{"id":1941,"date":"2018-08-31T12:00:41","date_gmt":"2018-08-31T17:00:41","guid":{"rendered":"https:\/\/blog.unmc.edu\/infectious-disease\/?p=1941"},"modified":"2018-08-31T11:31:15","modified_gmt":"2018-08-31T16:31:15","slug":"clinical-pearls-from-case-conference-focus-on-cns-infections","status":"publish","type":"post","link":"https:\/\/blog.unmc.edu\/infectious-disease\/2018\/08\/31\/clinical-pearls-from-case-conference-focus-on-cns-infections\/","title":{"rendered":"Clinical Pearls From Case Conference: Focus on CNS Infections"},"content":{"rendered":"

At Case Conference on August 16, Drs. Hankins and McCreery presented excellent cases of viral CNS infections combined with a great review of pertinent literature.\u00a0 Here are the key clinical pearls from their presentations.<\/p>\n

Dr. McCreery on viral and bacterial meningitis:<\/span><\/p>\n

    \n
  1. Empiric dexamethasone appears to be beneficial in S. Pneumoniae<\/em> and H. Influenza<\/em> meningitis but should be stopped if found to have viral meningitis or meningitis caused by other bacteria.<\/li>\n
  2. The addition of an aminoglycoside in the treatment of Listeria<\/em> bacteremia and neurolisteriosis was associated with improved mortality in the MONALISA study – France (OR 0.60 (0.38-0.94) p 0.024) n = 679.\u00a0 When neurolisteriosis was examined (n=-252 cases), some with bacteremia and some without, the addition of an aminoglycoside was not reported to have been associated with improved outcomes.<\/li>\n
  3. Mild HSV-2 meningitis likely does not require treatment, however there may be some benefit among immunocompromised patients related to preventing neurologic sequelea.<\/li>\n
  4. Suppressive valacyclovir after HSV-2 meningitis was associated with increased recurrence after cessation.<\/li>\n
  5. Data is lacking regarding the utility of suppressive valacyclovir therapy in the treatment of non-genital HSV-2 infection during pregnancy<\/li>\n<\/ol>\n
    \"\"

    Randy McCreery MD, UNMC 1st Year ID fellow.<\/p><\/div>\n

    Dr. Hankins on Influenza Encephalitis:<\/p>\n

      \n
    1. Diagnosis of exclusion in patients with altered level of consciousness and a positive influenza antigen or PCR.<\/li>\n
    2. Most often occurs in 24-48 hours after febrile incident.<\/li>\n
    3. 95% of patients with influenza encephalitis are younger than 21 years old.<\/li>\n
    4. Associated with bilateral thalamic necrosis on MRI.<\/li>\n
    5. Guidelines suggest that oseltamivir may be beneficial.\u00a0 Other studies suggest that methylprednisolone pulse therapy may be beneficial.<\/li>\n<\/ol>\n
      \"\"

      Richard Hankins, MD
      2nd Year ID Fellow<\/p><\/div>\n

       <\/p>\n

       <\/p>\n

       <\/p>\n

       <\/p>\n

       <\/p>\n

       <\/p>\n

       <\/p>\n