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Meningitis
- 1. Pokhara University School of Health and Allied Sciences Meningitis Presented By: Deepa kumari karn M Pharm (Clinical Pharmacy), 2nd Sem 07/30/17 1
- 2. Pokhara University School of Health and Allied Sciences Contents • Overview of Nervous System Types of Nervous system Meninges • Introduction • Clinical Presentations Physical Sign and Symptoms Laboratory Results • Risk Factors • Aetiology 07/30/17 2
- 3. Pokhara University School of Health and Allied Sciences • Pathophysiology • Treatments • Preventive Measures • Case • References 07/30/17 3
- 4. Pokhara University School of Health and Allied Sciences Overview of Nervous System Types of Nervous system 07/30/17 4
- 5. Pokhara University School of Health and Allied Sciences Meninges 07/30/17 5
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- 7. Pokhara University School of Health and Allied Sciences Introduction • Acute inflammation of the membranes (meninges) surrounding brain and spinal cord • Caused when the protective membranes around the brain and spinal cord known as the meninges become infected • It is not known why one person gets meningitis when others exposed to the same germs do not get as sick, or don't get sick at all 07/30/17 7
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- 9. Pokhara University School of Health and Allied Sciences Clinical Presentations 07/30/17 9 Physical Sign and Symptoms
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- 12. Pokhara University School of Health and Allied Sciences Laboratory Results Abnormal CSF-findings by type of meningitis 07/30/17 12
- 13. Pokhara University School of Health and Allied Sciences Risk Factors • Respiratory tract infection • Otitis media • Mastoiditis • Head trauma • Splenectomy • Sickle cell disease • Immunosuppressive therapy • Immunocompromised host • Alcoholic patients • Patients with hardware (shunts, etc.) 07/30/17 13
- 14. Pokhara University School of Health and Allied Sciences 07/30/17 14 Aetiology
- 15. Pokhara University School of Health and Allied Sciences Pathophysiology 07/30/17 15
- 16. Pokhara University School of Health and Allied Sciences 07/30/17 16 • Viral meningites: – Viral meningites can occurs when the protective barrier of the brain- skull , meninges and the blood brain barrier is covered by the viral infecting agent. – The infection may be caused either by the haematological route (as in the tubercular meningites, HIV infection, respiratory meningites) or by neurotropic spread of the agent as in the herpex virus, rabiese and polio.
- 17. Pokhara University School of Health and Allied Sciences 07/30/17 17 Infection ( Bacterial, Viral ,Fungal) Inflammations of the Meninges Increased CSF permeability Entry of the blood components into the subarachenoid space Cerebral oedema and elevated CSF protein levels
- 18. Pokhara University School of Health and Allied Sciences 07/30/17 18 Neutrophil migration from blood stream to CSF as well as intracranial hypertension Decrease in cerebral blood flow Anaerobic metabolism ensues, which contributes to increased lactate and decreases glucose concentrations Transient neuronal dysfunction or permanent neuronal injury
- 19. Pokhara University School of Health and Allied Sciences Treatment 07/30/17 19 • The management approach to patients with suspected or proven bacterial meningitis includes emergent cerebrospinal fluid analysis and initiation of appropriate antimicrobial and adjunctive therapies • Empiric antimicrobial therapy should be instituted as soon as possible to eradicate the causative organism • Antimicrobial therapy should last at least 48 to 72 hours or until the diagnosis of bacterial meningitis canbe ruled out
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- 22. Pokhara University School of Health and Allied Sciences • Continued therapy should be based on the assessment of clinical improvement, cultures, and susceptibility testing results • In addition to antibiotics, dexamethasone is a commonly used therapy for the treatment of pediatric meningitis • Dexamethasone should be administered prior to the first antibiotic dose and not after antibiotics have already been started 07/30/17 22
