1. Meningitis PHCL 442 Lab Discussion Jamilah Al-Saidan M.Sc

2. Topics we will cover in Meningitis Microbiology of bacterial meningitis Prevention of H. influenzae type b meningitis Prevention of N. meningitidis meningitis Prevention of S. pneumoniae meningitis

3. Microbiology The bacterial etiologies of meningitis correlate very well with age and underlying conditions. Q: For each age group or predisposing condition, what is the most likely causative organism of meningitis? Assignments: Word processing Reference (s) Answered by

4. Microbiology GroupMost likely organism ≤ 1 monthS.agalactiae, E.coli, L.monocytogenes, Klebsiella 1–23 monthsS.pneumoniae, N.meningitidis, S. agalactiae, H.influenzae, E. coli 2-50 yearsN.meningitidis, S.pneumoniae ≥ 50 yearsS.pneumoniae, N.meningitidis, L.monocytogenes, aerobic gram-negative bacilli Head traumaS. pneumoniae, H. influenzae, group A b-hemolytic streptococci Post- neurosurgery Gram - bacilli (P.aeruginosa), S.aureus, coagulase- negative staphy. (S.epidermidis)

5. Prevention of H. influenzae type b Meningitis Anyone > 2 mo should be vaccinated HbOC, PRPT, and PRP-OMP are equally effective Side effects: fever, redness & swelling at site of infection in only < 4% of patients

6. Prevention of H. influenzae type b Meningitis Schedule Vaccine2 mo4 mo6 mo12 mo15 mo HbOCDose 1Dose 2Dose 3--Booster PRP-TDose 1Dose 2Dose 3--Booster PRP-OMPDose 1Dose 2Booster--

7. Prevention of N. meningitidis Meningitis N. meningitidis is responsible for outbreaks & epidemics Type A, B & C are responsible for > 90% of N. meningitidis infections Vaccine not cover B Level of antibodies achieved in 7 – 10 days

8. Prevention of N. meningitidis Meningitis Vaccination not recommended for general population Who should be vaccinated? 1.Patients with underlying complement deficiency 2.Anatomical/functional asplenia 3.Patients traveling to endemic or epidemic areas 4.Areas of outbreaks or epidemic conditions 5.College freshman (living in a dormitory appear to have an increased risk of acquiring meningococci)

9. Prevention of S. pneumoniae Meningitis 25 serotypes of S. pneumoniae which are responsible for causing 88% of bacterial pneumococcal disease Not given for children < 2 years old Only one single dose is needed But may need to repeat it ≥ 5 years

10. Prevention of S. pneumoniae Meningitis Who should be vaccinated? 1.Chronic cardiopulmonary disease 2.DM 3.Alcoholism 4.Cirrhosis 5.CSF leak 6.Asplenia 7.Individuals > 65 years old 8.Immunocompromised ( Cancer, CRF, HIV & organ transplant patients DM = Diabetes Mellitus, CRF = Chronic Renal Failure, HIV = Human Immunodeficiency Virus