Bacterial Meningitis

Title: Neisseria Meningitis (Meningococcal Meningitis)
Author: Jill Peanasky
Date: May 13, 2009

Abstract
The pathogenic bacteria Neisseria Meningitis, also known as Meningococcal Meningitis, is infamous for its invasion of the Central Nervous System. Although initial symptoms may not seem severe, they often progress to become life-threatening within a couple hours. The five different serotypes of this bacteria include A, B, C, Y and W135. If the bacterial meningitis is treated early and accurately with antibiotics such as Cephalosporins and Penicillin there is an increased risk of survival. Unfortunately, the mortality rate is still between 10 and 14% and it remains the leading community-acquired bacterial meningitis in children and young adults. Hope rests in the new vaccines (Menactra® and Menomune®) that have been developed and lead the way in reducing epidemics from occurring. Research continues to pursue this pathogenic species in order to find a vaccine again serotype B and conquer it all together.

Introduction
This topic is very important to my family and of interest to myself because a several years back my cousin became infected with Meningococcal Meningitis at the age of 18. After an emotion scare and an airlift to the emergency room, my cousin pulled through. All I can remember was how close he was to entering a coma and how an extra half hour could have cost him his life. I find it most interesting how little time after the bacteria enters the nervous system you have to stop it before your body shuts down. It is scary how quickly these seemingly harmless symptoms such as a rash, stiff neck, fatigue and headache can lead to death. Fortunately, new vaccines research is being done. In my future as a nurse I hope that my knowledge of this potentially deadly bacterium can help me pursued people to vaccinate their children at an early age.

Background:
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Neisseria Meningitis is a bacterial disease that affects the central nervous system. It was first isolated in the cerebrospinal fluid of a patient in 1882 and has since then been continuously studied. Epidemics began to develop around the world as World War I started and military troops were mobilized. Studies with military recruits led to the use of chemoprophylaxis with sulfonamides as antimicrobials until penicillin was developed after World War II (Apicella, 2008). Neisseria meningitis exclusively infects humans. In the United States, it is the second most frequent cause of community-acquired bacterial meningitis in adults and the most common for children and young adults since the Haemophilus Influenzae Type B capsular conjugate vaccine was created. If not treated quickly and appropriately, highly fatal with a mortality rate of 10 to 14% (Apicella, 2009B).

Pathology:
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  • Gram Negative Bacteria
  • Diplococcus
  • 0.7 to 1 micron in diameter
  • Flattened adjacent sides
  • Aerobic or facultatively anaerobic
  • It oxidizes both glucose and maltose to produce acid (Apicella, 2008)
  • There are 5 serotypes that are known to cause meningitis: A, B, C , Y , and W-135. (Nassif, 2000)

Symptoms:

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As much as 10 percent of the population carries Neisseria Meningitis in the nose and throat. The meningococcal meningitis usually begins as a throat infection, that then lead to bacteremia and eventually meningitis. Once the endotoxin is produced many symptoms can be experienced including headache, stiff neck, photophobia (sensitivity to light), phonophobia (sensitivity to sound), fever, confusion, and fatigue. The most distinguishing symptom being a rash that does not fade when pressed. In the most extreme cases of Neisseria Meningitis it can proliferate into the bloodstream causing sepsis. Sepsis is a life-threatening and can lead to extensive tissue destruction that could require amputation. (Tortora, 2007).

Transmission:
Neisseria Meningitis is spread through the direct transmission of throat or nose secretions. Once the bacteria enters the system it becomes virulent through several factors including pili, opacity proteins, Lipooligosaccharides, and capsular polysaccharides. The polysaccharide coat is its best virulence factor because it allows it to enter the bloodstream. As discussed earlier, entry into the bloodstream leads to the life-threatening condition of sepsis. The pili are also important in initiating interactions between the bacteria and the host cell. The level of transmission is especially high in areas with people living in close proximities, such as college dormitories. (Nassif, 2000)

