ABSTRACT
Neuroinfections are seen in both adults and children. These can result in serious morbidity and if left untreated and/or associated with comorbidities can be life threatening. Cross-sectional imaging like computed tomography (CT) and magnetic resonance imaging (MRI) are advised by the clinicians for the diagnosing, confirmation of the diagnosis, assess any complications of the infection, and also for follow up. Though CT is the initial imaging investigation commonly asked by the clinician, due to its lesser soft tissue resolution, early brain changes may not be seen on CT. MRI has better soft tissue resolution with no ionizing radiation to the patient and helps in detecting the early signs of infection. Appropriate MRI, not only helps the radiologist to reduce the number of possibilities of the causative organism but also differentiates tumors from infection. However, CT is useful to assess the bony changes and also easily available and affordable cross-sectional imaging modality worldwide. The review summarizes the approach of the radiologist to central nervous system (CNS) infections and their typical imaging characteristic features.
ABSTRACT
Infections constitute an important and common category of diseases, particularly in less developed countries. Infections present with a broad spectrum of clinical and radiologic features dictated by the cell and tissue tropism and host response elicited, posing a considerable diagnostic challenge. Early diagnosis and treatment are crucial in preventing mortality and morbidity. Recourse is often made to biopsy for ascertaining the diagnosis, and hence the pathologist plays a vital role in patient management. Therefore, knowledge of the histopathologic changes is necessary to recognize the histological changes and guide the diagnostic workup and management. Each microbial agent elicits a distinctive pattern of inflammatory tissue response, which can serve as a clue to the etiological agent. Based on the causative organism, microbial, and host factors, the inflammatory response may be acute or chronic, necrotic or non-necrotic. The inflammation can be of varied patterns – lymphohistiocytic, granulomatous, inflammatory demyelinating, fibrosing, or showing minimal inflammation. The pattern of necrosis also differs based on the causative organism. Typically, pyogenic bacteria are associated with suppurative inflammation, tuberculosis with caseous granulomatous, and fungi with suppurative granulomatous inflammation. Viral infections are associated with lymphohistiocytic non-necrotizing inflammation and, based on cell tropism, can cause demyelination (e.g., JCV) and/or viral inclusions. Parasitic infections (protozoal or metazoal) display a broad spectrum of inflammatory changes that overlap with other types of infections. This review briefly describes pathological patterns and associated pathogens and provides an algorithmic approach based on pattern recognition that may be useful for the practicing pathologist.
ABSTRACT
La neuroinfección es un cuadro muy importante dentro de la salud, no tanto por su frecuencia, mas por su gravedad y pronóstico ya que un alto porcentaje se recuperan con secuelas neurológicas. Objetivo: Conocer las características de la neuroinfección en los niños menores de 14 anos que se internaron en el Hospital del Niño Dr. Ovidio Aliaga Uría. Metodología: Es un estudio descriptivo retrospectivo, donde se revisó historias clínicas de todos los niños menores de 14 años que fueron internados con el diagnostico de meningitis en los últimos 10 años. Resultados: Ingresaron 280 historias, el 44,6% correspondió a meningitis bacteriana, 32.1% tuberculosa, 16,4% viral y en 6,8% no se obtuvo germen. Clínicamente la fiebre, convulsiones e hipoactividad son los síntomas y signos más frecuentes. H. influenzae el agente más encontrado. Un 60% de los que cursan con meningitis bacteriana recibió la vacuna pentavalente. Conclusiones: Las infecciones del SNC representan actualmente el 0,3% de las internaciones, hace 10 años representaba el 1,2% del total de las hospitalizaciones en nuestro nosocomio. El origen bacteriano es el más frecuente.
Neuroinfections in children is a serious disease with high morbidity and mortality. Objectives: To describe the characteristics of meningitis en children less than 14 years of age admitted to the Hospital del Niño "Ovidio Aliaga Uría". Methods: Retrospective and descriptive study of children under 14 years of age with the diagnosis of meningitis Results: Of 280 cases, 44.6% were bacterial meningitis, 32.1% tuberculous meningitis and 6.8% with negative cultures. The prevalent signs were: fever, seizures and hypoactivity. The most common bacteria were H. Influenzae. 60% of children received the pentavalent vaccine. Conclusions: 0.3% of the present admissions to our hospital is due to meningitis; ten years ago they represented 1.2% of the admissions. Bacterial meningitis is the most common cause.