This document provides information about meningitis, including what it is, its causes, symptoms, and importance for public health. Meningitis is an inflammation of the meninges surrounding the brain and spinal cord. It can be caused by bacteria, viruses, fungi or other factors. Bacterial meningitis requires urgent antibiotic treatment and can be life-threatening. Common symptoms include fever, headache, neck stiffness, and rash. Public education is important for raising awareness of meningitis signs and encouraging timely medical care. Challenges for public health include educating the public and timely reporting, while opportunities include strengthening communication and partnerships.

1. In the name of God

2. MENINGITIS
Meningitis
Master:
Dr.Kermani
By:
Shaghayegh Noorani
Faezeh Sheikolvaezin

4. ?…… What is meningitis
o The brain and spinal cord are covered by connective
tissue layers collectively called the meninges which
form the blood-brain barrier.
(the pia mater (closest to the CNS-1
the arachnoid mater-2
(.the dura mater (farthest from the CNS-3
The meninges contain cerebrospinal fluid (CSF).
Meningitis is an inflammation of the meninges, which, if
severe, may become encephalitis, an inflammation
. of the brain

6. ? W is Meningitis
hat
 Meningitis can be caused by many different
organisms including viruses and bacteria.
 Meningitis, caused by a bacteria, is life
threatening and requires urgent medical attention
and treatment with antibiotics.
 Meningitis caused by a virus is very rarely life
threatening but can cause the body to become
very weak.
 When bacteria invade the body they can cause
meningitis, septicaemia or meningitis and
septicaemia together

7. Causes of Meningitis
Bacterial Infections-
Viral Infections-
Fungal Infections-
Cry p to c o c c us ne o fo rm a ns )
(Co c c id io d e s im m itus
Inflammatory diseases-
(SLE)
Cancer
.Trauma to head or spine-

8. Bacterial meningitis…..
: Etiological Agents
Pneumococcal, Stre p to c o c c us p ne um o nia e 
((3 8 %
(Meningococcal, N is s e ria m e ning itid is (1 4%
e 
(Ha e m o p hilus influe nz a e (4% 
(Staphylococcal, Sta p hy lo c o c c us a ure us (5 % 
Tuberculous, M c o ba c te rium tube rc ulo s is
y 

9. Bacterial Meningitis
.Potentially life threatening disease
.One million cases per year world wide. 200,000 die annually
. Can affect all age groups but some are at higher risk
Treatment available : antibiotics as per causative organism
.Humans are the reservoir
Pneumococcal meningitis is the most common type. Approximately
6,000 cases/yr
Haemophilus meningitis: Since 1985 Incidence has declined by
.95% due to the introduction of Ha e m o p hilus influe nz a b vaccine
Other bacterial meningitis caused by E-Co li K-1, Kle bs ie lla species
and Ente ro ba c te r species are less common overall, but may be
more prevalent in newborns, pregnant women, the elderly and
.immunocompromised hosts

10. ? W is Meningococcal disease
hat
Etiological Agent: N is s e ria m e ning itid is
e
Clinical Features: sudden onset. F,H,N,V
Reservoir: Humans only. 5-15% healthy carriers
Mode of transmission: direct contact with patients oral or nasal
.secretions. Saliva
Incubation period: 1-10 days. Usually 2-4 days
Infectious period: as long as meningococci are present in oral secretions
or until 24 hrs of effective antibiotic therapy
: Epidemiology
. Sporadic cases worldwide
.Meningitis belt” –sub-Saharan Africa into India/Nepal“
.In US most cases seen during late winter and early spring
Children under five and adolescent most susceptible. Overcrowding e.g.
dormitories and military training camps predispose to spread of

