This document discusses the etiology, epidemiology, clinical features, diagnosis, treatment and prevention of bacterial meningitis. It notes that the highest incidence is in neonates, usually caused by Group B streptococci or E. coli acquired during birth. From ages 1 month to 23 months, the most common causes are S. pneumoniae and N. meningitidis. Conjugated Hib vaccines have reduced cases in children aged 2-5 years. S. pneumoniae and N. meningitidis remain the most frequent causes in older children and adults. Proper treatment requires prompt diagnosis and empiric administration of broad-spectrum bactericidal antibiotics like ceftriaxone, along with adjuncts like van
Meningitis is a severe CNS pathology and early and appropriate intervention is needed to prevent adverse outcome including mortality and long term complications. This presentation focuses on the different types of meningitis and the appropriate management options
Meningitis By Dr Bashir Ahmed Dar Associate Professor Medicine Chinkipora Sop...Prof Dr Bashir Ahmed Dar
Dr.Bashir Ahmed Dar Chinkipora Sopore Kashmir India,Associate Prof of medicine presently working in malaysia is a keen teacher, educator and takes pride in his clinical and research accomplishments. His interests include publishing articles related to health issues.
email drbashir123@gmail.com
Meningitis is a severe CNS pathology and early and appropriate intervention is needed to prevent adverse outcome including mortality and long term complications. This presentation focuses on the different types of meningitis and the appropriate management options
Meningitis By Dr Bashir Ahmed Dar Associate Professor Medicine Chinkipora Sop...Prof Dr Bashir Ahmed Dar
Dr.Bashir Ahmed Dar Chinkipora Sopore Kashmir India,Associate Prof of medicine presently working in malaysia is a keen teacher, educator and takes pride in his clinical and research accomplishments. His interests include publishing articles related to health issues.
email drbashir123@gmail.com
Meningococci are a type of bacteria that cause serious infections. The most common infection is meningitis, which is an inflammation of the thin tissue that surrounds the brain and spinal cord. Meningococci can also cause other problems, including a serious bloodstream infection called sepsis. In its early stages, you may have flu-like symptoms and a stiff neck. But the disease can progress quickly and can be fatal. Early diagnosis and treatment are extremely important. Lab tests on your blood and cerebrospinal fluid can tell if you have it. Treatment is with antibiotics. Since the infection spreads from person to person, family members may also need to be treated.
A vaccine can prevent meningococcal infections.
Meningococci are a type of bacteria that cause serious infections. The most common infection is meningitis, which is an inflammation of the thin tissue that surrounds the brain and spinal cord. Meningococci can also cause other problems, including a serious bloodstream infection called sepsis. In its early stages, you may have flu-like symptoms and a stiff neck. But the disease can progress quickly and can be fatal. Early diagnosis and treatment are extremely important. Lab tests on your blood and cerebrospinal fluid can tell if you have it. Treatment is with antibiotics. Since the infection spreads from person to person, family members may also need to be treated.
A vaccine can prevent meningococcal infections.
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Role of Mukta Pishti in the Management of Hyperthyroidism
Meningitis
1.
2.
3. DEMOGRAPHY AND
EPIDEMIOLOGY
The highest incidence is among neonates, who are
usually infected by bacteria found in the birth canal
at the time of parturition.
• Group B streptococci (Streptococcus agalactiae) account
for the majority of cases; other causes include Listeria
monocytogenes, E.coli, other Gram-negative bacilli, and
enterococci.
From age 1 to 23 months, the most common
organisms are Streptococcus pneumoniae and
Neisseria meningitidis
4. Children from the second to the fifth year used to
have a high rate of infection caused by Haemophilus
influenzae type b. However the wide use of protein-
polysaccharide conjugated vaccines has
dramatically reduced the incidence of this infection
From age 2 through 18, N. meningitidis is the most
common cause, accounting for more than one-half
of cases, followed by S. pneumoniae
In adults up to age 60, S. pneumoniae is most
common followed by N. meningitis
Over age 60, most cases are due to S. pneumoniae
and less often L. monocytogenes
5. Etiology - in Adults
S. pneumoniae 30-50%
N. meningitidis 10-35%
H. influenzae 1-3%
G -ve bacilli 1-10%
Listeria species 5%
Streptococci 5%
Staphylococci 5-15%
6. Predisposing factors
Most cases of meningitis occur when colonization
by potential pathogens is followed by mucosal
invasion of the nasopharynx
However, some patients develop disease by direct
extension of bacteria across a skull fracture in the
area of the cribriform plate
Other patients develop meningitis following
systemic bacteremia as with endocarditis or a
urinary tract infection or pneumonia
Other predisposing conditions include asplenia,
complement deficiency, corticosteroid excess, and
HIV infection
7. Etiology and epidemiology of meningitis
Lack of immunity ( IgM or igG anti capsular antibody ) to
specific pathogens with young age.
