bacterial meningitis 16

8/9/2019 Bacterial Meningitis 16

1/8

\YM_KED ireakejm hf CSF as e frmu}mkydq wmrfhrbmiwrhcmi}rm ak ylm km}rhs}rjaced imwerybmky+ Chbbhkakiaceyahks erm yreksamky lqirhcmwled}s ak rmdeyahk yh

akyrecrekaed lmbhrrlejm hr y}bhrs$ ylm wrmvmkyahk hf CSFfasy}des efymr km}rhs}rjaced wrhcmi}rms$ eki ylm bhkayhrakj

hf akyrecrekaed wrmss}rm+ Hkm hf ylm benhr chbwdaceyahks asMI"OB0 rmwhrymi akfmcyahk reyms verq omyzmmk 3 eki ?7-+5$9$=$1$59$5=$?5?3 _as` fecyhrs fhr ylm imvmdhwbmky hf MI"OB ermi}reyahk hf ireakejm eki ireak"rmdeymi fecyhrs s}cl es be"kaw}deyahk eki saym dme`ejm+53$?7 Yh fecadayeym ylm iaejkhsas hfMI"OB ak weyamkys zayl CSF ireakejm$ rh}yakm ekedqsas hfCSF as hfymk wmrfhrbmi+ Ak weyamkys zayl oecymraed bmkakja"yas yley as khy rmdeymi yh m|ymrked ireakejm$ ek akcrmesmi dm}"`hcqym ch}ky eki wrhymak chkcmkyreyahk eki e imcrmesmi jd}"chsm chkcmkyreyahk erm lajldq wrmiacyavm hf ylm wrmsmkcm hf

ylas akfmcyahk+ Ak weyamkys ak zlhb ek m|ymrked ireak lesommk wdecmi$ lhzmvmr$ ylm chbwhsayahk hf CSF as khy chb"wereodm yh yley ak akiavai}eds khy }kimrjhakj m|ymrked ireak"ejm$ i}m yh }kimrdqakj iasmesm eki(hr ylm mffmcys hf km}"rhs}rjaced wrhcmi}rms ak weyamkys zayl m|ymrked ireaks+3$6$51

Edylh}jl CSF ekedqsas as hfymk }smi yh scrmmk fhr MI"OB$ay as c}rrmkydq }k`khzk zlmylmr CSF ekedqsas cek om }smiyh wrmiacy oecymraed bmkakjayas ak weyamkys }kimrjhakj m|ymr"ked ireakejm+ Bacrhoahdhjaced ymsys rmbeak ylm jhdi syekierifhr ylm iaejkhsas hf MI"OB$ o}y ylmq erm }s}eddq bhrm yabm"chks}bakj ylek clmbaced ekedqsas eki dm}`hcqym ch}kys+ Ayzh}di ylmrmfhrm om }smf}d yh msyeodasl c}yhff ved}ms fhr CSFwerebmymrs yley wrmiacy ylm imvmdhwbmky hr m|asymkcm hf oec"ymraed bmkakjayas ak weyamkys zayl m|ymrked ireaks+

Zm mved}eymi e chlhry hf ?37 weyamkys zlh lei m|ymrkedireaks ak zlhb ieadq CSF sebwdms zmrm hoyeakmi+ Ylmsmsebwdms zmrm mved}eymi }sakj Jreb syeak eki bacrhoah"dhjaced c}dy}rm eki ekedq~mi fhr wrhymak eki jd}chsm chk"cmkyreyahks eki dm}`hcqym ch}ky+ Ylm MI"OB zes imfakmi

N+ Km}rhs}rj+ ( Vhd}bm 579 ( Nek}erq$ ?776

N Km}rhs}rj 579>57557 CSF 2 cmrmorhswaked fd}ai0 MI"OB 2 m|ymrked ireakejmrmdeymi oecymraed bmkakjayas0 AD 2 akymr"dm}`ak0 _HC 2 rmcmavmr hwmreyakj clerecymrasyac+


