Prof. Abbas Hayat
NAME OF DISEASE:
Purulent meningitis Bacterial meningitis
The disease usually begins as an infection by normal body flora, of:
• The ear (otitis media) - Haemophilus influenzae
• The lung (lobar pneumonia) - Streptococcus pneumoniae
• The upper respiratory tract (rhinopharyngitis) - Neisseria meningitidis,
Haemophilus, influenzae, Streptococcus, Group B
• The skin and subcutaneous tissue (furunculosis) S. aureus
• The bone (osteomyelitis) - S. aureus
• The intestine - E. coli
This localized infection
develops into a Bacteremia
with a metastatic infection in
This is exceedingly rapid in
acute bacterial meningitis
and death may occur in
Males are affected twice as often
weeks to 3
Strept. Group B
Strept, Group A
The mechanism of pathology
may be either:
•1. Endotoxemic shock
– The infant with meningitis has signs of
infection but commonly is `simply fretful
and refuses food’.
• Vomiting occurs early in the disease
and is often repeated,……….
dehydration that may prevent the full
fontanelle as associated with
increased intracranial pressure.
• Fever may be absent and there may
• As the disease progresses, apnea
episodes, twitching, seizures (up to
30% of cases), opisthotonos, and
coma and death result.
• Skin rashes occur with meningococcemia,
with or without meningitis.
• From the 1st to the 3rd day, at least one-
third of patients with meningococcal meningitis
develop petechiae, most prominently in areas
subjected to pressure; for example, Axillary
folds and the belt line.
• Purplish ecchymoses and maculopapular
nodules up to 2 cm in diameter may also be
present, tending to appear first on the trunk
and later on the extensor surfaces of the thighs
The CSF should be examined in every
patient in whom the clinical findings are
consistent with even the possibility of
meningitis, no matter how minimal the
Examine the CSF for:
2. Appearance: clear or turbid
3. Wet Mount
4. Gram Stain for bacteria.
5. Geimsa stain for Presence of
neutrophils or lymphocytes or R.B.C.s.
Examination of the cerebrospinal fluid
6- Cell count:
Normal 0-5 cells /mm3 Markedly increased in
bacterial tuberculous and viral accordingly
7- Glucose measurement:
Normal 60 % of blood glucose, decreases in bacterial
8- Concentration of protein
Normal 40-60 mg/dl ++++ in bacterial +++in
tuberculous ++ in viral.
9- Look for Bacterial antigens in C.S.F
by specific Antibodies.
LAB. FINDINGS IN CSF
0-5 lympho Sterile 20-40
• Bacterial Meningitis:
Polymorphonuclear cells outnumber monocytes
Papilledema occurs late in disease when it occurs,
High lactate, Low glucose of CSF.
• Tubercular Meningitis:
Slight changes in CSF chemistry
Positive tuberculin test
• Fungal Meningitis:
Insidious onset, history of lung infection, yeast
cells in CSF, slight changes in CSF chemistry.
• Syphilitic Meningitis:
Insidious onset, slight change in CSF chemistry,
positive RPR test.
• Parasitic Meningitis
Acute onset, slight change in CSF chemistry,
presence of IgM in CSF .(Trypanosoma cruzi
infection = Chagas' disease, sleeping
(Acanthamoeba or Naegalaria species) Entry via
contaminated water or in children swimming in
contaminated water. 90% mortality, presense of
vegetative forms of amoeba on direct
examination of C.S.F.
• Viral Meningitis:
Acute onset, slight change in CSF chemistry.
Monocytes outnumber PMN's.
• Subarachnoid hemorrhage:
Red blood cells in CSF.
X-ray for tumor presence.
History of non-CNS viral disease ( a non-infective
state resembling meningitis).
• Brain Abscess
PMN's may outnumber monocytes, papilledema
occurs early in disease, acute or insidious onset.
Trismus, clean mentation.
The risk of death during early phases of acute bacterial
meningitis relates to problems other than the
• A combination of fever, dehydration secondary to
vomiting, and decreased food and fluid intake &
subsequent alkalosis predisposes patients, especially
children, to seizures.
• Respiratory arrest or airway obstruction follows;
if significant CNS or myocardial hypoxia occurs, fatal
cardiac arrhythmias or brainstem damage may result.
• Procedures commonly employed include:
1. Correction of fluid and electrolyte
2. Provision for adequate oxygenation.
3. Monitoring of cardiovascular function
(Give a cardiac-active glycoside if
4. Monitoring intracranial pressure -
administer urea or mannitol to reduce
Administration of antibiotics –
• Neonate (up to 1 month old) -
Ampicillin + Cefotoxime or
Ampicillin + Gentamycin
• Neonate (1-3 months old)-
Ampicillin + Dexamethazone or
Ampicillin + Dexamethazone +
• Other (3 months - 50 years old)
Cefotoxime + Vancomycin
• (Over 50 years old or alcoholic)-
Ampicillin + Cefotoxime
TREATMENT: of Fungal
1. Amphotericin B injected I.V. and into
the subarachnoid space.
5. Flucytosine (5-fluorocytosine)-
penetrates into all body fluids, including
CSF. Less toxic but higher doses required.