Meningitis Associated with CSF Leak

The incidence of bacterial meningitis following head trauma ranges from 0.2 to 18%. The incidence is greatly increased when there is an accompanying CSF leak, ranging anywhere from 3% to as high as 50% [32]. Direct implantation of organisms can occur with penetrating injuries, open depressed skull fractures or closed fractures that cross a chronically infected air sinus. Fractures of the cranial base are often associated with dural tears and often produce CSF rhinorrhea or otorrhea. Although meningitis can develop literally within hours after injury, the risk is highest within the initial few weeks following trauma. However, cases have been reported many years following injury.

Approximately 50-70% of cases of acute bacterial meningitis related to CSF leaks following basilar skull fracture are caused by pneumococ-cus; recurrent meningitis is highly correlated with head injury, with pneumococci accounting for 80% of these cases. The remaining cases are Hemophilus influenza, group A beta hemolytic streptococci and other genera. In cases of penetrating injury or open wounds of the brain, infection with Gram-negative organisms is more likely. In cases where there has been gross contamination, polymicrobial infections, especially involving anaerobes, are more common. Diagnosis and management of the bacterial infection are identical to those of other cases of acute bacterial meningitis. CSF leaks may spontaneously "seal" following treatment of meningitis, but those that persist require surgical repair.

An area of considerable controversy is the use of prophylactic antibiotics in patients with basilar skull fractures accompanied by CSF leaks. The premise supporting the use of prophylactic antibiotics is that CSF is exposed directly to pathogenic organisms and that infection is likely. However, interpretation of clinical studies is contaminated by multiple variables, including the definition of infection, patient selection and choice of antibiotics. Moreover, there exists no prospective randomized trial that examines this question. There are clearly

Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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