A case of Meningitis induced by amoxicillin


‘Super Bacteria’ Found At Brazil Olympic Venues, Beaches

The diseases can cause infections, meningitis and lead to death.

Scientists have found dangerous drug-resistant “super bacteria” off beaches in Rio de Janeiro that will host Olympic swimming events and in a lagoon where rowing and canoe athletes will compete when the Games start on Aug. 5.

The findings from two unpublished academic studies seen by Reuters concern Rio’s most popular spots for tourists and greatly increase the areas known to be infected by the microbes normally found only in hospitals.

They also heighten concerns that Rio’s sewage-infested waterways are unsafe.

A study published in late 2014 had shown the presence of the super bacteria – classified by the U.S. Centers for Disease Control and Prevention (CDC) as an urgent public health threat – off one of the beaches in Guanabara Bay, where sailing and wind-surfing events will be held during the Games.

The first of the two new studies, reviewed in September by scientists at the Interscience Conference on Antimicrobial Agents and Chemotherapy in San Diego, showed the presence of the microbes at five of Rio’s showcase beaches, including the ocean-front Copacabana, where open-water and triathlon swimming will take place.

The other four were Ipanema, Leblon, Botafogo and Flamengo.

The super bacteria can cause hard-to-treat urinary, gastrointestinal, pulmonary and bloodstream infections, along with meningitis. The CDC says studies show that these bacteria contribute to death in up to half of patients infected.

The second new study, by the Brazilian federal government’s Oswaldo Cruz Foundation lab, which will be published next month by the American Society for Microbiology, found the genes of super bacteria in the Rodrigo de Freitas lagoon in the heart of Rio and in a river that empties into Guanabara Bay.

Waste from countless hospitals, in addition to hundreds of thousands of households, pours into storm drains, rivers and streams crisscrossing Rio, allowing the super bacteria to spread outside the city’s hospitals in recent years.

Renata Picao, a professor at Rio’s federal university and lead researcher of the first study, said the contamination of Rio’s famous beaches was the result of a lack of basic sanitation in the metropolitan area of 12 million people.

“These bacteria should not be present in these waters. They should not be present in the sea,” said Picao from her lab in northern Rio, itself enveloped by stench from Guanabara Bay.

Cleaning the city’s waterways was meant to be one of the Games’ greatest legacies and a high-profile promise in the official 2009 bid document Rio used to win the right to host South America’s first Olympics.

That goal has instead transformed into an embarrassing failure, with athletes lamenting the stench of sewage and complaining about debris that bangs into and clings to boats in Guanabara Bay, potential hazards for a fair competition.


Picao’s study, which has undergone internal reviews at Rio’s federal university, analyzed water samples taken between September 2013 and September 2014. Using 10 samples taken at five beach locations, the study found super bacteria were most present at Botafogo beach, where all samples were positive.

Flamengo beach, where spectators will gather to watch Olympic sailors vie for medals, had the super bacteria in 90 percent of samples. Ten percent of Copacabana’s samples had the microbes.

Ipanema and Leblon beaches, the most popular with tourists, had samples that tested positive for super bacteria 50 and 60 percent of the time, respectively.

The Oswaldo Cruz study of the Olympic lagoon, which was peer reviewed, is based on water samples taken in 2013. It found that the lake is a potential breeding ground for super bacteria and their spread through the city.

While the studies both use water samples that are from 2013 and 2014, Picao and other experts said they had seen no advances in sewerage infrastructure in Rio to improve the situation.

Valerie Harwood, an expert in recreational water contamination and antibiotic-resistant bacteria at the University of South Florida who was not involved in the studies, said that if anything, things were getting worse, as the super bacteria naturally spread by infecting other microbes.

The contamination has prompted federal police and prosecutors to investigate whether Rio’s water utility Cedae is committing environmental crimes by lying about how much sewage it treats. Investigators are also looking into where billions of dollars in funds went since the early 1990s, money earmarked to improve sewage services and clean Guanabara Bay.

Cedae has denied any wrongdoing. It said in an emailed statement that any super bacteria found at the beaches or the Olympic lagoon must be the result of illegal dumping into storm drains. Cedae said it carries out sewage treatment and collection in the entire “south zone” of Rio, where the bodies of water are located and where the water samples were taken.


Five scientists consulted by Reuters said the immediate risk to people’s health when faced with super bacteria infection depends on the state of their immune systems.

These bacteria are opportunistic microbes that can enter the body, lie dormant, then attack at a later date when a healthy person may fall ill for another reason.

Super bacteria infect not only humans but also otherwise-harmless bacteria present in the waters, turning them into antibiotic-resistant germs.

Harwood said the super bacteria genes discovered in the Olympic lagoon were probably not harmful if swallowed by themselves: they need to be cocooned inside of a bacterium.

