When the drugs don t work- a case of HSV encephalitis.
|
|
- Barnard Harris
- 5 years ago
- Views:
Transcription
1 When the drugs don t work- a case of HSV encephalitis. Nicky Price Consultant Virologist Public Health Wales
2 67 year old Caucasian Female Presenting complaint 2 day history of: Confusion Shivering Headache Myalgia Vomited X1 (no diarrhoea) Bizarre behaviours Poor recall (short and long term) Repetitive questioning No hallucinations, no LOC, no seizures No alcohol or drugs No cough or dysuria No travel history PMH/DH: Nil of relevance
3 On examination: Expressive dysphasia and memory impairment Disorientated in time (orientated in person/place) Pyrexial (39 C) GCS 14/15 No further abnormality noted CT scan normal LP: 76 RBC DD: Encephalopathic? Cause Rx: IV Aciclovir 10mg/kg q8h, IV Ceftriaxone 2g q12h, IV Amoxicillin 2g q4h. 64 WBC (70% polymorphs/30% lymphocytes) Protein 0.64 (range g/l) CSF glucose 4.5, plasma glucose not available
4 3 days later Patient felt better However, no change in memory impairment or expressive dysphasia HSV 1 DETECTED by PCR (Stopped antibiotics as cultures negative) HIV test negative (no other immunosuppression)
5 1 st Dilemma: Should steroids be given? Yes No
6 1 st Dilemma: Should steroids be given? Corticosteroids have been used, especially if marked cerebral oedema, brain shift or raised intracranial pressure. We Controversial- do not routinely whilst use reduces steroids and swelling, did not also use has them in strong this case. immunomodulatory effect which may help viral replication. The Retrospective Management analysis of Suspected of 45 Viral patients Encephalitis showed that Guideline older age, 2012 lower advises admission to wait for GCS the and RCT lack results of steroids and all independently predicted poorer outcome. Kamei S et al. J not to use routinely. Soloman T et al. Association of British Neurologists and British Infection Neurol Association Neurosurg National Psychiatry Guidelines. 2005, 76: J.Infection : RCT (GACHE trial) currently performed to address this. Martinez-Torres F et al. GACHE Investigators. BMC Neurol 2008;8:40.
7 1 week into IV aciclovir No real change. Remains pyrexial Still disorientated time Expressive dysphasia Repeat LP: Raised WBC (420) 95% lymphocytes still HSV PCR positive Low density area within left temporal lobe (note previously normal CT scan- can be in 25%) L
8 R Parasagittal L Parasagittal L Lateral R Lateral R R T T Left Temporal slowing ( a non specific abnormality indicating underlying focal disturbance of cerebral activity)
9 2 nd Dilemma- Should IV aciclovir dose be increased? Yes No
10 Should IV aciclovir dose be increased? RCT studies used 10mg/kg q8h IV aciclovir for 10 days versus vidarabine and assessed outcome. This reduced mortality from 50% to 20% (severe morbidity or death from 70% to 30%). Skoldenberg B et al. Lancet 1984;2: Whitley RJ et al. N Eng J Med 1986;314: Reports of relapse, so minimum 14 days therapy then utilisednot based on trial data. Soloman T et al. Association of British Neurologists and British Infection Association National Guidelines. J.Infection : Due to continued pyrexia, raised CSF WBC and unchanged clinical picture we increased the dose of IV aciclovir to 15mg/kg tds, (with the caveat to monitor renal function and hydration). (Neonatal HSV is treated at an even higher dose of 20mg/kg q8h for 3 weeks).
11 3 weeks into IV aciclovir Pyrexia had settled by 2 weeks. Further LP still HSV DETECTED, WBC now 100. Patient feels memory gradually improving. CSF sent for culture and phenotypic resistance. Continue further 2/52 aciclovir and review. 5 weeks into IV aciclovir Further LP still HSV DETECTED, WBC now 56. Previous CSF sent for culture and phenotypic resistance testing- failed to culture. Stable clinical picture, not orientated to time as before
12 3 rd Dilemma- Should we continue present regimen? Currently Day 35 of IV aciclovir Should we: A) Continue B) Consider aciclovir resistance and switch to foscarnet? C) Add in foscarnet to the aciclovir? D) Switch to oral valaciclovir?
