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Meningitis: Presented By:dr. Alaa Nugud ABH-Medical Department

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ALaa Nugud

Meningitis is an acute infection of the meninges that can be caused by bacteria, viruses, or other organisms. Common bacterial causes include Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae. Clinical features include neck stiffness, fever, headache, and signs of increased intracranial pressure like vomiting and altered consciousness. Diagnosis involves lumbar puncture and analysis of cerebrospinal fluid. Treatment depends on the suspected causative organism but involves prompt administration of antibiotics.

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Meningitis: Presented By:dr. Alaa Nugud ABH-Medical Department

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ALaa Nugud
74 views23 pages
Meningitis is an acute infection of the meninges that can be caused by bacteria, viruses, or other organisms. Common bacterial causes include Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae. Clinical features include neck stiffness, fever, headache, and signs of increased intracranial pressure like vomiting and altered consciousness. Diagnosis involves lumbar puncture and analysis of cerebrospinal fluid. Treatment depends on the suspected causative organism but involves prompt administration of antibiotics.

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Meningitis

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Meningitis is an acute infection of the meninges that can be caused by bacteria, viruses, or other organisms. Common bacterial causes include Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae. Clinical features include neck stiffness, fever, headache, and signs of increased intracranial pressure like vomiting and altered consciousness. Diagnosis involves lumbar puncture and analysis of cerebrospinal fluid. Treatment depends on the suspected causative organism but involves prompt administration of antibiotics.

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74 views23 pages

Meningitis: Presented By:dr. Alaa Nugud ABH-Medical Department

Uploaded by

ALaa Nugud
Meningitis is an acute infection of the meninges that can be caused by bacteria, viruses, or other organisms. Common bacterial causes include Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae. Clinical features include neck stiffness, fever, headache, and signs of increased intracranial pressure like vomiting and altered consciousness. Diagnosis involves lumbar puncture and analysis of cerebrospinal fluid. Treatment depends on the suspected causative organism but involves prompt administration of antibiotics.

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Meningitis

Presented by :Dr. Alaa Nugud


ABH- Medical Department
Definition
Acute infection of the meninges
causes
 Bacteria
Neisseria meningitides
Streptococcus pneumoniae
H.Influenzae
Listeria monocytogenes
Mycobacterium tuberculosis
 Viruses
Enteroviruses( echo, coxsackie, polio)
Influenza
Herpes simplex
HIV
 Other causative organisms
Toxoplasma
Histoplasma
Candida
 Non-infective causes
Malignant cells
Drugs (mainly NSAIDs, antibiotics and intravenous
immunoglobulins)
.Blood following subarachnoid haemorrhage
Inflammatory disease (Sarcoidosis ,SLE ,Behçet's disease)
Clinical Features
Features of Meningeal irritation
 Neck stiffness
 +ve Kernig’s sign
 +ve Brudzinki’s sign
 Photophobia

Features of Infection
 Fever
 Rigors

Features of ↑ ICP:
 Headache
 Vomiting
 Deterioration in the level of consciouness
 Seizures
Acute Bacterial Meningitis
♦ Meningitis belt
♦ epidemic zones
♦ sporadic cases
Meningococcal Meningitis
Caused by bean shaped gram –ve dipolococcus
N.Mengitides
The reservoir of Neisseria meningitidis is found in the
nasopharynx of asymptomatic carriers
Incubation period: 1-5 days.
Occur mostly in winter, may occur in epidemics
After a meningococcal bacteremia, it is possible for
the clinical picture of meningitis to occur.
In meningococcal septicemia a combination of
purpura and maculopapular exanthema occurs in
approximately 75% of cases
There are significant differences in the local distribution

N. meningitides groups B and C cause most disease


episodes in Europe

N. meningitides group A is found in Asia and Africa,


where it accountins for about 80% to 85% of
documented meningococcal meningitis cases in the
meningitis belt
S.Pneumoniae Meningitis
Predisposing factors:
 Otitis media
 pnumonia
 Sinusitis
 Spleenectomy
 Head trauma with basilar skull fracture

Otoneurological complications occur in up to 25% of


cases.
Listeria monocytogenes meningitis
More likely in:
Diabetics
Alcoholics
Immunocompromised
Pregnant women
Clinical picture of bacterial Meningitis
Abrupt onset
Triad of fever, headache, neck stiffness
Signs of meningeal irritation
Features of complication:
Progressive drowsiness
Cranial nerve palsies
Focal neurogical deficits
Sezuires
Septicemia, DIC, shock
SIADH
Investigations
CBC,PT,PTT
CRP
U&E (R/O SIADH)
Blood cultures
CT
LP
Managment
Don’t Delay The Treatment
If bacterial meningitis and especially if meningococcal disease
suspected, general practitioners should give benzylpenicillin
(1.2 g IM/IV) before urgent transfer to hospital
When the causative organism is unknown antibiotics will be
given empirically based on the clinical settings and age of
patient:
Patients with typical meningococcal rash are given
benzylpenicillin 2.4 g every 4 hours.
Patients <55 yrs: cefotaxime 2g 6 hourly
Patients >55yrs :Cefotaxime + Ampicillin 2g 4 hourly
Once organism is isolated , antibiotics are given according to
sensetivities
Adjunctive therapy
Consider adjunctive treatment with dexamethasone
(particularly if pneumococcal meningitis suspected in
adults) starting before or with first dose of
antibacterial
Avoid dexamethasone in
septic shock
 meningococcal disease
 if immunocompromised
meningitis following surgery
Manitol: when there is ↑ ICP due to cerebral oedema
Tuberculous Meningitis
The diagnosis is made more difficult by the insidious course of
the disease over a period of days to weeks
uncharacteristic symptoms such as a reduced state of general
health, night sweats, weight loss, and subfebrile temperatures.
Meningism is absent in a fifth of patients with TB meningitis
In 75% evidence of TB outside the CNS can be found.
The treatment of TB meningitis is isoniazid, rifampcin,
pyrazinamide and ethambutol for two months, followed by
isoniazid and rifampicin alone for a further ten months.
Steroids are always used in the first six weeks of treatment
(and sometimes for longer).
Analysis of the CSF
Glucose Protein Predominant cells and Appearance Diagnosis
concentration concentration cell count

⅔ - ½ blood 15−45 mg/dL Lymphocytes Clear Normal


glucose 5/mm3 Findings

< ½ blood 50−1500 mg/dL 90% granulocytes, Turbid Bacterial


glucose 500−20000 infection

< ½ blood 45−500 mg//dL Lymphocytes, Turbid/viscous TB


glucose 100-300 mm3

> ½ blood up Initially granulocytes, Clear/turbid Viral


glucose to 120 mg/dL, after 48 h lymphocytes infection
10-100 mm3

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