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Friday, 29 November 2013

Meningitis - The Risk Factors

Meningitis is defined as a condition of inflammation of the protective membranes,  covering the brain and spinal cord (meninges). Meningitis, a life threaten disease, can kill and immediate action can and does save lives.(1) Although bacterial meningitis has become an uncommon disease in the developed world. Unfortunately, because of limited economic resources and poor living conditions, many developing countries are still affected by the devastating consequences of this life-threatening systemic infection(2)
B. Risk factors
Some people are more susceptible to meningitis than others

1. People with weakened immune systems
In a study conducted by Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Dr. Koppe U and the research team indicated "The innate immune system is critical for the control of colonization and for defence during invasive disease. Initially, pneumococci are recognized by different sensors of the innate immune system called pattern recognition receptors (PRRs), which control most subsequent host defence pathways. These PRRs include the transmembrane Toll-like receptors (TLRs) as well as the cytosolic NOD-like receptors (NLRs) and DNA sensors". Streptococcus pneumoniae is both a frequent colonizer of the upper respiratory tract and a leading cause of life-threatening infections such as pneumonia, meningitis and sepsis.(21)

2. Pregnant women
In the examine listeriosis cases reported through the U.S. Listeria Initiative during 2004-2007. Cases were classified as pregnancy-associated if illness occurred in a pregnant woman or an infant aged <28 days. Of 758 reported Listeria cases, 128 (16.9%) were pregnancy-associated. Maternal infection resulted in four neonatal deaths and 26 (20.3%) fetal losses. Invasive illnesses in newborns (n=85) were meningitis (32.9%) and sepsis (36.5%)(21). There is a case report of TBM in a previously healthy woman whose signs and symptoms developed immediately after delivery and were initially attributed to postpartum depression and a puerperal-acquired bacterial infection.  Although tuberculous meningitis (TBM) rarely complicates pregnancy and seldom occurs in puerperal women,(22)

3. Chronic Diseases 
a. AIDS 
People with AIDS are more susceptible to develop Meningitis. In a retrospective review of confirmed HIV-TB coinfected patients previously enrolled as part of the SAPiT study in Durban, South Africa. Patients with suspected meningitis were included in this case series. From 642 individuals, 14 episodes of meningitis in 10 patients were identified. For 8 patients, this episode of meningitis was the AIDS defining illness, with cryptococcus (9/14 episodes) and tuberculosis (3/14 episodes) as the commonest aetiological agents.(23)

b.  Diabetes
In a study conducted by , Far Eastern Memorial Hospital, Dr. Ho MP and the research team showed that advanced age, newly recognized DM, K. pneumoniae bacteremia, and DIC may be the cause of a fatal Klebsiella pneumoniae meningitis and concomitant disseminated intravascular coagulation (DIC) in a 72-year-old woman(24)

c. Rheumatoid arthritis
People with Rheumatoid arthritis may have an increased risk of Meningitis. Even though most common complications of RA occur in the severe and chronic stages of the disease, but Meningoencephalitis is a rare but aggressive complication of rheumatoid arthritis (RA).(25)

d. Others chronic diseases such as heart diseases, liver disease may also  risk factors of meningitis

4. Removal of your spleen puts you at risk for meningitis, as spleen is essential part of the immune system

5. In the study to overview outcome of meningococcal meningitis in Slovakia, researcher(s) indicated that risk factors such as underlying disease, cancer, diabetes, alcoholism, surgery (brain surgery), age (children under 5, teens and young adults ages 16 to 25 (especially college freshman living in dorms), and adults over 55), previous infections, trauma, sepsis were recorded and mortality, survival with sequellae, therapy failure were compared between meningococcal and non-meningococcal cases of bacterial meningitis(26)
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f. Etc.
  Sources
(1) http://www.ncbi.nlm.nih.gov/pubmed/15284663
(2) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2803%2913693-8/fulltext
(21) http://www.ncbi.nlm.nih.gov/pubmed/20158931
(22) http://jama.ama-assn.org/content/244/21/2440.extract
(23) http://www.ncbi.nlm.nih.gov/pubmed/22216407
(24) http://www.ncbi.nlm.nih.gov/pubmed/19561976
(25) http://www.ncbi.nlm.nih.gov/pubmed/22426662
(26) http://www.ncbi.nlm.nih.gov/pubmed/22395556