Meningitis, A complete detailed, and short PPT including Definition, Types, Etiology, Pathophysiology, treatment guideline, patient counseling, etc.

1. MENINGITIS
By : Saakshi Deokar
T.Y.PharmD , PD 303
Sub : Pharmacotherapeutics

2. Definition
 Meningitis is an inflammation of the meninges. The meninges are the three
membranes that cover the brain and spinal cord. Meningitis can occur when
fluid surrounding the meninges becomes infected.
The most common causes of meningitis are viral and bacterial infections. Other
causes may include:
 cancer
 chemical irritation
 Fungi
 drug allergies
Some viral and bacterial meningitis are contagious. They can be transmitted by
coughing, sneezing, or close contact.

3. Diagrammatical representation

4. Some Symptoms Of Meningitis
Viral meningitis in infants may cause:
Irritablility fever
lethargy
decreased appetite

5. In adults, viral meningitis may cause:
sensitivity to
bright light
Seizures
Nausea and
vomiting
Stiff neck Headaches Lethargy

6. Types of
Meningitis
 Viral Meningitis
 Fungal Meningitis
 Bacterial Meningitis
 Parasitic Meningitis
 Non-infectious Meningitis
Viral and bacterial infections are the most
common causes of meningitis. There are
several other forms of meningitis. Examples
include cryptococcal, which is caused by a
fungal infection, and carcinomatous, which is
cancer-related. These types are less common.

7. Each type of meningitis has a slightly different
cause, but each ultimately acts in the same way: A
bacterium, fungus, virus, or parasite spreads
through the bloodstream until it reaches the
brain, or spinal cord. There, it sets up in the lining
or fluids around these vital body parts and starts
developing into a more advanced infection.
Non-infectious meningitis is the result of a
physical injury or other condition; it doesn’t
involve an infection.
What is the etiology of
meningitis?

8. VIRAL MENINGITIS
 Viral meningitis is the most common type of meningitis. These are more common during the
summer and fall, and they include:
 coxsackievirus A
 coxsackievirus B
 Echoviruses
Other viruses can cause meningitis.
These include:
 West Nile virus
 influenza
 mumps
 HIV
 measles
 herpes viruses
 Coltivirus, which causes Colorado tick fever
Viral meningitis typically goes away without treatment. However, some causes do need to be treated.

9. BACTERIAL MENINGITIS
Bacterial meningitis is contagious and caused by infection from certain bacteria. It’s fatal if
left untreated.
The most common types of bacteria that cause bacterial meningitis are:
 Streptococcus pneumoniae, which is typically found in the respiratory tract, sinuses, and
nasal cavity and can cause “pneumococcal meningitis”
 Neisseria meningitides, which is spread through saliva and other respiratory fluids and
causes what’s called “meningococcal meningitis”
 Haemophilus influenza, which can cause not only meningitis but infection of the blood,
inflammation of the windpipe, cellulitis, and infectious arthritis
 Listeria monocytogenes, which are foodborne bacteria
 Staphylococcus aureus, which is typically found on the skin and in the respiratory tract,
and causes “staphylococcal meningitis”

10. FUNGAL MENINGITIS
 Fungal meningitis is a rare type of meningitis. It’s caused by a fungus that infects your
body and then spreads from your bloodstream to your brain or spinal cord.
 People with a weakened immune system are more likely to develop fungal meningitis.
This includes people with cancer or HIV.
The most common funguses related to fungal meningitis include:
 Cryptococcus, which is inhaled from dirt or soil that is contaminated with bird
droppings.
 Blastomyces, another type of fungus found in soil, particularly in the Midwestern United
States.
 Histoplasma, which is found in environments that are heavily contaminated with bat
and bird droppings, especially in the Midwestern States near the Ohio and Mississippi
Rivers.
 Coccidioides, which is found in soil in specific areas of the U.S. Southwest and South and

