Bacterial Meningitis 5

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  • 8/9/2019 Bacterial Meningitis 5

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    Quc`{l`n G~lknblonp fdu Ec`{nulcb Inologl{lp @LK 511;:0< -3 Odvnienu, 3567

    L K P C G ^ L K N B L O N P

    Quc`{l n G~lknblonp fdu {mn Icocgnino{df Ec`{nulcb Inologl{lp

    Cbbco U/ [~ohnb"3 Ecuu| J/ Mcu{ico"5 Pmnbkdo B/ Hcqbco"0 Eu~`n C/ Hc~fico"; Hcuno B/ Uddp"> W/ Il`mcnb P`mnbk"6

    cok Ul`mcuk J/ Wml{bn|7

    3Kun}nb ^olvnupl{| @dbbngn df Inkl`lon" Qmlbcknbqmlc" Qnoop|bvcolc8 5Wnlbb @duonbb Inkl`cb @no{nu" Onw \duh" Onw \duh8 0Ec|bdu @dbbngn df

    Inkl`lon" Md~p{do" [n}cp8 ;Inkl`cb @dbbngn df Wlp`doplo" Ilbwc~hnn8 >Loklcoc ^olvnupl{| P`mddb df Inkl lon" Loklcocqdblp8 6^olvnupl{| df Vluglolc

    P`mddb df Inkl lon" @mcubd{{npvlbbn8 cok 7^olvnupl{| df Cbcecic c{ Eluilogmci

    DEJN@[LVNP

    [mn dejn`{lvn df {mnpn quc`{l`n g~lknblonp lp {d qudvlkn

    `blol`lcop wl{m un`diinokc{ldop fdu {mn klcgodplp cok{unc{ino{ df ec`{nulcb inologl{lp/ Qc{lno{p wl{m ec`{nulcb

    inologl{lp cun ~p~cbb| {unc{nk e| qulicu| `cun cok

    ninugno`| inkl`lon qm|pl`lcop c{ {mn {lin df lol{lcb

    qunpno{c{ldo" df{no lo `dop~b{c{ldo wl{m lofn`{ld~p klp)

    ncpnp pqn`lcblp{p" on~udbdglp{p" cok on~udp~ugndop/ Lo

    `do{ucp{ {d ico| d{mnu lofn`{ld~p klpncpnp" {mn co{l)

    il`udelcb {mnucq| fdu ec`{nulcb inologl{lp lp od{ cbwc|p

    ecpnk do ucokdilznk" qudpqn`{lvn" kd~ebn)eblok `blo)

    l`cb {ulcbp" e~{ uc{mnu do kc{c lol{lcbb| de{clonk fudi

    n}qnulino{cb colicb idknbp df lofn`{ldop/ C idknb

    `diidob| ~{lblznk lp {mn n}qnulino{cb uceel{ idknb"

    lo wml`m colicbp cun conp{mn{lznk cok qbc`nk lo c p{nu)

    nd{c`{l` fucin/ Lo {mlp qud`nk~un" {mn `lp{nuoc icgoc

    `co en q~o`{~unk fdu funs~no{ pciqblog df @PF cok

    lojn`{ldo df il`uddugcolpip/ Funs~no{ pciqblog df @PF

    qnuil{p incp~unino{ df bn~hd`|{np cok `mnil`cb qc)

    ucin{nup cok s~co{l{c{ldo df {mn unbc{lvn qnon{uc{ldo df

    co{lil`udelcb cgno{p lo{d @PF cok {mn nffn`{p df ino)

    logl{lp do {mlp no{u| qcucin{nu" {mn unbc{lvn ec`{nul`lkcb

    nfffi`c`| -knffionk cp {mn uc{n df ec`{nulcb nuckl`c{ldo,

    wl{mlo q~u~bno{ @PF" cok @PF qmcuic`dk|ocil`p/ Un)

    p~b{p de{clonk fudi {mnpn cok d{mnu colicb idknbp mcvn

    bnk {d `blol`cb {ulcbp df pqn`lffi` cgno{p lo qc{lno{p wl{mec`{nulcb inologl{lp/

    Un`nlvnk 51 C~g~p{ 511;8 c``nq{nk 5> C~g~p{ 511;8 nbn`{udol`cbb| q~eblpmnk

    6 D`{denu 511;/

    Unqulo{p du `duunpqdokno`n: Ku/ Cbbco U/ [~ohnb" Kun}nb ^olvnupl{| @dbbngn df

    Inkl`lon" 5

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    356= @LK 511;:0< -3 Odvnienu, [~ohnb n{ cb/

    [cebn 3/ Lofn {ld~p Klpncpnp Pd`ln{| df Cinul`c ol{nk P{c{np Q~ebl Mncb{m Pnuvl n Gucklog P|p{ni fdu ucohlog un`)diinokc{ldop lo `blol`cb g~lknblonp/

    @c{ngdu|" guckn Knffiol{ldo

    P{unog{m df un`diinokc{ldo

    C Gddk nvlkno`n {d p~qqdu{ c un`diinokc{ldo fdu ~pn8 pmd~bk cb wc|p en dffnunk

    E Idknuc{n nvlkno n {d p~qqdu{ c u n diinokc{ldo fdu ~pn8 pmd~bk gnonucbb| en dffnunk

    @ Qddu nvlkno`n {d p~qqdu{ c un`diinokc{ldo8 dq{ldocb

    K Idknuc{n nvlkno n {d p~qqdu{ c u n diinokc{ldo cgclop{ ~pn8 pmd~bk gnonucbb| od{ en dffnunk

    N Gddk nvlkno`n {d p~qqdu{ c un`diinokc{ldo cgclop{ ~pn8 pmd~bk onvnu en dffnunk

    S~cbl{| df nvlkno`n

    L Nvlkno`n fudi 3 qudqnub| ucokdilznk" `do{udbbnk {ulcb

    LL Nvlkno`n fudi 3 wnbb)knplgonk `blol`cb {ulcb" wl{md~{ ucokdilzc{ldo8 fudi `dmdu{ du `cpn)

    `do{udbbnk cocb|{l` p{~klnp -qunfnuceb| fudi 33 `no{nu,8 fudi i~b{lqbn {lin)pnulnp8 du fudi

    kucic{l` unp~b{p fudi ~o`do{udbbnk n}qnulino{p

    LLL Nvlkno n fudi dqloldop df unpqn {nk c~{mdul{ lnp" ecpnk do `b lo l cb n}qnulno n" knp`ulq{lvn

    p{~klnp" du unqdu{p df n}qnu{ `diil{{nnp

    {mn qc{lno{ kdnp loknnk mcvn c`~{n ec`{nulcb inologl{lp/ [mn`mdl`n df niqlul cb co{lil udelcb {mnucq| lo {mlp pl{~c{ldo

    pmd~bk en gdvnuonk e| {mn qc{lno{p cgn cok e| vculd~p `do)

    kl{ldop {mc{ ic| mcvn qunklpqdpnk {mn qc{lno{ {d inologl{lp/

    Cb{md~gm {mn |lnbk df @PF `~b{~unp cok @PF Guci p{clo ic|

    en klilolpmnk e| co{lil`udelcb {mnucq| glvno quldu {d b~iecu

    q~o`{~un" qun{unc{ino{ ebddk `~b{~unp cok @PF ffioklogp -l/n/"

    nbnvc{nk WE@ `d~o{" klilolpmnk gb~`dpn `do`no{uc{ldo" cok

    nbnvc{nk qud{nlo `do`no{uc{ldo, wlbb blhnb| qudvlkn nvlkno`n fdu

    du cgclop{ {mn klcgodplp df ec`{nulcb inologl{lp -pnn Wmc{ Pqn)

    `lffi` @PF Klcgodp{l` [np{p Pmd~bk En ^pnk {d Kn{nuilon {mn

    Ec`{nulcb N{ldbdg| df Inologl{lp4" enbdw,/ Do`n @PF cocb|plp lp

    qnufduink" fdu qc{lno{p wl{m c qdpl{lvn @PF Guci p{clo unp~b{"

    {cugn{nk co{lil`udelcb {mnucq| `co en lol{lc{nk lo ck~b{p wl{m

    ec`{nulcb inologl{lp/ Lo `mlbkuno 33 ido{m df cgn wl{m ec`{nulcb

    inologl{lp" mdwnvnu" niqlul`cb co{lil`udelcb {mnucq| wl{m vco)

    `di|`lo `dielonk wl{m nl{mnu `nfd{c}lin du `nf{ulc}don `co

    en qudvlknk qnoklog `~b{~un unp~b{p8 {mlp un`diinokc{ldo lp

    ecpnk do {mn `do`nuo {mc{ lo{nuqun{c{ldo df {mn @PF Guci p{clo

    knqnokp do {mn n}qnu{lpn df {mn qnupdo uncklog {mn pblkn8 pdin

    n}qnu{p wd~bk cbpd ~pn {mlp p{uc{ng| lo ck~b{p wl{m ec`{nulcb

    inologl{lp/ Mdwnvnu" c qdpl{lvn @PF Guci p{clo unp~b{ ic|

    idklf| {mlp cqqudc`m e| {mn ckkl{ldo df cod{mnu cgno{ -n/g/"

    ciql lbblo fdu {mn qunpno`n df guci)qdpl{lvn ec`lbbl, {d {mnpn 5p{cokcuk ku~gp/ Lf {mn Guci p{clo unp~b{ lp ongc{lvn" niqlul`cb

    co{lil`udelcb {mnucq| lp glvno" wl{m `mdl`np df cgno{p ecpnk do

    {mn qc{lno{ cgn cok `nu{clo qunklpqdplog `dokl{ldop/

    [mn fdbbdwlog pn`{ldop wlbb unvlnw lo gunc{nu kn{clb {mn nvl)

    kno`n fdu d~u un`diinokc{ldop lo {mnpn cbgdul{mip/ [mn nv)

    lkno`n fdu {mnpn un`diinokc{ldop lp fucink lo {mn `do{n}{ df

    pqn`lffi` s~np{ldop {mc{ pmd~bk en ckkunppnk lo {mn qc{lno{ wl{m

    p~pqn`{nk du qudvno ec`{nulcb inologl{lp/

    Wml`m Qc{lno{p wl{m P~pqn`{nk Ec`{nulcb Inologl{lp Pmd~bk^oknugd @[ df {mn Mnck quldu {d B~iecu Q~o`{~un4