“Those genes are like candy. They are organic molecules and they’ll be eaten up by other bacteria, other organisms,” Harwood said. “That’s where the danger is – if a person then ingests that infected organism – because it will make it through their gastrointestinal tract and potentially make someone ill.”

The presence of the super bacteria genes in the lagoon indicates the bacteria themselves had recently died or simply were not detected by testing, Harwood said.

Health experts say Rio’s poor wastewater management has already created endemic illnesses associated with sewage that disproportionately impact the city’s poor, including gastrointestinal and respiratory problems, Hepatitis A and severe heart and brain conditions.

Rio’s Olympic organizing committee referred questions on water quality to state authorities.

Rio state’s Inea environmental agency said in an emailed statement it follows the World Health Organization’s recommendations for testing recreational water safety, and that searching for super bacteria is not included in that. It also said there was a lack of studies about the bacteria in water and health outcomes.

Probiotic Nose Drops May Protect Against Meningitis

Probiotic nose drops reduced the likelihood of students being colonized with the bacteria that cause meningitis, according to a study published online March 25 in Clinical Infectious Diseases.

The nose drops contained Neisseria lactamica, a non-disease-causing relative of the bacterium that causes meningitis, Neisseria meningitidis. Epidemiological studies had previously shown that people who carry N lactamica in their nose and throat are both less likely to be colonized with N meningitidis and less likely to contract meningitis than people who do not, possibly because colonization with one species prevents colonization with the other.
“Neisseria lactamica may therefore be a potential ‘bacterial medicine’ to suppress meningococcal outbreaks,” write Alice M. Deasy, MBBS, from the Department of Infection and Tropical Medicine, Sheffield Teaching Hospitals Foundation Trust, and colleagues. They note that the effect on N meningitidis colonization was stronger and happened more quickly than the effect seen in previous studies from meningococcal vaccine.

The study involved 310 students from two universities in Sheffield, United Kingdom. Each received either an inoculation of 104 colony-forming units of N lactamica or a sham inoculation. The investigators took samples of the students’ oropharyngeal bacteria at 2, 4, 8, 16, and 26 weeks after inoculation.

At baseline, a similar fraction of each group already carried N meningitidis: 24.2% of the treatment group and 22.4% of control patients. (Only a handful of participants in each group [1.9%; 95% confidence interval, 0.4% – 3.5%] carried N lactamica at baseline.) After inoculation, some, but not all, participants in the treatment group became colonized with N lactamica: 33.6% (95% confidence interval, 25.9% – 41.9%) 2 weeks after inoculation, rising to 41.0% (95% confidence interval, 33.0% – 49.3%) by 26 weeks.

Conversely, the proportion of students colonized with N meningitidis dropped after inoculation, going from 24.2% to 6.7% after 4 weeks, and then partially rebounding to 14.5% at 26 weeks. Colonization in the control group was not reduced.

The loss of N meningitidis was greater in the students who were colonized with N lactamica (P = .013), suggesting N lactamica competes with and displaces N meningitidis. These participants were also less likely to acquire new colonization with N meningitidis (P = .011). Of those who were colonized, 13.3% acquired N meningitidis within the 26-week study period compared with 29.2% of control patients and 28% of those who received the inoculation but were not colonized by the probiotic strain.
At the end of the study, all participants received another dose of N lactamica and were tested 2 weeks later. Those who had been in the treatment group were still able to be colonized by N lactamica, and those who had been in the control group showed a similar reduction in N meningitidis carriage as the treatment group had shown at the beginning of the study.

On the basis of these and previous results, including the ability of the treatment group to be recolonized with N lactamica, the investigators write that the protective effect is probably not a result of cross-protective antibodies; rather, “[t]he mechanism is either microbial competition within the nasopharynx, or innate immune responses that operate only in individuals actively carrying the commensal.”

Cryptococcal meningitis: improving access to essential antifungal medicines in resource-poor countries.

Cryptococcal meningitis is the leading cause of adult meningitis in sub-Saharan Africa, and contributes up to 20% of AIDS-related mortality in low-income and middle-income countries every year. Antifungal treatment for cryptococcal meningitis relies on three old, off-patent antifungal drugs: amphotericin B deoxycholate, flucytosine, and fluconazole. Widely accepted treatment guidelines recommend amphotericin B and flucytosine as first-line induction treatment for cryptococcal meningitis. However, flucytosine is unavailable in Africa and most of Asia, and safe amphotericin B administration requires patient hospitalisation and careful laboratory monitoring to identify and treat common side-effects. Therefore, fluconazole monotherapy is widely used in low-income and middle-income countries for induction therapy, but treatment is associated with significantly increased rates of mortality. We review the antifungal drugs used to treat cryptococcal meningitis with respect to clinical effectiveness and access issues specific to low-income and middle-income countries. Each drug poses unique access challenges: amphotericin B through cost, toxic effects, and insufficiently coordinated distribution; flucytosine through cost and scarcity of registration; and fluconazole through challenges in maintenance of local stocks—eg, sustainability of donations or insufficient generic supplies. We advocate ten steps that need to be taken to improve access to safe and effective antifungal therapy for cryptococcal meningitis.