11. Aseptic Meningitis
Definition: A syndrome characterized by acute onset of meningeal
symptoms, fever, and cerebrospinal fluid pleocytosis, with
. bacteriologically sterile cultures
:Laboratory criteria for diagnosis
CSF showing ≥ 5 W cu mm
BC/
. No evidence of bacterial or fungal meningitis
Case classification
Confirm a clinically compatible illness diagnosed by a physician as
ed:
aseptic meningitis, with no laboratory evidence of bacterial or fungal
meningitis
Comment
Aseptic meningitis is a syndrome of multiple etiologies, but most cases
are caused by a viral agent

12. Viral Meningitis
: Etiological Agents
. Enteroviruses (Coxsackie's and echovirus): most common
Adenovirus-
Arbovirus-
Measles virus-
Herpes Simplex Virus-
Varicella-
: Reservoirs
Humans for Enteroviruses, Adenovirus, Measles, Herpes Simplex, and-
Varicella
. Natural reservoir for arbovirus birds, rodents etc-
:Modes of transmission
Primarily person to person and arthopod vectors for Arboviruses-
: Incubation Period
Variable. For enteroviruses 3-6 days, for arboviruses 2-15 days-
. Treatment: N s p e c ific tre a tm e nt a v a ila ble
o
.Most patients recover completely on their own

13. Non Polio Enteroviruses
: Types:62 different types known
, Coxsackie A viruses 23 -
, Coxsackie B viruses 6 -
echoviruses, and 5 other 28 -
? H com on
ow m
of all viral meningitis is caused by Enteroviruses 90% -
. Second only to "common cold" viruses, the rhinoviruses-
Estimated 10-15 million/more symptomatic infections/ in US-
yr
. W is at risk? Everyone
ho
H does infection spread?
ow
. Virus present in the respiratory secretions & stool of a patient
. Direct contact with secretions from an infected person
Parents, teachers, and child care center workers may also become infected by
. contamination of the hands with stool

14. The difference between Meningitis
and Septicaemia
When bacteria cause disease i.e.
meningococcal disease the body can be
:affected in different ways
 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.)

15. Symptoms of Meningitis and
Septicemia
Meningitis and meningococcal septicaemia may
not always be easy to detect, in early stages
the symptoms can be similar to flu. They may
develop over one or two days, but sometimes
develop in a matter of hours.
It is important to remember that symptoms do
not appear in any particular order and some
.may not appear at all

16. Symptoms for meningitis 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

18. Older Children 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

20. 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

21. 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

22. In the early stages, signs and
symptoms can be similar to
many other more common
illnesses, foe example flu. Early
symptoms can include fever,
headache, nausea (feeling sick),
.vomiting and general tiredness
The common signs and symptoms
of meningitis and septicaemia
are shown above. Others can
include rapid breathing,
diarrhoea and stomach cramps.
In babies, check if the soft spot
(fontanelle) on the top of the
.head is tense or bulging

23. One sign of meningococcal septicaemia is a
rash that does not fade under pressure
’((see ‘Glass test
This rash is caused by blood leaking -
under the skin. It starts anywhere on the
body. It can spread quickly to look like
. fresh bruises
This rash is more difficult to see on darker -
skin. Look on the paler areas of the skin
.and under the eyelids

24. ’ Glass Test‘
A rash that does not fade
under pressure will still
be visible when the side
of a clear drinking glass
is pressed firmly against
.the skin
If someone is ill or
obviously getting worse,
do not wait for a rash. It
may appear late or not
.at all
A fever with a rash that
does not fade under
pressure is a medical
.emergency

25. 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

26. Be aware, be prepared
Meningitis and meningococcal septicaemia (blood
poisoning) are serious diseases that can affect
anyone at any time. Teenagers and studentsin
particular, are at increased risk.Most young
people in the UK have already had the MenC
vaccine. If you haven’t or can’t remember,
gettingvaccinated now is a good way to protect
yourself.
But remember, vaccines can’t preventall 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

27. Public Health Importance
: Challenges
Educating public-
Timely reporting and records keeping-
.Updating information daily-
Alleviating public anxiety and concerns-
Collaborating with health partners-
: Opportunities
Educating public-
Communication-
Strengthening partnerships-

28. The End