Sandbox ID Central Nervous System: Difference between revisions

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::* Baylisascaris procyonis
::* Baylisascaris procyonis
:::* Preferred regimen: [[Corticosteroids]]
:::* Preferred regimen: [[Corticosteroids]]
:::* Alternative regimen: [[Albendazole]] {{and}} [[diethylcarbamazine]]
:::* Alternative regimen: [[Albendazole]] {{and}} [[diethylcarbamazine]]
::* Gnathostoma
::* Gnathostoma
:::* Preferred regimen: [[Albendazole]] {{or}} [[Ivermectin]]
::* Taenia solium (cysticercosis)
::* Taenia solium (cysticercosis)
:* Prion
:* Prion

Revision as of 14:17, 28 May 2015

Lyme neuroborreliosis

  • Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines[1]
  • Early neurologic disease
  • Cranial nerve palsy (adult)
  • Cranial nerve palsy (pediatric)
  • Preferred regimen: Amoxicillin 50 mg/kg/day PO in 3 divided doses (maximum, 500 mg per dose) for 14 (14–21) days OR Doxycycline (for children aged ≥ 8 years) 4 mg/kg/day PO in 2 divided doses (maximum, 100 mg per dose) for 14 (14–21) days OR Cefuroxime 30 mg/kg/day PO in 2 divided doses (maximum, 500 mg per dose) for 14 (14–21) days.
  • Alternative regimen: Azithromycin 10 mg/kg/day PO (maximum of 500 mg per day) for 7–10 days OR Clarithromycin 7.5 mg/kg PO bid (maximum of 500 mg per dose) for 14–21 days OR Erythromycin 12.5 mg/kg PO qid (maximum of 500 mg per dose) for 14–21 days.
  • Meningitis or radiculopathy (adult)
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 (10–28) days.
  • Alternative regimen: Cefotaxime 2 g IV q8h for 14 (10–28) days OR Penicillin G 18–24 million U/day IV divided every 4 h for 14 (10–28) days.
Note: For nonpregnant adult patients intolerant of β-lactam agents, Doxycycline 200–400 mg/day PO/IV in 2 divided doses may be considered.
  • Meningitis or radiculopathy (pediatric)
  • Preferred regimen: Ceftriaxone 50–75 mg/kg IV q24h (maximum, 2 g) for 14 (10–28) days.
  • Alternative regimen: Cefotaxime 150–200 mg/kg/day IV in 3–4 divided doses (maximum, 6 g per day) for 14 (10–28) days OR Penicillin G 200,000–400,000 U/kg/day IV divided every 4 h (not to exceed 18–24 million U per day) for 14 (10–28) days.
Note: For children 􏱢≥ 8 years of age intolerant of β-lactam agents, Doxycycline 4–8 mg/kg per day PO/IV in 2 divided doses (maximum daily dosage of 200–400 mg) may be considered.
  • Late neurologic disease
  • Central or peripheral nervous system disease (adult)
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 (10–28) days.
  • Alternative regimen: Cefotaxime 2 g IV q8h for 14 (10–28) days OR Penicillin G 18–24 million U/day IV divided every 4 h for 14 (10–28) days.
  • Central or peripheral nervous system disease (pediatric)
  • Preferred regimen: Ceftriaxone 50–75 mg/kg IV q24h (maximum, 2 g) for 14 (10–28) days.
  • Alternative regimen: Cefotaxime 150–200 mg/kg/day IV in 3–4 divided doses (maximum, 6 g per day) for 14 (10–28) days OR Penicillin G 200,000–400,000 U/kg/day IV divided every 4 h (not to exceed 18–24 million U per day) for 14 (10–28) days.
  • American Academy of Neurology (AAN) Practice Parameter[2]
  • Meningitis
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
  • Alternative regimen: Doxycycline 100–200 mg BID for 14 days
  • Pediatric dose: Ceftriaxone 50–75 mg/kg/day in 1 dose, max 2 g; Cefotaxime 150–200 mg/kg/day in 3–4 divided doses, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day divided q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day in 2 divided doses, max 200 mg/dayose
  • Any neurologic syndrome with CSF pleocytosis
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
  • Alternative regimen: Doxycycline 100–200 mg BID for 14 days
  • Pediatric dose: Ceftriaxone 50–75 mg/kg/day in 1 dose, max 2 g; Cefotaxime 150–200 mg/kg/day in 3–4 divided doses, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day divided q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day in 2 divided doses, max 200 mg/dayose
  • Peripheral nervous system disease (radiculopathy, diffuse neuropathy, mononeuropathy multiplex, cranial neuropathy; normal CSF)
  • Preferred regimen: Doxycycline 100–200 mg BID for 14 days
  • Alternative regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
  • Pediatric dose: Doxycycline (≥ 8 y/o) 4–8 mg/kg/day in 2 divided doses, max 200 mg/dayose; Ceftriaxone 50–75 mg/kg/day in 1 dose, max 2 g; Cefotaxime 150–200 mg/kg/day in 3–4 divided doses, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day divided q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day in 2 divided doses, max 200 mg/dayose
  • Encephalomyelitis
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
  • Pediatric dose: Ceftriaxone 50–75 mg/kg/day in 1 dose, max 2 g; Cefotaxime 150–200 mg/kg/day in 3–4 divided doses, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day divided q4h, max 18–24 MU/day
  • Encephalopathy
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
  • Pediatric dose: Ceftriaxone 50–75 mg/kg/day in 1 dose, max 2 g; Cefotaxime 150–200 mg/kg/day in 3–4 divided doses, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day divided q4h, max 18–24 MU/day
  • Post-treatment Lyme syndrome
  • Preferred regimen: No antibiotics indicated; symptomatic management only

