Sandbox ID Central Nervous System: Difference between revisions

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:* Bacteria
:* Bacteria
::* Anaplasma phagocytophilum (human granulocytotrophic ehrlichiosis)
::* [[Anaplasma phagocytophilum]] ([[human granulocytotrophic ehrlichiosis]])
:::* Preferred regimen: [[Doxycycline]]
:::* Preferred regimen: [[Doxycycline]]
::* Bartonella bacilliformis (Oroya fever)
::* [[Bartonella bacilliformis]] ([[Oroya fever]])
:::* Preferred regimen: [[Chloramphenicol]] {{or}} [[Ciprofloxacin]]] {{or}} [[Doxycycline]] {{or}} [[Ampicillin]] {{or}} [[trimethoprim-sulfamethoxazole]]
:::* Preferred regimen: [[Chloramphenicol]] {{or}} [[Ciprofloxacin]]] {{or}} [[Doxycycline]] {{or}} [[Ampicillin]] {{or}} [[trimethoprim-sulfamethoxazole]]
::* Bartonella henselae (Cat scratch disease)
::* [[Bartonella henselae]] ([[Cat scratch disease]])
:::* Preferred regimen: [[Doxycycline]] {{or}} [[Azithromycin]] {{withorwithout}} [[Rifampin]]
:::* Preferred regimen: [[Doxycycline]] {{or}} [[Azithromycin]] {{withorwithout}} [[Rifampin]]
::* Borrelia burgdorferi (Lyme disease)
::* [[Borrelia burgdorferi]] ([[Lyme disease]])
:::* preferred regimen: [[Ceftriaxone]] {{or}} [[Cefotaxime]] {{or}} [[Penicillin G]]
:::* preferred regimen: [[Ceftriaxone]] {{or}} [[Cefotaxime]] {{or}} [[Penicillin G]]
::* Coxiella burnetii (Q fever)
::* [[Coxiella burnetii]] ([[Q fever]])
:::* Preferred regimen:  [[Doxycycline]] {{and}} [[Fluoroquinolone]] {{and}} [[Rifampin]]  
:::* Preferred regimen:  [[Doxycycline]] {{and}} [[Fluoroquinolone]] {{and}} [[Rifampin]]  
::* Ehrlichia chaffeensis (human monocytotrophic ehrlichiosis)
::* [[Ehrlichia chaffeensis]] ([[human monocytotrophic ehrlichiosis]])
:::* Preferred regimen: [[Doxycycline]]
:::* Preferred regimen: [[Doxycycline]]
::* Listeria monocytogenes
::* [[Listeria monocytogenes]]
:::* Preferred regimen: [[Ampicillin]] {{or}} [[Trimethoprim-sulfamethoxazole]] {{and}} [[Gentamicin]]
:::* Preferred regimen: [[Ampicillin]] {{or}} [[Trimethoprim-sulfamethoxazole]] {{and}} [[Gentamicin]]
::* Mycobacterium tuberculosis
::* [[Mycobacterium tuberculosis]]
:::'''with meningitis'''
:::'''with meningitis'''
:::* Preferred regimen: [[Dexamethasone]]  
:::* Preferred regimen: [[Dexamethasone]]  
:::'''without meningitis'''
:::'''without meningitis'''
:::* Preferred regimen: [[Isoniazid]] {{or}} [[Rifampin]] {{or}} [[Pyrazinamide]] {{or}} [[Ethambutol]]  
:::* Preferred regimen: [[Isoniazid]] {{or}} [[Rifampin]] {{or}} [[Pyrazinamide]] {{or}} [[Ethambutol]]  
::* Mycoplasma pneumoniae
::* [[Mycoplasma pneumoniae]]
:::* Preferred regimen: [[Azithromycin]] {{or}} [[Doxycycline]] {{or}} [[Fluoroquinolone]]  
:::* Preferred regimen: [[Azithromycin]] {{or}} [[Doxycycline]] {{or}} [[Fluoroquinolone]]  
::* Rickettsia rickettsii (Rocky Mountain spotted fever)
::* [[Rickettsia rickettsii]] ([[Rocky Mountain spotted fever]])
:::* Preferred regimen: [[Doxycycline]]  
:::* Preferred regimen: [[Doxycycline]]  
:::* Alternative regimen: [[Chloramphenicol]]
:::* Alternative regimen: [[Chloramphenicol]]
::* Treponema pallidum (syphilis)
::* [[Treponema pallidum]] ([[syphilis]])
:::* preferred regimen: [[Ceftriaxone]] {{or}} [[Penicillin G]]
:::* preferred regimen: [[Ceftriaxone]] {{or}} [[Penicillin G]]
::* Tropheryma whipplei (Whipple's disease)
::* [[Tropheryma whipplei]] ([[Whipple's disease]])
:::* Preferred regimen: [[Ceftriaxone]] for 2–4 weeks, followed by [[Trimethoprim-sulfamethoxazole]] {{or}} [[Cefixime]] for 1–2 years  
:::* Preferred regimen: [[Ceftriaxone]] for 2–4 weeks, followed by [[Trimethoprim-sulfamethoxazole]] {{or}} [[Cefixime]] for 1–2 years  