- 23. Pokhara University School of Health and Allied Sciences • Several studies have shown that dexamethasone causes a significant improvement in CSF concentrations of proinflammatory cytokines, glucose, protein, and lactate as well as a significantly lower incidence of neurologic sequelae commonly associated with bacterial meningitis • The commonly used IV dexamethasone dose is 0.15 mg/kg every 6 hours for 4 days. Alternatively, dexamethasone given 0.15 mg/kg every 6 hours for 2 days or 0.4 mg/kg every 12 hours for 2 days is equally effective and a potentially less toxic regimen 07/30/17 23
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- 29. Pokhara University School of Health and Allied Sciences • Preventative antibiotics are of no use following exposure to meningitis caused by Haemophilus influenza, Streptococcus pneumoniae, Listeria monoctogenes, Cryptococcal meningitis, viral (aseptic) meningitis, or West Nile Fever 07/30/17 29
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- 31. Pokhara University School of Health and Allied Sciences Preventive Measures • Vaccinations : The Centers for Disease Control and Prevention recommends getting vaccinated against meningitis at age 11 or 12, followed by a booster shot at age 16 to 18. Getting vaccinated against measles, mumps, rubella, and chickenpox can help prevent diseases that can lead to viral meningitis • Don't Share Personal Items: – Meningitis can be contracted when we come in contact with respiratory or throat secretions — saliva, sputum, nasal mucus — of someone who is infected, either through kissing or sharing personal items 07/30/17 31
- 32. Pokhara University School of Health and Allied Sciences • Keep distance from infected people – The bacteria found in nose and throat secretions can also spread through coughing and sneezing. we could get meningitis if we're close enough to an infected person to come in direct contact with these secretions. If someone we know has a respiratory infection, keep at least 3 feet away. • Wash hands vigorously – the viruses and bacteria responsible for meningitis can get on our hands and into our mouth. We can prevent meningitis from spreading by washing our hands vigorously, especially after we use the bathroom, change a diaper, spend time in a crowded place, and cough or blow our nose 07/30/17 32
- 33. Pokhara University School of Health and Allied Sciences • Boost our Immune System – A healthy immune system can help prevent an infection from the viruses and bacteria that cause meningitis. Keep our immune system at its fighting best by eating healthy including fresh fruits and vegetables, whole grains, and lean proteins and by getting regular exercise. • Get Prompt Treatment – If we have been in close contact with someone who has bacterial meningitis, call our doctor right away. Our health care provider can give us antibiotics to keep us away from developing meningitis 07/30/17 33
- 34. Pokhara University School of Health and Allied Sciences Case • A 4-week-old premature infant presents on the hospital neonatal unit with poor feeding, fever and increasing drowsiness. Lumbar puncture reveals 1200 WBC/μL (80% of which are polymorphs),and low glucose and elevated protein levels. No organisms are seen on a Gram-stained smear of the CSF. The diagnosis is acute purulent meningitis. • Questions: – What are the likely aetiological agents? – Which other investigations other than CSF culture might help in establishing the aetiological diagnosis? – What empiric antibiotic therapy should be commenced? 07/30/17 34
- 35. Pokhara University School of Health and Allied Sciences References 07/30/17 35 • Walker R and Whettlesa C (2012),Clinical Pharmacy and Therapeutics (5th ED), Churchill Livingstone Elsevier, Edinburgh (584-596). • Wells GB, Dipiro JT, Schwinghammer T, Diporo CV(2008) Pharmacotherapy Handbook (7th ED), The MCGraw-Hill, London(387- 399). • Harrison T (2008) Principles of Internal Medicine ((17th Ed), Mc Graw Hill Lange Medical Publication, United State America (885-995) . • Kumar R. (2005) "Aseptic Meningitis: Diagnosis and Management " Advances in Pediatrics 72(1).
- 36. Pokhara University School of Health and Allied Sciences • URL 1 : http://www.everydayhealth.com/hs/understanding-meningitis/prevent-mening (Assessed on July 29 2017) 07/30/17 36
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