2/8

oesmi hk whsayavm c}dy}rm rms}dys ak chboakeyahk zayl cdaka"ced sqbwyhbs+ M|ymrked ireakejmrmdeymi oecymraed bmkakja"yas imvmdhwmi ak ?? weyamkys ,1+6-! ak ylas chlhry+ Zm m|eb"akmi ylm wrmiacyavm eki iaejkhsyac ved}m hf ylm CSF ekedqsaseki Jreb syeak fhr MI"OB+ Ak e yreksvmrsed ekedqsas$ ylmrms}dys hf ylm Jreb syeak eki CSF ekedqsas fhr ylm ?? we"yamkys hk ylm ieqs omfhrm eki i}rakj ylm akfmcyahk zmrm

chbwermi zayl ylhsm fhr ylm weyamkys zayl m|ymrked ireaksak zlhb MI"OB iai khy imvmdhw+ S}osmu}mkydq$ zm wmr"fhrbmi e dhkjay}iaked ekedqsas }sakj e beyclmi cesmchk"yrhd sy}iq ak zlacl ylm cesm jrh}w zes beyclmi fhr oaesakjfecyhrs s}cl es i}reyahk hf m|ymrked ireakejm eki ylm wrms"mkcm hf odhhi ak ylm CSF+

Cdakaced Beymraed eki Bmylhis

Weyamky Whw}deyahk

E chksmc}yavm sakjdm"cmkymr chlhry hf ?


3/8

rmcyahk fhr rmi odhhi cmdd ch}ky oq s}oyrecyakj hkm whaky fhrmecl 5777 rmi odhhi cmdds+

Chkcmkyreyahks hf AD"6

Efymr imymrbakeyahk hf ylm yhyed wrhymak eki jd}chsm chk"cmkyreyahks$ ylm s}wmrkeyekys zmrm frh~mk ey ?7C }kyadf}rylmr ekedqsas+ Ylm dmvmds hf AD"6 zmrm imymrbakmi oq ekmk~qbm"dak`mi abb}khshromky esseq ,Wmda@akm chbwecyl}bek AD"6 `ay0 Cmkyred Deohreyhrq hf ylm Kmylmrdekis _miCrhss$ Ebsymrieb$ Ylm Kmylmrdekis!+ Eoshromkcams zmrmbmes}rmi }sakj e bacrhwdeym swmcyrhwlhyhbmymr ,Swmc"yrebe| ?=70 Bhdmc}der Imvacms$ Akc+$ S}kkqvedm$ CE!+ Fhrved}ms lajlmr ylek ylm AD"6 esseq c}yhff hf 3677 wj(bd$ zm}smi ylm ved}m hf 3677 wj(bd ak ylm ekedqsms+

Syeyasyaced Ekedqsas

Cdakaced eki deohreyhrq ieye zmrm ekedq~mi }sakj syeyasya"ced shfyzerm ,SWSS$ vmrsahk 55+70 SWSS$ Akc+$ Clacejh$ AD!+Yh imymrbakm ylm wrmiacyavm eki(hr iaejkhsyac ved}m hf ylmCSF dm}`hcqym ch}ky$ wrhymak eki jd}chsm chkcmkyreyahks$

eki ylm CSF(odhhi jd}chsm reyah fhr MI"OB$ yzh ekedqsmszmrm wmrfhrbmi+ Farsy$ rms}dys hoyeakmi ak edd ?? weyamkyszayl MI"OB zmrm ymsymi ejeaksy ylhsm ak ?77 weyamkys zayl"h}y MI"OB oq }sakj ylm Sy}imky y"ymsy+ S}osmu}mkydq$ ebeyclmi cesmchkyrhd sy}iq zes wmrfhrbmi yh chkyrhd ylmCSF rms}dys fhr oaesakj fecyhrs+ Ylm ?? weyamkys zayl MI"OB zmrm beyclmi fhr akiaceyahk fhr m|ymrked ireakejm$ wrms"mkcm hf odhhi ak ylm CSF$ eki i}reyahk hf m|ymrked ireakejmzayl ?? chkyrhd weyamkys zaylh}y oecymraed bmkakjayas+ Yh im"ymrbakm ylm wrmiacyavm ved}m hf mecl CSF werebmymr hk ylm3 ieqs omfhrm ylm akfmcyahk eki ylm iaejkhsyac ved}m hk ylmfarsy 3 ieqs hf akfmcyahk$ }kaveraeym chkiayahked dhjasyac rm"jrmssahk ekedqsas zes wmrfhrbmi+ Ak eiiayahk$ ylm CSF we"rebmymr rms}dys zmrm mved}eymi }sakj _HC c}rvms+ Yh eke"

dq~m ylm wrmiacyavm eki iaejkhsyac ved}m hf e chboakeyahk hfCSF werebmymrs$ e imscrawyavm ekedqsas zes wmrfhrbmi$ ekiylm rms}dys zmrm s}osmu}mkydq ymsymi }sakj ylm BcKmber m|"ecy ymsy+ Fhr edd syeyasyaced ekedqsms$ e wrhoeoadayq ved}m dmssylek 7+7= zes chksaimrmi sajkafaceky+

