General Principles of Management - Central Nervous System Infections

GENERAL PRINCIPLES OF MANAGEMENT

In bacterial, mycobacterial, and fungal infections of the CNS, prompt and aggressive an-timicrobial therapy is required. The duration of treatment varies from as little as 10 days for uncomplicated bacterial meningitis, to 12 months or longer for tuberculous meningi-tis, and to several years for some cases of fungal meningitis.

In addition to antimicrobial therapy, correction of associated metabolic defects (acido-sis, hypoxia, saline depletion, inappropriate antidiuretic hormone secretion) is necessary. Increased intracranial pressure as a result of vasogenic edema or hydrocephalus must be monitored and controlled accordingly; osmotic agents such as intravenous mannitol are often used to control acute cerebral edema, and neurosurgical shunting procedures may be needed to treat progressive hydrocephalus. Abscesses often require drainage. Except for those patients with herpes simplex encephalitis, who often respond to early treatment with antiviral agents, most viral infections of the CNS can only be managed supportively. This includes specific attention to the metabolic and respiratory problems that may de-velop in severe cases.