13 Resistance to aciclovir? dntp (A,C,G,T) P P P + P P Inhibit the growing dntp chain and viral replication P DNA POL Viral replication Foscarnet aciclovir P P P P Thymidine kinase Cellular kinases Can t culture this CSF. Only 1 case in HSE literature of virologically confirmed aciclovir resistance in immunocompetents. Kakiuchi S et al. J Clin Micro 2013; 51 : Prevalence of aciclovir resistance is 0.1%-0.7% in immunocompetent patients and 3.5%-10% in those with immunosuppression in general clinical isolates. Collins P and M.N. Ellis. J Med Virol 1993 Suppl Stranska R et al. J Clin Virol :7-18
14 Foscarnet-switch or add? RISK BENEFIT Toxicity- marked reduction in renal function Reduction in VL Good CSF penetration Unlikely resistance in this case
15 Oral valaciclovir Adult patients received between 10mg/kg q8h to 20mg/kg q8h for days, then randomised to placebo or valaciclovir 2g q8h for 90 days. The results are on the trial website. There was no statistical analysis provided. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. [accessed ]. Oral valaciclovir 1g q8h given for 21 days in confirmed HSE in Vietnam. 4 patients were studied and the [aciclovir] CSF was above the IC 50 required to inhibit HSV1 or HSV2. However, there is no full outcome data in this study. Pouplin T et al AAC; 55: Insufficient outcome data on oral valaciclovir for HSE use.
16 Management of Encephalitis Guidelines 2012 HSV/VZV Encephalitis confirmed NO Immunosuppressed? Or age 3 months-12 years? YES 14 days IV aciclovir 21 days IV aciclovir Repeat LP PCR Positive? NO YES Stop aciclovir 7 days IV aciclovir Soloman T et al. Association of British Neurologists and British Infection Association National Guidelines. J.Infection :
17 CSF Indices Post aciclovir Wk 0 Wk 1 Wk 3 Wk 5 CT Value WBC Improving CSF Indices Stable clinical picture
18 3 rd Dilemma- Should we continue present regimen? Currently Day 35 of IV aciclovir Should we: A) Continue in view of improving CSF and stable clinical picture (F/U imaging not available) B) Consider aciclovir resistance and switch to foscarnet? C) Add in foscarnet to the aciclovir? D) Switch to oral valaciclovir?
19 Follow on 2 weeks later the LP showed only 14 WBC and was HSV PCR negative. 47 days of IV aciclovir. Patient was transferred to a neurological rehabilitation unit for 2 months Neurocognitive assessments: (Addenbrookes Cognitive Evaluation-Revised) At 5 weeks into IV aciclovir 62/100 At end of aciclovir treatment 70/100
20 Summary Poor prognosis even with antivirals 58% moderately or severely disabled or death Death in up to 15% 42% favourable outcome (mild or no disability) 14% full recovery Mailles et al Long term outcome of patients presenting with acute infectious encephalitis of various causes in France. CID 54: Individual cases often thought provoking, especially when aciclovir use is 47 days! Await RCT GACHE results
21
Managing meningitis not just antibiotics. Helena White December 2013
Managing meningitis not just antibiotics Helena White December 2013 Case history 43 year old British-born Asian lady Legal advisor Married with a three year old child (on Amoxicillin for recent ear infection)
More informationMANAGEMENT OF SUSPECTED VIRAL ENCEPHALITIS IN CHILDREN
MANAGEMENT OF SUSPECTED VIRAL ENCEPHALITIS IN CHILDREN OVERVIEW 1980s: dramatically improved by aciclovir HSV encephalitis in adults Delays treatment(> 48h after hospital admission): associated with a
More informationANTIBIOTIC GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED MENINGITIS AND ENCEPHALITIS IN ADULTS
ANTIBIOTIC GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED MENINGITIS AND ENCEPHALITIS IN ADULTS Version 4.0 Date ratified February 2009 Review date February 2011 Ratified by Authors Consultation Evidence
More informationAcyclovir treatment of herpes simplex encephalitis: experience
Postgraduate Medical Journal (1987) 63, 1037-1041 Acyclovir treatment of herpes simplex encephalitis: experience in a district hospital M.C. Gulliford, C.P. Chandrasekera, R.A. Cooper and R.P. Murphy Departments
More informationDilemmas in the Management of Meningitis & Encephalitis HEADACHE AND FEVER. What is the best initial approach for fever, headache, meningisums?