Treatment:
Neisseria Meningitis can be confirmed through the use of a spinal tap and a gram stain (Tortora, 2007). Once it has been diagnosed treatment should begin in no more than 30 minutes. A third-generation cephalosporin (such as vancomycin) is usually the first thing prescribed before identification is confirmed. If the organism is recognized to be penicillin-susceptible, then Penicillin-G should be used as treatment. It should be administered intravenously or intramuscularly and it should not be administer more than 24 million units/day. (Apicella, 2009B)

Prevention:
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There are currently two vaccines available to prevent a Neisseria Meningitis outbreak. As these vaccines are injected into the body, they cause a T-cell dependent response to prevent the occurrence of the bacterial infection. The first one is a quadrivalent (http://0-www.uptodateonline.com.iii.sonoma.edu/online/content/topic.do?topicKey=drug_l_z/155853&drug=true) meningococcal polysaccharide vaccine, (Menactra®, MCV-4) was developed in 2005 in the United States. It is quadrivalent because it attacks four of the five serotypes of Neisseria Meningitis. It contains antigens from capsular polysaccharides of serotypes A, C, Y and W135. The other one is a serogroup C conjugate vaccine (Menomune®) used in the United Kingdom and other countries. Unfortunately there is no vaccine developed for serogroup B meningococcal infections, which is one of the most common serotypes. New research and investigation into the genome of the bacteria is being done to find a vaccine and fight this infectious disease. (Apicella, 2009A)

References:
Apicella, Michael. "Meningococcal vaccines." 6 Feb. 2009A. Up To Date. Sonoma State, Rohnert Park. 13 May 2009 <http://0-www.uptodateonline.com.iii.sonoma.edu/online/content/topic.do?topicKey=immunize/9574&selectedTitle=3~49&source=search_result>.

Apicella, Michael. "Microbiology and Pathobiology of Neisseria Meningitidis." 12 June 2008. Up To Date. Sonoma State Unitversity, Rohnert Park. 23 Apr. 2009 <http://0-www.uptodateonline.com.iii.sonoma.edu/online/content/topic.do?topicKey=cns_infe/10809&selectedTitle=14~150&source=search_result#1>.

Apicella, Michael. "Treatment and prevention of meningococcal infection." 13 Feb. 2009B. Up To Date. Sonoma State, Rohnert Park. 13 May 2009 <http://0-www.uptodateonline.com.iii.sonoma.edu/online/content/topic.do?topicKey=cns_infe/10329#>.

Nassif, Xavier. "MICROBIOLOGY: A Furtive Pathogen Revealed." 10 Mar. 2000. Science. Sonoma State, Rohnert Park. 13 May 2009 <http://0-www.sciencemag.org.iii.sonoma.edu/cgi/content/full/sci;287/5459/1767?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&andorexacttitleabs=and&fulltext=Meningococcal+meningitis&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT>.

Tortora, Gerald J., Berdell R. Funke, and Christine L. Case. "Microbial Disease's of the Nervous System." Microbiology: an introduction. Nineth ed. San Francisco: Pearson Benjamin Cummings, 2007. 644-47.


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Title: Pneumococcal Meningitis
Author: Lindsay O'Kane
Date: 5.15.09

ABSTRACT
This paper gives a brief overview of the bacterial disease pneumococcal meningitis caused by Streptococcus pneumonia. This disease is usually found in young infants and older adults because of their weaker immune system. Streptococcus pneumonia is normally found in the respiratory tract and the reason it turns pathogenic is unknown. Symptoms of pneumococcal meningitis include fever, headache, a stiff neck, sensitivity to light and nausea. There is a vaccine available for infants for the prevention of pneumococcal meningitis and antibiotics to help treat current cases. There are long term effects of the disease that include deafness, paralysis, and decreased cognitive learning.


INTRODUCTION
Pneumococcal Meningitis is a disease that is caused by Streptococcus pneumonia and causes inflammation of the lining of the brain and spinal cord. It is the second most prevalent type of bacterial meningitis in the UK and Ireland. The bacteria are quite commonly carried, and are more likely to cause earache, pneumonia and less serious illnesses than meningitis. Pneumococcal meningitis is not considered to be contagious.

