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    Meningitis

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    nebulaa367

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    Meningitis

    Uploaded by

    nebulaa367
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    Copyright:

    © All Rights Reserved
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    Download as pptx, pdf, or txt
    2 views20 pages

    Meningitis

    Uploaded by

    nebulaa367

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 20

    Meningitis

    • It is the infection of the meninges characterized by


    inflammation of meninges mainly affacting
    subarachnoid space commonly caused by
    hematogeneous spread of an organism
    • Meningitis  inflammation of subarachnoid space
    • Abcess  epidural (outside dural space)
    Anatomy & Physiology
    • Brain & spinal cord are surrounded by meninges suspended in CSF
    • Meninges  three layers
     pia mater
     arachnoid
     dura mater
    • Blood-CSF & Blood-brain barrier
    • Many antimicrobials pass blood-CSF barrier few pass BBB
    Etiology
    Pathophysiology
    Pathogenesis
    Pathophysiology
    1. Release of
    Mucosal colonization
    inflammatory cytokines into CSF
    2. Invasion ofofmucosa
    Adhesion leukocytes to brain endothelium & diaphoresis into CSF
    3. Survival within
    Exudation of albumen
    blood stream
    through intacellular junctions of meningeal venules
    4. Penetration
    Brain edema,ofincreased
    blood-brain
    intracranial
    barrier pressure, altered cerebral blood flow
    5. Cranial nerve injury, hypoxic ischemia, seizures, brain damage & herniation
    • Pressure = 50—150mmH2O
    • Volume = 150ml
    Signs & Symptoms / Clinical
    Manifestation
    • Fever
    • Nuchal rigidity (stiff neck)
    • Altered mental state
    • Seizures
    • Kernig’s sign
    • Brudzinski’sign
    • Irritability
    • Anorexia
    • Headache
    • Photophobia
    • Nausea & vomiting
    • Focal neurologic deficits
    • Septic shock
    • Patachiae or pupura
    • Bulging (in skull) fontanelle
    Diagnosis
    • Definitive  detection of causative organism
    Biochemical changes in CSF & in cellular response in CSF
     CSF  lumber puncture (posterior to 3rd & 4th lumber vertebrae)
    Gram stained smears of CSF
    Ziehl-Neelsen stain  mycobacteria
    PCR  detection of microbial genomic material  viral meningitis
    India ink test (CRYPTOCOCCUS)
    Cryptococcal Meningitis
    • Cryptococcus neoformans
    • Cryptococcal meningitis takes 2—3 weeks for complete eradication
    • Amphotericin-B  0.7—1.0mg/kg/day together with Flucytocin
    100mg/kg/day (6 days)
    • Fluconazole  400—800mg/day (6 weeks)
    Viral Meningitis
    • Fortunately most cases of viral meningitis are self limiting & none of
    antiviral agents have useful
    • Usually herpes simplex viruses tend to present as encephalitis
    • Herpes simplex meningeoencephalitis treated with high dose
    acyclovir 10mg/kg x 3 /day

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