Dilemmas in the Management of Meningitis & Encephalitis Paul D. Holtom, MD Professor of Medicine and Orthopaedics USC Keck School of Medicine HEADACHE AND FEVER What is the best initial approach for fever,
More informationVIRAL ENCEPHALITIS EASY TO MISS
TAMORISH KOLE MBBS MRCS(EDIN) FRSM(UK) SENIOR CONSULTANT & HEAD, EMERGENCY MEDICINE, MAX HEALTHCARE, NEW DELHI, INDIA ADJUNCT ASSISTANT PROFESSOR, EMERGENCY MEDICINE, GEORGE WASHINGTON UNIVERSITY, WASHINGTON
More informationDr Paul Holmes Guy s and St Thomas NHS Foundation Trust, London
Dr Paul Holmes Guy s and St Thomas NHS Foundation Trust, London HIV and Lumbar punctures in 2018 Paul Holmes Consultant Neurologist Guy s and St Thomas Hospitals I have no competing interests Summary of
More informationCNS Infections. Philip Gothard Consultant in Infectious Diseases Hospital for Tropical Diseases, London. Hammersmith Acute Medicine 2011
CNS Infections Philip Gothard Consultant in Infectious Diseases Hospital for Tropical Diseases, London Hammersmith Acute Medicine 2011 Case 1 HISTORY 27y man Unwell 3 days Fever Headache Photophobia Previously
More informationGUIDELINE FOR THE MANAGEMENT OF MENINGITIS. All children with suspected or confirmed meningitis
GUIDELINE FOR THE MANAGEMENT OF MENINGITIS Reference: Mennigitis Version No: 1 Applicable to All children with suspected or confirmed meningitis Classification of document: Area for Circulation: Author:
More informationID Emergencies. BGSMC Internal Medicine Edwin Yu
ID Emergencies BGSMC Internal Medicine Edwin Yu Learning Objectives Bacterial meningitis IDSA guidelines: Clin Infect Dis 2004; 39:1267-84 HSV encephalitis IDSA guidelines: Clin Infect Dis 2008; 47:303-27
More informationH erpes simplex virus encephalitis (HSVE) is associated
1544 PAPER Evaluation of combination therapy using aciclovir and corticosteroid in adult patients with herpes simplex virus encephalitis S Kamei, T Sekizawa, H Shiota, T Mizutani, Y Itoyama, T Takasu,
More informationHuman Herpes Virus-6 Limbic Encephalitis
Case Studies [1] March 19, 2013 Case history: A 32-year-old Caucasian female with newly diagnosed acute myeloid leukemia (AML) was treated with induction chemotherapy and attained complete remission. She
More informationBrain abscess rupturing into the lateral ventricle causing meningitis: a case report
Brain abscess rupturing into the lateral ventricle causing meningitis: a case report Endry Martinez, and Judith Berger SBH Health System, 4422 Third Ave, Bronx, NY 10457 Key words: brain abscess, rupture
More informationReactivation of herpesvirus under fingolimod: A case of severe herpes simplex encephalitis
Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2015 Reactivation of herpesvirus under fingolimod: A case of severe herpes
More informationChallenges in viral CNS infections [encephalitis]
Challenges in viral CNS infections [encephalitis] PIGS Training Course 2013 Basel November 8, 2013 Christoph Aebi christoph.aebi@insel.ch Definition Encephalitis is defined as a syndrome of neurological
More informationENCEPHALITIS. Diana Montoya Melo
ENCEPHALITIS Diana Montoya Melo 4 yo female patient, brought to the ED after having a GTC seizure 30 mins ago, which lasted up to a min. Mom reports that he has a ho 3 days of fever and runny nose, associated
More informationHerpes simplex virus I and II: a therapeutic approach
Herpes simplex virus I and II: a therapeutic approach Abstract Van der Plas H Division Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town Hardie D Division of Virology,
More informationExample Clinician Educational Material for Providers of Immune Effector Cellular Therapy
Example Clinician Educational Material for Providers of Immune Effector Cellular Therapy Disclaimer: This example is just one of many potential examples of clinician education material that can be provided
More informationVIRAL ENCEPHALITIS PRESENTING AS CVA (STROKE)
Case Report VIRAL ENCEPHALITIS PRESENTING AS CVA (STROKE) AM.P.Gorkhaly*, A. Poudel**, Rewati Raman Malla*** Abstract Acute viral encephalitis is due to direct invasion of the brain by virus with herpes
More informationInitial Management of Suspected Encephalitis. Dr Ruth Palmer Consultant Microbiologist
Initial Management of Suspected Encephalitis Dr Ruth Palmer Consultant Microbiologist CNS infections are urgent and important Mortality is significant recovery is slow and and post infection deficits occur
