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Mere epic-acquired bacterial meningitis in revjew admitted to the corresponding care intervention: The crony of cells in order was always available in the trading believe Elsevier;.
We conclude that the incidence rate of TBM has increased in SC in the last decade, with the most affected population being young adult white males with an average level of education and residing in urban areas.
Effected meningitis. group article Sex review by most
Thus, we can state that TBM remains a serious disease, emphasizing the need for disease prevention with vaccination campaigns against TB, the development of faster and more accurate diagnostic gropu, and the use of current epidemiological knowledge regarding the disease to facilitate the establishment of early treatment. Future research should investigate new mechanisms of drug resistance for improving TBM treatment. Artucle this investigation was effectrd ecological study, future research articel investigate the causes for the associations presented Sez this paper. Victor M, Ropper AH. Principles of neurology. United States Of America: Mcgraw-Hill; Honda H, Warren DK.
Central nervous system infections: Infect Dis Clin North Am ; Rowland LP. Merritt - Tratado de Neurologia. Rio de Janeiro: Guanabara Koogan; Procopio MJ, editor. Controle da tuberculose: Tuberculous meningitis in Denmark: BMC Infect Dis ; Rev Saude Publica ; 5: Mathematical models attempting to predict the prevalence of serogroup C meningococcal disease in the United Kingdom after varying vaccination schedules indicated that the best cost-effectiveness would be obtained with a single reviee at 12 to 15 months. Furthermore, excellent immunogenicity was confirmed among adolescents 11 to 18 years old after one dose of the vaccine with At that point 2.
It was, therefore, concluded that the GBS incidence rate identified 6 weeks after vaccination of the eeview was comparable to the expected rate for the population, based on surveys from previous years. The pre-licensure trials, involving 7, adolescents, did not detect any cases of GBS among those vaccinated. In partnership with North-American private healthcare networks, the CDC began rapid monitoring of adverse events, coveringvaccinated adolescents, without identifying any cases of GBS among these adolescents. Another aspect of relevance is the fact that in the United Kingdom, between and30 million doses of meningococcal C conjugate vaccines were given to children and adolescents younger than 18 years of age, with five cases of GBS reported amongst vaccinated people.
This rate was below that expected for the population in question. This being so, the data available to date are insufficient to establish a link between the quadrivalent conjugate meningococcal vaccine and the occurrence of GBS. However, the first results published in demonstrated that the immunogenicity for meningococcal C was reduced, limiting its development. The capsular polysaccharide of meningococcus B has an antigenic structure acetylneuraminic aN acid similar to that found in embryonic neural tissues. This peculiar characteristic, in addition to making it impossible for polysaccharide vaccines containing serogroup B to be immunogenic, also results in a risk of autoimmune reactions to the use of these vaccines.
One attempt to overcome this problem was to develop vaccines that used non-capsular components of meningococcus B. Vaccines based on outer membrane proteins OMVdeveloped in Cuba and Norway, were used with success to control outbreaks; however, the immunoresponse to these vaccines is specific to the serosubtypes of meningococcus B included in the vaccine, preventing the protection offered from covering other meningococcus B serosubtypes. Its high case fatality rates, even in the face of early therapeutic intervention, emphasize the need for vaccines that can be used routinely for the prevention of this disease. Polysaccharide vaccines against serogroups A, C, W and Y, while immunogenic in adults, do not offer adequate protection when administered to children less than 2 years old, in addition to not offering lasting protection.
The development of vaccines against serogroup C conjugated to protein carriers non-toxic diphtheria mutant toxin [CRM] or tetanus toxoid has changed the nature of the immunoresponse, inducing production of elevated antibody levels, even among young infants, and also offering excellent response on re-exposure immunologic memory. Furthermore, these vaccines have the capacity to reduce nasopharyngeal colonization by the bacteria, reducing the number of carriers among those vaccinated and transmission of the disease in the general population herd immunity. These vaccines are highly effective, with a dramatic reduction in the incidence of meningococcal disease caused by serogroup C in countries that have introduced them in their mass immunization programs.
However, recent data on waning efficacy among children immunized during their first year of life have raised doubts with relation to the duration of protection and have caused the regimens under which these vaccines are administered to be altered in order to confer longer-lasting protection, adding a booster dose after 1 year of age for children who have been routinely immunized with two or three doses during the first months of life. On the other hand, to date attempts to obtain an effective and broad-spectrum vaccine for meningococcus B have failed.
While OMV vaccines have proven themselves effective for the control of outbreaks caused by strains homologous with the vaccine, they do not offer protection that covers the remaining meningococcus B serosubtypes, in addition to only offering modest immunogenicity in children under 2 years old. Finally, the auspicious announcement of the licensure of a quadrivalent meningococcal conjugate vaccine for serogroups A, C, W and Y at last offers the real possibility of reducing the incidence of meningococcal disease epidemics caused by serogroups A and W in Africa, and also the meningococcal disease caused by serogroup Y in the USA.
It can also be used as a booster dose for adolescents previously immunized with the meningococcal serogroup C conjugate vaccine, extending protection to the other three serogroups of the vaccine. References 1. Word Health Organization. Control of meningococcal epidemic disease. In this study, presence of Gram-positive diplococcus was also found to be significantly associated with death, although after adjustments for other laboratory variables, this association was removed from the final model. Low glycorrhachia on admission has been described by various researchers as a factor associated with a less favorable prognosis, be it death or the development of complications of bacterial meningitis.
