The document discusses meningitis and encephalitis. It defines meningitis as an inflammation of the protective membranes covering the brain and spinal cord, known as the meninges. There are various causes of meningitis including bacterial, viral, parasitic and non-infectious. Common symptoms include headache, fever and neck stiffness. Diagnosis involves spinal fluid analysis and imaging. Treatment depends on the cause but may include antibiotics, antivirals or antifungals. Encephalitis additionally involves inflammation of the brain tissue and can be caused by viruses, bacteria, parasites and fungi. It presents with fever and neurological symptoms. Treatment focuses on the underlying cause and management of symptoms.

1. RATHEESH R L

2.  Meningitis is an acute inflammation of the
protective membranes covering the brain and
spinal cord, known collectively as the
meninges.

3.  Bacterial
 Aseptic
 Viral
 Parasitic
 Non infectious

4.  In premature babies and newborns up to three
months old-group B streptococci,Escherichia coli.
 Listeria monocytogenes may affect the newborn
 Older children- neisseria meningitidis streptococcus
pneumoniae
 under five- haemophilus influenzae type B
 In adults, N. meningitides and S. pneumoniae
together cause 80% of all cases of bacterial
meningitis
 L. monocytogenes in those over 50 years old

5.  Recent trauma to the skull
 Individuals with a cerebral shunt or related device
(such as an extra ventricular drain)- infection with
staphylococci pseudomonas and gram negative
bacilli
 In a small proportion of people, an infection in the
head and neck area such as otitis media or
mastoiditis can lead to meningitis.
 Recipients of cochlear implants for hearing loss are
at increased risk of pneumococcal meningitis

6.  Tuberculous meningitis, meningitis due to infection
with mycobacterium tubercle
 Recurrent bacterial meningitis may be caused by
persisting anatomical defects, either congenital or
acquired.
 Anatomical defects allow continuity between the
external environment and the nervous system.
 common cause of recurrent meningitis is skull
fracture; particularly fractures that affect the base
of the skull or extend towards the sinuses.

7.  Endocarditis ( Infection of the heart valves with the
spread of small clusters of bacteria to the blood stream)
may cause aseptic meningitis.
 Aseptic meningitis also result from the infection with
spirochetes.
 Meningitis may be encountered in cerebral malaria (
malaria infecting the brain ).
 Fungal meningitis Eg: due to cryptococeus Neo formans is
typically seen in people with immune deficiency such as
AIDS.
 Amoebic meningitis due to the infection with Amoebae
such as naegleria fowleria, is contacted from fresh water
sources.

8. Viruses that can cause meningitis include
 Entero viruses
 Herpes Simplex virus type 2
 varicella zoster virus ( known for causing
chickenpox )
 Mumps Virus
 HIV.

9.  A parasitic cause is often assumed when
there is predominance of Eosinophils in the
CSF.
 Most common parasites are angiostrongylus
cantonensis and gnathostoma spinigerum.
 Tuberculosis, Syphilis and Cryptococeosis are
rare causes of Eosinophilic Meningitis

10.  Spread of cancer to the meninges ( Malignant
Meningitis )
 certain drugs ( mainly non steroidal anti
inflammatory drugs, antibiotics and intravenous
immunoglobulins )
 Inflammatory conditions such as sarcoidosis and
connective tissue disorders such as systemic lupus
erythematosus.
 Epidermoid cysts and dermoid cysts may cause
Meningitis by releasing irritant matter into the
subarachnoid space.

11.  In adults, a severe headache is the most
common symptom of meningitis
 Followed by nuchal rigidity
The classic triad of diagnostic signs consists of
 nuchal rigidity
 sudden high fever
 altered mental status.

12.  photophobia(intolerance to bright light)
 phonophobia(intolerance to loud noises)
 positive kerning’s sign
 positive brudzinski’s sign
 The rash consists of numerous small, irregular,
purple or red spots on the trunk, lower
extremities, mucous membranes, conjunctiva,
and palms of the hands or soles of the feet

13.  is positive when the thigh is flexed at the hip
and knee at 90 degree angles, and
subsequent extension in the knee is painful

14.  Severe neck stiffness causes a patient's hips
and knees to flex when the neck is flexed.

16.  Increased intracranial pressure.
 Residual neurological dysfunction.
 Cranial nerve dysfunction often occurs with
cranial nerves III, IV,VI, or VIII in bacterial
meningitis.