More informationhigher in CSF samples from patients infected with HSV type 2 (median, cells/l) than in samples from 6
MAJOR ARTICLE Clinical Features of Viral Meningitis in Adults: Significant Differences in Cerebrospinal Fluid Findings among Herpes Simplex Virus, Varicella Zoster Virus, and Enterovirus Infections Ugo
More informationDiagnosis and Treatment of Neurological Disease from Herpesvirus infection in Neonates and Children Cheryl Jones The Children s s Hospital at
Diagnosis and Treatment of Neurological Disease from Herpesvirus infection in Neonates and Children Cheryl Jones The Children s s Hospital at Westmead, NSW University of Sydney Overview Members of herpesvirus
More informationAn Intriguing Case of Meningitis. Tiffany Mylius MLS (ASCP)
An Intriguing Case of Meningitis { Tiffany Mylius MLS (ASCP) A 4yo male presents with 2wk history of URI symptoms. On the day of admission, the patient woke up with a HA in the morning, took a nap later
More informationID Emergencies. BUMC-P Internal Medicine Edwin Yu
ID Emergencies BUMC-P Internal Medicine Edwin Yu Learning Objectives Bacterial meningitis IDSA guidelines: Clin Infect Dis 2004; 39:1267-84 HSV encephalitis IDSA guidelines: Clin Infect Dis 2008; 47:303-27
More informationCerebral Toxoplasmosis in HIV-Infected Patients. Ahmed Saad,MD,FACP
Cerebral Toxoplasmosis in HIV-Infected Patients Ahmed Saad,MD,FACP Introduction Toxoplasmosis: Caused by the intracellular protozoan, Toxoplasma gondii. Immunocompetent persons with primary infection
More informationEmergency Neurological Life Support Meningitis and Encephalitis
Emergency Neurological Life Support Meningitis and Encephalitis Version: 2.0 Last Updated: 19-Mar-2016 Checklist & Communication Meningitis and Encephalitis Table of Contents Emergency Neurological Life
More informationUK Meningitis Study CRF
History Date of onset of symptoms Route of admission A and E GP Other Date of admission to hospital* / / Time of admission (24 hour clock) : *record time and date of admission to A and E if admitted ia
More informationLocal Natalizumab Treatment Protocol
Local Natalizumab Treatment Protocol 1. New medicine name: Natalizumab 300mg concentrate for solution for infusion (Natalizumab ) 2. Licensed indication(s): Natalizumab is indicated for single disease
More informationACIVIR DT Tablets (Aciclovir)
Published on: 29 Jan 2016 ACIVIR DT Tablets (Aciclovir) Composition ACIVIR-200 DT Each dispersible tablet contains Aciclovir, BP 200 mg (in a flavoured base) ACIVIR-400 DT Each dispersible tablet contains
More informationCryptococcal Meningitis
Cryptococcal Meningitis Dr N Thumbiran Infectious Diseases Department UKZN Index patient 27 year old female Presented to King Edward Hospital on 17/07/2005 with: Severe headaches Vomiting Photophobia X
More informationViral Infections. 1. Prophylaxis management of patient exposed to Chickenpox:
This document covers: 1. Chickenpox post exposure prophylaxis 2. Chickenpox treatment in immunosuppressed/on treatment patients 3. Management of immunosuppressed exposed to Measles All children with suspected
More informationPEDIATRIC INFECTIOUS DISEASES UPDATE. Neonatal HSV. Recognition, Diagnosis, and Management Coleen Cunningham MD
Neonatal HSV Recognition, Diagnosis, and Management Coleen Cunningham MD Important questions Who is at risk? When do you test? What tests do you perform? When do you treat? What is appropriate therapy?
More informationPost-operative Herpes Simplex Virus Encephalitis after Surgical Resection of Meningioma: A Case Report and Review of the Literature
Review Article imedpub Journals http://www.imedpub.com/ JOURNAL OF NEUROLOGY AND NEUROSCIENCE DOI: 10.21767/2171-6625.100090 Post-operative Herpes Simplex Virus Encephalitis after Surgical Resection of
More informationA Child with Cross Eye. Nia Kurniati
A Child with Cross Eye Nia Kurniati Background When dealing with new case with potential social problem, complication related to ARV treatment may pose difficulties Restricted resource to address potential
More informationA common case definition for PML
A common case definition for PML Transatlantic workshop: Drug-related Progressive Multifocal Leukoencephalopathy (PML) 25.-26.7.2011, EMA, London Paul-Ehrlich-Institut Dr. Dirk Mentzer, MD Paul-Ehrlich-Str.
