Life-threatening Meningitis Research Articles

The pneumococcal protein conjugate vaccines

A bedrock principle of pediatric medicine is that we do better to render children resistant to infection than to treat disease. The importance of vaccination is greatest when infection cannot be promptly or reliably identified, disease is prevalent and severe, and treatment is ineffective. Streptococcus pneumoniae is an extremely successful pathogen that kills more than 1 million children each year worldwide.1 This organism is responsible for numerous clinical syndromes and is a major cause of otitis media and life-threatening pneumonia, bacteremia, and meningitis.

Prenatal diagnosis of a Currarino triad

Prenatal diagnosis of the Currarino triad by means of obstetrical ultrasonography is described. Three related cases are presented. A literature review regarding the therapeutic, ultrasound-guided approach are discussed. The Currarino triad is a genetically transmitted syndrome consisting of an anorectal malformation, a sacral boney defect and a presacral mass. Prenatal diagnosis aids the early recognition and surgical management of persistent spinal-rectal fistulas, thus potentially avoiding life-threatening bacterial meningitis.

Bacterial meningitis in infants and children: a review.

Emergency physicians are often required to evaluate febrile infants and children with no obvious source of infection. Most have uncomplicated viral illnesses. It is imperative, however, to identify the child with potentially life-threatening bacterial meningitis. The clinical presentation of meningitis is variable and depends on many factors. These variables are discussed as well as the indications for lumbar puncture and guidelines for laboratory evaluation. Recommendations for antibiotic selection and dosages are provided. The clinical trials regarding the use of dexamethasone are also reviewed.

Unusual Presentation of Meningococcal Infection

Infection with Neisseria meningitidis usually results in life-threatening septicemia and/or meningitis. Occasionally, howerver, infection may be mild or localized. Awareness of this fact is essential to avoid delays in diagnosis, management and prophylaxis. Three cases are presented with localized or mild presentation. A 40-day-old male with purulent conjunctivitis, a six-year-old male with peritonitis and a nine-year-old with C5 deficiency with Neisseria meningitidis bacteremia who presented with a one day history of fever, but was not toxic, and was treated with oral antibiotics. However, he returned with a clinical picture of systemic infection. Based on these three cases, we suggest an aggressive diagnostic, therapeutic and prophylactic approach whenever meningococcal infection is strongly suspected.

Prevention of airborne fungal infection in immunocompromised patients

Immunocompromised patients are at serious risk of developing opportunistic infections, especially during periods of intensive hospital treatment for their underlying disease. In the case of patients suffering from haematological malignancy, infection is an almost inevitable consequence of remission-induction chemotherapy or bone marrow transplantation. A wide range of bacterial, viral, fungal and protozoa1 pathogens are implicated. Many of these usually arise from endogenous sources within the patient. Notable examples are latent herpes viruses and enterobacteriaceae. But, in addition, there are a number of important exogenously acquired infections (Table I), some of which have been implicated in outbreaks of infection on leukaemia units. While traditionally bacterial sepsis has been the most serious consequence of leukaemia therapy (Young, 1981) it is noticeable that currently fewer patients develop life-threatening septicaemias, pneumonia or meningitis. This may be explained by the dramatic improvement that has been seen in the supportive care of these patients, but also because more potent antibiotics are available for treatment. Furthermore, preventive measures have primarily been directed towards protection against bacterial infection and have been shown to be effective in carefully conducted comparative trials (Hann & Prentice, 1984; Rogers, 1985).

791 THE INCIDENCE OF CHLORAMPHENICOL-INDUCED NEUTROPENIA John P. Blank

The emergence of resistant organisms has increased the use of chloramphenicol. The hematologic toxicity of chloramphenicol is of two types: idiopathic and dose-related. In the dose-related toxicity, recent reviews emphasized the red cell changes and commented that neutropenia is rare. In order to assess clinically significant marrow toxicity, we reviewed charts of 56 patients treated with chloramphenicol between August 1975 and August 1980. These patients were treated for life-threatening infections, either meningitis or epiglotitis, believed to be caused by Hemophilus influenzae. All patients were treated with chloramphenicol at a dose of 100 mg/kg/d. There were 17 patients with epiglotitis, the mean age being 45 months (range 12-96 mos.). One patient in this group developed neutropenia (ANC<1500/mm3). Thirty-nine patients had meningitis, the mean age being 18.9 months (range 4-84 mos.). Of the 39, eight developed neutropenia. Of patients treated with chloramphenicol, 14 were less than 12 months of age and 42 were older than 12 months of age. The mean onset of neutropenia was 9 days into therapy. The incidence of neutropenia was 2/42 for those patients greater than one year old and 7/14 for those less than one year of age. We believe our data indicates that neutropenia is a clinically significant side effect, particularly in patients less than 12 months of age. Such findings emphasize the need to measure chloramphenicol levels in the child less than one year old.