3. .
9 month old master Rustam weighing 7 kg resident of
thatta admitted through ER with complain of
fever ………………………………..10 days
fits…………………………………….2 days
7. FAMILY HISTORY
Second issue of consanguineous marriage
one brother of 4 years of age ,he is healthy and alive
All the family members are healthy and no any chronic
illness in family
9. EXAMINATION
sick looking irritable baby
with GCS 15/15
laying on bed with no
dysmorphic features
H/R 120/mi
R/R 26/min
temp 100
B.p 90 / 60
A-,,J-,cy-.cl-E-
11. CNS
Ant fontanella normal
Neck Retracted ,neck stiffness positive
Kernig s sign negative
Brudzinski s sign negative
Tone; increased in all four limbs
Power; moving all four limbs against gravity
Reflexes; brisk
Planter; B/L up going
16. CSF D/R
Physical Examination 1.o cc
colour pale yellow APP; C .turbid
Glucose………………….60
Proteins………………….295
Chlorides,,,,,,,,,,,,,,,,,,,,108
white cells/cu m.m……………500
Redcells/ cu m.m…………..300
Polymorphs………………80
Lymphocytes……………20
18. MRI BRAIN
IMPRESSION
Mildly dilated ventricular system with tranependymal csf
seepage,in view of history of fever and fits p1ossibility of complicated
meningitis can be considered.
Focal subdural signal abnormality seen in right pareital region
appearing hyperintense on T2 and hypointense on T1 and flair images
It is causing mild compression effect over adjacent brain
parenchyma,this suggestive of sub dural collection
22. What is meningitis?……
o The brain and spinal cord are covered by connective
tissue layers collectively called the meninges which
form the blood-brain barrier.
1-the pia mater (closest to the CNS)
2-the arachnoid mater
3-the dura mater (farthest from the CNS).
The meninges contain cerebrospinal fluid (CSF).
Meningitis is an inflammation of the meninges, which, if
severe, may become encephalitis, an inflammation of
the brain.
23. Causes of Meningitis
-Bacterial Infections
-Viral Infections
-Fungal Infections
(Cryptococcus neoformans
Coccidiodes immitus)
-Inflammatory diseases
(SLE)
Cancer
-Trauma to head or spine.
25. Bacterial Meningitis
Potentially life threatening disease.
One million cases per year world wide. 200,000 die annually.
Can affect all age groups but some are at higher risk.
Treatment available : antibiotics as per causative organism
Humans are the reservoir .
Pneumococcal meningitis is the most common type. Approximately
6,000 cases/yr
Haemophilus meningitis: Since 1985 Incidence has declined by 95%
due to the introduction of Haemophilus influenza b vaccine.
Other bacterial meningitis caused by E-Coli K-1, Klebsiella species and
Enterobacter species are less common overall, but may be more
prevalent in newborns, pregnant women, the elderly and
immunocompromised hosts.
26. What is Meningococcal disease?
Etiological Agent: Neisseria meningitidis
Clinical Features: sudden onset. F,H,N,V
Reservoir: Humans only. 5-15% healthy carriers
Mode of transmission: direct contact with patients oral or nasal secretions.
Saliva.
Incubation period: 1-10 days. Usually 2-4 days
Infectious period: as long as meningococci are present in oral secretions or
until 24 hrs of effective antibiotic therapy
Epidemiology:
Sporadic cases worldwide.
“Meningitis belt” –sub-Saharan Africa into India/Nepal.
In US most cases seen during late winter and early spring.
Children under five and adolescent most susceptible. Overcrowding e.g.
dormitories and military training camps predispose to spread of
infection.
27. Aseptic Meningitis
Definition: A syndrome characterized by acute onset of meningeal
symptoms, fever, and cerebrospinal fluid pleocytosis, with
bacteriologically sterile cultures.
Laboratory criteria for diagnosis:
CSF showing ≥ 5 WBC/cu mm
No evidence of bacterial or fungal meningitis.
Case classification
Confirmed: a clinically compatible illness diagnosed by a physician as
aseptic meningitis, with no laboratory evidence of bacterial or
fungal meningitis
Comment
Aseptic meningitis is a syndrome of multiple etiologies, but most
cases are caused by a viral agent
28. Viral Meningitis
Etiological Agents:
Enteroviruses (Coxsackie's and echovirus): most common.
-Adenovirus
-Arbovirus
-Measles virus
-Herpes Simplex Virus
-Varicella
Reservoirs:
-Humans for Enteroviruses, Adenovirus, Measles, Herpes Simplex, and
Varicella
-Natural reservoir for arbovirus birds, rodents etc.
Modes of transmission:
-Primarily person to person and arthopod vectors for Arboviruses
Incubation Period:
-Variable. For enteroviruses 3-6 days, for arboviruses 2-15 days
Treatment: No specific treatment available.
