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
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.