Definition Symptoms Signs in newborns Causes Bacterial meningitis Risk factors Complications Lab Diagnosis Treatments and drugs Prevention Immunizations

2.  Definition
 Symptoms
 Signs in newborns
 Causes
 Bacterial meningitis
 Risk factors
 Complications
 Lab Diagnosis
 Treatments and drugs
 Prevention
 Immunizations

3.  Meningitis is an inflammation of the
membranes (meninges) surrounding brain and
spinal cord.

4. The signs and symptoms that may occur in anyone
older than age of 2 include:
 Sudden high fever
 Severe headache that isn't easily confused with other
types of headache
 Stiff neck
 Vomiting or nausea with headache
 Confusion or difficulty concentrating
 Seizures
 Sleepiness or difficulty waking up
 Sensitivity to light
 Lack of interest in drinking and eating
 Skin rash in some cases, such as in meningococcal
meningitis

5. Newborns and infants may not have the classic signs
and symptoms of headache and stiff neck. Instead,
signs of meningitis in this age group may include:
 High fever
 Constant crying
 Excessive sleepiness or irritability
 Inactivity or sluggishness
 Poor feeding
 A bulge in the soft spot on top of a baby's head (fontanel)
 Stiffness in a baby's body and neck

6.  Bacterial meningitis
 Viral meningitis
 Chronic meningitis
 Fungal meningitis
 Other meningitis causes

7.  Streptococcus pneumoniae(pneumococcus)
 This bacterium is the most common cause of
bacterial meningitis in infants, young children and
adults.
 It more commonly causes pneumonia or ear or sinus
infections.
 There is a vaccine to help reduce the occurrence of
this infection.

8.  Neisseria meningitidis (meningococcus).
 This bacterium is another leading cause of bacterial
meningitis.
 Meningococcal meningitis commonly occurs when
bacteria from an upper respiratory infection enter
bloodstream.
 This infection is highly contagious.
 There is a vaccine to help reduce the occurrence of
this infection.

9.  Haemophilus influenzae (haemophilus).
 Haemophilus influenzae type b (Hib) bacterium used
to be the leading cause of bacterial meningitis in
children.
 New Hib vaccines — available as part of the routine
childhood immunization

10.  Listeria monocytogenes (listeria).
 These bacteria can be found in soft cheeses, hot
dogs and luncheon meats.
 Fortunately, most healthy people exposed to listeria
don't become ill, although pregnant women,
newborns, older adults and people with weakened
immune systems tend to be more susceptible.
 Listeria can cross the placental barrier, and
infections in late pregnancy may cause a baby to be
stillborn or die shortly after birth.
 People with weakened immune systems, due to
disease or medication effect, are most vulnerable.

11.  Skipping vaccinations. If child hasn't completed the
recommended childhood or adult vaccination schedule,
the risk of meningitis is higher.
 Age. Most cases of viral meningitis occur in children
younger than age 5. Bacterial meningitis commonly
affects people under 20, especially those living in
community settings.
 Living in a community setting. College students
living in dormitories, personnel on military bases, and
children in boarding schools and child care facilities are
at increased risk of meningococcal meningitis. This
increased risk likely occurs because the bacterium is
spread by the respiratory route and tends to spread
quickly wherever large groups congregate.

12.  Pregnancy. If pregnant, at increased risk of
contracting listeriosis — an infection caused by
listeria bacteria, which also may cause meningitis.
If have listeriosis, unborn baby is at risk, too.
 Compromised immune system. Factors that may
compromise immune system — including AIDS,
alcoholism, diabetes and use of
immunosuppressant drugs — also make more
susceptible to meningitis. Removal of spleen, an
important part of immune system, also may
increase risk.

13.  Hearing loss
 Memory difficulty
 Learning disabilities
 Brain damage
 Gait problems
 Seizures
 Kidney failure
 Shock
 Death

14.  CSF EXAMINATION
 HISTOPATHOLOGY
 LATEX AGGLUTNATION
 POLYMERASE CHAIN
REACTION
 VIRAL CULTURE
 RAPID DIAGNOSTIC
TESTS (RDT)
 SEROLOGIC STUDIES
 OTHER LAB STUDIES

15.  Laboratory examination of the CSF is usually the
first step to confirm the presence of meningitis.
 Cytological examination should precede
centrifugation and heating of CSF.

16.  Spinal tap (lumbar puncture). The definitive
diagnosis of meningitis requires an analysis of
cerebrospinal fluid (CSF), which is collected
during a procedure known as a spinal tap. In
people with meningitis, the CSF fluid often
shows a low sugar (glucose) level along with an
increased white blood cell count and increased
protein.