11. PARASITIC MENINGITIS
 This type of meningitis is less common than viral or bacterial meningitis, and it’s caused
by parasites that are found in dirt, feces, and on some animals and food, like snails, raw
fish, poultry, or produce.
 One type of parasitic meningitis is rarer than others. It’s called eosinophilic meningitis
(EM). Three main parasites are responsible for EM. These include:
 Angiostrongylus cantonensis
 Baylisascaris procyonis
 Gnathostoma spinigerum
 Parasitic meningitis is not passed from person to person. Instead, these parasites infect
an animal or hide out on food that a human then eats. If the parasite or parasite eggs
are infectious when they’re ingested, an infection may occur.
 One very rare type of parasitic meningitis, amebic meningitis, is a life-threatening type
of infection. This type is caused when one of several types of ameba enters the body
through the nose while you swim in contaminated lakes, rivers, or ponds. The parasite
can destroy brain tissue and may eventually cause hallucinations, seizures, and other

12. Non - infectious MENINGITIS
 Non-infectious meningitis is not an infection. Instead, it is
a type of meningitis that’s caused by other medical
conditions or treatments. These include:
 lupus
 a head injury
 brain surgery
 cancer
 certain medications

13. Example: Klebsiella Pneumoniae meningitis

14. PATHOPHYSIOLOGY
OF MENINGITIS

16. DIAGNOSIS

17. How is meningitis diagnosed
Diagnosing meningitis starts with a health history and physical exam.
Age, dorm residence, and day care center attendance can be important
clues. During the physical exam, your doctor will look for:
 a fever
 an increased heart rate
 neck stiffness
 reduced consciousness
Your doctor will also order a lumbar puncture. This test is also called a
spinal tap. It allows your doctor to look for increased pressure in the
central nervous system. It can also find inflammation or bacteria in the
spinal fluid. This test can also determine the best antibiotic for
treatment.

18. Other tests may also be ordered to diagnose meningitis.
Common tests include the following:
Complete
blood count
{CBC}
Blood
culture
Chest X - rays
Chest X – rays can reveal the presence of pneumonia,
tuberculosis, or fungal infections. Meningitis can
occur after pneumonia. A chest X-ray showed the
right middle lobe and left lingular consolidation.
Consolidation refers to the alveolar airspaces being
filled with fluid, cells. Tissue, or other material.
identify bacteria in the blood. Bacteria can travel from
the blood to the brain. N. meningitidis and S.
pneumonia, among others, can cause both sepsis and
meningitis.
A complete blood count with differential is a general index of
health. It checks the number of red and white blood cells in
your blood. White blood cells fight infection. The count is
usually elevated in meningitis.

19. Other tests may also be ordered to diagnose meningitis.
Common tests include the following:
CT Scan
Cerebral oedema in bacterial meningitis.
Computed tomography scan of brain of a young
patient with meningitis (a). There is severe cerebral
oedema: the third ventricle is obliterated when
compared with the third ventricle (arrow) of a
normal individual (b)
The CT scan is a valuable tool in diagnosing
meningitis. The contrast dye that is injected during
the test can highlight brain, skull, and sinus
inflammation- all complications and signs of
meningitis.

20. Other tests may also be ordered to diagnose meningitis.
Common tests include the following:
Glass
test
Lumbar puncture
test
Your doctor may also conduct a glass test. For this
test, your doctor will roll a glass over the meningitis
rash. If the rash doesn’t fade under the pressure, it’s
likely meningitis rash. If it does fade, the unusual
spots on the skin may be the result of another
condition.
A lumbar puncture (spinal tap) is performed in your lower back,
in the lumbar region. During a lumbar puncture, a needle is
inserted between two lumbar bones (vertebrae) {L3 and L5} to
remove a sample of cerebrospinal fluid. This is the fluid that
surrounds your brain and spinal cord to protect them from
injury. This test can detect meningitis, leukemia and other
illness.

