Neonatal Meningtis

Microbiology
Designed By: Dr. Esraa Alnabilsy

1. Neonatal Meningitis Designed By: Dr. Esraa Alnabilsy

2. Introduction : Neonatal meningitis is a serious medical condition in infants. It’s an inflammation of the meninges and is more common in the neonatal period ( infants less than 44 days old ) than any other time in life.

3. Causes: The most common causes of neonatal meningitis is bacterial infection of the blood, known as bacteremia . 1) Early-onset neonatal meningitis : Bacteria is from the mother before the baby is born or during birth. The most common bacteria found here are: - Group B Streptococcus. - Escherichia coli. - Listeria monocytogenes. - Gram-ve enteric (gut) bacteria .

4. 2) Late-onset neonatal meningitis: Most likely infection from the community. Caused by: - Gram-negative bacteria. - Staphylococcal species. - Streptococcus pneumoniae. 3) Herpes Simplex Virus-derived meningitis: Is a rare cause of meningitis. HSV is transmitted to the neonate mainly during delivery when infected maternal secretions come into contact with the baby ( 85 % of cases ).

5. Signs: Fever Poor appetite Dyspnea Irritability Anorexia Vomiting Diarrhea

6. Symptoms: Anterior fontanelle bulging. Seizure. Jitteriness. Abdomminal distention (increase in abdominal size) . Neck rigidity. Cyanosis. Jaundice. Sunset eyes. Abnormal body temprature (hypo- or hyperthermia ). Change of activity (lethargy or irritability).

7. Signs and symptoms : Symptoms seen with neonatal meningitis are often non specific that may point to several conditions, such as sepsis ( whole body inflamation ). These can include fever, irritability, and dyspnea. The only method to determine if meningitis is the cause of these symptoms is lumbar puncture ( LP ; an examination of crebrospinal fluid ).

8. Pathogenesis : The progression of neonatal meningitis starts with bacteria colonizing the gastrointestinal tract. The bacteria then invades through the intestinal mucosa layer into the blood, causing bacteremia followed by invasion of the cerebrospinal fluid ( CSF ). The neonate’s less efficient immune system lessens their defense against invading bacteria. Colonization of the mother plays an important role in transmission to the neonate, causing early-onset meningitis.

9. Diagnosis : Diagnosis of neonatal meningitis is based on both: clinical manifestation , and CSF examination via lumbar puncture . CSF should be cultured . CSF analysis : - WBCS count. - glucose. - protein. PCR EEG CT US CBC

10. Complications: Hydrocephalus: abnormal accumulation of cerebrospinal fluid ( CSF ) within the brain. Hemorrhage and cerebral infarction . Brain abscess formation . Increased intracranial pressure Subdural effusion or empyema ( collection of pus in the brain ). Ventriculitis: inflammation of the ventricles in the brain ( especially with bacterial infection ). Cerebral edema ( vasogenic and cytotoxic ).

11. Treatment and Management: It is important to start treatment as soon as possible ! Delayed treatment of neonatal meningitis may cause cerebral palsy , blindness, deafness. Fluids . Antimicrobial agents: medications that work against bacteria causing meningitis .

12. A mix of: Ampicillin , with an aminoglycoside Gentamicin , and 3 rd generation Cephalosporin Cefotaxime is used for early-onset meningitis before identification of infection if it’s bacterial or viral. A regimen of antistaphylococcal antibiotic, such as Nafcillin or Vancomycin , plus Cefotaxime , Ceftriaxone or Ceftazidime with or without an aminoglycoside is recommended for late-onset neonatal meningitis . In cases of herpes simplex virus-derived meningitis , antiviral therapy Acyclovir or vidarabine .

13. The aim for these treatments is to sterilize the CSF of any meningitis causing pathogens . A repeated LP 24–48 hours after initial treatment should be used to declare sterilization. Depending on the severity of the illness, the infant may require other therapies, such as : Anticonvulsant medicine, if the baby is having seizures. Monitoring with an intracranial pressure monitoring device placed. Evaluation for cerebral abscess. Evaluation for hydrocephalus. Treatment and Management:

14. How to Prevent Neonatal Meningitis ?!

15. Like with any vaccine, the vaccines that protect against these bacteria are not 100% effective , The vaccines also do not protect against all the types (strains) of each bacteria. For these reasons, there is still a chance you can develop bacterial meningitis even if you were vaccinated . There are vaccines for three types of bacteria that can cause meningitis: - Neisseria meningitides. - Streptococcus pneumoniae. - Hib ( Haemophilus Influenzae type B ).

16. Pregnant women should talk to their doctor or midwife about getting tested for group B Streptococcus. Women receive the test when they are 35 to 37 weeks pregnant. Doctors give antibiotics ( during labor ) to women who test positive in order to prevent passing group B Strep to their newborns .

17. You can also help protect yourself and others from bacterial meningitis by maintaining healthy habits: - Don’t smoke and avoid cigarette smoke. Get plenty of rest. Avoid close contact with people who are sick. This is especially important for people at increased risk for disease, including: - Young babies. - Older adults. - People with weak immune systems.

18. THANK YOU Designed By: Dr. Esraa Alnabilsy