Neuroinfectious Disease
What You'll Learn
CSF Profiles Comparison
| Parameter | Bacterial | Viral | TB/Fungal | Carcinomatous |
|---|
| WBC | 1,000–10,000+ (PMNs) | 10–500 (lymphocytes) | 100–500 (lymphocytes) | 10–200 (lymphocytes) |
| Protein | ↑↑ (100–500+) | Normal–mildly ↑ | ↑↑↑ (100–500+) | ↑↑ (50–200+) |
| Glucose | ↓↓ (<40 or <2/3 serum) | Normal | ↓↓↓ (often <20) | ↓↓ |
| Opening pressure | ↑↑ (200–500+) | Normal–mildly ↑ | ↑↑ | ↑ |
| Special tests | Gram stain, culture, latex agglutination | PCR (enterovirus, HSV) | AFB smear/culture, India ink, CrAg | Cytology (×3 LPs), flow cytometry |
Empiric Antibiotic Therapy by Age
| Age Group | Common Organisms | Empiric Regimen |
|---|
| Neonates (<1 month) | GBS, E. coli, Listeria | Ampicillin + gentamicin + cefotaxime |
| Infants/Children (1 mo–18 yr) | S. pneumoniae, N. meningitidis, H. influenzae | Ceftriaxone + vancomycin + dexamethasone |
| Adults (18–50 yr) | S. pneumoniae, N. meningitidis | Ceftriaxone 2 g IV q12h + vancomycin 15–20 mg/kg IV q8–12h (target trough 15–20 mcg/mL) + dexamethasone 0.15 mg/kg IV q6h × 4 days |
| Adults ≥50 yr / Immunocompromised / Pregnant | S. pneumoniae, Listeria, gram-negatives | Above regimen + ampicillin 2 g IV q4h for Listeria coverage (cephalosporins do NOT cover Listeria) |
| Hospital-acquired / post-neurosurgical / penetrating trauma / CSF shunt | S. aureus (incl. MRSA), Pseudomonas, gram-negatives, coag-neg Staph | Vancomycin 15–20 mg/kg IV q8–12h + cefepime 2 g IV q8h OR meropenem 2 g IV q8h (covers Pseudomonas + MRSA + gram-negatives) |
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