Treatment for bacterial meningitis symptoms 9dpo,bv treatment when pregnant 2014,get rid of bad smelling hair extensions - Good Point

admin | What Treats Bv | 22.10.2013
Meningitis is an inflammation of the meninges which can be associated with modification of the cerebrospinal fluid which is contained between this membranes. Immediate medical attention is necessary for a prompt diagnosis of meningitis when symptoms are observed. The patient will usually be isolated after being recognized as a potential case of meningitis so as to protect other patients and hospital staff.
A spinal tap is conducted as the patient lies on one side and an anaesthetic is injected locally in the lower back to numb the area.
Initial ApproachThe initial approach to the child with suspected meningitis is the same as that for any seriously ill child. Get full access to all EB Medicine articles published 3 years (or more) ago, including evidence-based, peer-reviewed diagnosis and treatment recommendations. One consequence of traditional antibiotic meningitis treatment is bacterial lysis which may lead to inflammation of the subarachnoid space, resulting in unfavorable neurological outcomes. Glycerol, traditionally used as an osmotic diuretic to reduce raised tissue pressure, has also been shown to be an effective adjuvant therapy for meningitis [5].
There exists a stretch of 25 countries from Senegal to Ethiopia which make up Africa's Meningitis Belt [9]. Many diseases, like cancer or connective tissue diseases, like lupus erythematosus or sarcoidosis may be accompanied by an inflammatory reaction of the meninges. Meningitis can occur due to allergies to medicines, some cancers and autoimmune diseases such as lupus.
And it is these individuals with severe community-acquired bacterial meningitis, that Drs. In these and surrounding countries, over 450 million people are at risk for meningococcal meningitis. Meningitis is a very serious disease and requires urgent diagnosis and initiation of treatment. A group of viruses known as the enteroviruses, causing stomach problems, are responsible for approximately 90% of recorded viral meningitis. In the absence of treatment, the infection will spread to the brain (meningo-encephalitis) and can lead to coma, behavioral disorders, paralysis and convulsions.
Infants and children treated for meningitis should always be monitored after they healed and should be checked to prevent long-term complications such as hearing loss.
For children with significant depression of consciousness level, suctioning and placement of an oropharyngeal or nasopharyngeal airway may be required. Peltola and his team at the Helsinki University Central Hospital in Finland suggest that glycerol's ability to reduce neurolgoical sequelae and prevent deafness may be superior to that of dexamethasone.
Fatality rates soar with little access to antibiotic treatment, as in 1996 and 1997 when a single epidemic caused 250,000 people to become ill and 25,000 to die. Supplemental oxygen by face mask is indicated and should be guided by continuous pulse oximetry. It has since been implemented on a large scale in the Netherlands and is now commonly recommended for use in high-income countries [2].
In decreasing body temperature, hypothermia causes a number of beneficial effects, including "reduced production of reactive oxygen and nitrogen species, inhibition of the neuroexcitatory cascade, a reduction in proinflammatory cytokine level, maintenance of blood-brain barrier integrity, decreased intracranial pressure, and finally decreased neuronal apoptosis" [7].
Endotracheal intubation may be required if the child has insufficient muscle tone to maintain the airway, respiratory failure, profound shock, markedly depressed mental status, or evidence of increased ICP.Intravenous access should be achieved rapidly. In the 2010 study mentioned above, patients were selected based on their low levels of cerebrovascular carbon dioxide reactivity (CO2R) measured by Transcranial Doppler, which Lepur, Kutlesa, and Barsic claim to be the best indicator of potential benefit from hypothermia treatment. La Force and Okwo-Bele state in their Health Affairs article that "when medicine, nursing care, transportation to health services, lost wages, and other direct and indirect costs are tallied, a single case of meningitis may cost a Burkina Faso family about $90 - the equivalent of three to four months' income" [9]. If attempts are unsuccessful, intraosseous access should be established and used as the initial resuscitative route. One Cochrane review associated its use with lower mortality rates and lower rates of hearing loss, a disability which occurs in 22-30% of survivors of pneumoccal meningitis.
The initial fluid for resuscitation should be an isotonic crystalloid, with the rate of administration determined by the physical assessment. On the other hand,  "a recent meta-analysis of individual patient data of five randomized controlled trials" disagrees with these findings, claiming there to be "no effect of adjunctive dexamethasone in pneumococcal meningitis" [3].

