The Half Decent Pharmaceutical Chemistry Blog

A couple of days ago, my supervisor pointed out that, for her, one of signs that most strongly marks the approaching Christmas time is the Star Wars trilogy (or whatever it’s become now) being shown on TV. Generally, the broadcaster schedules the former-trilogy so that the final episode could (sort of) cathartically reach the conclusion of the story on Christmas eve, when children’s impatience to get their present has reached its zenith and, therefore, parents desperately need something to keep them quiet and silent while they go through a seven (!) courses dinner: a couple of starters (where secretly depressed women get instantly drunk and you can foresee, from the beginning, how the dinner is going to end), first course (for example a supper), second (massive) course (any sort of meat prepared in such a way that it’ll certainly take you until New Year’s eve to be completely digested), fruit (which, on this occasion, nobody eats because “C’mon, you only live once! Forget about health!”) and, last but not least, a couple of different deserts (but you’d be a bit disappointed finding out they are only two). This, in a few words, is your average, middle-class, Christmas’s Eve, Italian banquet. Unfortunately, kids don’t eat all that stuff and refuse (how can you blame them?) to sit around a table for hours, pretending to enjoy themselves and, in particular, relatives and in-laws, talking about their jobs, their income, their car, their holidays and so on. What they would normally do is trying to set the house on fire or kill themselves or hung their cousin or look under the girl’s skirts (as daddy does, only in a less spontaneous way). To avoid all this, what’s better than a spectacular, science-fiction film which, despite its age, hasn’t lost its touch yet?
Whenever it comes to sixologies or whatever, you cannot avoid setting up a poll to unquestionably determine which episode is the best one. My current group seem to prefer “The Empire Strikes Back”, although I think it’s the worst. By the way, this is pointless because there’s already a winner in this contest : by a large margin, “Spaceballs”. And that’s the end of it.

Nevertheless, there’s something else which is currently striking back in this country and threatens to ruin our joyful Christmas time, with all those people gathering, those cheers and those shared glasses: meningitis. Looking at the figures, you shouldn’t be scared at all: last year the number of infected patients was almost the same, so it’s absolutely incorrect to claim we are facing an epidemic, although this could, in theory, easily result given that meningococci are involved and they know how to viciously and violently spread the disease. However, we are currently right in the middle of an alarming infection spreading from a party in a pub located in the North East. Worryingly, yesterday saw the fourth death in less than a week and five new cases in five different parts of the country, which means something unusual is undoubtedly going on. Luckily, Italian, though, haven’t gone mad that much yet, as they are too busy complaining about the ridiculously rising prices which are making everyone sad, depressed and disillusioned.

Unsurprisingly, neisseria meningitidis is responsible for this latest infection: meningococci are, in fact, the most common cause of epidemics, as they can easily trigger acute leptomeningitis (which is the proper, scientific term for this disease) primarily in adolescents and adults, the two groups of individuals certainly most likely to have an active, social life, which often includes gathering in crowded rooms and drinking in glasses that may not THAT clean after all. In other kinds of people, such as babies and elderly patients, meningitis could be attributed to other infecting bacteria, such as E. Coli, H. influenzae, Streptococcus pneumoniae, Staphylococcus aureus, etc.

What’s more, albeit bacterial meningitis is, by far, the most frequent type, viruses can lead to a so-called lymphocytic meningitis, while other agents (fungi, for instance), infecting immunocompromised individuals, might turn meningitis from an acute to a chronic form.
Bacterial meningitis is also called “purulent” because of its distinguishing, disgusting exudates in the subarachnoid space. Moreover, the (lepto)meninges are characteristically congested as well, with an awful lot of neutrophils and fibrin clearly detectable microscopically. The cerebrospinal fluid turns turbid, due to a massive concentration of neutrophils and proteins, as the vascular permeability is worryingly enhanced. The spinal cord, too, is often edematous.

Early prognosis is vital: if penicillin (drug of choice in the absence of resistance) isn’t given promptly (even prior to the result of the microbiological culture), there could be few chances for the patient to survive. If resistance appears, a possible alternative is to use third or fourth generation cephalosporins, such as ceftriaxone and cefepime. In fact, generally speaking, cephalosporins show only 5-10 % of cross-resistance with penicillins and most recent cephalosporins are effective against neisseria meningitidis.
So, if you are experiencing headache, neck stiffness, photo- or phono-phobia and everyone is telling you that today you’re incredibly irritable, perhaps, you’d better check in and look back that wild party you went to a couple of nights ago: meningitis is striking back.