More informationAcyclovir dose for meningitis
P ford residence southampton, ny Acyclovir dose for meningitis Aciclovir (ACV), also known as acyclovir, is an antiviral medication. It is primarily used for the treatment of herpes simplex virus infections,
More informationA systematic review of evidence-based guidelines for drug therapies for viral encephalitis in children
DOI:10.16636/j.cnki.jinn.2015.06.007 2 015 4 2 6 1 1 1 2 1 1. 530021 2. 530021 PubMed EMbase CBM CNKI NGC GIN TRIP CDC IDSA AAP WHO 2014 10 2 Ⅱ AGREEⅡ ICC 3 5 B AGREEⅡ6 68. 54 % Ⅱ A systematic review of
More informationDiagnosis of CMV infection UPDATE ECIL
UPDATE ECIL-4 2011 Recommendations for CMV and HHV-6 management in patients with hematological diseases Per Ljungman, Rafael de la Camara, Hermann Einsele, Dan Engelhard, Pierre Reusser, Jan Styczynski,
More informationPACKAGE LEAFLET: INFORMATION FOR THE USER. Erpizon Lyophilisate for solution for infusion 250 mg/vial Aciclovir
PACKAGE LEAFLET: INFORMATION FOR THE USER Erpizon Lyophilisate for solution for infusion 250 mg/vial Aciclovir 1. DESCRIPTION OF THE MEDICINAL PRODUCT 1.1 Name: ERPIZON 250 mg/vial 1.2 Qualitative composition:
More informationmodified dye uptake assay including formazan test EC 90 not tested plaque reduction assay
Sauerbrei A, Bohn-Wippert K, Kaspar M, Krumbholz A, Karrasch M, Zell R. 2015. Database on natural polymorphisms and resistance-related non-synonymous mutations in thymidine kinase and DNA polymerase genes
More informationAntibiotic Protocols for Paediatrics Steve Biko Academic Hospital
Antibiotic Protocols for Paediatrics Steve Biko Academic Hospital Respiratory tract infections in children Uncomplicated URTI A child with a cold should not receive an antibiotic Paracetamol (15 mg/kg/dose
More informationTB and HIV co-infection including IRIS
TB and HIV co-infection including IRIS Richard Lessells SAHCS Conference 2018 Clinical scenario 1 36-year-old male Presents with cough, fever & weight loss HIV test positive (new diagnosis) Sputum Xpert
More informationA challenging neurological complication in a young HIV-infected woman
A challenging neurological complication in a young HIV-infected woman Ianache Irina-Cristiana Vi tor Ba es Clini al Hospital for Infectious and Tropical Diseases Bucharest - HIV/AIDS department Assessment
More informationA Neurologist s Approach to Altered Mental Status
A Neurologist s Approach to Altered Mental Status S. Andrew Josephson, MD Department of Neurology University of California San Francisco October 23, 2008 The speaker has no disclosures Case 1 A 71 year-old
More informationCommunity Acquired Pneumonia
April 2014 References: 1. Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, Kaplan SL Mace SE, McCracken Jr. GH, Moor MR, St. Peter SD, Stockwell JA, and Swanson JT. The Management of
More informationClinical Diagnosis & Management of SARS
Clinical Diagnosis & Management of SARS Joseph SUNG MD, PhD Department of Medicine & Therapeutics Prince of Wales Hospital The Chinese University of Hong Kong Hospital Authority of Hong Kong SAR Diagnosis
More informationStroke in the ED. Dr. William Whiteley. Scottish Senior Clinical Fellow University of Edinburgh Consultant Neurologist NHS Lothian
Stroke in the ED Dr. William Whiteley Scottish Senior Clinical Fellow University of Edinburgh Consultant Neurologist NHS Lothian 2016 RCP Guideline for Stroke RCP guidelines for acute ischaemic stroke
More informationBHIVA Best Practice Management Session
BHIVA Best Practice Management Session CNS (The brain) - I keep forgetting things DEMENTIA DIAGNOSIS, CLASSIFICATION AND INVESTIGATIONS Paul Holmes Consultant Neurologist Guy s and St Thomas Hospitals
More informationA Cerebellar Conundrum
BHIVA AUTUMN CONFERENCE 2011 Including CHIVA Parallel Sessions Dr Lavanya Raman Chelsea and Westminster Hospital, London 17 18 November 2011, Queen Elizabeth II Conference Centre, London A Cerebellar Conundrum
More informationpatient group direction
ACICLOVIR v01 1/8 ACICLOVIR PGD Details Version 1.0 Legal category Staff grades Approved by POM Paramedic (Non-ECP) Nurse (Non-ECP) Emergency Care Practitioner (Paramedic) Emergency Care Practitioner (Nurse)
More informationManagement of Cryptococcal Meningitis in HIV-infected children in National Pediatric Hospital
Management of Cryptococcal Meningitis in HIV-infected children in National Pediatric Hospital Olivier Marcy 1,2, Sam Sophan 2, Ung Vibol 2, Chan Bunthy 2, Pok Moroun 2, Chy Kam Hoy 2, Ban Thy 2, Chhour
More informationChallenges in Management of Cryptococcal Meningitis. Yunus Moosa Department of ID NRMSM Durban
Challenges in Management of Cryptococcal Meningitis Yunus Moosa Department of ID NRMSM Durban Overview Epidemiology Pathogenesis Clinical presentation Diagnosis Prognostic factors Antifungal Treatment
More informationHost genotypes, inflammatory response and outcome of TBM Vietnam
Host genotypes, inflammatory response and outcome of TBM Vietnam Nguyen T.T. Thuong Oxford University Clinical Research Unit Ho Chi Minh City, Vietnam Tuberculous Meningitis (TBM) Diagnosis remains difficult