:* Fungi
:* Fungi
::* Coccidioides
::* [[Coccidioides]]
:::* Preferred regimen: [[Fluconazole]]
:::* Preferred regimen: [[Fluconazole]]
:::* Alternative regimen: [[Itraconazole]] {{or}} [[Voriconazole]] {{or}} [[Amphotericin B]] (intravenous and intrathecal)
:::* Alternative regimen: [[Itraconazole]] {{or}} [[Voriconazole]] {{or}} [[Amphotericin B]] (intravenous and intrathecal)
::* Cryptococcus neoformans
::* [[Cryptococcus neoformans]]
:::* Preferred regimen: [[Amphotericin B]] [[deoxycholate]] {{and}} [[flucytosine]] for 2 weeks, followed by [[fluconazole]] for 8 weeks {{or}}v 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
:::* Preferred regimen: [[Amphotericin B]] [[deoxycholate]] {{and}} [[flucytosine]] for 2 weeks, followed by [[fluconazole]] for 8 weeks {{or}}v 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
::* [[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
:::* Preferred regimen: Liposomal amphotericin B for 4–6 weeks, followed by itraconazole for at least 1 year and until resolution of CSF abnormalities


:* Protozoa
:* Protozoa
::* Acanthamoeba
::* [[Acanthamoeba]]
:::* Preferred regimen: Trimethoprim-sulfamethoxazole {{and}} [[rifampin]] {{and}} [[ketoconazole]] {{or}} [[Fluconazole]] {{and}} [[sulfadiazine]] {{and}} [[pyrimethamine]]
:::* Preferred regimen: Trimethoprim-sulfamethoxazole {{and}} [[rifampin]] {{and}} [[ketoconazole]] {{or}} [[Fluconazole]] {{and}} [[sulfadiazine]] {{and}} [[pyrimethamine]]
::* Balamuthia mandrillaris
::* [[Balamuthia mandrillaris]]
:::* Preferred regimen: [[Azithromycin]] {{or}} [[Clarithromycin]] {{and}} [[pentamidine]] {{and}} [[flucytosine]] {{and}} [[fluconazole]] {{and}} [[sulfadiazine]] {{and}} [[thioridazine]] {{or}} [[trifluoperazine]]
:::* Preferred regimen: [[Azithromycin]] {{or}} [[Clarithromycin]] {{and}} [[pentamidine]] {{and}} [[flucytosine]] {{and}} [[fluconazole]] {{and}} [[sulfadiazine]] {{and}} [[thioridazine]] {{or}} [[trifluoperazine]]
::* Naegleria fowleri
::* [[Naegleria fowleri]]
:::* Preferred regimen: Amphotericin B (intravenous and intrathecal) {{and}} rifampin {{and}} [[azithromycin]] {{or}} [[sulfisoxazole]] {{or}} [[miconazole]]
:::* Preferred regimen: Amphotericin B (intravenous and intrathecal) {{and}} rifampin {{and}} [[azithromycin]] {{or}} [[sulfisoxazole]] {{or}} [[miconazole]]
::* Plasmodium falciparum
::* [[Plasmodium falciparum]]
:::* Preferred regimen: [[Quinine]] {{or}} [[quinidine]] {{or}} [[artesunate]] {{or}} [[artemether]]
:::* 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)
:::* Alternative regimen: Atovaquone {{or}} proguanil {{or}} Exchange transfusion (less than 10% parasitemia or cere- bral malaria)
::* Toxoplasma gondii
::* [[Toxoplasma gondii]]
:::* Preferred regimen: [[Pyrimethamine]] {{and}} [[Sulfadiazine]] {{or}} [[Clindamycin]] [[and}} [[Pyrimethamine]]
:::* Preferred regimen: [[Pyrimethamine]] {{and}} [[Sulfadiazine]] {{or}} [[Clindamycin]] [[and}} [[Pyrimethamine]]
:::* Alternative regimen (1): [[Trimethoprim-sulfamethoxazole]]
:::* Alternative regimen (1): [[Trimethoprim-sulfamethoxazole]]
:::* Alternative regimen (2): [[Pyrimethamine]] {{and}} [[atovaqone]] {{or}} [[Pyrimethamine]] {{and}} [[clarithromycin]] {{or}} Pyrimethamine {{and}} [[azithromycin]] {{or}} Pyrimethamine {{and}} [[dapsone]]
:::* Alternative regimen (2): [[Pyrimethamine]] {{and}} [[atovaqone]] {{or}} [[Pyrimethamine]] {{and}} [[clarithromycin]] {{or}} Pyrimethamine {{and}} [[azithromycin]] {{or}} Pyrimethamine {{and}} [[dapsone]]
::* Trypanosoma brucei gambiense (West African trypanosomiasis)
::* [[Trypanosoma brucei gambiense]] ([[West African trypanosomiasis]])
:::* Preferred regimen: [[Eflornithine]] {{or}} [[Melarsoprol]]
:::* Preferred regimen: [[Eflornithine]] {{or}} [[Melarsoprol]]
::* Trypanosoma brucei rhodesiense (East African trypanosomiasis)
::* [[Trypanosoma brucei rhodesiense]] ([[East African trypanosomiasis]])
:::* Preferred regimen: [[Melarsoprol]]
:::* Preferred regimen: [[Melarsoprol]]


