Chapter: Diseases of The Brain and Nervous System(A Health Education Guide): Infectious diseases of the brain

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Pyogenic Meningitis and its Drugs

Apart from TB, this is an important and dangerous type of meningitis that occurs due to certain infectious organisms, which form pus in the brain.

Pyogenic Meningitis :

Apart from TB, this is an important and dangerous type of meningitis that occurs due to certain infectious organisms, which form pus in the brain. The pus is formed rapidly on the membranes of the brain and spreads more quickly compared to TB, leading to the deterioration of the patient’s condition within a span of few hours or days. Symptoms range from high fever, severe unbearable headache, vomiting, pain in the posterior part of the neck and photophobia to ultimately unconsciousness, seizures and eventually death in a short time, in the absence of proper treatment.

The various types of Gram-positive and Gram-negative bacteria that can rapidly cause harm to the brainare,meningococcus, staphylococcus, pneumococcus,streptococcus, listeria, H. influenzie, pseudomonas, proteus, E.coli etc. An early diagnosis and treatment cancure the patient without any long-term disability or side effects. If there is a severe headache with high fever, there is always a doubt of an infection of the brain. If along with this, the person’s speech and gait (walking) is affected, seizures or loss of consciousness occurs then, he should be immediately taken for a CT Scan even in the middle of the night and be admitted to the hospital and if necessary CSF examination should also be conducted so that the right diagnosis comes immediately for the treatment. These tests should be done under proper supervision in a reputed laboratory because the CSF report decides the appropriate antibiotic to be given to the patient and this decides the patient’s future. No compromise should ever be done in such cases.

In meningitis, the CSF report shows hundreds and thousands of neutrophils with increase in protein levels while the glucose levels fall very low. Thus, the reports of CSF differ for TB meningitis and pyogenic, meningitis. These germs can be identified accurately under a microscope with the help of gram stain. From all these reports, the doctor decides the immediate drugs. In all the cases, it is necessary to carry out CSF culture and sensitivity test, the results of which are available in 48 to 72 hours. This allows the doctor to decide whether the medicines, which are prescribed prior to the test, are accurate or need to be changed. If required Latex particle Agglutination, serological tests for syphilis, virus isolation test, immunoassay, test for fungus and PCR test for TB are carried out. Thus, it is confirmed that the patient is definitely suffering from pyogenic meningitis and appropriate drugs are given after identifying the disease causing organisms.

 

Drugs :

If necessary drugs like cephalosporin, penicillin, vancomycin, gentamycin, chloramphenicol, metronidazole etc. are administered. All these medicines are very effective and 80 to 95 % cases can be cured if these drugs are used in appropriate dose and combination at an early stage. Usually, these medicines are given for 10 to 14 days continuously and if required, changes can be made on the basis of the culture report. The medication is stopped only after another C.S.F examination shows that all organisms have been destroyed and no more pus formation is taking place. Even if a little infection remains in the brain, there is a possibility of a recurrence of the disease in a short time. Now the same drug may not be effective, this is called drug resistance.

If there is an extensive edema in the brain or there is seizure or paralytic attack on one side (focal symptom), a CT Scan should be immediately done. There may be an abscess. In such cases lumbar puncture is not carried out and suitable medicines are given. If necessary, surgery is done or the pus is extracted from the abscess by an expert neurosurgeon. This can save the life of the patient.

Increase in the swelling of the brain (raised Intracranial tension), seizure, hydrocephalus, subdural effusion or subdural empyema (abscess between the membranes of the brain) or brain abscess, hearing loss, venous thrombosis, vasculitis etc., are well known-though rarely occurring complications of meningitis and they should also be treated. These strong medicines at times can cause side effects and therefore they should be taken carefully.

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