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Global Issue
• Meningitis kills or disables around 1.2 million
people worldwide each year.
• Bacterial meningitis, which i...
Definition
“Meningitis is a disease caused by the inflammation
of the protective membranes covering the brain
and spinal c...
FactsOf Meningitis
• Meningitis may develop in response to a number of causes,
usually bacteria or viruses but meningitis ...
Nasopharyngeal colonization
Local invasion
Bacteremia
Meningeal invasion
Bacterial replication in the subarachnoid
space
R...
Classification of Meningitis
Based on duration:
• Acute: symptoms present within a period of 0-24 hours.
• Sub acute: symp...
Bacterial Meningitis
Causative agents varies
according to age:
• Newborn to 3 months:
Escherichia Coli, Group B Streptococ...
Viral Meningitis
Causative agents:
• Enteroviruses
• Adenovirus
• Herpes Simplex Virus
• Varicella-Zoster Virus
• Mumps Vi...
Fungal Meningitis
Causative agents:
• Cryptococcus Neoformans
• Coccidioides Immitis
• Histoplasma Capsulatum
• Aspergillu...
Parasitic Meningitis
Causative pathogens
• Angiostrongylus Cantonensis
• Cystic Echinococcosis
• Naegleria Fowler
Occurren...
Non InfectiousMeningitis
Causes:
• Cancers
• Systemic Lupus Erythematosus (Lupus)
• Certain Drugs
• Head Injury
• Brain Su...
Clinical Presentation
Young Infants <3 months:
• Fever or Hypothermia
• Bulging Fontanel
• Convulsion/Seizures
• High-pitc...
Physical Examination
Kerning's Sign
• It is an assessed with patient lying in Supine Position
with Hip Joint and Knee Join...
Physical Examination
Brudzinski`s Sign
• A Positive Brudzinski`s sign occurs when flexion of
the Neck causes involuntary f...
Physical Examination
Skin Findings:
• Non Specific Erythmatous,
Macular, Papular rash to a
Petechial or Purpuric rash.
• T...
Investigations
• Lumber Puncture (LP)
• CSF Culture
• Polymerase Chain
Reaction (PCR)
• Blood Counts
• Blood Culture
• X-r...
CSF Normal Bacterial
Meningitis
Viral Meningitis Fungal Meningitis Parasitic Meningitis
Appearance Clear Opale-scant to
Pu...
Management
• Monitor vital sign hourly (B.P,R/R,
Pulse rate, temperature)
• Monitor input and output
• Give treatment as p...
Treatment: Antibiotics
Ampicillin In neanate:100-200mg/kg/day, every 6
hours
In children:200-400mg/kg/day, every 6
hours
C...
SupportiveTreatment
• Give Paracetamol 15mg/kg 6-8 hourly for fever (>38.5 M).
• IV fluids: isotonic fluids at maintenance...
Complication
• Increased intracranial
pressure(ICP)
• Cranial nerve palsy
• Seizures
• Stroke
• Ataxia
• Inappropriate ADH...
MeningitisAccording to Tibb
(Unani Medicine)
MENINGIES
• Dura matter (Supportive and as an
infrastructure)
• Arachanoid ma...
Pia Matter Arachanoid Matter Brain
Atrabilious (Cold & Dry) Bilious (Hot & Dry) Phlegmatic (Cold & Moist)
Fever Pale eyes ...
Prognosis
• It depends on patient`s age and disease severity.
Mortality rate
• 5% Neisseria Meningitis
• 8% in Haemophillu...
PREVENTION
• Haemophilus vaccine (Hib vaccine) in children.
• The pneumococcal conjugate vaccine is now a routine childhoo...
REFERENCES
• www.slideshare.net
• News health(2010) management
of acute bacterial meningitis in
infants and children clini...
