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Infectious meningitis in children

Posted by Xanit Internacional Xanit Internacional | Posted in Pediatrics, Xanit salud | Posted on 24-04-2019

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What is meningitis?

Meninges are membranes covering the Central Nervous System (CNS: brain, cerebellum and spinal cord) that have protective functions, among others. Between meninges, there is cerebrospinal fluid (CSF), which surrounds the CNS, also helping in its protection. When a pathogen germ penetrates these membranes and reaches the Central Nervous System, inflammation of the meninges (“meningitis”) occurs as a result of both the pathogenic activity of the germ and the body’s defensive response to the invasion. Some patients may also have particular risk factors that make them especially prone to certain types of meningitis.

Further to infectious meningitis, which is the most common type of meningeal inflammation, other diseases can cause inflammation by abnormal activation of the immune system in the absence of infection (autoimmune meningitis).

On some occasions meningitis can be accompanied by a very severe generalised disorder known as sepsis.

 

How many types of infectious meningitis are there?

Classification of meningitis can be made based on different parameters. In general, the most common classification differentiates meningitis according to the germ that causes the infection. Thus, we can distinguish:

  1. Viral meningitis: Caused by many different viruses. It is the most frequent type of meningeal inflammation.
  2. Bacterial meningitis: Produced by different bacteria. It is the most severe type of meningitis. The most common bacteria in our environment today are meningococcus and pneumococcus. In the case of meningococcus, there are several different subtypes (serogroups) (A, C, Y, W, B), each with some specific characteristics. In newborns, the most common are germs related to the birth canal.
  3. Tuberculous meningitis: Provoked by the bacteria that causes tuberculosis. This type of meningitis is also serious, although it is rare in our environment in the absence of risk factors.

 

Is meningitis common?

We should mention that, despite the potential severity of the disease, the meningitis is rare in Spain at present, with the majority of cases occurring in children under five years of age, especially children under one year of age and adults over 65.

Talking about meningitis/meningococcal sepsis, which is the most frequent among bacterial types, the incidence has decreased progressively over the last 15-20 years. The causes of this decline are little known, although there is evidence that these microorganisms usually have periods of activity oscillating over time that can be unpredictable, further to causing outbreaks in some closed communities (universities, etc.). In fact, in the last 2-3 years, it seems that in Spain we had more cases as a result of the increase in some emerging serogroups.

In this respect, there are great differences between the various serogroups. The most common in Europe and Spain is meningococcus B, responsible for more than 40% of all cases of meningitis in children. On the other hand, although they are less frequent in children, it is worrying the already mentioned rapid rise evidenced worldwide of different serotypes such as W and Y, responsible for around 12 — 13% of cases in children, being more frequent in young adults and over 65 years old.

 

What are the symptoms of meningitis?

Symptoms depend on the age of the patient, as in almost any infection in children. In general, the younger the child, the more non-specific are the symptoms, although fever is present in virtually all cases. In newborns and small children, irritability or drowsiness may also occur. In older children more common are headache, vomiting, stiff neck, or sleep tendency. In all cases, seizures or other signs of neurological involvement may occur. The range of possibilities is very wide.

We should not forget that these symptoms can be non-specific and could be a part any other banal infectious process, so when in doubt, it is crucial to assess the patient by a paediatrician.

 

How is meningitis diagnosed?

First, the complete medical history is taken and analysed, and a detailed physical examination is performed to establish the diagnosis of suspected acute meningitis. A blood test is usually required to check certain parameters that help the diagnosis and allow to differentiate one type of meningitis from another.

However, in order to confirm or rule out suspected meningitis, a lumbar puncture is the definitive and necessary test to be performed.

Further to lumbar puncture, imaging tests, such as cranial ultrasound or computed tomography (CT), are sometimes performed at the discretion of the paediatrician.

 

What does lumbar puncture consist of?

Cerebrospinal fluid sampling is a technique in which a sample is removed through a puncture in the lower back. It is also used to administer epidural anaesthesia used in childbirth and some surgeries.

We usually perform it under topical anaesthesia in the form of cream over the puncture site, although depending on the age and the specific case, it can also be performed under sedation with systemic mediation, generally, but not exclusively, intravenously.

