Meningitis is an inflammation of the protective membranes covering the brain and spinal cord, usually caused by a bacterial or viral infection. It can be life-threatening and is considered a medical emergency. Symptoms may include fever, headache, stiff neck, sensitivity to light, and confusion. Diagnosis involves physical examination, lumbar puncture, and tests of cerebrospinal fluid. Treatment depends on the cause but may include antibiotics, antivirals, or antifungals. Complications can include hearing loss, brain damage, and death. Vaccines can prevent some types of bacterial meningitis.

1. MENINGITIS

2. Meningitis
• Meningitis is an inflammation (swelling) of the protective membranes
covering the brain and spinal cord. A bacterial or viral infection of the fluid
surrounding the brain and spinal cord usually causes the swelling.
However, injuries, cancer, certain drugs, and other types of infections also
can cause meningitis. It is important to know the specific cause of
meningitis because the treatment differs depending on the cause.
• Meningitis can be life-threatening because of the inflammation's proximity
to the brain and spinal cord; therefore the condition is classified as
a medical emergency.

4. Facts Of Meningitis
• Meningitis may develop in response to a number of causes, usually bacteria or viruses
but meningitis can also be caused by physical injury, cancer or certain drugs.
• Viral meningitis is often less severe than bacterial meningitis and usually resolves without
specific treatment.
• Those surviving meningitis can have their lives devastated as a result of long-term effects,
such as deafness, brain damage, learning difficulties, seizures, difficulties with physical
activities and when septicemia is involved loss of limbs.
• Meningitis can be hard to recognize in the early stages. Symptoms can be similar to those
of the common flu, including: fever, vomiting, headache, stiff neck, sensitivity to light,
drowsiness, muscle and leg pain.

5. Epidemiology
• Every year, bacterial meningitis epidemics affect more than 400 million people
living in the 21 countries of the “African meningitis belt” (from Senegal to
Ethiopia). In this area over 800 000 cases were reported in the last 15 years
(1996-2010). Of these cases, 10% resulted in deaths, with another 10-20%
developing neurological sequelae. During the 2010 epidemic season (weeks 26)
22831 cases were recorded in 14 countries under enhanced surveillance. Among
these 22 831 cases there were 2415 deaths.
• Every year, too, an estimated 23,000 children die of bacterial meningitis in
Pakistan. Meningococcus is a germ that causes meningitis in children and adults.
We do not know if this is a common cause of meningitis in Pakistan or not as
epidemiological studies have not been conducted.

6. Risk factors
• Risk factors for meningitis include:
• Skipping vaccinations.
• 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. This
increased risk likely occurs because the bacterium is spread by the respiratory route and
tends to spread quickly wherever large groups congregate.
• Pregnancy. If you're pregnant, you're at increased risk of contracting listeriosis — an infection
caused by listeria bacteria, which also may cause meningitis. If you have listeriosis, your
unborn baby is at risk, too.
• Compromised immune system. Factors that may compromise is immune system —
including AIDS, alcoholism, diabetes and use of immunosuppressant drugs.

7. Classification of Meningitis
• Based on duration:
• Acute: symptoms present within a period of 0-24 hours.
• Sub acute: symptoms lasting from 1-7 days.
• Chronic: symptoms lasting over 7 days.
• Based on etiology:
• Bacterial meningitis
• Viral Meningitis
• Fungal Meningitis
• Parasitic Meningitis
• Non infectious Meningitis Trauma, cancer or certain drugs

8. Bacterial Meningitis
• Causative agents varies according to age:
• Newborn to 3 months: Escherichia Coli,
Group B Streptococci, Listeria
Monocytogenes, Streptococcus
Pneumoniae, Haemophilus Influenzae
type b, Neisseria Meningitides.
• Age 3 months to Adolescence:
Neisseria meningitis, Streptococcus
Pneumoniae, Haemophilus Influenzae
type b. Mycobacterium Tuberculosis is
most common in young children of any
age.
• Adolescence to Young adults: Neisseria
Meningitides, Streptococcus Pneumoniae
• Older Adults: Streptococcus
Pneumoniae, Neisseria Meningitides,
Listeria Monocytogenes
• Streptococcus Pneumoniae is the most
common type of Meningitis. Approximately
6,000 cases/yr. Haemophilus Meningitis
incidence has declined about 95% due to
the introduction of Haemophilus Influenza
b vaccine.

9. Viral Meningitis
• Causative agents:
• Enteroviruses
• Adenovirus
• Herpes Simplex Virus
• Varicella-Zoster Virus
• Mumps Virus
• Measles Virus
• Viral Meningitis is often less severe than Bacterial Meningitis.
• Duration of illness approx 7 to 10 days.
• Viral Meningitis occurs mostly in children younger than age 5.
• There are certain diseases and medications that may weaken the immune system and increase risk
of Meningitis. For example, Chemotherapy and recent organ or Bone Marrow Transplant.

