Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: Meningitis and Blood Brain Barrier

Category: Child Care


    Dr. Elaine Tuomanen at the Rockerfeller University in Can­ada recently discovered a way of breaching the blood brain barri­er and helping patients with meningitis.  Her findings were reported in SCIENTIFIC AMERICAN, the February 1993 issue.

     Meningitis, which strikes up to 50,000 people annually, is still one of the biggest killers and one of the most dreaded infections in both children and adults. Fortunate­ly, because of the HiB vaccine, we are now see­ing almost no cases of the most common pedi­atric form of meningitis (hemophilus influenza B) or HiB.  We still see cases, however, in both children and adults of meningococcal and pneumococcal meningitis. 

     The pneumococcal is the most serious because of what it does to the blood brain barrier.  In the process of killing the pneumococcal bacteria antibiotics cause bursting of the bacte­ria which floods fragments through the blood brain barrier.  The fragments attract and stimulate white blood cells to burst through the blood brain barrier.  This causes a major disruption in blood flow and inflammation and scarring.  This is what causes most of the complications and the ultimate death in patients with meningitis.  The most common complication is loss of hearing in those who survive.  Through Dr. Tuomanen's research in under­standing the flow of these fragments in and out of the blood brain barrier, she was able to develop a medicine which blocks the flow of these tiny fragments into the brain and thus, blocks the heavy flow of white blood cells into the brain which causes the scarring and complications. 

     The medicine which she discovered is called Oxindanac.  It is not presently approved for children.  The next best thing to this which has been approved for children for the past three years is the use of steroids.  Dr. McKracken in Dallas noticed that steroids combined with antibiotics caused a major decrease in hearing loss from 15% to 3% in H-flu meningitis in children and shortened the course of fever from 5 to 1.6 days. 

     Finally, in 1990, the American Academy of Pediatrics recommended routine use of steroids in all cases of childhood meningitis. 

     There are complications with the use of these steroids such as GI bleeding. Perhaps newer therapies such as Dr. Tuomanen's Oxindanac and other new medicines will be even more effective and safe for treatment of meningitis in the future.  Ongoing research will one day allow us to completely control this once dreaded disease and its' complications.  Interestingly, a pediatric infectious diseases doctor who was at LSU in the 70's was recommending this same therapy (that is, the use of steroids along with antibiotics in treatment of meningitis) when no one else thought it made sense.  Sometimes the out of the way things turn out to be right after all.