Etio-parthenogenesis, Clinical presentation, Treatment

1. Meningitis
Mr. Dhaval B. Joshi

3. Types
Microbial Involvement
• Infectious
• Non-Infectious
Location
• Lepto Meningitis
• Pachy meningitis

4. Bacterial meningitis

5. Epidemiology
• Approximately 1.2 million cases of acute
bacterial meningitis occur every year around
the world, resulting in 1,35,000 deaths
• Overall mortality rates for patients with
meningitis range from 2% to 30% depending
on the causative microorganism, approaching
20% in most cases of bacterial meningitis

6. Epidemiology
• Neurologic sequelae frequently associated with
meningitis include seizures, sensorineural hearing
loss and hydrocephalus
• Risk for development of neurologic sequelae
depends on the infecting organism, with
pneumococcal meningitis associated with the
highest risk
• Generally, 30% to 50% of patients who survive
meningitis may develop neurologic disabilities

7. Risk Factors
• Both passive and active exposure to cigarette
smoke were shown to be risk factors for
bacterial meningitis, especially meningococcal
disease
• Children with cochlear implants that include a
positioner are at increased risk for bacterial
meningitis, specifically pneumococcal
meningitis.

8. Etiology
• Haemophilus influenzae was the most
commonly identified cause of bacterial
meningitis (45%)
• Followed by S. pneumoniae (18%) and
Neisseria meningitidis (14%)

9. Etiology
• S. pneumoniae became the most commonly
identified cause of bacterial meningitis (47%)
• followed by N. meningitidis (25%), Listeria
monocytogenes (8%), and H. influenzae (7%)

10. Routes of invasion of microbes/
exposure of stimuli
• Direct implantation of microbes
• Congenital Malformation
• Neighbouring Infection
• Haematogenous spread
• Virus
• Iatrogenic

11. Pathophysioloy

13. Signs and Symptoms
• Classic signs and symptoms include fever, nuchal
rigidity, and altered mental status (the classic
triad), chills, vomiting, photophobia, and severe
headache
• Kernig and Brudzinski signs may be present but
are poorly sensitive and frequently are absent in
children
• Other signs and symptoms include irritability,
delirium, drowsiness, lethargy, and coma

15. Signs and Symptoms
• Clinical signs and symptoms in young children
also may include bulging fontanelle, apneas,
purpuric rash, and convulsions
• Seizures occur more commonly in children
(20%–30%) than in adults (0%–12%)

16. Differential Signs and Symptoms
• Purpuric skin lesions typically indicate
meningococcal involvement
• H. influenza meningitis and meningococcal
meningitis both can cause involvement of the
joints during the illness
• A history of head trauma with or without skull
fracture or presence of a chronically draining ear
is associated with pneumococcal involvement

17. Investigation
• History & physical Examination
• CBC
• Blood culture & Gram staining
• CSF Examination

18. Management

19. Management
• Increased ICP: Steroids
• Dexamethasone: 0.15 mg/kg IV 6 hrly for 4
days
• Decrease hearing loss & neurologic sequel

21. Neisseria meningitidis
(Meningococcus)
• The patient develops a characteristic
immunologic reaction of fever, arthritis and
pericarditis approximately 10 to 14 days after the
onset of disease and despite successful treatment
• Patients may develop deafness and transiently
impaired ocular movements
• Purpuric rashes

22. Neisseria meningitidis
(Meningococcus)
• IV Cryst. Penicillin G (50,000 units/kg every 4
hours)
• Alt: Chloramphenicol
• 3rd G. Cephalosporins
• Duration of therapy: 7 days

23. Streptococcus Pneumoniae
• Neurologic complications, such as coma and
seizures, are common with pneumococcal
meningitis
• Treatment with intravenous crystalline
penicillin G (50,000 units/kg every 4 hours) in
adult patients with a penicillin-susceptible
isolate and normal renal function usually
results in a favourable outcome

24. Streptococcus Pneumonia
• Ceftriaxone and cefotaxime have served as
alternatives to penicillin
• Cephalosporin resistant pneumococcus
include the addition of vancomycin and
rifampin
• Duration of therapy: 10-14 days

25. Streptococcus pneumoniae
• Meropenam
• Newer FQs
• Linezolid and daptomycin have emerged as
therapeutic options for treatment of
multidrug-resistant gram-positive infections

26. Streptococcus pneumoniae
• In 2000, a heptavalent pneumococcal
conjugate vaccine (Prevnar) was approved for
use in children aged 2 months and older
• According to current recommendations, all
healthy infants younger than 2 years should
be immunized with the heptavalent vaccine at
2, 4, 6, and 12 to 15 months

27. H.Influenza
• Cephalosporins (until sensitivity is available)
• FQs
• Duration of therapy: 7 days

28. Listeria monocytogenes
• Penicillin-G/ Ampicillin + Vancomycin
• Combination therapy usually is given for at least
10 days, with the remaining course of therapy
completed with penicillin G or ampicillin alone
• Trimethoprim-sulfamethoxazole may be an
effective alternative because adequate CSF
penetration is achieved

29. Listeria monocytogenes
• Chloramphenicol and vancomycin both
possess in vitro activity against Listeria, but
they are not recommended for use in
meningitis caused by L. monocytogenes
because of unacceptably high failure rates
• Duration of therapy: > 21 days

30. Gram-Negative Meningitis
• Elderly debilitated patients are at increased
risk
• Neonates also are at risk for gram-negative
meningitis with E. coli and Klebsiella
pneumoniae

31. Gram-Negative Meningitis
• P. aeruginosa meningitis should be treated
with an extended-spectrum β-lactam such as
ceftazidime or cefepime
• or alternatively piperacillin ± tazobactam, or
• Meropenem plus an aminoglycoside, usually
tobramycin

32. Gram-Negative Meningitis
• Intraventricular aminoglycoside dosages should
be adjusted to the estimated CSF volume (0.03
mg tobramycin or gentamicin per milliliter of CSF
and 0.1 mg amikacin per milliliter of CSF every 24
hours)
• Ventricular levels of aminoglycoside should be
monitored every 2 or 3 days, just prior to the next
intraventricular dose, and should approximate 2
to 10 mg/L

33. Gram-Negative Meningitis
• Multidrug-resistant Pseudomonas and
Acinetobacter infections: colistin and ceftazidime
• Other gram-negative organisms causing
meningitis, excluding P. aeruginosa and
Acinetobacter species, most likely can be treated
with a third or fourth-generation cephalosporin,
such as cefotaxime, ceftriaxone, ceftazidime, or
cefepime

35. Prophylaxis
• Chemo-prophylaxis
• Immuno-prophylaxis:
Hib vaccine
PCV13, 23
PMV

36. Viral meningitis - Etiology
• HSV
• VZV
• EBV

37. Management of Acute viral meningitis
• Seriously ill patients should probably receive
intravenous acyclovir (15–30 mg/kg per day in
three divided doses), which can be followed by an
oral drug such as acyclovir (800 mg, five times
daily), famciclovir (500 mg tid), or valacyclovir
(1000 mg tid) for a total course of 7–14 days
• Patients who are less ill can be treated with oral
drugs alone.

38. Management of Acute viral meningitis
• IG therapy
• investigational drug: pleconaril

39. assignment
• Read dosing regimen of antibiotics from dipiro
• Make a brief note on cryptococcal meningitis

40. THANK U !!