This document discusses meningitis, including its causes, symptoms, diagnosis, and treatment. Meningitis is an inflammation of the meninges caused by bacteria, viruses, or fungi. It occurs when pathogens invade the bloodstream and cross the blood-brain barrier. Common symptoms include fever, headache, stiff neck, and vomiting. Diagnosis involves lumbar puncture and examination of cerebrospinal fluid. Treatment focuses on antibiotics and managing complications such as shock. Prompt treatment is important as meningitis can cause long-term issues like hearing loss and developmental delays if not addressed quickly.

1. Meningitis
By
Dr Prashant Jadav
MBBS, MD

2. What is meningitis ?
 Inflammation of the
meninges/leptomeninges – the pia,
arachnoid, and dura mater.
 Can have various causes – bacteria,
viruses, fungus.

3. How it happens
 Nasopharyngeal colonization of
susceptible individual and invasion of
respiratory tract
 Invasion of bloodstream (Bacteremia)
 Choroid plexitis
 Spread to meninges
 Ventriculitis and increased intracranial
pressure
 Recruitment of inflammatory mediators

4. How it happens
 Damage to blood-brain barrier leads to
cerebral edema
 Endothelial cell damage, thrombosis
 Increase in CSF protein, decrease in
glucose from hypoxia, decreased aerobic
metabolism
 Infarction, Seizures, Abscess formation

5. Signs and Symptoms
 Usually occur one week after exposure
Fever
Headache
Stiff neck
Tiredness
Rash
Sore Throat
Vomiting

6. Typical presentations
 You are seeing a 14 day old infant in the
emergency room with a 2 day history of
congestion. Parents note infant to be
increasingly irritable and lethargic,
sleeping through feeds, multiple episodes
of vomiting, difficult to console. Fever of
103 rectal. Infant looks pale and feels
cool with HR of 225. A spinal tap shows
5000 white blood cells and a gram stain
reveals gram negative rods.

7. Typical presentations
 You are seeing a 15 yo high school
student in your office with a 24 hour
history of lethargy, repeated vomiting, and
fever to 102. On exam he is unable to
touch his chin to his chest and resists full
extension of his knee while lying flat.

8. Pathogens of Bacterial Meningitis
 Neonates (<1mo) :
– Group B streptococcus, E. coli, Listeria
 Infants (1-24 mos):
– Haemophilus influenzae type B, Streptococcus
pneumoniae, Neisseria meningitidis
 Children (>2yo):
– Neisseria (meningococcus), Strep pneumo
(pneumococcus), H. flu

10. Meningococcemia

11. Gram negative diplococci

13.  To check for the Brudzinski sign:
 Lie flat on your back.
 Your doctor will place one hand behind
your head, and another on your chest to
prevent you from rising.
 Then, your doctor will lift your head,
bringing your chin to your chest.

15.  To look for Kernig’s sign:
 Lie face up.
 Flex your knee and hip in a 90˚ angle
while someone else slowly extends your
knee.

16. Diagnosis
 Must maintain a high index of suspicion in
many cases
 Gold standard is positive culture in CSF,
may have CSF positive gram stain
 Lumbar puncture and CSF also show
pleocytosis, increased protein, and
hypoglycorrhea

17. CSF findings
Component Normal Bacterial
meningitis
Viral
meningitis
TB
meningitis
Glucose
mg/dL
40-80 <30 Normal Normal
Protein
mg/dL
20-50 >100 50-100 >75
WBCs 0-6 >1000 100-500 10-1000
Neutrophils 0 >50 % <20 % <50 %
RBCs 0-2 0-10 0-2 100-500

18. Incidence
 1.1 cases per 100,000 in US in 2004 as
compared to:
 Cases per 100,000:
– Pakistan 4.4
– Haiti 6.1
– Iraq 5.9
– China 7.7
– India 53.5

19. Treatment
 Antibiotics – Penicillins, Vancomycin,
Cephalosporins
 ? Steroids - Dexamethasone
 Treat underlying hemodynamic
compromise (shock) and other
complications
 Monitor for and treat sequelae

20. Complications and Sequelae
 Complications:
 Shock/Sepsis
 Cerebral edema
 Subdural empyema
 Subdural effusion
 Ventriculitis
 Abscess
 Seizures
 Sequelae:
 Deafness
 Developmental delay,
cognitive impairments
 Chronic seizure
disorder
 Hydrocephalus

21. Prophylaxis
 Most often for meningococcal meningitis
and Haemophilus influenzae
 Close contacts
 Rifampin or Ciprofloxacin

22. Any Que?

23. Thank you