An Early Dose of Dexamethasone Can Prevent Long Term Effects of Bacterial Meningitis

As reported in News Wise, in Hackensack Meridian Jersey Shore University Medical Center and the Cleveland Clinic, one patient’s unlikely success story led researchers to conclude that a balance of antibiotics and the anti-inflammatory hormone dexamethasone to treat bacterial meningitis early after exposure is the most effective way to help patients reach full recovery.

Bacterial Meningitis

Bacterial meningitis is a rare disease caused by various types of bacteria, causing severe symptoms. The illness causes symptoms to appear rapidly during the week following exposure to the bacteria. This causes the meninges, the membranes around the spinal cord and brain, to swell, causing severe headaches, fevers, and a stiff neck. Without appropriate, rapid care, the illness progresses rapidly into more complicated symptoms, including learning disabilities, brain damage, and deafness. In some cases, it is fatal.

A Misdiagnosis and a Success Story

The researchers used the case study of a 70-year-old woman with the disease, who came in to be treated for severe joint pain. The doctors administered the hormone dexamethasone.
However, three days later, she fell into a coma before her doctors diagnosed her with Neisseria meningitis.
In the report, the authors explain,
“This patient was comatose when admitted to the hospital. She continued to be treated with dexamethasone, and antibiotics were initiated. She was discharged from the ICU within 13 hours of admission, awake, alert, and fully oriented without any neurological deficits. After long-term follow-up, a year later, the patient showed no residual neurological consequences from the meningitis.”
This case’s dramatic turn around and her total recovery showed how effective the hormone can be for long-term recovery when administered rapidly.  The hormone is believed to fight the secondary inflammation caused by the disease, which often causes the long term physiological damage.
Dexamethasone’s Past Research
This is not the first study to link the drug to the treatment of bacterial meningitis. In 2002, a study in The New England Journal of Medicine found patients receiving dexamethasone proved to have significantly fewer unfavorable outcomes (15% with the hormone vs 25% with the placebo.) The hormone’s results were even more impressive for those with the rare pneumococcal meningitis, of whom 26% demonstrated unfavorable outcomes as opposed to the placebo’s 52%.
While their case study came by the timely good luck that a misdiagnosis yielded the correct treatment, they recognize the exceptional nature of her recovery. Still, they note that doctors should understand that an early dose of dexamethasone upon suspicion of meningitis is a precaution that could prove pertinent. One of the lead authors of the study, Dr. Sushil K. Mehandru advised,
“While it is challenging to foresee oligoarticular arthritis as the prodromal signs of Neisseria meningitis, as seen in this patient, this case may make physicians more aware of the possibility. It also may help physicians consider dexamethasone earlier upon suspicion of meningitis much prior to culture and sensitivity reports and certainly before administration of antibiotics.”
Dr. Mehandru and the authors concluded their case report by commenting, “The early use of dexamethasone may be found beneficial in all types of bacterial meningitis.”

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