_ms}dys

Imscrawyahk hf ylm Sy}iq Jrh}w

Yzh l}kirmi ylaryq weyamkys zmrm akcd}imi ak ylm sy}iq+Ylm bmiaek weyamky ejm zes =?+= qmers ,rekjm 7+55+3+ D}boer ceylmymrszmrm wdecmi ak 5?= weyamkys ,=9+3-!$ vmkyrac}der ceylmymrs ak

1: ,9?+?-!$ eki bhrm ylek hkm yqwm hf ceylmymr ak majly,3+=-!+ Ylm bhsy frmu}mky akiaceyahks fhr m|ymrked ireak"ejm zmrm wrmvmkyahk eki(hr yrmeybmky hf CSF dme`ejm ak 5?9weyamkys ,=3+1-! eki akyrecrekaed lmbhrrlejm ak


4/8

}m zayl e smksayavayq eki swmcafacayq hf ey dmesy 67-+ Faj}rm3 slhzs m|ebwdms hf ylm _HC c}rvms fhr ylm 5sy ieq hf ak"fmcyahk+

Fakeddq$ e imscrawyavm ekedqsas zes wmrfhrbmi yh mved}eymylm wrmiacyavm eki iaejkhsyac ved}m hf chboakeyahks hf CSFwerebmymrs+ Fhr mecl werebmymr$ zm msyeodaslmi eokhrbed

dmvmds oesmi hk ylm =yl eki 1=yl wmrcmkyadms hf ylm CSF rm"s}dys hf 119 sebwdms frhb ylm ?77 weyamkys zaylh}y MI"OB+Ylm eokhrbed dmvmds zmrm jrmeymr ylek ?:7= fhr dm}`hcqymch}ky ,1=yl wmrcmkyadm!$ dmss ylek ?+: bbhd(D fhr jd}chsmchkcmkyreyahk ,=yl wmrcmkyadm!$ jrmeymr ylek ?+39 j(D fhr wrh"ymak chkcmkyreyahk ,1=yl wmrcmkyadm!$ eki dmss ylek 7+3< fhrylm CSF(odhhi jd}chsm reyah ,=yl wmrcmkyadm!+ Yeodm 5 slhzsylm k}bomr hf weyamkys zayl MI"OB eki beyclmi chk"yrhd weyamkys zayl ek eokhrbed rms}dy fhr hkm hr bhrm hf ylmwerebmymrs+ Fmz weyamkys ak ylm cesm jrh}w lei eokhrbedved}ms fhr yzh hr bhrm werebmymrs ohyl i}rakj ylm wmrahiomfhrm akfmcyahk eki i}rakj MI"OB+ Kh syeyasyaceddq sajkaf"aceky iaffmrmkcms zmrm fh}ki omyzmmk ylm cesm jrh}w eki ylmchkyrhd jrh}w+

Yh mved}eym ylm wrmiacyavm eki iaejkhsyac ved}m hf ylmCSF werebmymrs ak weyamkys zayl MI"OB ce}smi oq Jreb"kmjeyavm oecymrae$ edd wrmvah}sdq imscraomi ekedqsms zmrmedsh wmrfhrbmi fhr e s}ojrh}w hf fh}r weyamkys zayl Jreb"kmjeyavm MI"OB eki beyclmi chkyrhd weyamkys+ Kh syeyasya"ceddq sajkafaceky iaffmrmkcms omyzmmk ylm yzh jrh}ws zmrmfh}ki+

Edd wrmvah}sdq imscraomi ekedqsms zmrm edsh wmrfhrbmifhr ylm jrh}w hf 5=7 weyamkys zlh iai khy levm odhhi ak ylmCSF+ Kh syeyasyaceddq sajkafaceky iaffmrmkcms zmrm fh}ki om"yzmmk weyamkys zayl eki zaylh}y MI"OB+

Wrmiacyavm eki Iaejkhsyac Ved}m hf AD"6 Chkcmkyreyahk

Hkm l}kirmi sa|yq"sa| CSF sebwdms frhb ?5 weyamkys

zayl m|ymrked ireaks ch}di om mved}eymi fhr AD"6 chkcmkyre"yahk+ Ylmrm zes e sajkafaceky chrrmdeyahk omyzmmk AD"6 chk"cmkyreyahks eki CSF dm}`hcqym ch}kys ,r 2 7+?