Most patients recover completely on their own.
29. Non Polio Enteroviruses
Types:62 different types known:
-23 Coxsackie A viruses,
-6 Coxsackie B viruses,
-28 echoviruses, and 5 other
How common?
-90% of all viral meningitis is caused by Enteroviruses
-Second only to "common cold" viruses, the rhinoviruses.
-Estimated 10-15 million/ more symptomatic infections/yr in US
Who is at risk? Everyone.
How does infection spread?
Virus present in the respiratory secretions & stool of a patient.
Direct contact with secretions from an infected person.
Parents, teachers, and child care center workers may also become infected by
contamination of the hands with stool.
30. Meningitis and Septicaemia
When bacteria cause disease i.e. meningococcal disease
the body can be affected in different ways:
Meningitis - bacteria enter the blood stream and
travel to the meninges and cause inflammation.
Septicaemia - when bacteria are present in the blood
stream they can multiply rapidly and release toxins
that poison the blood. (The rash associated with
meningitis is due to septicaemia.)
Meningitis and septicaemia often occur together.
31. meningococcal septicaemia:
:Babies and Young Children
-High temperature, fever, possibly with cold hands and feet
-Vomiting or refusing feeds
-High pitched moaning, whimpering cry
-Blank, staring expression
-Pale, blotchy complexion
-Stiff neck
-Arched back
-Baby may be floppy, may dislike being handled, be fretful
-Difficult to wake or lethargic
-The fontanelle (soft spot on babies heads) may be tense or
bulging.
32.
33. Older Children and Adults
-High temperature, fever, possibly with cold hands and feet.
-Vomiting, sometimes diarrhoea.
-Severe headache.
-Joint or muscle pains, sometimes stomach cramps.
-Neck stiffness (unable to touch the chin to the chest)
-Dislike of bright lights.
-Drowsiness.
The patient may be confused or disorientated. Fitting may
also be seen.
A rash may develop.
34.
35. One of the physically
demonstrable symptoms
of meningitis is Kernig's
sign. Severe stiffness of
the hamstrings causes an
inability to straighten the
leg when the hip is flexed
to 90 degrees.
37. In the early stages, signs and symptoms
can be similar to many other more
common illnesses, foe example flu.
Early symptoms can include fever,
headache, nausea (feeling sick),
vomiting and general tiredness.
The common signs and symptoms of
meningitis and septicaemia are
shown above. Others can include
rapid breathing, diarrhoea and
stomach cramps. In babies, check if
the soft spot (fontanelle) on the top of
the head is tense or bulging.
38. One sign of meningococcal septicaemia is a rash
that does not fade under pressure (see ‘Glass
test’)
-This rash is caused by blood leaking under the
skin. It starts anywhere on the body. It can
spread quickly to look like fresh bruises.
-This rash is more difficult to see on darker skin.
Look on the paler areas of the skin and under
the eyelids.
39. ‘Glass Test’
A rash that does not fade
under pressure will still be
visible when the side of a
clear drinking glass is
pressed firmly against the
skin.
If someone is ill or obviously
getting worse, do not wait
for a rash. It may appear late
or not at all.
A fever with a rash that does
not fade under pressure is a
medical emergency.
40. What to do if you suspect meningitis or
septicaemia:
Contact your GP immediately. If you GP is not
available, go straight to your nearest accident and
emergency department.
Describe the symptoms carefully and say that you
think it could be meningitis or septicaemia
Early diagnosis can be difficult. If you have seen a doctor
and are still worried, don’t be afraid to ask for medical
help again
41. Meningitis and meningococcal septicaemia (blood
poisoning) are serious diseases that can affect
anyone at any time. Teenagers and studentsin
particular, are at increased risk.Most young
people in the UK have already had the MenC
vaccine. If you haven’t or can’t remember,
gettingvaccinated now is a good way to protect
yourself.
But remember, vaccines can’t preventall forms of
meningitis and septicaemia.So it is very important
that you are aware of the signs and symptoms so
that you can get medical help urgently if you
Be aware, be prepared
42. Public Health Importance
Challenges:
-Educating public
-Timely reporting and records keeping
-Updating information daily.
-Alleviating public anxiety and concerns
-Collaborating with health partners
Opportunities:
-Educating public
-Communication
-Strengthening partnerships
Distribution of WBC count in CSF specimens, by site, among persons of all ages presenting with suspected acute bacterial meningitis. Counts are given in cells/mL.
Background characteristics of countries in which an evaluation of the Binax NOW immunochromatographic test of Streptococcus pneumoniae antigen was conducted.
Percentage of CSF specimens positive for Streptococcus pneumoniae by culture, latex agglutination test (Latex), or an immunochromatographic test (ICT) of pneumococcal antigen (NOW S. pneumoniae Antigen Test; Binax), among children aged <5 years.