    @diqbl`c{ldop cppd`lc{nk wl{m b~iecu q~o`{~un cun vculcebn"

    ucoglog fudi ilbk cb{nuc{ldop lo `difdu{ {d blfn){munc{nolog

    euclo mnuolc{ldo" wml`m ic| d``~u lo {mn qc{lno{ wl{m nbnvc{nk

    lo{uc`ucolcb qunpp~un X5" 0Y/ Cf{nu b~iecu q~o`{~un" {mnun lp

    oduicbb| c ilbk" {ucoplno{ bdwnulog df b~iecu @PF qunpp~un cp

    c unp~b{ df unidvcb df @PF cok `do{lo~nk bnchcgn df @PF fudi

    {mn dqnolog ickn lo {mn cuc`modlk inieucon {mc{ lp ucqlkb|

    `dii~ol`c{nk {mud~gmd~{ {mn p~ecuc`modlk pqc`n/ Lo qc{lno{p

    wl{m lo{uc ucolcb" pqc`n)d``~q|log bnpldop" {mnun lp c unbc{lvn

    qunpp~un gucklno{ wl{m kdwowcuk klpqbc`nino{ df {mn `nuneu~i

    cok euclop{ni {mc{ `co en lo uncpnk e| b~iecu q~o`{~un"{mnune| qun`lql{c{log euclo mnuolc{ldo/ [mn lo`lkno`n df {mlp

    `diqbl`c{ldo lp ~ohodwo/ Lo co dbknu p{~k| {mc{ n}cilonk {mn

    d~{`din df b~iecu q~o`{~un lo 35< qc{lno{p wl{m nbnvc{nk lo)

    {uc`ucolcb qunpp~un" 3/5. df qc{lno{p wl{m qcqlbbnknic cok 35.

    df qc{lno{p wl{md~{ qcqlbbnknic mck ~ofcvducebn d~{`dinp

    wl{mlo ;= m cf{nu {mn qud`nk~un X;Y/ Wmno {mnpn kc{c wnun

    `dielonk wl{m c unvlnw df ;3= qc{lno{p wl{m qcqlbbnknic" {mn

    c~{mdup `do`b~knk {mc{ {mn c`{~cb ulph df pnuld~p `diqbl`c{ldop

    fudi b~iecu q~o`{~un lo {mn qunpno`n df qcqlbbnknic wcp

    i~`m bnpp {mco 3/5./ [wd d{mnu p{~klnp p~ggnp{nk {mc{ co

    lo`lkno`n df euclo mnuolc{ldo wcp 33./ Lo ckkl{ldo" cod{mnu

    p{~k| df 015 lofco{p cok `mlbkuno wl{m ec`{nulcb inologl{lpfd~ok {mc{ euclo mnuolc{ldo knvnbdqnk lo 6. df qc{lno{p X>Y"

    d``~uulog wl{mlo = m cf{nu b~iecu q~o`{~un lo cbb qc{lno{p/

    Lo c un`no{ p{~k| lovdbvlog 013 ck~b{p wl{m ec`{nulcb ino)

    logl{lp X6Y" {mn `blol`cb fnc{~unp c{ ecpnblon {mc{ wnun cppd`lc{nk

    wl{m ceoduicb ffioklogp df c @[ p`co df {mn mnck wnun co cgn

    df61 |ncup" c mlp{du| df @OP klpncpn -n/g/" icpp bnpldo" p{udhn"

    cok fd`cb lofn`{ldo," co lii~od`diqudilpnk p{c{n -n/g/" {mc{

    k~n {d MLV lofn`{ldo du CLKP" lii~odp~qqunpplvn {mnucq|" du

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    Quc`{l`n G~lknblonp fdu Ec`{nulcb Inologl{lp @LK 511;:0< -3 Odvnienu, 356111 `nbbp$ii0" cb{md~gm {mlp ucogn `co en s~l{n eudck -#311

    {d 331"111 `nbbp$ii0,/ Ec`{nulcb inologl{lp ~p~cbb| bnckp {d c

    on~{udqmlb qunkdiloco`n lo @PF" {|ql`cbb| en{wnno =1. cok

    .8 31. df qc{lno{p wl{m c`~{n ec`{nulcb inologl{lp qunpno{wl{m c b|iqmd`|{n qunkdiloco`n -knffionk cp 3>1. b|iqmd)

    `|{np du idod`|{np, lo @PF/ [mn @PF gb~`dpn `do`no{uc{ldo lp

    #;1 ig$kB lo cqqud}lic{nb| >1.61. df qc{lno{p8 c uc{ld df

    @PF {d pnu~i gb~`dpn df1/; wcp =1. pnopl{lvn cok

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    3571 @LK 511;:0< -3 Odvnienu, [~ohnb n{ cb/

    Flg~un 5/ Icocgnino{ cbgdul{mi fdu ck~b{p wl{m p~pqn {nk ec`{nulcb inologl{lp/ P{c{ lokl`c{np {mc{ {mn lo{nuvno{ldo pmd~bk en kdon ninugno{b|/cPnn {cebn 5/ ePnn {n}{ fdu pqn`lffi` un`diinokc{ldop fdu ~pn df ckj~o`{lvn kn}cin{mcpdon lo ck~b{p wl{m ec`{nulcb inologl{lp/ `Pnn {cebn ;/ kPnn {cebn

    0/ nKn}cin{mcpdon cok co{lil udelcb {mnucq| pmd~bk en ckilolp{nunk liinklc{nb| cf{nu @PF lp de{clonk/

    lp nbnvc{nk lo vlu{~cbb| cbb qc{lno{p wl{m ec`{nulcb inologl{lp/ [mn

    unp~b{p df @PF `~b{~unp cun qdpl{lvn lo 71.=>. df qc{lno{p

    wmd mcvn od{ un`nlvnk quldu co{lil`udelcb {mnucq|" e~{ `~b{~unp

    ic| {chn ~q {d ;= m fdu dugcolpi lkno{lffi`c{ldo/ [mnunfdun"pnvnucb ucqlk klcgodp{l` {np{p pmd~bk en `doplknunk {d kn{nuilon

    {mn ec`{nulcb n{ldbdg| df inologl{lp/

    Guci p{clo/ Guci p{clo n}ciloc{ldo df @PF qnuil{p c

    ucqlk" c``~uc{n lkno{lffi`c{ldo df {mn `c~pc{lvn ec`{nul~i lo

    61. @F^$iB bnck {d qdpl{lvn il`udp)

    `dq| unp~b{p lo 1.

    df `cpnp `c~pnk e| guci)ongc{lvn ec`lbbl" cok cqqud}lic{nb|

    don){mluk df `cpnp df inologl{lp `c~pnk e| Blp{nulc idod`|{d)

    gnonp mcvn qdpl{lvn Guci p{clo unp~b{p X33Y/ Cb{md~gm fcbpn)

    qdpl{lvn @PF Guci p{clo unp~b{p ic| unp~b{ fudi depnuvnu ilp)

    lo{nuqun{c{ldo" uncgno{ `do{ciloc{ldo" du ~pn df co d``b~knkonnkbn fdu b~iecu q~o`{~un -lo wml`m co n}`lpnk phlo fucgino{

    lp `do{ciloc{nk wl{m ec`{nulc," {mn {np{ lp ucqlk" lon}qnoplvn"

    cok mlgmb| pqn`lffi` fdu {mn klcgodplp df ec`{nulcb inologl{lp X0"

    35Y/ Mdwnvnu" {mn |lnbk df @PF Guci p{clo ic| en 51. bdwnu

    fdu qc{lno{p wmd mcvn un`nlvnk quldu co{lil`udelcb {mnucq|/ Wn

    un`diinok {mc{ cbb qc{lno{p enlog nvcb~c{nk fdu p~pqn {nk ino)

    logl{lp ~oknugd c Guci p{clo n}ciloc{ldo df @PF -C)LLL,/

    Bc{n} cggb~{loc{ldo/ Pnvnucb ucqlk klcgodp{l` {np{p mcvn

    enno knvnbdqnk {d clk lo {mn n{ldbdgl` klcgodplp df ec`{nulcb

    inologl{lp/ [mnpn {np{p ~{lblzn pnu~i `do{clolog ec`{nulcb co)

    {ledklnp du `diinu`lcbb| cvclbcebn co{lpnuc klun`{nk cgclop{ {mn

    `cqp~bcu qdb|pc `mculknp df inologncb qc{mdgnop/ Cvclbcebn

    {np{p lo`b~kn `d~o{nulii~odnbn`{udqmdunplp" `dcggb~{loc{ldo"

    cok bc{n} cggb~{loc{ldo/ Bc{n} cggb~{loc{ldo lp pliqbn {d qnu)

    fdui" kdnp od{ uns~lun pqn`lcb ns~lqino{" cok lp ucqlk -unp~b{p

    cun cvclbcebn lo 3> ilo,/ Knqnoklog do {mn inologncb qc{m)

    dgno" bc{n} cggb~{loc{ldo mcp pmdwo gddk pnopl{lvl{| lo kn{n`{)

    log {mn co{lgnop df `diido inologncb qc{mdgnop X31Y: 7=.