Encephalitis

  • Viruses
  • Adenovirus
  • Preferred regimen: supportive
  • B virus
prophylactic antiviral therapy after bite or scratch
established disease
  • CMV
  • Eastern equine encephalitis virus
  • Preferred regimen: supportive
  • EBV
  • Hendra virus
  • HHV-6
  • HIV
  • HSV-1 and -2
  • Influenza virus
  • Japanese encephalitis virus
  • Preferred regimen: supportive
  • JC virus
  • Preferred regimen: Reversal or control of immunosuppression AND HAART in patients with AIDS
  • La Crosse virus
  • Preferred regimen: supportive
  • Measles virus
life-threatening disease
SSPE
  • Mumps virus
  • Preferred regimen: supportive
  • Murray Valley encephalitis virus
  • Preferred regimen: supportive
  • Nipah virus
  • Nonpolio enteroviruses
  • Preferred regimen: supportive AND Intraventricular γ-globulin (for chronic and/or severe disease)
  • Poliovirus
  • Preferred regimen: supportive
  • Powassan virus
  • Preferred regimen: supportive
  • Rabies virus
postxposure prophylaxis
  • Preferred regimen: rabies immunoglobulin AND vaccine
after onset of disease
  • Preferred regimen: supportive
  • Rubella virus
  • Preferred regimen: supportive
  • St. Louis encephalitis virus
  • Preferred regimen: supportive
  • Alternative regimen: IFN-a-2b
  • Tickborne encephalitis virus
  • Preferred regimen: supportive
  • Vaccinia
  • Venezuelan equine encephalitis virus
  • Preferred regimen: supportive
  • VZV
  • West Nile virus
  • Preferred regimen: supportive
  • Western equine encephalitis virus
  • Preferred regimen: supportive
  • Bacteria
  • Anaplasma phagocytophilum (human granulocytotrophic ehrlichiosis)
  • Bartonella bacilliformis (Oroya fever)
  • Bartonella henselae (Cat scratch disease)
  • Borrelia burgdorferi (Lyme disease)
  • Coxiella burnetii (Q fever)
  • Ehrlichia chaffeensis (human monocytotrophic ehrlichiosis)
  • Listeria monocytogenes
  • Mycobacterium tuberculosis
with meningitis
without meningitis
  • Mycoplasma pneumoniae
  • Rickettsia rickettsii (Rocky Mountain spotted fever)


  • Treponema pallidum (syphilis)
  • Tropheryma whipplei (Whipple's disease)
  • Fungi
  • Coccidioides
  • Cryptococcus neoformans
  • Preferred regimen: Amphotericin B deoxycholate AND flucytosine for 2 weeks, followed by fluconazole for 8 weeks ORv Lipid formulation of amphotericin B AND flucytosine for 2 weeks, followed by fluconazole for 8 weeks OR Amphotericin B AND flucytosine for 6–10 weeks
  • Histoplasma capsulatum
  • Preferred regimen: Liposomal amphotericin B for 4–6 weeks, followed by itraconazole for at least 1 year and until resolution of CSF abnormalities


  • Protozoa
  • Acanthamoeba
  • Balamuthia mandrillaris
  • Naegleria fowleri
  • Plasmodium falciparum
  • Preferred regimen: Quinine OR quinidine OR artesunate OR artemether
  • Alternative regimen: Atovaquone OR proguanil OR Exchange transfusion (less than 10% parasitemia or cere- bral malaria)
  • Toxoplasma gondii
  • Trypanosoma brucei gambiense (West African trypanosomiasis)
  • Trypanosoma brucei rhodesiense (East African trypanosomiasis)
  • Helminths
  • Baylisascaris procyonis
  • Gnathostoma
  • Taenia solium (cysticercosis)
  • Prion
  • Human transmissible spongiform encephalopathy
  • Preferred regimen: supportive

Epidural abscess

References

  1. Wormser, Gary P.; Dattwyler, Raymond J.; Shapiro, Eugene D.; Halperin, John J.; Steere, Allen C.; Klempner, Mark S.; Krause, Peter J.; Bakken, Johan S.; Strle, Franc; Stanek, Gerold; Bockenstedt, Linda; Fish, Durland; Dumler, J. Stephen; Nadelman, Robert B. (2006-11-01). "The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 43 (9): 1089–1134. doi:10.1086/508667. ISSN 1537-6591. PMID 17029130.
  2. Halperin, J. J.; Shapiro, E. D.; Logigian, E.; Belman, A. L.; Dotevall, L.; Wormser, G. P.; Krupp, L.; Gronseth, G.; Bever, C. T.; Quality Standards Subcommittee of the American Academy of Neurology (2007-07-03). "Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology. 69 (1): 91–102. doi:10.1212/01.wnl.0000265517.66976.28. ISSN 1526-632X. PMID 17522387.