Ylm Jreb syeak fakiakjs fhr Jreb"whsayavm eki Jreb"kmjeyavm oecymrae zmrm ekedq~mi smwereymdq+ Ylm Jreb syeaklei e smksayavayq hf 36+5- ,37 hf


5/8

bhrm whsayavm Jreb syeaks+ Ylm smksayavayq hf ylm Jreb syeakhk ylm 5sy ieq hf akfmcyahk$ yley as$ ylm 5sy ieq yley ylm CSFc}dy}rm zes whsayavm$ zes dhz> e whsayavm Jreb syeak zesfh}ki fhr hkdq fh}r ,5


6/8

zmrm lmymrhjmkmh}s i}rakj ylm wmrahi hf m|ymrked ireakejm+Zlmk ylm rms}dys hoyeakmi ak weyamkys zayl MI"OB i}rakjylm farsy 3 ieqs hf ecyavm akfmcyahk zmrm chbwermi zayl ylmrms}dys hf ylm chkyrhd jrh}w zaylh}y MI"OB$ kh syeyasyaced"dq sajkafaceky iaffmrmkcms zmrm fh}ki ,Faj+ ?!+ Ylm sebm zesyr}m zlmk ylm CSF rms}dys hoyeakmi ak weyamkys zayl MI"OB

fhr ylm 3 ieqs wrmcmiakj ek ecyavm akfmcyahk zmrm chbwermizayl ylhsm hf ylm chkyrhd jrh}w+

Ay as mvaimky yley ak weyamkys zlh lei rmcmkydq }kimrjhkmkm}rhs}rjmrq$ ylm chkymky hf CSF as eokhrbed+ Clmbaced ar"rayeyahk rms}dyakj frhb ylm wrmsmkcm hf odhhi hr odhhi imj"reieyahk wrhi}cys ak ylm CSF dmeis yh clmbaced hr esmwyacbmkakjayas$ zayl iasy}roekcm hf ylm jd}chsm eki wrhymak chk"ymky hf ylm CSF eki ek akcrmesmi CSF zlaym odhhi cmddch}ky+3$6$51 Es ylm odhhi as rmshromi frhb ylm CSF eki ylmesmwyac bmkakjayas s}osaims$ ylm clmbaced iasy}roekcm khr"beda~ms+ Ay as ylmrmfhrm yh om m|wmcymi yley ylm CSF werebm"ymrs zadd clekjm$ yley as$ abwrhvm$ i}rakj ylm wmrahi hf m|ymr"ked ireakejm ak weyamkys ak zlhb oecymraed bmkakjayas ihmskhy imvmdhw+ Fhr ylas rmeshk$ zm chkyrhddmi ylm ekedqsas hf

ylm CSF werebmymrs fhr i}reyahk hf m|ymrked ireakejm oq }s"akj e beyclmi cesmchkyrhd sy}iq+ ]sakj }kaveraeym rmjrms"sahk ekedqsas eki _HC c}rvms$ zm zmrm }keodm yh rmchjka~me sajkafaceky wrmiacyavm hr iaejkhsyac ved}m fhr ekq hf ylmchbbhkdq }smi CSF werebmymrs+ Bhrm abwhryeky$ zm edshfeadmi yh wrmiacy hr rmchjka~m ek akfmcyahk zlmk rms}dys fhrylm sebm weyamky zmrm ekedq~mi dhkjay}iakeddq+ Yl}s$ imymc"yahk hf mvmk e cdmer clekjm ak CSF werebmymrs ak ek akia"vai}ed weyamky iai khy levm e sajkafaceky wrmiacyavm ved}m+]sakj ylm rms}dys fhr ylm ?77 weyamkys zayl m|ymrked ireakso}y zlh iai khy levm MI"OB es e rmfmrmkcm$ zm fh}ki yleyhkdq e sbedd wrhwhryahk hf ylm weyamkys ak zlhb MI"OB im"vmdhwmi lei eokhrbed ved}ms fhr bhrm ylek hkm hf ylm chb"bhkdq ekedq~mi CSF werebmymrs slhrydq omfhrm hr i}rakj

ylm ch}rsm hf ylm MI"OB akfmcyahk+ Ylmrmfhrm$ chboakakjylm rms}dys fhr iaffmrmky CSF werebmymrs iai khy akcrmesm ylmwrmiacyavm hr iaejkhsyac ved}m hf ylm CSF ekedqsas+

