CD-ROM Today 1996 January/CD-ROM Today 1996 January.iso/dp/0399/03994.txt

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$Unique_ID{BRK03994}
$Pretitle{}
$Title{Meningitis, Bacterial}
$Subject{Meningitis Bacterial Bacterial Meningitis Pyogenic Meningitis
Meningitis Encephalitis}
$Volume{}
$Log{}

Copyright (C) 1990, 1991 National Organization for Rare Disorders, Inc.

819:
Meningitis, Bacterial

** IMPORTANT **
It is possible the main title of the article (Bacterial Meningitis) is
not the name you expected.  Please check the SYNONYMS listing on the next
page to find alternate names and disorder subdivisions covered by this
article.

Synonyms

     Bacterial Meningitis
     Pyogenic Meningitis

Information on the following disorder may be found in the Related
Disorders section of this report:

     Meningitis
     Encephalitis

General Discussion

** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only.  It should not be used for diagnostic or treatment
purposes.  If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.

Bacterial Meningitis is a central nervous system disease caused by
certain types of bacteria.  Meningitis is characterized by inflammation of
the membranes (meninges) around the brain or spinal cord.  Inflammation can
begin suddenly (acute) or develop gradually (subacute).  Major symptoms may
include fever, headache, and a stiff neck, sometimes with aching muscles.
Nausea, vomiting and other symptoms may occur.

Symptoms

Bacterial Meningitis in adults and children is often preceded by respiratory
illness or a sore throat.  Most forms of bacterial meningitis are acute.  In
its acute form, the disorder is characterized by sudden fever, headache, a
stiff neck, and vomiting.  Adults may become seriously ill within 24 hours.
In children, the course of the infection may be even shorter.

Symptoms among older children and adults may progress from irritability
through confusion, drowsiness, and stupor, possibly leading to coma.
Dehydration is common.  Other symptoms may include chills, sweating,
weakness, loss of appetite, or inability to tolerate bright light
(photophobia).  Later symptoms may include hydrocephalus (accumulation of
fluid in the brain cavity), paralysis of one side of the body (hemiparesis),
hearing loss, or other neurological abnormalities.

Among infants between 3 months and 2 years of age, fever, refusal of
feedings, vomiting, irritability, and convulsions usually occur.  A high-
pitched cry, and a bulging or tight soft spot (fontanel) on the crown of the
head (where the parts of the still unhardened bones join) may also occur.
Since the incidence of Meningitis is highest among this age group, any
unexplained fever needs to be investigated.  Cerebral fluid may accumulate
just inside the tough outer membrane covering the brain (subdural effusions)
after several days.  Typical signs of Meningitis include seizures, a
persistent fever, and an enlarging head size.  A brain abscess or subdural
pus accumulation may also occur.  Water accumulating in the brain
(hydrocephalus), deafness and slowed mental and physical development are
possible effects of Bacterial Meningitis on the central nervous system.

A neonatal form of Bacterial Meningitis in newborn babies up to 4 weeks
old may be caused by infections in parts of the body other than the brain or
spine.  Some cases may arise from complications occurring at birth.  The
disorder is characterized by subtle and nonspecific signs such as
jitteriness, interrupted breathing (apnea), vomiting, diarrhea, and a
yellowish skin color (jaundice).  Usually signs of infection elsewhere in the
body (e.g. middle ear infection) are also present.  The cerebrospinal fluid
can be tested for a definite diagnosis.

Bacterial Meningitis due to Group B pneumococcus bacteria may be present
in the first 10 days of life, when it frequently accompanies a lung illness.
Usually, however, this form of Meningitis occurs after 10 days of age as an
isolated illness.  Other symptoms such as fever, drowsiness, and seizures may
occur.

Causes

Bacterial Meningitis is the most common type of meningitis.  Three types of
bacteria are responsible for 80% of all Bacterial Meningitis.  These are:  1)
Hemophilus influenzae (type B), 2) Streptococcus pneumoniae (Pneumococcus),
and 3) Neisseria meningitidis (Meningococcus).  (For more information on
Meningococcal Meningitis, choose "meningococcal" as your search term in the
Rare Disease Database).  All three types occur most often in winter.

Gram-negative bacteria such as Escherichia coli, Klebsiella-Entero, or
Pseudomonas often cause Bacterial Meningitis in newborn infants.  Other types
of bacteria that may cause the disorder are Streptococci, Staphylococci
(Staphylococcus aureus) or listeria monocytogenes.

Bacterial Meningitis due to hemophilus influenza type B bacteria occurs
most often in infants over 1 month old and young children.  It usually does
not occur in adults except in relation to another condition such as head
trauma or impaired immunity.  Bacterial Meningitis caused by pneumococcus
occurs most often in adults, especially those with alcoholism, chronic otitis
(inflammation of the ear), sinusitis (inflammation of the mucous membranes
lining the sinuses that open into the nose), mastoiditis (infection of the
bone located behind the ear), closed head injury, recurrent meningitis,
pneumococcal pneumonia, or sickle cell anemia.  (For more information choose
"meningitis," or "sickle" as your search terms in the Rare Disease Database).

Bacterial Meningitis from gram-negative organisms such as Escherichia
coli and Klebsiella-Enterobacter is called Gram-negative Meningitis and
frequently occurs after central nervous system trauma or surgery, or from
blood poisoning).  Newborns or people who have impaired immunity may also
become infected.

