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lecture on bacterial meningitis for all medical personnel
by Dr. khalid Al-Harby , consultant family physician , Al- madinah , KSA

Published in: Health & Medicine
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  2. 2. 2<br />Bacterial meningitis<br />Dr / Khalid Al-Harby<br />
  3. 3. 3<br />INTODUCTION<br />High morbidity and mortality<br />60% of infant who survive G-ve bacillary meningitis have developmental disabilities and/or neurological sequelae<br />25% was the case-fatality rate in a review of 493 episodes of bact.meningitis in adults.<br />It is a life-threatening medical emergency<br />cases of meningitis are a leading cause of malpractice suits against emergency doctors<br />
  4. 4. 4<br />Cont. introduction<br />Meningitis is characterized by inflammation of the pia-arachnoid and surrounding CSF.<br />Nasopharyngeal mucosal colonization by potentially pathogenic bacteria is the usual first step, although the organism may be included by trauma or at the time of a neurosurgical or diagnostic procedure.<br />Individuals who are especially susceptible include: - <br />
  5. 5. 5<br />Cont.introduction<br />Those who are asplenic ( sicklers, or splenectomized)<br />who congenitally lack terminal complement components.<br />Who have poor anti-body response to bacterial polysaccharides ( young children or persons with multiple myeloma ).<br />
  6. 6. 6<br />Epidemiological trends<br />The frequency of meningitis due to H. influenzae in children has declined dramatically because of widespread use of H. influenzae type b vaccines ( 95% reduction in incidence in the past decade).<br />Lasker Award in 1996.<br />H. influenzae meningitis has almost disappeared from U.S.A.<br />
  7. 7. 7<br />Diagnostic evaluation <br />It should be considered as a medical emergency and promptly evaluated.<br />Typical CSF finding but -ve gram stain: -<br />latex agglutination test: -specific<br />c-reactive protein in CSF : sensitive<br />petechial scraping :- diagnostic in 70% of cases.<br />A CT scan is rarely needed (? Delay diagn.)<br />
  8. 8. 8<br />Diagnostic evaluation<br />Prior oral antibiotics can decrease the positive yield of CSF culturs by 4-33% and of Gram’s stain 7-41%.<br />Cell count, glucose, and protein usually are not affected.<br />C&S obtained 24h after initial antibiotic administration are +ve only in 20% of cases<br />lymphocyte predominance in a patient who otherwise appears to have bact.meningitis.<br />
  9. 9. 9<br />Empirical treatment<br />When lumpar puncture is delayed or Gram’s stain of the CSF is nondiagnostic.<br />Ceftriaxone is avoided in neonate because of concerns regarding protein binding and displacement of bilirubin.<br />Many antibiotics penetrate BBB poorly under normal circumstances (penetration improves if meninges are inflamed).<br />Patients with bacterial meningitis must <br />
  10. 10. 10<br />cont<br />always be admitted to a hospital ward for I.V antibiotics, observation, and supportive care (no role for oral or I.M. treatment) <br />
  11. 11. 11<br />Adjuvant therapy<br />Inflammatory potential of G+ve cell wall and G-ve lipopolysaccharide.<br />Dexamethasone 0.15mg per kg every 6 h. for 2-4 days is recommended in children over 2m of age suspected to have bact.meningitis.<br />It should be initiated I.V. with or slightly before the antibiotics<br />if delayed 3-4h after 1st dose of antibiotics <br />
  12. 12. 12<br />Cont.<br />Do not give <br />sever sepsis, suspected or documented is a contra-indication.<br />
  13. 13. 13<br />Meningococcal meningitis<br />Sudden onset of fever, intense headache, nausea, and often vomiting, stiff neck and, a petechial rash with pink macules.<br />Case fatality rate (10-50%)<br />in fulminant meningococcemia, the death rate remains high despite prompt antibacterial treatment.<br />Neisseria meningitidis groups(A,B,C,X,Y,W135,Z)<br />
  14. 14. 14<br />cont<br />It occurs in winter and springs mainly<br />preliminarily a disease of very small children*(m&gt;f).<br />Irregular epidemics<br />man is the only reservoir.<br />Transmitted by direct contact, including respiratory droplets<br />during epidemics, over half of the men in <br />
  15. 15. 15<br />cont<br />In a military unit may be healthy carriers of pathogenic meningococci.<br />I.P = 2-10 days<br />C.P = Until eradicated from the nose and mouth.<br />Susceptibility decrease with age<br />group-specific immunity of unknown duration follows even subclinical infections<br />
  16. 16. 16<br />Preventive measures<br />Health education<br />reduce overcrowding<br />quadrivalent vaccine (A,C.Y.W135) is effective in adults and is only used vaccine in U.S.A. since 1971.<br />Duration of protection is limited in children 1-3 y. of age.(poor immunogenicity especially C)<br />no vaccine against B <br />
  17. 17. 17<br />Control<br />Report to local health authority.<br />Respiratory isolation for 24h. After starting antibiotics<br />concurrent disinfection of discharge<br />close contacts (share utensils) need obsevat-<br />Ion for early signs of the disease.<br />Rifampicine 600mg BID for 2 d. (10mg/kg for children , 5mg/kg for neonate)<br />ceftriaxone 250mg IM stat, 125mg if under 15 y. of age.<br />Ciprofloxacin 500mg <br />
  18. 18. 18<br />Cont.<br />P.o stat for adults<br />health care personnel :- only intimate exposure to nasopharyngeal secretions (e.g.mouth to mouth resuscitation) warrant prophylaxis.??<br />Vaccination of close <br />Contact is of no practical use.<br />The pt. should be given rifampicine prior to discharge from the hospital*<br />the goal of prophylaxis is to eliminate the carrier state from naso-pharynx<br />