Meningeal infection

Sinner SW, Tunkel AR. Antimicrobial agents in the treatment of bacterial meningitis. Infect Dis Clin North Am 2004 18 581-602. 

Kozar, M. Krahmer, M. Fox, A. Gray, B. M. Failure to detect muramic acid in normal rat tissues but detection in cerebrospinal fluid from patients with pneumococcal meningitis. Infect. Immun. 2000, 68, 4688 1698. 

A 26-year-old female with acquired immunodeficiency syndrome (AIDS) develops cryptococcal meningitis. She refuses all intravenous medication. Which antifungal agent can be given orally to treat the meningeal infection ... 

Korhonen, T. K., Valtonen, M. V., Parrkinen, J., Vaisanen-Rhen, V., Finne, J., Orskov, L, Svenson, S. B., and Makela, P. H. (1985). Serotypes, hemolysin production, and receptor recognition of Escherichia coli strains associated with neonatal sepsis and meningitis. Infect. Immun. 48,486-491. 

Secondary epilepsy A number of reversible disturbances, such as tumors, head injury, hypoglycemia, meningeal infection, or rapid withdrawal of alcohol from an alcoholic, can precipitate seizures. Antiepileptic drugs are given until the primary cause of the seizures can be corrected. Seizures secondary to stroke or trauma may cause irreversible CNS damage. 

In the treatment of entero-coccal endocarditis with penicillin and streptomycin or cryptococcal meningitis infections with amphotericin B in combination with flucytosine. 

Cerebrospinal fluid is often abnormal in cerebral venous thrombosis the pressure is usually raised and there may be elevated protein and pleocytosis, especially in patients with focal signs. Lumbar puncture may be indicated in patients with isolated intracranial hypertension in order to lower cerebrospinal fluid pressure when vision is threatened and to exclude meningeal infection. 

Polymerase chain reaction (PCR) techniques can be used to diagnose meningitis caused by M meningitidis, S. pneumoniae, and H. influenzaetype b (Hib). PCR is considered to be highly sensitive and specific. PCR testing of the CSF is the preferred method of diagnosing most viral meningitis infections. 

The majority of meningitis infections are acquired by blood-bome spread. An individual may have another... 

Andes DR, Craig WA. Pharmacokinetics and pharmacodynamics of antibiotics in meningitis. Infect Dis CUn North Am 1999 13 595-618. 

PCR testing of the CSF is the preferred method of diagnosing most viral meningitis infections. 

Kaplan SL. CUnical presentations, diagnosis, and prognostic factors of bacterial meningitis. Infect Dis Qin North Am 1999 13 579-594, vi—vii. 

Only fluconazole penetrates into the CSF and can be used in meningeal infection. Fluconazole is eliminated in the urine, largely in unchanged form. 

Korhonen TK, Valtonen MV, Parkkinen J et al. (1985) Serotypes, hemolysin production, and receptor recognition of Escherichia coli strains associated with neonatal sepsis and meningitis. Infect Immun 48 486—491... 

Polymyxin B may be indicated (when less toxic drugs are ineffective or contraindicated) in serious infections caused by susceptible strains of the following organisms Haemophilus influenzae (meningeal infections) Escherichia coli (urinary tract infections) Enterobacter aero-genes (bacteremia) Klebsiella pneumoniae (bacteremia). In meningeal infections, polymyxin B sulfate must be administered only intrathecally. 

Antibiotic broad-spectrum agent inhibits protein synthesis (SOS) uses restricted to backup drug for bacterial meningitis, infections due to anaerobes, salmonella. Tox reversible myelosuppression, aplastic anemia, gray baby syndrome. 

It is comparatively less effeetive than sulfadiazine in meningal infections because of its poor penetration into the eerebrospinal fluid. However, for other infections it is often regarded as the choicest sulphonamide. It is readily absorbed from the gastro-intestinal tract, hence desired concentration in blood may be achieved with regular oral doses. 

The drug gets easily absorbed from the Gl-tract after oral administration and, therefore, the desired concentration in blood is accomplished with usual dosage regimen employed. As it exhibits relatively poor penetration right into the cerebrospinal flnid hence, it is much less effective in the treatment of meningal infections in comparison to the congener sulfadiazine. 

There was no operative mortality in cases of primary surgery. One of our patients (case no. 5) died in two weeks after an urgent transoral reoperation necessitated by sudden medullary respiratory disturbance. Although neurological symtoms improved remarkably in the early post-operative period we lost the cachectic patient from pulmonary and meningeal infections. 

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