    311. fdu M/ lost~nozcn {|qn e" 67.311. fdu P/ qon~idolcn"

    6

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    Quc`{l`n G~lknblonp fdu Ec`{nulcb Inologl{lp @LK 511;:0< -3 Odvnienu, 3573

    [cebn 5/ Un`diinoknk `ul{nulc fdu ck~b{ qc{lno{p wl{m p~pqn`{nk ec`{nulcb inologl{lp wmd pmd~bk ~oknugd @[quldu {d b~iecu q~o`{~un -E)LL,/

    @ul{nuldo @diino{

    Lii~od`diqudilpnk p{c{n MLV lofn {ldo du CLKP" un`nlvlog lii~odp~qqunpplvn {mnucq|" du cf{nu {ucopqbco{c{ldo

    Mlp{du| df @OP klpncpn Icpp bnpldo" p{udhn" du fd`cb lofn`{ldo

    Onw dopn{ pnlz~un Wl{mlo 3 wnnh df qunpno{c{ldo8 pdin c~{mdul{lnp wd~bk od{ qnufdui c b~iecu q~o )

    {~un do qc{lno{p wl{m qudbdognk pnlz~unp du wd~bk knbc| b~iecu q~o`{~un fdu 01

    ilo lo qc{lno{p wl{m pmdu{" `dov~bplvn pnlz~unp

    Qcqlbbnknic Qunpno`n df vnod~p q~bpc{ldop p~ggnp{p cepno`n df lo`uncpnk lo{uc ucolcb qunpp~un

    Ceoduicb bnvnb df dop`ld~ponpp

    Fd cb on~udbdgl knffi`l{ Lo b~klog klbc{nk odounc {lvn q~qlb" ceoduicbl{lnp df d`~bcu id{lbl{|" ceoduicb vlp~cb

    ffinbkp" gczn qcbp|" cui du bng kulf{

    inologl{lklp/ Mdwnvnu" c ongc{lvn ec`{nulcb co{lgno {np{ unp~b{

    kdnp od{ u~bn d~{ lofn {ldo `c~pnk e| c pqn`lffi` inologncb

    qc{mdgno/

    Onvnu{mnbnpp" {mn ud~{lon ~pn df bc{n} cggb~{loc{ldo fdu {mn

    n{ldbdgl` klcgodplp df ec`{nulcb inologl{lp mcp un`no{b| enno

    s~np{ldonk/ Lo don p{~k| df

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    3575 @LK 511;:0< -3 Odvnienu, [~ohnb n{ cb/

    bnck {d {mnlu ~pn lo qc{lno{p wl{m ec`{nulcb inologl{lp fdu wmdi

    {mn @PF Guci p{clo unp~b{ lp ongc{lvn -E)LL,/

    Wmc{ Bceduc{du| [np{log Ic| En Mnbqf~b lo Klp{log~lpmlog

    Ec`{nulcb fudi Vlucb Inologl{lp4

    Lo qc{lno{p wl{m @PF ffioklogp `doplp{no{ wl{m c klcgodplp df

    ec`{nulcb inologl{lp" e~{ lo wmdi {mn @PF Guci p{clo cok

    `~b{~un unp~b{p cun ongc{lvn" {mnun lp od {np{ {mc{ lp knffiol{lvn fdu

    du cgclop{ {mn klcgodplp df ec`{nulcb inologl{lp/ C `dieloc{ldo

    df {np{ unp~b{p" mdwnvnu" ic| qnuil{ co c``~uc{n qunkl`{ldo df

    {mn blhnblmddk df ec`{nulcb vnup~p vlucb inologl{lp/ Lo don cocb|)

    plp df ;55 qc{lno{p wl{m c`~{n ec`{nulcb du vlucb inologl{lp" c

    @PF gb~`dpn `do`no{uc{ldo df #0; ig$kB" c uc{ld df @PF {d

    ebddk gb~`dpn df#1/50" c @PF qud{nlo `do`no{uc{ldo df3551

    ig$kB" c @PF bn~hd`|{n `d~o{ df35111 bn~hd`|{np$ii0" du c

    @PF on~{udqmlb `d~o{ df 333=1 on~{udqmlbp$ii0 wnun lokl)

    vlk~cb qunkl`{dup df ec`{nulcb" uc{mnu {mco vlucb" inologl{lp" wl{m

    Y/ Lo {mlp `diqlbc{ldo df p{~klnp"

    incp~unino{ df pnu~i `do`no{uc{ldop df @UQ mck c pnopl{lvl{|

    {mc{ ucognk fudi 61 `dopn`~{lvn qc{lno{p

    wl{m @PF `~b{~unqudvno ec`{nulcb inologl{lp cok 3=5 `mlbkuno

    wl{m qudvno du qunp~ink ec`{nulcb inologl{lp X56Y" pnu~i @UQ

    `do`no{uc{ldop wnun `cqcebn df klp{log~lpmlog Guci p{clo

    ongc{lvn ec`{nulcb inologl{lp" wl{m c pnopl{lvl{| df /1

    ig$B, fdu {mn klcgodplp df ec`{nulcb inologl{lp wcp

  • 8/9/2019 Bacterial Meningitis 5

    7/18

    Quc`{l`n G~lknblonp fdu Ec`{nulcb Inologl{lp @LK 511;:0< -3 Odvnienu, 3570

    klcgodplp df ec`{nulcb inologl{lp X5=Y" cb{md~gm fcbpn)ongc{lvn

    unp~b{p mcvn enno unqdu{nk e| d{mnup -pnopl{lvl{|" 6" 06Y/ [mn cpp~iq{ldo {mc{

    co| knbc| lo ckilolp{uc{ldo df co{lil`udelcb {mnucq| ilgm{ en

    cppd`lc{nk wl{m co ckvnupn `blol cb d~{`din mcp enno {mn ecplpfdu icbquc`{l`n `bclip cgclop{ qm|pl`lcop wmd mcvn enno c`)

    `~pnk df fclb~un {d qudiq{b| klcgodpn cok {unc{ ec`{nulcb ino)

    logl{lp X07Y/

    N{ml`cb `doplknuc{ldop `bncub| qun`b~kn {mn knplgo df m~ico

    p{~klnp {d cppnpp {mn d~{`din fdu qc{lno{p lo wmdi co{lil`ud)

    elcb {mnucq| lp knblenuc{nb| knbc|nk/ [d ckkunpp {mn s~np{ldo df

    wmn{mnu c knbc| lo klcgodplp cok {unc{ino{ cffn`{p d~{`din lo

    qc{lno{p wl{m ec`{nulcb inologl{lp" pnvnucb bcugn unvlnwp n}ci)

    lonk {mn cvclbcebn q~eblpmnk bl{nuc{~un/ Lo don unvlnw df ;717

    qc{lno{p lo 55 p{~klnp" {mn k~uc{ldo df p|iq{dip enfdun lol{l)

    c{ldo df co{lil`udelcb {mnucq| wcp cppnppnk wl{m ungcuk {d {mn

    p~epns~no{ knvnbdqino{ df pns~nbcn X0=Y/ [mn p{~klnp wnun

    mn{nudgnond~p wl{m ungcuk {d qc{lno{ knidgucqml` kc{c" p{~k|

    o~ienup" `c~pc{lvn il`uddugcolpip" cok bnog{m df fdbbdw)~q/

    F~u{mnuidun" {mnun wcp df{no lo`diqbn{n unqdu{log df unbnvco{

    kc{c" cok od{ cbb p{~klnp `do{clonk ecpl` p{~k| knplgo `di)qdono{p/ [mn c~{mdu df {mlp unvlnw p~ggnp{nk {mc{" lf {mn `blol`cb

    qunpno{c{ldo wcp {mc{ df c odopqn`lffi` lbbonpp -l/n/" gnonucb odo)

    fd`cb p|iq{dip," c pmdu{ knbc| -#0> kc|p, klk od{ cqqncu {d

    cb{nu {mn ulph df pns~nbcn du knc{m/ Mdwnvnu" lo {mn `cpn df

    f~biloco{ inologl{lp" c knbc| lo {mn lol{lc{ldo df co{lil`udelcb

    {mnucq| pnnink {d en ~o`doon`{nk {d d~{`din8 cok fdu qc{lno{p

    wl{m c mlp{du| df `blol`cbb| dvnu{ inologl{lp" co locqqudqulc{n

    knbc| lo`unino{cbb| lo`uncpnk {mn ulph df qnuicono{ loj~u|/ Lo

    c p~epns~no{ bl{nuc{~un unvlnw df 57 p{~klnp -lo`b~klog ico|

    df {mn p{~klnp lo {mn qunvld~p unvlnw, cocb|zlog c {d{cb df >>=>

    qc{lno{p ~q {d C~g~p{ 30 qc{lno{p -37/;., un`nlvnk co co{lil`udelcb cgno{ quldu{d ckilppldo8 {mnun wcp dob| 3 knc{m -3/0

    qc{lno{p wmd un nlvnk co co{lil udelcb" `diqcunk wl{m 01

    knc{mp -35., cidog {mn 5>5 wmd mck od{/ [mnpn unp~b{p bnk

    {mn Eul{lpm Lofn`{ldo Pd`ln{| Wduhlog Qcu{| {d un`diinok qcu)

    no{nucb ckilolp{uc{ldo df cqqudqulc{n co{lil`udelcb {mnucq|

    wl{md~{ knbc| {d cbb ck~b{ qc{lno{p lo wmdi {mn klcgodplp df

    ec`{nulcb inologl{lp lp p~pqn`{nk wmlbn cuucoglog ~ugno{ {ucopfnu

    {d {mn mdpql{cb X;3Y/ Lo cod{mnu un`no{ un{udpqn`{lvn `dmdu{

    p{~k| df 56< ck~b{ qc{lno{p wl{m `dii~ol{|)c`s~lunk ec`{nulcb

    inologl{lp lo {mn ^ol{nk P{c{np X;5Y" 0 ecpnblon `blol`cb fnc{~unp

    wnun cppd`lc{nk wl{m ckvnupn d~{`din: m|qd{nopldo" cb{nunk

    ino{cb p{c{~p" cok pnlz~unp/ [mnpn 0 fc`{dup wnun ~pnk {d `unc{nc qudgodp{l` idknb {mc{ qunkl`{nk `blol`cb d~{`din" lo wml`m

    qc{lno{p wnun p{uc{lffink lo{d 0 qudgodp{l` p{cgnp df bdw" lo{nu)

    inklc{n" du mlgm ulph fdu ckvnupn d~{`din ecpnk do {mnpn `blol cb

    fnc{~unp/ [mn unp~b{p knidop{uc{nk {mc{ c knbc| lo lol{lc{ldo df

    co{lil`udelcb {mnucq| cf{nu qc{lno{ cuulvcb lo {mn ninugno`| kn)

    qcu{ino{ wcp cppd`lc{nk wl{m ckvnupn `blol cb d~{`din wmno {mn

    qc{lno{p `dokl{ldo ckvco`nk fudi c bdw) du lo{nuinklc{n)ulph

    p{cgn {d c mlgm)ulph p{cgn df qudgodp{l` pnvnul{|/ [mnpn kc{c p~q)

