Infections of the Nervous System

Osmotic therapies added to antibiotics for acute bacterial meningitis

Abstract Background Every day children and adults die from acute community-acquired bacterial meningitis, particularly in low-income countries, and survivors risk deafness, epilepsy and neurological disabilities. Osmotic therapies may attract extra-vascular fluid and reduce cerebral oedema, and thus reduce death and improve neurological outcomes. This is an update of a Cochrane Review first published in 2013. […]

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Intravenous immunoglobulin for the treatment of childhood encephalitis

Abstract Background Encephalitis is a syndrome of neurological dysfunction due to inflammation of the brain parenchyma, caused by an infection or an exaggerated host immune response, or both. Attenuation of brain inflammation through modulation of the immune response could improve patient outcomes. Biological agents such as immunoglobulin that have both anti-inflammatory and immunomodulatory properties may […]

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Pre-admission antibiotics for suspected cases of meningococcal disease

Abstract Background Meningococcal disease can lead to death or disability within hours after onset. Pre-admission antibiotics aim to reduce the risk of serious disease and death by preventing delays in starting therapy before confirmation of the diagnosis. Objectives To study the effectiveness and safety of pre-admission antibiotics versus no pre-admission antibiotics or placebo, and different […]

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Antibiotics for the neurological complications of Lyme disease

Abstract Background Various central nervous system-penetrant antibiotics are bactericidal in vitro and in vivo against the causative agent of Lyme neuroborreliosis (LNB), Borrelia burgdorferi. These antibiotics are routinely used clinically to treat LNB, but their relative efficacy is not clear. Objectives To assess the effects of antibiotics for the treatment of LNB. Search methods On […]

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Valacyclovir versus acyclovir for the treatment of herpes zoster ophthalmicus in immunocompetent patients

Abstract Background Herpes zoster ophthalmicus affects the eye and vision, and is caused by the reactivation of the varicella zoster virus in the distribution of the first division of the trigeminal nerve. An aggressive management of acute herpes zoster ophthalmicus with systemic antiviral medication is generally recommended as the standard first-line treatment for herpes zoster […]

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Fluid therapy for acute bacterial meningitis

Abstract Background Acute bacterial meningitis remains a disease with high mortality and morbidity rates. However, with prompt and adequate antimicrobial and supportive treatment, the chances for survival have improved, especially among infants and children. Careful management of fluid and electrolyte balance is an important supportive therapy. Both over- and under-hydration are associated with adverse outcomes. […]

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Six months therapy for tuberculous meningitis

Abstract Background Tuberculous meningitis (TBM) is the main form of tuberculosis that affects the central nervous system and is associated with high rates of death and disability. Most international guidelines recommend longer antituberculous treatment (ATT) regimens for TBM than for pulmonary tuberculosis disease to prevent relapse. However, longer regimens are associated with poor adherence, which […]

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Corticosteroids for managing tuberculous meningitis

Abstract Background Tuberculous meningitis is a serious form of tuberculosis (TB) that affects the meninges that cover a person’s brain and spinal cord. It is associated with high death rates and with disability in people who survive. Corticosteroids have been used as an adjunct to antituberculous drugs to treat people with tuberculous meningitis, but their […]

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Vaccines for preventing herpes zoster in older adults

Abstract Background Herpes zoster, also known as ‘shingles’, is a neurocutaneous disease characterised by the reactivation of the latent varicella zoster virus (VZV), the virus that causes chickenpox when immunity to VZV declines. It is an extremely painful condition that can last many weeks or months and it can significantly compromise the quality of life […]

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Corticosteroids for acute bacterial meningitis

Abstract Background In experimental studies, the outcome of bacterial meningitis has been related to the severity of inflammation in the subarachnoid space. Corticosteroids reduce this inflammatory response. Objectives To examine the effect of adjuvant corticosteroid therapy versus placebo on mortality, hearing loss and neurological sequelae in people of all ages with acute bacterial meningitis. Search […]

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