Hospital General de Medellín, Medellín, Colombia.
School of Medicine, University of Antioquia, Medellín, Colombia.
Minerva Med. 2024 Aug;115(4):476-502. doi: 10.23736/S0026-4806.24.09097-9.
Central nervous system infections are due to different microorganisms such as viruses, bacteria, mycobacteria, fungi, amoebas, and other parasites. The etiology depends on multiple risk factors, and it defines the infection location because some microorganisms prefer meninges, brain tissue, cerebellum, brain stem or spinal cord. The microorganisms induce diseases in the nervous system through direct invasion, neurotoxin production, and the triggered immune response. To determine the infection etiology, there are several diagnostic tests which may be conducted with cerebrospinal fluid, blood, respiratory and stool samples. These tests include but are not limited to direct microscopic examination of the sample, stains, cultures, antigenic tests, nucleic acid amplification tests, metagenomic next-generation sequencing, immunologic biomarker and neuroimaging, especially contrast-enhanced magnetic resonance imaging. The treatment may consist of specific antimicrobial treatment and supportive standard care. Since viruses have no specific antiviral treatment, antimicrobial treatment is mainly targeted at non-viral infections. This article will focus on diagnosis and treatment of acute acquired infections of the central nervous system beyond the neonatal period. The discussion defines the disease, provides the clinical presentation, explains the etiology and risk factors, and briefly mentions potential complications. This updated review aims to provide the reader with all the elements needed to adequately approach a patient with a central nervous system infection. Mycobacterium tuberculosis infection, Cryptococcus spp. infection and vaccines are not within the scope of this article.
中枢神经系统感染是由不同的微生物引起的，如病毒、细菌、分枝杆菌、真菌、阿米巴虫和其他寄生虫。病因取决于多种危险因素，并决定了感染部位，因为有些微生物更喜欢脑膜、脑组织、小脑、脑桥或脊髓。微生物通过直接侵袭、产生神经毒素和引发免疫反应来引起神经系统疾病。为了确定感染的病因，有几种诊断测试可以用脑脊液、血液、呼吸道和粪便样本进行。这些测试包括但不限于对样本进行直接显微镜检查、染色、培养、抗原检测、核酸扩增检测、宏基因组下一代测序、免疫生物标志物和神经影像学，特别是增强磁共振成像。治疗可能包括特定的抗菌治疗和支持性标准护理。由于病毒没有特定的抗病毒治疗，抗菌治疗主要针对非病毒感染。本文将重点介绍新生儿期后急性获得性中枢神经系统感染的诊断和治疗。讨论定义了疾病，提供了临床表现，解释了病因和危险因素，并简要提到了潜在的并发症。本次更新的综述旨在为读者提供充分处理中枢神经系统感染患者所需的所有要素。本文不包括结核分枝杆菌感染、新型隐球菌感染和疫苗。
