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Author: admin | 20.09.2015 | Category: Homeopathic Treatment For Tinnitus

Pneumococcal meningitis occurs when the bacteria that have invaded the bloodstream move across to infect the 'meninges' (the membranes that surround and protect the brain and spinal cord). Bacteria can multiply freely in CSF, and there they release poisons, causing inflammation and swelling in the meninges and the brain tissue itself. It is important to note that not everyone gets all the symptoms, and no two cases are exactly the same. Many people, including approximately half of pre-school children[1], carry pneumococcal bacteria in the back of their nose and throat, and constantly pass them around by coughing and sneezing and close contact. Prompt recognition of the symptoms and rapid treatment offer the best chance of a good recovery. Pneumococcal meningitis can be difficult to recognise in the early stages because there is usually no rash, and if the patient already has a milder pneumococcal infection, such as ear ache or bronchitis, this can confuse the diagnosis. Observation of the patient will involve a physical examination and normally blood will be taken for tests.
If the doctor suspects meningitis, antibiotics will be given even if it has not been possible to do an LP, or if the LP results are delayed.
Most patients are treated on a regular hospital ward, but the most severely ill patients will need intensive care treatment. Most people who catch pneumococcal meningitis recover, but it is among the most life-threatening major forms of meningitis[2].
Behavioural and emotional effects are quite common: children can be clingy and have temper tantrums, adults can feel despondent and irritable. Once discharged, patients should be followed up and carefully assessed for signs of damage. The meningitis guideline from NICE3 (the National Institute for Health and Clinical Excellence) specifies that for children recovering from meningitis, doctors should consider their needs for after care, and discuss potential problems with parents before discharge from hospital. The hospital will inform the child’s GP, health visitor or school nurse so that they can watch out for any problems that might arise later on. Many people find that it helps to talk to someone who has been through a similar experience.
Am I at risk of spreading or contracting the disease if I have been in contact with a patient with pneumococcal meningitis? Outbreaks of invasive pneumococcal disease in a nursery or nursing home or other ‘closed’ setting need prompt investigation. With World Meningitis Day on 24th April, I have written about my daughter Holly’s experience of contracting Pneumococcal Meningitis two years ago when she was just twenty six months old. Our quick action and the actions of the doctors on duty that day, saved our daughters life.
Graeme usually picked Holly up in the afternoons and when he got there at 3:30pm she did as she normally did, ran up to him, he picked her up and gave her a big kiss and cuddle and they went home. Graeme then noticed that she went and lay down on the couch so he put telly on for her to watch while she laid there.
When I got home and saw Holly she was flopped over the pillow on the couch and her little body was just like a rag doll. Around 6am Holly sat up and just started crying and holding her hand against her forehead, so I knew she was in pain. I yelled out to Graeme and when he came out I told him what happened and I said that we needed to get Holly to hospital. Graeme said that she was probably really dehydrated and so would be a bit delirious and we should just keep an eye on her and see how she went over the next couple of hours and take her to the doctor when they opened later on around 9am. He was a little quiet then said “okay but we will go to Joondalup Emergency as traffic will be building up and trying to get into PMH and find parking will be a nightmare.” He was unconvinced that we needed to go to hospital, but he knew by my tone that either he took me or I would take her on my own. When we arrived at Joondalup Hospital emergency we hadn’t even got to the reception desk and Holly started vomiting again. We had to syringe 5mls of hydrolyte into her mouth every 10 minutes and record the times and amounts. The nurses said that they also needed to get a urine sample to see if there was a urinary tract infection so they put one of those silver “pie tins” (the ones they make custard tarts in at the bakery) into her nappy to try and catch the wee.
So we then started on the second cup of hydrolyte and waiting on a wee, which just didn’t want to come. The doctor came back and said that he would organize some blood tests and called the paediatrician who was on the ward to come and check Holly out. By then it was around 12pm and as we were walking along the long corridor from emergency to the main hospital I was walking on one side of the bed talking with the paediatrician and Graeme was walking on the other side of the bed. Once at the X-rays the nurse said that we had to take the silver tray out of Holly’s nappy which was still dry.
The nurse wheeled us back to the emergency department and when we walked in we were shocked to see 5 other doctors waiting there with the paediatrician.
I just couldn’t bare it and I remember just yelling at them to stop because they were hurting her. In that moment there was a flurry of activity and I don’t know how I got through that moment, but I was totally aware of everything being said and I knew that in that moment, Holly was in a bad way. By then, Graeme was extremely distressed and I told him that he needed to go outside, that I would stay with Holly and that this was what they needed to do to find out what was wrong with her. While they were preparing for the lumbar puncture, they then took blood tests and also decided to get Holly’s urine through a catheter.
