ACUTE MENINGOCOCCAL SEPTICAEMIA WITH ADRENAL HEMORRHAGE

ACUTE MENINGITIS DUE TO OTHER BACTERIA

Meningitis due to pneumococcus, streptococcus, staphylococcus and H. influensscs is almost always secondary to some other focus of infection in the body, the most common situation being the paranasal air cells or the mastoid process. Should the bacteriological report incriminate one of these organisms, both sulphonamide and antibiotic therapy should be given. The treatment calls for the closest co-operation of physician, neurosurgeon and bacteriologist, and such patients should rarely be treated outside of hospital. Pneumococcal menin­gitis is by far the most serious form and still carries a high fatality rate. Thus prompt and rigorous treatment is especially important. The following are;the main principles of treatment;
Sulphonamides.—The dosage should be high and should be continued for ten days. Sulphadiazine or sulphadimidine should be given. The -organism isolated should be tested for its sensitivity to sulphonamides.Antibiotics.—Penicillin is the antibiotic most generally useful and is given systemically in a dose of at least 500,000 units every four hours. Intrathecal administration is usually essential, the dose being 20,000 units once daily. By giving large doses of penicillin, purulent foci can usually be brought under control without the need for immediate surgical interference. The testing of the bacterium originally isolated for sensitivity to a wide range of antibiotics is very important, especially in haemophilus and staphylococcus infections. Frequent bacteriological control of the cerebrospinal fluid during treatment is essential. Sfr.-eptomycin combined with sulphadiazine is the initial treatment of choice for H. influenza meningitis. Systemically the dose of streptomycin –is 1 to 3 g. daily for a period of five days ; intrathecally a dose of 50 to 100 mg. should be given at each lumbar puncture. Tetracycline, chloramphenicol or erythromycin may be preferred for certain patients as a result of the initial sensitivity testing, but, particularly with H. influenza strains, it is important to bear in mind not only the possibility of infection by initially resistant strains but also of the development, under treatment, of resistance to the antibiotic in use. For this reason repeated changes of treatment for " panic " reasons unsupported by precise bacteriological data are to be condemned. In guiding the patient through these hazards close co-operation with the bacteriologist is essential. Testing of the direct antibacterial activity of the cerebrospinal fluid against the organism responsible for the meningitis is a useful measure for it ensures that the parenterally administered antibiotic is reaching the meninges in adequate amounts. As a general rule antibiotic treatment should be continued for 10 days.
Relapse, Blockage, Encephalitis and Brain Abscess.—These complications are much more liable to arise from the organisms mentioned above than after meningococcal meningitis and must be kept constantly in mind. There must be no hesitation in performing lumbar, cisternal or ventricular puncture; any indication of rising intracranial pressure, especially in streptococcal infec­tions, should raise the suspicion of abscess formation. Electro-encephalography is most valuable in confirming a suspicion of abscess and in helping to localizeit. The co-operation of the neurosurgeon is essential for success.