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Query: UMLS:C0085437 (bacterial meningitis)
 4,038 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In developed countries the mortality from bacterial meningitis acquired outside the neonatal period is relatively low. In contrast, in developing countries it is often higher (20%-40%). In developed countries despite (and perhaps because of) the introduction of increasingly potent antimicrobials, the morbidity of bacterial meningitis has remained high. For example, up to 25% of patients with Haemophilus influenzae meningitis have some form of neurological deficit. Neisseria meningitidis is the major cause of bacterial meningitis in many areas of the world. A clone of Group A meningococcus has spread from China to cause the most recent major epidemic in Sub-Saharan Africa. Group B meningococcal infections causing sporadic meningitis are increasing in parts of Europe and South America. The mortality from meningococcal disease is greatest when there is a septicaemic component to the infection. Although antimicrobial chemotherapy is of major importance some adjuncts to therapy are beneficial. High dose corticosteroid therapy has been shown to decrease mortality in pneumococcal meningitis in an uncontrolled study and to speed recovery and decrease neurological sequelae in H. influenzae meningitis. Nevertheless to prevent infection would be of greater benefit. Prevention can be achieved by either chemoprophylaxis or immunoprophylaxis. Although safe and effective vaccines are available to prevent pneumococcal, H. influenzae (Hib) and Groups A and C meningococcal meningitis; apart from the protein conjugate Hib vaccine they are less effective in children under two years of age. There is no effective vaccine to protect against group B meningococcal meningitis.
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PMID:Management of bacterial meningitis. 840 98

Hemophilus influenza type b (Hib), Neisseria meningitides (Mnc), and Streptococcus pneumonia (Pnc) cause more than three-quarters of all cases of acute bacterial meningitis in developing countries. A controlled clinical trial was carried out to compare the efficacy at day 4 of a double intramuscular injection of long-acting chloramphenicol 100 mg/kg with that of ampicillin administered intravenously for 8 days at 200 mg/kg (4 times a day). The study was conducted from May 1989 to May 1990 in the pediatric ward of Hopital Gabriel Toure in Bamako, Mali, and from March 1989 to May 1990 in the infectious diseases ward of the Hopital National in Niamey, Niger. Patients assigned to the ampicillin group received a solution of isotonic sodium chloride intravenously for 8 days. The final series consisted of 528 cases (274 in the ampicillin group and 254 in the chloramphenicol group). In 44.9% (123) of those who received ampicillin, the drug was injected intramuscularly. Among children aged 3 years, 48.5% (128) of the cases were caused by Hib, 27.3% (72) by Pnc, 10.6% (28) by Mnc, and 4.5% (12) by other agents. Among patients aged or = 3 years, 50.4% (133) of the cases were caused by Mnc, 1.9% (5) by Hib; 16.3% (43) by Pnc, and 1.9% (5) by other agents. The cumulative case fatality rate (CFR) at day 4 was 28% for the chloramphenicol group vs. 24.5% for the ampicillin group. The germ- specific hospital CFR and rate of major neurological sequelae, respectively were as follows: 13% (21/161) and 4.9% (7/140) for N. meningitides; 36.1% (48/133) and 28.2% (24/85) for H. influenza; 67% (77/115) and 21% (8/38) for S. pneumonia; and 64.7% (11/17) and 0% (0/6) for the other agents (8 deaths out of 10 cases of salmonella). The very high hospital CFR, (42%), irrespective of the treatment given, was noteworthy. These results are indicative of an endemic, since no outbreak of meningococcal meningitis occurred in either place during the study.
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PMID:Long-acting chloramphenicol for bacterial meningitis. 844 31

