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The Diagnosis of Nervous System Infections in Pediatric Cancer Patients

The Diagnosis of Nervous System Infections in Pediatric Cancer Patients. Hadir Ahmed El-Mahallawy Clinical Pathology Department. Infections of CNS in Pediatric Cancer Patients. Although rare but awareness of the disease is particularly important because

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The Diagnosis of Nervous System Infections in Pediatric Cancer Patients

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  1. The Diagnosis of Nervous System Infections in Pediatric Cancer Patients Hadir Ahmed El-Mahallawy Clinical Pathology Department

  2. Infections of CNS in Pediatric Cancer Patients • Although rare but awareness of the disease is particularly important because • It usually manifests as an indolent process • Are usually caused by organisms different from those found in the general population • A significant source of morbidity and mortality 42 to 77%

  3. Infections of CNS in Pediatric Cancer Patients • Shunt and reservoir infections: Children with intraventricular shunts and reservoirs are at highest risk for CNS inf. • Meningitis: signs of meningeal irritation: fever, headache and nuchal rigidity ± altered mental status are the most consistent signs at presentation. • Encephalitis: commonly present with fever, mental status changes (confusion may progress to stupor and finally coma), ± focal neurologic signs

  4. Causes of CNS Infections CNS in Pediatric Cancer Patients • BACTERIAL causes Whereas the pneumococcus, meningococcus or Hemophilus influenza are responsible for 75% of cases of bacterial meningitis in patients with no underlying disease, the causal organism differ widely in impaired hosts. Gram positive AHS Enterococci Listeria Gram negative E. Coli K. Pneumoniae Ps. aeruginosa Mycobacteria

  5. VIRAL CAUSES HSV VZV CMV HHV-6 EBV MEASLES MUMPS FUNGAL CAUSES Cryptococcus neoformans Aspergillus C. albicans Mucor Others Toxoplasma gondii Causes of CNS Infections CNS in Pediatric Cancer Patients (cont.)

  6. Differential Diagnosis For the cancer patients with focal neurologic deficits or altered mentation, it is important to separate INFECTIONS METABOLIC TOXIC AND NEOPLASTIC CAUSES LEUKEMIA & LYMPHOMA

  7. The Lab. Diagnosis of Nervous System Infections in Pediatric Cancer Patients • Sample inspection • Cell count • Leishman stain for blasts • Gram and acid fast stains • Chemistry: Protein levels Glucose • Culture: for bacteria, fungi and viral cultures

  8. The Lab. Diagnosis of Nervous System Infections in Pediatric Cancer Patients (cont.) • Specific Tests to Identify the Opprtunistic Pathogen • Antigen detection • Genome detection • Antibody detection

  9. Herpes Simplex virus infection in CNS • Viral infections are mainly seen in patients with T- lymphocyte defects. • Patients develop acute or subacute onset of headache, fever, alteration in personality or behavioral changes progressing over hours or days. • More slowly evolving disease may be seen in immunocompromised hosts • Olfactory system is characteristically involved

  10. Diagnosis of Herpes virus infection in CNS • The affected tissue undergoes marked tissue necrosis combined with an inflammatory reaction in the perivascular space in the brain parenchyma. • Initial CSF findings may be normal. • CSF count typically contains 20- 200 cells • CSF protein is usually elevated 50-200mg/dl • CSF glucose is usually normal

  11. Diagnosis of HSV Encephalitis

  12. Diagnosis of Herpes virus infection in CNS (cont.) • Brain biopsy was considered the gold standard With the development of both MRI scanning and newer lab. Methods PCR and Antigen studies in CSF, the need for brain biopsy in patients with suspected HSV has been greatly reduced.

  13. The NCI Experience in CNS Herpes simplex encephalitis • In 2 years (2001 and 2002) • 40 cases of clinically suspected CNS INFECTIONS in pediatric practice • 12 (30%) were laboratory documented to be HSV positive. • HSV encephalitis was found to be the commonest cause of CNS inf. at NCI.

  14. Minimal findings of headache, and fever in a compromised host should elicit a search to exclude possible CNS infection. Clinically suspected Herpes simplex virus and Varicella Zoster virus encephalitis should quickly lead to iv treatment with acyclovir. CONCLUSIONS

  15. THANKYOU

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