phenylephrine-hydrochloride and Meningitis--Pneumococcal

Pneumococcal meningitis is a life-threatening disease characterized by an acute purulent infection affecting piamater, arachnoid and the subarachnoid space. The intense inflammatory host's response is potentially fatal and contributes to the neurological sequelae. Streptococcus pneumoniae colonizes the nasopharynx, followed by bacteremia, microbial invasion and blood-brain barrier traversal. S. pneumoniae is recognized by antigen-presenting cells through the binding of Toll-like receptors inducing the activation of factor nuclear kappa B or mitogen-activated protein kinase pathways and subsequent up-regulation of lymphocyte populations and expression of numerous proteins involved in inflammation and immune response. Many brain cells can produce cytokines, chemokines and others pro-inflammatory molecules in response to bacteria stimuli, as consequence, polymorphonuclear are attracted, activated and released in large amounts of superoxide anion and nitric oxide, leading to the peroxynitrite formation, generating oxidative stress. This cascade leads to lipid peroxidation, mitochondrial damage, blood-brain barrier breakdown contributing to cell injury during pneumococcal meningitis.

Topics: Acute Disease; Adrenal Cortex Hormones; Cytokines; Humans; Matrix Metalloproteinases; Meningitis, Pneumococcal; Nose; Oxidative Stress; Streptococcus pneumoniae

In most cases, surgical management of craniofacial fractures involves correction of occlusion. This requires nasal intubation. In the case of frontobasal fractures with simultaneous cerebrospinal fluid (CSF) fistula, nasal intubation is thought to increase the risk of meningitis. An analysis of the records of 160 patients with frontobasal fractures and CSF fistulae showed that the route of intubation had no influence on the postoperative complication rate. Nasal intubation is therefore not contraindicated in frontobasal fractures with CSF fistulae.

Topics: Anti-Bacterial Agents; Cerebrospinal Fluid; Dura Mater; Facial Bones; Fistula; Fracture Fixation, Internal; Frontal Bone; Humans; Incidence; Intubation, Intratracheal; Meningitis, Pneumococcal; Nose; Retrospective Studies; Risk Factors; Skull Fractures; Time Factors

We present an interesting case of a 7-year-old child who developed severe bacterial meningitis requiring admission to paediatric ICU. Initial investigations failed to identify the reason for this otherwise healthy child to develop this life-threatening condition. The child recovered fully with no long-term sequelae. Further on-going unilateral purulent rhinorrhoea lead to ENT referral. CT head from a previous admission showed mucosal thickening and fluid within paranasal sinuses. Reluctance to expose the child to further radiation meant that no formal scan of sinuses was organised and the child was diagnosed with chronic rhinosinusitis. Symptoms failed to improve despite the treatment. A subsequent CT scan of sinuses revealed a radiopaque foreign body in the nasal cavity. This is a rare presentation of a nasal foreign body causing bacterial meningitis. This case highlights the importance of comprehensive investigations to avoid delays in establishing a correct diagnosis and initiating the appropriate treatment.

Topics: Child; Foreign Bodies; Humans; Maxillary Sinus; Meningitis, Pneumococcal; Nose; Rhinitis; Sinusitis; Tomography, X-Ray Computed

In most cases the surgical management of craniofacial fractures involves a correction of the occlusion. This requires nasal intubation. In a frontobasal fracture with simultaneous CSF fistula, nasal intubation is thought to increase the risk of meningitis. An analysis of the records of 160 patients with frontobasal fractures and CSF fistulae revealed that the route of intubation had no influence on the post-operative complication rate. Nasal intubation is therefore not contraindicated in frontobasal fractures with CSF fistulae.

Topics: Cerebrospinal Fluid Rhinorrhea; Contraindications; Frontal Bone; Humans; Intubation, Intratracheal; Meningitis, Pneumococcal; Nose; Skull Fractures

A case of a complicated penetrating nasal injury is presented. The rapid diagnosis of cerebrospinal fluid rhinorrhea, with appropriate bedside tests and imaging techniques, is essential for the prevention of bacterial meningitis.

Topics: Cerebrospinal Fluid Rhinorrhea; Child, Preschool; Humans; Male; Meningitis, Pneumococcal; Nose; Skull Fractures

Topics: Craniotomy; Encephalocele; Humans; Meningitis; Meningitis, Pneumococcal; Neurosurgery; Neurosurgical Procedures; Nose; Postoperative Complications

Topics: Drug Resistance; Drug Resistance, Microbial; Erythromycin; Humans; Injections; Meningitis; Meningitis, Pneumococcal; Nose; Postoperative Complications; Spinal Canal; Streptococcus pneumoniae