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"
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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
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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)
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8/9/2019 Bacterial Meningitis 5
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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
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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
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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$iB/k
Gc{lstd}c`lo du id}lstd}c`lo/n
Ckkl{ldo df co cilodgb|`dplkn pmd~bk en `doplknunk/f
@doplknu ckkl{ldo df ulfciqlo/g
@mdl`n df c pqn`lffi` co{lil`udelcb cgno{ i~p{ en g~lknk e| lo vl{ud p~p`nq{lelbl{| {np{ unp~b{p/
q~eblpmnk X65" 60Y/ [mn ffiup{ wcp c un{udpqn`{lvn p{~k| lovdbvlog
`mlbkuno wl{m qon~id`d``cb inologl{lp cok pmdwnk {mc{" lo
{mn kn}cin{mcpdon gud~q" {mnun wcp c mlgmnu lo`lkno`n df idk)
nuc{n du pnvnun mnculog bdpp -;6. vp/ 50.8 , du co|Qq /136
on~udbdgl` knffi l{p ->>. vp/ 00.8 , X65Y/ Mdwnvnu" `mlb)Qq /15
kuno lo {mn kn}cin{mcpdon gud~q idun funs~no{b| uns~lunk
lo{~ec{ldo cok in`mcol`cb vno{lbc{ldo cok mck c bdwnu lol{lcb
@PF gb~`dpn `do`no{uc{ldo/ F~u{mnuidun" {mnun wnun od kc{c
do ~pn df pqn`lffi` co{lil`udelcb cgno{p lo nc`m gud~q" cok {mn
kn}cin{mcpdon wcp glvno bc{nu {mco lo d{mnu p{~klnp -l/n/" wl{mlo
61 ilo df {mn ffiup{ co{lil`udelcb kdpn,/ [m~p" l{ lp qdpplebn {mc{
{mn `blol`cb enonffi{ wcp od{ cp dq{licb cp wcp co{l`lqc{nk/ Lo c
un`no{b| q~eblpmnk ucokdilznk" qbc`ned)`do{udbbnk" kd~ebn)
eblok {ulcb df ckj~o {lvn kn}cin{mcpdon lo `mlbkuno lo Icbcwl
X60Y" {mn dvnucbb o~ienu df knc{mp -03. vp/ 03.8 , cokQq /
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8/9/2019 Bacterial Meningitis 5
11/18
Quc`{l`n G~lknblonp fdu Ec`{nulcb Inologl{lp @LK 511;:0< -3 Odvnienu, 3577
[cebn 6/ Un`diinoknk kdpcgnp df co{lil udelcb {mnucq| lo qc{lno{p wl{m ec`{nulcb inologl{lp -C)LLL,/
Co{lil`udelcb cgno{
[d{cb kclb| kdpn -kdplog lo{nuvcb lo md~up,
Ondoc{np" cgn lo kc|p
Lofco{p cok `mlbkuno Ck~b{p17c
=5=c
Cilhc`loe
3>51 ig$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
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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
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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, 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|
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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, 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
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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
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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
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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
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