Meningitis (According to Modern & Unani Medicine)
Meningitis (According to Modern & Unani Medicine)
Meningitis (According to Modern & Unani Medicine)
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Meningitis (According to Modern & Unani Medicine)

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Transcript of "Meningitis (According to Modern & Unani Medicine) "

  1. 1. Global Issue • Meningitis kills or disables around 1.2 million people worldwide each year. • Bacterial meningitis, which is the most severe and common form of meningitis, causes around 120,000 deaths globally every year.
  2. 2. Definition “Meningitis is a disease caused by the inflammation of the protective membranes covering the brain and spinal cord known as the meninges.”
  3. 3. FactsOf Meningitis • Meningitis may develop in response to a number of causes, usually bacteria or viruses but meningitis can also be caused by physical injury, cancer or certain drugs. • Viral meningitis is often less severe than bacterial meningitis and usually resolves without specific treatment. • Those surviving meningitis can have their lives devastated as a result of long-term effects, such as deafness, brain damage, learning difficulties, seizures, difficulties with physical activities and when septicemia is involved loss of limbs. • Meningitis can be hard to recognize in the early stages. Symptoms can be similar to those of the common flu, including: fever, vomiting, headache, stiff neck, sensitivity to light, drowsiness, muscle and leg pain.
  4. 4. Nasopharyngeal colonization Local invasion Bacteremia Meningeal invasion Bacterial replication in the subarachnoid space Release of bacterial components (cell wall, LOS) Cerebral micro vascular endothelium Macrophages, neutrophils, other CNS Cells Cytokines Subarachnoid space inflammation Cerebral vasculitis Increased CSF outflow resistance Hydrocephalus Interstitial edema Increased intracranial pressure Decreased cerebral blood flow and loss of cerebro vascular auto Cytotoxic edema Cerebral infarction Increased BBB permeability Vasogenic edema
  5. 5. Classification of Meningitis Based on duration: • Acute: symptoms present within a period of 0-24 hours. • Sub acute: symptoms lasting from 1-7 days. • Chronic: symptoms lasting over 7 days. Based on etiology: • Bacterial meningitis • Viral Meningitis • Fungal Meningitis • Parasitic Meningitis • Non infectious Meningitis Trauma, cancer or certain drugs
  6. 6. Bacterial Meningitis Causative agents varies according to age: • Newborn to 3 months: Escherichia Coli, Group B Streptococci, Listeria Monocytogenes, Streptococcus Pneumoniae, Haemophilus Influenzae type b, Neisseria Meningitides. • Age 3 months to Adolescence: Neisseria meningitis, Streptococcus Pneumoniae, Haemophilus Influenzae type b. Mycobacterium Tuberculosis is most common in young children of any age. • Adolescence to Young adults: Neisseria Meningitides, Streptococcus Pneumoniae • Older Adults: Streptococcus Pneumoniae, Neisseria Meningitides, Listeria Monocytogenes • Streptococcus Pneumoniae is the most common type of Meningitis. Approximately 6,000 cases/yr • Haemophilus Meningitis incidence has declined about 95% due to the introduction of Haemophilus Influenza b vaccine
  7. 7. Viral Meningitis Causative agents: • Enteroviruses • Adenovirus • Herpes Simplex Virus • Varicella-Zoster Virus • Mumps Virus • Measles Virus • Viral Meningitis is often less severe than Bacterial Meningitis. • Duration of illness approx 7 to 10 days. • Viral Meningitis occurs mostly in children younger than age 5. • There are certain diseases and medications that may weaken the immune system and increase risk of Meningitis. For example, Chemotherapy and recent organ or Bone Marrow Transplant.
  8. 8. Fungal Meningitis Causative agents: • Cryptococcus Neoformans • Coccidioides Immitis • Histoplasma Capsulatum • Aspergillus Fumigatus • Candida Albicans (Yeast) Occurrence: Rare Mode of Transmission: • Fungal Meningitis is not contagious, usually the result of spread of a fungus through blood to the spinal cord and also potentially contaminated medication injected into the body.. • Fungal Meningitis, people with weakened immune systems, like those with HIV infection or Cancer are at higher risk. Treatment: Fungal Meningitis is treated with long courses of high dose Anti-Fungal medications.
