surgical interventions and require rapid intervention. In conclusion, a multidisciplinary approach involving infectious diseases, neurology, and neurosurgery is vital in the management of CNS infections.
Referanslar
Greenberg MS.(ed) Part VI Infection içinde Bacterial Infections of the Parenchyma and Meninges and Complex Infections. In Handbook of neurosurgery içinde. VIII edition. New York:Thieme; 2016. p. 318-339 .
Archibald LK, Quisling RG. Textbook of Neurointensive Care. [Online] Textbook of Neurointensive Care. 2013. doi:10.1007/978-1-4471-5226-2
IE McCutcheon. Volume 1, Chapter 44 Meningitis and Encephalitis. William T. Couldwell, H. Richard Winn(eds) Youmans Neurological Surgery içinde.VI edition. Philadelphia: Elsevier Inc.2011. p. 600-611.
Bijlsma MW, Brouwer MC, Kasanmoentalib ES, et al. Community-acquired bacterial meningitis in adults in the Netherlands, 2006-14: A prospective cohort study. The Lancet Infectious Diseases. Elsevier Ltd; 2016;16(3): 339–347. doi:10.1016/S1473-3099(15)00430-2
van de Beek D, de Gans J, Spanjaard L, et al. Clinical Features and Prognostic Factors in Adults with Bacterial Meningitis. New England Journal of Medicine. New England Journal of Medicine (NEJM/MMS); 2004;351(18): 1849–1859. doi:10.1056/NEJMoa040845
Kim KJ, Cho JH, Moon JB, et al. What factors determine the need for lumbar puncture in patients with fever and headache? Singapore Medical Journal. Singapore Medical Association; 2017;58(10): 618. doi:10.11622/SMEDJ.2016184
Doherty CM, Forbes RB. Diagnostic Lumbar Puncture. The Ulster Medical Journal. Ulster Medical Society; 2014;83(2): 93. /pmc/articles/PMC4113153/
Salazar L, Hasbun R. Cranial Imaging Before Lumbar Puncture in Adults With Community-Acquired Meningitis: Clinical Utility and Adherence to the Infectious Diseases Society of America Guidelines. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. Oxford University Press; 2017;64(12): 1657. doi:10.1093/CID/CIX240
Armon C, Evans RW. Addendum to assessment: Prevention of post-lumbar puncture headaches: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. Neurology; 2005;65(4): 510–512. doi:10.1212/01.WNL.0000173034.96211.1B
Hasbun R, Abraham J , Jekel J, et al. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. The New England journal of medicine. N Engl J Med; 2001;345(24): 1727–1733. doi:10.1056/NEJMOA010399
Allan R Tunkel, MD, PhD M. Initial therapy and prognosis of bacterial meningitis in adults - UpToDate. Uptodate. 2017; 1–41. https://www.uptodate.com/contents/initial-therapy-and-prognosis-of-bacterial-meningitis-in-adults?search=meningitis&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H9%0Ahttp://uptodates.ses.csinet.es/contents/initial-therapy-and
van de Beek D, Brouwer M, Hasbun R, et al. Community-acquired bacterial meningitis. Nature reviews. Disease primers. Nat Rev Dis Primers; 2016;2. doi:10.1038/NRDP.2016.74
Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice Guidelines for the Management of Bacterial Meningitis. Clinical Infectious Diseases. Oxford Academic; 2004;39(9): 1267–1284. doi:10.1086/425368
Luque-Paz D, Revest M, Eugène F, et al. Ventriculitis: A Severe Complication of Central Nervous System Infections. Open Forum Infectious Diseases. Oxford University Press (OUP); 2021;8(6). doi:10.1093/ofid/ofab216
Wright WF, Pinto CN, Palisoc K, et al. Viral (aseptic) meningitis: A review. Journal of the Neurological Sciences. Elsevier B.V; 2019;398: 176–183. doi:10.1016/j.jns.2019.01.050
Rice P. Viral meningitis and encephalitis. Medicine (United Kingdom). 2017;45(11): 664–669. doi:10.1016/j.mpmed.2017.08.009
McGill F, Griffiths MJ, Solomon T. Viral meningitis: Current issues in diagnosis and treatment. Current Opinion in Infectious Diseases. 2017;30(2): 248–256. doi:10.1097/QCO.0000000000000355
Kupila L, Vuorinen T, Vainionpää R, et al. Etiology of aseptic meningitis and encephalitis in an adult population. Neurology. 2006;66(1): 75–80. doi:10.1212/01.wnl.0000191407.81333.00
Pagliano P, Esposito S, Ascione T, et al. Burden of fungal meningitis. Future Microbiology. 2020;15(7): 469–472. doi:10.2217/fmb-2020-0006
Darlow CA, McGlashan N, Kerr R, et al. Microbial aetiology of brain abscess in a UK cohort: Prominent role of Streptococcus intermedius. Journal of Infection. Elsevier Ltd; 2020;80(6): 623–629. doi:10.1016/j.jinf.2020.03.011