:* Helminths
:* Helminths
::* 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]]
:::* Preferred regimen: [[Albendazole]] {{or}} [[Ivermectin]]
::* Taenia solium (cysticercosis)
::* [[Taenia solium]] ([[cysticercosis]])
:::* Preferred regimen: [[Albendazole]] {{or}} [[Corticosteroids]]
:::* Preferred regimen: [[Albendazole]] {{or}} [[Corticosteroids]]
:::* Alternative regimen: [[Praziquantel]]
:::* Alternative regimen: [[Praziquantel]]


:* Prion
:* Prion
::* Human transmissible spongiform encephalopathy
::* [[Human transmissible spongiform encephalopathy]]
:::* Preferred regimen: supportive
:::* Preferred regimen: supportive


Revision as of 14:32, 28 May 2015

Lyme neuroborreliosis

Further information: Lyme disease medical therapy and therapeutic approach
  • 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
  • Preferred regimen: supportive
prophylactic antiviral therapy after bite or scratch
established disease
  • Preferred regimen: supportive
  • Preferred regimen: supportive
  • Preferred regimen: supportive
  • Preferred regimen: Reversal or control of immunosuppression AND HAART in patients with AIDS
  • Preferred regimen: supportive
life-threatening disease
SSPE
  • Preferred regimen: supportive
  • Preferred regimen: supportive
  • Preferred regimen: supportive AND Intraventricular γ-globulin (for chronic and/or severe disease)
  • Preferred regimen: supportive
  • Preferred regimen: supportive
postxposure prophylaxis
  • Preferred regimen: rabies immunoglobulin AND vaccine
after onset of disease
  • Preferred regimen: supportive
  • Preferred regimen: supportive
  • Preferred regimen: supportive
  • Alternative regimen: IFN-a-2b
  • Preferred regimen: supportive
  • Preferred regimen: supportive
  • Preferred regimen: supportive
  • Preferred regimen: supportive
  • Bacteria
with meningitis
without meningitis
  • Fungi
  • 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
  • Preferred regimen: Liposomal amphotericin B for 4–6 weeks, followed by itraconazole for at least 1 year and until resolution of CSF abnormalities
  • Protozoa
  • 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)
  • Helminths
  • Prion
  • Preferred regimen: supportive

Epidural abscess

Further information: Epidural abscess medical therapy and therapeutic approach

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.
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