Meningitis

1. MENINGITIS
By Dr. Wafa Zahra
House officer peads-II

2. Definition:
Meningitis is defined as inflammation
(swelling) of the membranes surrounding
the brain and spinal cord, including dura,
arachnoid and pia matter.
Meningoencephalitis represents
inflammation of both the meninges and
the cortex of the brain.

4. AETIOLOGY
 Bacterial meningitis- caused by bacteria and can e deadly
 Viral meningitis- caused by viruses and often less severe
 Fungal meningitis- caused by fungi and its mostly rare, people get it by
inhaling fungal spores
 Parasitic meningitis- much less common
 Amebic meningitis- primary amebic meningoencephalitis is rare but
devastating infection caused by Naegleria fowleri
 Non infectious meningitis- sometime cancers, SLE, certain drugs, head injury
and brain surgery can also cause this.

5. PYOGENIC MENINGITIS
 INCIDENCE it can occur at all ages but more common in infancy
 CAUSATIVE AGENTS RESPONSIBLE AT DIFF AGES

6. CLINICAL FINDINGS
 High grade fever ( 100 F or 38. 2 C)
 Infant does not look well, feeds poorly and develop hypothermia, vomiting,
irritability
 Bulging ant fontanelle, head retraction, high pitched cry
 Seizures
 Neck stiffness, Kernig's positive (flexion of leg 90 deg at hip with pain on
extension of leg thereafter) positive Brudzinski ( involuntary flexion of legs
when neck is placed in flexion)
 Cranial nerves palsy and papilledema
 Hemiplegia, ataxia
 Generalized pruritic rash, purple mottling of skin, peripheral cyanosis
 Otitis media or mastoiditis

8. DIAGNOSIS
 LUMBAR PUNCTURE

9. DIAGNOSIS
 CSF culture
 Blood culture its mostly positive in case of H. influenza, and 80 percent in
case of S. pneumonia
 Blood count total and differential count
 Chest Xray to rule out pneumonia and tb
 CT scan
 Rapid diagnostic tests ELISA, CSF lactase ldh, enzyme radioisotope assay,
latex particle agglutination test lpa
 Gram staining pneumococci- gram positive diplococci
Influenzas- gram neg coccobacilli
E.coli- gram neg bacilli
Meningococci- gram neg intracellular diplococci

10. MANAGEMENT
 SUPPORTIVE MEASURES
 The first 3- 4 days of treatment of bacterial meningitis are critical and
requires intensive care
 Vitals should be monitored every 15-30 mins until pt. is stable
 Frequent neurological assessment like papillary reflexes, LOC, cranial nerves
signs
 Measure head circumference
 Strict intake output record
 Pt daily body weight and serum electrolytes
 Control temperature with sponging and antipyretics
 Feeding should be continued
 Fluid restriction to 60-70% because of fear of SIADH
 For seizures IV diazepam is given as 0.1-.2 mg/kg/dose

11. MANAGEMENT
 SPECIFIC MEASURES
 Antibiotics:

12. MANAGEMENT

13. MANAGEMENT
 Steroids:
DEXAMTHASONE in a dose of 0.6 mg/kg/day in 2-4 divided doses for –
days
 TREATMENT OF COMPLICATIONS:
 Cerebral edema and raised icp: elevate the head, steroid therapy an
mannitol
 Subdural effusions: aspiration of effusion
 SIADH: fluid restriction and diuretics
 Shock ( warehouse Friedrichsen syndrome): normal saline or plasma,
steroids, dopamine infusions

14. COMPLICATONS
 Raised intracranial pressure
 Cranial nerves palsy
 Seizures, stroke
 SIADH
 Hydrocephalus
 Sub Dural effusions
 Cerebral infarcts
 Anemia
 Cerebral or cerebellar herniation
 Epilepsy
 Deafness

15. PREVENTION
 VACCINATION:
1. Pneumococcal polysaccharide- it’s a 23 valent vaccine, effective
in children older than 17 months. Dose is 0.5 ml IM single dose.
2. Meningococcal vaccine- it’s a quadrivalent vaccine (A, C, Y,
W135), Recommended in children with defects of the terminal component of
complement cascade.
3. H. Influenza vaccine- given to all infants above 2 months of age.
 ANTIBIOTIC PROPHYLAXIS:
1. Meningococcal- Rifampicin, dose is 10mg/kg (max 600mg)
given every 12 hourly.
2. H. Influenza- Rifampicin, dose is 20mg/kg ( max 600mg) given
once daily for 4 days.

16. TUBERCULOUS MENINGITIS
 It’s a inflammation of leptomeninges (pia, arachnoid) by Mycobacterium
tuberculosis
 The max risk of TBM is within 6months of primary infection.
CLINICAL FINDINGS:
 STAGE 1 (PRODROMAL) it lasts for 1-2 weeks, non specific symptoms, child
becomes listless, irritable, loses interest in playing, fever, wt. loss, headache.
No foal neurologic signs
 STAGE 2 Its onset is abrupt, signs of meningeal irritation appears, positive
Kernig's and Brudzinski sign, neck stiffness present, headache is cardinal
symptom, fever. CN 3, 6, 7 palsy common, in infants ant fontanelle bulges
and sutures become separated ( crackpot sign )
 STAGE 3 Child becomes comatose, hemi and paraplegia, opisthotonos
develops. Taches-cerebral is seen by stroking the skin with blunt obj

17. DIAGNOSIS
 Clinical suspicion
 Blood – ESR high, predominant lymphocytosis
 CXR
 Lumbar puncture- CSF findings
 CT scan
 Gastric lavage or sputum examination
 LN biopsy
 Fundoscopy

18. MANAGEMENT
 GENERAL MEASURES:
 Corticosteroid therapy, Prednisolone is given in a dose of 1-2 mg/kg/d for
6-8 weeks
 Record vitals
 Phenobarbitone, to control convulsions, dose is 5 mg/kg/day
 Antipyretic
 Pyridoxamine- 10mg daily,
 Give tube feeding
 Prevent bed sores
 Care of comatose, bowl and bladder

19. MANAGEMENT
 SPECIFIC TREATMENT:
 Isoniazid- dose is 10-15mg kg/day
 Rifampicin – dose is 10-20mg/kg/day
 Pyrazinamide- dose is 30mg/ k/day
 Streptomycin- dose is 20-40mg/kg/day
 Ethambutol- dose is 15-25m/k/day

20. COMPLICATIONS
 Mental retardation
 CN palsy 3. 6. 7
 Blindness due to optic atrophy
 Deafness
 hydrocephalus,
 Epilepsy
 Hemi para or monoplegia
 Endocrine disturbances like DI
 Tuberculoma

21. THANK YOU!