pengetahuan umum mengenai menginitis.pptx

all about meningitis

1. HEADACHE

2. “ Red Flags” in the history Abrupt onset of a new type of severe HA 2. Worst headache the patient ever had 3. Progressive worsening of HA over a period of days or weeks Precipitated by exertion Accompanied by generalized illness or fever, nausea, or stiff neck

3. “Red Flags” on examination Abnormal vital signs (increased BP, HR or temperature) Change in higher intellectual functions or cognition Alteration in level of consciousness Signs of meningeal iritation Papil edema Focal neurological signs

4. CLINICAL FEATURES SUGGESTIVE OF SECONDARY HEADACHE HEADACHE FEATURES First headache Worst headache Persistent headache Different headache Onset with valsava manuever Onset with head trauma Onset after age 50 Exacerbation by head position

5. ASSOCIATED FEATURES Focal neurologic signs or symptoms Change in consciousness Fever Seizure Nuchal rigidity Papiledema or (pre)retinal hemorrhage History of bleeding diathesis History of hypercoagulable state History of cancer History of AIDS or AIDS risk factors

6. MENINGITIS

7. Blood Brain Barrier

8. Mechanisms for microorganism entering the brain

9. Viral Meningitis Pathogenesis

10. CLINICAL PRESENTATION Headache Fever Meningeal signs ( jolt, nuchal rigidity, brudzinski,kernig ) Photophobia Vomiting Lethargy / altered level of consciousness

11. Neonates & Infants Fever (50%) Lethargy Poor feeding Irritability Vomiting and diarrhea Apnea Seizure Bulging anterior fontanel

12. Children & Adults Fever Headache Photophobia Nuchal rigidity Lethargy, confusion, stupor, coma Seizure Focal neurological deficits Nausea & vomiting

13. Older adults Fever Headache Nuchal rigidity Confusion, coma Seizure

14. Meningeal signs Nuchal Rigidity

15. Jolt accentuation

16. DD Neck Stiffness Meningitis SAH Raised ICP SOL infratentorial Carcinomatous or leukemic meningal infiltratiom Neuroleptic Malignant Syndrome

17. Diagnosis Examination of CSF 1. confirm the dx 2. identify the organism 3. test for antibiotic sensitivity 4. rationalize the treatment of contacts in the case of meningococcal or haemophilus influenza meningitis

18. Head CT 1. coma 2. focal neurological deficit 3. papiledema 4. dilated pupils 5. signs of posterior fossa lesion

19. Normal LCS 1. Opening pressure 8-20 cmH2O 2. WBC count 0-5 mononuclear cells ( monocytes & lymphocytes ) 3. Glucose 45-80 mg/ dL (or 65% serum glucose) 4. Protein< 50 mg/ dL

20. Bacterial Meningitis Increased opening pressure Polymorphonuclear pleocytosis Decreased glucose concentration Elevated protein concentration

21. Etiologic organism Neonatal (Group B streptococi , E.coli ) Childhood ( H.influenza , N.meningitidis ) Adults ( S.pneumoniae ) Older adults ( S.pneumoniae , enteric gram- negative bacilli)

22. Treatment Neonate : combination of Ampicillin & Aminoglycoside or Cefotaxime , Vancomycin Infants & children : Cefotaxime or Ceftriaxone Adults : Ampicillin 6x2 gr iv Ceftriaxon 2x2 gr iv Cefotaxime 4x2 gr iv Ceftazidime 3x2 gr iv Vancomycin 4x500 mg iv

23. Prophylaxis of meningococcal & Hib meningitis Rifampin 2x600 mg (2 d;4d) Ceftriaxon 125 ; 250 Ciprofloxacin 1x750 mg

24. Aseptic meningitis Acute onset Meningeal signs CSF : mononuclear predominance Absence of bacteria on smear & by culture No parameningeal focus of infection Self limited benign course

25. DD infectious etiologies Viral Enteroviruses,mumps,HSV-2 ,HIV, arthropod borne viruses Non viral Listeria, M.tbc , mycoplasma, rickettsia, treponema , cryptococcus Other partially treated bacterial meningitis acute disseminated encephalomyelitis

26. DD Non-infectious etiologies SLE Sarcoidosis Migraine Traumatic LP Vasculitis Meningeal carcinomatosis

27. Routine studies on CSF Opening pressure Cell count, diff count Chemistries VDRL Bacterial smear and culture Viral culture India ink, fungal culture Cryptococcal antigen AFB smear and culture

28. Terima kasih