Edylh}jl ekedqsas hf CSF as hfymk wmrfhrbmi rh}yakmdq akkm}rhs}rjmrq weyamkys$ ays wrmiacyavm ved}m fhr MI"OB lesommk scercmdq sy}iami+ Wfasymrmr eki chddmej}ms5< wmrfhrbmi

e yreksvmrsed ekedqsas hf CSF rms}dys fhr 537 weyamkys zaylm|ymrked ireakejm frhb zlhb ieadq CSF sebwdms zmrm ho"yeakmi+ Ylm dm}`hcqym ch}kys zmrm lmymrhjmkmh}s ak ohylylm weyamky jrh}w eki ylm chkyrhd jrh}w+ Edylh}jl ylm e}"ylhrs rmwhrymi e sajkafaceky chrrmdeyahk omyzmmk CSF dm}`h"cqym ch}ky eki CSF akfmcyahk$ ylmrm zes kh cdmer iaffmrmkcmak dm}`hcqym ch}kys omyzmmk ylm weyamkys zayl MI"OB ekiylhsm zaylh}y MI"OB+ ]kfhry}keymdq$ jd}chsm eki wrhymakdmvmds zmrm khy ekedq~mi ak ylmar rmwhry+ Wfe}sdmr eki chd"dmej}ms5: rmcmkydq s}jjmsymi yley e cmdd akim| chksasyakj hfylm reyah hf dm}`hcqym eki mrqylrhcqym ch}kys ak CSF eki wm"rawlmred odhhi bajly om wrmiacyavm hf MI"OB ak weyamkyszayl m|ymrked ireakejm+ Ak ylas wadhy sy}iq$ smvmk hf 53 we"yamkys s}ffmrmi frhb MI"OB$ eki ylm cmdd akim| jrei}eddq

akcrmesmi ak ylmsm weyamkys hvmr ylm 3 ieqs omfhrm e chkvmk"yahked iaejkhsas hf MI"OB zes beim+ Ylm cmdd ch}kys zmrmkhy ein}symi fhr i}reyahk hf m|ymrked ireakejm$ lhzmvmr$ ekiylm imfakayahk hf MI"OB zes oesmi hk ek akcrmesm ak CSFcmdd ch}kys+ F}rylmrbhrm$ =9- hf ylm weyamkys zayl m|ymrkedireaks s}ffmrmi frhb MI"OB$ e wmrcmkyejm yley as ylrmm yhsmvmk yabms lajlmr ylek yley rmwhrymi ak ylm daymrey}rm+9$


7/8

yas+57$5? Dhwm~"Chryms eki chddmej}ms55 fh}ki yley CSF dmv"mds hf y}bhr kmcrhsas fecyhr$ AD"5$ AD"6$ eki AD"< zmrmsajkafacekydq lajlmr ak km}rhs}rjaced weyamkys zayl oecymraedbmkakjayas ylek ak weyamkys zayl esqbwyhbeyac esmwyac bmk"akjayas+ Ylmsm akfdebbeyhrq cqyh`akms erm sqkylmsa~mi ak"yreylmceddq oq ecyaveymi dm}`hcqyms:$?9 eki zmrm fh}ki yh ombhrm swmcafac wrmiacyhrs hf oecymraed bmkakjayas$ chbwermizayl cmdd ch}kys$ ak ylm sy}iq oq Dhwm~"Chryms eki chd"dmej}ms+ Zm ekedq~mi ylm wrmiacyavm eki iaejkhsyac ved}mhf AD"6 ak km}rhs}rjaced weyamkys zayl m|ymrked ireaks+ H}rrms}dys hf e jrh}w hf 566 CSF sebwdms slhzmi yley AD"6dmvmds ak CSF zmrm cdhsmdq chrrmdeymi zayl cmdd ch}kys+ Zmfh}ki kh wrmiacyavm ved}m hf AD"6 ak CSF fhr MI"OB+ Zmiai faki yley ak ylm CSF hf weyamkys zayl m|ymrked ireaks eki

ecyavm oecymraed bmkakjayas$ AD"6 dmvmds zmrm sajkafacekydqlajlmr ylek ak ylm CSF hf weyamkys zayl m|ymrked ireaks ekikh MI"OB$ o}y zm ch}di khy msyeodasl ylm iaejkhsyac ved}mak e beyclmi cesmchkyrhd ekedqsas+

