Infective meningitis is an inflammation of the membranes surrounding the brain and spinal cord caused by various microorganisms. Over 1.2 million cases of bacterial meningitis occur worldwide each year, with 16,217 cases and 300 deaths recorded in India between 2014-2015. Bacterial, viral, fungal, and parasitic infections can all cause meningitis. Clinical presentation varies depending on the causative organism but may include headache, neck stiffness, fever, and vomiting. Diagnosis involves cerebrospinal fluid analysis, CT scan, and PCR testing. Treatment depends on the identified organism and involves antibiotics, antifungals, antivirals, and corticosteroids. Complications can include hearing loss,

1. V.S.Swathi
Assistant
Professor
VIPT, Duvvada
INFECTIVE MENINGITIS

2. Definition
According to CDC, Infective meningitis is an
inflammation of protecting membranes of brain
and spinal cord caused by microorganisms such as
bacteria, virus, fungus, and amoeba.

3. Epidemiology
 Over 1.2 millon cases of bacterial meningitis are
estimated to occur worldwide each year
 Between 2014 and 2015, a total of 16,217 cases
and 300 deaths due to meningitis were recorded in
India

4. Types
Bacterial meningitis
It is a predominant disease in young children
Caused by:
 Neisseria meningitides
 Haemophilus influenzae
 Escheria coli
 Enterobactericiae
 Listeria monocytogenes
 Staphylococcus aureus
 Enterococcus species

5. Viral Meningitis
Caused by:
 Herpes simplex virus
 Human Enterovirus ( Echo virus, Coxsackie virus)
 Varicella zoster
 Mumps
 HIV

6. Fungal Meningitis
Caused by:
 Candida
 Cryptococcus neoformans
 Histoplasma
Parasitic Meningitis
caused by:
 Ameoba

7. Risk factors
 Children
 Elders
 Students
 Immune compromised patients ( HIV, TB, SLE
and Cancer)
 Family members
 Health care workers
 Patients underwent surgeries
 Pregnant women

8. Etiology
 Bacteria
 Viruses
 Fungi
 Protozoa
See in detail in Types

9. Pathogenesis
Bacteria/ Virus/Fungi/Parasite
↓ Risk Factors
Enter in to body via
 Abnormal communication (Trauma and Congenital
anomaly)
 Other source of infections (Ear infections like Otitis media
or Sinusitis)
 Direct spread from nasopharynx
↓
Attach to host mucosal surface
↓
Invade in to meningitis by disrupting BBB
↓

10. Induction of pathophysiological changes in CSF
↓
Vascular leakage
↓
Entry of blood components in subarachnoid space
↓
Cerebral edema, cerebral protein ↑, glucose↓ ,WBC ↑
↓
Intracranial Hypertension
↓
Ischemia
↓
Neurological dysfunction and injury

11. Cellular changes and biochemical responses in
different forms of Infective Meningitis
Type of
meningitis
Cell count and type of
WBC
Protein(g/d) Glucose
Bacterial 500-2000μL-1
Polymorphs
1-3 Less than 50% of
blood glucose
Viral 50-500 μL-1
Lymphocytes
0.5-1 Normal
Fungal 50-1000 μL-1
Lymphocytes
1-3 Less than 50% of
blood glucose
Tubercular 100-600 μL-1
Lymphocytes
1-6 Less than 50% of
blood glucose

12. Clinical Presentation
Bacterial Meningitis in children
 Sudden onset of headache
 Neck stiffness
 Photophobia
 Fever and vomiting
 Kerning’s sign positive
 Seizures
 Haemorrhagic skin rash

14. Bacterial Meningitis in Infants
 Fever
 Diarrhea
 Lethargy
 Feeding difficulty
 Respiratory distress
 Seizures
 Bulging Fontanalle

15. Viral Meningitis
 Acute onset of low grade fever
 Head ache
 Photophobia
 Neck stiffness
 Lack of orientation

16. Fungal and Tubercular Meningitis
 Malaise
 Apathy
 Anorexia

18. Complications
 Hearing loss
 Recurrent seizures
 Problems with memory and concentration
 Problems with co ordination, movement and
balance
 Learning difficulties and behavioural problems
 Vision loss
 Arthritis
 Kidney damage