  • 8/9/2019 Bacterial Meningitis 5

    8/18

    357; @LK 511;:0< -3 Odvnienu, [~ohnb n{ cb/

    [cebn 0/ Un`diinokc{ldop fdu co{lil`udelcb {mnucq| lo ck~b{ qc{lno{p wl{m qunp~iq{lvn qc{mdgno lkno{lffi`c{ldo e|qdpl{lvn Guci p{clo/

    Il`uddugcolpi Un`diinoknk {mnucq| Cb{nuoc{lvn {mnucqlnp

    P{unq{d`d``~p qon~idolcn Vco`di|`lo qb~p c {mluk)gnonuc{ldo

    `nqmcbdpqduloc"e

    Inudqnoni -@)LLL," st~duds~lodbdon`

    -E)LL,

    Onlppnulc inologl{lklp [mluk)gnonuc{ldo nqmcbdpqduloc

    Qnol`lbblo G" ciql`lbblo" `mbduciqmnol`db" st~dud)

    s~lodbdon" cz{undoci

    Blp{nulc idod`|{dgnonp Ciql`lbblok du qnol`lbblo Gk [ulin{mdquli)p~bfcin{md}czdbn" inudqnoni -E)LLL,

    P{unq{d`d``~p cgcbc`{lcn Ciql`lbblok

    du qnol`lbblo Gk

    [mluk)gnonuc{ldo nqmcbdpqduloc

    -E)LLL,

    Mcnidqmlb~p lost~nozcn [mluk)gnonuc{ldo nqmcbdpqduloc

    -C)L, @mbduciqmnol`db" `nfnqlin -C)L," inudqnoni -C)L,"

    st~duds~lodbdon

    Np`mnul`mlc `dbl [mluk)gnonuc{ldo nqmcbdpqduloc

    -C)LL, @nfnqlin" inudqnoni" cz{undoci" st~duds~lod)

    bdon" {ulin{mdquli)p~bfcin{md}czdbn

    OD[N/ Cbb un`diinokc{ldop cun C)LLL" ~obnpp d{mnuwlpn lokl`c{nk/ Lo `mlbkuno" ciql`lbblo lp ckknk {d {mn p{cokcuk {mnucqn~{l` unglino

    df `nfd{c}lin du `nf{ulc}don qb~p vco`di|`lo wmno B/ idod`|{dgnonp lp `doplknunk cok {d co cilodgb|`dplkn lf c guci)ongc{lvn no{nul`

    qc{mdgno lp df `do`nuo/c

    @nf{ulc}don du `nfd{c}lin/e

    Pdin n}qnu{p wd~bk ckk ulfciqlo lf kn}cin{mcpdon lp cbpd glvno -E)LLL,/`

    Gc{lstd}c}lo du id}lstd}c`lo/k

    Ckkl{ldo df co cilodgb|`dplkn pmd~bk en `doplknunk/

    qdu{ {mn cpp~iq{ldo {mc{ {unc{ino{ df ec`{nulcb inologl{lp enfdun

    l{ ckvco`np {d c mlgm bnvnb df `blol`cb pnvnul{| liqudvnp d~{`din/

    Wmc{ nvlkno`n)ecpnk un`diinokc{ldop `co en ickn wl{m

    ungcuk {d {mn {lilog df co{lil`udelcb ckilolp{uc{ldo lo qc{lno{p

    wmd qunpno{ wl{m p~pqn`{nk du qudvno ec`{nulcb inologl{lp4 [mn

    hn| fc`{du wd~bk cqqncu {d en {mn onnk {d ckilolp{nu co{l)

    il`udelcb {mnucq| enfdun {mn qc{lno{p `blol`cb `dokl{ldo ck)

    vco`np {d c mlgm bnvnb df `blol`cb pnvnul{|" c{ wml`m qdlo{ {mn

    qc{lno{ lp bnpp blhnb| {d mcvn c f~bb un`dvnu| cf{nu {unc{ino{ wl{m

    cqqudqulc{n co{lil`udelcb {mnucq|/ Mdwnvnu" {mn d~{`din df

    ec`{nulcb inologl{lp lp i~b{lfc`{dulcb cok kdnp od{ cbwc|p `du)

    unbc{n wl{m k~uc{ldo df p|iq{dip" en`c~pn pdin qc{lno{p wmdun`nlvn klcgodpnp cok cun {unc{nk wl{mlo c fnw md~up df cuulvcb

    knvnbdq plgolffi`co{ pns~nbcn" wmnuncp d{mnup wmd cun p|iq{di)

    c{l` fdu kc|p mcvn c pnnilogb| oduicb d~{`din/ [mnunfdun" l{

    lp od{ qdpplebn {d cp`nu{clo wmno {mn mlgm bnvnb df `blol`cb pn)

    vnul{| lp unc`mnk/ [mn bdgl`cb cok lo{~l{lvn cqqudc`m lp {d ck)

    ilolp{nu co{lil`udelcb {mnucq| cp pddo cp qdpplebn cf{nu {mn

    klcgodplp df ec`{nulcb inologl{lp lp p~pqn`{nk du qudvno/ [mlp

    ic| lo`b~kn ckilolp{uc{ldo quldu {d mdpql{cb ckilppldo lf {mn

    qc{lno{ lol{lcbb| qunpno{p d~{plkn {mn mdpql{cb/ [mlp `do`nq{ mcp

    enno p~qqdu{nk e| 5 un`no{ un{udpqn`{lvn p{~klnp X;0" ;;Y/ Don

    knidop{uc{nk c unk~`{ldo lo idu{cbl{| wl{m ncub| ckilolp{uc)

    {ldo df co{lil`udelcb {mnucq| X;0Y" cok {mn d{mnu pmdwnk c

    enonffi{ lo {nuip df on~udbdgl` d~{`din cok p~uvlvcb lo qc{lno{p

    wmd un`nlvnk co{lil`udelcb {mnucq| enfdun {mn qc{lno{p bnvnb df

    `dop`ld~ponpp kn{nulduc{nk {d #31 do {mn Gbcpgdw @dic P`cbn

    X;;Y/ Mdwnvnu" do {mn ecplp df {mn cvclbcebn nvlkno`n" wn {mloh

    {mc{ {mnun cun lockns~c{n kc{c {d knblonc{n pqn`lffi` g~lknblonp

    do {mn lo{nuvcb en{wnno {mn lol{lcb qm|pl`lco no`d~o{nu cok {mn

    ckilolp{uc{ldo df {mn ffiup{ kdpn df co{lil`udelcb {mnucq| -@)

    LLL,/ [mc{ enlog pclk" ec`{nulcb inologl{lp lp c on~udbdgl` ninu)

    gno`|" cok cqqudqulc{n {mnucq| -pnn Wmc{ Pqn`lffi` Co{lil`ud)

    elcb Cgno{p Pmd~bk En ^pnk lo Qc{lno{p wl{m P~pqn {nk du

    Qudvno Ec`{nulcb Inologl{lp4" enbdw, pmd~bk en lol{lc{nk cp pddo

    cp qdpplebn cf{nu {mn klcgodplp lp `doplknunk {d en blhnb|/

    Wmc{ Pqn`lffi` Co{lil`udelcb Cgno{p Pmd~bk En ^pnk

    lo Qc{lno{p wl{m P~pqn`{nk du Qudvno Ec`{nulcb Inologl{lp4

    Do`n {mn klcgodplp df ec`{nulcb inologl{lp lp np{ceblpmnk e| @PF

    cocb|plp" co{lil`udelcb {mnucq| pmd~bk en lol{lc{nk/ [cugn{nk

    co{lil`udelcb {mnucq| lp ecpnk do qunp~iq{lvn qc{mdgno lkno)

    {lffi`c{ldo e| @PF Guci p{clo -{cebn 0," cb{md~gm -cp p{c{nk

    cedvn, {mn `dieloc{ldo df vco`di|`lo qb~p nl{mnu `nf{ulc}don

    du `nfd{c}lin lp ~pnk fdu lofco{p cok `mlbkunocok un`di)

    inoknk e| pdin n}qnu{p fdu ck~b{pwl{m p~pqn`{nk ec`{nulcb

    inologl{lp/ Niqlul`cb co{lil`udelcb {mnucq| lp lol{lc{nk nl{mnu

    wmno {mn b~iecu q~o`{~un lp knbc|nk -n/g/" lo {mdpn qc{lno{p

    pno{ fdu @[ df {mn mnck Xpnn Wml`m Qc{lno{p wl{m P~pqn`{nk

    Ec`{nulcb Inologl{lp Pmd~bk ^oknugd @[ df {mn Mnck quldu {d

    B~iecu Q~o`{~un4" cedvnY, du fdu qc{lno{p wl{m q~u~bno{ ino)

    logl{lp cok c ongc{lvn @PF Guci p{clo unp~b{ -{cebn ;,/ [mn

    `mdl`n df pqn`lffi` co{lil`udelcb cgno{p fdu {cugn{nk du niqlul`cb

    {mnucq| lp ecpnk do {mn `~uuno{ hodwbnkgn df co{lil`udelcb

    p~p`nq{lelbl{| qc{{nuop df {mnpn qc{mdgnop/ Fdu lol{lcb {mnucq|"{mn cpp~iq{ldo pmd~bk en {mc{ co{lil`udelcb unplp{co`n lp blhnb|/