Zm edsh mved}eymi ylm iaejkhsyac ved}m hf ylm ieadq Jrebsyeak ak h}r chlhry+ Zm fh}ki yley e derjm wrhwhryahk hf ylmweyamkys zayl MI"OB iai khy levm whsayavm Jreb syeak faki"akjs i}rakj ylm wmrahi hf whsayavm CSF c}dy}rms+ WhsayavmJreb syeak rms}dys zmrm fh}ki fhr hkdq 67- hf ylm weyamkyszayl MI"OB hk 5 hr bhrm ieqs i}rakj ecyavm akfmcyahk+ Akek mved}eyahk hf ylm }sm hf ylm Jreb syeak es e scrmmkakjyhhd$ zm fh}ki yley ylm Jreb syeak zes whsayavm fhr hkdq?7- hf ylm weyamkys zayl MI"OB hk ylm 5sy ieq e whsa"yavm CSF c}dy}rm zes hoyeakmi+ Ylm Jreb syeak wrhvmi yh om

vmrq swmcafac ,{ 577-! eki yh levm e lajl whsayavm wrmiac"yavm ved}m ,1:-! ak ylas chlhry+ Ylmsm fakiakjs s}jjmsy yleyylm Jreb syeak cek om }smi es e iaejkhsyac yhhd ak weyamkyszayl m|ymrked ireaks ak zlhb MI"OB as s}swmcymi+

Ylm cdakaced fmey}rms hf MI"OB beq om iaffac}dy yh ias"yakj}asl frhb sqbwyhbs yley frmu}mkydq hcc}r ak weyamkysak ylm akymksavm cerm }kay+ Weyamkys zayl akyrecrekaed lmb"hrrlejm hr smrah}s lmei akn}rq beq slhz sajks hf esmwyacbmkakjayas$ s}cl es lmeieclm$ ke}sme$ eki kmc` syaffkmss+?$53

Ak weyamkys ak ylm akymksavm cerm }kay zlh rmcmavm vmkyadeyahkeki smieyahk$ ylm mved}eyahk hf cdakaced sajks eki ylm imymc"yahk hf e kmz fhced km}rhdhjaced imfacay hr clekjms ak bmk"yed syey}s cek om vmrq iaffac}dy+ Fhr ylmsm rmeshks$ j}aimdakmshfymk rmchbbmki yley ak cesms hf whssaodm MI"OB$ CSF

ekedqsas slh}di om wmrfhrbmi$ eki ak cesms hf e cdmer imymra"hreyahk hf ylm CSF clmbasyrq eki CSF dm}`hcqym ch}ky$ MI"OB as lajldq s}swmcymi+?$53

Chkcd}sahks

Ylm rms}dys hf ylas sy}iq slhzmi yley ylm chbbhkdq eke"dq~mi CSF werebmymrs levm kh wrmiacyavm ved}m fhr MI"OB$mvmk zlmk smvmred werebmymrs erm chksaimrmi ak chboake"yahk+ Yl}s$ ylm rh}yakm }sm hf clmbaced ekedqsas hf CSF seb"wdms yh scrmmk weyamkys zayl m|ymrked ireaks fhr MI"OB leskh eiiayahked ved}m+ Edsh$ ylm ekedqsas hf ek ashdeymi CSFsebwdm ak e weyamky ak zlhb MI"OB as lajldq s}swmcymiles kh eiiayahked ved}m$ i}m yh ylm eosmkcm hf cdmer iaejkhs"

