Bacterial Meningitis http:www'slideworld'comslideshow'aspxBacterialMeningitisppt2765681

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Bacterial Meningitishttp//www.slideworld.com/sli
deshow.aspx/Bacterial-Meningitis-ppt-2765681

• By Lok
• Modified by K S Chung

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Meningitis

• The word meningitis usually describes
  inflamation of the meninges owing to the
  infective agents.

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Types of meningitis

• Acute pyogenic
• usually bacterial meningitis
• Aseptic
• usually acute viral meningitis
• Chronic
• usually tuberculous, spirochetal, or cryptococcal

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Signs and symptoms

• Over the age of 2 years
• common symptoms of High fever, headache, and
  stiff neck
• nausea, vomiting, confusion, and sleepiness.
• Newborns and small infants
• classic symptoms of fever, headache
• inactive, or be irritable, have vomiting, or be
  feeding poorly.
• As the disease progresses, patients may have
  seizures.

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Symptoms of viral meningitis

• fever, severe headache, stiff neck
• bright lights hurt the eyes, drowsiness or
  confusion, nausea, vomiting
• In babies, the symptoms are more difficult to
  identify
• fever, fretfulness or irritability,
• difficulty in awakening

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Is viral meningitis a serious disease?

• Rarely fatal in persons with normal immune
  systems
• Symptoms last from 7 to 10 days and the person
  recovers completely

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How is viral meningitis treated ?

• No specific treatment for viral meningitis exists
  at this time. 
• Most patients recover completely on their own.
• Doctors often will recommend bed rest, plenty of
  fluids, and medicine to relieve fever and
  headache.

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Is viral meningitis contagious?

• Spread through direct contact with respiratory
  secretions ( saliva, sputum, or nasal mucus) of
  an infected person
• shaking hands,
• touching something they have handled,
• and then rubbing your own nose, mouth or eyes. 
• Stool of persons who are infected
• Small children who are not yet toilet trained
• Through changing the diapers of an infected
  infant
• Fewer than 1 of every 1000 persons infected
  actually develop meningitis. 

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Bacterial meningitis

• -Caused by any one of several bacteria. 
• -The leading cause of acute confusional state and
  one of which early diagnosis greatly improves the
  outcome
• -Primary causative agents
• 1. Haemophilus influenzae type b
• 2. Neisseria meningitidis or "meningococcus"
• 3. Streptococcus pneumoniae or "pneumococcus"

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H. Influenzae Meningitis
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Secondary causative agents

• Staphylococcus aurues
• Sterptococcus group B
• Listeria monocytogenes
• Gram-negative bacilli
• Mycobacterium tuberculosis
• Treponema pallidum
• Eischerichia coli

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Is meningitis contagious?

• Some forms are bacterial meningitis are
  contagious through the exchange of respiratory
  and throat secretions (coughing, kissing)
• Not spread by casual contact or by simply
  breathing the air where a person with meningitis
  has been

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• Three main portals of entry
• Hematogenous spread
• most common means of entry
• Direct implantation
• trauma, congenital malformations
• Local extension
• otitis media and sinusitis

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Diagnosis

• Early diagnosis treatment are very important.
• Identification of the type of bacteria is
  important for selection of correct antibiotics.
• Blood culture
• CSF culture
• Spinal tap for CSF showing increase white blood
  cells, low glucose, high protein
• Head CT is usually normal

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Signs and Symptoms

• Physical examination shows
• 1. fever
• 2. stiff neck
• 3. thigh flexion upon flexion of the neck
  (Brudzinskis sign)

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• 4.resistance to the passive extension of the knee
  with the hip flexed (Kernigs sign)
• 5. Vomiting, photophobia may be seen
• 6. Patients always like to lie still
• 7. Petechial rashes is seen in 50-60 patients
• 8. Meningial irritation is seen is 80 patients

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Neurological examination shows

• 1.Acute confusional state
• 2. Seizures and cranial nerve palsy
• 3. Coma in severe cases

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Lab Diagnosis

• -When meningococcal meningitis is diagnosed
  clinically by petechial rashes accompained by
  other stymptoms, immediate parenteral antibiotics
  should be given before any further
  investigations. (benzylpenicilin 1200 mg,
  alternative cefotaxime)
• -The causative organisms can be cultured from
  blood in 40-90 cases
• -If there is any suspecion of the intracranial
  lesion, CT scan or MRI can be done

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• -Although these studies may be helpful, the most
  essential test in all suspected case is promt
  lumbar puncture and CSF examination.
• in case of meningococcal meningitis, CSF is
  usually not performed since it may result
  cerebellar tonsils, so blood culture is main in
  this case

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CSF examination
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• CSF pressure is elevated in about 90 of the
  cases
• Appearance of fluid ranges from slightly turbid
  to grossly purulent
• WBC count 90,000 /mm3 consisting of chiefly
  polymorphonuclear leukocytes (predominantly in L.
  monocytogenes meningitis)

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• -CSF protein rises to 0.5-2 g/L ( normal 0.2-0.4
  g/L)
• -CSF glucose level is lower than half of normal
  blood glucose level
• -Gram stained smears of CSF indentify the
  causative organism is 80 cases.

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Differential diagnosis

• -it may be difficult to distinguish between the
  sudden headache of SAH, migraine and meningits
• -neck stiffness should be considered carefully
• -cerebral malaria often mimics bacterial
  meningitis

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Can meningitis be treated?

• Can be treated with a number of effective
  antibiotics
• Treatment be started early in the course of the
  disease
• Antibiotic treatment should reduce the risk of
  dying from meningitis to below 15

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Treatment
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Vaccines against bacterial meningitis

• Hib vaccine very safe and highly effective
• N. meningitidis (meningococcal meningitis)
• not effective in children under 18 months of age
• S. pneumoniae (pneumococcal meningitis)
• Polysaccharide vaccine
• for all persons over 65 years of age and
• younger persons (at least 2 years of age) with
  certain chronic medical problems
• Conjugate vaccine
• effective in infants
• all children greater than 2 years of age.

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Prevention

• Children should be routinely immunized against H
  influezae type B by vaccination
• N. meningitidis vaccine is recommended for
  military recruits, college students and travelers
  to areas of ongoing epidemics

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Nonpyogenic bacteria associated with aseptic
meningitis

• Mycobacterium tuberculosis
• Leptospira
• Treponema pallidum
• Borrelia Nocardia
• Bartonella
• Atypical mycobacteria
• Brucella

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Neonatal Meningitis

• Neonatal meningitis is inflammation of the
  meninges due to bacterial invasion in the 1st 90
  days of life.
• Neonatal meningitis occurs in 2/10,000 full-term
  and 2/1,000 low-birth-weight (LBW) neonates, with
  a male predominance