Neurological infections in the elderly
Journal Title: Journal of the Indian Medical Association - Year 2017, Vol 115, Issue 12
Abstract
The elderly is predisposed to develop neurological infections due to immunosenescence and other co-morbidities. Bacterial meningitis in the elderly is most commonly caused by Streptococcus pneumoniae, Listeria monocytogenes must always be considered when dealing with bacterial meningitis in the elderly. The elderly patients with bacterial meningitis requires empiric treatment with third generation cephalosporin plus vancomycin and ampicillin. The elderly is also at greater risk of developing tuberculosis and tuberculous meningitis. The tuberculous meningitis in elderly can present with atypical clinical features. Cerebrospinal fluid may not show pleocytosis in elderly patients with tuberculous meningitis. The elderly tuberculous meningitis patients are also more prone to develop hepatotoxicity after initiation of antituberculosis treatment. Elderly persons are also at increased risk of fungal infections of the nervous system, cryptococcal meningitis being most common of them. The treatment of cryptococcal meningitis in elderly is complicated by the fact that amphotericin B is a potentially nephrotoxic drug; elderly patients should be well hydrated while being treated with amphotericin B. Common viral infections of nervous system seen in elderly are herpes simplex encephalitis, varicella zoster encephalitis and arboviral encephalitis. Viral encephalitis in elderly carries poor prognosis as compared to the younger patients. Toxic/ metabolic encephalopathy is a close differential diagnosis.
Authors and Affiliations
Imran Rizvi, Ravindra Kumar Garg
Keywords
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