17.  The optic nerve(CNII) is compressed by increased
intracranial pressure. Papilledema is often present and
blindness may occur
 When the occulomotor(CN III) trochlear(CNIV) and
abducens(CN VI) nerves are irritated, occular
movements are affected. Ptosis, unequal pupils and
diplopia are common
 Irritation of the trigeminal nerve(CNV) is evidenced by
sensory losses and loss of the corneal reflex
 Irritation of the facial nerve(CNVII)results in facial
paresis
 Irritation of the vestibulocochlear nerve(CNVIII) causes
tinnitus, vertigo, and deafness

18.  Acute cerebral edema may occur with bacterial
meningitis, causing seizures, CNIII palsy,
bradycardia, hypertensive coma and death
 A non communicating hydrocephalus
 The syndrome is manifested by petechiae,
disseminated intravascular coagulation and adrenal
hemorrhage
 Disseminated intra vascular coagulation

19. TREATMENT OF BACTERIAL MENINGITIS
Antibiotics
 Ceftriaxone, one of the third generation
cephalosporins antibiotics
 Empiric antibiotics (treatment without exact
diagnosis) must be started immediately
 Empirical treatment consists of a third
generation cephalosporin such as cefotaxime or
ceftriaxone.

20. Steroids
 Adjuvant treatment with corticosteroids(usually
dexamenthasone) -to reduce rates of mortality,
severe hearing loss and neurological damage in
adults and adolescents.
 mechanism is suppression of overactive
inflammation.
 Professional guidelines recommend the
commencement of dexamenthazone or a similar
corticosteroid just before the first dose of
antibiotics is given and continued for four days.

21. TREATMENT OF VIRAL MENINGITIS
 Requires supportive therapy only.
 Herpes simplex virus and varicella zoster
virus may respond to the treatment with
antiviral drugs such as acyclovir.
 Mild cases of viral meningitis can be treated
at home with conservative measures such as
fluid, bed rest and analgesics

22. TREATMENT OF FUNGAL MENINGITIS
 Fungal meningitis such as cryptococcal
meningitis is treated with long courses of
highly dosed antifungals such as
amphotericin B and flucytosine.
 Frequent lumbar punctures

23.  Meningococcus vaccine
 Routine vaccination against streptococcus
pneumoniae with the pneumococcal conjugate
vaccine
 Childhood vaccination with Bacillus Calmette
Guerin
 In cases of meningococcal meningitis,
prophylactic treatment of close contacts with
antibiotics (e.g rifampicin, ciprofloxacin or
ceftriaxone) can reduce their risk of contracting
the condition
 Hib vaccine provides long lasting immunity.

24. The specific measures for preventing or reducing your risk
for viral meningitis includes:
 Following good hygienic practices
 Wash your hands thoroughly and often.
 Cleaning contaminated surfaces, such as handles and
door knobs
 Cover your cough
 Avoid kissing or sharing a drinking glass, eating utensil,
lip stick or other items with sick people or with others
when you are sick.
 Receiving vaccinations included in the childhood
vaccination schedule
 Avoid bites from mosquitoes and other insects that carry
diseases

25. ENCEPHALITIS

26.  Encephalitis is irritation and swelling
(inflammation) of the brain, most often due
to infections.

27. Viral
Exposure to viruses can occur through:
 Breathing in respiratory droplets from an
infected person
 Contaminated food or drink
 Mosquito, tick, and other insect bites
 Skin contact

28. A number of viruses cause encephalitis. These include:
 Measles
 Mumps
 Polio
 Rabies
 Rubella
 Varicella (chickenpox)
Other viruses that cause encephalitis include:
 Adenovirus
 Coxsackievirus
 Cytomegalovirus
 Eastern Equine Encephalitis Virus
 Echovirus
 West Nile virus

