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

Six common clinical situations in infants and children are discussed from the point of view of standard therapeutic regimens: neonatal sepsis and meningitis; febrile episodes in neutropenia; bacterial meningitis; acute pulmonary exacerbations of cystic fibrosis; pneumonia, bone and joint infections, and cellulitis in patients less than four years of age; and intra-abdominal sepsis. Potential or actual problems with these therapeutic regimens and newer therapeutic options are outlined.
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PMID:Current needs for new beta-lactam antibiotics in pediatrics. 407 87

A single-blind therapeutic trial, using randomly either cefotaxime or a benzyl-penicillin-gentamicin combination, was carried out in 68 hospitalised paediatric patients with 72 episodes of severe infection, which were, in the main, septicaemia, pneumonia, neonatal meningitis and a few other miscellaneous infections. The cefotaxime group showed a cure rate of 94.4% compared with 72.2% in the other group. One patient with bacterial meningitis treated initially with cefotaxime died a month later; however, penicillin and chloramphenicol had been added due to clinical deterioration. In the penicillin-gentamicin group there were five deaths, all from suspected neonatal septicaemia, and three cases required a change in antibiotic regimen before a cure could be effected. The results indicate that cefotaxime should be considered a drug of choice in many neonates with life-threatening sepsis.
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PMID:A therapeutic trial of cefotaxime versus penicillin-gentamicin for severe infections in children. 609 34

In 52 children with meningitis caused by Hemophilus influenzae, pneumococci, meningococci and group B streptococci the organism responsible could be identified in 41 cases (79%) within one hour with specific antisera by means of countercurrent immunoelectrophoresis (CIE). False positive results were not observed in meningitis caused by other organisms, aseptic meningitis, septicemia, etc. In 4 cases the organism could only be identified by CIE since the children had received antibiotics and the culture was negative. Group B meningococci are often missed in CIE. CIE proved to be a valuable tool in diagnostic procedures of bacterial meningitis.
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PMID:[The diagnostic significance of countercurrent immunoelectrophoresis (CIE) in bacterial meningitis in children (author's transl)]. 611 17

Overwhelming infections caused by encapsulated bacteria, salmonella spp. and Plasmodium falciparum (in malarious areas) are an important cause of morbidity and death in patients with sickle cell disease. Bacterial infections afflicting these patients include fulminant meningitis and septicaemia caused by Str. pneumoniae and H. influenzae type b, and non-typhoid salmonellosis. Children less than five years of age are at greatest risk for meningitis and septicaemia, while salmonella osteomyelitis is probably common to all age groups. The most important contributing factors to this increased susceptibility to encapsulated bacteria are: a state of functional asplenia, an opsonophagocytic defect due to an abnormality of the alternative complement pathway, and a deficiency of specific circulating antibodies. Devitalisation of gut and bone due to repetitive vaso-occlusive crises, saturation of the macrophage system with red cell breakdown products of chronic haemolysis, and underlying splenic and hepatic dysfunction all predispose to salmonella infections. Seventy per cent of septicaemias and meningitis among under-fives with sickle cell disease is caused by Str. pneumoniae. Septicaemia frequently presents with sudden fever, few prodromal features, and a deceptive appearance of well-being, followed within hours by rapid relentless progression to shock and death. Adrenal haemorrhage is common, and mortality can be as high as 50 per cent, unless intravenous antibiotic, with or without steroid therapy, is promptly initiated. The clinical presentation of bacterial meningitis, its management and mortality follow the normal patterns, but recurrent meningitis and cerebrovascular morbidity are common in patients with sickle cell disease. An acute pulmonary involvement, indistinguishable from bacterial pneumonia (the 'chest syndrome') is the commonest single complication of sickle cell disease at any age. Str. pneumoniae is responsible for about half of the episodes. The protective values of the pneumococcal vaccine and long-term penicillin prophylaxis remain to be established in sickle cell disease. Over 70 per cent of haematogenous osteomyelitis in sickle cell disease is caused by salmonellae. The distinction from vaso-occlusive bone crisis is often difficult, but the presence of multiple, often symmetrical bone involvement, diaphyseal fissuring and involucrum should suggest osteomyelitis rather than bone infarction. Chloramphenicol remains the drug of choice and often has to be given in high doses for up to six weeks. The role of surgery is limited by the presence of multiple bone involvement and the known anaesthetic risks in this group.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Sickle cell disease and infection. 631 9

Bacterial infections are frequent events in premature and newborn infants. The reason is a defective specific and nonspecific defence of bacterial organisms. Some immunoglobulins like IgM and IgA including secretory IgA are absent. Premature infants also show a decreased level of IgG. Cellular immunity is anatomically intact but functionally defective. A number of complement factors are lacking, the activation of the alternative pathway is impaired. Newborn infants with perinatal problems like asphyxia or difficult delivery, show defects of leucocyte function like decreased deformability, defective chemotaxis and defective killing of ingested bacteria. Certain diseases, like hypoxia and malformations of immature organ functions in this age group (decreased acid production in the stomach), facilitate bacterial colonization of surface epithelia and the invasion of tissues. Consequences of these pathogenetic mechanisms are an unimpaired propagation of bacterial organisms into the blood and meninges without localization of the infecting organisms at the entry site. Bacterial meningitis is not considered a separate disease entity but a complication of bacteremia and sepsis. Clinical symptoms are nonspecific at the onset of the infection. Fever is frequently absent; decreased appetite, vomiting, a bloated abdomen, diarrhea, tachycardia, tachypnea are early signs of a bacterial infection, a grey mottled appearance, cyanosis, jaundice, petechiae, apneic spells, seizure activity and a metabolic acidosis are symptoms of advanced infection. Successful treatment at this stage is often not possible. Every sign of a decreased well being of a newborn of premature infant warrants laboratory and bacteriologic work up for septicemia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Chemotherapy of severe bacterial infections in pediatrics]. 631 69

