MENINGITIS
Viral & Bacterial
Presented by
Ghanwa Qayyum
Roll No# 21
Meningitis
◦ At the end of the topic, you will be able to answer
◦ Defination of meningits
◦ causes
◦ Clinical features
◦ Viral & bacterial meningitis
◦ Investigation
◦ Treatment
Meningitis
◦ Defination
It is an inflammatory process involving the
leptomeningis ( pia & arachnoid )within
subarachnoid space called meningits
If the infection spreads into underlying brain
It is termed as meningioencephalits
Causes
1. Infective meningitis
◦ Aseptic ( viral)
◦ Acute pyogenic ( bacterial)
◦ Chronic( tuberculous,spirochetal or fungal )
2. Non-infective meningitis ( chemical meningitis)
◦ non-bacterial irritant
◦ Malignant diseases. 2. Inflammatory diseases
◦ Breast cancer. Sarcoidosis
◦ Bronchial cancer SLE
◦ Leukemia & lymphoma
3. Carcinomatous meningitis
◦ spread of metastatic cancer cells to the subarachnoid space
Clinical Features
◦Pyrexia
◦ Headache
◦ Neck stiffness
◦ Confusion or alterd mental status
◦ Nausea
◦ Vomiting
◦ Meningism ( occur in pt with subarachnoid
haemmorrhage ) it consists of
1. Headache
2. Photophobia
3. Stiffness of neck
4. Kernig’s sign(extension at knee with hip joint flexed causes spasm in
hamstring muscles)
5. Brudzinski’s sign( passive flexion of neck causes flexion of hips & knees
Viral meningitis
◦ Most common cause of meningitis
◦ Benign& selflimiting illness requiring no therapy
◦ Less serious than bacterial meningitis unless assciated with encephalitis
◦ Occur mainly in children or yound adults
◦ Viruses
◦ Enteroviruses ( most common )
◦ Mumps ( if immunization is not employed ,the mump virus is common cause )
◦ EBV
◦ HIV
◦ Influenza
◦ Herpes simplex
◦ Varicella zoster
Clinical features
1.Acute onset of headache ( most severe feature
2.Irritability
3.Rapid development of meningism
4.high pyrexia
5.Focal neurological (Rare)
Investigations
◦The diagnosis is made by Lumber puncture .
◦ CSF contains CsF pressure normal.
1. Clear fluid
2. Excess lymphocytes
3. Glucose normal
4. protein level normal,later may raised
5. chloride level normal.
6. Gram staining results negative.
Treatment
◦
There is No specific treatment because it’s self limiting
benign condition.
◦ Treated symptomatically.
◦ Recovery usually occur within days but lymphocytic
pleocytosis may persist in csf.
Bacterial meningitis
◦ Defination
◦ It refers to acute bacterial inflammation of leptomeninges & CSF within
subarachnoid space. ◦ Pyogenic meningitis is usually part of bacteraemic
illness
◦ Spread
1.Direct spread From an adjacent focus of infection in the ear ,skull fracture
or sinus .
1.Pathogenic strains are accquired by tge air borne route.
Causes
1. Overall = streptococcus pneumoniae (most common)
2. Neonates= E.coli, group b streptococcus, proteus
3. Infants & childrens=H.influenzae,Neisseria meningitis(2nd most common
cause),S.pneumoniae
4. Adults=Neisseria meningitis, Strep.pneumoniae
5. Elderly= Listeria Monocytogenes & S.pneumoniae
Pathophysiology
1. Infection stimulates an immune response.
Cause pia arachnoid membrane to become congested & infiltrated with
2.
inflamatory cells.
3. Pus then form in layers , which may later organise to form adhesions.
4. This obstruct the flow of CSF leading to Hydrocephalus Or damage of
cranial nerves at base of brain.
5. CSF pressure raises rapidly & protein content increases.
Clinical features
◦ Headache
◦ Meningial irritation
◦ Drowsiness
◦ High grade fever
◦ Neck stiffness
◦ Clouding consiousness
◦ Photophobia
◦ Rash
◦ Otitis media( H.influenzae
◦ Pneumonia ( pneumoccoal espcially in old pt, alcholics & person with hyposplenism)
◦ Meningitis accompained by meningiococcal spesis , above presentins signs evolve rapidly .
Complications of Pyogenic
meningitis
◦ Deafness (CN VIII palsy ) most
common ◦ Cerebral edema.
◦ Communitication& non communicating.
◦ Ventriculitis(fulminant cases).
◦ Hyponatremia.
◦ Subdural empyema.
Investigations
1. Best intial & Most accurate Test = LUMBER PUNCTURE.
2. CT scan of head
◦ before lumber is necessory becuase of risk of coning ( space occuping
lesion mag cause herniation)
◦ Indications of CT scan before lumber
puncture. Focal neurologic
abnormalities seziures
Papilledema
recent
neurosurgery
Head injury
3. Blood culture before starting antibiotics.
CT scan of head however should not delay antibiotic treatment of
presumptive meningitis.
4. PCR techniques can be used to identify bacterial DNA.
Lumber punture
findings
◦ CSF contains
1. Turbd fluid
2. Raised pressure
3. Glucose very low
4. Protein high
5. Chloride low
6. Neutrophils
7. Gram staining positivd
Treatment
◦ Best initial treament
1. Ceftriaxone 2g IV 12 hourly + vancomycin 15-20 mg/kg
IV 12hourly +steroids
2. Steroids (dexamethasone ) therapy is given
◦ both in children & adults
◦ Given in 15 – 20mins before antibiotics for 2 – 4 days.
◦ prevent severe deafness following H.influenzae.
1. In suspected bacterial meningitis benzylpenicillin IV is
given.
Prevention of meningococcal
Infection
1.Children= oral Rifampcin for 2 days
◦ Age 3-12months =5mg/ kg12 hourly
◦ Agr >1yr = 10mg/kg 12 hourly
2.Adults
◦ Rifampicin or single oral dose of 500mg
ciprofloxacin.
3.Meningococcal vaccine .
Chronic
meningitis
◦ Tuberculous meningitis
◦ It is caused by Mycobacterium tuberculosis.
◦ Results from complication of primary tuberculosis.
◦ Common site is base of brain.
◦ More frequently in pt with AIDS as a secondary infection.
Investigation
◦ Lumber puntcure should be performed
◦ Csf findings
1. CSF pressure Increased
2. Cloudy (spider web formed ).
3. Initially neutrophils then predominantly lymphocytes.
4. Protein increased(markedly).
5. Glucose decreased.
6. Gram stain Negative.
Treatment
1. Anti tuberculous therapy + steroid
◦Steroid improves mortality but not focal neurological
signs
2. Surgical ventricular drainage needed◦ Obstructive
hydrocephalus develops.
3. Adequate hydration & nutrition maintaind during acute
phase illness .