In 2007, a meningitis outbreak cost Burkina Faso 5 percent of its health care budget, or $9.43 million. It was determined that without hypothermia treatment, the disease would have been fatal in all 10 cases of illness. To cut healthcare costs and reduce the death toll, effective preventative care is an absolute necessity. If there is insufficient response to aggressive fluid resuscitation, vasoactive agents may be required.Once the child is stabilized, the rate of fluid administration should be reduced, since overhydration may contribute to the development of cerebral edema. Brouwer and his colleagues at the Center of Infection and Immunity Amsterdam (CINIMA) sought to review these findings in a 2006-2009 study of all Dutch patients over 16 years of age with pneumococcal meningitis. As it was, many patients died from complications existing prior to their treatment, including refractory intracranial hypertension and severe residual neurological deficits. Polysaccharide vaccines, which use the outer coatings of meningococcal bacteria to induce an immune response, are currently the standard method of prevention.
However, fluid restriction to one half to two thirds of maintenance, as was often recommended in the past, may also contribute to poor outcomes.21 Patients given full maintenance fluids during treatment for bacterial meningitis were not found to develop any adverse outcomes. The outcomes of these patients were compared with those of a similar cohort from 1998-2002, before dexamethasone treatment was commonplace. But these vaccines are deficient in that they only provide two to three years of protection, do not block person-to-person transmission, and do not work effectively in infants and toddlers. Therefore, those patients who are judged to be normovolemic with normal blood pressure should probably receive full maintenance fluid administration.20The use of hypotonic fluids may contribute to overhydration and the development of edema. Brouwer and his team discovered a decrease in fatality from 30% to 20% which they attributed to dexamethasone use after correcting for changes in disease severity and differences in case mix between the cohorts.
Giving full maintenance levels with hypotonic fluids will result in edema in up to one quarter of children with bacterial meningitis.
However, they also found data indicating dexamethasone to be more effective in patients over 55 years of age, a finding which they cite as a possible cause of the conflicting results in randomized controlled trials which used patients of various ages.
Proteins used in prior research include diptheria and tetanus toxoids, toxins rendered non-toxic and used to stimulate an immune response via antibody production.
This has led to recommendations for the use of isotonic fluids only, but this area remains controversial and needs further study.20Neurologic ComplicationsSeizures may occur during the course of bacterial meningitis. The vaccines produced by these methods, LaForce and Okwo-Bele write, are both "more powerful and capable of providing longer-lasting protection" [9]. The American Academy of Pediatrics Committee on Infectious Diseases advises consideration of dexamethasone for infants at least six weeks of age with pneumococcal meningitis [4]. The Bill and Melinda Gates Foundation established the Meningitis Vaccine Project which partnered the WHO and the Program for Appropriate Technology in Health, or "PATH".
Useful alternatives include rectal administration of diazepam and intramuscular administration of midazolam. The Meningitis Vaccine Project then went on to establish relationships with SynCo Bio Partners in Amsterdam to provide purified capsular sugar from Group A meningococci and the Serum Institute of India to produce the vaccine at a cost of $0.40, a price affordable for the affected African countries and low enough to allow for vaccination of birth cohorts, not simply as a reactive measure to stem epidemic spread. Clinical chemistries must be assessed, since hypoglycemia, hypocalcemia, and hyponatremia may all occur in the setting of bacterial meningitis, leading to seizures. Kim of the Johns Hopkins School of Medicine warns that dexamethasone may make it particularly difficult to monitor clinical responses to antimicrobial treatment including fever curves given that recurrence of fever occurs 28% more often when dexamethasone is administered. In addition, dexmethasone may inhibit vancomysin penetration into the CSF due to dexamethasone's anti-inflammatory properties, causing treatment failure.
On December 6, 2010 almost 3,000 vaccination teams were given 10 days to vaccinate eleven million people in Burkina Faso. The drug has also been shown to cause neuronal injury in the form of hippocampal apoptosis in animals with pneumoccal and E coli meningitis. Similar programs were initiated in Niger and Mali and by the end of 2010, 19.5 million people had been vaccinated in these three countries. Some degree of increased intracranial pressure is probably present in nearly all cases of bacterial meningitis.23 When uncontrolled, increased ICP can lead to seizures and brainstem herniation. Kim recommends long-term cognitive and neuropsychological follow up studies on individuals receiving dexamethasone treatment. In addition, GAVI aid ends after initial vaccination efforts, national and local governments will be responsible for generating continued funds to vaccinate newborns, once the WHO approves the vaccine for use in infants, expected in 2014.