  9. 9. Parasitic Meningitis Causative pathogens • Angiostrongylus Cantonensis • Cystic Echinococcosis • Naegleria Fowler Occurrence: Very rare Transmission: Spread through Warm Freshwater ( Lake, River & Swimming Pool )
  10. 10. Non InfectiousMeningitis Causes: • Cancers • Systemic Lupus Erythematosus (Lupus) • Certain Drugs • Head Injury • Brain Surgery Mode of Transmission: • This type of Meningitis is not spread from person to person. Non- Infectious Meningitis can be caused by Cancers, Systemic Lupus Erythematosus (Lupus), Certain Drugs, Head Injury and Brain Surgery.
  11. 11. Clinical Presentation Young Infants <3 months: • Fever or Hypothermia • Bulging Fontanel • Convulsion/Seizures • High-pitched cry and Irritability • Lethargy and Altered Mental State • Apnea • Poor Feeding and Vomiting Children >3 months to Adolescent: • Fever (50% of patients) • Headache, Photophobia, Stiff Neck, Irritability, Lethargy, Vomiting and Altered Level of Consciousness • Papilledema
  12. 12. Physical Examination Kerning's Sign • It is an assessed with patient lying in Supine Position with Hip Joint and Knee Joint flexed to 90 degree. In a patient with Positive kerning's sign pain limits passive Extension of the Knee.
  13. 13. Physical Examination Brudzinski`s Sign • A Positive Brudzinski`s sign occurs when flexion of the Neck causes involuntary flexion of the Knee and Hip Joints.
  14. 14. Physical Examination Skin Findings: • Non Specific Erythmatous, Macular, Papular rash to a Petechial or Purpuric rash. • TUMBLER TEST is Positive
  15. 15. Investigations • Lumber Puncture (LP) • CSF Culture • Polymerase Chain Reaction (PCR) • Blood Counts • Blood Culture • X-ray Chest • CT Scan • Latex Agglutination • Gram Staining
  16. 16. CSF Normal Bacterial Meningitis Viral Meningitis Fungal Meningitis Parasitic Meningitis Appearance Clear Opale-scant to Purulent Clear Normal or Cloudy Normal Glucose(mg/ dL) 40-85 mg/ dL Normal to Marked Decrease. <40 mg/ dL Normal (> 40 mg/dL.) <40 mg/dL (Low) Normal or Minimal Low Protein(mg/ dL) 15-45 mg/dL (Marked Increase) > 250 mg/dL. <100 mg/dL (Moderate Increase) (Moderate to Marked Increase) 25 -500 mg/ dL Slightly Elevated WBCs(cells/ µL) 0–5/µL (Adults / Children); 30/µL (Newborn) >500 (Usually > 1000). Early: May be < 100. < 100 cells/µL Variable (10 -1000 cells/µL) <500cells/µL Increased no. of Esinophils CSF Culture Sterile Positive Negative Positive Mostly Negative Gram`s/ZN Staining Not Seen Gram +ve Cocci (Pneumococcai), Gram –ve Cocci (Meningococci), Gram –ve Bacilli (H.Influenzae) No organisms are seen No organisms are seen No organisms are seen Detection of Micro Organism Negative Latex Agglutination Test, Blood Culture CSF for PCR is the Diagnostic procedure of choice Blood Culture Blood Culture
  17. 17. Management • Monitor vital sign hourly (B.P,R/R, Pulse rate, temperature) • Monitor input and output • Give treatment as prescribed • Keep proper ventilation • Turn patient at every 2 hours • Monitor the child's state of consciousness and pupil size at every after hours during the first 24 hours ( thereafter every 6 hours) • Assess for increased ICP (Intra cranial pressure) • Measure and records the head circumference of infants • Document the characteristics of seizure activity and duration • On discharge ,assess all children for neurological problems, especially hearing loss
  18. 18. Treatment: Antibiotics Ampicillin In neanate:100-200mg/kg/day, every 6 hours In children:200-400mg/kg/day, every 6 hours Cefotaxime In neonate: 100-150 mg/kg/day, every 6-8 hours In children 200mg/kg/day, every 6-8 hours Ceftriaxone 100mg/kg, every after 12 hours or 24 hours Gentamicin In neonate:5 mg/kg/day, every 8 hours In children:60mg/kg/day, every 6 hours Vancomycin In neonate:45mg/kg/day, every 8 hours Benzyl penicillin In neonate: 100,000 units/kg/day, every 6- 12 hours according to age In children: 400,000 units/kg/day every 4 to 6 hours Chlor-amphenicol 100mg/kg/day I/V every 6 hours (max dose 4 g/day)
  19. 19. SupportiveTreatment • Give Paracetamol 15mg/kg 6-8 hourly for fever (>38.5 M). • IV fluids: isotonic fluids at maintenance rate(250 ml/24hrs). • Feeding according to age requirement (75-100 kcal/kg/day). • Give anticonvulsant if convulsing. • Correct hypoglycemia if present. • NGT for feeding. • Physiotherapy.