Most cases of pneumococcal meningitis are in children under two and adults with diseases of the blood or immune deficiency. A weak immune system is the biggest risk factor in contracting pneumococcal meningitis.

DISCUSSION
Streptococcus pneumonia:

S.pneumoiaemlst.jpg
Streptococcus pneumonia, a Gram-positive bacterium, is found in the back of the nose and throat. The reason that it attacks the body is still unknown. The bacteria usually progresses into pneumococcal meningitis during an ear infection or pneumonia.

Symptoms:
• Irritability
• Nausea/Vomiting
• Low Appetite
• Fever
• Headache
• Stiff Neck

Effects of the Disease:
The mortality rate of pneumococcal meningitis is 20% and half of everyone who has contracted the disease has serious long-term health issues after fighting the disease. These heath problems include deafness, paralysis, and/or loss of a limb. Adult survivors of bacterial meningitis are also at risk of cognitive impairment, which consists mainly of cognitive slowness. The loss of cognitive speed is stable over time after bacterial meningitis but there is a significant improvement in subjective physical impairment in the years after bacterial meningitis (Hoogman). In another experiment looking long-term effects, males were found to have had lower quality of life scores than females. Also, hearing loss is significantly related to pneumococcal meningitis (Legood).

Detection:
It is only possible to detect all types of meningitis by growing bacteria from a sample of a patient’s spinal fluid. The bacteria are then stained in order to be correctly identified.

Prevention:
There is a vaccine available for all infants whom are less than 24 months old called Prevnar. The shot is given in four doses, one at age 2, 4, and 6 months, then a booster at a 12 to 15 months. There are other options for children to get vaccinated with Prevnar if they are unable to start the series of shots at two months. This vaccine protects only 7 of the 80 most common strains of Streptococcus pneumonia. These strains account for 86% of the pneumococcal infections. This vaccine was introduced in 2000, and since then, the hospitalization rate among pneumococcal meningitis cases have significantly decreased, especially in infants. Most cases today are found in adults (Tsai).

Treatment:
Antibotics, such as ceftriaxone and penicillin, are available for the treatment of pneumococcal meningitis and are given intravenously. Oral antibiotics, ciproflaxin and rifampin, are also given to a patient until the infection’s resistance to the drug causes the treatment to no longer work.


LITERATURE CITED

www.meningitis.org
ww.meningitisfoundationofamerica.org

Hoogman, Martine, et al. "Cognitive outcome in adults after bacterial meningitis." Journal of Neurology Neurosurgery & Psychiatry 78.10 (Oct. 2007): 1092-1096. Biological Abstracts 1969 - Present. EBSCO. 15 May 2009 <http://0-search.ebscohost.com.iii.sonoma.edu/login.aspx?direct=true&db=boh&AN=BACD200800042251&loginpage=Login.asp&site=ehost-live&scope=site>.

Legood, Rosa, et al. "Health related quality of life in survivors of pneumococcal meningitis." Acta Paediatrica 98.3 (Mar. 2009). Biological Abstracts 1969 - Present. EBSCO. 15 May 2009 <http://0-search.ebscohost.com.iii.sonoma.edu/login.aspx?direct=true&db=boh&AN=BACD200900104313&loginpage=Login.asp&site=ehost-live&scope=site>.

Tsai, Chiaojung Jillian, et al. "Changing epidemiology of pneumococcal meningitis after the introduction of pneumococcal conjugate vaccine in the United States." Clinical Infectious Diseases 46.11 (01 June 2008). Biological Abstracts 1969 - Present. EBSCO. 15 May 2009 <http://0-search.ebscohost.com.iii.sonoma.edu/login.aspx?direct=true&db=boh&AN=BACD200800252776&loginpage=Login.asp&site=ehost-live&scope=site>.

http://sitemaker.umich.edu/mc2/pneumonia (Image)