It is the only test that can confirm or rule out the diagnosis of meningitis and identify the germ causing the infection, so it should always be carried out if meningitis is suspected and in the absence of any contraindications.

 

What complications does lumbar puncture have?

In expert hands, it is a straightforward safe technique. With this technique, complications are infrequent and almost always local (pain after the puncture, local bleeding, etc.). In children, pain or stiffness in the back after the puncture is much less common than in adults. In some children, especially newborns and small infants (because of their small size) the technique may be somewhat more complicated and more than one attempt may be needed to obtain a valid sample (it may even be that no sample is obtained at all).

 

What is the treatment of infectious meningitis?

Viral meningitis requires almost no specific treatment. Like many other viral infections, these are banal processes that heal themselves after a few days, so the only treatment is the usual analgesics to control possible symptoms (headache, a general feeling of weakness, etc.). Many of the patients affected by viral meningitis do not even need hospital admission and can be treated at home. A notable exception is the case of infection with the herpes virus (herpetic meningoencephalitis), which is a severe condition that requires hospital admission, often in paediatric ICU, and prolonged intravenous antiviral treatment.

On the other hand, bacterial meningitis requires hospital admission in all cases and intravenous antibiotic treatment, sometimes with more than one antibiotic until the causal germ is identified. It is a serious condition that may need admission to the ICU and aggressive support measures, such as mechanical ventilation, etc.

Other treatments, such as corticosteroids, anti-epileptics or intravenous fluids, may also be necessary.

 

What is the prognosis for infectious meningitis?

Viral meningitis heals itself, and the possibility of complications or sequelae is extraordinarily rare, except in the case of herpetic meningoencephalitis, which is associated with a high percentage of neurological sequelae and mortality, even with the correct treatment.

Bacterial meningitis/sepsis has a mortality of practically 100% of the cases without adequate antibiotic therapy, although with a correct treatment patient clinical progress is usually good. However, even with early and correct treatment, approximately 1 in 10 patients die and, of those who survive, 2-3 out of 10 have severe and chronic sequelae.

The actual prognosis depends on many factors (age of the patient, progress period, the presence of other risk factors, causal germ). These are cases that, although rare, are potentially very serious and have a great impact not only on the patient and his family but on the whole community in which they develop.

 

How can we prevent infectious meningitis?

Viral meningitis cannot be prevented. The viruses that cause it are multiple, and of constant circulation between humans, so it is impossible to avoid contact. The exception is herpetic meningoencephalitis, which does have some measures to avoid infection in the birth canal in newborns, although there is no real prevention option at a later age.

Most bacterial meningitis can be prevented by using vaccines. Severe meningitis caused by some bacteria very common a few years ago, such as those produced by Haemophilus influenza type B or meningococcus C, have decreased drastically today (they have almost disappeared in the case of Haemophilus) thanks to the vaccination of the entire population against these germs included in the vaccination calendar financed by the Public Health System. Another bacterium that causes many cases of meningitis is pneumococcus, whose vaccine (Prevenar ®) has also recently been included in vaccination programs throughout Spain.

Finally, vaccines against the rest of the meningococcal serogroups are also available on the private market. In this respect, it is worth noting:

  • Vaccines against meningococcus B: there are currently two vaccines in pharmacies, Bexsero® and Trumenba®. The first can be used from 6 weeks of age, and the second – from 10 to 25 years. These vaccines are recommended for all children, especially under the age of 5, when the disease is most common. Fortunately, some autonomous communities have begun to include them in their funded vaccination schedules and it is expected that this practice will be extended progressively to the rest of Spain.
  • Vaccines against meningococcus ACWY: there are also two vaccines in pharmacies against these four germs, Nimenrix® and Menveo®. Recently, the Public Health Commission has reported that this vaccine will become funded throughout the country soon, replacing the meningococcal C vaccine that is currently administered at the age of 12. However, the Vaccine Advisory Committee of the Spanish Association of Paediatrics recommends starting vaccination during the lactation period, as some autonomous communities have already put in practice.

In some specific cases, such as patients with risk factors, under current outbreaks of the disease or laboratory personnel, these vaccines may be financed by Social Security.

Further to vaccines, preventive antibiotic treatment is recommended when in close contact with confirmed cases of bacterial meningitis, which, in the event of school outbreaks, can be extended to all staff and students at the centre.