More informationnumber Done by Corrected by Doctor
number 34 Done by حسام ابو عوض Corrected by Waseem Alhaj Doctor مالك الزحلف Antiviral Chemotherapy (chemotherapy is another way of saying drugs بنحب نتفلسف وهيك.(بس When dealing with viruses we are entering
More informationGeneral Identification. Name: 江 X X Age: 29 y/o Gender: Male Height:172cm, Weight: 65kg Date of admission:95/09/27
General Identification Name: 江 X X Age: 29 y/o Gender: Male Height:172cm, Weight: 65kg Date of admission:95/09/27 Chief Complaint Sudden onset of seizure for several minutes Present illness This 29-year
More informationby author ESCMID Online Lecture Library Steroids in acute bacterial meningitis
Steroids in acute bacterial meningitis Javier Garau, MD, PhD University of Barcelona Spain ESCMID Summer School, Porto, July 2009 Dexamethasone treatment in childhood bacterial meningitis in Malawi: a
More informationBrain disorders mimicking encephalitis, but it s not infectious encephalitis
Brain disorders mimicking encephalitis, but it s not infectious encephalitis Prof. Pierre TATTEVIN Maladies Infectieuses et Réanimation Médicale Hôpital Pontchaillou, CHU Rennes 0 Déclaration de liens
More informationAdvanced HIV and seriously ill: challenges in low resource settings Rosie Burton, Southern African Medical Unit, MSF
Advanced HIV and seriously ill: challenges in low resource settings Rosie Burton, Southern African Medical Unit, MSF Mozambique Mozambique Mozambique Mozambique Preventing mortality MSF hospital, Kinshasa,
More informationClinical Information on West Nile Virus (WNV) Infection
Clinical Information on West Nile Virus (WNV) Infection Introduction In 1999, West Nile Virus (WNV), an Old World flavivirus, producing a spectrum of disease including severe meningoencephalitis, appeared
More informationGenital herpes is caused by infection with the herpes simplex viruses (HSV) of which there are two types (HSV-1 and HSV-2).
ANO-GENITAL HERPES Introduction Genital herpes is caused by infection with the herpes simplex viruses (HSV) of which there are two types (HSV-1 and HSV-2). Definitions Initial episode: First episode with
More informationOne View of STEROIDS Who is this? EBV/Mono. Infections With Possible Steroid Rx STEROID USE IN PEDIATRIC INFECTION. EBV TB Meningitis Septic Arthritis
One View of STEROIDS Who is this? STEROID USE IN PEDIATRIC INFECTION Peggy Weintrub Infections With Possible Steroid Rx EBV/Mono EBV TB Meningitis Septic Arthritis Who painted this young woman with mono?
More informationCNS Infections in the Pediatric Age Group
CNS Infections in the Pediatric Age Group Introduction CNS infections are frequently life-threatening In the Philippines, bacterial meningitis is one of the top leading causes of mortality in children
More informationAlthough herpes simplex encephalitis is the most
Use of the Polymerase Chain Reaction in the Diagnosis of Herpes Simplex Encephalitis: A Decision Analysis Model* Pablo Tebas, MD, Robert F. Nease, PhD, Gregory A. Storch, MD PURPOSE: To evaluate the utility
More informationOpportunistic Infections BHIVA Guidelines
Opportunistic Infections BHIVA Guidelines Mark Nelson David Dockrell Simon Edwards I have.. 1. Read all of the BHIVA guidelines 12% 2. Read some of the BHIVA guidelines in their entirety 3. Browsed some
More informationHIV Neurology Persistence of Cognitive Impairment Despite cart
HIV Neurology Persistence of Cognitive Impairment Despite cart Victor Valcour MD PhD Professor of Medicine Memory and Aging Center, Dept. of Neurology University of California San Francisco, USA 8 th International
More informationStructure of viruses
Antiviral Drugs o Viruses are obligate intracellular parasites. o lack both a cell wall and a cell membrane. o They do not carry out metabolic processes. o Viruses use much of the host s metabolic machinery.
More informationMeningitis. Matthew Grant MD
Meningitis Matthew Grant MD Objectives Understand the diagnostic accuracy of clinical findings Appreciate the differential diagnosis of aseptic meningitis syndrome, and indications for hospitalization
More informationCLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION
Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 3/12/2011 Radiology Quiz of the Week # 11 Page 1 CLINICAL PRESENTATION AND RADIOLOGY
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Jain S, Kamimoto L, Bramley AM, et al. Hospitalized patients
More informationGUIDELINE FOR THE MANAGEMENT OF
GUIDELINE FOR THE MANAGEMENT OF Reference: Febrile Convulsions Version No: 1 Applicable to All children admitted with Febrile Convulsion to the Children s Hospital for Wales Classification of document:
More informationThis resource was first published in 2014 and revised in 2017.
This resource was first published in 2014 and revised in 2017. 0 There is good evidence to suggest that patients eventually diagnosed with HIV infection have had contact with medical services, with symptoms
More informationDisclosure Statement. Dr. Kadish has no relevant financial relationships with any commercial interests mentioned in this talk.
