8. meningitis- PDF.pdf pharmacy students

Meningitis

1. Meningitis
General Overview
DR KACHINDA W.
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2. Clinical description
Meningitis is a disease caused by the inflammation of the
protective membranes covering the brain and spinal cord
known as the meninges.
The inflammation is usually caused by an infection of the fluid
surrounding the brain and spinal cord.
Meningitis can be life-threatening because of the
inflammation's proximity to the brain and spinal cord;
therefore the condition is classified as amedical emergency.
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3. Meninges
The meningesis the system of membranes which envelops the
central nervous system.
It has 3layers:
1.Dura mater
2.Arachnoidmater
3.Piamater
Subarachnoid space -
is the space which
exists between the
arachnoidand the pia
mater, which is filled
with cerebrospinal
fluid.
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4. Causes of Meningitis
-Bacterial
-Viral
-Fungal
-Ricketsial(Rocky mountain spotted fever)
-Parasitic/ protozoal
-Physical injury
-Cancer
-Certain drugs ( mainly, NSAID’S)
Severity/treatment of illnesses differ
depending on the cause. Thus, it is
important to know the specific cause of
meningitis.
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5. Bacterial
-Haemophilusinfluenzae
-Listeria
-Meningococcus
-Mumps
-Pneumococcus
-Group A Streptococcus
-Group B Streptococcus
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6. Premature babiesandnewborns(< 3 months):group B
streptococci, Listeriamonocytogenes(serotype IVb).
Older children:Neisseriameningitidisand Streptococcu
pneumoniae(serotypes 6, 9, 14, 18 and 23) and those
under five byHaemophilusinfluenzaetype B
Adults:N. meningitidisandS. pneumoniae(80% of all
cases) of bacterial meningitis, with increased risk ofL.
monocytogenes(>50yrs)
Bacterial
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7. HaemophilusinfluenzaeMeningitis
•Occurs mostly in children (6 months to 4 years).
•Gram-negative aerobic bacteria, normal throat microbiota
•Capsule antigen type b
•Prevented by Hibvaccine
Reduction in H.influenzaemeningitis due to development of Hibvaccine
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8. NeisseriaMeningitis,
(Meningococcal Meningitis)
•Gram-negative aerobic cocci,
capsule
•10% of people are healthy
nasopharyngeal carriers
•Begins as throat infection, rash
•Serotype B is most common in
the United States
•Vaccination recommended for
college students.
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9. Streptococcus pneumoniaeMeningitis,
Pneumococcal Meningitis
•Gram-positive diplococci
•70% of people are healthy
nasopharyngeal carriers
•Most common in children (1
month to 4 years)
•Mortality: 30% in children,
80% in elderly
•Prevented by vaccination
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10. Viral
-Enterovirus(coxsackie, echovirus)
-Arboviral(mosquito-borne diseases)
-Influenza
-Herpes simplex virus type2 ( especially in infants)
-Varicellazoster
-HIV
-Mumps
-measles
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11. Viral Meningitis
Incubation period : 3 to 6 days.
Duration of the illness : approx 7 to 10 days.
Milder and occurs more often than bacterial
meningitis.
Affects children and adults under age 30. Most
infections occur in children under age 5.
Most viral meningitis is due to enteroviruses, that
also can cause intestinal illness.
Diagnosed by laboratory tests of a patient’s spinal
fluid
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12. Fungal
Cryptococcus
Coccidiodes
Histoplasma
Mucormycosis
Aspergillus
Candida (yeasts)
Parasitic/protozoal
Angiostrongylus
Toxoplama
Hydatid
Amoeba
Plasmodium
Cysticercosis
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13. Symptoms can be the same for Viral and
Bacterial
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14. COMPLICATIONS
•Brain damage
•Buildup of fluid between the skull
and brain (subdural effusion)
•Hearing loss
•Hydrocephalus
•Seizures
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15. DIAGNOSIS
Tests that may be done include:
•For any patient who is suspected of having
meningitis, lumbar puncture ("spinal tap") is done
for CSF examination .
