Acute Confusion: Infectious

Delirium can occur in many febrile diseases. Confusion is prominent in typhoid fever, rickettsiosis, cerebral malaria, viral encephalitis (rabies, herpes, Japanese encephalitis, West Nile and other arboviroses), Naegleria fowleri encephalitis (amoebae), acute meningitis and cerebral abscess (tuberculous, pyogenic or amoebiasis). Endocarditis can cause septic cerebral emboli. Cerebritis and cerebellitis with ataxia can occur in Q-fever and also very rarely in Mycoplasma infections.

Syphilitic cerebral gumma, West African trypanosomiasis and cerebral toxoplasmosis cause a subacute to chronic condition. Differentiation from dementia is important. Melarsoprol used in the treatment of African trypanosomiasis can cause an acute reactive encephalitis. Chronic or subacute meningitis due to tuberculosis or cryptococcosis, can occur in AIDS.

Worm infestations of the central nervous system tend to provoke severe symptoms. Infection with Angiostrongylus cantonensis, cysticerci, Echinococcus, Gnatostoma sp, Toxocara sp and ectopic migrations of schistosomes or Paragonimus sp usually cause acute symptoms. The cerebrospinal fluid can contain eosinophils. Schistosoma japonicum especially affects the brain during ectopic migration. S. haematobium and S. mansoni more often cause lesions in the spinal cord, though these findings are not proven.

Category: Medicine Notes , Neurology notes , Psychiatry Notes