Meningitis, bacterial

Infection Systemic lupus erythematosus Appendicitis Bacterial meningitis Bacterial sepsis or infections Pneumonia... 

Eyes Erythematous, painful globe with dilated unreactive pupil (rubeosis iiidis) Papilledema Roth spot Cholesterol embolus Hypertensive or diabetic retinopathy Subhyaloid hemorrhage Ischemic eye due to combined ICA and ECA disease Increased intracranial pressure from intracranial mass, venous sinus thrombosis, hydrocephalus, chronic meningitis Bacterial endocarditis Cholesterol embolus from aorta or carotid Hypertension and/or diabetes Subarachnoid hemorrhage... 

GI diseases ulcerative coHtis and anorectal disorders Bacterial meningitis... 

The natural and semi ynthetic penicillins are used in tire treatment of bacterial infections due to susceptible microorganisms. Fbnicillins may be used to treat infections such as urinary tract infections, septicemia, meningitis, intra-abdominal infection, gonorrhea, syphilis, pneumonia, and other respiratory infections. Examples of infectious microorganisms (bacteria) that may respond to penicillin therapy include gonococci, staphylococci,... 

Meropenem (Merrem IV) inhibits syndiesis of die bacterial cell wall and causes die deadi of susceptible cells. This drug is used for intra-abdominal infections caused by Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, and odier susceptible organisms Meropenem also is effective against bacterial meningitis caused by Neisseria meningitidis, Streptococcus pneumoniae, and Hemophilus influenzae. 

The treatment of bacterial infections of the central nervous system highlights a number of important therapeutic considerations. Bacterial meningitis is caused by a variety of bacteria although their incidence varies with age. In the neonate, E. coli and group B streptococci account for the majority of infections, while in the preschool child H. influenzae is the commonest pathogen. Neisseria meningitidis has a... 

Antimicrobials also can be classified as possessing bactericidal or bacteriostatic activity in vitro. Bactericidal antibiotics generally kill at least 99.9% (3 log reduction) of a bacterial population, whereas bacteriostatic antibiotics possess antimicrobial activity but reduce bacterial load by less than 3 logs. Clinically, bactericidal antibiotics may be necessary to achieve success in infections such as endocarditis or meningitis. A full discussion of the application of antimicrobial pharmacodynamics is beyond the scope of this chapter, but excellent sources of information are available.15... 

Bacterial meningitis is the most common cause of CNS infections. An epidemiologic review of bacterial meningitis in 1995 revealed that Streptococcus pneumoniae (pneumococcus) was the most common pathogen (47%), followed by Neisseria... 

S. pneumoniae, N. meningitidis, and H. influenzae type b dramatically. Prior to the availability of Hib conjugate vaccines, Hib meningitis or other invasive disease was documented in 1 in 200 children by the age of 5 years.5 Widespread use of the Hib vaccine has reduced the incidence of invasive Hib disease by 99% and has shifted the age distribution of bacterial meningitis to older age groups (from 15 months in 1986 to 25 years in 1995).1,6 Recent data indicate that routine use of the 7-valent... 

Non-infectious causes of meningitis include malignancy, medications, autoimmune disease (such as lupus), and trauma.8,9 The most common pathogens causing bacterial meningitis, by age group and other risk factors, are found in Table 67-1. 

Normal CSF has a characteristic composition in terms of protein and glucose content, as well as cell count. Table 67-2 lists CSF findings observed in the absence of infection, as well as in patients with bacterial, viral, fungal, and tuberculous meningitis. 

Gram stain (adequate for diagnosis in 60% to 90% of patients with bacterial meningitis)... 

Polymerase chain reaction (PCR DNA amplification of the most common bacterial meningitis pathogens) may be useful to help exclude bacterial meningitis. 

Development of resistance to P -lactam antibiotics, including penicillins and cephalosporins, has significantly impacted the management of bacterial meningitis. Approximately 17% of United States pneumococcal CSF isolates are resistant to penicillin, and 3.5% of CSF isolates are resistant to cephalosporins.26 The Clinical and Laboratory Standards Institute (CLSI) has set a lower ceftriaxone susceptibility breakpoint for pneumococcal CSF isolates (1 mg/L) than for isolates from non-CNS sites (2 mg/L). Increasing pneumococcal resistance to penicillin G... 

Pediatric Doses of Selected Agents Used in Bacterial Meningitis Treatment... 

CSF findings consistent with bacterial meningitis Negative CT scan of the head... 

Management algorithm for adults with suspected bacterial meningitis.3 Management algorithm is similar for infants and children with suspected bacterial meningitis. 

See Table 67-1 for empirical treatment recommendations. cSee text for specific recommendations for use of adjunctive dexamethasone in adults with bacterial meningitis. dSee Table 67-3 for pathogen-based definitive treatment recommendations. (Adapted, with permission, ref. 14.)... 

Prior to the introduction of the Hib conjugate vaccine, H. influenzae type b was the most common cause of bacterial meningitis in the United States.5 Routine inoculation of pediatric patients against Hib since 1991 has reduced the incidence of invasive Hib disease (i.e., meningitis and sepsis) in children younger than 5 years of age by 99%,6 with mortality from Hib... 

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

Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004 39 1267-1284. 

Haemophilus influenzae is a bacterial respiratory pathogen that causes a wide spectrum of disease ranging from colonization of the airways to bacterial meningitis. It causes considerable morbidity and mortality, especially in children less than 5 years of age. H. influenzae is either encapsulated or unencapsulated. The encapsulated strains can be further differentiated into six antigenically distinct serotypes, a through f. H. influenzae type b was primarily found in cerebrospinal fluid and blood of children with meningitis, while the unencapsulated strains were found in the upper respiratory tract of adults. Before the introduction of the vaccine, H. influenzae was responsible for 20,000 to 25,000 cases of invasive disease annually and was the most common cause of bacterial meningitis. Since the introduction of the vaccine, invasive disease due to H. influenzae type b has been nearly eliminated. 

Streptococcus pneumoniae is the most common bacterial cause of community-acquired respiratory tract infections. S. pneumoniae causes approximately 3000 cases of meningitis, 50,000 cases of bacteremia, 500,000 cases of pneumonia, and over 1 million cases of otitis media each year. The increasing prevalence of drug-resistant S. pneumoniae has highlighted the need to prevent infection through vaccination. Both licensed pneumococcal vaccines are highly effective in preventing disease from the common S. pneumoniae serotypes that cause human disease. 

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