- 1. NERVOUS SYSTEMINFECTIONS MENINGITISAcute infection of the
meninges presentswith the characteristic combination: pyrexia
Headache Meningism
2. CAUSES OF MENINGITIS InfectiveBacteriaViruses:
Enteroviruse,Mumps,Influenza Herpes simplex Protozoa &
parasites:ToxoplasmaAmoebaFungi:Cryptococcus neoformans, 3.
Fever,Headache,Nuchal rigidity Altered mental
statusYesNoEncephalitis,ADEM,AbscessMeningitis Brain imaging CSF
Imaging,CT or MRI.CSF 4. Bacterial causes of meningitisAge of onset
CommonLess common Neonate G-negativeListeriabacillia,Group B
monocytogenesstreptococciPre-school child
H-influenzaeMycobacteriumN-meningitidistuberculosisSt-pneumoniaOlder
childN-MeningitidisL m,T.B,Crypto 5. NeonateG-negative bacilli
Group B streptococci 6. Pre-school childHaemophillus ifluenza
Neisseria meningitidisStreptococcus pneumonia 7. Older childadult
& Neisseria StreptococcusListeriameningitidis pneumoniae
monocytogenes 8. CSF INDICES IN MENINGITISConditi CELlCELL Glucose
protein -GonType CountstainNormal Lymp 0-4Normal - >60%B-GViral
Lymp 10-2000 normal - normalBacteri Poly 1000Low /N +al
5000IncreaseTBL/P,M 50-5000Low Increase often 9. CHEMOTHERAPY OF
BACTERIALMENINGGITISN-meningitidisBenzylpenicillinStrep.pneumoniae
CefotaximeSensitive to B-lactams CeftriaxoneResistant
+VancomycinH.InfluenzaeCefotaximeCeftriaxone 10. Treatment of
pyogenicmeningitisunknown cause of1-patients with a typical
meningococcal rashBenzylpenicillin 2.4 gIV.6-hourly2-Adult aged
18-50 years without meningococcal rash Cefotaxime 2 g IV.6-hourly
Ceftriaxone 2g IV.12-hourly3-Patient in whome pencillin-resistant
pneumococcal infection issuspectedAs 2 but add-Vancomycin 1g
Iv,12-hourly or Rifampicin 600 mgIV.12-hourly4-Adult aged over 50
years and those in whome Listeriamonocytogees infection is
suspected As for 2 but add Ampicillin 2g IV.4-jourly or
Co-trimoxazole5-Patients with a clear history of anaphylaxis to
B-lactams Chloramphenicol 25 mg/kg IV.6-hourly plus Vancomycin
1gIV.12-hourly 11. Recommendations for Empiricalantimicrobial
therapy in adult withcommunity-acquired meningitisPredisposing
factor pathogen Drugs16-50 yrN-St-pnVancomycin +3rd
cephalosporin>50 yr St-pn, N, ListVan+3rd Ceph+
AmpicillinPresence of a risk St-pn, list, Van+3rd ceph+
H-infuenzaeAmpicillinwww.NEJM.ORG ,N ENGL ,Jan-2006 12.
Chemoprophylaxis for meningococcal infectionDose it reduce the
incidence of clinical diseaseamong contact?Observational data
suggest that antibioticreduce the risk of diseaseIn adults a single
dose of 500 mg ciprofloxacinor oral rifampicin 600mg(12-hourly) for
2days.Vaccines for groups A&C but not B menigococci. 13.
COMPLICATIONSOF MININGOCOCCAL SEPTICEMIA Menigitis Rash Shock
Intravascular coagulation Renal failure Gangrene Arthritis
Pericarditis 14. Major intracranial complications in Bacterial
meningitis in
adult-----------------------------------------1-Transtentorial
herniation2-Hydrocephalus3-Infarction4-Seizures 15. CLINICAL
FEATURES OF TB MENINGITIS Vomiting Depression Low-grade
Confusionfever Behavior lassitudechanges 16. SignsMeningism (may be
absent)Ocular palsiesPapilloedemaDepression of conscious levelFocal
hemispher signs 17. Viruses causing acute
encephalitisCommonArbovirusesEnterovirsusesHSVLess
commonCMVEBVHIVMumps 18. Viruses causing acute meningitis
Enterviruses =75-90Echo 30% Coxsa-A 10%Coxsac-B 40%Mumpsvirus 15%
19. Practical points The typical profile is
lymphocyticpleocytosis(25-500 cells/uL.) A normal or slightly
elevated protein A normal glucose concentration. PMN pleocytosis
should always promt analternative diagnosis In both enterovirus
&HSV,PCR is thediagnostic procedure of choice 20. Differential
diagnosisBacterial menigitis:
Mycoplasma,lasteria,brucellaParameningeal infectionPartially
treated bacterial meningitisTb,fungal, parasitic, Syphilitic
diseaseNeoplastic meningitisSarcoid, Behcets disease 21. Chronic
& recurrent meningitisCharacteristic neurological syndrome
for>4weeks &Persistent inflammation in CSF
(WBC>5/Ul)Causes:1-Meningeal infection 2-Malignancy
3-Noninfectious inflammatory disorder 4-Chemical meningitis
5-Parameningeal infections 22. Symptoms & signs of chronic
meningitis SymptomSignChronic headacheSign of Meningeal
irritationChange in personality Altered mental statusFacial
weakness Crainal nerve palsyDouble visionsPapilledema,optic
atrophyWeaknessMyelopathy,radiculopathySensory symptoms Frontal
lobe dysfunctionSphincter dysfunction Ataxia
