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Meningitis
1. Pokhara University
School of Health and Allied Sciences
Meningitis
Presented By:
Deepa kumari karn
M Pharm (Clinical Pharmacy), 2nd
Sem
07/30/17 1
2. Pokhara University
School of Health and Allied Sciences
Contents
• Overview of Nervous System
Types of Nervous system
Meninges
• Introduction
• Clinical Presentations
Physical Sign and Symptoms
Laboratory Results
• Risk Factors
• Aetiology
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3. Pokhara University
School of Health and Allied Sciences
• Pathophysiology
• Treatments
• Preventive Measures
• Case
• References
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4. Pokhara University
School of Health and Allied Sciences
Overview of Nervous System
Types of Nervous system
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7. Pokhara University
School of Health and Allied Sciences
Introduction
• Acute inflammation of the membranes (meninges)
surrounding brain and spinal cord
• Caused when the protective membranes around the
brain and spinal cord known as the meninges
become infected
• It is not known why one person gets meningitis when
others exposed to the same germs do not get as sick,
or don't get sick at all
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16. Pokhara University
School of Health and Allied Sciences
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• Viral meningites:
– Viral meningites can occurs when the protective barrier of
the brain- skull , meninges and the blood brain barrier is
covered by the viral infecting agent.
– The infection may be caused either by the haematological
route (as in the tubercular meningites, HIV infection,
respiratory meningites) or by neurotropic spread of the
agent as in the herpex virus, rabiese and polio.
17. Pokhara University
School of Health and Allied Sciences
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Infection ( Bacterial, Viral ,Fungal)
Inflammations of the Meninges
Increased CSF permeability
Entry of the blood components into the subarachenoid
space
Cerebral oedema and elevated CSF protein levels
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School of Health and Allied Sciences
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Neutrophil migration from blood stream to CSF as well
as intracranial hypertension
Decrease in cerebral blood flow
Anaerobic metabolism ensues, which contributes to
increased lactate and decreases glucose
concentrations
Transient neuronal dysfunction or permanent neuronal
injury
19. Pokhara University
School of Health and Allied Sciences
Treatment
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• The management approach to patients with
suspected or proven bacterial meningitis includes
emergent cerebrospinal fluid analysis and initiation
of appropriate antimicrobial and adjunctive
therapies
• Empiric antimicrobial therapy should be instituted as
soon as possible to eradicate the causative organism
• Antimicrobial therapy should last at least 48 to 72
hours or until the diagnosis of bacterial meningitis
canbe ruled out
22. Pokhara University
School of Health and Allied Sciences
• Continued therapy should be based on the
assessment of clinical improvement, cultures, and
susceptibility testing results
• In addition to antibiotics, dexamethasone is a
commonly used therapy for the treatment of
pediatric meningitis
• Dexamethasone should be administered prior to the
first antibiotic dose and not after antibiotics have
already been started
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23. Pokhara University
School of Health and Allied Sciences
• Several studies have shown that dexamethasone
causes a significant improvement in CSF
concentrations of proinflammatory cytokines,
glucose, protein, and lactate as well as a significantly
lower incidence of neurologic sequelae commonly
associated with bacterial meningitis
• The commonly used IV dexamethasone dose is 0.15
mg/kg every 6 hours for 4 days. Alternatively,
dexamethasone given 0.15 mg/kg every 6 hours for 2
days or 0.4 mg/kg every 12 hours for 2 days is
equally effective and a potentially less toxic regimen
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29. Pokhara University
School of Health and Allied Sciences
• Preventative antibiotics are of no use following
exposure to meningitis caused by Haemophilus
influenza, Streptococcus pneumoniae, Listeria
monoctogenes, Cryptococcal meningitis, viral
(aseptic) meningitis, or West Nile Fever
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31. Pokhara University
School of Health and Allied Sciences
Preventive Measures
• Vaccinations :
The Centers for Disease Control and Prevention
recommends getting vaccinated against meningitis at age
11 or 12, followed by a booster shot at age 16 to 18.
Getting vaccinated against measles, mumps, rubella, and
chickenpox can help prevent diseases that can lead to viral
meningitis
• Don't Share Personal Items:
– Meningitis can be contracted when we come in contact
with respiratory or throat secretions — saliva, sputum,
nasal mucus — of someone who is infected, either
through kissing or sharing personal items
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32. Pokhara University
School of Health and Allied Sciences
• Keep distance from infected people
– The bacteria found in nose and throat secretions can also
spread through coughing and sneezing. we could get
meningitis if we're close enough to an infected person to
come in direct contact with these secretions. If someone
we know has a respiratory infection, keep at least 3 feet
away.
• Wash hands vigorously
– the viruses and bacteria responsible for meningitis can
get on our hands and into our mouth. We can prevent
meningitis from spreading by washing our hands
vigorously, especially after we use the bathroom, change a
diaper, spend time in a crowded place, and cough or blow
our nose
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33. Pokhara University
School of Health and Allied Sciences
• Boost our Immune System
– A healthy immune system can help prevent an infection
from the viruses and bacteria that cause meningitis. Keep
our immune system at its fighting best by eating healthy
including fresh fruits and vegetables, whole grains, and
lean proteins and by getting regular exercise.
• Get Prompt Treatment
– If we have been in close contact with someone who has
bacterial meningitis, call our doctor right away. Our health
care provider can give us antibiotics to keep us away from
developing meningitis
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34. Pokhara University
School of Health and Allied Sciences
Case
• A 4-week-old premature infant presents on the hospital neonatal unit with poor
feeding, fever and increasing drowsiness. Lumbar puncture reveals 1200 WBC/μL
(80% of which are polymorphs),and low glucose and elevated protein levels. No
organisms are seen on a Gram-stained smear of the CSF. The diagnosis is acute
purulent meningitis.
• Questions:
– What are the likely aetiological agents?
– Which other investigations other than CSF culture might help in
establishing the aetiological diagnosis?
– What empiric antibiotic therapy should be commenced?
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35. Pokhara University
School of Health and Allied Sciences
References
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• Walker R and Whettlesa C (2012),Clinical Pharmacy and Therapeutics (5th
ED), Churchill Livingstone Elsevier, Edinburgh (584-596).
• Wells GB, Dipiro JT, Schwinghammer T, Diporo CV(2008)
Pharmacotherapy Handbook (7th
ED), The MCGraw-Hill, London(387-
399).
• Harrison T (2008) Principles of Internal Medicine ((17th
Ed), Mc Graw Hill
Lange Medical Publication, United State America (885-995) .
• Kumar R. (2005) "Aseptic Meningitis: Diagnosis and Management "
Advances in Pediatrics 72(1).
36. Pokhara University
School of Health and Allied Sciences
• URL 1 :
http://www.everydayhealth.com/hs/understanding-meningitis/prevent-mening
(Assessed on July 29 2017)
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