Meningitis in service-age personnel

2015 ◽  
Vol 101 (1) ◽  
pp. 63-68
Author(s):  
R Miller ◽  
K Houlberg
Keyword(s):  
Bacterial Meningitis ◽  
Case Fatality ◽  
Acute Bacterial Meningitis ◽  
Operational Environment ◽  
Bacterial Strains ◽  
Threatening Condition ◽  
Life Threatening ◽  
Classical Triad ◽  
The Uk ◽  
Medical Advances

AbstractThe incidence of meningitis is declining in the UK population largely due to increased availability of vaccinations against the most common bacterial strains. Acute bacterial meningitis, however, is a life-threatening condition and distinguishing it from more benign causes of headache and fever is difficult in an operational environment due to limited access to diagnostic tests. Despite medical advances, the case fatality rate in the United Kingdom in adults with invasive meningococcal disease is 10.5%. Acute bacterial meningitis presents with the classical triad of fever, neck pain and altered mental state in less than half of adults, and in the initial course of the disease it frequently mimics common viral illnesses. The aim of this article is to discuss the recognition and management of meningitis with special emphasis on the deployed military environment.

scholarly journals Intramedullary abscess associated with acute bacterial meningitis: a case report and review of the literature

2020 ◽  
Vol 10 (3) ◽  
pp. 120-123
Author(s):  
Marouane Hammoud ◽  
Fayçal Lakhdar ◽  
Mohammed Benzagmout ◽  
Khalid Chakour, ◽  
Mohammed El Faiz Chaou
Keyword(s):  
Spinal Cord ◽  
Bacterial Meningitis ◽  
Antibiotic Therapy ◽  
Contralateral Side ◽  
Acute Bacterial Meningitis ◽  
Intramedullary Spinal Cord ◽  
Intramedullary Abscess ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Central Nervous System

Intramedullary spinal cord abscess (ISCA) is a rare infection of the central nervous system. Untreated, it may result in significant morbidity and mortality. We describe the case of a 34-year-old man, who initially was admitted for bacterial meningitis. 3 days after initiation of antibiotic therapy, a gradually and progressive weakness appeared on the left side of his body with numbness on the contralateral side. MRI of the spine demonstrated an ISCA at level of C4. A myelotomy and surgical drainage was performed. Postoperatively, the patient had improved significantly his neurological deficit. ISCA is still a life-threatening condition, we point out that the diagnosis should be highly suspected, if a cystic spinal cord lesion is surrounded by significant medullar edema associated with fast onset of symptoms, especially in a context of sepsis or acuate meningitis. Prompt surgical evacuation followed by adequate antibiotic therapy, are the mainstays of treatment.

Recognising and managing an acute asthma attack

2021 ◽  
Vol 2 (1) ◽  
pp. 12-18
Author(s):  
Richard Elston
Keyword(s):  
Acute Asthma ◽  
Asthma Attack ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Uk ◽  
Inhaled Salbutamol

Asthma is a potentially life-threatening condition, characterised by a reversible narrowing of the airways. It affects 1 in 10 children in the UK. During exacerbations, it is difficult for the child to breathe and get enough oxygen into their blood. There is a huge variance in the severity of an attack. Some can be managed in the community while others are potentially fatal and need urgent transfer to hospital. For that reason, criteria have been created to categorise attacks as mild, moderate, severe or life threatening. Initially, an asthma attack should be treated using inhaled salbutamol; however, if the patient does not respond or has severe or life-threatening asthma, they need urgent transfer to hospital.

Management of meningitis and encephalitis in the critically ill

2016 ◽  
Author(s):  
Simon Nadel ◽  
Johnny Canlas
Keyword(s):  
Bacterial Meningitis ◽  
Care Setting ◽  
Antimicrobial Agents ◽  
Acute Bacterial Meningitis ◽  
Supportive Treatment ◽  
Intensive Care Setting ◽  
Vaccine Research ◽  
Common Causes ◽  
Life Threatening ◽  
The Common

Management of CNS infections requires specific antimicrobial agents, as well as specific supportive treatment targeted at reducing raised intracranial pressure and other life-threatening complications. It is important that the need for management in an intensive care setting is considered early in the illness. Antibiotic resistance amongst the most common organisms causing bacterial meningitis is becoming more common and antibiotic therapy should be adjusted accordingly. Anti-inflammatory treatment such as steroids should be started as soon as possible in patients with proven acute bacterial meningitis. Optimally, this should be before or with the first dose of antibiotics. Vaccine research is progressing so that effective vaccines should be available in the future against all the common causes of bacterial meningitis and encephalitis, including Neisseria meningitidis serogroup b.