 

António J. Conejo Fernández.

Specialists from Vithas Costa del Sol health group offer nutritional and physical advice for a healthy Easter Week processions

Posted by Xanit Internacional Xanit Internacional | Posted in Miscellaneous, World Xanit | Posted on 12-04-2019

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We are getting ready for a week full of passion, with some of us actively participating in the Brotherhoods processional parade that will make their way through the streets of Spain starting tomorrow. And although we understand the importance of devotion among people, the precautions must be taken when it comes to long processions when, given certain lack of preparation, can end up leaving a mark on our health. That is why today, Dr Antonio Narváez, Head of Traumatology Department at Vithas Xanit, Dr Diego Fernández, Head of Endocrinology and Nutrition Department at Vithas Xanit, and Rafael Díaz Soria, physiotherapist at Hospital Vithas Parque San Antonio, part of the Vithas health group, wanted to offer us some healthy advice so that the members of the brotherhood (nazarenos) or those carrying large floats (pasos) can have a season of healthy penance.

 

Paying attention to what we eat the days before and during the processions

– Nutrition must be taken care of by everybody actively taking part in Holly Week’s celebrations.

– Participating in Semana Santa parades without adequate nutrient intake can lead to lipothymias and lower blood glucose levels, as well as muscle cramps or even muscle injuries.

– Before embarking on processional activities, we should eat foods with great nutritional value such as cooked rice, wholemeal pasta and fruit and nuts.

– Avoid heavy meals and animal fats as fats can hinder physical performance due to the laborious digestive process required.

– During the processions, we should opt for small snacks, fresh and dried fruit, including walnuts or almonds as a source of energy.

– Proper hydration is also very important if possible avoiding fizzy drinks. We can also opt for infusions or isotonic drinks to restore electrolyte balance.

 

A good warm-up and stretching correctly during the processions are of great importance

From the physiotherapeutic point of view, the best prevention of injuries that can occur during the processional parade is the prior physical preparation.

– Wearing a lumbosacral corset during the procession is recommended, gradually loosening it towards the end of the procession.

– Functional bandages on ankles can help prevent injuries, especially on irregular terrains.

– Wearing suitable footwear that protects the ankle and if possible with air chamber for good distribution of weight on the feet.

– Post-processions, we advise applying local ice packs for 12-15 minutes at the level of the joints of the lower limbs, local heat packs at the level of the shoulder muscles to help relax the contracture and to stretch shoulder and cervical muscles, as well as lower limbs.

– Applying ice to inflamed joints, as well as a good physiotherapeutic treatment for muscle injuries.

 

All the above recommendations can help us avoid the most frequent injuries in people carrying the floats:

Joints: Inflammation of the acromioclavicular joint and shoulder. Knees also suffer on inclined terrains and the ankles when the terrain is uneven.

Spine: There is an asymmetric axial load on the spine that can cause inflammation of small posterior joints with pain and muscle contracture and sometimes displacement of the intervertebral disc with consequent compression of the nerves that go to the limbs, resulting in sciatica pain.

Contractures: Fibrillary breaks can sometimes occur, mainly in calves and quadriceps.

The approach of the patients with Parkinson’s disease at Vithas Xanit International Hospital

Posted by Xanit Internacional Xanit Internacional | Posted in World Xanit | Posted on 08-04-2019

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Nowadays, it is possible to significantly improve the quality of life of Parkinson’s patients by reducing the intensity of symptoms. However, when a person is diagnosed with the disease, both the patient and the family members are faced with many uncertainties about this neurodegenerative disease that affects more than one hundred and fifty thousand people in Spain alone.

