Central Nervous System Infections in the Elderly

Central nervous system (CNS) infections are a major cause of morbidity and mortality among the elderly. Meningitis and encephalitis are two common presentations of CNS infection, and have distinct clinical presentations that frequently require prompt diagnosis and treatment. In elderly patients with acute bacterial meningitis, empiric antimicrobial therapy with vancomycin, ampicillin, and a third-generation cephalosporin (either cefotaxime or ceftriaxone), along with adjunctive dexamethasone therapy in those with suspected pneumococcal meningitis, is the recommended approach. In those patients with suspected viral encephalitis, improved diagnostics (such as the use of polymerase chain reaction for herpes simplex encephalitis) have enabled the rapid and accurate identification of the causative pathogen. Prompt initiation of empiric acyclovir therapy is another cornerstone of care for elderly patients with presumed herpes simplex encephalitis, in order to prevent the substantial morbidity, mortality, and, in many cases, chronic neurologic sequelae that can be associated with untreated disease. © 2014 Springer Science+Business Media New York.