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- Current Epidemiology
- Antimicrobial Susceptibility of The Major Pathogens
- Managing Suspected Or Confirmed Meningitis
- Steroids as Adjuvant Therapy
- Duration of Treatment
- Audiology Assessment
The epidemiology of meningitis in Canada has been influenced dramatically by universal immunization programs delivering conjugate vaccines for Haemophilus influenzae type b (Hib), Neisseria meningitidis, and Streptococcus pneumoniae. The epidemiology of meningitis in the United States, and elsewhere where universal immunization programs are similar to those in Canada, is also evolving (see Figure 1 at www.nejm.org/doi/full/10.1056/NEJMoa1005384) -. The Netherlands reported a substantial drop in adult cases of community-acquired bacterial meningitis between 2006 and 2014 . In the North American Arctic, including the Canadian Arctic, data from 2000 to 2010 indicated decreasing pneumococcal meningitis but increasing prevalence of H influenzae serogroup type a meningitis . Despite limitations with reporting, there has also been an observed decrease in meningitis rates within the African meningitis belt due to improved access to vaccines . In Canada, the Hib vaccine...
Meningitis susceptibility breakpoints should always be applied in the setting of presumed or confirmed meningitis, given the requirement for adequate drug levels in the central nervous system (CNS). S pneumoniae breakpoints have been specifically designed for interpretation in the context of meningitis. The organism is penicillin-susceptible if minimal inhibitory concentration (MIC) is ≤0.06 mcg/mL penicillin, and penicillin-resistant if MIC is ≥0.12 mcg/mL . Using current criteria for an...
In the past several years, many countries, notably Belgium, Australia, and several countries in Latin America, have reported increasing prevalence (ranging from 30% to 80%) of N meningitidis with reduced susceptibility to penicillin -. In the United States, ciprofloxacin-resistant N meningitidis has also emerged . One report from Ontario indicated that the percentage of strains with reduced susceptibility to penicillin between 2000 and 2006 was 21.7% . Surveillance data of 408...
While Hib is now an uncommon cause of meningitis in children, it as well as other H influenzae serotypes should still be considered in a child who is not fully immunized or unimmunized, or from an area in northern Canada with a higher incidence of invasive H influenzae. Increasingly, Hib and other typeable strains of H influenzae have shown increased beta-lactamase production, ranging from 4% to 42%, making these isolates resistant to ampicillin . Because of this trend, ceftriaxone or cef...
Infants with meningitis often present with nonspecific findings of fever, poor feeding, lethargy (or decreased interaction with caregivers), vomiting, and irritability. They sometimes have a rash. Inconsolable crying, prolonged or worsening irritability, or progressive lethargy are also important clinical features that may indicate a CNS focus such as meningitis. Nuchal rigidity is uncommon in infants. Older children are more likely to have specific symptoms related to meningitis, such as headache, nuchal pain or rigidity, and impaired consciousness, as well as other nonspecific symptoms . Patients should undergo a full examination, including respiratory status and detailed neurological examinations, to detect focal neurological signs, posturing, cranial nerve abnormalities, and assessment of level of consciousness. A lumbar puncture (LP) for CSF analysis (cell count, glucose and protein levels, microbiological culture and molecular detection of bacterial DNA (if clinical suspic...
Because the prognosis of meningitis depends on treating infection before clinically severe disease ensues, the timely administration of empirical antimicrobial therapy (Table 1) is critical. Antimicrobials should be administered without delay when meningitis is suspected or confirmed. Also, the careful, ongoing assessment and appropriate management of hemodynamic status is required. An LP should be performed to support the diagnosis, but if an LP is not possible, antimicrobials should be given empirically irrespective of the delay in obtaining an LP, and the patient should be transferred to a facility where an LP can be performed. One study involving adults showed that a delay in starting antimicrobial treatment was one of three independent variables associated with poor prognosis. The other two factors were the severity of clinical state at presentation and the isolation of non-penicillin-susceptible S pneumoniae. Other factors to consider in the choice of antimicrobials ar...
In adults, multiple studies and meta-analysis have determined that adjuvant empiric steroids offered clinical benefit resulting in slightly lower mortality rates and reduction in hearing losses -. Studies in Sweden and Denmark, where adult patients who received steroids were compared with those who did not, concluded that there was likely some mortality benefit, although rapid diagnosis and treatment made historical comparisons difficult . Based on the potential benefit and the low risk profile of 24 h to 48 h of initial dexamethasone therapy, the European guidelines recommend empiric dexamethasone for both adults and children with suspected or proven meningitis . A landmark study in children who received empiric steroids in the management of acute bacterial meningitis due mainly to Hib showed that when they were administered just before or within 2 h of antimicrobials, there was a reduction in severe hearing loss (RR 0.34, 95% CI 0.20 to 0.59) . Subsequent t...
Treatment of bacterial meningitis should always be with intravenous antimicrobials to achieve high CSF levels. The recommended length of treatment varies with the pathogen and the clinical course of infection. Recommended length of therapy for uncomplicated meningitis due to S pneumoniae is 10 to 14 days; due to Hib, 7 to 10 days; and due to N meningitidis, 5 to 7 days. Recommended therapy for uncomplicated GBS meningitis is 14 to 21 days, and may be longer if cerebritis or ventriculitis is present.
Formal audiology assessment should be performed as soon as possible after diagnosis of meningitis for all children affected (and always before discharge from hospital) to optimize management in the event of hearing loss .
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Jul 17, 2021 · Bacterial meningitis: pathogenesis (calgaryguide.ucalgary.ca). when autocomplete results are available use up and down arrows to review and enter to select. Pathophysiology. the calgary guide the calgary guide pathophysiology and treatment of bacterial meningitis. therapeutic advances in neurological disorders, 2.
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