Rasmussen Annotated Bibliography: Advances in Treatment Assignment Treatment options for acute and chronic diseases continue to advance in efforts to cure

Rasmussen Annotated Bibliography: Advances in Treatment Assignment Treatment options for acute and chronic diseases continue to advance in efforts to cure diseases or manage symptoms and improve quality of life. While working in healthcare, it is important to be able to research treatment options to understand the different treatments or questions patients may need to consider.Select 1 disease directly related to one of the body systems reviewed in this module. Research and select a peer reviewed article written within the past 5 years discussing treatment options for the selected disease and write a 1-page (minimum) Annotated Bibliography. For annotated bibliographies, use standard APA format for the citations, then add a brief entry, including:2 to 4 sentences to summarize the main idea(s) of the source including a brief summary of the disease and treatment option(s).1 or 2 sentences to assess and evaluate the source including if this information is reliable and discuss if the source is objective or biased.1 or 2 sentences to reflect on the source including how this information can benefit a patient and your understanding of the Empiric Treatment of Acute Meningitis Syndrome…
Tadesse BT. et al.
581
ORIGINAL ARTCLE
Empiric Treatment of Acute Meningitis Syndrome in a ResourceLimited Setting: Clinical Outcomes and Predictors of Survival or
Death
Birkneh Tilahun Tadesse1, Byron Alexander Foster2, Mulugeta Sitot Shibeshi1,
HenokTadele Dangiso1
ABSTRACT
OPEN ACCESS
Citation: Birkneh Tilahun Tadesse, Byron
Alexander Foster, Mulugeta Sitot
Shibeshi, HenokTadele Dangiso. Empiric
Treatment of Acute Meningitis Syndrome
in a Resource-Limited Setting: Clinical
Outcomes and Predictors of Survival or
Death.
Ethiop
J
Health
Sci.2017;27(6):581.
doi:http://dx.doi.org/10.4314/ejhs.v27i6.3
Received: June 11, 2017
Accepted: June 13, 2017
Published: November 1, 2017
Copyright: © 2017 Birkneh T. et al. This
is an open access article distributed under
the terms of the Creative Commons
Attribution License, which permits
unrestricted use, distribution, and
reproduction in any medium, provided the
original author and source are credited.
Funding: Nil
Competing Interests: The authors
declare that this manuscript was approved
by all authors in its current form and that
no competing interest exists.
Affiliation and Correspondence:
1
Department of Child Health, Hawassa
University College of Health Sciences,
Hawassa, Ethiopia
2
Department of Pediatrics, Oregon
Health & Science University, Oregon
,USA
*Email: fosterb@ohsu.edu
BACKGROUND: Bacterial meningitis is a significant cause of
morbidity and mortality in the developing world. However, limited
research has focused on the diagnosis and management of
meningitis in resource-limited settings.
METHODS: We designed a prospective case series of children
admitted to a large, academic referral hospital with acute
meningitis syndrome. Data were collected on age, time of
presentation, prior antibiotics, cerebrospinal fluid (CSF)
parameters, antibiotic and steroid prescription, and clinical
outcome.
RESULTS: Data on 99 patients were collected and analyzed. Most
of the patients were males, n=69 (70%), and were from a rural
area, n=83 (84%). Incomplete vaccination was common, n=36
(36%) and many have evidence of malnutrition, n=25 (38%). Most
patients, n=64 (72%), had received antibiotics prior to admission
with a mean duration of symptoms of 4.9 days prior to admission.
The CSF white blood cell (WBC) count was higher in those who
had not received prior antibiotics though it was elevated in both
groups. The CSF WBC count was not associated with survival;
malnutrition and length of symptoms prior to admission were both
associated with decreased survival.
CONCLUSIONS: While use of antibiotics prior to obtaining CSF
in patients with acute meningitis syndrome may decrease their CSF
WBC count, it is not clinically significant. Many patients had a
significant delay in presentation that had an effect on survival,
This is a potentially modifiable risk factor despite the resourcelimited setting.
