Central Nervous System Infections
Central Nervous System Infections
Central Nervous System Infections
SYSTEM INFECTIONS
Haemophilus influenzae & Neisseria meningitidis
ØNeisseria meningitidis
ØHemophilus influenzae
ØStreptococcus pnuemoniae
ØStaphylococcus aureus
ØE. coli
ØKlebsiella spp.
ØCitrobacter spp.
ØEnterobacter spp.
ØSerratia spp.
ØListeria monocytogenes
CAUSATIVE ORGANISMS
•Bacterial Causes
Meningitis in neonates
ØE. coli
ØStreptococcus agalactiae (group B)
ØListeria monocytogenes
ØKlebsiella spp.
Parasitic Causes
1.E. histolytica 7. Schistosoma spp.
2.Naegleria spp. 8. Strongyloides stercoralis
3.Acanthamoeba spp.
4.Toxoplasma gondii
5.Cysticercus cellulosae
6.Paragonimus westermani
LABORATORY DIAGNOSIS
•Specimen Collection
CSF is collected by lumbar puncture (spinal
tap)
LABORATORY DIAGNOSIS
•Specimen Collection
•Three or four tubes of CSF should be collected and immediately
labeled with the patient’s name. Tubes 3 or 4 is used for cell
count and differential.
LABORATORY DIAGNOSIS
•Specimen Collection
•A minimum of 5 to 10 mL is recommended for analysis.
•
•CSF should be hand-delivered immediately to the lab.
SPECIMENS SHOULD NEVER BE REFRIGERATED.
Microscopic examination
•CSF should be centrifuged in a sterile tube (preferably a 15-mL
conical tube with screw cap) at 10000g for 5-10 minutes
•Supernatant is removed to a sterile tube, leaving approx. 0.5
mLof fluid in which suspended the sediment. The
supernatant can be used to test for the presence of
antigens or for chemistry evaluations
LABORATORY DIAGNOSIS
Direct Microscopy
•Examine one drop of the sediment microscopically (x400),
between a slide and coverslip, for:
- leukocytes (PMNs or lymphocytes)
- erythrocytes
- bacteria
- yeasts
Organism Appearance
Moraxella Large, nonpigmented or gray, opaque,
catarrhalis smooth; friable “hockey puck”
consistency; colony may be moved
Neisseria intact over
Small, surface
grayish white,orconvex,
agar
gonorrheae translucent, shiny colonies with either
smooth or irregular margins; may be up
to five different colony types on
Neisseria Medium, smooth, round, moist, gray to
primary plates
meningitidis white; encapsulated strains are
mucoid; may be greenish cast in agar
underneath
*Appearance on blood agar is the same oncolonies
CA except for pigmentation; colonies
are less opaque on blood agar
N. MENINGITIDIS
BIOCHEMICAL AND PHYSIOLOGIC CHARACTERISTICS OF
M. catarrhalis and Coccoid Neisseria spp.
N. + - -
gonorrheae
N. + - -
meningitidis
IDENTIFICATION
Oxidase Test (Kovac’s Method)
Principle
To determine the presence of bacterial cytochrome oxidase
using the oxidation of the substrate tetramethyl-p-
phenylenediamine dihydrochloride to indophenol, a dark
purple-colored end product.
Glucose
Sucrose
Lactose
Maltose
N. MENINGITIDIS
Treatment
•Penicillin G is the drug of choice
•Chloramphenicol or a third-generation cephalosphorin such
as cefotaxime or ceftriaxone is used in persons allergic to
penicillins
•
Epidemiology, Prevention, & Control
•5 to 30% of the normal population may harbor
meningococci in the nasopharynx during interepidemics
•Rifampin, 600 mg orally twice daily for 2 days
(or minocycline, 100 mg every 12 hours)
•chemoprophylaxis is no longer reliable, due to appearance
of sulfonamide-resistant meningococci
•Vaccines are available but only protection against Group C
CULTURE
Genera and Species to be considered
Current Name Previous Name
Haemophilus influenzae
Haemophilus ducreyi
H. influenzae*
+ + - - -
H. Influenzae
biotype aegyptius* + + - - -
H. ducreyi
+ - - - -
Principle
Members of the genus Haemophilus require accessory
growth factors in vitro. Some Haemophilus spp. require X
factor (hemin) alone, V factor (NAD, nicotinamide-adenine
dinucleotide) alone, or a combination of both
Quality Control
Positive: Haemophilus influenzae
will show a halo of growth around
the XV disk; the rest of the agar
surface will show no growth.
Haemophilus parainfluenzae will
show a halo growth around the XV
and V disks.