Bacterial meningitis: recent advances in pathophysiology and treatment

Article Abstract:

Bacterial meningitis, the infection or inflammation of the membranes covering the spinal cord and brain, causes considerable sickness and death, even though antibiotics capable of destroying the bacteria are widely available. Haemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae are the bacteria which most commonly cause death from meningitis. The mortality caused by these bacteria has not changed in 30 years. Recent advances in the understanding of these organisms and how they cause disease have opened up new developments in the treatment of meningitis. Studies published from the years 1975 to 1989 were reviewed. Penicillin and ampicillin were still the drugs most often chosen to treat meningitis caused by Streptococcus pneumoniae, Neisseria meningitis and certain types of Haemophilus influenzae. Meningitis-causing bacteria that have the characteristic of being gram-negative, such as Pseudomonas aeruginosa, are now being treated with cephalosporin antibiotics, such as ceftazidime. Antibiotics do not get into the cerebral spinal fluid easily, and the environment of the cerebral spinal fluid is such the activities of antibiotics are inhibited. Other drugs and products are used to treat various pathological effects of bacterial meningitis. The use of anti-inflammatory agents has reduced inflammation of the subarachnoid space of the brain, which is caused by bacterial infection. Infants and children who were treated with antibiotics and the corticosteroid dexamethasone had a lower incidence of long-term neurologic damage. Other experimental studies include immunotherapy, or using monoclonal antibodies, which could neutralize bacterial factors that cause meningitis. Another investigation may use the factors produced by cells, such as interferon, which are involved in the inflammatory response (cytokine production) against the bacterial products. It is hoped that with greater understanding of the characteristics of the bacteria that cause meningitis, more can be done to treat this disease and reduce the sickness, mortality and neurologic damage that have been associated with it. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Physiological aspects, Drug therapy, Bacterial infections, Penicillin, Penicillins, Cephalosporins, Ampicillin

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Carbamazepine-induced aseptic meningitis

Article Abstract:

Carbamazepine is a drug that is being used more often for patients with seizure disorders, trigeminal neuralgia (inflammation of the trigeminal nerve of the face), peripheral nerve disorders, and occasionally, psychiatric illness. A case of aseptic meningitis, or inflammation of the membranes covering the spinal cord and brain that was not due to infection with microorganisms, was reported as an adverse effect of carbamazepine. The patient, who had been treated with carbamazepine for symptoms of the mood disorder mania, developed aseptic meningitis and an allergic reaction that was characterized by fever, rash, and an increased number of eosinophils, a type of white blood cell. When carbamazepine was discontinued, the patient's symptoms subsided, but when the drug was re-administered, the symptoms recurred. The patient was taking two other drugs, disulfiram and lithium carbonate. Although it is unlikely, the reaction of aseptic meningitis may have been caused by the combination of medications. The reported side effects of carbamazepine include blood, skin, and liver abnormalities, drowsiness, loss of coordination, double vision, and dizziness. The only other association between carbamazepine and aseptic meningitis, which has been reported, involved a patient with Sjogren syndrome, an autoimmune disease. Carbamazepine may cause aseptic meningitis. With the increased use of carbamazepine, this uncommon adverse reaction may be seen more often. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Central nervous system diseases, Anticonvulsants, Drug allergy, Drug hypersensitivity, Carbamazepine

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Evidence of Zoonotic Transmission of Cryptococcus neoformans from a Pet Cockatoo to an Immunocompromised Patient

Article Abstract:

Patients with weak immune systems should avoid exposure to birds. A 72-year-old woman who owned a pet cockatoo developed cryptococcal meningitis. This is a brain infection caused by a bacterium called Cryptococcus neoformans. Using detailed molecular techniques, doctors were able to show that the bacterium infecting her was identical to one found in fecal samples taken from the bird. The woman had been taking immunosuppressive drugs for several years because she had received a kidney transplant.

Cryptococcal infections, Zoonoses, Cryptococcosis, Disease transmission

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