    Nvlkno`n)ecpnk un`diinokc{ldop fdu pqn`lffi` cgno{p cok kdp)

    cgnp cun unvlnwnk lo {cebnp > cok 6" unpqn`{lvnb|/

    Wmc{ Lp {mn Udbn df Ckj~o`{lvn Kn}cin{mcpdon [mnucq| lo

    Qc{lno{p wl{m Ec`{nulcb Inologl{lp4

    @doplknuc{ldo pmd~bk en glvno {d ckilolp{uc{ldo df ckj~o`{lvn

    kn}cin{mcpdon lo `nu{clo qc{lno{p wl{m p~pqn`{nk du qudvno

  • 8/9/2019 Bacterial Meningitis 5

    9/18

    Quc`{l`n G~lknblonp fdu Ec`{nulcb Inologl{lp @LK 511;:0< -3 Odvnienu, 357>

    [cebn ;/ Un`diinokc{ldop fdu niqlul`cb co{lil`udelcb {mnucq| fdu q~u~bno{ inologl{lp ecpnk do qc{lno{ cgn cok pqn`lffi` qunklpqdplog`dokl{ldo -C)LLL,/

    Qunklpqdplog fc`{du @diido ec`{nulcb qc{mdgnop Co{lil`udelcb {mnucq|

    Cgn

    #3 ido{m P{unq{d`d``~p cgcbc`{lcn" Np`mnul`mlc `dbl" Blp{nulc

    idod`|{dgnonp" Hbneplnbbc pqn`lnp

    Ciql`lbblo qb~p `nfd{c}lin du ciql`lbblo qb~p co

    cilodgb|`dplkn

    350 ido{mp P{unq{d`d``~p qon~idolcn" Onlppnulc inologl{lklp"

    P/ cgcbc`{lcn" Mcnidqmlb~p lost~nozcn" N/ `dbl

    Vco`di|`lo qb~p c {mluk)gnonuc{ldo `nqmcbdpqduloc"e

    5>1 |ncup O / inologl{lklp" P/ qon~idolcn Vco`di|`lo qb~p c {mluk)gnonuc{ldo `nqmcbdpqduloc"e

    3>1 |ncup P/ qon~idolcn" O/ inologl{lklp" B/ idod`|{dgnonp"

    cnudel` guci)ongc{lvn ec`lbbl

    Vco`di|`lo qb~p ciql`lbblo qb~p c {mluk)gnonuc{ldo

    `nqmcbdpqduloc"e

    Mnck {uc~ic

    Ecplbcu ph~bb fuc`{~un P/ qon~idolcn" M/ lost~nozcn" gud~q C e)mnidb|{l`

    p{unq{d`d``l

    Vco`di|`lo qb~p c {mluk)gnonuc{ldo `nqmcbdpqduloc

    Qnon{uc{log {uc~ic P{cqm|bd`d` ~p c~un~p" `dcg~bcpn)ongc{lvn p{cqm|bd)

    `d``l -npqn`lcbb| P{cqm|bd`d``~p nqlknuilklp," cnu)

    del` guci)ongc{lvn ec`lbbl -lo`b~klog Qpn~kdidocpcnu~glodpc,

    Vco`di|`lo qb~p `nfnqlin" vco`di|`lo qb~p `nf{czl)

    klin" du vco`di|`lo qb~p inudqnoni

    Qdp{on~udp~ugnu| Cnudel guci)ongc{lvn ec lbbl -lo`b~klog Q/ cnu~glodpc,"

    P / c~un~p" `dcg~bcpn)ongc{lvn p{cqm|bd`d``l -np)

    qn`lcbb| P/ nqlknuilklp,

    Vco`di|`lo qb~p `nfnqlin" vco`di|`lo qb~p `nf{czl)

    klin" du vco`di|`lo qb~p inudqnoni

    @PF pm~o{ @dcg~bcpn)ongc{lvn p{cqm|bd`d` l -npqn lcbb| P/ nql)

    knuilklp," P/ c~un~p" cnudel` guci)ongc{lvn ec`lbbl

    -lo`b~klog Q/ cnu~glodpc," Qudqldolec`{nul~i c`onp

    Vco`di|`lo qb~p `nfnqlin"`

    vco`di|`lo qb~p `nf{czl)

    klin"`

    du vco`di|`lo qb~p inudqnoni`

    c@nf{ulc}don du `nfd{c}lin/

    ePdin n}qnu{p wd~bk ckk ulfciqlo lf kn}cin{mcpdon lp cbpd glvno/

    `Lo lofco{p cok `mlbkuno" vco`di|`lo cbdon lp uncpdocebn ~obnpp Guci p{clop unvncb {mn qunpno`n df guci)ongc{lvn ec`lbbl/

    ec`{nulcb inologl{lp/ [mn uc{ldocbn fdu ~pn lp knulvnk fudi n})

    qnulino{cb colicb idknbp df lofn`{ldo" wml`m mcvn pmdwo {mc{

    {mn p~ecuc`modlk pqc`n lostciic{du| unpqdopn k~ulog ec`{nulcb

    inologl{lp lp c icjdu fc`{du `do{ule~{log {d iduelkl{| cok

    idu{cbl{| X3Y/ C{{no~c{ldo df {mlp lostciic{du| unpqdopn ic|

    en nffn`{lvn lo kn`uncplog ico| df {mn qc{mdqm|pldbdgl` `do)

    pns~no`np df ec`{nulcb inologl{lp" p~`m cp `nuneucb nknic" lo)

    `uncpnk lo{uc`ucolcb qunpp~un" cb{nunk `nuneucb ebddk stdw" `n)uneucb vcp ~bl{lp" cok on~udocb loj~u|" cp inklc{nk e| qud)

    lostciic{du| `|{dhlon n}qunppldo X;>;7Y/

    Do {mn ecplp df {mnpn n}qnulino{cb depnuvc{ldop" o~inud~p

    `blol cb {ulcbp wnun ~oknu{chno {d cppnpp {mn nfffi`c`| df ckj~o`)

    {lvn kn}cin{mcpdon lo qc{lno{p wl{m ec`{nulcb inologl{lp/ P{~k)

    lnp mcvn vculnk p~`m {mc{: -3, od{ cbb wnun qbc`ned `do{udbbnk"

    -5, vculd~p co{lil`udelcb cgno{p wnun ~pnk -pdin df wml`m ic|

    od{ mcvn enno ckns~c{n fdu {mn {unc{ino{ df ec`{nulcb inolo)

    gl{lp," -0, kn}cin{mcpdon wcp ckilolp{nunk c{ klffnuno{ {linp

    lo unbc{ldo {d {mn ffiup{ co{lil`udelcb kdpn" cok -;, qc{lno{p mck

    vcu|log bnvnbp df lbbonpp pnvnul{|/ Lo ichlog nvlkno`n)ecpnk un`)

    diinokc{ldop" l{ lp qu~kno{ {d cocb|zn {mn kc{c c``duklog {dqc{lno{ cgn/

    Ondoc{np/ [mnun lp dob| 3 q~eblpmnk {ulcb {mc{ mcp nvcb~c{nk

    {mn nfffi`c`| df ckj~o`{lvn kn}cin{mcpdon lo ondoc{np wl{m ec`)

    {nulcb inologl{lp X;=Y/ Lo {mlp ucokdilznke~{ od{ qbc`ned)

    `do{udbbnk{ulcb lovdbvlog >5 f~bb){nui ondoc{np" qc{lno{p wnun

    glvno kn}cin{mcpdon 313> ilo enfdun {mn ffiup{ co{lil`udelcb

    kdpn/ Idu{cbl{| wcp 55. lo {mn {unc{nk gud~q cok 5=. lo {mn

    `do{udb gud~q - ,/ C{ fdbbdw)~q n}ciloc{ldo ~q ~o{lbQq /=7

    {mn cgn df 5 |ncup" 01. df {mn kn}cin{mcpdon){unc{nk qc{lno{p

    cok 0

  • 8/9/2019 Bacterial Meningitis 5

    10/18

    3576 @LK 511;:0< -3 Odvnienu, [~ohnb n{ cb/

    [cebn >/ Un`diinokc{ldop fdu pqn`lffi` co{lil`udelcb {mnucq| lo ec`{nulcb inologl{lp ecpnk do lpdbc{nk qc{mdgno cok p~p`nq{lelbl{|{np{log/

    Il`uddugcolpi" p~p`nq{lelbl{| P{cokcuk {mnucq| Cb{nuoc{lvn {mnucqlnp

    P{unq{d`d``~p qon~idolcn

    Qnol`lbblo IL@

    #1/3 ig$iB Qnol`lbblo G du ciql`lbblo [mluk)gnonuc{ldo nqmcbdpqdulo"c

    `mbduciqmnol`db

    1/33/1 ig$iBe

    [mluk)gnonuc{ldo nqmcbdpqduloc

    @nfnqlin -E)LL," inudqnoni -E)LL,

    5/1 ig$iB Vco`di|`lo qb~p c {mluk)gnonuc{ldo

    `nqmcbdpqduloc"`

    Fb~duds~lodbdonk -E)LL,

    @nfd{c}lin du `nf{ulc}don

    IL@ 3/1 ig$iB

    Vco`di|`lo qb~p c {mluk)gnonuc{ldo

    `nqmcbdpqduloc"`

    Fb~duds~lodbdonk

    -E)LL,

    Onlppnulc inologl{lklp

    Qnol`lbblo IL@

    #1/3 ig$iB Qnol`lbblo G du ciql`lbblo [mluk)gnonuc{ldo nqmcbdpqdulo"c

    `mbduciqmnol`db

    1/33/1 ig$iB [mluk)gnonuc{ldo nqmcbdpqduloc

    @mbduciqmnol`db" st~duds~lodbdon" inudqnoni

    Blp{nulc idod`|{dgnonp Ciql`lbblo du qnol`lbblo Gn

    [ulin{mdquli)p~bfcin{md}czdbn" inudqnoni -E)LLL,

    P{unq{d`d``~p cgcbc`{lcn Ciql`lbblo du qnol`lbblo Gn

    [mluk)gnonuc{ldo nqmcbdpqduloc

    -E)LLL,

    Np`mnul`mlc `dbl cok

    d{mnu No{nudec`{nulc ncng

    [mluk)gnonuc{ldo `nqmcbdpqdulo -C)LL, Cz{undoci" st~duds~lodbdon" inudqnoni" {ulin{mdquli)

    p~bfcin{md}czdbn" ciql`lbblo

    Qpn~kdidocp cnu~glodpcg

    @nfnqlinn

    du `nf{czlklinn

    -C )LL , C z{undoci"n

    `lqudstd}c`lo"n

    inudqnonin

    Mcnidqmlb~p lost~nozcn

    e)Bc`{cicpn ongc{lvn Ciql`lbblo [mluk)gnonuc{ldo nqmcbdpqdulo"c

    `nfnqlin" `mbdu)

    ciqmnol`db" st~duds~lodbdon

    e)Bc {cicpn qdpl{lvn [mluk)gnonuc{ldo `nqmcbdpqdulo -C)L, @nfnqlin -C)L," `mbduciqmnol db" st~duds~lodbdon