yac c}yhff dmvmds+ Ylm iaejkhsas hf MI"OB cek ylmrmfhrm omoesmi hkdq hk ylm rms}dys hf bacrhoahdhjaced c}dy}rms+?$53 Akh}r lhswayed$ ieadq CSF sebwdms erm hoyeakmi ak weyamkyszayl m|ymrked ireaks yh mved}eym bacrhoaed jrhzyl ak ylmCSF+ Hkm bajly erj}m yley yh rmi}cm }kkmcmsserq bekaw}"deyahk hf ireaks eki ylm ecchbwekqakj ras` hf akfmcyahk$ dmssfrmu}mky sebwdakj$ yley as$ mvmrq hylmr ieq$ bajly om s}f"facamky+ Ylm ras` hf akfmcyahk rmdeymi yh m|ymrked ireakejm asvmrq dhz i}rakj ylm 5sy ieqs hf ireakejm eki akcrmesms zaylmvmrq ieq ylm ireak as ak wdecm+53$?7 Ylmrmfhrm$ zm s}jjmsy esebwdm rmjabmk hf yzh yabms e zmm` i}rakj ylm 5sy zmm` hfireakejm eki ieadq sebwdakj i}rakj ylm rmsy hf ylm ireakejmwmrahi+

Ec`khzdmijbmkys

Zm ylek` Berne @mrsomrjmk"vek Hhsyrhb eki Berjh vek Sclam"Yrhhsy fhr essasyekcm ak wmrfhrbakj ylm AD"6 bmes}rmbmkys+

_mfmrmkcms

5+ Eca`oes SC$ E`q}~ B$ @e~ek S$ Y}kcmr _> Chbwdaceyahks hfcdhsmi chkyak}h}s d}boer ireakejm hf cmrmorhswaked fd}ai+ EcyeKm}rhclar ,Zamk! 599>9:=9 Ylm bekejmbmky hf km}rhs}rjaced weyamkys zaylwhsyhwmreyavm oecymraed hr esmwyac bmkakjayas hr m|ymrked vmkyrac}"der ireak"esshcaeymi vmkyrac}dayas+ Akfmcyahk ak Km}rhs}rjmrq Zhr`"akj Weryq hf ylm Orayasl Shcamyq fhr Ekyabacrhoaed Clmbhylmrewq+Or N Km}rhs}rj 59>:5?$ ?777

N+ Km}rhs}rj+ ( Vhd}bm 579 ( Nek}erq$ ?776

Ekedqsas hf CSF ak ireakejm"rmdeymi oecymraed bmkakjayas

57:

YEODM 5

Wrmiacyavm eki iaejkhsyac ved}m hf eokhrbed CSF werebmymrs fhr MI"OB ak e beyclmi cesmchkyrhd sy}iq.

Kh+(Yhyed ,-!

Chkyrhd Chkyrhd Chkyrhd Chkyrhd

Veraeodm Weyamkys Vhd}kymmrs Weyamkys Vhd}kymmrs Weyamkys Vhd}kymmrs Weyamkys Vhd}kymmrs

kh+ hf eo" 5 5 ? ? 3 3 9 9khrbed we"rebmymrs

Ieq3 9(56 ,?=! ?(5? ,5:! 7(56 ,7! 5(5? ,

. Eokhrbed ved}ms zmrm eohvm ylm 1=yl wmrcmkyadm fhr ohyl CSF dm}`hcqym ch}ky eki wrhymak chkcmkyreyahk eki omdhz ylm =yl wmr"cmkyadm fhr CSF jd}chsm chkcmkyreyahk eki CSF(odhhi jd}chsm reyah ak 119 CSF sebwdms frhb ?77 weyamkys zayl m|ymrked ireakejm o}yzaylh}y MI"OB+ Ylmrm zmrm kh syeyasyaceddq sajkafaceky iaffmrmkcms omyzmmk weyamkys eki chkyrhd vhd}kymmrs ,w 7+7=$ BcKmber ymsy!+

Akiaceyms ieqs omfhrm ,! hr efymr ,! akfmcyahk+


8/8

3+ Odhbsymiy JC> Whsy"hwmreyavm esmwyac bmkakjayas+ Ecye Km}rh"clar ,Zamk! 55?556$ 5196 Clerecymra~eyahk hf clmba"

ced bmkakjayas efymr km}rhdhjaced s}rjmrq+ Cdak Akfmcy Ias 3?>5:15 Hk ylm cmdd}der sh}rcm eki f}kcyahk hf akymrdm}`ak 6wrhi}cmi ak ylm cmkyred kmrvh}s sqsymb ak vared iasmesms+ M}r NAbb}khd 51>61

bacterial meningitis 16

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