scholarly journals Pathogenesis of Multiple Organ Injury in COVID-19 and Potential Therapeutic Strategies

2021 ◽  
Vol 12 ◽  
Author(s):  
Miquéias Lopes-Pacheco ◽  
Pedro Leme Silva ◽  
Fernanda Ferreira Cruz ◽  
Denise Battaglini ◽  
Chiara Robba ◽  
...  
Keyword(s):  
Respiratory Disease ◽  
Biological Activities ◽  
Case Fatality ◽  
Cell Types ◽  
Multiple Organ ◽  
Organ Injury ◽  
Downstream Effects ◽  
Threatening Condition ◽  
Life Threatening ◽  
Novel Coronavirus

Severe acute respiratory disease coronavirus 2 (SARS-CoV-2, formerly 2019-nCoV) is a novel coronavirus that has rapidly disseminated worldwide, causing the coronavirus disease 2019 (COVID-19) pandemic. As of January 6th, 2021, there were over 86 million global confirmed cases, and the disease has claimed over 1.87 million lives (a ∼2.2% case fatality rate). SARS-CoV-2 is able to infect human cells by binding its spike (S) protein to angiotensin-conversing enzyme 2 (ACE2), which is expressed abundantly in several cell types and tissues. ACE2 has extensive biological activities as a component of the renin-angiotensin-aldosterone system (RAAS) and plays a pivotal role as counter-regulator of angiotensin II (Ang II) activity by converting the latter to Ang (1-7). Virion binding to ACE2 for host cell entry leads to internalization of both via endocytosis, as well as activation of ADAM17/TACE, resulting in downregulation of ACE2 and loss of its protective actions in the lungs and other organs. Although COVID-19 was initially described as a purely respiratory disease, it is now known that infected individuals can rapidly progress to a multiple organ dysfunction syndrome. In fact, all human structures that express ACE2 are susceptible to SARS-CoV-2 infection and/or to the downstream effects of reduced ACE2 levels, namely systemic inflammation and injury. In this review, we aim to summarize the major features of SARS-CoV-2 biology and the current understanding of COVID-19 pathogenesis, as well as its clinical repercussions in the lung, heart, kidney, bowel, liver, and brain. We also highlight potential therapeutic targets and current global efforts to identify safe and effective therapies against this life-threatening condition.

scholarly journals Community-acquired acute bacterial meningitis in adults: a clinical update

2019 ◽  
Vol 131 (1) ◽  
pp. 57-70 ◽  
Author(s):  
Jayne Ellis ◽  
Akish Luintel ◽  
Arjun Chandna ◽  
Robert S Heyderman
Keyword(s):  
Bacterial Meningitis ◽  
Molecular Diagnostics ◽  
Clinical Care ◽  
Molecular Techniques ◽  
Acute Bacterial Meningitis ◽  
Published Data ◽  
Mortality And Morbidity ◽  
Cerebral Herniation ◽  
Guidelines Development ◽  
The Uk

Abstract Background Acute bacterial meningitis (ABM) in adults is associated with a mortality that may exceed 30%. Immunization programs have reduced the global burden; in the UK, declining incidence but persistently high mortality and morbidity mean that clinicians must remain vigilant. Sources of data A systematic electronic literature search of PubMed was performed to identify all ABM literature published within the past 5 years. Areas of agreement and controversy Clinical features cannot reliably distinguish between ABM and other important infectious and non-infectious aetiologies. Prompt investigation and empirical treatment are imperative. Lumbar puncture (LP) and cerebrospinal fluid microscopy, biochemistry and culture remain the mainstay of diagnosis, but molecular techniques are increasingly useful. The 2016 UK joint specialist societies’ guideline provides expert recommendations for the management of ABM, yet published data suggest clinical care delivered in the UK is frequently not adherent. Anxiety regarding risk of cerebral herniation following LP, unnecessary neuroimaging, underutilization of molecular diagnostics and suboptimal uptake of adjunctive corticosteroids compromise management. Growing points There is increasing recognition that current antibiotic regimens and adjunctive therapies alone are insufficient to reduce the mortality and morbidity associated with ABM. Areas timely for developing research Research should be focused on optimization of vaccines (e.g. pneumococcal conjugate vaccines with extended serotype coverage), targeting groups at risk for disease and reservoirs for transmission; improving adherence to management guidelines; development of new faster, more accurate diagnostic platforms (e.g. novel point-of-care molecular diagnostics); and development of new adjunctive therapies (aimed at the host-inflammatory response and bacterial virulence factors).