Holly hardly moved through the whole procedure and just let out a little whimper and a cry as the needle was inserted into her back, and I felt the hot tears falling down my cheeks as her panicked eyes looked at me like a scared, trapped little animal. By this time it was roughly around 2:30pm and I hadn’t had anything to eat apart form a muffin that Graeme had bought me at the cafe earlier that morning for breakfast. The testing side of things was over probably quicker than what I thought at the time, and by 3pm we were taken through to an isolated room on the paediatric ward to wait. At around 5pm two of the doctors came back and told us that Holly had Pneumococcal Meningitis and that she was a very sick little girl.
They explained that the microbiologist was growing the bacteria and then would treat each culture with antibiotics to find out which one would kill it.
They told us that this was a critical time and that we needed to prepare ourselves for the worst as she was a very sick little girl.
She had swelling and inflammation on the brain so they said they would continue to give her 4 high doses of steroids per day to help.
It was just heartbreaking seeing her in so much pain when she moved and they were giving her as much pain killers as they could.
We were very well looked after by all the nursing staff and specialists and her two paediatricians spent a lot of time with Holly.
For 5 days we just watched her lifeless, unresponsive body lying in bed, hooked up to all sorts of machines and drips praying for our precious little girl to get better after a gut-wrenching morning of Holly screaming in pain (which saw me really break down in a blubbering mess for the first time after having to hold it all together for so long).
It wasn’t until day 6 that things really improved in the afternoon quite suddenly and then continued to do so. She became a little bit more responsive and the doctor then came to tell us that her inflammation counter had come down to 19 (the normal level is 10) so they now knew that she had turned the corner. On Day 8 I was just bursting with happiness as Holly was wide awake, was eating, giggling and we could see the sparks shining in her beautiful blue eyes.
The doctors were really pleased with her progress but said that the microbiologist had said that because of the severity of her condition there were no short cuts – that we were stuck there until they were sure that the bacteria had been fully treated. By Day 11 the doctors said that the next few days would be more about getting her mobile as she was still not able to walk unassisted (although we had seen an improvement), but the doctor was confident that she just needed to get her strength back in her legs so we were doing push ups with her legs – (her pushing her feet against our hands) to try and strengthen the muscles. On day 15 the specialist paediatrician came and gave us the good news that Holly’s blood tests and cultures had come back all clear and told us that Holly was being released the next day and I started to cry – big, happy sobs of joy.
The next day Holly had her final treatment of penicillin at 6am and we were released at 1pm to go home. What a perfect end to our terrible ordeal as we drove home we were guided and protected by yet another rainbow and as we pulled into the driveway of our home, there shone another rainbow right over the top of our house.
We recently had Holly’s final check-ups at Princess Margaret Hospital and she has been cleared of any side effects such as hearing loss or brain damage, which we are very thankful for. The 7-valent (strain) pneumococcal conjugate vaccine Prevnar (PCV7) for all infants and children below five years of age. The 23-valent pneumococcal polysaccharide vaccine (Pneumovax, Pnu-Immune) or PPSV23 for some adults and older children. The recommended schedule of immunization for Prevnar (PCV7) is 4 doses, given at 2, 4, 6, and 12 - 15 months of age.

Anyone older than two years of age with heart disease, lung disease (including asthma), kidney disease or on dialysis; alcoholics, people with diabetes, cirrhosis, or those with cochlear implants or leaks of cerebrospinal fluid. All people over 65 years old; some experts believe that all adults aged 50 - 64 should also be vaccinated.
Patients with autoimmune diseases, such as rheumatoid arthritis and lupus, although protection may not be as strong for these patients. Older people who have had transplant operations or those with kidney disease may require a revaccination after 6 years.
Alaska Natives or American Indians over age 50 who live in areas with high rates of invasive pneumococcal disease. The safety of the pneumococcal vaccine hasn't been proven during the first trimester of pregnancy; however, there have been no adverse effects reported.
Protection lasts for more than 6 years in most people, although the protective value may be lost at a faster rate in elderly people than in younger adults. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
Introduction          Bacterial meningitis is a leading cause of death from infectious disease worldwide. In this article, we present a case of bacterial meningitis complicated by an unusual number of neurological complications that occurred in spite of a timely diagnosis, adequate treatment, and intensive neurological monitoring. A 45-year-old man with rheumatoid arthritis and chronic hepatitis C infection presented with a two day history of low grade fever and confusion and required intubation.
