Meningococcal meningitis

QHgNiOiS. Colourless crystals, m.p. 164 5-166-5" C. It is usually prepared by treating p-acetamidobenzenesulphonyl chloride with ammonia, and hydrolysing the acetyl derivative to the base. Used for the treatment of streptococcal infections, gonorrhoea, meningococcal meningitis and urinary infections. Liable to cause unpleasant reactions, such as nausea, cyanosis and skin rashes. 

From a clinical point of view, the sulphonamides are extremely useful for the treatment of uncomplicated urinary tract infection caused by E. coli in domiciliary practice. They have also been employed in treating meningococcal meningitis (a current... 

Penicillin is the dmg of choice for the treatment of group B streptococcal, meningococcal and pneumococcal infections but, as discussed earlier, CSF concentrations of penicillin are significantly influenced by the intensity of the inflammatoiy response. To achieve therapeutic concentrations within the CSF, high dosages are required, and in the case of pneumococcal meningitis should be continued for 10-14 days. 

Skin lesions (diffuse petechial rash observed in 50% of patients with meningococcal meningitis)... 

Determine whether prophylaxis is indicated for close contacts of patients with CNS infections. Close contacts should be located for patients with suspected meningococcal or Hib meningitis. After consultation with the local health department, antibiotic prophylaxis should be provided promptly to these individuals to avoid secondary disease. 

Purpuric and petechial skin lesions typically indicate meningococcal involvement, although the lesions may be present with H. influenzae meningitis. Rashes rarely occur with pneumococcal meningitis. 

H. influenza meningitis and meningococcal meningitis both can cause involvement of the joints during the illness. 

Approximately 50% of patients with meningococcal meningitis have purpuric lesions, petechiae, or both. Patients may have an obvious or subclini-cal picture of disseminated intravascular coagulation, which may progress to infarction of the adrenal glands and renal cortex and cause widespread thrombosis. 

A further type of vaccine included in the subunit category is the capsular polysaccharide vaccines, for example, those against Haemophilus influenzae and meningococcal meningitis. In this case an extract of the polysaccharide outer capsule of the bacterium is used as a vaccine and is sometimes conjugated to protein to... 

Meningococcal vaccines Purified surface polysaccharide antigens of one or more strains of Neisseria meningitidis Active immunization against Neisseria meningitidis (can cause meningitis and septicaemia)... 

Nathan N, Borel T, Djibo A, Evans D, Djibo S, Corty JE et al. Ceftriaxone as effective as long-acting chloramphenicol in short-course heatment of meningococcal meningitis during epidemics a randomised noninferiority study. Lancet 2005 366(9482) 308-13. 

Epidemics of bacterial meningitis have been described in crowded places such as military institutions and schools. In some countries in Africa ( meningococcal belt ) the incidence of seasonal meningococcal meningitis is so high that meningococcal vaccination is advised. 

Salmonella and Haemophilus infections and meningococcal and pneumococcal meningitis. 

Streptococcal infections Pharyngitis, rheumatic fever, otitis media and even for subacute bacterial endocarditis. Staphylococcal infections Penicillinase resistant penicillin can be used. Meningococcal infections Meningitis other infections caused by meningococci. 

Because of potential toxicity, bacterial resistance, and the availability of many other effective alternatives, chloramphenicol is rarely used. It may be considered for treatment of serious rickettsial infections such as typhus and Rocky Mountain spotted fever. It is an alternative to a B-lactam antibiotic for treatment of meningococcal meningitis occurring in patients who have major hypersensitivity reactions to penicillin or bacterial meningitis caused by penicillin-resistant strains of pneumococci. The dosage is 50-100 mg/kg/d in four divided doses. 

Rifampin is used in a variety of other clinical situations. An oral dosage of 600 mg twice daily for 2 days can eliminate meningococcal carriage. Rifampin, 20 mg/kg/d for 4 days, is used as prophylaxis in contacts of children with Haemophilus influenzae type b disease. Rifampin combined with a second agent is used to eradicate staphylococcal carriage. Rifampin combination therapy is also indicated for treatment of serious staphylococcal infections such as osteomyelitis and prosthetic valve endocarditis. Rifampin has been recommended also for use in combination with ceftriaxone or vancomycin in treatment of meningitis caused by highly penicillin-resistant strains of pneumococci. 

Meningococcal disease (purulent meningitis) commonly occurs in children, but is also observed in adults. Without antibiotic treatment, the mortality rate is high (85%), and, even with this treatment, cured patients can suffer serious and permanent neurological deficiencies.165 These facts, together with the emergence of antibiotic-resistant strains,8 prompted the rapid development of a commercial vaccine. This vaccine was developed almost simultaneously with the pneumococcal vaccine. 

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