Central nervous system infections in the intensive care unit

Neurological infections constitute an uncommon, but important aetiological cause requiring admission to an intensive care unit (ICU). In addition, health-care associated neurological infections may develop in critically ill patients admitted to an ICU for other indications. Central nervous system infections can develop as complications in ICU patients including post-operative neurosurgical patients. While bacterial infections are the most common cause, mycobacterial and fungal infections are also frequently encountered. Delay in institution of specific treatment is considered to be the single most important poor prognostic factor. Empirical antibiotic therapy must be initiated while awaiting specific culture and sensitivity results. Choice of empirical antimicrobial therapy should take into consideration the most likely pathogens involved, locally prevalent drug-resistance patterns, underlying predisposing, co-morbid conditions, and other factors, such as age, immune status. Further, the antibiotic should adequately penetrate the blood-brain and blood- cerebrospinal fluid barriers. The presence of a focal collection of pus warrants immediate surgical drainage. Following strict aseptic precautions during surgery, hand-hygiene and care of catheters, devices constitute important preventive measures. A high index of clinical suspicion and aggressive efforts at identification of aetiological cause and early institution of specific treatment in patients with neurological infections can be life saving

Doses in the Vicinity of Mobile X-ray Equipment in a Children’s Intensive Care Unit

Most of the patients in the intensive care unit for children are newborns and infants having an infection of the central nervous system, with systemic septic and respiratory infections. Therefore, mobile X-ray equipment including mobile shields is routinely used for diagnosis of the respiratory tract, heart and endovascular cateterisation. The aim of this work was to determine the radiation exposure to the children in the vicinity of the exposed patient in the same or next room. Three measurement runs were carried out with thermoluminescence dosimetry system. The results show that the homogeneity of the irradiation field is adequate, the exposure of children to radiation in the vicinity of the exposed patient in the same or next room is very low, practically in the range of the lowest detectable dose. The entrance dose on the breast of the patient was found to be 0.07 mSv. Therefore, there is no basis for the risk estimation of genetic, leukemogenic and cancerogenic detriment

Doses in the Vicinity of Mobile X-ray Equipment in a Children’s Intensive Care Unit

Most of the patients in the intensive care unit for children are newborns and infants having an infection of the central nervous system, with systemic septic and respiratory infections. Therefore, mobile X-ray equipment including mobile shields is routinely used for diagnosis of the respiratory tract, heart and endovascular cateterisation. The aim of this work was to determine the radiation exposure to the children in the vicinity of the exposed patient in the same or next room. Three measurement runs were carried out with thermoluminescence dosimetry system. The results show that the homogeneity of the irradiation field is adequate, the exposure of children to radiation in the vicinity of the exposed patient in the same or next room is very low, practically in the range of the lowest detectable dose. The entrance dose on the breast of the patient was found to be 0.07 mSv. Therefore, there is no basis for the risk estimation of genetic, leukemogenic and cancerogenic detriment

PREMATURE NEWBORNS WITH VERY-LOW BIRTH WEIGHT - MEDICAL AND SOCIAL ISSUES

The newborns with very-low birth weight (VLBW) present a high-risk group in terms of morbidity and mortality. In 1996-2000, a total of 264 newborns with birth weight below 1500g were treated in the Neonatology Intensive Care Unit of the Clinic of Neonatology, Department of Obstetrics and Gynaecology, Medical University of Varna and in the Clinic of Obstetrics, Specialized Hospital of Obstetrics and Gynaecology of Varna. Respiratory distress syndrome and infectious pathology were the leading causes for VLBW morbidity. The most widespread infectious agents were Enterococcus, E. coli, Pseudomonas, and Enterobacteriae. The mortality rate was highest within the first 24 hours. Most commonly, the respiratory distress syndrome, maternal- fetal infections caused by Gram-negative flora and perinatal asphyxia caused death. The intensive treatment included mechanical ventilation, oxygen therapy, surfactants, parenteral nutrition, bioproducts, and antibiotics. Modern methods for noninvasive monitoring of blood gases and saturation, follow-up by ophthalmopediatricians, neurologists and psychologists, ultrasound and C T diagnosis of the central nervous system could decrease of the complications and damages of prematurity

The epidemiology and outcomes of central nervous system infections in Far North Queensland, tropical Australia; 2000-2019