    P{cqm|bd`d``~p c~un~p

    In{ml`lbblo p~p`nq{lebn Ocf`lbblo du d}c`lbblo Vco`di|`lo" inudqnoni -E)LLL,

    In{ml`lbblo unplp{co{ Vco`di|`lof

    [ulin{mdquli)p~bfcin{md}czdbn" blonzdblk -E)LLL,

    P{cqm|bd`d``~p nqlknuilklp Vco`di|`lof

    Blonzdblk -E)LLL,

    No{nud`d``~ppqn`lnp

    Ciql`lbblo p~p`nq{lebn Ciql`lbblo qb~p gno{cil`lo

    Ciql`lbblo unplp{co{ Vco`di|`lo qb~p gno{cil`lo

    Ciql`lbblo cok vco`di|`lo unplp{co{ Blonzdblk -E)LLL,

    OD[N/ Cbb un`diinokc{ldop cun C)LLL" ~obnpp d{mnuwlpn lokl`c{nk/c

    @nf{ulc}don du `nfd{c}lin/e

    @nf{ulc}don$`nfd{c}lin)p~p`nq{lebn lpdbc{np/`

    @doplknu ckkl{ldo df ulfciqlo lf {mn IL@ df `nf{ulc}don lp 35 ig$iB/k

    Gc{lstd}c`lo du id}lstd}c`lo/n

    Ckkl{ldo df co cilodgb|`dplkn pmd~bk en `doplknunk/f

    @doplknu ckkl{ldo df ulfciqlo/g

    @mdl`n df c pqn`lffi` co{lil`udelcb cgno{ i~p{ en g~lknk e| lo vl{ud p~p`nq{lelbl{| {np{ unp~b{p/

    q~eblpmnk X65" 60Y/ [mn ffiup{ wcp c un{udpqn`{lvn p{~k| lovdbvlog

    `mlbkuno wl{m qon~id`d``cb inologl{lp cok pmdwnk {mc{" lo

    {mn kn}cin{mcpdon gud~q" {mnun wcp c mlgmnu lo`lkno`n df idk)

    nuc{n du pnvnun mnculog bdpp -;6. vp/ 50.8 , du co|Qq /136

    on~udbdgl` knffi l{p ->>. vp/ 00.8 , X65Y/ Mdwnvnu" `mlb)Qq /15

    kuno lo {mn kn}cin{mcpdon gud~q idun funs~no{b| uns~lunk

    lo{~ec{ldo cok in`mcol`cb vno{lbc{ldo cok mck c bdwnu lol{lcb

    @PF gb~`dpn `do`no{uc{ldo/ F~u{mnuidun" {mnun wnun od kc{c

    do ~pn df pqn`lffi` co{lil`udelcb cgno{p lo nc`m gud~q" cok {mn

    kn}cin{mcpdon wcp glvno bc{nu {mco lo d{mnu p{~klnp -l/n/" wl{mlo

    61 ilo df {mn ffiup{ co{lil`udelcb kdpn,/ [m~p" l{ lp qdpplebn {mc{

    {mn `blol`cb enonffi{ wcp od{ cp dq{licb cp wcp co{l`lqc{nk/ Lo c

    un`no{b| q~eblpmnk ucokdilznk" qbc`ned)`do{udbbnk" kd~ebn)

    eblok {ulcb df ckj~o {lvn kn}cin{mcpdon lo `mlbkuno lo Icbcwl

    X60Y" {mn dvnucbb o~ienu df knc{mp -03. vp/ 03.8 , cokQq /

  • 8/9/2019 Bacterial Meningitis 5

    11/18

    Quc`{l`n G~lknblonp fdu Ec`{nulcb Inologl{lp @LK 511;:0< -3 Odvnienu, 3577

    [cebn 6/ Un`diinoknk kdpcgnp df co{lil udelcb {mnucq| lo qc{lno{p wl{m ec`{nulcb inologl{lp -C)LLL,/

    Co{lil`udelcb cgno{

    [d{cb kclb| kdpn -kdplog lo{nuvcb lo md~up,

    Ondoc{np" cgn lo kc|p

    Lofco{p cok `mlbkuno Ck~b{p17c

    =5=c

    Cilhc`loe

    3>51 ig$hg -35, 01 ig$hg -=, 5101 ig$hg -=, 3> ig$hg -=,

    Ciql`lbblo 3>1 ig$hg -=, 511 ig$hg -6=, 011 ig$hg -6, 35 g -;,

    Cz{undoci 6= g -6=,@nfnqlin 3>1 ig$hg -=, 6 g -=,

    @nfd{c}lin 3113>1 ig$hg -=35, 3>1511 ig$hg -6=, 55>011 ig$hg -6=, =35 g -;6,

    @nf{czlklin 3113>1 ig$hg -=35, 3>1 ig$hg -=, 3>1 ig$hg -=, 6 g -=,

    @nf{ulc}don =1311 ig$hg -355;, ; g -355;,

    @mbduciqmnol`db 5> ig$hg -5;, >1 ig$hg -355;, 7>311 ig$hg -6, ;6 g -6,`

    @lqudstd}c`lo =113511 ig -=35,

    Gc{lstd}c`lo ;11 ig -5;,k

    Gno{cil`loe

    > ig$hg -35, 7/> ig$hg -=, 7/> ig$hg -=, > ig$hg -=,

    Inudqnoni 351 ig$hg -=, 6 g -=,

    Id}lstd}c`lo ;11 ig -5;,k

    Ocf`lbblo 7> ig$hg -=35, 3113>1 ig$hg -6=, 511 ig$hg -6, ig$hg -=35, 3>1511 ig$hg -6=, 511 ig$hg -6, i^$hg -=35, 1/5 i^$hg -6=, 1/0 i^$hg -;6, 5; i^ -;,

    Ulfciqlo 3151 ig$hg -35, 3151 ig$hg -355;,n

    611 ig -5;,

    [deuci|`loe

    > ig$hg -35, 7/> ig$hg -=, 7/> ig$hg -=, > ig$hg -=,

    [IQ)PIZf

    3151 ig$hg -635, 3151 ig$hg -635,

    Vco`di|`log

    5101 ig$ hg -=35, 01;> ig$hg - 6=, 61 ig$ hg - 6, 01;> ig$hg - =35,

    OD[N/ [IQ)PIZ" {ulin{mdquli)p~bfcin{md}czdbn/c

    Picbbnu kdpnp cok bdognu lo{nuvcbp df ckilolp{uc{ldo ic| en ckvlpcebn fdu vnu| bdwelu{m wnlgm{ ondoc{np -#5111 g,/e

    Onnk {d idol{du qnch cok {ud~gm pnu~i `do`no{uc{ldop/`

    Mlgmnu kdpn un`diinoknk fdu qc{lno{p wl{m qon~id`d``cb inologl{lp/k

    Od kc{c do dq{licb kdpcgn onnknk lo qc{lno{p wl{m ec`{nulcb inologl{lp/n

    Ic}li~i kclb| kdpn df 611 ig/f

    Kdpcgn ecpnk do {ulin{mdquli `diqdono{/g

    Iclo{clo pnu~i {ud~gm `do`no{uc{ldop df 3>51 ig$iB/

    Knpql{n pdin vculcelbl{| lo unp~b{ df q~eblpmnk {ulcbp" wn en)

    blnvn {mn cvclbcebn nvlkno`n p~qqdu{p {mn ~pn df ckj~o`{lvn kn})

    cin{mcpdon lo lofco{p cok `mlbkuno wl{m M/ lost~nozcn {|qn e

    inologl{lp -C)L,/ Kn}cin{mcpdon pmd~bk en lol{lc{nk 3151

    ilo quldu {d" du c{ bncp{ `do`dil{co{ wl{m" {mn ffiup{ co{lil`ud)

    elcb kdpn" c{ 1/3> ig$hg nvnu| 6 m fdu 5; kc|p/ Ckj~o`{lvn

    kn}cin{mcpdon pmd~bk od{ en glvno {d lofco{p cok `mlbkuno

    wmd mcvn cbunck| un`nlvnk co{lil`udelcb {mnucq|" en`c~pn ck)

    ilolp{uc{ldo df kn}cin{mcpdon lo {mlp `lu`~ip{co`n lp ~oblhnb|

    {d liqudvn qc{lno{ d~{`din -C)L,/ Lo lofco{p cok `mlbkuno wl{m

    qon~id`d``cb inologl{lp" {mnun lp `do{udvnup| `do`nuolog {mn

    ~pn df ckj~o {lvn kn}cin{mcpdon {mnucq| -@)LL,/ [mn 5110

    p{c{nino{ e| {mn @diil{{nn do Lofn`{ld~p Klpncpnp df {mn

    Cinul`co C`ckni| df Qnklc{ul`p do {mn ~pn df p{nudlkp fdu

    qon~id`d``cb inologl{lp lp cp fdbbdwp: Fdu lofco{p cok `mlb)

    kuno 6 wnnhp df cgn cok dbknu" ckj~o`{lvn {mnucq| wl{m kn}c)

    in{mcpdon ic| en `doplknunk cf{nu wnlgmlog {mn qd{no{lcb eno)

    nffi{p cok qdpplebn ulphp/ N}qnu{p vcu| lo un`diinoklog {mn ~pn

    df `du{l`dp{nudlkp lo qon~id`d``cb inologl{lp8 kc{c cun od{

    p~fffi`lno{ {d knidop{uc{n `bncu enonffi{ lo `mlbkuno X66" q/ ; q~eblpmnk {ulcbp df ckj~o`{lvn

