- Meningitis is an inflammation of the membranes surrounding the brain and spinal cord. It is more common in neonates and infants due to their immature immune systems. - The highest incidence is between birth and 2 years of age, especially immediately after birth and between 3-8 months. Increased exposure to infections and underlying immune problems increase risk. - Bacteria enter the meninges through the bloodstream from sites like the ears, sinuses, skull fractures, or pneumonia. Common causes vary by age but include E. coli, Group B Strep, and H. influenzae type b. - Symptoms depend on age but may include fever, irritability, neck stiffness, bulging fontanel

1. Presented by:
Dr. SONAM YADAV
Assistant professor
(Kaumarbhritya- Bal Roga)
SRV Ayu. Medical college, Lucknow

2. Meningitis is a term used to describe an
inflammation of the membranes that surround
the brain & the spinal cord.

3. • Acute bacterial meningitis is commoner in neonates and
infants than in older children.
• Their immune mechanism and phagocytic functions are
not fully matured.

4. INCIDENCE:-
The highest incidence of meningitis between birth -2 yrs
of age, with the great risk immediately following birth
and at 3-8 months of age.
Increased exposure to infections and underlying immune
system problems present at birth increase an infant’s risk
of meningitis.

5. modeS OF INFECTION:
The infection spreads hematogeneously to meninges:
 Bacterial sepsis
 Middle ear infection
 Sinusitis
 Mastoidis
 Fracture of the base of skull
 Head injury
 Pneumonia
 Empyema
 Osteomylitis
 Infected ventriculoperitoneal shunts

6. SIGNS & SYMPTOMS
The symptoms of
meningitis vary and
depend on the age of the
child and cause of the
infection. Common
symptoms & signs are:
 Fever
 Lethargy
 Irritability
 Bursting Headache
 Photophobia
 Stiff neck
 Generalised hypertonia
 Brudzinski sign +ve
 Kernig sign+ ve
 Seizures
 Altered consciousness

7.  Other symptoms of meningitis in Neonates/infants can
include:
 Vacant stare
 Projectile vomiting
 Neck rigidity
 Abnormal temperature(hypo/hyperthermia)
 Poor feeding /weak sucking
 A high pitched cry
 Bulging fontanelles
 Poor reflexes

8. PYOGENIC MENINGITIS
ETIOLOGY:
 Meningococcal meningitis ,N. Meningitides( A,B,C
and W135) are recognized to cause epidemics.
 The commonest organisms according to age group are
0-3 months E.coli, Group B streptococci, S.aureus,S.
pneumonie, Salmonella species, Listeria etc.
3 m to 2-3 yrs H. Influenzae type b, S.pneumoniae,
N.meningitides
2 yrs to15yrs
& onwards..
N . meningitides( serotype A,B,C,Y & W135)
S . pneumoniae (serotype 1,3,6,7)
H.influenzae

9. PATHOGENESIS
ENTRY OF ORGANISM THROUGH BBB
RELEASE OF CELL WALL & MEMBRANE PRODUCTS
(TEICHOIC ACIDS & ENDOTOXINS etc.)
TNF,CYTOKINES & CHEMOKINES,PAF(INFLAMMATORY MEDIATORS)
RELEASED
INFLAMED MENINGES COVERED WITH EXUDATE.
MENINGITIS

10. VIRAL MENINGITIS
Viral meningitis comprises most aseptic meningitis
syndromes. The viral agents for aseptic meningitis
include the following:
 Enterovirus
 Herpes virus
 Paramyxovirus
 Togavirus
 Rhabdovirus
 Retrovirus

11. Tuberculous Meningitis
complication of childhood TB & common cause of
prolonged morbidity, handicap & death.
It may occur at any age but most common between 6-
24 months of age.
C/F:
 First phase symptoms( Stage of invasion)
 Onset is insidious with low grade fever,loss of
appetite, disturbed sleep.
 Child doesn’t play,irritable, restless or drowsy.
 vomiting is frequent.
 Older child may complain of headache.
 Possibly preceding history of measles or another
illness with incomplete recovery.

12.  Second phase symptoms( Stage of
meningitis)
 Kernig & Brudzinski sign may become positive,
anterior fontanels bulges (in neonates & infants).
 Twitching of muscles ,convulsions, raised temp.
 Child is drowsy with neck stiffness & rigidity.
 As ds progresses convulsions,neurological deficits
like monoplegia and hemiplagia may occur.
 Sphincter control is usually lost.

13.  Terminal phase symptoms(Stage of Coma)
 Child is characteristically comatose with opisthotonus
& multiple focal paresis.
 Cranial nerve palsies are present.
 Pupils are dilated,often unequal with nytagmus and
squint.
 Ptosis and ophthalmoplegia are frequent.
 High grade fever often occurs terminally.

14. EXAMINATION
 General physical- check for consciousness level
according to GCS scoring, irritability.
 Vitals: Temp., HR,B.P.,R/R
 Signs of Raised ICP- Bulging fontanelle, headache,
nausea, vomiting, altered level of consciousness &
papilledema.
 Meningismus- check for nuchal rigidity with passive
neck flexion.