recent colonization with pathogenic bacteria .
Close contact with invasive disease ( respiratory tract
secration)
Crowding , poverty , black race , male .
Defect in complement (C5- C8 ) associated with recurrent
meningococcal infection .
8. Etiology and epidemiology of meningitis
ventricular-peritoneal shunts:
Coagulase negative staphylococci and
corynebacteria .
CSF leaks due to fracture cribriform palate or
paranasal sinus ( pneumococcal ).
9. Etiology and epidemiology of meningitis
Splenic disfunction (sickle cell anemia or
asplenia ) increased risk of
pneumococcal , H.influenza type b
,rarely meningococcal sepsis and
meningitis .
.
head trauma or neurosurgical
procedures ( staphylococci )
10. Immuno-suppressed patients with T-cell
defects (AIDS, and malygnancy) :
Cryptococcal and L.monocytogens.
Open neural tube defect :
Meningomyelocele and lombosacral
dermal sinus associated with
staphylococci -Aureus and gram –
negative
Etiology and epidemiology of
meningitis(con)
11.
12. CLINICAL FEATURES
The overwhelming majority of patients with
bacterial meningitis have fever and headache
Most patients have high fevers, but a small
percentage have hypothermia
CNS symptoms
• Some patients will have significant photophobia
and/or clouding of the sensorium
• Changes in mentation and level of consciousness,
seizures, and focal neurologic signs tend to
appear later in the course of disease
13. CLINICAL FEATURES
Nuchal rigidity
• Passive or active flexion of the neck will usually
result in an inability to touch the chin to the chest
Tests to illustrate nuchal rigidity
• The Brudzinski sign refers to spontaneous flexion of
the hips during attempted passive flexion of the neck
• The Kernig sign refers to the inability or reluctance to
allow full extension of the knee when the hip is
flexed 90 degrees
14. CLINICAL FEATURES
Other findings
• Some infectious agents, particularly N.
meningitidis, can also cause characteristic skin
manifestations, petechiae and palpable purpura
• If meningitis is the sequela of an infection
elsewhere in the body, there may be features of
that infection still present at the time of diagnosis
of meningitis eg, otitis or sinusitis
15.
16.
17. Differential Dx
Viral - 40 % of meningitis
Fungal
Tuberculous
Spirochete
Chemical / Drug induced
Collagen Vascular Disease
Parameningeal infection: brain abscess,
epidural abscess
Subarachnoid hemorrhage
Neuroleptic Malignant Syndrome
18. LABORATORY FEATURES
Most often the WBC count is elevated with a shift
toward immature forms
Platelets may be reduced if disseminated
intravascular coagulation is present or in the face of
meningococcal bacteremia
Blood cultures are often positive, and can be very
useful in the event that CSF cannot be obtained
before the administration of antimicrobials
• At least one-half of patients with bacterial meningitis
have positive blood cultures, with the lowest yield being
obtained with meningococcus
19. LABORATORY FEATURES
CSF analysis – every patient with meningitis should have
CSF obtained unless the procedure is contraindicated
Chemistry and cytologic findings highly suggestive of
bacterial meningitis include a CSF glucose concentration
below 45 mg/dL, a protein concentration above 500
mg/dL, and a white blood cell count above 1000/mm3
A Gram stain should also be obtained
The Gram stain is positive in up to 10 percent of patients
with negative CSF cultures and in up to 80 percent of
those with positive cultures
20. Opening pressure>180 mmH2O
White blood cells10/ L to 10,000/ L; neutrophils
predominateRed blood cellsAbsent in nontraumatic
tapGlucose <2.2 mmol/L (<40 mg/dL)CSF/serum
glucose <0.4Protein>0.45 g/L (>45 mg/dL)
Gram's stainPositive in >60%CulturePositive in >80%
Latex agglutinationMay be positive in patients with
meningitis due to S. pneumoniae, N. meningitidis, H.