Disclosure Statement Dr. Kadish has no relevant financial relationships with any commercial interests mentioned in this talk. Head Trauma Evaluation Primary and secondary injury Disposition Sports related
More informationBrain and Central Nervous System Cancers
Brain and Central Nervous System Cancers NICE guidance link: https://www.nice.org.uk/guidance/ta121 Clinical presentation of brain tumours History and Examination Consider immediate referral Management
More informationHỘI CHỨNG THỰC BÀO MÁU. (HEMOPHAGOCYTIC LYMPHOHISTOCYTOSIS)
HỘI CHỨNG THỰC BÀO MÁU. (HEMOPHAGOCYTIC LYMPHOHISTOCYTOSIS) INTRODUTION. An aggressive and life-threatening syndrome of excessive immune activation. Was described in 1952. Most frequently affects infants
More informationCentral Nervous System Immune Reconstitution Disease: Pathology
Central Nervous System Immune Reconstitution Disease: Pathology F.Gray, H.Adle-Biassette, F.Héran, G. Pialoux, A.Moulignier, APHP Hôpital Lariboisière Université Paris VII Introduction of HAART, which
More informationINFLUENZA VACCINATION AND MANAGEMENT SUMMARY
INFLUENZA VACCINATION AND MANAGEMENT SUMMARY Morbidity and mortality related to influenza occur at a higher rate in people over 65 and those with underlying chronic medical conditions. Annual influenza
More information8/29/2011. Brain Injury Incidence: 200/100,000. Prehospital Brain Injury Mortality Incidence: 20/100,000
Traumatic Brain Injury Almario G. Jabson MD Section Of Neurosurgery Asian Hospital And Medical Center Brain Injury Incidence: 200/100,000 Prehospital Brain Injury Mortality Incidence: 20/100,000 Hospital
More informationCase Report. Herpes simplex virus encephalitis presenting as frontal lobe hemorrhage
1 Case Report Herpes simplex virus encephalitis presenting as frontal lobe hemorrhage Authors: Shila, MD, *Jessica Erfan, MPAS, PA-C, Ray Bogitch, MD, Jefferson T. Miley, MD Department of Neurology, Dell
More informationvalganciclovir, 450mg tablets, 50mg/ml powder for oral solution (Valcyte ) SMC No. (662/10) Roche Products Ltd
valganciclovir, 450mg tablets, 50mg/ml powder for oral solution (Valcyte ) SMC No. (662/10) Roche Products Ltd 17 December 2010 The Scottish Medicines Consortium (SMC) has completed its assessment of the
More informationKAP conference 19 th March 2008: Dr Mohamed Hussein Jin.
SENSITIVITY PATTERNS, SEROTYPES OF CRYPTOCOCCUS NEOFORMANS AND DIAGNOSTIC VALUE OF INDIA INK IN PATIENTS WITH CRYPTOCOCCAL MENINGITIS AT KENYATTA NATIONAL HOSPITAL. KAP conference 19 th March 2008: Dr
More informationPeople with genital herpes require enough information and medication (when indicated) to self-manage their condition.
Genital Herpes Summary of Guidelines Taken from: Guidelines for the Management of Genital Herpes in New Zealand 11th Edition - 2015 www.herpes.org.nz Genital Herpes Key Management Points Genital herpes
More informationCentral Nervous System Penetration of ARVs: Does it Matter?
NORTHWEST AIDS EDUCATION AND TRAINING CENTER Central Nervous System Penetration of ARVs: Does it Matter? Christina M. Marra, MD Neurology and Medicine (Infectious Diseases) University of Washington 15
More informationClass 10. DNA viruses. I. Seminar: General properties, pathogenesis and clinial features of DNA viruses from Herpesviridae family
English Division, 6-year programme Class 10 DNA viruses I. Seminar: General properties, pathogenesis and clinial features of DNA viruses from Herpesviridae family II. Assays to be performed: 1. Paul-Bunnel-Davidsohn
More informationWessex Regional Paediatric Neurology Guideline: Management of Suspected Encephalitis
1 Wessex Regional Paediatric Neurology Guideline: Management of Suspected Encephalitis An algorithm summarising management is shown below (Figure 1). This must be read in conjunction with the text that
More informationVALCIVIR Tablets (Valacyclovir hydrochloride)
Published on: 10 Jul 2014 VALCIVIR Tablets (Valacyclovir hydrochloride) Composition VALCIVIR-500 Tablets Each film-coated tablet contains: Valacyclovir Hydrochloride equivalent to Valacyclovir.. 500 mg
More informationObjectives & Disclosures
Meningitis and Encephalitis: Diagnostic and Management Challenges October 28 th, 2017 Infectious Diseases update 2017 Rodrigo Hasbun, MD MPH FIDSA UT Health Medical School Professor of Medicine Section
More informationGuidelines for the Immediate Management of Paediatric Patients with Sickle Cell Disease (SCD) and Acute Neurological Symptoms
Guidelines for the Immediate Management of Paediatric Patients with Sickle Cell Disease (SCD) and Acute Neurological Symptoms Document Information Version: 2 Date: Sept 2014 Authors (incl. job title):
More information2017 CST-Astellas Canadian Transplant Fellows Symposium. Optimizing use of organs from Increased Risk Donors
2017 CST-Astellas Canadian Transplant Fellows Symposium Optimizing use of organs from Increased Risk Donors Atual Humar, MD Atul Humar is a Professor in the Department of Medicine, University of Toronto.