Further increases in ICP can be prevented during intubation by the use of intravenous lidocaine and fentanyl prior to intubation. Use of the conjugate vaccine within the "hyperendemic region" of meningitis belt, with a population of about 240 million, is expected to prevent 142,000 deaths and 284,000 disabilities over the next decade and save $350 million [9]. Recommendations for hyperventilation to maintain the PaCO2 as low as 25 mmHg have been made in the past. LaForce and Okwo-Bele caution that $475 million of additional funding will be required to realize the vaccine's promise "to eliminate epidemic meningitis from sub-Saharan Africa." Over the next few years, researchers will continue to gather data on the life-saving benefits of the vaccine in Burkina Faso, Niger, and Mali.
Lumbar puncture is a stressful and sometimes lengthy procedure, and critically ill children may develop respiratory compromise, shock, seizures, or signs of increased ICP during the procedure.
Initiation of antibiotics prior to obtaining CSF for analysis may prevent recovery of the organism on culture, but a reasonable procedure is to obtain specimens for blood culture and then to proceed with antibiotic administration.
In addition, antibiotics must have good penetration into the CSF, must maintain high concentrations in the CSF, and must have good intrinsic activity in the infected fluid. This recommendation is based on the increased prevalence of Streptococcus pneumoniae resistant to penicillin, cefotaxime, and ceftriaxone, and in addition provides coverage for disease due to Haemophilus influenzae and Neisseria meningitidis. Twenty to 45% of pneumococcal strains worldwide have been reported to be resistant to penicillin, and many of these strains are also resistant to chloramphenicol and third-generation cephalosporins.82 An alternative approach is to hold the administration of vancomycin if CSF is negative for gram-positive diplococci.
For children with significant hypersensitivity reactions to penicillin and cephalosporins, the combination of vancomycin and rifampin can be used.
These two should be used in combination and must never be used alone, since it is difficult to maintain bactericidal CSF concentrations with vancomycin, and resistance to rifampin during therapy may develop.
An advantage of trovafloxacin is that it has excellent antimicrobial activity against beta-lactam–resistant pneumococci, potentially obviating the need to use vancomycin to cover for resistant pneumococci.30 However, the clinical usefulness of trovafloxacin is limited, due to other reports of serious liver toxicity. As more clinical trials are performed, the newer fluoroquinolones may find a role in the therapy of bacterial meningitis, especially when pneumococcus is a potential pathogen. 84In many developing countries, the availability and high cost of third-generation cephalosporins prevent their use.
Eighteen randomized, controlled trials, including 993 patients, mostly conducted in the decade of the 1980s, were included in the review. No statistically significant differences between the groups were found in the risk of death, deafness, treatment failure, neutropenia, or rash.
Cultures of CSF after 10-48 hours of treatment were less likely to be positive in the cephalosporin group, but diarrhea was more likely in the cephalosporin group.
With the emergence of aminoglycoside- resistant, gram-negative enteric bacilli, concerns regarding the renal and auditory side effects of the aminoglycosides, and their low bactericidal activity in CSF, the use of aminoglycosides has been supplanted by cefotaxime, which has a better safety profile and achieves high bactericidal activity in CSF against most coliforms.
Ceftriaxone, although equivalent in activity to cefotaxime, is not recommended in the neonatal period, because of the potential for displacement of bilirubin from albumin binding sites, and due to its profound inhibitory effect on the growth of bacterial flora in the intestinal tract.85 SteroidsRecognition that the immunologically mediated inflammatory response is central to the pathophysiology of bacterial meningitis has stimulated interest in adjunctive treatment with steroids for many years.
Not all studies have found steroids to be beneficial, especially when the cause of meningitis is S pneumoniae.89-91 Studies involving the use of steroids in bacterial meningitis have been the subject of meta-analysis and extensive review.
The data are reasonably conclusive that, when given in close proximity to the first dose of antibiotics, dexamethasone reduces the incidence of hearing loss in patients with meningitis caused by H influenzae type b. Things are not so clear in children with pneumococcal meningitis; there may be a trend toward a decrease in hearing loss. In the clinical setting the obvious problem confronting the physician is that the decision to use or not use steroids must in general be made concomitant with the decision to use or not use antibiotics.
Literature emphasizes prompt treatment in cases of suspected bacterial meningitis, without waiting for confirmatory laboratory tests.
In most cases, this would involve administering dexamethasone and antibiotics immediately after a lumbar puncture, while awaiting the results of the CSF cell count and Gram stain. Since in developed countries H influenzae type b meningitis has virtually disappeared and pneumococcal meningitis in children is becoming increasingly uncommon, and considering that the benefit of treating pneumococcal meningitis in pediatric patients with dexamethasone remains controversial, empiric treatment with dexamethasone in cases of suspected meningitis in pediatric patients in whom the offending organism is unknown remains an evolving question.

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