A follow up head MRI showed new areas of ischemic infarction at right medial pons, left capsulothalamic area, right-sided splenium of corpus callosum, and mesial temporal areas bilaterally. Over the next six weeks his condition improved significantly, and he was discharged to an inpatient rehabilitation facility with a modified Rankin Scale of 4. The inflammatory process in the subarachnoid space may have a primary role in causing vasculitis, vasospasm, and localized or diffuse thrombosis of the vessels (Figure 2).7,19,20 Three phases of meningitis-induced cerebral angiopathy are recognized. The role of antithrombotic or thrombolysis in the treatment of arterial ischemia associated with bacterial meningitis is unclear.
Venous infarction involves thrombosis of either dural venous sinuses, deep veins, or cortical veins.6,10 The incidence of venous infarction is far less than arterial infarction. Due to the rarity of venous thrombosis in bacterial meningitis, prospective trials on the role of anticoagulants in this condition have not been performed. Intracranial hemorrhage (ICH) is less common than ischemic stroke and occurs in 2-9 % of all bacterial meningitis patients, approximately 14-28% of all stroke events.4,10,23 However, in a series of patients with S. After profound hearing loss is established, cochlear implantation can improve hearing thresholds. The spectrum of mental status changes seen in these cases ranges from irritability to coma. The management of increased ICP includes appropriate fluid management, osmotic therapy, hypertonic saline, hyperventilation with the PaCO2 25-35 mmHg, head elevation, and CSF drainage. Seizures can complicate bacterial meningitis as a result of the inflammatory exudate, bacterial toxins, and changes within the cortex. Brain abscess and focal cerebritis can be either the cause of or a complication of bacterial meningitis. Treatment requires broad spectrum antibiotics, such as third or fourth generation cephalosporins plus metronidazole, which also cover anaerobic bacteria, and neurosurgical consultation. Bacterial meningitis can result in collection of extra-axial fluid that may be sterile (subdural effusion) or infected (subdural empyema).
Ventriculitis and intraventricular empyema were not considered a common complication of bacterial meningitis. Hypothalamic-pituitary dysfunction is not a common complication of bacterial CNS infection. Cognitive and neuropsychiatric impairments following bacterial meningitis can be the result of direct damage to cerebral structures by the infection or can be secondary to complications from the infection.
Bacterial meningitis is a central nervous system infection which causes high mortality rates in adults. Flores-Cordero JM, Amaya-Villar R, Rincon-Ferrari MD, Leal-Noval SR, Garnacho-Montero J, Llanos-Rodriguez AC, et al.
Classic stigmata of congenital syphilis SNHL, interstitial keratitis, Hutchinson teeth (notched incisors), mulberry molars, Clutton joints (bilateral painless knee effusions), nasal septal perforation & saddle deformity& frontal bossing.
The meninges are filled with a liquid called cerebrospinal fluid (CSF), which is there to bathe the brain and cushion it against physical damage.
Four to six weeks after discharge, the child should be assessed by a paediatrician and referred for follow up care if after effects are identified. Teachers should be informed when a child has had meningitis so that educational support can be arranged if necessary.
Bacterial meningitis and meningococcal septicaemia in children: draft full guideline for consultation.
Interim UK guidelines for the public health management of clusters of serious pneumococcal disease in closed settings. Invasive Pneumococcal Disease in England and Wales after 7-valent conjugate vaccine potential impact of 10 and13-valent vaccines. Rushing around getting ready for work, getting our 26 month old Holly up, fed and dressed to go to daycare.
She couldn’t lie on her back or be lifted as that pulled on the nerves along the spinal cord and meninges which made her scream and she couldn’t wear any clothing or have the blanket on as that also caused her pain. The doctor said it was still a long road ahead with treatment but she had taken a good step forward on the road to recovery. She was sitting up, eating, talking, laughing and being a cheeky monkey and even giving us some attitude but we loved every minute of it. Dapika Wagh (Paediatrician) who met with Holly in the Emergency Department and was instrumental in saving her life! Holly just celebrated her 4th birthday as Princess Rapunzel, and we look at her every day and feel so blessed.
Pneumococcal PneumoniaThe pneumococcal bacterium (also called Streptococcus pneumoniae or S. The vaccine has reduced hospital admissions for pneumonia in children under age 2 by up to 40 %.
