Division of Pediatrics, Medanta- The Medicity, Sector 38, Gurugram, Haryana, 122001, India.
Department of Pediatrics, Government Medical College and Hospital, Sector 32, Chandigarh, India.
Indian J Pediatr. 2019 Jan;86(1):52-59. doi: 10.1007/s12098-017-2583-y. Epub 2018 Jan 15.
CNS infections in children are medical emergency and are associated with high mortality and morbidity. For diagnosis, a high index of suspicion is required. Clinical assessment should be supplemented by laboratory investigations including CSF Gram stain and cultures, blood culture, PCR on CSF, serological tests, and imaging. Commonly associated life threatening complications include coma, seizure, raised intracranial pressure (ICP), focal deficits, shock, respiratory failure, and fluid and electrolyte abnormalities. Immediate management should first address control of airway, breathing and circulation; protocolized management of raised ICP and status epilepticus; maintaining adequate intravascular volume; and close monitoring for early detection of complications. Appropriate antimicrobial agents should be administered promptly according to the suspected pathogen. Clinical evaluation, laboratory workup, specific antimicrobial therapy, supportive treatment, and management of associated complications should go hand in hand in a protocolized way for better outcome.
儿童中枢神经系统感染是一种医疗急症，与高死亡率和高发病率相关。为了进行诊断，需要高度怀疑。临床评估应通过实验室检查来补充，包括脑脊液革兰氏染色和培养、血培养、脑脊液 PCR、血清学检查和影像学检查。常见的危及生命的并发症包括昏迷、癫痫发作、颅内压升高 (ICP)、局灶性缺损、休克、呼吸衰竭以及液体和电解质异常。立即的管理应首先解决气道、呼吸和循环的控制问题；制定 ICP 升高和癫痫持续状态的管理方案；维持足够的血容量；并密切监测早期并发症的发生。应根据可疑病原体迅速给予适当的抗菌药物。临床评估、实验室检查、特定的抗菌治疗、支持性治疗以及相关并发症的管理应按照既定方案协同进行，以获得更好的结果。
