![Page 1: Mellss microbe cns meningitis treatment and prophylaxis](https://reader034.vdocument.in/reader034/viewer/2022051502/58ed41901a28ab5b2c8b4639/html5/thumbnails/1.jpg)
Treatment and
ProphylaxisNur Amalina bt. Aminuddin Baki
60
![Page 2: Mellss microbe cns meningitis treatment and prophylaxis](https://reader034.vdocument.in/reader034/viewer/2022051502/58ed41901a28ab5b2c8b4639/html5/thumbnails/2.jpg)
Objectives
• Treatment: – Supportives measures– Drugs
• Prophylaxis:– Chemoprophylaxis– immunoprophylaxis
![Page 3: Mellss microbe cns meningitis treatment and prophylaxis](https://reader034.vdocument.in/reader034/viewer/2022051502/58ed41901a28ab5b2c8b4639/html5/thumbnails/3.jpg)
Introduction
Bacterial Meningitis• More severe• Requires treatment• Available vaccine present
Viral Meningitis• Less severe• Supportives measures• Self -limited
![Page 4: Mellss microbe cns meningitis treatment and prophylaxis](https://reader034.vdocument.in/reader034/viewer/2022051502/58ed41901a28ab5b2c8b4639/html5/thumbnails/4.jpg)
Recommended Empiric Antibiotics for Suspected Bacterial Meningitis
Age or Predisposing Feature AntibioticsAge 0-4 wk Ampicillin plus either cefotaxime or an
aminoglycosideAge 1 mo-50 y Vancomycin plus cefotaxime or ceftriaxone
Age >50 y Vancomycin plus ampicillin plus ceftriaxone or cefotaxime plus vancomycin
Impaired cellular immunity Vancomycin plus ampicillin plus either cefepime or meropenem
Recurrent meningitis Vancomycin plus cefotaxime or ceftriaxone
Basilar skull fracture Vancomycin plus cefotaxime or ceftriaxone
Head trauma, neurosurgery, or CSF shunt Vancomycin plus ceftazidime, cefepime, or meropenem
![Page 5: Mellss microbe cns meningitis treatment and prophylaxis](https://reader034.vdocument.in/reader034/viewer/2022051502/58ed41901a28ab5b2c8b4639/html5/thumbnails/5.jpg)
Bacterial Meningitis
• Neisseria meningitidis
• B,C,Y serogroup = developed region• A, w-135 serogroup = less developed region
Treatment Prevention
•Penicillin /chloramphenicol•Ciprofloxacin / Rifampicin for close contacts•Meningococcal vaccine
![Page 6: Mellss microbe cns meningitis treatment and prophylaxis](https://reader034.vdocument.in/reader034/viewer/2022051502/58ed41901a28ab5b2c8b4639/html5/thumbnails/6.jpg)
Meningococcal Vaccine • Quadrivalent (A,C , W-
135, Y)– MCV-4 (9m-55y)
– MPSV-4• Elderly (>55 years old)• Last for 3 year
• Bivalent (C,Y): – infant >6w – to prevent meningitis
C ,Y and HiB disease
• Serogroup A: MenAfriVac
• Serogroup B : difficult as too similar to neural antigen
•11-18y •HIV adolescent •>16y•Two doses
1: 11-12y2: 16y
•Three doses2 doses 2 months apart at 11-12yBooster : 16y
•X booster dose
![Page 7: Mellss microbe cns meningitis treatment and prophylaxis](https://reader034.vdocument.in/reader034/viewer/2022051502/58ed41901a28ab5b2c8b4639/html5/thumbnails/7.jpg)
• Haemophilus influenzae
Treatment Prevention
•ceftriaxone or cefotaxime•Ampicillin,
•Rifampicin X 4 days for close contact•Hib PRP vaccine
![Page 8: Mellss microbe cns meningitis treatment and prophylaxis](https://reader034.vdocument.in/reader034/viewer/2022051502/58ed41901a28ab5b2c8b4639/html5/thumbnails/8.jpg)
HiB PolyribosylRibitolPhosphate Vaccine
• Polysaccharide: limited usefulness• Conjugate:– Tetanus toxoid, diphteria toxoid, N. meningitidis
OMP– >2 months ( 2 doses at 2 month interval)
• Combination – Hib + DPT in USA
![Page 9: Mellss microbe cns meningitis treatment and prophylaxis](https://reader034.vdocument.in/reader034/viewer/2022051502/58ed41901a28ab5b2c8b4639/html5/thumbnails/9.jpg)
• Streptococcus pneumoniae
Treatment Prevention
•Penicillin• ceftriaxone / cefotaxime•Vancomycin
•PPSV23•PCV13•PCV7
![Page 10: Mellss microbe cns meningitis treatment and prophylaxis](https://reader034.vdocument.in/reader034/viewer/2022051502/58ed41901a28ab5b2c8b4639/html5/thumbnails/10.jpg)
Pneumococcal Vaccine• Polysaccharide : PPSV23
For increased risk groupoDysfunctional spleen,
nephrotic synd., sickle cell anemia, multiple myeloma, DM, immunodeficiency patient.