Adults over 65 who received a pneumococcal polysaccharide vaccine before they were 65 should receive a second dose after they turn 65.
When the vaccine is administered to pregnant women, it may actually protect their infants against certain respiratory infections. Anyone at risk for serious pneumonia should be revaccinated 6 years after the first dose, including those who were vaccinated before age 65.
Children are more likely to have fever within 48 hours if they receive other vaccines at the same time, and also after the second dose. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions.
The neurological complications secondary to bacterial meningitis contribute to the high mortality rate and to disability among the survivors.
Despite the availability of increasingly effective antibiotics and intensive neurological care, the overall mortality remains high, with 17-34% of the survivors having unfavorable outcomes.1,2,3 Neurological complications associated with bacterial meningitis are major contributing factors to this high disability and mortality among survivors. We also review various neurological complications of bacterial meningitis in adults with emphasis on the incidence, clinical characteristics, pathophysiology, and treatment. A repeat MRI showed hydrocephalus, obstruction of the cerebral aqueduct, and intraventricular empyema of the occipital horns of the lateral ventricles.
The initial phase is the presence of vasospasm triggered by the surrounding purulent material in the subarachnoid space and Virchow Robin spaces. Delayed vasculopathy is rare, and there are no systematic studies on how to best treat this complication. Based on limited information, heparin should be started cautiously after the patient develops clinical symptoms associated with venous infarction.
In a double-blind, randomized controlled trial, oral glycerol therapy used to decrease intracranial pressure increased mortality and neurological disability in adult patients with bacterial meningitis (83%).36 A retrospective study suggested that lumbar drainage of CSF targeting ICP of 37 At this point, these various measures to decrease ICP are best used based on clinical indication rather than as a routine treatment. Increase in size of the third and lateral ventricles with normal size of the fourth ventricle  (a,b; day 14 after admission) comparing with the MRI on day 2 after admission (c) suggesting obstructive hydrocephalus at the level of cerebral aqueduct.
If patients have a history of trauma or recent neurosurgical procedures, vancomycin should be added to an empirical regimen.

Posterior craniotomy for subdural empyema drainage and extraventricular drainage for hydrocephalus.
The majority of the cases occur in children, and the presenting symptoms are quadriparesis, paraplegia, bowel and bladder dysfunction, and a sensory level loss.51 In cases with cervicomedullary involvement, respiratory arrest can happen abruptly or following lumbar puncture. Tonsillar herniation secondary to increased ICP may compress the brainstem at the cervicomedullary junction resulting in compressive myelopathy.52,53 Spinal epidural abscess is a rare complication of bacterial meningitis that can compress the spinal cord. Meningococcal, Neisserial and Streptococcal meningitis have been reported to cause myelitis in adults.55,56 Inflammation in the subarachnoid space can spread from the intracranial space to the spinal canal and cause polyradiculitis. The direct infection at the leptomeninges can cause indirect complications to other nervous system structures, such as cerebral and spinal vessels, ventricles, cranial nerves, brain parenchyma, spinal cord, spinal nerve roots, hypothalamus, and pituitary.
Acute community-acquired bacterial meningitis in adults admitted to the intensive care unit: clinical manifestations, management and prognostic factors.
Relationship between short-term outcome and occurrence of cerebral artery stenosis in survivors of bacterial meningitis.
Delayed recurrent ischemic stroke after initial good recovery from pneumococcal meningitis. Pneumococcal meningitis in adults: Spectrum of complications and prognostic factors in a series of 87 cases. Cerebral arteritis with extremely late onset secondary to bacterial meningitis-case report.
The use of clinical scales in depicting cerebrovascular complications in bacterial meningitis. Clinical relevance and frequency of transient stenoses of the middle and anterior cerebral arteries in bacterial meningitis. Three phases of cerebral arteriopathy in meningitis: vasospasm and vasodilatation followed by organic stenosis. Diffuse cerebral intravascular coagulation and cerebral infarction in pneumococcal meningitis. Procoagulant and fibrinolytic activity in cerebrospinal fluid from adults with bacterial meningitis. Intracerebral hemorrhages in adults with community associated bacterial meningitis in adults: should we reconsider anticoagulant therapy? Major cerebral events in Staphylococcus aureus infective endocarditis: is anticoagulant therapy safe?
Hearing loss in adults surviving pneumococcal meningitis is associated with otitis and pneumococcal serotype. Epidemiology, clinical manifestations, and outcomes of Streptococcus suis infection in humans.
