by M S Sivapriya, S8, 2017 MBBS, Azeezia Institute of Medical Sciences and Research

1. MENINGITIS
M S SIVAPRIYA
R.NO: 35

4. MENINGITIS
• A/c infection of meninges
• Combination of pyrexia + headache + meningism
• Meningism
1. Headache
2. Photophobia
3. Stiffness of neck
4. Kernig’s sign
5. Brudzinski’s sign

6. CAUSES OF MENINGITIS
1. INFECTIVE
• BACTERIA
• VIRUS
• PROTOZOA and PARASITES
• FUNGI
2. NON INFECTIVE (sterile)
• MALIGNANT DISEASE
• INFLAMMATORY DISEASE

7. VIRAL MENINGITIS
• Most common
• Benign & self-limiting
• Mc : ENTEROVIRUSES <Echo, Coxsackie, Polio>
• Other viruses: mumps, influenza, herpes simplex,
varicella zoster, EBV, HIV
Lymphocytic choriomeningitis
Mollaret meningitis – HSV 2

8. VIRAL MENINGITIS
C/F
• Children and young adults
• a/c onset of headache
• Irritability
• Rapid devpt of meningism
• High pyrexia
• Focal neurological signs – rare

9. VIRAL MENINGITIS
INVESTIGATIONS
• Lumbar puncture - CSF findings:-
Appearance : clear
Protien : N
Sugar : N
Cells : lymphocytes
Note:- verify that Pt had not taken antibiotics prior to lumbar puncture
Partially treated bacterial meningitis show CSF lymphocytosis

10. VIRAL MENINGITIS
MANAGEMENT
• No specific Rx
• Treated symptomatically in quiet envt
• Recovery within few days
• Whatever be the virus, complete recovery without specific therapy is
the rule

11. BACTERIAL MENINGITIS
CAUSES
India - H. influenza B , Strep. pneumoniae
Western Europe – Strep. pneumoniae , N. meningitides
US – H. influenza

12. BACTERIAL MENINGITIS

13. BACTERIAL MENINGITIS
CAUSES
• Part of Bacteraemic illness
• Direct spread from adj focus of infn
Ear, Skull fracture, Sinus

14. BACTERIAL MENINGITIS
MENINGITIS BELT – Sub Saharan Africa – drought and dust storms
a/w Meningococcal outbreaks HARMATTAN MENINGITIS

15. BACTERIAL MENINGITIS
PATHOPHYSIOLOGY
infection
immune response
pia-arachinoid matter – congestion and infiltration
pus formed in layers – adhesions
obstruct free flow of CSF
Hydrocephalus, damage of cranial nerves at base of brain,

16. BACTERIAL MENINGITIS
C/F
• Headache
• Drowziness
• Fever
• Neck stiffness
• Severe – comatose , focal neurological signs

17. BACTERIAL MENINGITIS
MENINGOCOCCAL MENINGITIS
• 90% cases have 2 of the following
• fever, neck stiffness, altered consciousness, rash
• +sepsis  evolve rapidly ,
abrupt onset of obtundation d/t cerebral edema

18. BACTERIAL MENINGITIS
INVESTIGATIONS
1.Lumbar puncture – CSF findings
• Appearance : turbid
• Protein : elevated
• Sugar : reduced
• Cells : neutrophils
2.Gram film
3.Blood culture
4.PCR

21. BACTERIAL MENINGITIS
• Untreated case -80% mortality
• Parenteral BENZYL PENICILLIN iv
• Adj GLUCOCORTICOIDES prevent hearing loss and neurological
sequelae
• Intensive care

23. BACTERIAL MENINGITIS
PREVENTION
• Close contacts – RIFAMPICIN * 2days
- CIPROFLOXACIN * single dose
• Vaccines available: PCV, Hib

24. BACTERIAL MENINGITIS

25. TUBERCULOUS MENINGITIS
In immunocompromised individuals
PATHOPHYSIOLOGY
-Aft primary infn in childhood
-miliary TB
-local source – caseous focus in meninges , brain substance adj to CSF
pathway

26. TUBERCULOUS MENINGITIS
C/F
SYMPTOMS
Headache
Vomiting
Low grade fever
Lassitude
Depression
Delirium
Behaviour changes
SIGNS
Meningism
Occulomotor palsy
Papilloedema
Depression of conscious level
Focal hemisphere signs

27. TUBERCULOUS MENINGITIS
STAGING OF SEVERITY
Stage 1 <early> : non specific symptoms and signs without alteration of
consciousness
Stage 2 <intermediate> : altered consciousness without coma or
delirium + focal neurological signs
Stage 3 <advanced> : stupor or coma , severe neurological deficits,
seizures or abnormal movements .

28. TUBERCULOUS MENINGITIS
INVESTIGATIONS
1. Lumbar puncture : CSF findings
• Appearance : clear initially
spider web when allowed to stand
• Protein : raised
• Sugar : reduced
• Cells : lymphocytes
AFB

30. TUBERCULOUS MENINGITIS
CSF Smear
Brain imageing – hydrocephalus
- intracranial tuberculoma

31. TUBERCULOUS MENINGITIS
MANAGEMENT
• Chemotherapy
• Surgical ventricular drainage in obstructive hydrocephalus
• Adequate hydration
• Nutrition

32. OTHER MENINGITIS
• FUNGAL MENINGITIS –Cryptococcus
- In immunocompromised
- CSF findings ~ TB meningitis
- Dx – microscopy / serological tests
• SPIROCHETES – leptospirosis, lyme d/s, syphilis
• RICKETTSIAE – typhus fever
• PROTOZOA – amoebiasis

33. THANK YOU