Upload
bhupendra-shah
View
176
Download
1
Embed Size (px)
Citation preview
Meningitis
Dr Bhupendra Shah
Why we need to know it?
• Medical emergency
• High prevalence
• Early recognition is must
Objectives • Definition
• Causative agent
• Pathogenesis
• Clinical features
• Investigations
• Management
Definition
• Meningitis:
• Meningo-encephalitis:
• Brain abscess:
Common bacterial organismsOrgansism Age range Predisposing condition
N.Meningitidis All ages Usually none
S.Pneumonia All ages Cribiform plate fracture
Listerial monocytogenes Elderly adults and neonates Defects in cell mediated immunity ,pregnancy
Coagulase negative stap.aureus
All ages Surgery
Gram negative bacilli Elderly ,neonate Advanced medical illnness
H .influenza Adult Diminished humural immunity.
Pathogenesis:
Dvasogenic edema Obstructive edema
FfAltered blood brain barrier permeability
Raised intracranial pressure and coma
Cytotoxic edema
Dproduction of excitatory amino acid
Dfleukocytes adherence to cerebral capillary endothelial cell
Subarachnoid space invasion by meningeal pathogens
Release of bacterial cell wall components
Clinical features
• Fever
• Altered mental status
• abnormal jerky movements
• Neck stiffness
• Headache
History of…..
• Immuno-compromised status
• Ear discharge
• Body rashes
• Head trauma/surgery
Physical examination
• Neck rigidity
• Kernig’s sign
• Brudzinski’s sign
• Head jolt test
Kernig’s sign
BRUDZINSI’S SIGN
Rash of menigococcemia
Normal CSF finding
• Apperance :clear• Opening pressure:10-12 cm H2O• WBC count:0-5 /mm3 • Glucose :>60% of serum glucose• Protein:< 45 mg/dl
Lumbar puncture
Ct scan of head
Empiric antimicrobial therapy
<1 months Ampicillin +cefotaxime
1-23 months Vancomycin +3rd generation cephalosporin
2-50 yrs Vancomycin +3rd generation cephalosporin
>50 yrs Vancomycin +ampicillin+3rd generation cephalosporin
Basillar skull fracture Vancomycin +3rd generation cephalosporin
Post neurosurgery Vancomycin +cefepime
Immunocompromised Vancomycin +ampicillin+cefepime
Prophylaxis for meningococcal meningitis
• Rifampin 600 mg bd for 2 days• Azithromycin 500 mg single dose• Ceftriaxone 250 mg IM single dose
Steroids in meningitis
merits• Inhibit synthesis of TNF
• Decrease CSF flow resistance
• Stabilise the blood brain barrier
demerits• Delays sterilisation of CSF
fluid
• Hippocampal injury thus reducing learning capacity
20 minute prior antibiotics.Dexamethasone 0.15mg/kg qid 3-4 days
Other causative agent
• M.tuberculois • Herpes simplex virus
Summary
• Meningitis is medical emergency• Mortality approach to 100% if untreated.• CBC,2 set blood cultures,CSF analysis,CT scan.• Antibiotics:proper timing :proper antibiotics :proper duration