Source: Lancet

The Long-Term Effects of Childhood Bacterial Meningitis.

Adult survivors of childhood bacterial meningitis have lower educational achievement and a lower likelihood of economic self-sufficiency than matched healthy controls.


The short-term sequelae of childhood bacterial meningitis can include hearing loss, motor deficits, seizures, and cognitive impairment. But what about functioning in adult life? In a recent cohort study, investigators used national patient registries in Denmark to compare the educational achievement and economic self-sufficiency of individuals with meningococcal, pneumococcal, or Haemophilus influenzae meningitis diagnosed between 1977 and 2007, before age 12 years, with those of age- and sex-matched controls who had not had meningitis. To assess for family-related cofactors, the researchers also evaluated the siblings and parents of these two cohorts.

Survivors of pneumococcal or H. influenzae meningitis were less likely than matched controls to complete high school or to obtain higher education by age 35. They also were less likely to attain these goals than their siblings, who performed similarly to the siblings of controls. In contrast, although meningococcal meningitis survivors were less likely than controls to complete high school or to obtain higher education by age 35, these survivors had educational achievement comparable to that of their siblings, who had lower achievement than the siblings of controls. Educational achievement was lower among parents of meningococcal meningitis survivors than among parents of controls; achievement among pneumococcal and H. influenzae meningitis survivor parents was comparable to that among controls. By 2010, fewer survivors than controls were economically self-sufficient (–3.8%, –10.6%, and –4.3%, respectively, for meningococcal, pneumococcal, and H. influenzae meningitis).

Comment: This large, well-designed study confirms sustained intellectual and economic sequelae of childhood bacterial meningitis but also suggests different routes to these long-term effects. Intellectual and economic impairments are likely direct consequences of the severity of pneumococcal and H. influenzae meningitis. However, family factors appear to predominate in the poorer intellectual and economic achievements of meningococcal meningitis survivors.


Source: Journal Watch Infectious Diseases


Overheated and melted intracranial pressure transducer as cause of thermal brain injury during magnetic resonance imaging.

Case report

Magnetic resonance imaging is used with increasing frequency to provide accurate clinical information in cases of acute brain injury, and it is important to ensure that intracranial pressure (ICP) monitoring devices are both safe and accurate inside the MRI suite. A rare case of thermal brain injury during MRI associated with an overheated ICP transducer is reported.

This 20-year-old man had sustained a severe contusion of the right temporal and parietal lobes during a motor vehicle accident. An MR-compatible ICP transducer was placed in the left frontal lobe. The patient was treated with therapeutic hypothermia, barbiturate therapy, partial right temporal lobectomy, and decompressive craniectomy. Immediately after MRI examination on hospital Day 6, the ICP monitor was found to have stopped working, and the transducer was subsequently removed. The patient developed meningitis after this event, and repeat MRI revealed additional brain injury deep in the white matter on the left side, at the location of the ICP transducer. It is suspected that this new injury was caused by heating due to the radiofrequency radiation used in MRI because it was ascertained that the tip of the transducer had been melted and scorched. Scanning conditions—including configuration of the transducer, MRI parameters such as the type of radiofrequency coil, and the specific absorption rate limit—deviated from the manufacturer’s recommendations. In cooperation with the manufacturer, the authors developed a precautionary tag describing guidelines for safe MR scanning to attach to the display unit of the product.

Strict adherence to the manufacturer’s guidelines is very important for preventing serious complications in patients with ICP monitors undergoing MRI examinations.

Source: Journal of Neurosurgery





Aspergillus Meningitis Linked to Steroid Injections Sickens 26, Kills 4 .

Twenty-six patients have contracted fungal meningitis after receiving spinal steroid injections for back pain, CNN reports. Four of the patients have died.

The majority of cases — 18 — have occurred in Tennessee; the rest are divided among Florida, Maryland, North Carolina, and Virginia.

Clinicians suspect that the steroid, preservative-free methylprednisolone acetate, was contaminated with the fungus Aspergillus. All patients received injections between July 1 and September 20, and with the incubation period lasting as long as 4 weeks, more cases may still be identified.

The New England Compounding Center, which has been implicated in the outbreak, has recalled three lots of methylprednisolone acetate: #05212012@68, #06292012@26, and #08102012@51.

Asked to comment, Journal Watch‘s Paul Sax said: “What makes this [outbreak] notable is both the severity and the rarity of the condition, Aspergillus meningitis. Needless to say, consultation with a specialist in infectious diseases would be highly recommended for any clinician encountering such a case.”

Source: CNN