19. Diagnosis
 CSF analysis
 CT scan
 PCR

20. Non Pharmacological Treatment
 Vaccination
 Avoid sharing of needles
 Maintain good diet
 Surgery in case of cerebral oedema and spinal
abnormalities

21. Treatment Algorithm

22.  Adjunctive therapy with Dexamethasone to reduce inflammation
in brain
 Adults-10mg-QID for 4 days adults
 Paediatrics-0.15mg/kg- QID for 4 days
Viral Meningitis
 Acyclovir-10mg/kg-TID for 10 days
Fungal Meningitis
Amphotericin B –IV-0.7-1mg/kg/day
or
Flucytosine-100mg/kg/day for 6-10 weeks
or
Fluconazole-400mg/day- 10 weeks

23. Tubercular Meningitis
Isoniazid, Rifampicin, Pyrizinamide and Ethambutal
for 2 months
↓
Isoniazid and Rifampicin for 8 months
+
 Prednisolone 20-40mg if on Rifampicin otherwise 10-
20mg (Adults)
 Prednisolone 1-2mg/ Kg (Children)

24. Drugs used in treatment of Meningitis
Drug Category Mode of action Dose Adverse effects
Ampicillin Pencillin Inhibit cell wall synthesis
in bacteria
50mg/kg-BD/
TID
 Hypokelemia
 Hypomagnesemia
 Chills
 Anemia
 Nephrotoxicity
Amoxicillin Pencillin
Inhibit cell wall synthesis
in bacteria
25mg/kg-BD/
TID
 Anaphylaxis
 Anemia
 Hepatotoxicity
 Colitis
 Candidiasis
Cefotaxime Cephalosporin Inhibit cell wall synthesis
in bacteria
50mg/kg-BD/
TID
 Hepatotoxicity
 Colitis
 Candidiasis
 Thrombocytopenia
 Anemia
Ceftazidime Cephalosporin Inhibit cell wall synthesis
in bacteria
50mg/kg-
BD/TID
 Hepatotoxicity
 Eosinophilia
 Diarrhea
 Phlebitis
 GI disturbances
Ceftrioxone Cephalosporin Inhibit cell wall synthesis
in bacteria
75-100mg/kg-
BD
 Induration after injection
 Eosinophilia
 Hepatotoxicity
 Leukopenia
 Anemia

25. Amphotericin B Anti Fungal agent Inhibit cell membrane
synthesis of bacteria
0.7-
1mg/kg/day
IV 6-10
weeks
 Hypokelemia
 Hypomagnesemia
 Anemia
 Chills
 Nephrotoxicity
Flucytosine Anti Fungal agent Inhibit DNA synthesis in
bacteria
100/kg/day
for 6-10
weeks
 Confusion
 Headache
 Hallucination
 Pruritis
 Photosensitivity
Fluconazole Anti Fungal agent Inhibit DNA and lipid
synthesis in bacteria
400mg/day
for 10 weeks
 Headache
 Nausea
 Abdominal pain
 Diarrhea
 Rash
 Vomiting
Acyclovir Anti viral drug Inhibit DNA replication in
bacteria
100mg/kg-
TID
 Malaise
 Inflammation at injection site
 Phlebitis
 GI disturbances
 Hepatotoxicity
Dexamethasone Corticosteroid Reduces inflammation 10mg-QID -4
days
 Dry skin
 Hyperglycaemia
 Cushing syndrome
 Abdominal fat deposition
 Glaucoma

26. Resources
 https://www.ncbi.nlm.nih.gov/pubmed/24440644
 https://www.ncbi.nlm.nih.gov/pubmed/23013403
 https://www.ncbi.nlm.nih.gov/pubmed/20046106
 https://www.ncbi.nlm.nih.gov/pubmed/29642927
 https://www.ncbi.nlm.nih.gov/pubmed/24440644