  20. 20. Complication • Increased intracranial pressure(ICP) • Cranial nerve palsy • Seizures • Stroke • Ataxia • Inappropriate ADH secretion • Rapidly increasing head circumference • Subdural Effusions • Blindness • Cerebral Infarcts • Anemia • Cerebral or Crebeller Herniation • Deafness • Spasticity • Visual Handicap or Squint • Epilepsy
  21. 21. MeningitisAccording to Tibb (Unani Medicine) MENINGIES • Dura matter (Supportive and as an infrastructure) • Arachanoid matter(Bilious) • Pia matter(Atrabilious) • Brain( Phlegmatic)
  22. 22. Pia Matter Arachanoid Matter Brain Atrabilious (Cold & Dry) Bilious (Hot & Dry) Phlegmatic (Cold & Moist) Fever Pale eyes Papilledema Nausea Vomiting Nausea & Vomiting Neck Stiffness Bitter Taste Chills and Rigors Seizures Seizures Nasal Discharge Headache Headache Headache Perspiration Photophobia Vertigo & Lethargy Irritability Rod shape Cocci shape Spiral shape Emollient, Atrabilious Concoctive & Purgative Exhilarant, Sedative & Hypnotics, Brain Tonic, Bilious Purgative Phlegmatic Purgative, Emollient Khisanda-e- Astokhuddoos, Jawarish-e- Anareen & Jawarish-e- Ood-e-tursh Luab bahidana, sharbat- e-neelofer, mufarah-e- barid Aab anar-e-Tursh Sharbat-e-Badyan, Roghan-e-Kafoor Sharbat-e-Deenar, Roghan-e-Khashkhash Sharbat-Allu-Bukhara, Sikanjbeen-e- Sadah & Roghan-e-Gul DIFFERENTIAL DIAGNOSIS ACCORDING TO TIBB (Unani medicine) Sign & Symptoms Herbal treatment Causative pathogens
  23. 23. Prognosis • It depends on patient`s age and disease severity. Mortality rate • 5% Neisseria Meningitis • 8% in Haemophillus Influenza • 25% in Streptococcal Pneumoniae • 35% of survivors have permanent deficit e.g. Deafness, Learning Disabilities, Blindness, Seizures and Hydrocephalous.
  24. 24. PREVENTION • Haemophilus vaccine (Hib vaccine) in children. • The pneumococcal conjugate vaccine is now a routine childhood immunization and is very effective at preventing pneumococcal meningitis. • Household members and other in close contact with people who have meningococcal meningitis should receive preventive antibiotics.
  25. 25. REFERENCES • www.slideshare.net • News health(2010) management of acute bacterial meningitis in infants and children clinical practice guidelines. • Who (2005) pocket book of hospital care for children guidelines for the management of common illnesses with limited resources. • www.cdc.gov • Basis of pediatrics( 8th Edition) • Tarteeb ul Adwiya
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