Chemical meningitis

Glucocorticoids given intrathecally can cause a rise in cerebrospinal fluid protein and carry the risk of arachnoiditis (SED-8, 820). Chemical meningitis has been reported after two intrathecal injections of methylpredni-solone acetate (450) and after lumbar facet joint block (SEDA-17, 450). Intraspinal injections of hydrocortisone for multiple sclerosis apparently led in one case to a cauda equina syndrome, with subsequent ulceromutilating acro-pathy (SEDA-17, 450). Intra-discal injections of triamcinolone acetonide in a number of French cases led to disk or epidural calcification, sometimes symptomless (SEDA-17, 450). 

Plumb VJ, Dismukes WE. Chemical meningitis related to intrathecal corticosteroid therapy. South Med J 1977 70(10) 1241-3. 

Thomson SJ, Lomax DM, Collett BJ. Chemical meningism after lumbar facet joint block with local anaesthetic and steroids. Anaesthesia 1991 46(7) 563-4. 

Chemical meningitis has been reported after spinal anesthesia with bupivacaine [21 ]. 

Tateno F, Sakakibara R, Kishi M, Ogawa E. Bupivacaine-induced chemical meningitis. J Neurol 2010 257 1327-9. 

Chemical meningitis has been reported in four patients undergoing spinal anesthesia for different procedures [41 ]. All developed meningitis on the first postoperative day. In each case cerebrospinal fiuid... 

Santos MC, de Albuquerque BC, Monte RL, Filho GG, Alecrim MG. Outbreak of chemical meningitis following spinal anesthesia caused by chemically related bupivacaine. Infect Control Hosp Epidemiol 2009 30(9) 922-4. 

Water-soluble preparations should be avoided for intraspinal injections of glucocorticoids as they may cause severe chemical meningitis of short duration (133 ). 

There are a number of practical problems involved with using polysaccharides as vaccines as there are frequently too many different chemotypes for it to be practicable to prepare a vaccine. In some cases a limited number of serotypes are the dominant cause of infection and it may then be possible to produce vaccines. A major problem is the poor immune response elicited by polysaccharide antigens, which may in some cases be improved by chemical modification. This is (fie case for vaccines for Haemophilus influenzae type b (a causative agent of meningitis), where the antigenicity of the polysaccharide can be increased by coupling to proteins. 

Cephalosporins are important bactericidal broad spectrum (3-lactam antibiotics used for the treatment of septicaemia, pneumonia, meningitis, urinary tract infections, peritonitis and biliary tract infections. They are obtained from fungus Cephalosporium acremonium and are chemically related to penicillin. It consists of beta lactam ring fused to a dihydrothiazine ring. 

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