contains the basic information you need to know about meningitis - definition, etiology, pathophysiology, clinical signs and symptoms, investigation, complications, management

1. Abubakr Ibrahim, Adv. Diploma
Department of Community Medicine and Heath
College of Health and Well-being, Kintampo

2.  Definition
 Aetiology
 Pathophysiology
 Clinical presentation and Physical Exams
 Investigations
 Diagnosis
 Complications
 Management

3.  Meningitis is an inflammatory disease of the
leptomeninges and is defined by abnormal
number of cells in the CSF
Epidemiology
 Over one million cases annually worldwide
 Causes more than 130,000 deaths worldwide
 In Ghana more prevalent in the north
 In neonates : group B streptococcus

4.  In children : Strep. pneumoniae, H. influenza,
N. meningitidis
 In adults : strep. pneumoniae and N.
meningitidis
 TB and Listeria monocytogenes can also
cause meningitis
 Viral meningitis : HIV, Enterovirus,
 Fungal meningitis : candida, Cryptococcus

5.  Hematogenous spread : Strep pneumoniae
from pneumonia
 Entry via the URT: N. meningitidis
 Ear infection : H influenza
 Post surgery or trauma: Staph, gram -ve
This enable microorganisms to colonize ,
invade and cross the blood brain barrier , and
multiply within the CSF.

6.  Fever
 Neck stiffness Triad-bacteria meningitis
 Altered mental status
 Headache
 Seizures
 Focal neurologic deficits/cranial nerve deficit
 Cerebral vasculopathy leading to stroke
 Skin petechiae
 Photophobia

7.  Brudzinski’s sign
 kerning’s sign
 Nuchal rigidity/meningismus
Investigations
 CSF analysis

8.  Elevated protein
 Decreased glucose
 Elevated WBC
predominance PMNs – bacteria meningitis
predominance mononuclear cells – Fungal
meningitis, viral meningitis, encephalitis
 Blood – trauma from tab, intracranial bleeding

9.  Bacterial meningitis
 Fungal meningitis
 TB meningitis
 Carcinomatous/lymphomatous meningitis
 Neurosarcoidosis
 Profound systemic hypoglycemia

10.  History of fever, altered mental status, stiff
neck(Triad) + headache, seizures, photophobia
 PE positive for Brudzinski’s sign, Kerning’s sign
,nuchal rigidity
 Lumber puncture consistent with a particular
meningitis

11.  Cranial nerve injury – CN VIII hearing loss
 Seizure disorder
 Long term cognitive delay
 Venous sinus thrombosis
 stroke
Hydrocephalus

12.  Ceftriaxone 2g IV 12hr +
 Vancomycin 15-20mg/kg 8hr +
 Ampicillin 2g IV 4hr – for patients >50
Plus
 High dose steroids