18.  The typical profile:
CSF opening pressure: 50–180 mmH2O
Glucose: 40–85 mg/dL.
Protein (total): 15–45 mg/dL.
Leukocytes (WBC): 0–5/µL (adults / children); up to
30/µL (newborns).
Culture: sterile.
Gross appearance: Normal CSF is clear and
colorless.
Differential: 60–70% lymphocytes; up to 30%
monocytes
and macrophages; other cells 2% or less.

19.  Glucose (mg/dL): Normal (> 40 mg/dL.)
 Protein (mg/dL) <100 mg/dL (moderate
increase)
 WBCs (cells/µL) < 100 cells/µL.
 Cell differential: Early: neutrophils. Late:
lymphocytes.
 Culture: Negative
 Opening Pressure Usually normal

20.  Glucose (mg/dL): Normal to marked
decrease. <40 mg/dL.
 Protein (mg/dL): (Marked increase) > 250
mg/dL.
 WBCs (cells/µL): >500 (usually > 1000). Early: May
be < 100.
 Cell differential: Predominance of
Neutrophils (PMNs)
 Culture: Positive
 Opening Pressure: Elevated

21.  Neutrophils fill the
subarachnoid space
in severely affected
areas and are found
predominantly around
the leptomeningeal
blood vessels in the
less severe cases.

24.  Positive reaction: agglutination (or visible
clumping) of the latex particles and slight clearing
of the suspension occurs within 2-10 minutes .
 Negative reaction: the suspension remains
homogenous and slightly milky in appearance.

25. POLYMERASE
CHAIN REACTION
 Amplification of virus specific
DNA or RNA from CSF using
PCR amplification has become
the single most effective method
for diagnosing CSF viral
infections.
 It is a highly sensitive and
specific test since only trace
amounts of the infecting agent's
DNA is required.
 It may identify bacteria in
bacterial meningitis and may
assist in distinguishing the
various causes of viral
meningitis.

26.  The sensitivity of CSF cultures for the
diagnosis of viral meningitis is poor in
comparison to the detection of bacterial
meningitis.
 Viruses may also be isolated from throat
swabs, blood and urine.
 Enterovirus and adenoviruses maybe found in
the feces.

30.  Crucial diagnostic tool
 Serum antibody detection is less useful for viruses with
high prevalence rates in the general population.
 For viruses with low prevalence rates , diagnosis of
acute viral infection can be made by documenting
 Seroconversion between acute phase and
convalescent sera.
 The documentation of synthesis of virus specific
antibodies in CSF is more useful than serum serology
alone.

31.  RDTs have been developed for direct testing of
CSF specimens without prior heat or
centrifugation.
 The test is based on the principle of vertical
flow immunochromatography.
 Gold particles and nitrocellulose membranes
are coated with monoclonal antibodies to
capture soluble serogroup-specific
polysaccharide antigens in the CSF.

32.  Appearance of red lines on the dipsticks will indicate
whether one of the four meningococcal serogroups has
been detected in the CSF.
 The upper line on the dipstick is the positive control
and should always be present.
 If the CSF is positive for one of the serogroups, a lower
red line will also be present. The position of that red
line indicates the specific serogroup based on the RDT
that was tested.
 A negative result consists of a single upper pink control
line only.

34.  CBC (complete blood count) & DLC (differential
leucocyte count)
 Liver and Renal function tests
 ESR (erythrocyte sedimentation rate)
 C- Reactive protein
 Electrolytes etc
 MRI and CT are not necessary in patients with
uncomplicated meningitis.
 They may be performed in patients with altered
consciousness, seizures etc

35.  Imaging. X-rays and computerized
tomography (CT) scans of the head, chest or
sinuses may reveal swelling or inflammation.
These tests can also help doctor look for
infection in other areas of the body that may be
associated with meningitis.

37.  Bacterial meningitis
 Acute bacterial meningitis requires prompt
treatment with intravenous antibiotics and, more
recently, cortisone medications, to ensure recovery
and reduce the risk of complications, such as brain
swelling and seizures. The antibiotic or
combination of antibiotics that your doctor may
choose depends on the type of bacteria causing
the infection. Your doctor may recommend a
broad-spectrum antibiotic until he or she can
determine the exact cause of the meningitis.
 Infected sinuses or mastoids — the bones behind
the outer ear that connect to the middle ear — may
need to be drained.

38.  Wash hands.
 Practice good hygiene.
 Stay healthy
 Cover your mouth.
 pregnant, take care with food.

39.  Haemophilus influenzae type b (Hib) vaccine.
 Pneumococcal conjugate vaccine (PCV7).
 Haemophilus influenzae type b and Neisseria
meningitidis serogroups C and Y vaccine (Hib-
MenCY).
 Pneumococcal polysaccharide vaccine
(PPSV).
 Meningococcal conjugate vaccine (MCV4).