Friday, 29 November 2013

Meningitis Treatments In conventional Medicine

Meningitis is defined as a condition of inflammation of the protective membranes,  covering the brain and spinal cord (meninges). Meningitis, a life threaten disease, can kill and immediate action can and does save lives.(1) Although bacterial meningitis has become an uncommon disease in the developed world. Unfortunately, because of limited economic resources and poor living conditions, many developing countries are still affected by the devastating consequences of this life-threatening systemic infection(2)
A. In conventional Medicine
A.1. Vaccines
Vaccine is defined as is a biological preparation to enhance immune function against a particular disease.
1. Monovalent meningococcal C conjugate vaccine (MCV-C)
 One dose of serogroup C meningococcal conjugate vaccine (MCV-C) at 12 months of age is the most common immunization schedule in Canada, but immunity may wane over time.(52)

2. Tetravalent meningococcal polysaccharide vaccine (MPV-ACWY)
Serum bactericidal activity and antibodies against serogroups A and C were determined before and after they received MCV-C, and 4 weeks after they received MPV-ACWY. Near-total splenectomy provides a favourable immunological basis for natural and vaccine-induced protection against meningococcal serogroup A and C infections. Sequential meningococcal vaccination is immunogenic in patients splenectomized for hereditary spherocytosis.(53)

3. Meningococcal conjugate vaccine(MCV-4) 
A newly licensed vaccine (pneumococcal conjugate vaccine) that appears to be effective in infants for the prevention of pneumococcal infections and is routinely recommended for all children greater than 2 years of age.(54)

4. The pneumococcal polysaccharide vaccine
College freshman, especially those who live in dormitories are at higher risk for meningococcal disease and should be educated about the availability of a safe and effective vaccine which can decrease their risk. Although large epidemics of meningococcal meningitis do not occur in the United States, some countries experience large, periodic epidemics. Overseas travelers should check to see if meningococcal vaccine is recommended for their destination. Travelers should receive the vaccine at least 1 week before departure, if possible. Information on areas for which meningococcal vaccine is recommended can be obtained by calling the Centers for Disease Control and Prevention at (404)-332-4565. There are vaccines to prevent meningitis due to S. pneumoniae (also called pneumococcal meningitis) which can also prevent other forms of infection due to S. pneumoniae . The pneumococcal polysaccharide vaccine is recommended for all persons over 65 years of age and younger persons at least 2 years old with certain chronic medical problems(54)

5. Etc.

A. 2. Medication
1. Antibiotics
a. Bacterial meningitis can be treated with a number of effective antibiotics, depending to  the bacteria causing the infection, In the study of moxifloxacin and ampicillin + gentamicin in the treatment of Listeria monocytogenes meningitis in a rabbit meningitis model, scientists at Ege University showed that moxifloxacin (M), ampicillin + gentamicin (A), ampicillin + gentamicin 2 (A2) and control (C). Group M received 20 mg/kg moxifloxacin at the end of the incubation time and 5 h later by intravenous (i.v.) route. Group A received ampicillin (30 mg/kg/h) and gentamicin (2.5 mg/kg/h) by i.v. route with continuous infusion for 8 h in 36 mL of 0.9% NaCl, group A2 received the same dosage of gentamicin and ampicillin in two different 36 mL 0.9% NaCl solutions and group C did not receive any treatment. Cerebrospinal fluid (CSF) samples (0.1-0.25 mL) were obtained 16 and 24 h after induction of meningitis. When the three treatment groups were compared, bacterial counts were found to be similar (P > 0.05)(55)

b. Side effects are not limit to diarrhea and gastrointestinal discomfort. In some cases, antibiotics can cause
b.1. Vomiting Severe watery diarrhea and
b.2. Abdominal cramps
b.3. Allergic reaction, such as shortness of breath, hives, swelling, etc.
b.4. Skin  Rash
b.5. Etc.

