Infection

Infection is more common as a cause of AMS in children than in adults. The incidence of bacterial meningitis and septicemia is highest in early infancy and considerably higher throughout childhood than in adulthood. Bacterial meningitis should be high on the differential diagnostic list in a pediatric patient with AMS.

Unless there are contraindications to lumbar puncture, examination of cerebrospinal fluid (CSF) should be considered in lethargic, febrile pediatric patients ( Table

126-2). Similarly, pediatric patients may become encephalopathic due to direct invasion of the brain by multiple pathogens. Patients with encephalitis have fever, headache, and, may have signs of meningeal irritation or neurologic deficits. Herpes viruses, arbovirus, rotavirus, and Epstein-Barr virus are among the most common viral agents associated with encephalitis. Encephalitis may occur in the course of mycoplasmal illness, shigellosis, Lyme disease, or cat-scratch disease. Visceral larva migrans may produce encephalopathy in the young. A brain abscess may create signs and symptoms suggestive of encephalitis. Patients with a brain abscess present with fever and headache that precede changes in presentation and consciousness. Affected patients may also present with generalized or focal seizure activity. Patients at risk for brain abscess include those with sinusitis, cyanotic congenital heart disease, immunodeficiency, and intravenous drug abuse. Any systemic infection associated with vasculitis, or vasodepressant toxins, with shock may lead to AMS secondary to cerebral hypoperfusion.

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