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BACTERIAL MENINGITIS

Meningitis is the inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. Meningitis can be life-threatening because of the inflammation's proximity to the brain and spinal cord; therefore the condition is classified as a medical emergency. The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs. Bacterial meningitis refers to meningitis that is caused by bacterial infection. It is much more serious and can cause severe disease that can result in brain damage and even death. The bacteria often live harmlessly in a person's mouth and throat. In rare instances, however, they can break through the body's immune defenses and travel to the fluid surrounding the brain and spinal cord. There they begin to multiply quickly. Soon, the thin membrane that covers the brain and spinal cord (meninges) becomes swollen and inflamed, leading to the classic symptoms of meningitis. The bacteria are spread by direct close contact with the discharges from the nose or throat of an infected person. Fortunately, none of the bacteria that cause meningitis are very contagious, and they are not spread by casual contact or by simply breathing the air where a person with meningitis has been. Many of the bacteria and viruses that cause meningitis are fairly common and associated with other routine illnesses. Bacteria and viruses that infect the skin, urinary system, gastrointestinal or respiratory tract can spread by the bloodstream to the meninges through cerebrospinal fluid, the fluid that circulates in and around the spinal cord. In some cases of bacterial meningitis, the bacteria spread to the meninges from a severe head trauma or a severe local infection, such as a serious ear infection (otitis media) or nasal sinus infection (sinusitis). Bacterial meningitis is most commonly caused by one of three types of bacteria:

Haemophilus influenzae type b (Hib) o they usually live in their host without causing disease, but cause problems only when other factors, such as a viral infection or reduced immune function, create an opportunity. o causes ear infections (otitis media), eye infections (conjunctivitis), and sinusitis in children, and is associated with pneumonia. Neisseria meningitidis - Meningococcal meningitis o is a consequence of bacteria entering the cerebrospinal fluid. It can be transmitted through saliva and occasionally through close, prolonged general contact with an infected person. Streptococcus pneumonia - Pneumococcal meningitis o normally found in the nasopharynx of 5-10% of healthy adults, and 20-40% of healthy children. It can be found in higher amounts in certain environments, especially those where people are spending a great deal of time in close proximity to each other (day care centers, military barracks).

Before the 1990s, Hib was the leading cause of bacterial meningitis, but new vaccines being given to children as part of their routine immunizations have reduced the occurrence of serious Hib disease. Today, Neisseria meningitidis and Streptococcus pneumoniae are the leading causes of bacterial meningitis. Bacterial meningitis more frequently occurs in black and Hispanic children. This is thought to be related to socioeconomic rather than racial factors. Prevalence of bacterial meningitis is higher in males. A recent report from Finland showed males more often had mumps and varicella encephalitis, whereas females had adenoviral and Mycoplasma encephalitis more often. For both meningitis and encephalitis, the greatest occurrence is in children younger than 4 years with a peak incidence in those aged 3-8 months. Bacterial meningitis continues to be among the top ten killers of children less than four years old in the Philippines. Morbidity and mortality rates depend on the infectious agent, age of the child, general health, and prompt diagnosis and treatment. Despite improvement in antibiotic and supportive therapy, a significant mortality and morbidity rate remains.