medical 5th

1. Reda Said Ramadan
489

2. What is meningitis?……
Meningitis is an inflammation of the meninges, which, if
severe, may become encephalitis, an inflammation
of the brain.

3. Causes of Meningitis
-Bacterial Infections
-Viral Infections
-Fungal Infections
)Crypto co ccus ne o fo rm ans
Co ccidio de s im m itus(
-Inflammatory diseases
)SLE(
Cancer
-Trauma to head or spine.

4. Bacterial meningitis…..
Etiological Agents:
Newborn : G.B.Stre pto co ccus, E. co li, Liste ria, Staph. aure us
Infancy : Pneumococcus, Meningococcus ,H. Influenza type
b.
Older children : Pneumococcus, Meningococcus

5. Specific RiskFactors
Pneumococcus: (40%)Otitis media, head injury, pneumonia,
immunocompromised
N meningitidis: (30%) – Children and adolescents
Staphylococcus: Penetrating skull injury, ear or neuro operations
Fungal: HIV and organ transplantListeria: Extremes of age
H Influenzae: (3%) – Head trauma with CSF leak, otitis, sinusitis, anatomica
defects such as dermal sinus tracts.
Anaerobes: Consider brain abscess, elderly

6. Bacterial Meningitis
Potentially life threatening disease.
Pneumococcal meningitis is the most common
type.
Haemophilus meningitis: Since 1985 Incidence
has declined by 95% due to the introduction of
Hae m o philus influe nza b vaccine.
Other bacterial meningitis are less common
overall, but may be more prevalent in newborns,
pregnant women, the elderly and

7. What is Meningococcal disease?
Etiological Agent: Ne isse ria m e ning itidis
Clinical Features: sudden onset. F,H,N,V.
Mode of transmission: direct contact with patients oral or
nasal secretions. Saliva.
Infectious period: as long as meningococci are present in
oral secretions or until 24 hrs of effective antibiotic therapy
Children under five and adolescent most susceptible.
Overcrowding e.g. dormitories and military training camps
predispose to spread of infection.

8. Aseptic Meningitis
Definition: A syndrome characterized by acute onset of meningeal
symptoms, fever, and cerebrospinal fluid pleocytosis, with
bacteriologically sterile cultures.
Laboratory criteria fordiagnosis:
CSF showing ≥ 5 WBC/cu mm
No evidence of bacterial orfungal meningitis.
Case : a clinically compatible illness diagnosed by a physician as
aseptic meningitis, with no laboratory evidence of bacterial or
fungal meningitis
Aseptic meningitis is a syndrome of multiple etiologies (post
infectious- post vaccination- ….) , but most cases are caused by a
viral agent

9. Viral Meningitis
Etiological Agents:
Enteroviruses (Coxsackie's and echovirus): most common.
-Adenovirus
-Arbovirus
-Measles virus
-Herpes Simplex Virus
-Varicella
Modes of transmission:
-Primarily person to person and arthopod vectors forArboviruses
Incubation Period:
-Variable. Forenteroviruses 3-6 days, forarboviruses 2-15 days
Treatment: No spe cific tre atm e nt available . (AcyclovirforHerpetic(
Most patients recovercompletely on theirown.

10. The difference between Meningitis
and Septicaemia
 Meningitis - bacteria enter the blood stream
and travel to the meninges and cause
inflammation.
 Septicaemia - when bacteria are present in the
blood stream they can multiply rapidly and
release toxins that poison the blood. (The rash
associated with meningitis is due to
septicaemia.)
Meningitis and septicaemia often occur together.

11. Symptoms formeningitis and
meningococcal septicaemia:
:Babies and Young Children
-High temperature, fever, possibly with cold hands and feet
-Vomiting or refusing feeds
-High pitched moaning, whimpering cry
-Blank, staring expression
-Pale, blotchy complexion
-Stiff neck
-Arched back
-Baby may be floppy, may dislike being handled, be fretful
-Difficult to wake or lethargic
-The fontanelle (soft spot on babies heads) may be tense or
bulging.

13. Bulging anterior fontanel

14. OlderChildren and Adults
-High temperature, fever, possibly with cold hands and
feet.
-Vomiting, sometimes diarrhoea.
-Severe headache.
-Joint or muscle pains, sometimes stomach cramps.
-Neck stiffness (unable to touch the chin to the chest(
-Dislike of bright lights.
-Drowsiness.
The patient may be confused or disorientated. Fitting may
also be seen.
A rash may develop.

16. Purpuric rash

17. One of the physically
demonstrable symptoms
of meningitis is Kernig's
sign. Severe stiffness of
the hamstrings causes
an inability to straighten
the leg when the hip is
flexed to 90 degrees.
Kernig's sign

18. Another physically
demonstrable symptoms
of meningitis is
Brudzinski's sign.
Severe neck stiffness
causes a patient's hips
and knees to flex when
the neck is flexed.
Brudzinski's sign

19. CSF Analysis

20. What to do if you suspect meningitis or
septicaemia:
 Contact your GP immediately. If you GP is not
available, go straight to your nearest accident
and emergency department.
 Describe the symptoms carefully and say that
you think it could be meningitis or septicaemia
Early diagnosis can be difficult. If you have seen
a doctor and are still worried, don’t be afraid to
ask for medical help again

21. Meningitis and meningococcal septicemia can
affect anyone at any time. Teenagers and
students in particular, are at increased risk.
If you haven’t or can’t remember, getting
vaccinated now is a good way to protect yourself.
But remember, vaccines can’t prevent all forms of
meningitis and septicaemia . So it is very
important that you are aware of the signs and
symptoms so that you can get medical help
urgently if you become ill.
Be aware, be prepared