Bacterial meningitis continues to be a life-threatening disease and an important cause of severe disability in otherwise healthy individuals. This article reviews the aspects related to the prevention of secondary cases. Our understanding about the factors leading to an epidemic and the identification of high risk groups remains limited. For this reason, chemoprophylaxis can be used only for the prevention of secondary cases once an index case has been identified. The objectives of prophylaxis are threefold: (i) to eliminate nasopharyngeal carriage in household contacts; (ii) to prevent contacts from acquiring the disease and (iii) to treat infection in those incubating the disease. Chemoprophylaxis can only achieve the first of these objectives. Nasopharyngeal carriage of meningococci and Haemophilus influenzae can be eradicated with the use of antibiotics and their advantages and disadvantages are discussed. Prophylaxis should be given to household members and kissing and saliva-exchanging contacts of a case of meningococcal meningitis. The decision to give prophylaxis to extended family contacts, close neighbour contacts or children attending day-care centres where a case has occurred is controversial. It does not alter the course of an epidemic and close contacts are liable to become reinfected soon after prophylaxis. Prophylaxis of H. influenzae should be given to households in which there is at least one child (other than the index case) under 48 months of age. There is no agreement on the need to provide chemoprophylaxis to children in day-care centres because the risk of secondary infections is uncertain. An alternative to chemoprophylaxis is protective chemotherapy which can prevent the development of meningitis in individuals incubating the disease.
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PMID:Chemoprophylaxis of bacterial meningitis. 844 48

The therapy of bacterial meningitis has evolved over the past century. Initially, antimeningococcal antiserum was used to treat patients with meningococcal meningitis. During the 1930s, sulphonamides were the first antibiotics used in the treatment of bacterial meningitis. The use of other antibiotics followed in later decades. Insights into the pathophysiology of meningitis have led to the use of prophylaxis against infection, as well as adjunctive therapy aimed at attenuating the harmful sequelae, should infection occur. This article outlines the basic principles important in the selection of appropriate antimicrobials. the emergence of resistant organisms, specifically Streptococcus pneumoniae and Haemophilus influenzae, has necessitated changes in previously effective antimicrobial regimens. The availability of third generation cephalosporins has increased the survival rate for meningitis caused by Gram-negative bacilli. Research into the use of adjunctive steroids has led to the recommendation that these agents be used in the paediatric population, which traditionally has had a high prevalence of H. influenzae meningitis. The high efficacy of H. influenzae type b conjugate vaccine and the observation that steroids, by decreasing inflammation, also decrease CNS penetration of some drugs, has led to reconsideration of routine steroid use. Effective chemoprophylactic regimens for contacts of patients with either H. influenzae or Neisseria meningitidis can diminish the spread of infection. Vaccination for both immunocompetent and immunodeficient patients protects against disease caused by some of the more common meningeal pathogens.
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PMID:Bacterial meningitis. Practical guidelines for management. 858 29

Although known for centuries, bacterial meningitis is a disease which still causes death and invalidity no matter there are modern diagnostic methods and therapeutic modalities. Our investigation included 45 patients treated for a purulent meningitis during a two-year period at the Clinic for Infectious Diseases in Novi Sad. Most patients suffered from meningococcal meningitis. The onset of the disease was sporadic, during winter and spring, and there were no contact cases. Most patients were 2-3 and 8-15 years of age. Patients with pneumococcal meningitis had the most serious clinical picture, course of the disease, laboratory results, as well as outcome of the disease.
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PMID:[Basic characteristics of bacterial meningitis in patients treated at the Clinic for Infectious Diseases in Novi Sad during a 2-year period]. 869 83

Bacterial meningitis is a major cause of childhood morbidity and mortality in South Africa. However, comprehensive regional or national epidemiological data, essential for rational public health interventions, are lacking. The purpose of this 1-year prospective study, from 1 August 1991 to 31 July 1992, was to define the magnitude of the problem of childhood bacterial meningitis in Cape Town. The study group consisted of all children, aged > 1 month to < 14 years, who presented with proven bacterial meningitis at all the hospitals in the Cape Town metropolitan area. During the year 201 cases were identified: 101 (50.2%) were due to Neisseria meningitidis, 74 (36.8%) were due to Haemophilus influenzae and 26 (12.9%) were due to Streptococcus pneumoniae. The overall incidence rate (95% confidence interval) for children less than 14 years, 5 years and 1 year was 34 (30-40), 76 (65-88) and 257 (213-309) per 100,000 children, respectively. The rate was highest in black infants, 416 (316-545)/100,000. This was 2 times greater than the rate in coloured infants and about 4.5 times greater than the rate in white infants. The median age of all the children was 10 months. The ages of children with haemophilus and pneumococcal meningitis were similar, 9 and 7.5 months respectively (P = 0.43), while children with meningococcal meningitis were significantly older (22 months) than the others (P < 0.01). The overall case fatality rate was 5%, and 12.9% of survivors had significant neurological sequelae (disability) on discharge.
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PMID:Epidemiology of post-neonatal bacterial meningitis in Cape Town children. 925 40