•Blood culture
•Chest x-ray
•CSF examination for cell count, glucose, and
protein
•CT scan of the head
•Gram stain, other special stains, andculture of CSF
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16. DIAGNOSIS (contd..)
•Specimen: CSF, blood, urine culture
•Blood tests and imaging
•Blood testsare performed for markers of inflammation (e.g.C-
reactive protein,complete blood count), as well asblood
cultures.
•Most important is CSF examination by LP. Blood tests are done
when it is C/I
•In severe forms of meningitis, monitoring of blood electrolytes
may be important; for example,hyponatremiais common in
bacterial meningitis.
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17. DIAGNOSIS (contd..)
Lumbar puncture
A lumbar puncture is done by positioningthe patient, usually lying on
the side, applyinglocal anesthetic, and inserting a needle into thedural
sac. CTorMRIscan is recommended prior to the lumbar puncture.
The CSF sample is examined for presence and types ofwhite blood cells,red
blood cells,protein content andglucoselevel.Gram stainingof the sample may
demonstrate bacteria in bacterial meningitis (60% cases).
C/I: Mass in the brain (tumor or abscess) or theintracranial pressure(ICP) is
elevated.
Gram stainof meningococcifrom a
culture showing Gram negative (pink)
bacteria, often in pairs
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18. CSF findings in different forms of meningitis
Type of meningitisGlucose Protein Cells
Acute bacteriallow high
PMNs
often > 300/mm³
Acute viral normal normal or high
mononuclear
< 300/mm³
Tuberculous low high
mononuclear and
PMNs, < 300/mm³
Fungal low high < 300/mm³
Malignant low high
usually
mononuclear
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19. •Latex agglutination -The clumping of cells such as
bacteria or RBCs in the presence of an antibody. The
antibody or other molecule binds multiple particles and
joins them, creating a large complex. Positive in meningitis
caused byStreptococcus pneumoniae,Neisseria
meningitidis,Haemophilusinfluenzae,Escherichia
coliandgroup B streptococci.
•Serotyping-Group of microorganisms classified together
based on their cell surface antigens (virulence,
lipopolysaccharidesin Gram-negative bacteria), presence
of an exotoxinor other characteristics which differentiate
two members of the same species.
DIAGNOSIS (contd..)
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20. •Limulus amebocytelysate(LAL): An aqueous
extract of blood cells (amoebocytes) from the
horseshoe crab, (Limulus polyphemus).
LAL reacts with bacterial endotoxinor
lipopolysaccharide(LPS), which is a membrane
component of “Gram negative bacteria”.
•Polymerase chain reaction(PCR)is a technique
used to amplify small traces of bacterial DNA
DIAGNOSIS (contd..)
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21. Kernig’ssign -is assessed with the patient lyingsupine, with the hip and knee
flexed to 90degrees. In a patient with a positive Kernig'ssign, pain limits passive
extension of the knee.
Brudzinskisigns-A positive Brudzinski'ssign occurs when flexion of the neck
causes involuntary flexion of the knee and hip.
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22. Skin findings: Nonspecific blanching, erythematous, maculopapularrash to a
petechialor purpuricrash.
**Approximately 6% of affected infants and children show signs
of disseminated intravascular coagulopathyand endotoxicshock.
These signs are indicative of a poor prognosis.
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23. Treatment
•Antibiotics for bacterial meningitis :Type vary depending on the
bacteria causing the infection.
•Antibiotics are not effective in viral meningitis.
•Other medications andintravenousfluids will be used to treat
symptoms such as brain swelling,shock, andseizures.
Prevention
•Haemophilusvaccine (HiBvaccine) in children.
•Thepneumococcal conjugate vaccineis now a routine childhood
immunization and is very effective at preventing pneumococcal
meningitis.
•Household members and others in close contact with people who
have meningococcal meningitis should receive preventive antibiotics.
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