Induced Hypothermia for Meningitis Patients
When I was working in the emergency department as a scribe over the summer my doctor and I encountered a patient who later is diagnosed with acute bacterial meningitis. At the time I did not know how serious this was until my doctor told me that we may have been exposed to the diseases. Luckily, a few days later, I found out I was safe. Ever since then I have had a fascination with the diseases and took an interest into what treatments were out there to help people with this disease. The article I am writing about, experiments with hypothermia to help relieve symptoms of meningitis. The authors hypothesize that hypothermia treatment for meningitis may reduce brain and cerebral spinal fluid inflammation and prevent brain blood barrier disruption. They also hypothesize that hypothermia treatment may reduce brain cellular swelling.
In this study therapeutic hypothermia is induced, lowering patients’ body temperature to 32-34C, with passive rewarming. The experimental group consisted of 49 patients undergoing hypothermic treatment, while the control group of 49 patients underwent standard treatment for meningitis.
Table 2 on page 2178 shows the primary and secondary outcomes after 3 months in the hypothermia and control groups. I have two key observations to point out. The unfavorable outcome for the experimental group was 86% compared to the control group of 74%. The mortality rate for the experimental group was 51% and the control group was 31%. Figure 4 on page 2179 shows the estimates of survival of patients treated with hypothermic treatments vs standard treatment. As you can see in the graph, the control group has a significantly higher survival rate.
Hypothermia treatment had a higher mortality rate. Patients that underwent hypothermic treatment also had a higher rate of septic shock. Septic shock is associated as an unfavorable outcome and was higher in the experimental group of 47% while the control group had 32 %. Hypothermic treatment did not improve symptoms or the outcome of the patients and may have even caused more problems than standard treatment.
Meningitis has everything to do with cells. While most cases of meningitis are viral, the most hazardous cases are bacterial. Meningitis is one of the deadliest diseases known today. What makes bacterial meningitis so deadly, is the speed at which the disease progresses. In the worst cases, a patient can die within a day, although this is rare if a patient receives early medical care. “Despite the widespread availability of antibiotic therapies, acute bacterial meningitis still shows significant morbidity and mortality in both high and low-income countries”. (O’Neill et al., 1993) Bacterial meningitis is usually contracted by breathing in airborne bacteria. Bacterial Meningitis can also be contracted by kissing, or by any other contact with another person’s saliva. Once the bacteria enter the mouth it is able to cross over to the bloodstream. The bacteria now how access to the body’s tissue, including the brain and spinal cord.
Meningitis is an inflammation of the meninges surrounding the brain and spinal cord. While the infection is being fought the blood-brain barrier begins to expand causing an increase in intracranial pressure. If the bacteria happen to break through the blood-brain barrier, more swelling will occur that can eventually lead to stroke. The biggest concern of meningitis is that it causes an increase in intracranial pressure. This increase in pressure will eventually damage the brain stem and cause the infected patient to lose their brain stem reflexes. Meningitis bacteria will eventually release toxins into the bloodstream and eventually cause septicemia. The toxins also reduce oxygen levels in the blood that will eventually cause organ shutdown.
Although the results of the experiment were negative, I am glad to know that researchers are still looking for better treatments of such a deadly disease when it is in its later stages. Treatments for antibiotics may not always be exact. “Effective antimicrobial therapy for the three commonest causes of bacterial meningitis-meningococcus, pneumococcus, and Haemophilus influenza type b-has been available for many years, but we are still unsure of the length of treatment required to cure these infections.”(Schmutzhard, 2009). The search for more effective treatment is still needed for this disease.
References
Mourvillier, B., Tubach, F., van de Beek, D., Garot, D., Pichon, N., Georges, H., Lefevre, L., Bollaert, P., Boulain, T., Luis, D., Cariou, A., Girardie, P., Chelha, R., Megarbane, B., Delahaye, A., Chalumeau-Lemoine, L., Legriel, S., Beuret, P., Brivet, F., Bruel, C., Camou, F., Chatellier, D., Chillet, P., Clair, B., Constantin, J., Duguet, A., Galliot, R., Bayle, F., Hyvernat, H., Ouchenir, K., Plantefeve, G., Quenot, J., Richecoeur, J., Schwebel, C., Sirodot, M., Esposito-Farèse, M., Le Tulzo, Y. and Wolff, M. (2013). Induced Hypothermia in Severe Bacterial Meningitis. JAMA, 310(20), p.2174.
O’Neill, P., Heath, C., Shann, F., Henry, D., Hilton-Jones, D., Squier, M., Örtqvist, Å. and O’Neill, P. (1993). MENINGITIS. The Lancet, 341(8844), p.530.
Schmutzhard, E. (2009). IN13-MO-02 Meningitis. Journal of the Neurological Sciences, 285, p.S13.