21. Complications from meningitis
These complications are typically associated with meningitis:
 Seizures
 hearing loss
 vision loss
 memory problems
 Arthritis
 migraine headaches
 brain damage
 Hydrocephalus
 a subdural empyema, or a buildup of fluid between the brain and the skull
A meningitis infection may produce bacteria in the bloodstream. These bacteria multiply
and some release toxins. That can cause blood vessel damage and leaking of blood into the
skin and organs.
A serious form of this blood infection can be life-threatening. Gangrene may damage skin
and tissue. In rare cases, amputation may be necessary. Several other serious
complications may occur in people with meningitis. Read more about them and the long-
term effects of an infection.

22. Risk factors for meningitis
Compromised
immunity
Community
living
Pregnancy
Age Working with
animals

23. TREATMENT

24. Reflexology
and
Aromatherapy
TREATMENT {Non Pharmacological}
Plenty of
fluids
Bed rest
Relaxation and
Distraction
Over-the-counter pain medications
to help reduce fever and relieve
body aches.

25. PHARMACOLOGICAL
TREATMENT

26. Antibiotic therapy: neonates to age 1 month:
Age 0-7 days – 50 mg/kg IV every 8 hours
Age 8-30 days – 50-100 mg/kg IV every 6 hours of
ampicillin and Gentamicin.
Alternative treatment consists of ampicillin plus
gentamicin. Gentamicin dosages are as follows:
Age 0-7 days – 2.5 mg/kg IV or intramuscularly (IM)
every 12 hours
Age 8-30 days – 2.5 mg/kg IV or IM every 8 hours

27. Antibiotic therapy: age 1-3 months:
 In infants 1 to 3 months of age, the first-line agent is cefotaxime
(50 mg/kg IV every 6 hours, up to 12 g/day) or ceftriaxone (75
mg/kg initially, then 50 mg/kg every 12 hours, up to 4 g/day)
plus ampicillin (50-100 mg/kg IV every 6 hours). An alternative
agent is chloramphenicol (25 mg/kg orally or IV every 12 hours)
plus gentamicin (2.5 mg/kg IV or IM every 8 hours).
 If the local prevalence of drug-resistant S pneumoniae (DRSP) is
higher than 2%, vancomycin (15 mg/kg IV every 8 hours) should
be added. Treatment with dexamethasone (0.4 mg/kg IV every
12 hours for 2 days or 0.15 mg/kg IV every 6 hours for 4 days)
should be strongly considered, starting 15 to 20 minutes before
the first dose of antibiotics.

28. Antibiotic therapy: age 3 months to 7 years:
 In older infants or young children (age 3 months to 7 years), the most
common microorganisms are S pneumoniae, N meningitidis, and H
influenzae. Primary treatment is with either cefotaxime (50 mg/kg IV
every 6 hours, up to 12 g/day) or ceftriaxone (75 mg/kg initially, then
50 mg/kg every 12 hours, up to 4 g/day).
 If the prevalence of DRSP is greater than 2%, vancomycin (15 mg/kg
IV every 8 hours) should be added. In countries with a low
prevalence of DRSP, penicillin G (250,000 units/kg/day IM or IV in 3-4
divided doses) may be considered. Because of the increasing
prevalence of DRSP, penicillin G is no longer recommended in the
United States.
 An alternative (which may also be chosen if the patient is severely
allergic to penicillin) is chloramphenicol (25 mg/kg orally or IV every
12 hours) plus vancomycin (15 mg/kg IV every 8 hours). Treatment
with dexamethasone (0.4 mg/kg IV every 12 hours for 2 days or 0.15
mg/kg IV every 6 hours for 4 days) should be strongly considered,
starting 15 to 20 minutes before the first dose of antibiotics.

