Discussion on the Chemotherapy of Meningitis Secondary to Infection of the Ear and Nasal Sinuses

Abstract

OTOGENIC meningitis and meningitis secondary to infection of the nasal sinuses have much in common. In both the bacteriology is similar, in both the meningitis may be complicated by abscess formation and in both the problems of treatment are in many respects the same. We therefore propose to discuss these two groups of cases together. We also include certain cases where the meningitis arose not from a frank sinusitis but as a result of a fracture involving the nasal sinuses (Table I). Proceedings of the Royal Society of Medicine 16 We have treated one case of otogenic influenzal meningitis. CASE I.-R.I. 25486/44. A baby of 8 months was one day noticed to have a thick purulent discharge coming from his right ear. He did not seem unwell at that time but five days later the left ear also began to discharge. Eight days late,r he was admitted to the Ear, Nose and Throat Department of the Radcliffe Infirmary, and the following day a bilateral Schwartze mastoidectomy was performed. The right mastoid contained a fair amount of mucopus, but the left only showed some injection. Following operation the condition of his ears was uniformly satisfactory, but his temperature rose, and he was given sulphathiazole (3 grammes daily). For the next ten days his temperature was maintained at about 1020 F. without the development of any physical signs, but on the eleventh day he developed a squint and on the twelfth day was found to have considerable neck stiffness. A lumbar puncture revealed-a cloudy fluid but no organisms were seen on the direct film, and it was not until four days later that the organism grown on culture was identified as H. influenzce. During these four days, treatment with intramuscular and intrathecal penicillin was given in view of the previous lack of improvement on sulphathiazole. There was no clinical improvement throughout this period. When the organism was reported as insensitive to penicillin, sulphadiazine (3 grammes daily) was begun, and the penicillin discontinued. Thereafter the child slowly improved, but one attempt to reduce the dose of sulphadiazine, and another to discontinue the drug after three weeks, were quickly followed by clinical and bacteriological relapse. Finally the child made a complete recovery after having received sulphadiazine for seven weeks. At no time were any signs of drug intolerance detected.