Streptococcus equi subspecies zooepidemicus meningitis--a case report and review of the literature.
Histopathologic correlation of spiral ganglion cell count and new bone formation in the cochlea following meningogenic labyrinthitis and deafness. Cochlear ossification in patients with profound hearing loss following bacterial meningitis.
Magnetic resonance imaging in the evaluation of patients with sensorineural hearing loss caused by meningitis: implications for cochlear implantation. Glycerol adjuvant therapy in adults with bacterial meningitis in a high HIV seroprevalence setting in Malawi: a double-blind, randomized controlled trial. Hydrocephalus is a rare outcome in community-acquired bacterial meningitis in adults: a retrospective analysis. Community-acquired bacterial meningitis: Risk stratification for adverse clinical outcome and effect of antibiotic timing. Spectrum and Prevalence of Pathological Intracranial Magnetic Resonance Imaging Findings in Acute Bacterial Meningitis.
Hypothalamic-pituitary insufficiency following infectious diseases of the central nervous system. Quadriplegia complicating Escherichia coli meningitis in a newborn infant?: case report and review of 22 cases of spinal cord dysfunction in patients with acute bacterial meningitis.
Skeletal findings osteochondritis& periostitis of long bones SNHL, interstitial keratitis, Hutchinson teeth (notched incisors), mulberry molars, Clutton joints (bilateral painless knee effusions), nasal septal perforation & saddle deformity& frontal bossing.
Anatomical relationships between manubrium, plica mallearis, incus and footplate are shown. Sensorineural hearing loss, moderate, bilateral, sequel of pneumococcal meningitisHistopathologic:1.
The Meningitis Centre was a big support to our family and two years on are still a big part of our lives with us doing all we can to raise awareness of this deadly disease. Pneumococci are typically associated with pneumonia, but may cause infection in other organs, such as the brain (pneumococcal meningitis) and bloodstream (pneumococcal septicemia).
The vaccine has even lowered hospital admissions among adults aged 18 - 39, likely because they are parents of young children who might otherwise have been exposed to the disease. Fortunately, severe reactions are very rare, even if a person is mistakenly revaccinated before the effects of the first vaccination have worn off.
This is followed by myonecrosis of the vessel wall that subsequently results in vasodilatation.
Early implantation can avoid dealing with labyrinthitis ossificans (LO) and improves hearing performances.
Subarachnoid infection can cause vasculitis or vasospasm of the arteries of the spinal cord resulting in spinal cord infarction. The diagnosis of epidural abscess requires radiological confirmation with MRI with gadolinium or CT myelogram. Patients can have asymmetrically flaccid weakness of proximal and distal muscle groups of the extremities with alteration of sensation and decreased deep tendon reflexes. The onset of these complications can occur from disease presentation to several months after the treatment. Loss of spiral ganglion cells, presumed secondary to cochlear neuritis from bacterial meningitis, bilateral.2. He still says today that he is thankful that I was so strong in my conviction to take her to hospital when we did. This bacterium is dangerous for people with serious underlying chronic medical conditions and illnesses, and is the leading cause of ear infections and sinusitis in children.
Recurrent ear infections in children have fallen by 28% since the introduction of the vaccine. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Inflammation and increased pressure in the subarachnoid space result in cranial neuropathy. Brain edema with herniation can cause compressive vasculopathy by compressing the spinal artery around the foramen magnum and cause infarction of the craniocervical cord.
Awareness of these complications should lead to the early detection and appropriate treatment which can improve the recovery outcomes. In addition the patient is often put on an intravenous drip to give fluids, which stops them getting dehydrated and ensures the correct balance of sugars and other components in the blood. Seizures occur in either the acute or delayed phase after the infection and require early detection and treatment. In ventriculitis, imaging may show irregular debris in ventricles, hydrocephalus, and ependymal contrast enhancement.44,45 The role of intrathecal and intraventricular antibiotic is not well studied in bacterial meningitis in non-neurosurgical cases. Any duplication or distribution of the information contained herein is strictly prohibited.
Involvement of other intracranial structures, including the subdural space, brain parenchyma, and ventricles, increases morbidity and mortality in survivors.
Infection can also spread to the spinal canal causing spinal cord abscess, epidural abscess, polyradiculitis, and spinal cord infarction secondary to vasculitis of the spinal artery. Having the diagnosis confirmed in this way can be helpful after recovery, for example when seeking long-term medical advice and follow-up care.
Hypothalamic-pituitary dysfunction is also an uncommon complication after bacterial meningitis.

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