INTERNAL MEDICINE

Meningitis

Def: Meningitis is swelling and irritation

(inflammation) of the membranes covering the brain and spinal cord. This inflammation causes changes in the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord.

Meningitis

Types of meningitis: Pyogenic meningitis Tuberculous meningitis Viral meningitis

Meningitis

Aetiology: A)bacterial meningitis- E.colli Group B streaptococci Neisseria meningitidis Streaptococcus pneumoniae Haemophilus influenzae

Meningitis

Aetiology: B)Tuberculous meningitis- Micobacterium tuberculosis C)Viral meningitis- Enterovirus Arbovirus Herpes simplex virus Mumps virus Inflenza virus

Meningitis

Aetiology: D)Protozoa and parasites- Toxoplasma Amoeba E)Fungi- Candida Histoplasma Cryptococcus neoformans

Meningitis

Aetiology: F)Others- Breast cancer Leukaemia Bronchial cancer Lymphoma SLE Sarcodosis (is a multisystem granulomatous

inflammatory dis.)

Meningitis

Clinical feature in bacterial meningitis:

Headache Fever Vomiting Drowsiness Restlessness Irritability Neck rigidity, kernig’s sign and brudzinski’s sign

may positive Convulsion Coma

Meningitis

Clinical feature in tuberculous meningitis:

Headache Vomiting Low grade fever Depression confusion Oculomotor palsies Palilloedema

Meningitis

Clinical features of viral meningitis: Occurs mainly in children or young adults Headache Irritability Rapid development of mental irritation There may be high pyrexia

Meningitis

Investigation- A)Bacterial meningitis CSF study Blood for C/S B)Tuberculous meningitis CSF study Culture of CSF CT scan C)Viral meningitis CSF study

CSF study

Normal Pyogenic tuberculous Viral

Colour Crystal clear Cloudy/purulent

Clear/cloudy Clear

Pressure 50-180 mm of CSF

Normal/ increased

Normal / increased

Normal

Cell count 0-4/cu mm lymphocytes

Polymorphs 1000-50000

Lymphocytes 50- 5000

Lymphocytes 10- 2000

Glucose 40-80 mg/dl Decreased Decreased Normal

Protein 20-40 mg/dl Increased Increased Normal / increased

Chloride 720-750 mg/dl

Decreased Decreased Normal

Meningitis

Management of bacterial meningitis: 1.Appropriate antibiotics- Benzylpenicillin 2.4 g i/v 6 hrly Cefotaxime 2 g i/v 6 hrly Ceftriaxone 2 g i/v 12 hrly with Vancomycin 1 g i/v 12 hrly 2.Fluid and electrolytes balance 3.Diazepam for convulsion 4.Good nursing care 5.Prevention and treatment of complication

Meningitis

Management of tuberculous meningitis:

1.Antituberculous chemotherapy 2.Pprednisolone 10 mg 6 hrly 3.Maintin adequate hydration and nutrition Skilled nursing care

Meningitis

Management of viral meningitis: 1.There is no specific treatment and usually

benign and self-limiting 2.Symptomatic treatment in a quiet enviroment 3.Recovery usually occurs with in days