Background: The epidemiology of central nervous system (CNS) infections in tropical Australia is incompletely defined. Methods: A retrospective study of all individuals in Far North Queensland, tropical Australia, who were diagnosed with a CNS infection between January 1, 2000, and December 31, 2019. The microbiological aetiology of the infection was correlated with patients' demographic characteristics and their clinical course. Results: There were 725 cases of CNS infection during the study period, meningitis (77.4%) was the most common, followed by brain abscess (11.6%), encephalitis (9.9%) and spinal infection (1.1%). Infants (24.3%, p<0.0001) and Aboriginal and Torres Strait Islander Australians (175/666 local residents, 26.3%, p<0.0001) were over-represented in the cohort. A pathogen was identified in 513 cases (70.8%); this was viral in 299 (41.2%), bacterial in 175 (24.1%) and fungal in 35 (4.8%). Cryptococcal meningitis (24 cases) was diagnosed as frequently as pneumococcal meningitis (24 cases). There were only 2 CNS infections with a S. pneumoniae serotype in the 13-valent pneumococcal vaccine after its addition to the National Immunisation schedule in 2011. Tropical pathogens-including Cryptococcus species (9/84, 11%), Mycobacterium tuberculosis (7/84, 8%) and Burkholderia pseudomallei (5/ 84, 6%)-were among the most common causes of brain abscess. However, arboviral CNS infections were rare, with only one locally acquired case-a dengue infection in 2009-diagnosed in the entire study period. Intensive Care Unit admission was necessary in 14.3%; the overall case fatality rate was 4.4%. Conclusion: Tropical pathogens cause CNS infections as commonly as traditional bacterial pathogens in this region of tropical Australia. However, despite being highlighted in the national consensus guidelines, arboviruses were identified very rarely. Prompt access to sophisticated diagnostic and supportive care in Australia's well-resourced public health system is likely to have contributed to the cohort's low case-fatality rate

Prospective surveillance of hospitalisations associated with varicella-zoster virus infections in children and adolescents

Our goal was to determine the epidemiology of severe varicella-zoster virus (VZV) infections in hospitalised paediatric patients. Admissions associated with VZV infection of patients aged 0-16 years were reported by all 38 paediatric units in Switzerland to the Swiss Paediatric Surveillance Unit (SPSU) during 3 consecutive years (4/2000-3/2003). We verified completeness of reporting by capture-recapture analysis with patient records identified by ICD-10 codes. Outcome of illness was assessed 6 months after hospitalisation. A total of 335 cases (235 identified by SPSU reports, 100 by ICD-10 code) were included in this study. Mean age of patients was 4.1 years (median 3.5 years, range 0-16 years); 54% were male. Some 293 (87%) patients presented with chickenpox, 42 (13%) with herpes zoster and 291 (87%) patients were not immunocompromised. A total of 319 complications occurred in 237 (71%) patients: secondary bacterial infections (n =109); central nervous system involvement (n =76); VZV pneumonitis (n =7); others (n =127). Eleven (3%) patients required intensive care and three died. On follow-up, 303 (96%) of 315 patients had completely recovered; sequelae were present in 12 (4%) patients. The calculated hospitalisation rate was 13 per 104 cases. Conclusion:This study describes a sizeable hospitalisation and complication rate of varicella-zoster virus infections and provides a solid basis for future immunisation recommendations in Switzerlan

Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients

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NICU Infants & SNHL: Experience of a western Sicily tertiary care centre

Introduction: The variability of symptoms and signs caused by central nervous system (CNS) lesions make multiple sclerosis difficult to recognize,Introduction: This study adds the evaluation of the independent etiologic factors that may play a role in the development of SNHL in a NICU population. We compared neonatal intensive care unit NICU infants with sensorineural hearing loss SNHL to age and gender matched normal hearing NICU controls. Materials and methods: 284 consecutive NICU infants positive to the presence of risk indicators associated with permanent congenital, delayed-onset, or progressive hearing loss underwent to global audiological assessment. The following risk factors were researched, making a distinction between prenatal and perinatal risk factors: in the first group, family history of permanent childhood hearing impairment, consanguinity, pregnant maternal infection and drugs exposition during pregnancy; in the second group, premature birth, respiratory distress, hyperbilirubinemia requiring exchange tranfusion, very low birth weight, cranio-facial abnormality, perinatal infections, ototoxic drugs administration, acidosis, hyponatremia, head trauma. Results: The analysis of the auditory deficit for infants according to numbers of risk factors showed mean values of: 78 + 28.08 dB nHL for infants positive to two risk factors; 75.71 + 30.30 dB nHL in cases positive to three risk factors; 96.66 + 34.46 dB nHL for four risk factors and 85 + 35 dB nHL in case of &gt;5 risk factors. Conclusion: NICU infants have greater chances of developing SNHL, because of the presence of multiple risk factors; in fact, as the number of coexisting risk factors increases, the prevalence rate of SNHL also increases (r=0.81)

Recognition and Clinical Presentation of Invasive Fungal Disease in Neonates and Children

AW and JK are supported by the Wellcome Trust Strategic Award (grant 097377) and the MRC Centre for Medical Mycology (grant MR/N006364/1) at the University of AberdeenPeer reviewedPublisher PD