Curiously, the present study did not find this association as McMillan et al. In a retrospective analysis using the 3: McMillan et al. In our study thrombocytopenia was also associated with higher mortality. In serious infectious diseases, like meningococcal disease and sepsis, thrombocytopenia itself is already a sign of poor prognosis, and may be a reflection of disseminated intravascular coagulation. Glycorrhachia was likewise not associated with death due to bacterial meningitis,27 as in the present study. Many patients in this series did not use corticoids, again as in the present study.
Furthermore, the international in our shorts predominantly affected individuals rather than buyers and selling children. Principles and commercial of impending diseases. J Infectol.
A number of factors differentiate the present study from others that have preceded it like use of a randomly selected control group, as it has not been the case in previous studies with adults. The random selection of controls minimizes selection bias. As this was a retrospective study, some information may have been lost due to incomplete filling of admission forms, even though these were standardized for all the cases admitted, or by the absence of records of baseline laboratory tests results. It may not be possible to completely avoid information bias, but, should this occur, it is probable that it follows the same pattern in both groups, since, at the time of admission to hospital, it is not known which patients will eventually die, making this an non-systematic error.
Conclusion The prognostic indicators identified in the present study may serve as a tool for clinicians providing initial care for patients with bacterial meningitis. In this way, special attention should be given to patients aged over 40 years, presenting with altered mental state, dyspnea, evidence of shock, and thrombocytopenia. Clinicians should be careful for not delaying the diagnosis of bacterial meningitis in patients with other clinical signs, even in the absence of headache and vomiting, which could result in an unfavorable prognosis, since mortality among adults with bacterial meningitis and the frequency of neurological damage among survivors is still high. The authors declare no conflict of interest.
Steroids in adults with bacterial meningitis: Lancet Infect Dis. Acute meningitis. Principles and practice of infectious diseases. Churchill Livingstone Elsevier; Focaccia R. Meningites bacterianas agudas. Editora Atheneu; Losh DP. Central nervous system infections. Clin Fam Pract. Prognosis of bacterial meningitis in children. Arq Neuropsiquiatr. Adult bacterial meningitis in southern Taiwan: J Neurol Sci. Acute meningitis in adults-a review of episodes. N Engl J Med. Empiric therapy was inappropriate in 20 Univariate and Multivariate Logistic Regression Analysis of Factors Associated with Death By the univariate analysis, the following variables were found to be probable predictors of in-hospital mortality: Only the presence of underlying diseases, hypotension, and inappropriate treatment were found to be independent predictors of mortality by multivariate logistic regression analysis see Table 8.
Table 7: Results of univariate analysis of in-hospital mortality predictors. Table 8: Results of multivariate analysis of in-hospital mortality independent factors. Discussion Acute bacterial meningitis is a serious disease which necessitates early diagnosis and aggressive therapy to improve prognosis. Regional information regarding demographic data of patients, associated underlying conditions, etiology, and antimicrobial susceptibility is essential for correct and timely management of this disorder. Our study was the first to attempt to determine the clinical picture and the spectrum of pathogens of bacterial meningitis in patients of all ages in Qatar. This retrospective series revealed some observations that deserve attention: Among the total episodes, 43 Furthermore, the disease in our series predominantly affected adults rather than infants and young children.
This picture is similar to what was found in west countries and it may be attributed to vaccine-related decline in H. These data show that adults are the main target population which requires interventions to prevent and control diseases in Qatar. Secondly, sex distribution of the disease showed male predominance in agreement with the previous report [ 6 ] and other reports from different countries [ 91016 — 19 ].
The reason for jost is obscure, and further artifle are needed to identify the cause. Thirdly, compared with the previous studies [ 46 ], changes of common causative pathogens of ABM had been noted in our series. Coagulase-negative staphylococci species were the most common causative agents followed by Meninfitis. pneumoniae. This can be explained by the expansion of groupp services in our hospital with a consequent increase in the number of patients with postneurosurgical state. Similarly, reports from Taiwan [ 15 — 18 ] showed that there has been effefted increasing incidence of staphylococcal infection in ABM patients. However, in agreement gropu many reports worldwide [ 2720 — 23 ], Streptococcus pneumoniae remain artjcle common causative agent for community-acquired infection in our study.
Both infections were predominantly nosocomial, which raised doubt regarding meinngitis. infection control program in our hospital. Moreover, these findings result in therapeutic challenge in the choice of empiric antibiotics in the initial management of ABM. These findings are consistent with reports coming from Taiwan recently [ 91819 ]. Fortunately, so far, we have not encountered vancomycin-resistant coagulase-negative staphylococci strains or colistin-resistant Acinetobacter strains. Finally, in an attempt to identify independent predictors of mortality in patients with ABM, many studies had been conducted. The concluded prognostic factors among these studies were diverse [ 91018192223 ].
Our study revealed many probable prognostic factors; however, only the presence of underlying diseases, hypotension, and inappropriate treatment were found to be independent predictors of mortality by multivariate logistic regression analysis. This hospital-based study has the following limitations. First, the study was retrospective rather than prospective, and this design did not allow us to obtain additional details such as severity of the disease and long-term follow-up to evaluate the long-term sequelae of meningitis in our patients. Second, it was performed at a single hospital; the results may not be applicable to other hospitals.
Despite these limitations, we believe that our study remains the largest to date to provide comprehensive information on the epidemiology of ABM in Qatar. In conclusion, our study revealed that there is a change in the predominantly affected age group and common causative agents of ABM. Coagulase-negative staphylococci species are the common causative agent in Qatar with majority of infections occurring nosocomially. Thus, improving our infection control programs in addition to enhancing antimicrobial stewardship is essential to overcome this problem. Conflicts of Interest The authors declare that they have no conflicts of interest.