Acute bacterial meningitis is a medical emergency characterized by infection of the membranes surrounding the brain and spinal cord. The classic triad of symptoms includes fever, headache, and neck stiffness. Common causative organisms vary by age but include Streptococcus pneumoniae in about 50% of cases. Diagnosis involves lumbar puncture and CSF analysis showing elevated white blood cells, low glucose, and high protein levels. Treatment involves prompt administration of antibiotics like third generation cephalosporins and vancomycin before diagnostic tests. Outcomes depend on causative organism and presence of complications like seizures, altered mental status, and increased intracranial pressure.
This presentation focuses on Acute Bacterial Meningitis.
Viral and fungal cause is mentioned but focus is on bacterial meningitis in Pediatrics Patient.
Feel free to correct if there is any error.
Refer to other reference books for clarity.
meningitis
types or classification of meningitis
causes of meningitis
signs and symptoms of meningitis
diagnostic evaluation of meningitis
management of meningitis
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Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
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The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
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Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
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Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
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http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
6. What is ? MENINGISM :the symptoms and signs of meningeal irritation assosciated with acute febrile illness or dehydration without actual infection of the meninges…also called meningismus…PSEUDOMENINGITIS.
7. KERNIG’S SIGN Patient to be in supine position. Thigh flexed on abdomen. Knee flexed. Attempt to passively extend knee elicit pain when irritation is present.
8. BRUDZINSKI’S sign Supine position. Passive flexion of neck –spontaneous flexion of hips and knees. Specificity and sensitivity of these tests –UNCERTAIN.
9. Where they could be absent are? Immunocompromised Very young or elderly. Severely depressed mental state. False positive – cervical spine disease..
10. IMPORTANT POINTS.. It is an emergency. Empirical antibiotics to be started. Do CT scan/MRI in case of immunocompromised,recent head trauma,focal neurological deficits ---LP – but AB not to be delayed. No depressed level of consciousness –think of viral meningitis. Immunocompetent ,consciousness good –can be treated on OP basis. Failure of a patient to improve < 48 hrs – reevaluate the patient,repeat LP ,lab studies and neurological examination.
12. It is an acute purulent infection within the subarachnoid space.
13. Most common orgnaisms responsible for community acquired bacterial meningitis S.pneumoniae 50% N.meningitidis 25% Group B streptococci - 15% Listeriamonocytogenes 10% Hemophilusinfluenzae 10%
19. Much of the pathophysiology is due to direct consequence of chemokines,cytokines.
20.
21. Clinical features Decreased level of consciousness >75% Nausea,vomiting,photphobia common Classical triad –less sensitivity Only two may be present nearly in all cases. Seizure –initial presentation in 20-40% cases Focal –focal arterial ischemia,cortical venous thrombosis,focal edema GTCS– hyponatremia,anoxia,high dose penicillin. RAISED ICP- >90 % have CSF pressure – 180mmH20 20% -- 400mm H20 Rash of meningococcemia – diffuse,petechial;
22. DIAGNOSIS CSF analysis Blood cultures CT scan/MRI --- LP Latex agglutination – S.pneumoniae,N.meningitidis Lumuluslysate –gram negative In case of immunocompetent,no h/o head trauma,no evidence of papilledema –LP without CT scan AB therapy to be started hrs before LP –no change in analysis,or visualization of organisms
24. CSF glucose may be zero – CSF/serum glucose corrects for hyperglycemia CSF/s.glucose < 0.6 CSF/s.glucose < 0.4 – bacterial,fungal,tuberculosis,carcinomatosis 30 min to several hours to reach equilbrium with blood glucose levels –so can start 50 ml of 50 % D. PCR –useful in pretreated pts,gram stain negative MRI >CT for cerebral edema Diffuse meningeal enhancement --gadolinium –increased permeability of BBB.
27. Treatment BEGIN AB < 60 min Empirical treatment –dexamethasone,cefotaxime or ceftriaxone,vancomycin,azithromycin,acyclovir,doxycycline. Post op cases –ceftazidime,cefepime,meropenem,vancomycin Then change according to culture reports
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29. Meningococcal PENICILLIN G is DOC In case of resistance – Ceftriaxone,cefotaxime Uncomplicated course--7 day course. All close contacts should receive chemoprophylaxis – 2 day regimen of rifampicin 600 mg every 12 hrs * 2days/ciprofloxacin 750 mg od/azithromyxin 500 mg OD/ceftriaxone 250 mg OD Who are close contacts --- nasopharyngeal secretions,kissing,toys,beverages use.
30. pneumococcal Cephalosporin plus vancomycin If resistance – vancomycin Rifampin can be added synergistic action 2 week course Repeat LP after 24-36 hrs –sterilization of CSF –if not introventricularvancomycin
31. Listeria and others Ampicillin for 3 weeks Gentamicin 2mg/kg/d loading – 7.5 mg/kg/d every 8hrs TMP SMX –every 6hrs STAPHYLOCOCCAL –vancomycin Gram negative – 3 weeks of third generation cephalosporin.
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33. Adjunctive therapy Dexamethasone – decreases synthesis of IL1,TNF,stabilises BBB 20 min before AB Rx Inhibits TNF production by macrophages only before activated by endotoxin. Decreases penetration of vancomycin into CSF. 10 mg IV 30 min before AB every 6hrs -4 days.
34. Raised ICP Elevate head end of bed 30-45 Intubation Hyperventilation PaCo2 – 25-30 mm Hg mannitol
36. Who are at risk of poor prognosis Decreased level of consciousness at admission Seziures < 24 hrs of onset Raised ICP Young age,>50 yrs Mechanical ventilation Delay in treatment <40 mg /dl -glucose >300 mg/dl -protein
38. SUMMARY Acute bacterial meningitis is an emergency Triad is seen less commonly Pathognomonic feature is neck rigidity Altered level of consciousness and seziures can be the presenting features. S pneumoniae is the most common organism overall Other organisms based on the age ,and clinical background CSF analysis after CT scan is the rule… PMNs,hypoglycoracchchia,raised proteins and pressure is the hallmark PCR to be done only in negative cases MRI for cerebral edema
39. Antibiotics for a week in case of uncomplicated meninogcocci,2 weeks in s pneumoniae,3 weeks listeria. All close contacts to be given chemoprophylaxis in case of meningococci with rifampicin 600 mg bid for 2 days. Triad of meningitis is fever,headache,neckstiffness Postoperative cases think of s aurues,gram negative. Ampicillin to be given in case of suspicion of listeria for 3 weeks S. pneumoniae has high mortality of 20%
40. Antibiotic treatment not to be delayed for the results of investigations Third generation cephalosporins,vancomycin,ampicillindurgs empirically will cover all organisms. Dexamethasone for stabilisingBBB,to be given beofre AB. HSV encephalitis is closest DD 1 week therapy in case of meningococci,2 weeks pneumoniae,3 weeks –listeria Raised ICP –hyperventilate,raise head end,mannitol Sequelae decrease on early management 20% mortality in case of s.pneumoniae Thank you