meningitis

2. MeningitisMeningitis

3. Meningitis is the inflammation of the
membranes surrounding the brain &
spinal cord, including the dura,
arachinoid & pia matter.

4. • Meningitis can occur at all ages but it
is commonest in infancy. While 95%
of the cases take place between 1
month- 5 years of age.
• It is more common in males than
females.

5. • The bacteria are transmitted from person to person
through droplets of respiratory or throat secretions.
• Close and prolonged contact (e.g. sneezing and
coughing on someone, living in close quarters or
dormitories (military recruits, students), sharing
eating or drinking utensils, etc.)
• The incubation period ranges between 2 -10 days.

6. • Bacterial
• Viral (aseptic)
• Fungal
• Parasitic
• Non-infectious

8. N. meningitides
G-ve diplococci
N. meningitides
G-ve diplococci
Streptococci-GBS
G+ve cocci
Streptococci-GBS
G+ve cocci
Strep. pneumoniae
G+ve diplococci
Strep. pneumoniae
G+ve diplococci
E.Coli
G-ve bacilli
E.Coli
G-ve bacilli

10. • Acute inflammation of the
membranes covering the brain and
spinal cord with evidence of bacteria
and polymorph nuclear leukocytes in
CSF
•

11. Pyogenic Meningitis
ETIOLOGY
• ‘Meningococcal’ meningitis- N. meningitidis. A, B, C and W135)
are recognized to cause epidemics
• The commonest organisms according to age groups are:
0-2 months0-2 months E.ColiE.Coli, Group B streptococci, S.Aureus, Listeria, Group B streptococci, S.Aureus, Listeria
MonotocytogenesMonotocytogenes
2 months- 2yrs2 months- 2yrs H.Influenzae type bH.Influenzae type b, S.Pneumoniae,, S.Pneumoniae,
N.Meningitides.N.Meningitides.
2 yrs – 15+yrs2 yrs – 15+yrs N.MeningitidesN.Meningitides (serotypes A,B,C, Y & W135)(serotypes A,B,C, Y & W135)
S.PneumoniaeS.Pneumoniae (serotypes 1,3, 6,7)(serotypes 1,3, 6,7)
H.InfluenzaeH.Influenzae

12. •
• Most commonly result from
haematogenous spraed of the
microorganism from distance infection
eg: pneumonia
• Also from direct spread :
sinusitis-mastioditis -otitis media .

13. • Vary thickness around the brain and
spinalcord
• Vascular changes:
arteritis-thromposis
• Damage of the cerebral cortex 2ry
to thromposis-hypoxia-bacterial
invasion- toxic encephalopathy

16. 1)Acute onset of fever-anaroxia-N&V and
poor feeding.
2)Manifestations of (+++) ICP:
headache-projectile vomitting-blurred of
vission and papilledema

17. • Bulging Anterior
fontanelle
&irritability of the
fetus-irregular
respiration
bradycardia-cranial
nerves pulsy

18. 3)Disturbed level of consciousness
from drowsness up to coma
4)Covulsions
5)Sings of meningeal irritation

19. Meningitis: older children

20. Septicaemia

21. • Neck stiffness
• Kerning’s sign
• Brudzinisky sign
• Purpura and shock
• Paralytic
manifestations
(facial nerve pulsy)

25. Diagnosis
1)Clinical picture
2)LP: CSF collected in 2 sterile tubes
one for chemical examination and
microscopic study
3)Blood culture and scraping skin
lesions culture
4)CT brain

26. Diagnosis

29. • .Increase intracranial pressure.
• .Unstable patient.
• .Skin infection at site of LP.
• .Thrombocytopenia.
• .Papilloedema.

31. 1)Hydrocephalus
2)Subdural effusion
3)Vascular collapse (shock)
4)Metstatic infections
5)Different forms of paralysis
6)Brain damage

33. Prevention:
• Isolate the pts.
• Contacts of H.Influenza are given
Rifampicine (20 mg/kg/dayfor4 days)
• Contacts of meningococcal meningitis are given
( Rifampicine (10 mg/kg/12hrs for2days)
• No chemoprophlaxsis given for pneumococcal
meningitis

34. TTT
• Antipyretic
• Care of feeding
• Anti covulsants:
iv Diazepam slowly 0,1-0.2 mg/kg/dose
• Management of increase ICP by:
Fursamide 1mg/kg & mannitoleo.5-1 g/kg

35. TTT
• Care of defecation and micturtion
and prevent bed sores
• Recetly iv:dexamethasone
(0.15 mg/kg/dose) given every 6 hrs
for 4 day is recommended.

36. Specific:
• Till results of culture present start
immediately:
1)ceftriaxone (100mg/kg/day )in 2 divided doses
2) cefotaime (200 mg/kg/day )in 4 divided doses
3) combination bt Ampicillin (300mg/kg/d) and
iv chloramphenicol (100mg/kg/d) divided every 6hrs.
In infant give ampicillin and cefotaxime

38. • Subdural ifusion:dialy tapping of subdural space
throw lateral angle of anteroir fonanelle
• Hydrocephalus shunt operation
• Vascular collapse :anti shock management
1) i.v fluid
2)blood &plasma transfision
3)Hydrocortisole i.v.
4)pressor subs to BP as :Dopamine.

41. • Definition :
Acute meningitis where organism could
be detected,on direct smear,culture and
CSF shows prodominantly lymphocytes.

42. 1)Infections :
* viruses as coxackia,ECHO,mumps, measeles,
varicella,herpes simplex and influenza.
* Bacteria: mycobacteruim TB.
* Recketssia, spirochetes,fungi , protozoa &
helminthes

43. 2)Post infectious (allergic)
3)others:
* irritationsof meninges from adjacent lesion
as hematomas , tumors and granulomas.
* Intrathecal injections as Methotrexate in
treatment of leukemia.
* Leukemic infiltration.

46. • Acute or gradual onset
• Clinical features of causative infection:
(( enlargement of parotid gland in mumps
or skin rash in measles))
• CSF exam:
* increase cell (( lymphocytes))
* normal or + proteins.
* slightly (-) glucose.
* organisms can be isolated by
special media .

48. • General :
as acute septic meningitis.
• Specific :
If TB meningitis :Anti T.B drugs.
• In viral cause :no specific therapy.