scholarly journals Community-acquired CTX-M-15-type ESBL-producing Escherichia coli meningitis: a case report and literature review

2013 ◽  
Vol 7 (05) ◽  
pp. 424-431 ◽  
Author(s):  
Nazif Elaldi ◽  
Mustafa Gokhan Gozel ◽  
Fetiye Kolayli ◽  
Aynur Engin ◽  
Cem Celik ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Bacterial Meningitis ◽  
Empiric Antibiotic Therapy ◽  
Acute Bacterial Meningitis ◽  
Elderly Male ◽  
E Coli ◽  
Empiric Antibiotic ◽  
Life Threatening ◽  
Stool Samples

In this report, a case of community-acquired acute bacterial meningitis (CA-ABM) caused by CTX-M-15-producing Escherichia coli in an elderly male patient was presented in the light of literature. Cultures of cerebrospinal fluid, blood, ear discharge, and stool samples yielded CTX-M-15-producing E. coli in-vitro, which was resistant to the extended-spectrum cephalosporins and ciprofloxacin and susceptible to imipenem, meropenem and amikacin. Meningitis was treated with parenteral meropenem plus parenteral and intraventricular amikacin administration. Since bacterial meningitis is a life-threatening infection, empiric antibiotic therapy with carbapenem can be started before the culture results are obtained, mainly in areas where the ESBL epidemiology is well known.

scholarly journals Epilepsy emergency rescue training

2015 ◽  
Vol 4 (1) ◽  
pp. u208167.w3566 ◽  
Author(s):  
Rohit Shankar ◽  
Caryn Jory ◽  
juliet ashton ◽  
Brendan McLean ◽  
Matthew Walker
Keyword(s):  
Rescue Medication ◽  
Premature Death ◽  
Convulsive Status Epilepticus ◽  
Web Based ◽  
Emergency Rescue ◽  
Prolonged Seizure ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Uk ◽  
Safe Care

AbstractThe NICE audit of epilepsy related deaths revealed that 1200 epilepsy deaths occur every year in the UK, with 42% potentially avoidable.[1] Convulsive status epilepticus (SE) is a life-threatening condition with over 20% mortality rate, especially if early treatment is not initiated .[2] Ten percent of all UK emergency department (ED) admissions are due to epilepsy, usually over represented by cases of SE.[3] Six out of seven epilepsy cases seen in the ED are admitted into medical care.[4]Patients with chronic and/or treatment resistant epilepsy carry a higher risk of premature death. When a seizure lasts for five minutes or more then the patient is at high risk of continuing to SE and this may result in causing brain damage or death.[2]Buccal midazolam is an emergency rescue medication prescribed on a special named patient license to reduce the duration of an epileptic seizure and prevent SE.[2,5] It should be administered by a trained person and is widely used due to its effectiveness and social acceptability. In the UK, epilepsy education and training courses are expected to be conducted by epilepsy professionals in line with the agreed training guidelines of Joint Epilepsy Council (JEC) backed up by evidence from NICE.[6,7] Training should provide an overview of epilepsy to facilitate safe care and appropriate administration of rescue medication for people with epilepsy (PWE) when experiencing a prolonged seizure. The medication is prescribed on specialist advice by the GP or specialists directly.Unfortunately the JEC guidelines are not robust enough to provide assurances of safe care. This problem had a myriad of complexities and an appropriate solution using web based resource was piloted, tested, and applied successfully using quality improvement methodology.

scholarly journals Etiologyand occurrence of acute bacterial meningitis in children in Benghazi Libyan Arab Jamahiriya

1998 ◽  
Vol 4 (1) ◽  
pp. 50-57
Author(s):  
Bandaru Narasinga Rao ◽  
Ibrahim Mahdi Kashbur ◽  
Nuri Mohamed Shembesh ◽  
Suliman Mohamed El Bargathy
Keyword(s):  
Bacterial Meningitis ◽  
Case Fatality ◽  
Antibiotic Sensitivity ◽  
Acute Bacterial Meningitis ◽  
Bacterial Isolates ◽  
Presumptive Diagnosis ◽  
Female Ratio ◽  
Meningitis In Children ◽  
Male To Female ◽  
Klebsiella Spp

Over a 14-month period, 77 children with a presumptive diagnosis of acute bacterial meningitis were investigated. The incidence of acute bacterial meningitis was 0.8%, with a case fatality rate of 13.0%. Children pound 1 year of age were more affected [64.9%]. The total male to female ratio was 1.2:1. Gram stain detected more cases [85.7%] than culture [66.2%]. A total of 48 isolates were identified by culture and their antibiotic sensitivity was determined. Haemophilus influenzae [33.8%] was the predominant organism identified, followed by Streptococcus pneumoniae [26.0%], Klebsiella spp. [6.5%] and Neisseria meningitidis [2.6%]. Many of the bacterial isolates were sensitive to gentamicin, cefotaxime and ceftriaxone and least sensitive to tetracycline and ampicillin

scholarly journals A primary care physician’s approach to a child with meningitis