influenzae type b, E. coli, group B
streptococci Limulus lysatePositive in cases of gram-
negative meningitisPCRDetects bacterial DNA
21. Typical Cerebrospinal Fluid Findings in
Patients with Bacterial Meningitis
Cerebrospinal Fluid Parameter Typical Finding
Opening pressure 200-500 mm H2O
White blood cell count 1000-5000/mm3
(range <100 to >10,000)
Percentage of neutrophils ≥80%
Protein 100-500 mg/dL
Glucose ≤40 mg/dL
CSF-to-serum glucose ratio ≤0.4
Gram stain Positive in 60%-90%
Culture Positive in 70%-85%
Polymerase chain reaction Promising
22. DX Color Opening
Pressure
RBC WBC Gluc Prot Smear Cx
Viral Normal Normal
or
elevated
0 100-
1000
mostly
mono’s
45-85 Normal
or
elevated
Neg Neg
Funga
l
Normal
or
cloudy
Normal
or
elevated
0 100-
1000
mostly
mono’s
< 45 > 50 Fungal
smear
positive
+/-
TB Normal
or
cloudy
Elevated 0 100-
1000
mostly
mono’s
< 45 > 50 AFB
positive
+/-
23. Complications ofComplications of
MeningitisMeningitis
Young children:
1. Babyish behavior
2. Forgetting recently learned skills
3. Reverting to bed-wetting
4. Babyish behavior
One of the most common problems
resulting from meningitis is hearing
loss. Anyone who has had
meningitis should take a hearing test.
26. Vaccine for meningitis~~Vaccine for meningitis~~
There are vaccines against Hib and against some strains
of N. meningitidis and many types of Streptococcus
pneumoniae. The vaccinevaccine against haemophilus
influenze (Hib) has reduced Hib meningitis cases by 95) has reduced Hib meningitis cases by 95
percentpercent since 1985.
There are vaccines to prevent meningitis due to S.
pneumoniae. The pneumococcal polysaccharide
vaccine is recommendedrecommended for all persons over 65 yearspersons over 65 years
of ageof age and younger persons at least 2 years oldat least 2 years old with
certain chronic medical problems.
27. Treatment and prevention of bacterial
meningitis
Suspected bacterial meningitis is a medical
emergency and immediate diagnostic steps must be
taken to establish the specific cause
The mortality rate of untreated bacterial meningitis
approaches 100 percent and, even with optimal
therapy, there is a high failure rate
Empiric treatment should be begun as soon as the
diagnosis is suspected using bactericidal agent(s)
that achieve significant levels in the CSF
28. Use of bactericidal agents
Bactericidal therapy is generally necessary to cure
meningitis
Bacteriostatic drugs, such as clindamycin and
tetracycline, are inadequate for meningitis
Chloramphenicol is a bacteriostatic drug for most
enteric Gram negative rods; however, it is usually
bactericidal for H. influenzae, N. meningitidis, and
S. pneumoniae and has been extensively and
successfully used to treat meningitis caused by these
organisms
29. Choice of agent
Selected third generation cephalosporins such as
cefotaxime and ceftriaxone, have emerged as the
beta-lactams of choice in the empiric treatment of
meningitis
These drugs have potent activity against the major
pathogens of bacterial meningitis with the notable
exception of listeria
Ceftazidime, another third generation
cephalosporin, is much less active against
penicillin-resistant pneumococci than cefotaxime
and ceftriaxone
30. Treatment - Empiric
Ceftriaxone 2 gm IV q12h or Cefotaxime
2 gm IV q4-6h
plus Vancomycin 15 mg/kg q6h
If > 50 years, also add Ampicillin 2 gm IV
q4h (for Listeria)
31. THERAPY FOR SPECIFIC PATHOGENS
Streptococcus pneumoniae
• The conventional approach to the treatment of
pneumococcal meningitis was the administration of
penicillin alone for two weeks at a dose of four
million units intravenously every four hours
• Good results have also been obtained with third
generation cephalosporins
However, the problem of treating pneumococcal
meningitis has recently been compounded by the
widespread and increasingly common reports of
pneumococcal strains resistant to penicillin
32. Cefotaxime or ceftriaxone can be used if the MIC
for these drugs is less than 0.5 µg/mL
It is recommended that vancomycin (2 g/day)
should be given with cefotaxime or ceftriaxone in
the initial treatment of pneumococcal meningitis if
there has been beta-lactam resistance noted locally
Vancomycin should be continued if there is high
level penicillin resistance and an MIC >0.5 µg/mL
to third generation cephalosporins
If corticosteroids are given, rifampin should be
added as a third agent since it increases the efficacy
of the other two drugs
The usual duration of therapy is two weeks
33. Haemophilus influenzae
A third generation cephalosporin is the drug of choice
for H. influenzae meningitis
Patients with H. influenzae meningitis should be treated
for five to seven days
For adults, a dose of 2 g every six hours of cefotaxime
and 2 g every 12 hours of ceftriaxone is more than
adequate therapy
