2. OBJECTIVE
• Define Meningitis
• Differentiate between Acute bacterial and
tuberculous meningitis.
• Discuss Epidemiology, Pathogenesis and Risk
factor.
• Enlist Clinical features.
• Discuss the modalities for Diagnosis.
• Enlist differential diagnosis.
• Discuss treatment and its complications.
3. OBJECTIVE
• Define Encephalitis.
• Discuss Japanese Encephalitis.
• Enlist Clinical features.
• Discuss the modalities for diagnostic and
prognostic factor.
• Discuss its Management.
4. Meningitis
• Meningitis is an inflammatory process of
leptomeninges and CSF within subarachnoid
space, usually caused by an infection.
• Infectious meningitis are broadly classified into:-
1. Acute pyogenic.
2. Acute aseptic .
3. Chronic (tuberculous, spirochetal, or
cryptococcal) .
5. Acute Bacterial Meningitis
• It is an acute purulent infection within the sub
arachnoid space and is a major cause of
morbidity and mortality in young children.
6. Epidemiology
Age Group Common Organisms
Neonates E.coli, Streptococcus pneumoniae,
Salmonella species, Pseudomonas
aeruginosa, Streptococcus fecalis,
Staphylococcus aureus
3 months to 3 yr Haemophilus influenzae, S.pneumoniae
and meningococci (Neisseria meningitidis)
Beyond 3 yr S.Pneumoniae , N.meningitidis
7. Epidemiology
• Host-Patients with diminished host resistance,
malignancies, on immunosuppressive drugs
are more susceptible to develop meningitis by
fungi, listeria and mycoplasm.
12. Clinical features
• Brudzinski sign- knees show
flexion as neck of the child
is passively flexed.
• Neck stiffness- reduce
ability to flex the neck
forward.
13. Sign and symptoms of bacterial
meningitis
• Sepsis
• Vacant stare
• Alternating irritability and drowsiness
• Persisting vomiting and fever
• Refusal to suck
• Poor tone and poor cry
• Shock, circulatory collapse
• Fever or hypothermia
• Tremor or convulsion
15. Meningococcal Meningitis
• Caused by serotype A.
• Petechial haemorrhages.
• Waterhouse friderichsen syndrome ( adrenal
insufficiency,hypotension,sock and coma).
• In chronic case – intermittent fever, chills ,
joint pain, maculopapular rash.
16. Pneumococcal Meningitis
• Occurs in all age group but it is uncommon in
the first few months of life.
• Exudates are common on the cortex and
subdural effusion is a usual complication.
17. Staphylococcal Meningitis
• Neonatal staphylococcal meningitis is often
associated with umbilical sepsis, pyoderma or
septicemia.
• In older children it follows otitis media,
mastoiditis, sinus thrombosis, pneumonia,
arthritis and septic lesion of the scalp or skin.
18. Haemophilus influenza type B
Meningitis
• Subdural effusion is suspected in infants
• Convulsion are common.
• Residual auditory defecit is also a
common complication.
25. Duration of Therapy
• Normally treatment is for 10-14 days.
• But in staphylococcal meningitis and gram –
negative infection it extends to 3 weeks.
• Dexamethasone is used as steroidal therapy to
reduce the neurological complication.
• Especially used in haemophilus meningitis.
27. Complication
• CNS complication- subdural effusion or
empyema, ventriculitis, arachnoiditis, brain
abscess and hydrocephalus.
• Systemic complication- shock, myocarditis, status
epilepticus and syndrome of inappropriate ADH
secretion(SIADH).
• Longterm neurological deficits include
hemiplegia, aphasia, ocular palsies, hemianopsia,
blindness, deafness and mental retardation.
28. Tuberculous Meningitis
• It is a serious complication of childhood
tuberculosis.
• Occur in any age group but most common
between 6 -24 months of age.
30. Clinical Manifestation
• Prodromal stage or stage of invasion- low
grade fever, loss of appetite and disturbed
sleep. Vomiting is frequent and headache.
• Stage of meningitis- neck rigidity may be
present and kernig sign may be positive. Fever
may be remittent or intermittent, pulse is slow
but regular. Muscle tone may be increased.
Convulsion and neurological deficits may also
occur.
31. Clinical Manifestation
• Stage of coma- this stage is characterized by
loss of consciousness, rise in temperature and
altered respiratory pattern. pupils are dilated,
ptosis and opthalmoplegia are frequent.
• Respiration becomes Cheyne Strokes and
bradycardia is common.
• Hemiplegia, quadriplegia, cranial nerve palsies
and decerebrate rigidity are common findings.
32. Diagnosis
• Lumber puncture- elevated CSF pressure 30-
40 cm of water, CSF show lymphocytic
pleocytosis, elevated protein
• CT scan- reveal basal exudates, inflammatory
granulomas, hydrocephalus,
• Serological tests.
35. Prognosis
• Poorer in young children.
• Stage 1 disease- recovery.
• Stage 2 disease- mortality 20-25% cases, 25%
are the neurological deficits
among survivors.
• Stage 3 disease- mortality 50% cases, almost
all have neurological deficits
among survivors.
37. Treatment
• Steroids – reduce the intensity of cerebral
edema, risk of development of arachnoiditis,
fibrosis, spinal block.
• Symptomatic therapy.
39. Japanese Encephalitis
• Japanese encephalitis caused by JEV which is
spread through mosquito bites.
• Symptoms usually take 5-15 days to develop
fever, headache, vomiting, confusion.
47. Diagnosis
• Careful history.
• Systemic examination.
• CSF cytology, biochemistry, serology and
cultures.
• Serum electrolyte, blood sugar, urea blood
ammonia, metabolic screening, ABG, serum
lactate, urinalysis should be done.
48. Management
Emergency treatment
• Hyperpyrexia- water sponging and anti-pyretics.
• Shock- infusion of appropriate fluid or
vasopressors.
• Blood pressure- dopamine or dobutamine.
• Seizures- diazepam and phenytoin.
• Raised intracranial pressure- mannitol and
corticosteroids.
49. Acute Encephalitis syndrome
• AES is characterized by acute onset of fever
and neurological manifestation.
• Mainly Caused by JEV other causes are
bacteria, fungus, parasites, spirochetes,
chemical and toxins.
• Severe form of leptospirosis and
toxoplasmosis can cause AES.
