• There is increasing concern about antibiotic resistance in meningitis infections
• In the US, a five-month-old baby with meningitis recently proved to be resistant to standard antibiotic treatment
• Researchers say this calls for closer partnerships between infectious disease doctors and microbiology labs

Antibiotic-resistant bacteria affected the treatment of meningitis at a major children’s hospital in Washington, D.C.

This single case at Children’s National Hospital raises concerns about drug resistance in the common bacterium that caused the infection, and researchers say it could change lab and clinical procedures around the world.

Normally, when doctors first suspect meningitis in children, they usually give the broad-spectrum antibiotic ceftriaxone, which acts against a wider range of disease-causing bacteria. When the meningitis organism is identified through lab tests, penicillin or ampicillin are used, the researchers explained.

People who have had close contact with the patients are also given ciprofloxacin as a precaution.

Inappropriate treatment

In this case, a five-month-old baby was taken to the emergency room after six days of fever and congestion. The infant’s particular meningitis contained an enzyme that makes the germ resistant to penicillin and ampicillin, and also to ciprofloxacin.

The hospital sent samples of the resistant bacteria to several health agencies, including the US Centers for Disease Control and Prevention, to compare with other samples.

“These bacteria wouldn’t have been susceptible to the common antibiotics that we would normally use for this infection, so it’s entirely possible that the infections caused by these bacteria could have been treated inappropriately if doctors used the standard protocol,” co-author Dr Gillian Taormina said in a hospital news release. She is a fellow in paediatric infectious diseases.

Taormina said the baby’s condition improved after seven days on ceftriaxone. Relatives and other contacts were treated with the antibiotic rifampin.

Close partnerships

Although this case had a good outcome, it underscores increasing concern about antibiotic resistance in other meningitis infections.

Taormina and co-author Joseph Campos said the growing number of antibiotic-resistant bacteria calls for close partnerships between infectious disease doctors and microbiology labs. Campos is director of the hospital’s Infectious Diseases Molecular Diagnostics Laboratory.

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• A third of diabetes have complications related to their eyes 
• This can, however, be prevented
• This can be done by focusing on good blood sugar management and regular eye exams

Diabetes can wreak havoc on many parts of the body, including the eyes, but people with diabetes aren’t doomed to have vision problems.

With good blood sugar management and regular eye exams, many eye conditions can be prevented or treated, experts say.

Patricia Welter, a Pilates studio owner from Palm Harbor, Florida, wishes she’d known more about preventing eye problems related to diabetes before it was too late. She was diagnosed with type 1 diabetes at 14, and lost one of her eyes because of diabetes when she was in her 40s.

Blurry vision

“I was always scared to death of eye complications and blindness from diabetes,” Welter said. Her uncle and her mother both had type 1 diabetes and had vision issues from the disease. But Welter was diagnosed in the 1970s before a lot of advances had been made in treating diabetes and diabetic eye disease.

“Looking back, I saw signs. I started getting blurry vision and would see little dots. If I had been diagnosed and treated earlier for my eye disease, maybe I wouldn’t have lost my eye,” she said.

When she was in her 40s, Welter started experiencing bleeding in her retina (the part of the eye that senses light and sends visual messages to the brain). She saw an eye doctor and had laser surgery performed in both eyes. Then one day she saw flashes in her left eye. The doctors diagnosed a retinal detachment. She had three surgeries to try to save the eye, but had a stroke during the third surgery and lost her left eye.

“I really felt sorry for myself the first few months,” she said. But her boyfriend (now her husband) pushed her to get active again, to return to Pilates. He also challenged her to complete a half marathon, which they did together.

Welter said she hasn’t let the loss of her eye stop her in any way. “It’s part of my being now,” she added.

‘Get a team of people’

In addition to having diabetic retinopathy, she also developed an early cataract – another concern for people with diabetes. Cataracts cause cloudy lenses in the eyes. Welter had surgery to correct the cataract and said it changed her world because it gave her so much of her vision back in her remaining eye.

Her advice to others with diabetes is, “Get a team of people around you to help manage your diabetes – family, friends, co-workers, endocrinologist, diabetes educator, registered dietician and an eye doctor. If you catch eye problems early, you can treat it.”

Tracey Brown, CEO of the American Diabetes Association (ADA), also stresses the need for early care.

“One-third of people with diabetes have complications related to their eyes, and eye care doesn’t get nearly the attention it should,” Brown said. “Eye care needs to be a priority, even during this stressful time, because if you can do the things that are required, you don’t necessarily have to have the eye problems of diabetes.”

Brown recently led an expert panel for the ADA’s Focus on Diabetes: Look Closer at Eye Health initiative, including experts from the ADA, VSP Vision Care and Regeneron.

