BACTERIAL MENINGITIS

ALYSIA GIANI CHEM 4205

What is it?
Bacterial meningitis is a serious infection of the spinal cord and the fluid that surrounds the brain.

What causes it?

There are 3 main bacterial species that contribute to this disease:
Haemophilus influenzae type b Neisseria meningitidis (Meningococcal)

Streptococcus pneumoniae (Pneumococcal)

How is it diagnosed?
When patient presents symptoms of Meningitis, a sample of CSF is acquired from a spinal tap, which is then analyzed for bacterial presence.

Bacterial Meningitis Facts

There are 1.2 million cases annually worldwide, approximately 135,000 deaths. Bacterial meningitis is 1 of the top 10 infectious causes of death worldwide, according to the CDC.

Half of survivors suffer neurological damage, and/or other permanent side effects.

Haemophilus influenzae type b

Affects about 13/1,000,000 children (2005), 3-4% are fatal. Infection has decreased drastically:
From 4-10/10,000; since routine use of the Hib vaccine (since 1990)

A major cause of lower respiratory tract infections in developing countries

Neisseria meningitidis
5-50/1,000,000 people are infected worldwide every year. Most Deadly form of Bacterial Meningitis

Humans are only host of bacteria, it is present in the nasopharynx

11-19% of people who have recovered suffer from permanent hearing loss, mental retardation, or other serious health problems. 10-14% of cases are fatal

Streptococcus pneumoniae
Infection rate in the U.S. has now decreased to 13/ 100,000, due to vaccination. (2002) Kills 14% of hospitalized adults with invasive disease. In some recovery cases, the patients sustain learning disabilities, and/or other impairments typical of meningitis, but less so than with other forms of meningitis. Overuse of antibiotics contributes to emerging drug resistance in this strain.

Symptoms
Most Common
Fever Headache Stiff Neck Nausea & vomiting Sensitivity to light Confusion Sleepiness

Advanced Disease
Bruises develop under skin & spread rapidly

Advanced Disease can lead to:

Brain Damage Coma Death

In Infants
Inactivity Irritability Vomiting Poor feeding

Symptoms

Risk Factors
Infants and young children Elderly College freshmen who live in dorms Patients without spleens People exposed to active or passive tobacco smoke. African Americans, American Indians, Alaskan Natives. People with underlying medical conditions (Ex. HIV & Sickle-cell disease)

Treatment & Medication

Antibiotics:
Broad-Spectrum cephalosporin Ampicillin & Broad-Spectrum cephalosporin Vancomycin plus ceftazidime

All antibiotics administered intravenously

H. Influenzae & N. meningitidis- 7 days S. pneumoniae- 10-14 days

Medications Continued
N. meningitidis
Chloramphenicol resistance
Used in resource-limited settings (Sub-Saharan Africa). Stopped using in West because of very rare, yet serious side effect: Aplastic anemia. Very cheap synthesis Derived from bacteria- disrupts translation process by preventing peptide bond formation

There are no non-pharmaceutical treatments for bacterial meningitis.

Vaccines: H. influenzae type b

Bacteria contains polysaccharide capsule Questions have arisen on the length of time the vaccine is effective. Cost of vaccine: $7.00 (typical vaccines are $1.00) The cost of this vaccine has limited their use in developing countries, even though this bacteria is a major cause of death.

Vaccine: N. Meningitidis
Meningococcal conjugate vaccine (MCV4)
Price: $82; intramuscularly as single dose. Effective in all age groups Preferred over MPSV4

Meningococcal Polysaccharide Vaccine (MPSV4)

Price: $86.10; subcutaneously as single dose. Re-administered every 3-5 years Age groups: Not under 2 and 11-12 years old

Vaccine: S. Pneumoniae
Bacteria contains polysaccharide capsule lactam resistance is common, resistance to multiple classes of drugs are increasing. 23-valent polysaccharide vaccine (Prevnar)NEW
$80.00 per dose Underused Supplies are inadequate

New urinary antigen test may be useful in adults to identify if S. pneumoniae is present.

Research for Paper

Mechanism that causes the side effects and symptoms of bacterial meningitis and their role in cytokine response. Mechanism of antibiotics to specific bacteria and mechanisms of resistance by bacteria to antibiotics Interview Peter Hicks, Epidemiologist at the CDC.