Stephens Robert J, Liang Stephen Y
Department of Emergency Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA.
Department of Emergency Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA; Department of Internal Medicine, Division of Infectious Disease, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA.
Emerg Med Clin North Am. 2021 Feb;39(1):101-121. doi: 10.1016/j.emc.2020.09.006. Epub 2020 Nov 5.
Over the past 2 decades, the population of immunocompromised patients has increased dramatically in the United States. These patients are at elevated risk for both community-acquired and opportunistic central nervous system infections. We review the most common and serious central nervous system pathogens affecting these patients and outline a diagnostic and therapeutic approach to their management in the emergency department. We recommend a broad diagnostic evaluation, including neuroimaging and cerebrospinal fluid studies where appropriate, empiric antimicrobial therapy, and early involvement of subspecialists to provide comprehensive care for these complex patients.
在过去20年里,美国免疫功能低下患者的数量急剧增加。这些患者发生社区获得性和机会性中枢神经系统感染的风险均有所升高。我们回顾了影响这些患者的最常见且严重的中枢神经系统病原体,并概述了在急诊科对其进行管理的诊断和治疗方法。我们建议进行广泛的诊断评估,包括在适当情况下进行神经影像学检查和脑脊液检查、经验性抗菌治疗,以及尽早让专科医生参与,为这些复杂患者提供全面护理。