Salmonella - fecal contamination Antibiotics - Cover gram negatives/Listeria/ GBS GBS pathogenesis: High grade bacteremia poor neonatal host defenses (PMN function, complement function, lack of Ab for
phagocytosis) Meningeal receptors endocytosis ? Intracellular ? Replication persistence Clinical relevance need for prolonged therapy ? GBS Streptococcus agalactiae
Common commensal flora childbearing women Lack of preformed Ab sepsis meningitis in neonate Early onset disease Sepsis pneumonia Late onset disease Sepsis MENINGITIS Vertical transmission most important - Preventable
E.coli K1 (not all E. coli - specific capsular type) Maternal fecal flora ascending infection CHO capsule lack of antibody High grade bacteremia meningitis specific receptors on meninges Problem with antibiotic resistance
Meningitis - neonate Listeria monocytogenes Gram positive bacillus - motile Found in animal feces - very common ! Contamination of unpasteurized animal products - organic produce - Mexican cheese
Epidemiology 2000 cases/year Associated with a flu-like illness in the mother Immunocompromised patients - T cell function Listeria - pathogenesis Maternal infection
Preterm delivery (not always) Pneumonia - sepsis - meningitis Intracellular pathogen - ? Lack of T cell function in the neonate Cell to cell spread - like Shigella breaks out of phagosome - avoids Ab Need T cell function- macrophage activation
Meningitis - neonate/young infant Greater incidence of sepsis - immature immune function Greater incidence of meningitis - Sepsis work-up includes LP - difficult to distinguish viral from bacterial disease Clinical clues high or low WBC irritability non specific sxs
Very small premature infants Complex congenital heart diseas Premature infants improved ventilatory support Coagulase negative staphylococci sepsis/meningitis Enterococci selection by antibiotics
Fungi Meningitis in infants and toddlers: Case - 4 month old - T- 104 - seen by M.D. - rxd with tylenol Still febrile the next day - seen again, said to have otitis media - prescribed amoxicillin Increasingly irritable Seen in CPMC E.R.(by clinical clerk)
chief complaint - lump on head which was a bulging fontanel S. pneumoniae in CSF - Arrow - exudate - pus PMNs
meninges Cortex - note edema Pathophysiology:
PMNs Inflammation Edema Elevated CSF protein
Increased intracranial pressure Breakdown of blood-brain barrier Loss of perfusion
Low glucose Loss of autoregulation - BP control SIADH Pneumococcal meningitis
Sporadic cases - NP colonization - bacteremia - meningeal seeding - Inflammation Worst prognosis Treatment - Achieve 20x MIC of the organism in the CSF Penicillin MIC = 1.0 - need level of 20 micrograms/ml only get 10% of the blood level What to do ???
S. pneumoniae 1999 S. pneumo - 1999 data Prevention of S. pneumoniae infections
Eradication of a common disease: H. influenzae non typeable otitis acquire type B capsule Poly ribose phosphate Bacteremia Meningitis Paradigms for the management of meningitis Universal vaccination of infants
HiB PRP-protein conjugate vaccine Disease gone in vaccinated children Meningitis - Haemophilus influenzae type B Antibody - polyribose phosphate capsule Allows efficient phagocytosis
Development of conjugate vaccines: PRP - Diphtheria toxin Meningococcal OMP Sporadic cases - adults who lack Ab Use of anti-inflammatory agents in
meningitis H. influenzae experience Give corticosteroids BEFORE antibiotics Decreases the secondary increase in TNF due to the release of bacterial cell wall fragments
Improved clinical outcome ? Other organisms ? Other ages Case - 20 year old college sophomore - goes to nurse with headache, T- 102. Diagnosed as having flu. Still feels unwell,nurse gives tyelenol with codeine spends night at dorm - collapses and is unarowsable. Sent to local hospital, T- 103 , WBC -2500
CSF - WBC- 120 - 100% PMNs; Glucose 20/96, Protein275. PE - Diffuse petecchiae, cold, clammy extremities, Poor air entry... N. meningitidis N. meningitidis - Epidemic strains/endemic strains meningitis belt in sub-Saharan Africa (type A) Sporadic cases types B, A, W135,
Gram negative (LPS) - Rapid uptake by theSepsis epithelial cells Receptor mediated endocytosis Encapsulated - requires IgG + complement to phagocytose Carriers in the population - increased carriage - disease in those lacking antibody
Gram stain of CSF - note PMNs and intracellular bacteria N. meningitidis - 1999 data N. meningitidis OUTBREAKS !
Who is at risk ? How is the organisms spread - carriers? How can disease be prevented N. meningitidis Development of protective immunity - cross reactive CHOs
commensal flora (Neisseria lactamica) Vaccines - (epidemic types) - A and C, Y, W 135 Not B - associated with sporadic cases Sialic acid epitopes - look like self Who to vaccinate? College students? Military, travellers to endemic areas
Prophylaxis - Rifampin, ciprofloxacin, ceftriaxone achieve levels in naso-pharyngeal secretions Diagnosis of meningitis - When to do an L.P. Interpretation of results
Richard Normann Service Encounters Range from High-Contact to Low-Contact Distinctions between High-Contact and Low-Contact Services The Servuction System Source: Adapted and expanded from an original concept by Eric Langeard and Pierre Eiglier The Servuction System: Service Production and Delivery Servuction...
The public audience is made up of all members of society who want information in a personal capacity or on behalf of another organisation. The professional audience is made up of professionals in the public, private and educational sectors who...
Pagtukoysakanyangmgakatangian, talento, kakayahangamitang Multiple Intelligences Survey Form ni Walter Mckenzie. ... Magiging masaya sila kung magiging musician , kompositor o "Disk Jockey". IntrapersonalIntelligence.
FDT: NET absorption from classical field. (Valid also in steady nonequilibrium States) Nothing is emitted from a T = 0 sample, but it may absorb… Noise power depends on final state filling. Exp confirmation: deBlock et al, Science 2003, (TLS...
Key Stage 2 SATs Changes. In 2014/15 a new national curriculum framework was introduced by the government for Years 1, 3, 4 and 5. From 2015/16 children in all years at Key Stage 1 and 2 are expected to study...
Area Team Structure Arden, Herefordshire and Worcestershire June 2013 Arden, Herefordshire and Worcestershire Local Area Team * Business Office Jane Gordijn Jenny McGill Jo Clode Medical Director Martin Lee Director of Nursing Sue Doheny Director of Finance Brian Hanford Director...