Single dose injection , last 5 years
(-): <2 years old, not lifelong
• Conjugated:PCV13 children at 2, 4,
6, and 12–15 months oldPCV7 bind to diphteria
toxoido 2-23monthso Increased risk in 2-5 years
old
![Page 11: Mellss microbe cns meningitis treatment and prophylaxis](https://reader034.vdocument.in/reader034/viewer/2022051502/58ed41901a28ab5b2c8b4639/html5/thumbnails/11.jpg)
• Mycobacterium tuberculosis
Isoniazid• Only in risk groups( 5mg/kg daily X 6-12M)
Unavoidable contact with patient with open TB Children which is tuberculin +ve but radiology clear adult with radiological evidence of inactive disease
Treatment Prevention•Isoniazid (H),rifampin (R), pyrazinamide (Z) , ,streptomycin(E)
•Isoniazid•BCG vaccination
![Page 12: Mellss microbe cns meningitis treatment and prophylaxis](https://reader034.vdocument.in/reader034/viewer/2022051502/58ed41901a28ab5b2c8b4639/html5/thumbnails/12.jpg)
Bacille Calmette Guerin Vaccine
• Strain of M bovis weakened by 239 serial subculture in glycerine- bile- potato medium (13 ears)
• 0.1ml ID small nodule (2-3w)• Given soon after birth • Complications :
Local : abscess, keloid formationRegional: lymphadenitisGeneral: fever , erythema nodosum
![Page 13: Mellss microbe cns meningitis treatment and prophylaxis](https://reader034.vdocument.in/reader034/viewer/2022051502/58ed41901a28ab5b2c8b4639/html5/thumbnails/13.jpg)
• Escherichia coli and group B streptococci
• Listeria monocytogenes
Treatment Prevention
•Gentamicin + cefotaxime or ceftriaxone (or chloramphenicol)
•No vaccines available
Treatment Prevention
Penicillin or ampicillin + gentamicin No vaccines available
![Page 14: Mellss microbe cns meningitis treatment and prophylaxis](https://reader034.vdocument.in/reader034/viewer/2022051502/58ed41901a28ab5b2c8b4639/html5/thumbnails/14.jpg)
Viral Meningitis
• Self-limited, offer supportive measureso Herpes simplex virusoMumpso Lymphocytic choriomeningitiso Enteroviruses including coxsackievirus, echovirus
and poliovirusPicornaviruses o Japanese encephalitiso HIV
• Complete recovery
![Page 15: Mellss microbe cns meningitis treatment and prophylaxis](https://reader034.vdocument.in/reader034/viewer/2022051502/58ed41901a28ab5b2c8b4639/html5/thumbnails/15.jpg)
Fungal Meningitis
• Cryptococcus neoformans
• Coccidioides immitis
Treatment Prevention
•Amphotericin B and flucytosine
•No vaccines available
Treatment Prevention•amphotericin B, fluconazole or miconazole
•No vaccines available
![Page 16: Mellss microbe cns meningitis treatment and prophylaxis](https://reader034.vdocument.in/reader034/viewer/2022051502/58ed41901a28ab5b2c8b4639/html5/thumbnails/16.jpg)
Protozoal Meningitis
Treatment•not fully satisfactory
Naegleria :Amphotericin B, with miconazole and rifampinBalamuthia mandrillaris :albendazole and itraconazole
![Page 17: Mellss microbe cns meningitis treatment and prophylaxis](https://reader034.vdocument.in/reader034/viewer/2022051502/58ed41901a28ab5b2c8b4639/html5/thumbnails/17.jpg)
Conclusion
Pathogen Prevention
•Neisseria meningitidis
•MCV-4 •MPSV-4
•Haemophilus influenzae
•Hib vaccine
•Streptococcus pneumoniae
•PPSV23•PCV13•PCV7
•Mycobacterium tuberculosis
•BCG vaccination
![Page 18: Mellss microbe cns meningitis treatment and prophylaxis](https://reader034.vdocument.in/reader034/viewer/2022051502/58ed41901a28ab5b2c8b4639/html5/thumbnails/18.jpg)
Reference • Richard V. Goering, Hazel M. Dockrell, Mark
Zuckerman, Peter L. Chiodini, and Ivan M. Roitt, Mims’ Medical Microbiology,5th edition
• Ananthanarayan and Paniker , Textbook of Microbiology, 8th edition
• Prof CP Baveja, Textbook of Microbiology, 2nd edition
• http://www.cdc.gov/vaccines
![Page 19: Mellss microbe cns meningitis treatment and prophylaxis](https://reader034.vdocument.in/reader034/viewer/2022051502/58ed41901a28ab5b2c8b4639/html5/thumbnails/19.jpg)