Meningitis prevention

SSIs are defined and reported according to Centers for Disease Control and Prevention (CDC) criteria.5 SSIs are classified as either incisional or organ/space. Incisional SSIs are further divided into superficial incisional SSI (skin or subcutaneous tissue) and deep incisional SSI (deeper soft tissues of the incision). Organ/space SSIs involve any anatomic site other than the incised areas. For example, a patient who develops meningitis after removal of a brain tumor could be classified as having an organ/space SSI. An infection is considered an SSI if any of the above criteria is met and the infection occurs within 30 days of the operation. If a prosthetic is implanted, the timeline extends out to 1 year. 

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. 

Triclosan (10.279) kills a wide range of bacteria that cause food poisoning, dysentery, cholera, pneumonia, tetanus, meningitis, tuberculosis and sore throats. It also prevents the development of bacterially related odours and kills the yeasts responsible for Candida ulcers... 

Patients with AIDS and cryptococcal meningitis or recurrent oropharyngeal candidiasis usually require maintenance therapy to prevent relapse... 

The existence of the blood-brain barrier is an important consideration in the chemotherapy of neoplastic diseases of the brain or meninges. Poor drug penetration into the CNS has been a major cause of treatment failure in acute lymphocytic leukemia in children. Treatment programs for this disease now routinely employ craniospinal irradiation and intrathecally administered methotrexate as prophylactic measures for the prevention of relapses. The testes also are organs in which inadequate antitumor drug distribution can be a cause of relapse of an otherwise responsive tumor. 

Other routes of administration can be employed in certain situations. Methotrexate and cytarabine are given intrathecally or intraventricularly to prevent relapses in the meninges in acute lymphocytic leukemia and to treat carcinomatous meningitis. Thiotepa and bleomycin have been administered by intravesical instillation to treat early bladder cancers. Fluorouracil can be applied topically for certain skin cancers. 

Example 12.1 Fluconazole compared to amphotericin B in preventing relapse in cryptococcal meningitis... 

The aim of this study reported by Powderly et al. (1992) was to establish the non-inferiority of a test treatment, fluconazole, compared to an established treatment, amphotericin B, in preventing the relapse of cryptococcal meningitis in HIV-infected patients. It was thought that fluconazole would be less effective than amphotericin B, but would offer other advantages in terms of reduced toxicity and ease of administration fluconazole was an oral treatment while amphotericin B was given intravenously. The non-inferiority margin was set at —15 per cent in terms of relapse rates. 

This example has been presented previously in this chapter. The initial objective was to demonstrate the non-inferiority of fluconazole compared to amphotericin B in the prevention of cryptococcal meningitis in patients with AIDS. The non-inferiority margin was set at —15 per cent for the difference in the relapse rates. 

It is indicated in mucosal candidiasis, systemic candidiasis, crypttococcosis, prophylaxis of fungal infections following cytotoxic chemotherapy or radiotherapy maintenance to prevent relapse of cryptococcal meningitis in patients with AIDS sporotrichosis, histoplasmosis and vaginal candidiasis. 

Firefighters, in the normal course of their duties, may find themselves exposed to infectious/communicable diseases including hepatitis, meningitis, HIV, and tuberculosis. Potentially infectious persons may have no specific signs, symptoms, or complaints, and they may have no awareness of their potential to transmit their disease to others. Therefore, firefighters must take preventative and protective measures with each and every person to whom they respond to prevent or reduce the risk of direct exposure to communicable diseases. 

Pinkel D, Woo S. Prevention and treatment of meningeal leukemia in children. Blood 1994 84 355-366. 

Acute lymphoid leukemia During the initial phase, vincristine and prednisone are used. Methotrexate and mercaptopurine are used for maintenance therapy. In addition, methotrexate is given intrathecally, with or without radiotherapy, to prevent meningeal leukemia. 

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