    kn}cin{mcpdon lo ck~b{p wl{m ec`{nulcb inologl{lp X6773Y8 0

    wnun ucokdilznk cok qbc`ned `do{udbbnk X6=" 6

  • 8/9/2019 Bacterial Meningitis 5

    12/18

    357= @LK 511;:0< -3 Odvnienu, [~ohnb n{ cb/

    kdpn/ C{ = wnnhp cf{nu noudbbino{" {mn qnu`no{cgn df qc{lno{p

    wl{m co ~ofcvducebn d~{`din -3>. vp/ 5>.8 , cokQq /10

    knc{m -7. vp/ 3>.8 , wcp plgolffi`co{b| bdwnu lo {mnQq /1;

    kn}cin{mcpdon gud~q/ Cidog {mn p~egud~q df qc{lno{p wl{m

    qon~id`d``cb inologl{lp" enonffi{ wcp nvlkno{ lo {mdpn wmd

    un`nlvnk ckj~o`{lvn kn}cin{mcpdon" wl{m c bdwnu qnu`no{cgn df

    ~ofcvducebn d~{`dinp -56. vp/ >5.8 , cok knc{mpQq /116

    -3;. vp/ 0;.8 ,/ Enonffi{p wnun od{ pnno lo d{mnu p~e)Qq /15gud~qp wl{m inologl{lp `c~pnk e| d{mnu inologncb qc{mdgnop"

    cb{md~gm qc{lno{ o~ienup lo {mdpn gud~qp wnun picbb/ Lo cbb

    gud~qp" kn}cin{mcpdon cqqncunk {d en {mn idp{ enonffi`lcb lo

    qc{lno{p wl{m idknuc{n){d)pnvnun klpncpn do {mn Gbcpgdw @dic

    P`cbn/

    Do {mn ecplp df {mn cvclbcebn nvlkno`n do {mn ~pn df ckj~o {lvn

    kn}cin{mcpdon lo ck~b{p" wn un`diinok ~pn df kn}cin{mcpdon

    -1/3> ig$hg s6m fdu 5; kc|p wl{m {mn ffiup{ kdpn ckilolp{nunk

    3151 ilo enfdun" du c{ bncp{ `do`dil{co{ wl{m" {mn ffiup{ kdpn

    df co{lil`udelcb {mnucq|, lo ck~b{p wl{m p~pqn`{nk du qudvno

    qon~id`d``cb inologl{lp -C)L,/ Pdin n}qnu{p wd~bk dob| ck)

    ilolp{nu ckj~o`{lvn kn}cin{mcpdon lf {mn qc{lno{ mck idknu)

    c{n){d)pnvnun klpncpn -Gbcpgdw @dic P`cbn p`dun" 33,/ Mdw)

    nvnu" wn {mloh {mc{ ckj~o {lvn kn}cin{mcpdon pmd~bk en

    lol{lc{nk lo cbb ck~b{ qc{lno{p wl{m p~pqn`{nk du qudvno qon~)

    id`d``cb inologl{lp" en`c~pn cppnppino{ df {mn p`dun ic| knbc|

    lol{lc{ldo df cqqudqulc{n {mnucq|/ Kn}cin{mcpdon pmd~bk dob|

    en `do{lo~nk lf {mn @PF Guci p{clo unvncbp guci)qdpl{lvn klq)

    bd`d``l" du lf ebddk du @PF `~b{~unp cun qdpl{lvn fdu P/ qon~)

    idolcn/ Ckj~o {lvn kn}cin{mcpdon pmd~bk od{ en glvno {d ck~b{

    qc{lno{p wmd mcvn cbunck| un`nlvnk co{lil`udelcb {mnucq|" en)

    `c~pn ckilolp{uc{ldo df kn}cin{mcpdon lo {mlp `lu`~ip{co`n lp

    ~oblhnb| {d liqudvn qc{lno{ d~{`din -C)L,/ [mn kc{c cun lo)ckns~c{n {d un`diinok ckj~o`{lvn kn}cin{mcpdon {d ck~b{p

    wl{m inologl{lp `c~pnk e| d{mnu ec`{nulcb qc{mdgnop" cb{md~gm

    pdin c~{mdul{lnp wd~bk lol{lc{n kn}cin{mcpdon lo cbb ck~b{p"

    en`c~pn {mn n{ldbdg| df inologl{lp lp od{ cbwc|p cp`nu{clonk c{

    lol{lcb nvcb~c{ldo -E)LLL,/

    Qon~id d``cb inologl{lp/ Knpql{n {mn `blol`cb {ulcbp {mc{

    mcvn knidop{uc{nk {mn enonffi{p df ckj~o`{lvn kn}cin{mcpdon lo

    lofco{p" `mlbkuno" cok ck~b{p wl{m ec`{nulcb inologl{lp -pnn Wmc{

    Lp {mn Udbn df Ckj~o`{lvn Kn}cin{mcpdon [mnucq| lo Qc{lno{p

    wl{m Ec`{nulcb Inologl{lp4" cedvn," `do`nuop mcvn enno uclpnk

    ced~{ wmn{mnu ~pn df ckj~o`{lvn kn}cin{mcpdon ic| en mcuif~b

    lo qc{lno{p wl{m qon~id`d``cb inologl{lp `c~pnk e| mlgmb| qno)l`lbblo) du `nqmcbdpqdulo)unplp{co{ p{uclop X3Y8 {mnpn qc{lno{p ic|

    uns~lun co{lil`udelcb {mnucq| wl{m vco`di|`lo" cok {mn klilo)

    lpmnk lostciic{du| unpqdopn lok~`nk e| kn}cin{mcpdon ilgm{

    unk~`n @PF vco`di| lo qnon{uc{ldo cok knbc| @PF p{nulblzc{ldo/

    [mlp ffioklog mcp enno depnuvnk lo n}qnulino{cb colicb idknbp

    df unplp{co{ qon~id`d``cb inologl{lp X75" 70Y" cb{md~gm bcugnu

    vco`di|`lo kdpcgnp ic| `lu`~ivno{ {mn nffn`{ df `du{l`dp{nudlkp

    do @PF vco`di|`lo qnon{uc{ldo X7;Y/ @PF vco`di|`lo qnon)

    {uc{ldo wcp od{ unk~`nk lo c picbb p{~k| df `mlbkuno wl{m ec`{nulcb

    inologl{lp" wmno diqcunk wl{m `do`no{uc{ldop c`mlnvnk lo mlp)

    {dul`cb `do{udbp X7>Y/ [mn q~eblpmnk {ulcbp mcvn od{ n}cilonk

    d~{`din lo qc{lno{p wl{m {mnpn unplp{co{ lpdbc{np wmd mcvn un)

    `nlvnk ckj~o`{lvn kn}cin{mcpdon/ Lo {mn un`no{ p{~k| lo ck~b{p

    `l{nk cedvn X73Y" dob| 75. df 31= @PF qon~id`d``cb lpdbc{np

    wnun p~eil{{nk fdu lo vl{ud p~p`nq{lelbl{| {np{log" cok cbb wnun

    p~p`nq{lebn {d qnol`lbblo" co ~o~p~cb ffioklog lo {mn ^ol{nk P{c{npcok lo ico| cuncp df {mn wdubk/ Cb{md~gm l{ wd~bk en dq{licb

    {d nvcb~c{n {mn nfffi`c`| df ckj~o`{lvn kn}cin{mcpdon lo qc{lno{p

    wl{m inologl{lp `c~pnk e| mlgmb| unplp{co{ qon~id`d``l" glvno

    {mn klfffi`~b{| lo noudbblog ckns~c{n o~ienup df qc{lno{pwl{m {mnpn

    unplp{co{ p{uclop lo{d c `blol cb {ulcb" l{ lp ~oblhnb| {mc{ {mlp s~np{ldo

    wlbb en knffiol{lvnb| copwnunk lo {mn oncu f~{~un X76Y/ Wn un`)

    diinok {mc{ ckj~o`{lvn kn}cin{mcpdon en ckilolp{nunk {d cbb

    ck~b{ qc{lno{p wl{m qon~id`d``cb inologl{lp" nvno lf {mn lpdbc{n

    lp p~epns~no{b| fd~ok {d en mlgmb| unplp{co{ {d qnol`lbblo cok

    `nqmcbdpqdulop -E)LLL,/ @cunf~b depnuvc{ldo cok fdbbdw)~q cun

    `ul{l`cb {d kn{nuilon wmn{mnu kn}cin{mcpdon lp cppd`lc{nk wl{m

    ckvnupn `blol`cb d~{`din/ Fdu kc{c do d~{`din lo qc{lno{p wl{m

    inologl{lp `c~pnk e| unplp{co{ qon~id`d `cblpdbc{np"`cpn unqdu{p

    cok picbb `cpn pnulnp ic| mnbq cp`nu{clo wmn{mnu kn}cin{mcpdon

    lp mcuif~b {d {mnpn qc{lno{p/ F~u{mnuidun" lo qc{lno{p wl{m p~p)

    qn`{nk qon~id`d``cb inologl{lp wmd un`nlvn ckj~o`{lvn kn}c)

    in{mcpdon" ckkl{ldo df ulfciqlo {d {mn niqlul`cb `dieloc{ldo

    df vco`di| lo qb~p c {mluk)gnonuc{ldo `nqmcbdpqdulo ic| en

    uncpdocebn qnoklog `~b{~un unp~b{p cok lo vl{ud p~p`nq{lelbl{| {np{)

    log -E)LLL,/

    Do`n {mn Ec`{nulcb N{ldbdg| df Inologl{lp Lp Np{ceblpmnk" Wmc{

    Pqn`lffi` Co{lil`udelcb Cgno{p Pmd~bk En ^pnk fdu [unc{ino{4Do`n c ec`{nulcb qc{mdgno lp lpdbc{nk cok lo vl{ud p~p`nq{lelbl{|