Staphylococcal Meningitis (from Staphylococcus bacteria), another form of
Bacterial Meningitis, occurs after blood poisoning (e.g., from endocarditis
which is inflammation of the inner lining of the heart), open head trauma, or
neurosurgery.

Listeria Meningitis is another form of meningitis that occurs in
newborns, in patients who have chronic renal (kidney) failure, or adults
taking immunosuppressive drugs (e.g. organ transplant patients).  (For more
information on Listeria, choose "Listeria" as your search term in the Rare
Disease Database).

Intravenous drug use from unsterilized needles can cause blood poisoning
that may lead to Bacterial Meningitis.

Of all bacteria causing Bacterial Meningitis, Hemophilus influenza type B
is the most common and represents almost half of all Bacterial Meningitis
cases.  Meningococcal Meningitis represents about 27 per cent, and
Pneumococcal Meningitis represents about 11 per cent.

Affected Population

In the United States, about 20,000 to 25,000 cases of Bacterial Meningitis
are reported annually.  About 70 per cent of all Bacterial Meningitis occurs
in children aged 5 and under, especially those under the age of two.  Males
are affected more often than females.  Bacterial Meningitis in general occurs
most often during the first month of a newborn's life and is usually caused
by gram-negative bacteria such as Escherichia coli or by group B
streptococcus.  Bacterial Meningitis caused by Hemophilus influenzae type B
occurs most often in infants over 1 month old and young children.  Bacterial
Meningitis caused by pneumococcus bacteria occurs most often in adults.

Related Disorders

Symptoms of the following disorders may resemble those of Meningitis.
Comparisons may be useful for a differential diagnosis:

Meningitis is characterized by inflammation of the membranes (meninges)
around the brain or spinal cord.  This inflammation may be caused by
different types of bacteria, viruses, fungi, malignant tumors, or chemical
reactions to certain injections into the spinal canal.  (For more information
on other types of Meningitis, choose "meningitis" as your search term in the
Rare Disease Database).

Encephalitis is a brain infection.  There are different types of this
disorder which are caused by different types of viruses.  Encephalitis may
also be caused by hypersensitivity initiated by a virus or other protein that
is foreign to the body.  Symptoms may include headache, drowsiness,
hyperactivity, and/or general weakness.  This disorder may have some symptoms
similar to those of Meningitis such as a stiff neck, altered reflexes,
confusion, speech disorders, possible convulsions, paralysis and coma.  (For
more information choose "Encephalitis" as your search term in the Rare
Disease Database).

Therapies:  Standard

Testing for Bacterial Meningitis may include imaging techniques such as CT
scans or MR imaging.  Other testing may include examination of the patient's
blood and/or skin.  Diagnosis is made by examination of the cerebrospinal
fluid.

Bacterial Meningitis is usually treated with different types of
antibiotics used against the specific bacteria causing the infection.  These
may include ampicillin, chloramphenicol, gentamicin, penicillin, moxalactam,
nafcillin, cefuroxime, cefotaxime, ceftizoxime, oxacillin, vancomycin, or
rifampin.  The addition of dexamethasone to the antibiotic treatment is also
being used and is helpful in reducing meningeal inflammation.

For children under 5 who have come in close contact with a person having
Meningitis caused by Hemophilus influenzae, the drug rifampin may be
prescribed as a preventative measure.

Children over 2 years of age can be immunized against Meningitis with the
Hemophilus influenzae type b polysaccharide vaccine.  A vaccine composed of
attenuated bacteria with added protein, has been approved for use in children
under two years of age to protect them against Hemophilus influenzae type B
Meningitis.

Therapies:  Investigational

This disease entry is based upon medical information available through June
1991.  Since NORD's resources are limited, it is not possible to keep every
entry in the Rare Disease Database completely current and accurate.  Please
check with the agencies listed in the Resources section for the most current
information about this disorder.

Resources

For more information on Bacterial Meningitis, please contact:

     National Organization for Rare Disorders (NORD)
     P.O. Box 8923
     New Fairfield, CT  06812-1783
     [phone]

     NIH/National Institute of Allergy and Infectious Diseases (NIAID)
     9000 Rockville Pike
     Bethesda, MD  20892
     [phone]

     Centers for Disease Control (CDC)
     1600 Clifton Road, NE
     Atlanta, GA  30333
     [phone]

References

CECIL TEXTBOOK OF MEDICINE, 18th Ed.:  James B. Wyngaarden, and Lloyd H.
Smith, Jr., Editors; W.B. Saunders Co., 1988.  Pp. 57, 65, 1604-1610.

INTERNAL MEDICINE, 2nd Ed.:  Jay H. Stein, ed.-in-chief; Little, Brown
and Co., 1987.  Pp. 1494-1502.

BACTERIAL MENINGITIS IN OLDER CHILDREN.  W. A. Bonadio, et al.; Am J Dis
Child (Apr 1990; issue 144 (4)).  Pp. 463-465.

CEFTRIAXONE ALONE COMPARED TO AMPICILLIN AND CHLORAMPHENICOL IN THE
TREATMENT OF BACTERIAL MENINGITIS.  N. I. Girgis; Chemotherapy (1988; issue
34 (Suppl 1)).  Pp. 16-20.

Gd-DTPA-ENHANCED MR IMAGING OF THE BRAIN IN PATIENTS WITH MENINGITIS:
COMPARISON WITH CT.  K. H. Chang, et al.; AJR Am J Roentgenol (April 1990;
issue 154 (4)).  Pp. 809-816.