Pharyngeal colonization persists after curative therapy
and may require a short course of rifampin if there are
other children in the household at risk for invasive
Haemophilus infection
The recommended dose is 20 mg/kg per day (to a
maximum of 600 mg/day) for four days
34. Neisseria meningitidis
This infection is best treated with penicillin
Although there are scattered case reports of N.
meningitidis resistant to penicillin, such strains are still
very rare
A third-generation cephalosporin is an effective
alternative to penicillin for meningococcal meningitis
A five day duration of therapy is adequate
However, when penicillin is used, there may still be
pharyngeal colonization with the infecting strain. As a
result, the index patient may need to take rifampin, a
fluoroquinolone, or a cephalosporin
35. Listeria monocytogenes
Listeria has been traditionally treated with ampicillin
and gentamicin, as resistance to these drugs is quite rare
Ampicillin is given in typical meningitis doses (2 g
intravenously every four to six hours in adults) and
gentamicin is used for synergy
An alternative in penicillin-allergic patients is
trimethoprim-sulfamethoxazole (dose of 10/50 mg/kg
per day in two or three divided doses)
The usual duration of therapy is at least three weeks
36. Enteric Gram negative rods
Prior to the availability of third generation
cephalosporins, it was often necessary to instill an
aminoglycoside antibiotic such as gentamicin directly
into the cerebral ventricles
It is now possible to cure these infections with high
doses of third generation antibiotics
A repeat CSF sample should be obtained for culture two
to four days into therapy to help assess the efficacy of
treatment
The duration of therapy should be at least three weeks
37. PREVENTION OF MENINGITIS
Vaccines
A spectacular reduction in H. influenzae meningitis has
been associated with the near universal use of a vaccine
against this organism in developed countries since 1987
There has been a 94 percent reduction in H. influenzae
meningitis between 1987 and 1995
Pneumococcal vaccine administered to the chronically
ill and elderly is probably useful in reducing the overall
incidence of pneumococcal infections. However, its role
in the prevention of meningitis is as yet undetermined
38. Vaccines
Meningococcal vaccines are active against many
strains of N. meningitidis
However, the majority of meningococcal infections
in the United States are caused by type b
meningococcus for which there is no vaccine
Vaccines for other types (notably type a) are
recommended for travelers and American military
personnel to countries with epidemic meningitis
Immunization against meningococci is not
warranted as postexposure prophylaxis
39. Chemoprophylaxis
There is a role for chemoprophylaxis to prevent
spread of meningococcal and haemophilus
meningitis but not for pneumococcal disease
The use of antimicrobial therapy to eradicate
pharyngeal carriage of meningococci is widely
accepted to prevent development of disease in close
contacts and to eradicate pharyngeal carriage
Rifampin 600 mg PO every 12 h for a total of four
doses is recommended
Ciprofloxacin, in a single dose of 500 mg PO, is
equally effective and can be used in patients over
the age of 18
40. Role Of Steroids
The addition of antiinflammatory agents has been
attempted as an adjuvant in the treatment of
meningitis
Early administration of corticosteroids such as
dexamethasone for pediatric meningitis has shown
no survival advantage, but there is a reduction in the
incidence of severe neurologic complications and
deafness
A meta-analysis of five such studies in children
showed a relative risk of bilateral deafness of 4.1
and of late neurological sequelae of 3.9 in controls
compared to children treated with steroids
41. A second meta-analysis of trials of meningitis in
children evaluated the findings according to
organism
For H. influenzae type b meningitis, dexamethasone
therapy was associated with a significant reduction
in deafness
For pneumococcal meningitis, dexamethasone was
effective only if given early ; in this setting, there
was a significant reduction in hearing loss
Two days of therapy was as effective and less toxic
than longer courses of steroid administration
Dexamethasone as adjunctive therapy in bacterial meningitis. A
meta-analysis of randomized clinical trials since 1988. JAMA
1997; 278:925
42. There is no consensus regarding the utility of
corticosteroid therapy in adults
The Infectious Disease Society of America
considers adjuvant corticosteroids for meningitis to
be unsupported for routine use in adults but supports
them for H. influenzae infections in children
Guidelines for the use of systemic glucocorticoids in
the management of selected infections.