    {np{log lp qnufduink" co{lil`udelcb {unc{ino{ pmd~bk en idk)

    lffink fdu dq{licb {mnucq|/ D~u un`diinokc{ldop -wl{m cb{nu)

    oc{lvn p~ggnp{ldop," ecpnk do {mn lpdbc{nk il`uddugcolpi" cun

    blp{nk lo {cebn >/ Un`diinoknk kdpcgnp df co{lil`udelcb cgno{p

    lo ondoc{np" `mlbkuno" cok ck~b{p cun pmdwo lo {cebn 6/ [mnun

    cun od qbc`ned)`do{udbbnk {ulcbp df pqn`lffi` co{lil`udelcb cgno{p

    lo qc{lno{p wl{m ec`{nulcb inologl{lp/ Plo`n {mnlu knvnbdqino{"

    qnol`lbblop cok p~bfdocilknp mcvn enno {mn p{cokcuk" e~{ i~`m

    mcp `mcognk cp c unp~b{ df wlknpqunck co{lil udelcb unplp{co`n

    cgclop{ {mnpn ku~gp cok {mn onnk fdu knvnbdqino{ df onwnu

    cgno{p/ Kn`lpldop do {mn `mdl`n df c pqn`lffi` co{lil`udelcb cgno{cun ecpnk do hodwbnkgn df lo vl{ud p~p`nq{lelbl{| cok unbc{lvn

    qnon{uc{ldo lo{d @PF lo {mn qunpno`n df inologncb lostci)

    ic{ldo -wmn{mnu gbnconk fudi n}qnulino{cb colicb idknbp du

    qc{lno{p,/ @blol cb {ulcbp mcvn idp{ df{no `diqcunk onwnu cgno{p

    wl{m wmc{ mcp enno kn{nuilonk {d en p{cokcuk co{lil`udelcb

    {mnucq|" nvno {md~gm {mlp p{cokcuk {mnucq| mcp od{ cbwc|p

    enno n}{noplvnb| p{~klnk lo qc{lno{p/ [mn fdbbdwlog pn`{ldop wlbb

    unvlnw pqn`lffi` `bcppnp df co{lil`udelcb cgno{p {mc{ mcvn enno

  • 8/9/2019 Bacterial Meningitis 5

    13/18

    Quc`{l`n G~lknblonp fdu Ec`{nulcb Inologl{lp @LK 511;:0< -3 Odvnienu, 35731" 336Y8 {mn vno{ul`~bl{lp

    df {mn pm~o{ lofn`{ldo cqqncup {d `bncu idun ucqlkb| wl{m {mn

    kuclocgn `c{mn{nu" cok {mn qunpno`n df {mn `c{mn{nu cbbdwp `do)

    {lo~nk {unc{ino{ df {mn m|kud`nqmcb~p ~o{lb {mn lofn`{ldo mcp

    `bncunk -C)LL,/ P~``npp uc{np cun bdwnu wmno {mn pm~o{ lp {unc{nk

    lo pl{~" en`c~pn df {mn celbl{| df ico| df {mnpn il`uddugcolpip

    {d ckmnun {d qudp{mnpnp cok p~uvlvn co{lil`udelcb {mnucq|/

    [mn {lilog df pm~o{ unliqbco{c{ldo lp knqnokno{ ~qdo {mn

    lpdbc{nk il`uddugcolpi" {mn n}{no{ df lofn`{ldo cp knffionk e|

  • 8/9/2019 Bacterial Meningitis 5

    15/18

    Quc`{l`n G~lknblonp fdu Ec`{nulcb Inologl{lp @LK 511;:0< -3 Odvnienu, 35=3

    [cebn =/ K~uc{ldo df co{lil`udelcb {mnucq| fduec`{nulcb inologl{lp ecpnk do lpdbc{nk qc{mdgno-C)LLL,/

    Il`uddugcolpi

    K~uc{ldo df

    {mnucq|" kc|p

    Onlppnulc inologl{lklp 7

    Mcnidqmlb~p lost~nozcn 7

    P{unq{d`d``~p qon~idolcn 313;

    P{unq{d`d``~p cgcbc`{lcn 3;53

    Cnudel` guci)ongc{lvn ec`lbblc

    53

    Blp{nulc idod`|{dgnonp 53

    cK~uc{ldo lo {mn ondoc{n lp 5 wnnhp en|dok {mn ffiup{

    p{nulbn @PF `~b{~un du 0 wnnhp" wml`mnvnu lp bdognu/

    [cebn

  • 8/9/2019 Bacterial Meningitis 5

    16/18

    35=5 @LK 511;:0< -3 Odvnienu, [~ohnb n{ cb/

    {mc{ ic| en ~pnk {d kn{nuilon wml`m qc{lno{p wl{m ec`{nulcb

    inologl{lp `co un`nlvn d~{qc{lno{ co{lil`udelcb {mnucq| cun

    pmdwo lo {cebn < -E)LLL,/ L{ i~p{ en niqmcplznk" mdwnvnu" {mc{

    qc{lno{ pnbn`{ldo fdu d~{qc{lno{ co{lil`udelcb {mnucq| fdu ec`)

    {nulcb inologl{lp i~p{ en `cunf~bb| qnufduink" cok `bdpn inkl cb

    fdbbdw)~q lp nppno{lcb/

    C`hodwbnkgino{p

    Qd{no{lcb `dostl`{ df lo{nunp{/ C/U/[/ mcp pnuvnk cp c `dop~b{co{ fdu

    @no{d`du/ P/B/H/ mcp un`nlvnk guco{ p~qqdu{ fudi Qffiznu" Cvno{lp)Qcp{n~u"

    cok Ud`mn Bceduc{dulnp cok mcp pnuvnk cp c `dop~b{co{ fdu Cvno{lp)Qcp{n~u

    cok W|n{m/ W/I/P/ mcp pnuvnk do {mn pqnchnup e~unc~p fdu fdu Ec|nu"

    Qffiznu" Gbc}dPil{mHblon" cok Eulp{db)I|nup Ps~lee cok mcp pnuvnk do {mn

    Qffiznu Ckvlpdu| Edcuk/ E/J/M/" E/C/H/" cok H/B/U/: Od `dostl`{/

    Unfnuno`np

    3/ [~ohnb CU/ Ec`{nulcb inologl{lp/ Qmlbcknbqmlc: Blqqlo`d{{ Wlbblcip &

    Wlbhlop" 5113/

    5/ Icu{do HL" Gnco CK/ [mn pqlocb {cq: c onw bddh c{ co dbk {np{/ Coo

    Lo{nuo Ink 3:375700/

    7/ Edockld WC/ [mn `nuneudpqlocb st~lk: qm|pldbdgl` cpqn`{p cok cb{nu)

    c{ldop cppd`lc{nk wl{m ec`{nulcb inologl{lp/ Qnklc{u Lofn`{ Klp J 3/

    51/ Pqcodp C" Mcuunbb FN Ju" K~uc h K[/ Klffnuno{lcb klcgodplp df c`~{n

    inologl{lp: co cocb|plp df {mn qunkl`{lvn vcb~n df lol{lcb depnuvc{ldop/

    JCIC 3>6>/

    5>/ Gnuknp B^" Jdugnopno QN" On}d N" Wcog Q/ @)unc`{lvn qud{nlo cok

    ec`{nulcb inologl{lp: c in{c)cocb|plp/ P`cok J @blo Bce Lovnp{ 3

  • 8/9/2019 Bacterial Meningitis 5

    17/18

    Quc`{l`n G~lknblonp fdu Ec`{nulcb Inologl{lp @LK 511;:0< -3 Odvnienu, 35=0

    ;3/ Engg O" @cu{wulgm{ HCV" @dmno J" n{ cb/ @dopnop~p p{c{nino{ do

    klcgodplp" lovnp{lgc{ldo" {unc{ino{" cok qunvno{ldo df c`~{n ec`{nulcb

    inologl{lp lo lii~od`diqn{no{ ck~b{p/ J Lofn`{ 35=/

    ;>/ [~ohnb CU" P`mnbk WI/ Qc{mdgnonplp cok qc{mdqm|pldbdg| df ec`)

    {nulcb inologl{lp/ @blo Il`udeldb Unv 35;/ Hnoonk| WC" Md|{ IJ" I`@uc`hno GM Ju/ [mn udbn df `du{l`dp{nudlk

    {mnucq| lo `mlbkuno wl{m qon~id`d``cb inologl{lp/ Ci J Klp @mlbk

    3>/ P`mcck ^E" Blqp ^" Gonmi MN" n{ cb/ Kn}cin{mcpdon {mnucq| fdu

    ec`{nulcb inologl{lp lo `mlbkuno/ Bco`n{ 36/ Hlog PI" Bcw E" Bcogbn| JI" n{ cb/ Kn}cin{mcpdon {mnucq| fdu ec`)

    {nulcb inologl{lp: en{{nu onvnu {mco bc{n4 @co J Lofn`{ Klp 37/ Wcbk NU" Hcqbco PB" Icpdo ND Ju" n{ cb/ Kn}cin{mcpdon {mnucq| fdu

    `mlbkuno wl{m ec`{nulcb inologl{lp/ Qnklc{ul`p 3=/ Hcouc G\" Dzno M" Pn`innu G" n{ cb/ [mn enonffi`lcb nffn`{p df kn})

    cin{mcpdon lo `mlbkuno wl{m qon~id`d``cb inologl{lp/ Qnklc{u Lofn`{

    Klp J 35:500

  • 8/9/2019 Bacterial Meningitis 5

    18/18

    35=; @LK 511;:0< -3 Odvnienu, [~ohnb n{ cb/

    =7/ Pcnz)Bbdunop ]" @cp{cod N" Gcu lc U" n{ cb/ Qudpqn {lvn ucokdilznk

    `diqculpdo df `nfnqlin cok `nfd{c}lin fdu {unc{ino{ df ec`{nulcb

    inologl{lp lo lofco{p cok `mlbkuno/ Co{lil`ude Cgno{p @mnid{mnu

    31:77/

    337/ Uckn{ph| I/ K~uc{ldo df {unc{ino{ lo ec`{nulcb inologl{lp: c mlp{dul`cblos~lu|/ Qnklc{u Lofn`{ Klp J 3