Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd
Upload
15 views

Prevention: Postmortem

Uploaded by

jafasoh293
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
15 views

Prevention: Postmortem

Uploaded by

jafasoh293
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 3

Postmortem

[edit]

Histopathology of bacterial meningitis: autopsy case of a person


with pneumococcal meningitis showing inflammatory infiltrates of the pia mater consisting of neutrophil
granulocytes (inset, higher magnification).

Meningitis can be diagnosed after death has occurred. The findings from a post mortem are usually a
widespread inflammation of the pia mater and arachnoid layers of the meninges. Neutrophil granulocytes tend
to have migrated to the cerebrospinal fluid and the base of the brain, along with cranial nerves and the spinal
cord, may be surrounded with pus – as may the meningeal vessels.[57]

Prevention
[edit]

For some causes of meningitis, protection can be provided in the long term through [vaccination], or in the short
term with [antibiotic]s. Some behavioral measures may also be effective.

Behavioral
[edit]

Bacterial and viral meningitis are contagious, but neither is as contagious as the common cold or flu.[58] Both
can be transmitted through droplets of respiratory secretions during close contact such as kissing, sneezing or
coughing on someone,[58] but bacterial meningitis cannot be spread by only breathing the air where a person
with meningitis has been. Viral meningitis is typically caused by enteroviruses, and is most commonly spread
through fecal contamination.[58] The risk of infection can be decreased by changing the behavior that led to
transmission.

Vaccination
[edit]

Since the 1980s, many countries have included immunization against Haemophilus influenzae type B in their
routine childhood vaccination schemes. This has practically eliminated this pathogen as a cause of meningitis
in young children in those countries. In the countries in which the disease burden is highest, however, the
vaccine is still too expensive.[59][60] Similarly, immunization against mumps has led to a sharp fall in the number of
cases of mumps meningitis, which prior to vaccination occurred in 15% of all cases of mumps. [22]

Meningococcus vaccines exist against groups A, B, C, W135 and Y.[61][62][63] In countries where the vaccine for
meningococcus group C was introduced, cases caused by this pathogen have decreased substantially.[59] A
quadrivalent vaccine now exists, which combines four vaccines with the exception of B; immunization with this
ACW135Y vaccine is now a visa requirement for taking part in Hajj.[64] Development of a vaccine against group
B meningococci has proved much more difficult, as its surface proteins (which would normally be used to make
a vaccine) only elicit a weak response from the immune system, or cross-react with normal human proteins.[59]
[61]
Still, some countries (New Zealand, Cuba, Norway and Chile) have developed vaccines against local strains
of group B meningococci; some have shown good results and are used in local immunization schedules.[61] Two
new vaccines, both approved in 2014, are effective against a wider range of group B meningococci strains. [62]
[63]
In Africa, until recently, the approach for prevention and control of meningococcal epidemics was based on
early detection of the disease and emergency reactive mass vaccination of the population at risk with bivalent
A/C or trivalent A/C/W135 polysaccharide vaccines,[65] though the introduction of MenAfriVac (meningococcus
group A vaccine) has demonstrated effectiveness in young people and has been described as a model for
product development partnerships in resource-limited settings.[66][67]

Routine vaccination against Streptococcus pneumoniae with the pneumococcal conjugate vaccine (PCV),
which is active against seven common serotypes of this pathogen, significantly reduces the incidence of
pneumococcal meningitis.[59][68] The pneumococcal polysaccharide vaccine, which covers 24 strains, is only
administered to certain groups (e.g. those who have had a splenectomy, the surgical removal of the spleen); it
does not elicit a significant immune response in all recipients, e.g. small children, big children and adults .
[68]
Childhood vaccination with Bacillus Calmette-Guérin has been reported to significantly reduce the rate of
tuberculous meningitis, but its waning effectiveness in adulthood has prompted a search for a better vaccine. [59]

Antibiotics
[edit]

Short-term antibiotic prophylaxis is another method of prevention, particularly of meningococcal meningitis. In


cases of meningococcal meningitis, preventative treatment in close contacts with antibiotics
(e.g. rifampicin, ciprofloxacin or ceftriaxone) can reduce their risk of contracting the condition, but does not
protect against future infections.[48][69] Resistance to rifampicin has been noted to increase after use, which has
caused some to recommend considering other agents.[70] While antibiotics are frequently used in an attempt to
prevent meningitis in those with a basilar skull fracture there is not enough evidence to determine whether this
is beneficial or harmful.[71] This applies to those with or without a CSF leak.

Management
[edit]

Meningitis is potentially life-threatening and has a high mortality rate if untreated; [8] delay in treatment has been
associated with a poorer outcome.[3] Thus, treatment with wide-spectrum antibiotics should not be delayed while
confirmatory tests are being conducted.[49] If meningococcal disease is suspected in primary care, guidelines
recommend that benzylpenicillin be administered before transfer to hospital.[18] Intravenous fluids should be
administered if hypotension (low blood pressure) or shock are present.[49] It is not clear whether intravenous
fluid should be given routinely or whether this should be restricted.[72] Given that meningitis can cause a number
of early severe complications, regular medical review is recommended to identify these complications
early[49] and to admit the person to an intensive care unit, if deemed necessary.[3]

Mechanical ventilation may be needed if the level of consciousness is very low, or if there is evidence
of respiratory failure. If there are signs of raised intracranial pressure, measures to monitor the pressure may
be taken; this would allow the optimization of the cerebral perfusion pressure and various treatments to
decrease the intracranial pressure with medication (e.g. mannitol).[3] Seizures are treated with anticonvulsants.
[3]
Hydrocephalus (obstructed flow of CSF) may require insertion of a temporary or long-term drainage device,
such as a cerebral shunt.[3] The osmotic therapy, glycerol, has an unclear effect on mortality but may decrease
hearing problems.[73]

Bacterial meningitis
[edit]

Antibiotics
[edit]
Structural formula of ceftriaxone, one of the third-generation
cefalosporin antibiotics recommended for the initial treatment of bacterial meningitis.

Empiric antibiotics (treatment without exact diagnosis) should be started immediately, even before the results of
the lumbar puncture and CSF analysis are known. The choice of initial treatment depends largely on the kind of
bacteria that cause meningitis in a particular place and population. For instance, in the United Kingdom,
empirical treatment consists of a third-generation cefalosporin such as cefotaxime or ceftriaxone.[48][49] In the US,
where resistance to cefalosporins is increasingly found in streptococci, addition of vancomycin to the initial
treatment is recommended.[3][8][48] Chloramphenicol, either alone or in combination with ampicillin, however,
appears to work equally well.[74]

You might also like