29. Antibiotic therapy: age 7-50 years:
 Cefotaxime – 50 mg/kg IV every 6 hours, up to 12 g/day
 Ceftriaxone – 75 mg/kg initially, then 50 mg/kg every 12 hours, up to
4 g/day
 Vancomycin – 15 mg/kg IV every 8 hours
Adult dosing is as follows:
 Cefotaxime – 2 g IV every 4 hours
 Ceftriaxone – 2 g IV every 12 hours
 Vancomycin – 750-1000 mg IV every 12 hours or 10-15 mg/kg IV
every 12 hours

30. In areas with a low prevalence of DRSP{Drug Resistant Streptococcus Pneumoniae} ,
cefotaxime or ceftriaxone plus ampicillin is recommended. Pediatric dosing is as follows:
 Cefotaxime – 50 mg/kg IV every 6 hours, up to 12 g/day
 Ceftriaxone – 75 mg/kg initially, then 50 mg/kg every 12 hours, up to 4 g/day
 Ampicillin – 50 mg/kg IV every 6 hours
Adult dosing is as follows:
 Cefotaxime – 2 g IV every 4 hours
 Ceftriaxone – 2 g IV every 12 hours
 Ampicillin – 50 mg/kg IV every 6 hours

31. Antibiotic therapy: age ≥50 years:
 In adults older than 50 years or adults with disabling
disease or alcoholism, the most common microorganisms
are S pneumoniae, coliforms, H influenza, Listeria species,
P aeruginosa, and N meningitidis.
 Primary treatment, if the prevalence of DRSP is greater
than 2%, is with either cefotaxime (2 g IV every 4 hours) or
ceftriaxone (2 g IV every 12 hours) plus vancomycin (750-
1000 mg IV every 12 hours or 10-15 mg/kg IV every 12
hours). If the CSF gram stain shows gram-negative bacilli,
ceftazidime (2 g IV every 8 hours) is given. In areas of low
DRSP prevalence, treatment consists of cefotaxime (2 g IV
every 4 hours) or ceftriaxone (2 g IV every 12 hours) plus
ampicillin (50 mg/kg IV every 6 hours). Other options are
meropenem, TMP-SMX, and doxycycline.

32. Steroid therapy:
 The use of corticosteroids (typically,
dexamethasone, 0.15 mg/kg every 6 hours for
2-4 days) as adjunctive treatment for bacterial
meningitis improves outcome by attenuating
the detrimental effects of host defenses (eg,
inflammatory response to the bacterial
products and the products of neutrophil
activation). Controversy surrounds this
practice, however, in that dexamethasone
may interrupt the cytokine-mediated
neurotoxic effects of bacteriolysis, which are at
maximum in the first days of antibiotic use.

33. Intrathecal antibiotics:
 Intrathecal administration of antibiotics can be
considered in patients with nosocomial meningitis
(eg, meningitis developing after neurosurgery or
placement of an external ventricular catheter) that
does not respond to IV antibiotics. Although the
FDA has not approved any antibiotics for
intraventricular use, vancomycin and gentamicin
are often used in this setting. Other agents used
intrathecally include amikacin, polymyxin B, and
colistin.
 Intrathecal antibiotic dosages have been
determined empirically and are adjusted on the
basis of the CSF concentrations of the agent.

34. Typical daily doses are as follows:
 Vancomycin: 5-20 mg
 Gentamicin: 1-2 mg in infants and
children, 4–8 mg in adults
 Amikacin: 30 mg (range, 5-50 mg)
 Polymyxin B: 2 mg in infants and children,
5 mg in adults
 Colistin (usually formulated as
colistimethate sodium): 10 mg once daily
or 5 mg every 12 hours

36. HEALTH EDUCATION
Advise close contacts of the patient with
meningitis that prophylactic treatment may be
indicated; they should check with their health care
providers or the local public health department.
Encourage the patient to follow medication
regimen as directed to fully eradicate the infectious
agent. Encourage follow-up and prompt attention
to infections in future.

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References
https://emedic
ine.medscape.
com/article/23
2915-
treatment
https://www.h
ealthline.com/
health/menin
gitis#tests-or-
diagnosis
https://www.m
edicalnewstod
ay.com/articles
/9276
https://www.may
oclinic.org/diseas
es-
conditions/meni
ngitis/symptoms
-causes/syc-
20350508
https://kidshea
lth.org/en/pare
nts/meningitis.
html

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