2018 ◽  
Vol 33 (2) ◽  
pp. 31-37
Author(s):  
I Govender ◽  
C Steyn ◽  
G Maricowitz ◽  
C C Clark ◽  
M C Tjale
Keyword(s):  
Primary Care ◽  
Bacterial Meningitis ◽  
Primary Healthcare ◽  
Care Physician ◽  
Acute Bacterial Meningitis ◽  
Older Children ◽  
Neck Stiffness ◽  
Childhood Morbidity ◽  
Threatening Condition ◽  
Meningitis In Children

Background: Paediatric meningitis remains a common cause of childhood morbidity and mortality in developing countries. In children the peak age for meningitis is six to 12 months old, with 90% of cases occurring in children younger than five years. It is imperative that a primary healthcare physician be aware of and is capable of managing this life-threatening condition as most caregivers first present to a primary healthcare physician with their sick child.Discussion: Common symptoms are headaches, photophobia, drowsiness, fatigue, unexplained crying, convulsions, irritability, and lethargy. Signs include fever, vomiting, neck stiffness and signs of increased intracranial pressure. Acute bacterial meningitis, especially meningococcal meningitis can present with petechiae and/or purpura. Cranial nerve palsy occurs commonly in cryptococcal meningitis, which can occur as part of immune reconstitution inflammatory syndrome (IRIS) after initiation of antiretroviral therapy. Older children may present with behavioural changes and localising signs such as hemiparesis and coma.Conclusion: This paper discusses the lumbar puncture technique and findings, drug and non-drug management, information on chemoprophylaxis for bacterial meningitis, and the possible complications of meningitis in children. This is an important area for the primary care physician as they are usually the first port of call by caregivers.

scholarly journals An Evaluation of the Drone Delivery of Adrenaline Auto-Injectors for Anaphylaxis: Pharmacists’ Perceptions, Acceptance, and Concerns

Drones ◽  
2020 ◽  
Vol 4 (4) ◽  
pp. 66
Author(s):  
September Beck ◽  
Tam T. Bui ◽  
Andrew Davies ◽  
Patrick Courtney ◽  
Alex Brown ◽  
...  
Keyword(s):  
Threatening Condition ◽  
Life Threatening ◽  
Relevant Group ◽  
Chemical Purity ◽  
Vitro Model ◽  
The Stability ◽  
The Uk ◽  
Auto Injector ◽  
Temperature Storage

Anaphylaxis is a life-threatening condition where delays in medical treatment can be fatal. Such situations would benefit from the drone delivery of an adrenaline auto-injector such as EpiPen®. This study evaluates the potential risk, reward, and impact of drone transportation on the stability of adrenaline during episodes of anaphylaxis. Further, this study examines pharmacists’ perceptions on drone delivery—pharmacists approved the use of drones to deliver EpiPen® during emergencies but had concerns with drone safety and supply chain security. Laboratory simulated onboard drone conditions reflected typical missions. In these experiments, in vitro model and pharmaceutical equivalent formulations were subjected independently to 30 min vibrations at 5, 8.43, and 13.33 Hz, and temperature storage at 4, 25, 40, and 65 °C for 0, 0.5, 3, and 24 h. The chiral composition (an indicator of chemical purity that relates to molecular structure) and concentration of these adrenaline formulations were determined using ultraviolet (UV) and circular dichroism spectroscopy (CD). Adrenaline intrinsic stability was also explored by edge-of-failure experimentation to signpost the uppermost limits for safe transportation. During drone flight with EpiPen®, the temperature and vibration g-force were 10.7 °C and 1.8 g, respectively. No adverse impact on adrenaline was observed during drone flight and laboratory-simulated conditions shown by conformation to the British Pharmacopeia standards (p > 0.05 for CD and UV). This study showed that drone delivery of EpiPen® is feasible. There are more than 15,000 community pharmacies and ≈9000 GP surgeries spanning the UK, which are likely to provide achievable ranges and distances for the direct drone delivery of EpiPen®. The authors recommend that when designing future missions, in addition to medicine stability testing that models the stresses imposed by drone flight, one must conduct a perceptions survey on the relevant group of medical professionals, because their insights, acceptance, and concerns are extremely valuable for the design and evaluation of the mission.

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