Fever as a sign of central nervous system infection

Over the past decade, there has been a variety of changes in the epidemiology and management of central nervous system (CNS) infection in children. With the rapid decline of invasive Haemophilus influenzae type b disease, Streptococcus pneumoniae is now the most prominent pathogen responsible for bacterial meningitis in children 1 to 23 months. The emergence of penicillin-resistant pneumococcal disease has led to the recommendation of empiric vancomycin and either ceftriaxone or cefotaxime for all children older than 1 month with probable of definite bacterial meningitis. Use of adjunctive dexamethasone therapy has proven beneficial in HIB meningitis and a beneficial effect has been suggested in pneumococcal meningitis. Fluid restriction as a routine to treat presumptive syndrome of inappropriate antidiuretic hormone in acute meningitis does not appear to improve outcome in hospitalized children. In addition, newly available diagnostic modalities allow more specific diagnosis and treatment of aseptic meningitis and encephalitis. This article reviews the three most common causes of CNS infection in the pediatric population which are meningitis, brain abscess, and encephalitis. Emphasis is placed on clinical features, diagnostic evaluation, and appropriate treatment of patients with suspected CNS infection. Early recognition and presumptive treatment of suspected CNS infection could limit neurological damage, exerting a positive impact on final outcome. Clinicians must be knowledgeable of emerging diseases, developing diagnostic trends, and new therapeutic options to provide quality patient care.