More informative because my Ppt additionally have Unani medicinal point of view description

2. 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.

3. Definition
“Meningitis is a disease caused by the inflammation
of the protective membranes covering the brain
and spinal cord known as the meninges.”

4. 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.

5. 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

6. 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

7. 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

8. 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.

9. 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.

10. Parasitic Meningitis
Causative pathogens
• Angiostrongylus Cantonensis
• Cystic Echinococcosis
• Naegleria Fowler
Occurrence: Very rare
Transmission: Spread through Warm Freshwater ( Lake, River &
Swimming Pool )

11. 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.

12. 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

13. 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.

14. 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.

15. Physical Examination
Skin Findings:
• Non Specific Erythmatous,
Macular, Papular rash to a
Petechial or Purpuric rash.
• TUMBLER TEST is Positive

16. Investigations
• Lumber Puncture (LP)
• CSF Culture
• Polymerase Chain
Reaction (PCR)
• Blood Counts
• Blood Culture
• X-ray Chest
• CT Scan
• Latex Agglutination
• Gram Staining

17. 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

19. 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

20. 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)

21. 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.

22. 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

23. MeningitisAccording to Tibb
(Unani Medicine)
MENINGIES
• Dura matter (Supportive and as an
infrastructure)
• Arachanoid matter(Bilious)
• Pia matter(Atrabilious)
• Brain( Phlegmatic)

24. 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

25. 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.

26. 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.

27. 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