On the occasion of World Parkinson’s Day, we want to unveil some of the myths about the disease and answer the most frequent questions asked in our consulting room:

  • Did you know that Parkinson’s origin is multifactorial? We are talking about the existence of susceptibility genes associated with external factors that set in motion the degeneration systems of neurons in general and dopaminergic neurons in particular.
  • Did you know that tremor is not the only symptom of Parkinson’s? Parkinson’s is a global disease and can affect several organ systems. Although tremor is one of the most recognised symptoms, other problems may arise, such as those with speed and accuracy of movements, clumsiness, or other brain symptoms whose intensity will progress if not properly treated. Over time, the disease affects other groups of neurons with the appearance of symptoms of many organ systems (mental, digestive, urinary, vasomotor, affective).
  • Did you know that Parkinson does not just affect the elderly? Although the prevalence of the disease increases with age, 5% of people suffering from this disease are under 40 years old.
  • Did you know that there are new avenues of research to reduce the intensity of symptoms? Further to drug use, there are also highly effective surgical strategies for symptom control. “Deep brain stimulation” by implanting a “pacemaker” in the brain nucleus, cell therapy for “neuro-restoration” of brain structures or the use of vaccines for the elimination of abnormal protein accumulations, are some of the most effective techniques. Besides, for specific cases of a genetic anomaly, gene therapy is also used.
  • Did you know there are many techniques to fight Parkinson’s? Physiotherapy, occupational therapy, music therapy or biofeetback play an essential role in the approach of Parkinson’s patients.

Here at Neuroscience Department of Vithas Xanit International Hospital, we know the importance of the comprehensive patient approach whereby several specialists jointly assess patients needs. For this reason, the work of our specialists is supported by a multidisciplinary team of psychologists, speech therapists and psychiatrists, who address the global needs of the patient and their families.

 

If you want more information, you can consult our Youtube channel where you will find different interviews:
Dr Víctor Campos
Director of the Neuroscience Department at Vithas Xanit International Hospital

Spring allergies

Posted by Xanit Internacional Xanit Internacional | Posted in Allergies | Posted on 04-04-2019

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Spring brings along nice weather, the flowers are blooming and blossoming, however, annoying allergies also emerge. This is due to the fact that in spring the pollination period starts.

In the province of Málaga, from early on in the year, we can experience pollination of various trees and grasses, starting with that of cypress between February and March, followed by banana trees and wall pellitory in March and April and the pollen season of grasses and olive trees we can experience from April to June. When talking about spring allergies we should not forget those caused by dust mites; allergens present all year round (but more pronounced in autumn and spring).

The problem is that there are increasingly more people with more than one respiratory allergy at the same time. The evidence shows that common allergies and some more unusual ones are usually produced by plants and trees that flourish in certain areas, whose pollen particles weigh enough not to travel at a distance through the air, therefore affecting only those who live very close. In these cases, it is more challenging to reach an accurate diagnosis, sometimes due to difficulties in identifying the plant, and in others, due to the lack of specific tests and treatments for all species, not only for the most common ones.

What are the symptoms of respiratory allergy? 

People with respiratory allergies usually have a mixture of the following symptoms: nasal congestion, sneezing, itching of the nose, lacrimation, eye pruritus, respiratory distress, dry cough, wheezing, etc. They are always coinciding with the months of pollination of the plant/tree in question.

If you suspect that you are suffering from a respiratory allergy, we would recommend you to consult a specialist in allergology for diagnostic tests and, if necessary, the specialist will indicate a specific treatment with a vaccine targeted at your particular allergen.

Both the frequency and intensity of symptoms are always important because the choice of treatment will depend on them. Not all people with respiratory allergies need to get vaccinated.

People suffering from respiratory allergies and whose symptoms occur with a sufficiently high frequency or intensity, following the relevant study by the allergist, shall be indicated the specific immunotherapeutic treatment, including the administration of anti-allergic vaccines. For the control of symptoms, meanwhile, you should be using antihistamines, nasal, topical corticosteroids, inhaled corticosteroids, bronchodilators, etc.

The atopy or condition of the allergic individual also has to do with genetics. Having a family history of both parents being positive for a certain type or types of allergies makes you more prone to suffering from the same. What determines the development of allergies is a mixture of these genetic factors, environmental factors and the existence of exposure to the allergens. To give one example: a person living in Stockholm will never develop an allergy to olive pollen (as much as he/she may be genetically predisposed) because the nearest olive tree will be thousands of kilometres away.

In some cases, with the administration of vaccines, allergies can be cured, but in most cases what happens is that the symptoms are greatly minimised to the point that the patient gains ostensibly in quality of life. We should not forget that vaccines also prevent the progression of symptoms (the transition from rhinitis to asthma) and the emergence of new allergies.