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Archive for the ‘INFECTIONS’ Category

click here for the abstract of the article

BMJ 2008;336:36-40 (5 January). Clinical review
by: Sarah A E Logan, specialist registrar, Eithne MacMahon, consultant Infection and Immunology:

  • Bacterial and viral meningitis cannot reliably be differentiated clinically, and all suspected cases should be referred to hospital
  • Viral meningitis is most common in young children; the incidence decreases with age
  • Enteroviruses are the most common cause at all ages
  • Although most cases are self limiting, morbidity may be considerable
  • Herpes simplex virus causes viral meningitis, which may recur
  • Genital herpes infection may be acquired from a partner after many years within a monogamous relationship
  • Meningitis is a feature of HIV seroconversion
  • In the absence of associated encephalitis, the prognosis is usually good
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Clinical Review, BMJ  2007;335:929-932 (3 November).

Summary points

  • A favourable outcome depends on early, aggressive, treatment
  • Antimicrobial treatment must take into account both patient susceptibilities and local resistance patterns; advice from infectious disease or microbiology colleagues is often helpful
  • Volume resuscitation and cardiovascular support should be titrated to simple clinical end points
  • Subtle signs of organ hypoperfusion should be sought in physically robust patients
  • The role of activated protein C and low dose steroids remains to be clarified

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