2.  Corticosteroids
a. Dexamethasone treatment may be associated with a lower mortality in adults and fewer neurological and auditory sequelae in adults and children from high-income countries, in particular in adults suffering from pneumococcal meningitis. In contrast, studies conducted in developing countries have yielded less favourable results.(56). Others suggested that the adjunctive administration of corticosteroids is beneficial in the treatment of adolescents and adults with bacterial meningitis in patient populations similar to those seen in high-income countries and in areas with a low prevalence of HIV infection.(57)

b.  Side effects are not limit to
b.1. stomach irritation
b.2. rapid heartbeat (tachycardia)
b.3. nausea
b.4. insomnia
b.5. Etc.
Other severe side effects include hyperglycemia, insulin resistance, diabetes mellitus,osteoporosis, cataract, anxiety, depression, colitis, hypertension, ictus, erectile dysfunction, hypogonadism, hypothyroidism, amenorrhoea, and retinopathy.(58)

A.2. Viral Meningitis 
1. According to the statistic
Enteroviruses account for more than 85% of all cases of viral meningitis,  Arboviruses account for about 5% of cases in North America, Herpes family viruses (Herpes simplex virus (HSV)-1, HSV-2, varicella-zoster virus (VZV), Ebstein-Barr virus (EBV), cytomegalovirus (CMV), and human herpesvirus-6 collectively)  cause approximately 4% of cases of viral meningitis(58)

2.  There is no treatment for viral meningitis, as the immune system, however, will produce antibodies to destroy the virus. Care must be taken during the Leighton for the body to run its course.

A.3. Aseptic meningitis
Clinicians must consider partially-treated bacterial meningitis as a possible etiology for the aseptic nature of their patient's disease; for example, patients with bacterial otitis and sinusitis who have been taking antibiotics may present with meningitis and CSF findings identical to those of viral meningitis.(58)

A.4. Parasitic meningitis
Parasitic meningitis usually is treat with a benzimidazole derivative or corticosteroid
1. Benzimidazole derivative
a. Albendazole 
Researchers at the Chung Shan Medical University, in the study of the efficacy of Albendazole  in parasitic meningitis, showed that examination of brain tissue revealed a similar pattern of decrease (48.6% by day 7, and 53.9% by day 14). Albendazole may thus be an effective compound for the treatment of angiostrongyliasis through its larvicidal activity and facilitation of an improved inflammatory response via the reduction of MMP-9 activity(59)

b. Albendazole-GM6001 co therapy
The combination treatment reduced MMP-9 activity by 89.2% in cerebrospinal fluid. The numbers of inflammatory cells increased significantly upon establishment of infection, but subsided upon co-treatment. Significantly fewer larvae were recovered from treated mice than from untreated, infected mice. The present results strongly suggest that co-therapy with albendazole and GM6001 may be an useful approach for the treatment of human angiostrongyliasis.(60)

c. Etc.

2. Corticosteroid
Dr. Sawanyawisuth K, at the Khon Kaen University, in the study of Drug target in eosinophilic meningitis caused by Angiostrongylus cantonensis showed that eosinophilic meningitis caused by Angiostrongylus cantonensis is an emerging infectious disease. It is the most common form of human angiostrongyliasis. The diagnosis is made by clinical criteria including the presence of cerebrospinal fluid eosinophils and a history of exposure to A. cantonensis larvae, e.g., from raw freshwater snails or contaminated vegetables. Among various treatment options, corticosteroid is the only effective treatment.(61)

3. Others suggested treatment options consist of symptomatic interventions, steroid therapy, antihelminthic therapy, or a combination of these strategies(62). Others showed that interleukin-12 and mebendazole lower levels of worm recovery and dramatic lessening of the eosinophilic meningitis. A reverse transcriptase PCR assay of mRNA expression in the brain also revealed that the use of IL-12 had shifted the immune response of the mouse from Th2 type to Th1 type.(63)

4. Etc.

A.5. Non medication causes of meningitis
There is report of 39-year-old woman with systemic lupus who presented with recurrent aseptic meningitis secondary to treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), clinical manifestation resolved rapidly with ibuprofen discontinuation, and corticosteroids therapy was unnecessary. Aseptic meningitis related to NSAIDs reported in lupus patients should be considered because of their specific modality of care and their favourable outcome.(64).
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