There are four types of eye disease that are more common in people with diabetes, according to the US National Eye Institute (NEI):

• Diabetic retinopathy
• Diabetic macular oedema
• Glaucoma
• Cataracts

These conditions are more common in people who have higher blood sugar levels, so managing your diabetes well can help prevent eye disease, the NEI said.

There are a number of symptoms of eye disease that should prompt a visit to an eye doctor. These include:

• Blurred or wavy vision
• Vision that changes frequently, possibly from day to day
• Areas with no vision
• Dark areas in your vision
• Difficulty seeing colours
• Seeing spots or dark strings (floaters)
• Light flashes

But even if you don’t have symptoms of eye disease, it’s important to have annual dilated eye exams, according to the experts involved in the ADA’s eye initiative.

Control is key

Kate Renwick-Espinosa, president of VSP Vision Care, said, “For the more than 100 million people with diabetes or prediabetes, an annual eye exam plays a critical role in preventing blindness.”

There are newer medications that can treat diabetic eye disease, as well as laser procedures and surgeries that can help people with diabetes avoid vision loss.

Welter still regularly sees her eye doctor and a retinal specialist. Her doctors believe if Welter’s problems had started today, they would have been able to save her eye.

“The key to your eye health is control. Keep control of your blood sugar levels, exercise in some form – even if you have to sit in a chair and do exercises, there’s always a way. If you notice any changes in your vision, immediately consult your eye doctor. About 95% of eye disease is treatable if you get to it early,” she said.

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• Baby boomers (born between 1944 and 1964) are showing more cognitive decline than their parents
• This is surprising because they have more ‘going for them’ than previous generations
•  They are, however, experiencing higher rates of obesity and physical inactivity, as well as depression and loneliness

Ageing baby boomers may not be as mentally sharp as their parents were, a new study suggests – raising questions about what the pattern could mean for future dementia rates.

Looking at two decades’ worth of data on US adults, the study found generational differences in tests of cognitive function. That refers to essential mental abilities such as remembering, reasoning and problem-solving.

On average, Americans born in the early- to mid-boomer generation – between 1948 and 1959 – fared a bit worse on those tests than previous generations. The pattern reversed what had been an improving outlook: Americans born between 1942 and 1947 had generally outperformed those born between 1890 and 1923.

More obesity and inactivity

On one hand, the findings are surprising, according to study author Hui Zheng, an associate professor of sociology at Ohio State University.

Boomers would have certain things going for them – including higher education levels, less smoking and access to treatments for heart disease risk factors such as high blood pressure and high cholesterol. All have been linked to lower risks of mental decline.

In addition, studies have found that older adults today seem to have a lower risk of dementia than their parents and grandparents did. However, Zheng said, there’s some evidence that decline is stabilising.

And while boomers have some positives in their corner, they are worse off than previous generations in some respects – including higher rates of obesity and physical inactivity.

In fact, Zheng found that those two patterns seemed to offer a partial explanation for boomers’ lower scores on cognitive tests.

But, he said, there was an even stronger factor: rising rates of depression and loneliness.

It’s not clear why, but some studies have found a link between depression and dementia risk, Zheng said.

Underlying brain changes

Whether depression is actually a risk factor for dementia remains unknown, according to Heather Snyder, vice president of medical and scientific operations for the Alzheimer’s Association.

The dementia process is a long one, and it’s possible that those underlying brain changes cause the depression symptoms, explained Snyder, who wasn’t involved with the study.

“It’s a really important area of research,” she said.

To Snyder, the takeaway from this new study is that people should address modifiable factors that are believed to contribute to dementia. In general, good cardiovascular health supports brain health, so it’s important to eat a healthy diet, exercise and control blood pressure, cholesterol and blood sugar, she said.

The study, recently published online in Journals of Gerontology: Social Sciences, pulled data from a long-running health study of Americans older than 50.

Zheng focused on more than 30 000 people who took part in the study between 1996 and 2014. All took the same battery of cognitive tests. On average, test scores peaked among “war babies” born between 1942 and 1947 – then dipped among boomers.

Declining cognitive health 

The pattern held true for Americans of all income and education levels, according to Zheng.

And the findings were not explained by deaths among older generations leaving the healthier and hardier behind. Zheng said the cognitive differences between war babies and boomers were apparent before age 55.

“This study suggests cognitive health has started to decline in the US,” Zheng said, adding it’s not clear what the patterns will be for generations younger than the boomers.

Zheng echoed Snyder in stressing the ways that people can protect their brain health.

“Physical health and cognitive health aren’t separate – they’re related,” he said. “Try to spend more time being physically active, and pay attention to your cardiovascular risk factors.”

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