BACTERIAL MENINGITIS

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BACTERIAL MENINGITIS

• ALYSIA GIANI
• CHEM 4205

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What is it?

• Bacterial meningitis is a serious infection of
  the spinal cord and the fluid that surrounds the
  brain.

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What causes it?

• There are 3 main bacterial species that
  contribute to this disease
• Haemophilus influenzae type b
• Neisseria meningitidis (Meningococcal)
• Streptococcus pneumoniae (Pneumococcal)

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How is it diagnosed?

• When patient presents symptoms of Meningitis, a
  sample of CSF is acquired from a spinal tap,
  which is then analyzed for bacterial presence.

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Bacterial Meningitis Facts

• There are 1.2 million cases annually worldwide,
  approximately 135,000 deaths.
• Bacterial meningitis is 1 of the top 10
  infectious causes of death worldwide, according
  to the CDC.
• Half of survivors suffer neurological damage,
  and/or other permanent side effects.

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Haemophilus influenzae type b

• Affects about 13/1,000,000 children (2005), 3-4
  are fatal.
• Infection has decreased drastically
• From 4-10/10,000 since routine use of the Hib
  vaccine (since 1990)
• A major cause of lower respiratory tract
  infections in developing countries

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Neisseria meningitidis

• 5-50/1,000,000 people are infected worldwide
  every year.
• Most Deadly form of Bacterial Meningitis
• Humans are only host of bacteria, it is present
  in the nasopharynx
• 11-19 of people who have recovered suffer from
  permanent hearing loss, mental retardation, or
  other serious health problems.
• 10-14 of cases are fatal

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Streptococcus pneumoniae

• Infection rate in the U.S. has now decreased to
  13/ 100,000, due to vaccination. (2002)
• Kills 14 of hospitalized adults with invasive
  disease. In some recovery cases, the patients
  sustain learning disabilities, and/or other
  impairments typical of meningitis, but less so
  than with other forms of meningitis.
• Overuse of antibiotics contributes to emerging
  drug resistance in this strain.

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Symptoms

• Most Common
• Fever
• Headache
• Stiff Neck
• Nausea vomiting
• Sensitivity to light
• Confusion
• Sleepiness
• In Infants
• Inactivity
• Irritability
• Vomiting
• Poor feeding

• Advanced Disease
• Bruises develop under skin spread rapidly
• Advanced Disease can lead to
• Brain Damage
• Coma
• Death

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Symptoms
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Risk Factors

• Infants and young children
• Elderly
• College freshmen who live in dorms
• Patients without spleens
• People exposed to active or passive tobacco
  smoke.
• African Americans, American Indians, Alaskan
  Natives.
• People with underlying medical conditions (Ex.
  HIV Sickle-cell disease)

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Treatment Medication

• Antibiotics
• Broad-Spectrum cephalosporin
• Ampicillin Broad-Spectrum cephalosporin
• Vancomycin plus ceftazidime
• All antibiotics administered intravenously
• H. Influenzae N. meningitidis- 7 days
• S. pneumoniae- 10-14 days

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Medications Continued

• N. meningitidis
• Chloramphenicol resistance
• Used in resource-limited settings (Sub-Saharan
  Africa). Stopped using in West because of very
  rare, yet serious side effect Aplastic anemia.
• Very cheap synthesis
• Derived from bacteria- disrupts translation
  process by preventing peptide bond formation
• There are no non-pharmaceutical treatments for
  bacterial meningitis.

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Vaccines H. influenzae type b

• Bacteria contains polysaccharide capsule
• Questions have arisen on the length of time the
  vaccine is effective.
• Cost of vaccine 7.00 (typical vaccines are
  1.00)
• The cost of this vaccine has limited their use in
  developing countries, even though this bacteria
  is a major cause of death.

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Vaccine N. Meningitidis

• Meningococcal conjugate vaccine (MCV4)
• Price 82 intramuscularly as single dose.
• Effective in all age groups
• Preferred over MPSV4
• Meningococcal Polysaccharide Vaccine (MPSV4)
• Price 86.10 subcutaneously as single dose.
• Re-administered every 3-5 years
• Age groups Not under 2 and 11-12 years old

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Vaccine S. Pneumoniae

• Bacteria contains polysaccharide capsule
• ß lactam resistance is common, resistance to
  multiple classes of drugs are increasing.
• 23-valent polysaccharide vaccine (Prevnar)- NEW
• 80.00 per dose
• Underused
• Supplies are inadequate
• New urinary antigen test may be useful in adults
  to identify if S. pneumoniae is present.

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Research for Paper

• Mechanism that causes the side effects and
  symptoms of bacterial meningitis and their role
  in cytokine response.
• Mechanism of antibiotics to specific bacteria and
  mechanisms of resistance by bacteria to
  antibiotics
• Interview Peter Hicks, Epidemiologist at the CDC.