15.  Brudzinski sign (hip & knee flexion with flexion of
neck).
 Kernig sign( Extension of knee is limited less than
135 deg. due to spasm and pain in back of the thigh
or muscles of the back ).
 Hemiparesis may present.
 Rash: petechial or purpuric rash on skin or musosa
(not only in meningococcal but also pneumococcal
bactremia)

18. INVESTIGATION
 CBC
 Blood culture
 Gram staining
 LP- R/M, C/S (color, leukocyte count, glucose &
protein level)
 PCR
 LFT & KFT
 CXR
 CT/MRI
 EEG

19. DIAGNOSIS (CSF EXAMINATION)
.
AGENT WBC COUNT
PER MICRO LIT.
GLUCOSE
(mg/dl)
PROTEIN
(mg/dl)
MICROBIOLOGY
NORMAL
VALUES
0-5;
Lymphocytes
50-70 15-40 Negative findings on work up
Bacterial
meningitis
100-5000;
>80% PMN
<40 >100 Specific pathogen demonstrated in
60% of Gram stain & 80% of
cultures
Viral
meningitis
10-300;
lymphocytes
Normal,
reduced
in mumps
Normal
but may
be slightly
elevated
Viral isolation , PCR assays
TBM 100-500;
lymphocytes
<40 >100 Acid fast bacillus stain, culture, PCR
Cryptococcal
meningitis
10-200;
lymphocytes
Reduced 50-200 cryptococcal antigen, culture
Aseptic
meningitis
10-300;
lymphocytes
Normal Normal,
elevated
sometimes
Negative findings on workup

20. TREATMENT
Supportive therapy:
 Maintain fluid & electrolyte balance as required
 Transfer whole blood, FFP or platelets as required.
 Care of bowel and bladder.
 Maintain temp. Control.

21. INITIAL EMPIRIC THERAPY
3rd Generation Cephalosporins such as- Ceftriaxone
or Cefotaxim.
a) Inj. Ceftriaxone100 mg/kg/day BD
b) Inj. Cefotaxim (200mg/kg/day BD) + Amikacin 15
mg/kg/day OD
A combination of Ampicillin(200/mg) and
chloramphenicol(100mg/kg/24 hrs) for 10- 14 days is
also effective as initial empiric choice

22. SYMPTOMATIC THERAPY
INCREASED ICT:
• Lumber puncture should be done very carefully in
the presence of Incresed ICT.
• Osmotic diuresis with 0.5gm/kg of mannitol as 20%
solution is administerd IV every 4-6 hour for max of
6 doses.
CONVULSIONS:
• Diazepam0.3 mg /kg ( max 5 mg) IV,followed by
Phenytoin 10-15 mg/kg as initial treatment.
• Subsequently,Phenytoin is given 5mg/kg/day IV or
oraly untill the antibiotics are continued

23. Specific Antimicrobial therapy
Probable Staphylococcal meningitis:
 Vancomycin 15mg/kg/dose qid
Probable Meningococcal or Pneumococcal
Meningitis:
 Penicillin 4-5 lac units/kg/day q4 hourly or
 Cefotaxim 150- 200 mg/kg/day q8 hourly I V or
 Ceftriaxone 100-150 mg/kg/day q12 hourly I V.
Probable H. Influenzae:
 Ceftriaxone or cefotaxim IV use as sinle agent. or
 Ampicillin(300 mg /kg/day IV q6 hourly + Chloramphenicol
100 mg/kg/day

24. Probable E.coli:
 Ampicillin+gentamycin (200mg/kg+2.5-4 mg/kg) IV
12 hrly
Probable group B streptococci:
 Penicillin 50,000 IU/kg IV 4 hrly
Probable Pseudomonas:
 Inj. Ceftazidime(100 mg/kg/day BD)+ Inj Amikacin

25. Antibiotics IV:
Duration; 1-3 wks depending on age & type of
organisms.
Anti –virals:
 Acyclovir
 Ganciclovir
Anti-fungals:
 Amphotericin B
 Fluconazole

26. Steroid Therapy:
• Dexamethasone in dose of 0.15 mg/kg IV 6 hourly for
2-4 days is recommended.
• The first dose of corticosteroid should precede
antibiotic use by at least 15 minutes.
• This helps to reduce the incidence of residual
neurological complications,such as sensorineural
deafness, possibly internal hydrocephalus & behavioral
disturbances.
• This is specially useful in H.influezae meningitis
• There is no role of Dexamethasone in Neonatal
meningitis.

27. TREATMENT OF TBM
 12 months regimen of ATT-2HRZE + 10 HR
 Steroid – 1-2 mg/kg/day in divided BD doses for 8-12
wks
 Full dose given for 8 wks & then tapered in next 4
wks.
 Supportive therapy.

28. THANK YOU