More informationMetabolic complications of HIV and HAART: The hyperlactataemia syndromes
Metabolic complications of HIV and HAART: The hyperlactataemia syndromes Colin Menezes Division of Infectious Diseases Department of Internal Medicine Chris Hani Baragwanath Academic Hospital University
More informationPeriodic and Rhythmic Patterns. Suzette M LaRoche, MD Mission Health Epilepsy Center Asheville, North Carolina
Periodic and Rhythmic Patterns Suzette M LaRoche, MD Mission Health Epilepsy Center Asheville, North Carolina Continuum of EEG Activity Neuronal Injury LRDA GPDs SIRPIDs LPDs + NCS Burst-Suppression LPDs
More informationErrors in Dx and Rx of TB
Errors in Dx and Rx of TB David Schlossberg, MD, FACP Professor of Medicine Temple University School of Medicine Medical Director, TB Control Program Philadelphia Department of Public Health TB Still a
More informationLumbar puncture. Invasive procedure: diagnostic or therapeutic. The subarachnoid space 4-13 ys: ml Replenished: 4-6 h Routine LP (3-5 ml): <1h
Lumbar puncture Lumbar puncture Invasive procedure: diagnostic or therapeutic. The subarachnoid space 4-13 ys: 65-150ml Replenished: 4-6 h Routine LP (3-5 ml):
More informationBACKGROUND AND SCIENTIFIC RATIONALE. Protocol Code: ISRCTN V 1.0 date 30 Jan 2012
BACKGROUND AND SCIENTIFIC RATIONALE Protocol Code: ISRCTN15088122 V 1.0 date 30 Jan 2012 Traumatic Brain Injury 10 million killed or hospitalised every year 90% in low and middle income countries Mostly
More informationATTENDING PHYSICIAN'S STATEMENT ENCEPHALITIS
ATTENDING PHYSICIAN'S STATEMENT ENCEPHALITIS A) Patient s Particulars Name of Patient Gender NRIC/FIN or Passport No. Date of Birth (ddmmyyyy) B) Patient s Medical Records 1) Please state over what period
More informationChief Complaint. History. History of Similar Episodes. A 10 Year-Old Boy With Headache
A 10 Year-Old Boy With Headache Chief Complaint Recent Advances in Neurology 2013 10 year-old boy presented with his fifth lifetime bout of left-sided head pain followed by diplopia. Amy A. Gelfand, MD
More informationCase #1. Inter-ictal EEG. Difficult Diagnosis Pediatrics. 15 mos girl with medically refractory infantile spasms 2/13/2010
Difficult Diagnosis Pediatrics Joseph E. Sullivan M.D. Assistant Professor of Clinical Neurology & Pediatrics Director, UCSF Pediatric Epilepsy Center University of California San Francisco Case #1 15
More informationDr. Cristina Gutierrez, Laboratory Director, CARPHA SARI/ARI SURVEILLANCE IN CARPHA MEMBER STATES
Dr. Cristina Gutierrez, Laboratory Director, CARPHA SARI/ARI SURVEILLANCE IN CARPHA MEMBER STATES SARI/ARI Surveillance in CARPHA Member States* Objectives of SARI Surveillance: To detect unusual or unexpected
More informationTreatment of Cryptococcal Meningitis. Graeme Meintjes University of Cape Town GF Jooste Hospital Imperial College London
Treatment of Cryptococcal Meningitis Graeme Meintjes University of Cape Town GF Jooste Hospital Imperial College London Cryptococcal meningitis Predominantly in HIV infected patients with CD4 < 200 Studies
More informationExpert Review: Updates in Immune Thrombocytopenia. Reference Slides
Expert Review: Updates in Immune Thrombocytopenia Reference Slides Immune Thrombocytopenia (ITP): Overview ITP causality 1,2 Suboptimal platelet production Dysregulated adaptive immune system Increased
More informationImpact of Herpes simplex virus load and red blood cells in cerebrospinal fluid upon herpes simplex meningo-encephalitis outcome
Poissy et al. BMC Infectious Diseases 2012, 12:356 RESEARCH ARTICLE Open Access Impact of Herpes simplex virus load and red blood cells in cerebrospinal fluid upon herpes simplex meningo-encephalitis outcome
More information