10. Fungal Meningitis
• Causative agents:
• Cryptococcus Neoformans
• Coccidioides Immitis
• Histoplasma Capsulatum
• Aspergillus Fumigatus
• Candida Albicans (Yeast)
• Occurrence: Rare
• Mode of Transmission: Fungal Meningitis is not contagious, usually the result of spread of
a fungus through blood to the spinal cord and also potentially contaminated medication
injected into the body.

11. Parasitic Meningitis
• Causative pathogens
• Angiostrongylus Cantonensis
• Cystic Echinococcosis
• Naegleria Fowler
• Occurrence: Very rare
• Transmission: Spread through Warm Freshwater ( Lake, River &
Swimming Pool )

12. Non Infectious Meningitis
• Causes:
• Cancers
• Systemic Lupus Erythematosus (Lupus)
• Certain Drugs
• Head Injury
• Brain Surgery Mode of Transmission:
• This type of Meningitis is not spread from person to person. NonInfectious
Meningitis can be caused by Cancers, Systemic Lupus Erythematosus (Lupus),
Certain Drugs, Head Injury and Brain Surgery.

14. Clinical Presentation
• Young Infants <3 months:
• • Fever or Hypothermia
• • Bulging Fontanel
• • Convulsion/Seizures
• • High-pitched cry and Irritability
• • Lethargy and Altered Mental
• State
• • Apnea
• • Poor Feeding and Vomiting
Children >3 months to Adolescent:
• Fever (50% of patients)
• Headache, Photophobia, Stiff Neck, Irritability,
Lethargy, Vomiting and Altered Level of
Consciousness

15. Diagnosis
• Physical Examination
• Kerning's Sign: It is an assessed with patient lying in Supine Position with
Hip Joint and Knee Joint flexed to 90 degree. In a patient with Positive
kerning's sign pain limits passive Extension of the Knee.
• Brudzinski`s Sign: A Positive Brudzinski`s sign occurs when flexion of the
Neck causes involuntary flexion of the Knee and Hip Joints.
• Skin rashes

16. Diagnosis
• Lumber Puncture (LP)
• CSF Culture
• Polymerase Chain Reaction (PCR)
• Blood Counts
• Blood Culture
• X-ray Chest
• CT Scan
• Gram Staining

18. Management
• Monitor vital sign hourly (B.P,R/R, Pulse rate, temperature)
• Monitor input and output
• Give treatment as prescribed
• Keep proper ventilation
• Turn patient at every 2 hours
• Monitor the child's state of consciousness and pupil size at every after hours during the
first 24 hours ( thereafter every 6 hours)
• Assess for increased ICP (Intra cranial pressure)
• Measure and records the head circumference of infants
• Document the characteristics of seizure activity and duration
• On discharge ,assess all children for neurological problems, especially hearing loss

19. Treatment
• Bacterial meningitis
• Antibiotics
• Empiric antibiotics (treatment without exact diagnosis) should be started immediately. The
choice of initial treatment depends largely on the kind of bacteria that cause meningitis in
a particular place and population. The empirical treatment consists of a third-
generation cefalosporin such as cefotaxime or ceftriaxone. where resistance to
cefalosporins is increasingly found in streptococci, addition of vancomycin to the initial
treatment is recommended. Chloramphenicol, either alone or in combination
with ampicillin, however, appears to work equally well.
• Steroids
• Additional treatment with corticosteroids (usually dexamethasone) has shown some
benefits, such as a reduction of hearing loss, and better short term neurological
outcomes.

20. Treatment
• Viral meningitis
• Viral meningitis typically only requires supportive therapy; most viruses responsible for
causing meningitis are not amenable to specific treatment. Viral meningitis tends to run a
more benign course than bacterial meningitis. Herpes simplex virus and varicella zoster
virus may respond to treatment with antiviral drugs such as aciclovir, but there are no clinical
trials that have specifically addressed whether this treatment is effective. Mild cases of viral
meningitis can be treated at home with conservative measures such as fluid, bedrest, and
analgesics.
• Fungal meningitis
• Fungal meningitis, such as cryptococcal meningitis, is treated with long courses of high
dose antifungals, such as amphotericin B and flucytosine.

21. Complications
• The complications of meningitis can be severe. The longer the patient has the disease without
treatment, the greater the risk of seizures and permanent neurological damage, including:
• Hearing loss
• Memory difficulty
• Learning disabilities
• Brain damage
• Gait problems
• Seizures
• Kidney failure
• Shock
• Death

22. Prevention
• Wash your hands
• Practice good hygiene
• Stay healthy
• Cover your mouth
• If you're pregnant, take care with food
• Immunizations
• 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)