The Diagnosis of Nervous System Infections in Pediatric Cancer Pati

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1、TheDiagnosisofNervousSystemInfectionsinPediatricCancerPatientsHadirAhmedEl-MahallawyClinicalPathologyDepartmentInfectionsofCNSinPediatricCancerPatientsAlthoughrarebutawarenessofthediseaseisparticularlyimportantbecauseItusuallymanifestsasanindolentprocessAreusuallycausedbyorganismsdifferentfromth

2、osefoundinthegeneralpopulationAsignificantsourceofmorbidityandmortality42to77%InfectionsofCNSinPediatricCancerPatientsShuntandreservoirinfections:ChildrenwithintraventricularshuntsandreservoirsareathighestriskforCNSinf.Meningitis:signsofmeningealirritation:fever,headacheandnuchalrigidity±altered

3、mentalstatusarethemostconsistentsignsatpresentation.Encephalitis:commonlypresentwithfever,mentalstatuschanges(confusionmayprogresstostuporandfinallycoma),±focalneurologicsignsCausesofCNSInfectionsCNSinPediatricCancerPatientsBACTERIALcausesWhereasthepneumococcus,meningococcusorHemophilusinfluenza

4、areresponsiblefor75%ofcasesofbacterialmeningitisinpatientswithnounderlyingdisease,thecausalorganismdifferwidelyinimpairedhosts.GrampositiveAHSEnterococciListeriaGramnegativeE.ColiK.PneumoniaePs.aeruginosaMycobacteriaCausesofCNSInfectionsCNSinPediatricCancerPatients(cont.)VIRALCAUSESHSVVZVCMVHHV-

5、6EBVMEASLESMUMPSFUNGALCAUSESCryptococcusneoformansAspergillusC.albicansMucorOthersToxoplasmagondiiDifferentialDiagnosisForthecancerpatientswithfocalneurologicdeficitsoralteredmentation,itisimportanttoseparateINFECTIONSMETABOLICTOXICANDNEOPLASTICCAUSESLEUKEMIA&LYMPHOMATheLab.DiagnosisofNervousSys

6、temInfectionsinPediatricCancerPatientsSampleinspectionCellcountLeishmanstainforblastsGramandacidfaststainsChemistry:ProteinlevelsGlucoseCulture:forbacteria,fungiandviralculturesTheLab.DiagnosisofNervousSystemInfectionsinPediatricCancerPatients(cont.)SpecificTeststoIdentifytheOpprtunisticPathogen

7、AntigendetectionGenomedetectionAntibodydetectionHerpesSimplexvirusinfectioninCNSViralinfectionsaremainlyseeninpatientswithT-lymphocytedefects.Patientsdevelopacuteorsubacuteonsetofheadache,fever,alterationinpersonalityorbehav