Ong C Ter, Tsai CF, Wong YS, et al. Epidemiology of brain abscess in Taiwan: A 14-year population-based cohort study. PLoS ONE. 2017;12(5): 1–10. doi:10.1371/journal.pone.0176705
Wu S, Wei Y, Yu X, et al. Retrospective analysis of brain abscess in 183 patients: A 10-year survey. Medicine. 2019;98(46): e17670. doi:10.1097/MD.0000000000017670
Liu J, Bai R, Li Y, et al. MRI detection of bacterial brain abscesses and monitoring of antibiotic treatment using bacCEST. Magnetic Resonance in Medicine. 2018;80(2): 662–671. doi:10.1002/mrm.27180
Tonon E, Scotton P, Gallucci M, et al. Brain abscess: clinical aspects of 100 patients. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 2006;10(2): 103–109. doi:10.1016/j.ijid.2005.04.003
Brouwer MC, Coutinho JM, Van De Beek D. Clinical characteristics and outcome of brain abscess :Systematic review and meta-analysis. Neurology. 2014;82(9): 806–813. doi:10.1212/WNL.0000000000000172
Sonneville R, Ruimy R, Benzonana N, et al. An update on bacterial brain abscess in immunocompetent patients. Clinical Microbiology and Infection. Elsevier B.V.; 2017;23(9): 614–620. doi:10.1016/J.CMI.2017.05.004
Grossman R, Schmidek Hh, Quiñones-Hinojosa A. Chapter 143 Management of Suppurative Intracranial Infections, Section Eight Surgical Management Of Nervous System Infections içinde, Quiñones-Hinojosa A(ed). Schmidek & Sweet Operative Neurosurgical Techniques Indications Methods, And Results içinde, 6th edition, Philadelphia: 2012. p. 1631-1642.
Sellner J, Trinka E. Clinical characteristics, risk factors and pre-surgical evaluation of post-infectious epilepsy. European journal of neurology. Eur J Neurol; 2013;20(3): 429–439. doi:10.1111/J.1468-1331.2012.03842.X
Benevides GN, Salgado GA, Ferreira CR, et al. Bacterial sinusitis and its frightening complications: subdural empyema and Lemierre syndrome. Autopsy & case reports. Autops Case Rep; 2015;5(4): 19–26. doi:10.4322/ACR.2015.029
David I. Bruner M, Lanny Littlejohn M, Amy Pritchard D. UC Irvine Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Title Subdural Empyema Presenting with Seizure, Confusion, and Focal Weakness. Western Journal of Emergency Medicine. 2012;XIII, NO. doi:10.5811/westjem.2012.5.11727
Yoon J, Redmond M. Check the ear. The importance of ear examinations in assessment of intracranial subdural empyema. Tropical Medicine and Infectious Disease. 2019;4(3): 1–8. doi:10.3390/tropicalmed4030120
Osborn MK, Steinberg JP. Subdural empyema and other suppurative complications of paranasal sinusitis. Lancet Infectious Diseases. 2007;7(1): 62–67. doi:10.1016/S1473-3099(06)70688-0
Kim YS, Joo SP, Song DJ, et al. Delayed intracranial subdural empyema following burr hole drainage. Medicine (United States). 2018;97(18): 10–14. doi:10.1097/MD.0000000000010664
Xue H, Zhang W, Shi L, et al. Subdural empyema complicated after trepanation and drainage of chronic subdural hematoma: A case report. Medicine. Medicine (Baltimore); 2019;98(52). doi:10.1097/MD.0000000000018587
So G, Haraguchi W, Kinoshita N. [Subdural Empyema Caused by Propionibacterium Acnes after Burr-Hole Surgery of Chronic Subdural Hematoma:A Case Report]. No shinkei geka. Neurological surgery. No Shinkei Geka; 2018;46(7): 623–628. doi:10.11477/MF.1436203780
Infectious and Inflammatory Diseases of the Brain. (29/09/2021 tarihinde https://radiologykey.com/infectious-and-inflammatory-diseases-of-the-brain/ adresinden erişimiştir.)
Bok APL, Peter JC. Subdural empyema: burr holes or craniotomy? Journal of Neurosurgery. 2009;78(4): 574–578. doi:10.3171/jns.1993.78.4.0574
Chikani MC, Mezue W, Okorie E, et al. Subdural empyema: Clinical presentations and management options for an uncommon neurosurgical emergency in a developing country. Nigerian journal of clinical practice. Niger J Clin Pract; 2017;20(10): 1221–1225. doi:10.4103/NJCP.NJCP_340_16
Prieto R, Ortega C. Parafalcine subdural empyema: The unresolved controversy over the need for surgical treatment. Surgical Neurology International. 2019;10(437): 203. doi:10.25259/SNI_392_2019
Sogoba Y, Kanikomo D, Coulibaly O, et al. Nonsurgical treatment of infratentorial subdural empyema: A case report. Case Reports in Clinical Medicine. 2013;02(05): 294–297. doi:10.4236/crcm.2013.25079
Arifianto MR, Ma’Ruf AZ, Ibrahim A, et al. Interhemispheric and Infratentorial Subdural Empyema with Preseptal Cellulitis as Complications of Sinusitis: A Case Report. Pediatric Neurosurgery. 2018;53(2): 128–133. doi:10.1159/000481512