29. Bacterial and other
 It can be caused by a bacterial infection,
such as bacterial meningitis, spreading
directly to the brain (primary encephalitis),
or may be a complication of a current
infectious disease syphilis (secondary
encephalitis).
 Certain parasitic or protozoal infestations,
such as toxoplasmosis, malaria, or primary
amoebic meningoencephalitis

30.  Cryptococcus neoformans cause fungal
encephalitis in the immunocompromised.
 Streptococci, Pneumococci, Staphylococci and
certain gram negative bacilli cause ceribritis
prior to the formation of a brain abscess.
 Parasites such as roundworms, cysticercosis,
and toxoplasmosis in AIDS patients and other
people who have a weakened immune system
 Another cause is granulomatous amoebic
encephalitis.

31.  Age.
 Weakened immune system.
 Geographic regions.
 Outdoor activities.
 Season of the year.

32.  Fever that is not very high
 Mild headache
 Low energy and a poor appetite
 unsteady gait
 Confusion, disorientation
 Drowsiness
 Irritability or poor temper control
 Light sensitivity
 Stiff neck and back (occasionally)
 Vomiting

33. Emergency symptoms:
 Loss of consciousness, poor responsiveness, stupor,
coma
 Muscle weakness or paralysis
 Seizures
 Severe headache
 Sudden change in mental functions:
 "Flat" mood, lack of mood, or mood that is
inappropriate for the situation
 Impaired judgment
 inability to make a decision
 Less interest in daily activities
 Memory loss (amnesia), impaired short-term or
long-term memory

34.  CT scan or magnetic resonance imagining
(MRI)
 Electroencephalography
 lumbar puncture
 Blood culture
 Brain biopsy

35. The most severe cases can result in:
 Respiratory arrest
 Coma
 Death
Other complications may persist for many months or be
permanent:
 Fatigue
 Weakness
 Mood disorders
 Personality changes
 Memory problems
 Intellectual disabilities
 Lack of muscle coordination
 Paralysis
 Hearing or vision defects
 Speech impairments

36.  Antiviral medications, such as acyclovir (Zovirax)
and foscarnet (Foscavir)
 Antibiotics -- if the infection is caused by certain
bacteria
 Anti-seizure medications (such as phenytoin) -- to
prevent seizures
 Steroids (such as dexamethasone) -- to reduce
brain swelling (in rare cases)
 Sedatives -- to treat irritability or restlessness
 Acetaminophen -- for fever and headache

37.  Physical therapy
 Occupational therapy
 Speech therapy
 Psychotherapy

38.  Seek early treatment for any high fever or
infections.
 Wear long pants and long-sleeved shirts to avoid
ticks and mosquitoes when in forests or grassy
areas.
 Use insect repellant in exposed areas of the body.
 Avoid spending a long time outdoors during dusk
when insects tend to bite.
 National surveillance and control of mosquitoes
through aerial spraying can keep insect populations
under control.
 Vaccinate children against viruses that can cause
encephalitis (measles, mumps).

39.  Disturbed sensory perception related to
decreased level of consciousness as
evidenced by inaccurate interpretation of
environment, signs of fear or anxiety,
disorientation, restlessness
 Acute pain related to headache and muscle
and joint aches as evidenced by general
discomfort of head, joints and muscles,
apathy, grimacing on movement.

40.  Hyperthermia related to infection and
abnormal temperature regulation by
hypothalamus from increased ICP as
evidenced by increased body temperature
and chills.
 Ineffective therapeutic regimen management
related to lack of knowledge about the
disease process as evidenced by asking
doubts.

41.  Ineffective breathing pattern related to
decreased loss of consciousness and
respiratory fatigue as evidenced by altered
respiratory rate
 Altered cerebral tissue perfusion related to
decreased blood flow due to cerebral edema
as evidenced by altered level of
consciousness
 Risk for injury related to seizure episodes
secondary to disease condition

42.  Risk for aspiration related to decreased level
of consciousness and poor secretion control
 Risk for seizure activity related to cerebral
irritation
 Risk for increased ICP related to presence of
infectious exudates
 Risk for deficient fluid volume related to
increased metabolic rate and decreased oral
intake

43. THANK
YOU….