Types of CNS infections
abscess
empyema
meningitis
encephalomyelitis
sites of CNS infections
brain
cord
etiology of CNS infxns
bacterial, viral, fungal
oral sequence of CNS infxn
DIRECT extension of acute oral infection -caries-pulpitis -apical periodontitis -phlegmon/abscess -necrotizing ulcerative gingivitis bacteremia(uncommon)
what is the most common CNS infection secondary to dental pathology/procedure?
CNS abscess
symptoms of CNS abscess
changes in consciousness -focal neurologic signs speech visual field defects paresis -vomiting -fever
risk factors for bacterial abscess
oral pathology oral procedure immunocompromised chronic illness chronic heart disease skull facture meningitis sinus infxns
diagnosing CNS abscess
symptoms
physical exam
IMAGING
lab results
Tx of bacterial abscess
antibiotics and surgery
pathology of bacterial abscess
liquefactive
etiology of dental CNS infections
87% had intra-oral pathology(caries, gingivitis, periodontitis)
70% ipsilateral
most related to molar removal
where do most abscess happen in the CNS that are related to dental procedures
frontal and parietal lobes
organisms that cause CNS abscess
gram+ cocci (most)
anaerobes
Gram - bacillus
Gram + bacillus
T/F oral cultures matched with 61% of CNS cultures for microbiology
True
can you get a good blood culture of a CNS abscess
no 89% negative
*remember most are causes by direct advancement of microbes
Order the microbiology of CNS abscess based on polymicrobial, monomicrobial, and negative.
monomicrobial 49%
polymicrobial 47%
negative 4%
polymicrobial cultures
Actinomyces spp. dominant
- branching filamentous bacteria
- gram positive
- non acid fast
- normal flora
- aerobic/microaerophilic
mycoses CNS infections
immunocompromised patients
- aspergillus
- zygomycetes
- candida spp
- cryptococcus neoformans
- dimorphic fungi
aspergillus
- **most common fungal pathogen of CNS
- oral->sinus->CNS in immunocompromised host
- focal symptoms
Pathology of aspergillus
septate hypae
single/multiple abscess
granulomata
infarcted brain
tx of aspergillus
aggressive surgical excision
-amphotericin B + flucytosine (antifungals)
Zygomycetes aka mucormycosis
*diabetes and immunocompromised
will have rapidly progressive facial swelling
species that causes zygomycosis
mucor spp.
rhizomucor spp.
rhizopus spp.
morphology of zygomycetes
wide/ ribbon-like aseptate
90 degree branching
candidial infections
uncommon
oral etiology unproven
immunocompromised
forms of candidal infxns
meningitis
encephalitits
absecess
Tx of candidal CNS infections
multimodal antifungals
parasitic CNS pathogens
Helminths -neurocystercercosis ---Taenia solum (pork tape worm) Protozoa -Toxoplasmosis ---Toxoplasma gondii
Spirochetes CNS pathogens
uncommon Dental related CNS infection not known -Neurosyphilis ----Treponema pallidum -Lyme disease ---borrelia burgdoferi ---Gumma
Viral CNS pathogens
Herpetic gingivostomatitis -HSV1 or HSV2 very common in 6 mos-5 yrs and 20yrs -Herpes simplex encephalitis rare
Prion disease aka slow virus
misfolded protein types: -CJD -CJD new variant -Gerstmann-Straussler syndrome (GSS) -Kuru (extinct)
