Meningitis

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meningitis

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Meningitis

  1. 1. MeningitisMeningitis
  2. 2. Meningitis is the inflammation of the membranes surrounding the brain & spinal cord, including the dura, arachinoid & pia matter.
  3. 3. • Meningitis can occur at all ages but it is commonest in infancy. While 95% of the cases take place between 1 month- 5 years of age. • It is more common in males than females.
  4. 4. • The bacteria are transmitted from person to person through droplets of respiratory or throat secretions. • Close and prolonged contact (e.g. sneezing and coughing on someone, living in close quarters or dormitories (military recruits, students), sharing eating or drinking utensils, etc.) • The incubation period ranges between 2 -10 days.
  5. 5. • Bacterial • Viral (aseptic) • Fungal • Parasitic • Non-infectious
  6. 6. N. meningitides G-ve diplococci N. meningitides G-ve diplococci Streptococci-GBS G+ve cocci Streptococci-GBS G+ve cocci Strep. pneumoniae G+ve diplococci Strep. pneumoniae G+ve diplococci E.Coli G-ve bacilli E.Coli G-ve bacilli
  7. 7. • Acute inflammation of the membranes covering the brain and spinal cord with evidence of bacteria and polymorph nuclear leukocytes in CSF •
  8. 8. Pyogenic Meningitis ETIOLOGY • ‘Meningococcal’ meningitis- N. meningitidis. A, B, C and W135) are recognized to cause epidemics • The commonest organisms according to age groups are: 0-2 months0-2 months E.ColiE.Coli, Group B streptococci, S.Aureus, Listeria, Group B streptococci, S.Aureus, Listeria MonotocytogenesMonotocytogenes 2 months- 2yrs2 months- 2yrs H.Influenzae type bH.Influenzae type b, S.Pneumoniae,, S.Pneumoniae, N.Meningitides.N.Meningitides. 2 yrs – 15+yrs2 yrs – 15+yrs N.MeningitidesN.Meningitides (serotypes A,B,C, Y & W135)(serotypes A,B,C, Y & W135) S.PneumoniaeS.Pneumoniae (serotypes 1,3, 6,7)(serotypes 1,3, 6,7) H.InfluenzaeH.Influenzae
  9. 9. • • Most commonly result from haematogenous spraed of the microorganism from distance infection eg: pneumonia • Also from direct spread : sinusitis-mastioditis -otitis media .
  10. 10. • Vary thickness around the brain and spinalcord • Vascular changes: arteritis-thromposis • Damage of the cerebral cortex 2ry to thromposis-hypoxia-bacterial invasion- toxic encephalopathy
  11. 11. 1)Acute onset of fever-anaroxia-N&V and poor feeding. 2)Manifestations of (+++) ICP: headache-projectile vomitting-blurred of vission and papilledema
  12. 12. • Bulging Anterior fontanelle &irritability of the fetus-irregular respiration bradycardia-cranial nerves pulsy
  13. 13. 3)Disturbed level of consciousness from drowsness up to coma 4)Covulsions 5)Sings of meningeal irritation
  14. 14. Meningitis: older children
  15. 15. Septicaemia
  16. 16. • Neck stiffness • Kerning’s sign • Brudzinisky sign • Purpura and shock • Paralytic manifestations (facial nerve pulsy)
  17. 17. Diagnosis 1)Clinical picture 2)LP: CSF collected in 2 sterile tubes one for chemical examination and microscopic study 3)Blood culture and scraping skin lesions culture 4)CT brain
  18. 18. Diagnosis
  19. 19. • .Increase intracranial pressure. • .Unstable patient. • .Skin infection at site of LP. • .Thrombocytopenia. • .Papilloedema.
  20. 20. 1)Hydrocephalus 2)Subdural effusion 3)Vascular collapse (shock) 4)Metstatic infections 5)Different forms of paralysis 6)Brain damage
  21. 21. Prevention: • Isolate the pts. • Contacts of H.Influenza are given Rifampicine (20 mg/kg/dayfor4 days) • Contacts of meningococcal meningitis are given ( Rifampicine (10 mg/kg/12hrs for2days) • No chemoprophlaxsis given for pneumococcal meningitis
  22. 22. TTT • Antipyretic • Care of feeding • Anti covulsants: iv Diazepam slowly 0,1-0.2 mg/kg/dose • Management of increase ICP by: Fursamide 1mg/kg & mannitoleo.5-1 g/kg
  23. 23. TTT • Care of defecation and micturtion and prevent bed sores • Recetly iv:dexamethasone (0.15 mg/kg/dose) given every 6 hrs for 4 day is recommended.
  24. 24. Specific: • Till results of culture present start immediately: 1)ceftriaxone (100mg/kg/day )in 2 divided doses 2) cefotaime (200 mg/kg/day )in 4 divided doses 3) combination bt Ampicillin (300mg/kg/d) and iv chloramphenicol (100mg/kg/d) divided every 6hrs. In infant give ampicillin and cefotaxime
  25. 25. • Subdural ifusion:dialy tapping of subdural space throw lateral angle of anteroir fonanelle • Hydrocephalus shunt operation • Vascular collapse :anti shock management 1) i.v fluid 2)blood &plasma transfision 3)Hydrocortisole i.v. 4)pressor subs to BP as :Dopamine.
  26. 26. • Definition : Acute meningitis where organism could be detected,on direct smear,culture and CSF shows prodominantly lymphocytes.
  27. 27. 1)Infections : * viruses as coxackia,ECHO,mumps, measeles, varicella,herpes simplex and influenza. * Bacteria: mycobacteruim TB. * Recketssia, spirochetes,fungi , protozoa & helminthes
  28. 28. 2)Post infectious (allergic) 3)others: * irritationsof meninges from adjacent lesion as hematomas , tumors and granulomas. * Intrathecal injections as Methotrexate in treatment of leukemia. * Leukemic infiltration.
  29. 29. • Acute or gradual onset • Clinical features of causative infection: (( enlargement of parotid gland in mumps or skin rash in measles)) • CSF exam: * increase cell (( lymphocytes)) * normal or + proteins. * slightly (-) glucose. * organisms can be isolated by special media .
  30. 30. • General : as acute septic meningitis. • Specific : If TB meningitis :Anti T.B drugs. • In viral cause :no specific therapy.

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