Retrospective study of 14 cases of Staphylococcus aureus meningitis and of data from the literature shows that this as yet infrequent disease which carries a high mortality rate (40%) is always related to neurosurgery, primary or iatrogenic septicemia, or local infection, usually in the lumbar area (spinal, abscess, spondylitis). The major clinical problem is the search for the meningeal lead point of Staphylococcus aureus penetration, whose eradication is more essential than in usual bacterial meningitis. Prognosis is mainly dependent upon the eventual existence of associated severe septicemia. Antibiotics active on Peni-M resistant Staphylococcus aureus and meningeal infection are reviewed.
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PMID:[Purulent Staphylococcus aureus meningitis]. 631 57

The incidence of sepsis among neonates born in the United States varies from less than one to more than eight per 1,000 live births. Bacterial meningitis occurs in about one-third of infants with sepsis and is more frequent during the first month of life than during any subsequent period. The clinical diagnosis of sepsis in newborn infants is difficult since signs are subtle and nonspecific. Because of the difficulty of diagnosis, many infants receive treatment although few significant bacterial infections are subsequently documents; approximately 5%-10% of neonates born in the United States receive parenteral antibiotics. The choice of antimicrobial agents for treatment of bacterial infections in neonates is based on knowledge of the responsible organisms and their patterns of antimicrobial susceptibility. Group B Streptococcus and Escherichia coli are currently the bacterial pathogens most often responsible for sepsis and meningitis in the United States. A penicillin and an aminoglycoside are the drugs usually used for initial therapy in infants with suspected sepsis. Present regimens are not optimal, however; mortality from sepsis and meningitis varies from 10% to 50%. Many survivors have significant sequelae. In addition, dose-related toxicity of the aminoglycosides is a concern. New beta-lactam antibiotics with increased efficacy against gram-negative enteric bacilli and with minimal or no dose-related toxicity warrant careful evaluation in newborn infants.
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PMID:Selection of antimicrobial agents for treatment of neonatal sepsis. 634 99

The current incidence of neonatal sepsis in the United States varies from less than 1 to 8.1 per 1000 live births. The incidence of bacterial meningitis is about one-third of the number of infants with sepsis. The mortality is 20 to 30% and many survivors are severely impaired. Group B streptococcus and Escherichia coli are the most frequent causes of meningitis. Because of the difficulty of clinical diagnosis, many infants receive presumptive therapy for suspected sepsis or meningitis although few have documented infection. Between 5 and 10% of newborn infants born in the United States receive antimicrobial agents in the nursery, usually a penicillin and an aminoglycoside. To lower the continued high mortality and morbidity of meningitis due to gram-negative enteric bacilli, collaborative randomized trials evaluated the efficacy of gentamicin administered via the intrathecal route, gentamicin administered into the ventricle and most recently, the efficacy of moxalactam. Neither intrathecal or intraventricular drug, both in combination with parenteral drug, was advantageous when compared with parenterally administered drug alone. The mortality rate and number of days of culture positive cerebrospinal fluid were similar in infants who received moxalactam and ampicillin and infants who received amikacin and ampicillin. Adjunctive therapies including granulocyte transfusion, administration of hyperimmune gamma globulin and exchange transfusion are now under investigation. Initial studies of prevention of systemic bacterial infection by prophylactic ampicillin administered to the mother at delivery and use of group B streptococcal vaccine administered to susceptible women in the child bearing age show promise.
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PMID:Recent advances in management of bacterial meningitis in neonates. 639 49

The EEG of the newborn consists of a mixed activity which varies from 1 to 22/s. Waves in the alpha band may occur, but they indicate cerebral dysfunction if they are seen in a rhythmic uninterrupted sequence. Eight newborns who showed rhythmic alpha activity in their EEG are included in our study. This activity occurred together with rhythmic theta waves or was followed by them as part of ongoing electrographic seizure activity. All newborns studied were very sick. Three suffered from severe perinatal asphyxia with persistent fetal circulation; in addition one of them had bacterial meningitis. Two infants suffered from herpes encephalitis. In those cases the rhythmic alpha activity temporarily showed a certain periodicity. This EEG pattern was also seen in a small for gestational age premature infant who had septicemia and subarachnoid hemorrhage and in two extremely premature babies with intraventricular hemorrhage. Four infants were curarized. All of the others also had clinically observed seizures. Rhythmic alpha-activity in the neonatal EEG represents an electrical seizure discharge. It may also occur in premature infants who suffer from intraventricular hemorrhage. Obviously it does not have a diagnostic value. The prognostic value depends upon the underlying disease and the grade of background suppression in the EEG. Anticonvulsant therapy should be administered early using a sufficient dosage.
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PMID:[Rhythmic alpha activity in the EEG of premature and newborn infants]. 640 15

Cefoperazone (CPZ) was given intravenously to 23 children with the following acute bacterial infections; 10 cases of pneumonia, 4 cases of urinary tract infection, 2 cases of purulent cervical lymphadenitis, 2 cases of pertussis pneumonia, 2 cases of septicemia, 1 case of osteomyelitis, 1 case of perforative peritonitis and 1 case of bacterial meningitis. Clinical effectiveness was obtained in 20 cases out of 23 cases and bacteriological effectiveness in 14 cases out of 17 cases. With CPZ, the following side effects developed; transient diarrhea in 1 case, asymptomatic eosinophilia in 2 cases. From the above clinical results, it is apparent that CPZ is a useful antibiotic for treating pediatric patients with various kinds of bacterial infections.
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PMID:[Clinical experience with cefoperazone in the pediatric field (author's transl)]. 645 40


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