KEYWORDS: bacterial meningitis, children, antibiotics,
glucocorticoids
INTRODUCTION
DOI: http://dx.doi.org/10.4314/ejhs.v27i6.3
582
Ethiop J Health Sci.
Vol. 27, No. 6
Bacterial meningitis is a significant source of
mortality and morbidity, particularly in the
developing world (1–3). The incidence in the
United States is less than 1 per 100,000 persons
whereas in much of sub-Saharan Africa, it is 1025 per 100,000 persons (4). A recent study from
Canada found a 8.4% mortality rate and 18%
complication rate amongst patients with
meningococcal disease, one of the major causes of
meningitis (5). In resource-limited settings, the
mortality is approximately one third of patients
when examining all etiologies, with higher
mortality associated with either pneumococcal
disease or Haemophilus influenzae type b (Hib)
meningitis (1). Given the morbidity, treatment
decisions must be made in a timely manner before
any microbiologic confirmation can be done. One
of the major challenges faced by clinicians where
the worldwide preponderance of disease occurs is
the interpretation of cerebrospinal fluid (CSF) cell
counts in the absence of microbiologic culture,
antigen testing or viral testing, which is the case in
much of the developing world (6,7).
Theoretically, clinical prediction rules or
scoring systems could help stratify patients into
high risk and low risk for the diagnosis of
bacterial meningitis. However, the literature
discussing such clinical scoring systems use
Western populations with significantly different
pathogen and immunization patterns from other
parts of the world (8,9). Another significant
challenge is the evaluation of CSF in the context
of prior antibiotic exposure, with most of the
evidence informing this evaluation coming from a
clinical and epidemiologically population distinct
from sub-Saharan Africa with different
immunization regimens and disease patterns
(10,11).
In this study, we sought to address three
questions to help clarify the issues identified
above:
1. What is the pattern of CSF pleocytosis among
patients treated with antibiotics prior to
lumbar puncture?
2. What is the relationship between level of CSF
pleocytosis and outcome in children clinically
diagnosed to have acute meningitis?
DOI: http://dx.doi.org/10.4314/ejhs.v27i6.3
November 2017
3. What is the relative effectiveness of
commonly used antibiotic regimens in acute
meningitis syndrome?
METHODS
Study design and data collection: We designed a
prospective case series of patients presenting with
acute meningitis syndrome. Patient data were
collected on the pediatric ward of Hawassa
University Referral Hospital in Hawassa, Ethiopia,
between January 2013 and February 2014.
Patients with clinical suspicion for acute
meningitis were entered into the database
sequentially as they were admitted, with the World
Health Organization (WHO) clinical definition of
meningitis used: sudden onset of fever with one or
more typical clinical features (seizures other than
febrile
seizures,
neck
stiffness,
altered
consciousness, irritability, other meningeal signs,
petechial or purpuric rash). The inclusion criterion
was completion of a diagnostic lumbar puncture.
As per the national guidelines (12) for Ethiopia, if
patients presents with acute meningitis syndrome,
they should be started on high dose crystalline
penicillin and chloramphenicol. If patients have
taken antibiotics before they arrive to the hospital,
ceftriaxone is started empirically (12). If they
present to a health center prior to transfer to a
larger tertiary care hospital or teaching hospital
and a serious febrile illness is recognized by the
health staff, they should receive a dose of
ampicillin and gentamicin prior to transfer.
Patients who were too unstable for a lumbar
puncture or whose malaria smear was positive
were excluded from the study. Missing values
were addressed using a chart review when
possible.
We prospectively collected data on
vaccination status as per parental report,
demographic information of home town,
malnourishment status, HIV status, known
tuberculosis contacts, receipt of antibiotics prior to
admission and all prescribed antibiotics during the
hospitalization. The WHO guidelines for
malnourishment assessment were followed for all
admitted patients (13). Mild malnutrition is
Empiric Treatment of Acute Meningitis Syndrome…
defined as a weight-for-height between -1 and -2
z-scores below the median of WHO child growth
standards, and moderate malnutrition is defined as
a weight-for-height between -3 and -2 z-scores
below the median. Severe malnutrition is
diagnosed with a weight for height less than -3 zscores of the median, mean upper arm
circumference
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