Steroid therapy, in combination with antibiotics for bacterial meningitis in paediatric patients remains controversial. Steroids, and primarily dexamethasone a very potent anti-inflammatory agent, regulate the liberation of various cytokines and inflammatory mediators such as prostaglandins, released during bacterial meningitis and leading to long term complications. Several clinical trials studying infants and children with bacterial meningitis due to Haemophilus influenzae have evaluated the beneficial effects of the administration of dexamethasone at the onset of antibiotherapy and demonstrated that dexamethasone reduced the risk of acquired sensorineural deafness (bilateral moderate or more severe hearing loss) and the incidence of neurological sequelae. Limited information is available for the other bacterial meningitis, although meningococcal meningitis will become more frequent with the use of effective anti-Haemophilus vaccines. In addition some Streptococcus pneumoniae are now resistant to third generation cephalosporins and the use of dexamethasone in that case may be at risk. Finally, no evidence is available for an effective role for dexamethasone in neonatal bacterial meningitis, although it is quite often administered in that age group.
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PMID:[Role of corticoids in purulent meningitis in children: analysis of literature studies]. 908 10

Neisseria meningitidis is the main cause of bacterial meningitis in Spain. Of the 213 children included in this study with meningococcal meningitis, 7 died. Mortality was linked to a shorter time from the first symptom to diagnosis (mean time for fatal cases was 9.5 h, mean time for survivors was 19 h, p = 0.034), to deteriorated consciousness (DC) (mortality rate (MR) with DC = 6/87, MR without DC = 1/124, p = 0.02) and to shock (MR with shock = 5/7, MR without shock = 2/206, p < 0.0001). Previous treatment reduced the yield from blood culture (36/54 versus 45/137, p < 0.0001). Positivity in both Gram stain (GS) and cerebrospinal fluid (CSF) culture increased with longer duration of symptoms (mean GS+ = 25 h, GS- = 16 h, p = 0.004; CSF+ = 20 h, CSF- = 12 h, p = 0.001), and blood culture (BC) gave more positive results when carried out earlier (mean BC- = 14 h, BC- = 24 h, p < 0.001). Reduced susceptibility to penicillin was seen in 34% of the strains, and rapidly evolving forms were responsible for most of the deaths; reduced susceptibility was more frequent among strains responsible for death or sequelae (9/15 = 60%) as compared with the more harmless strains (69/ 215 = 32%) (p = 0.04). The progressive reduction of susceptibility to penicillin indicates that it should be replaced by a third-generation cephalosporine.
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PMID:Clinical data in children with meningococcal meningitis in a Spanish hospital. 911 21

In south-east Poland in the years 1993 till 1995 we observed a decreasing number of meningococcal meningitis in children and a growth of cases caused by Haemophilus influenzae. Changes in ethiology of bacterial meningitis should give a reason for epidemiological research in Poland because there is a chance to reduce number of patients when wider use of new vaccines is introduced.
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PMID:[Epidemiology and etiology of bacterial meningitis in postnatal period]. 913

During 1994, 603 cases of bacterial meningitis were reported in Italy. Seventy-five percent of cases with determined etiology was due to three agents: Neisseria meningitidis (33.4%), Streptococcus pneumoniae (23.4%) and Haemophilus influenzae (18.6%). The majority of cases due to N. meningitidis and H. influenzae occurred in subjects below five years of age (35.7% and 84.8%, respectively) while S. pneumoniae accounted for 52.8% of meningitis cases in subjects older than 44 year of age. The estimated incidence of N. meningitidis on the national population in 1994 was 0.27 per 100,000. Serogroup B accounted for 62.5% of the serotyped isolates, group C for 23.1%, group A for 7.2%, group W135 for 3.6%, group Y for 1.8%. All tested meningococcal strains were susceptible to penicillin as well as to rifampin. Incidence of meningococcal meningitis in 1994 has been low suggesting that its relative importance compared to other bacteria causing meningitis is likely to change in the future. Therefore, extended surveillance on bacterial meningitis by other etiological agents has to be maintained and implemented in order to undertake the appropriate control measures and evaluate their effect.
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PMID:Pattern of bacterial meningitis in Italy, 1994. 925 31


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