J Infect Dis 1992; 165:1
43. MORTALITY RATE AND LATE
SEQUELAE
The prognosis of meningitis is linked to age and the
presence of underlying disease
Bacterial meningitis accompanying advanced liver
disease, HIV infection, or organ transplantation is
likely to be associated with more morbidity and
mortality
In addition, the prognosis and complications differ
in children and adults
44. The mortality rates are lowest in children
A meta-analysis of prospectively enrolled cohorts of
children in developed countries showed a 4.8 percent
mortality from 1955 to 1993
The mortality rate varied by organism, ranging from
3.8% for H. influenzae to 7.5 percent for N. meningitidis
to 15.3% for S. pneumoniae
83.6 percent of the surviving children had apparently
complete recovery
The most common sequelae were
• Deafness – 10.5 percent.
• Bilateral severe or profound deafness – 5.1 percent.
• Mental retardation – 4.2 percent.
• Spasticity and/or paresis – 3.5 percent.
• Seizures – 4.2 percent.
45. Complications are more common in adults
A series of 86 adults with meningitis, for example,
showed a mortality rate of 18.6 percent with a
complication rate of 50 percent
The most common problems were:
• Cerebrovascular involvement – 15.1 percent.
• Cerebral edema – 14 percent.
• Hydrocephalus – 11.6 percent.
• Septic shock – 11.6 percent.
• Disseminated intravascular coagulation – 8.1 percent.
• Acute respiratory distress syndrome – 3.5 percent.
Spectrum of complications during bacterial meningitis
in adults. Results of a prospective clinical study.
Arch Neurol 1993; 50:575
46. A second review of bacterial meningitis in adults
from 1962 to 1988 found a mortality rate of 25
percent that did not vary during the 26 years of the
study
As in children, there was a higher rate of death due
to S. pneumoniae (37 percent) as compared to N.
meningitidis (13 percent) and listeria (10 percent)
Acute bacterial meningitis in adults.
N Engl J Med 1993; 328:21.
47. Selected Bedside Signs of
Meningitis
Bedside Test Description
• Nuchal
rigidity or neck
stiffness
• Inability to flex the head forward due to rigidity of the
neck muscles; however, nuchal rigidity is absent if
flexion of the neck is painful but there is full range of
motionI
• Kernig's sign •• Inability to flex the head forward due to rigidity of the
neck muscles; however, nuchal rigidity is Extension in the
knee is painful (leading to resistance) when the leg is
fully bent at both the hp and knee
• Brudzinski's
neck sign
• Lifting a patient's head causes involuntary lifting of
the legs
48. Chemoprophylaxis Regimens for
Meningococcal DiseaseAge Group Chemoprophylaxis Regimens
for Meningococcal Disease
Antibiotic Regimen for
Chemoprophylaxis
Infants aged 1 month or less Rifampin 5 mg/kg q12h for 2 days
Children and infants older than 1
month
Rifampin 10 mg/kg q12h for 2 days
Children less than 15 years of age Ceftriaxone 125 mg intramuscularly
once
Adults Ceftriaxone 250 mg intramuscularly
once
or
Ciprofloxacin 500 mg once*
or
Rifampin 600 mg PO BID for 2 days
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