What is Meningitis? Cerebrospinal fluid protects the brain and spinal ...

the “MENINGITIS BELT”,an area of endemic diffusion of meningococcus infection2

Bacterial Meningitis is very serious, can be contagious and requireshospitalization during treatment. Bacterial meningitis may result in braindamage, hearing loss, learning disability, and even death. For bacterialmeningitis, it is important to know which type of bacteria is causing themeningitis because antibiotics like CHLORAMPHENICOL can preventsome types from spreading and infecting other people. Neisseriameningitidis is the common cause of bacterial meningitis. There are 4known types, and there are vaccines. Unfortunately the vaccine is notalways effective in young children.3

Symptoms:A very bad headache that won't go awayNeck StiffnessBack StiffnessEye Pain or irritation when exposed to lightNausea or being sick to the stomachVomiting or throwing upBody achesFeverFeeling very sleepy or unable to fully wakeupFeeling very confused or out of it*Symptoms can come on very quickly or takea couple of days to appear.4

Diagnosis:A spinal tap is performed to collect cerebrospinal fluid that surroundsthe spinal cord for examination under the microscope. The doctorwill numb an area along the spine and then insert a needle betweentwo vertebras to collect a sample for testing. Treatment depends onthe type of meningitis. If bacterial meningitis is suspected thediagnosis is usually made by growing bacteria from a sample of spinalfluid.5

Causes of raised intracranial pressure in a patient with bacterialmeningitis.(A) Diffuse swelling of the brain. (B) Hydrocephalus results from basalobstruction of the cerebrospinal fluid. (C) Infarcts are caused byinflammatory occlusion of arteries. (D) Thrombosis of the cerebral veinsand sinuses.7

Chloramphenicol B.P.SuspensionComposition:Each 5ml (teaspoonful) of homogenous suspension contains Chloramphenicol palmitateequivalent of 125mg Chloramphenicol B.P.Indications:Typhoid and paratyphoid fevers caused by S. typhi and S. paratyphi and other Salmonellainfections, meningitis caused by Haemophilus influenza, Reckettsial infections and epidemictyphus, chronic infection of urinary tract caused by Proteus vulgaris which does not respond totreatment with other antibiotics.Side Effects:Agranulocytosis, aplastic anaemia, thrombocytopenic purpura and bone marrow depression mayoccur in long term therapy . Other side effects include renal toxicity, optic neuritis, jaundice,dryness of the mouth, nausea, vomiting diarrhoea, skin rashes, increase growth of Candidaalbicans or other fungi on the mucous membrane may occur causing stomatitis, sore tongue andrectal or vaginal irritation, and haemolytic anaemia in some patients with a genetic deficiency ofglucose – 6-phosphate dehydrogenase activity . Large doses on infant may lead to “the greysyndrome characterized by ashen colour of the skin; irregular respiration, perspiration,progressive pallid cyanosis, circulatory collapse and eventually death. Prolonged administrationmay induce bleeding, either by bone marrow depression or by reduction of intestinal flora whichleads to inhibition of vitamin K, hence high prothrombin time.Special Precautions:Avoid long-term treatment (not more than 10 days) and in hepatic renal impairment regularblood cell count should be performed. Chloramphenicol should not be given during activeimmunization.Drugs interaction:Avoid concomitant use with anticoagulants; antidiabetic agents etc. discontinue the treatment ifserum iron level is high, avoid use in newly born babies. Systemic half-life is enhanced by drugsthat inhibit liver oxidative enzymes; such rifampicin, paracetamol, phenobarbitone, phenytoin.This is important in cases of poor liver function, mild toxicity to Chloramphenicol and low fullblood count.8

Chloramphenicol has excellent oral bioavailability:The concentration achieved in brain andcerebrospinal fluid (CSF) is around 30 to 50% evenwhen the meninges are not inflamed; this increasesto as high as 89% when the meninges are inflamed.9

Gray (or Grey) baby syndromecausata da insufficiente capacità metabolicadel neonato(scarsa glicuronazione + insufficiente escrezione delfarmaco non coniugato)10