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Meningitis: Shair Muhammad Hazara

Meningitis is an inflammation of the meninges surrounding the brain and spinal cord, primarily caused by infectious agents such as bacteria, viruses, fungi, and parasites. Key bacterial causes include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae, with risk factors including age extremes and compromised immune systems. Diagnosis involves blood cultures, imaging, and lumbar puncture, while treatment requires prompt administration of broad-spectrum antibiotics and vaccination for prevention.

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Shair Muhammad hazara
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23 views29 pages

Meningitis: Shair Muhammad Hazara

Meningitis is an inflammation of the meninges surrounding the brain and spinal cord, primarily caused by infectious agents such as bacteria, viruses, fungi, and parasites. Key bacterial causes include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae, with risk factors including age extremes and compromised immune systems. Diagnosis involves blood cultures, imaging, and lumbar puncture, while treatment requires prompt administration of broad-spectrum antibiotics and vaccination for prevention.

Uploaded by

Shair Muhammad hazara
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Meningitis

Shair Muhammad Hazara


MSN (Scholar), MSPH, MSBE, BSN
Meningitis is clinical syndrome characterized by inflammation of the meninges, that envelope the brain and
. spinal cord

Types of meningitis
Most common bacteria causing meningitis:

Streptococcus
pneumoniae (pneumococcus)

Neisseria meningitidis
(meningococcus)

Haemophilus influenzae
(haemophilus)

Listeria monocytogenes)
(listeria
• Extremes of age (< 5 or >60 years)
• Diabetes mellitus, chronic kidney
failure, adrenal insufficiency,
hypoparathyroidism, or cystic fibrosis.
• Compromised immune system like
AIDS, alcoholism ,use of
immunosuppressant drugs.
• Recent exposure to others with
meningitis, with or without
prophylaxis.
• Malignancy.
• Pregnancy.
Pathophysiology

• Most cases of meningitis are caused by infectious agents that colonized in the
host.

• What are the main sites of colonization ?


These infectious agents like bacteria can arrive the CNS
via 3 ways :-
• Invasion of the bloodstream and subsequent hematogenous
seeding of the CNS.
• A retrograde neuronal (e.g., olfactory and peripheral nerves)
pathway .
• Direct contiguous spread.

• The migration pathways to meninges by:

Blood stream , Preformed tissue planes, window


.membranes of the labyrinths
• Meningitis in newborn can be transmitted either vertically e.g. pathogens
that have colonized the maternal intestinal or genital tract, or horizontally,
via nursery personnel or caregivers at home.
Invading to brain

-How bacteria invade the brain ??

•Factors that immortalize the infectious process in


meningitis are :-

• Replicating bacteria
• Increasing numbers of inflammatory cells
• cytokine-induced disruptions in membrane transport
• and increased vascular and membrane permeability
• All of these process make change in CSF cell count, pH,
lactate, protein, and glucose in patients.
Etiology and Epidemiology
• There are many microorganisms that can cause meningitis including bacteria,
viruses, fungi, parasites; also drugs may be a cause (e.g., NSAIDs, metronidazole, and
IV immunoglobulin).
Bacteria that cause meningitis include :
• Pachymeningitis.
• Haemophilus influenzae meningitis.
• Pneumococcal meningitis.
• Streptococcus agalactiae meningitis
• Meningococcal meningitis.
• Listeria monocytogenes meningitis.
• Gram-negative bacilli.
• Staphylococcal meningitis: it colonized in the normal skin flora. S
epidermidis is the most common cause of meningitis in patients with CNS
shunt (ventriculoperitoneal).
• Additional causes of meningitis: Congenital malformation of the stapedial
footplate, Head and neck surgery, penetrating head injury, comminuted
skull fracture, and osteomyelitic erosion, Skull fractures.
• H. influenzae meningitis primarily affects infants younger than 2 years. S
agalactiaemeningitis occurs principally during the first 12 weeks of life but has
also been reported in adults, primarily affecting individuals older than age 60
years.
• The overall case-fatality rate in adults is 34%. Among the bacterial agents that
cause meningitis, S pneumoniae is associated with one of the highest
mortalities (19-26%).
How bacteria reach meninges

• Pachymeningitis reach the meninges by skull defect, or an infection from


paranasal sinuses.
• Pneumococcal meningitis: it is the most common bacterial agent in meningitis
associated with basilar skull fracture and CSF leak.
• Listeria monocytogenes meningitis: it is widespread in nature and a common
food contaminant, most human cases was food borne.
Prognosis
• Patients who presented with an impaired level of
consciousness or seizures, have increase risk of death and
neurologic sequelae.

• In bacterial meningitis , a score was set to predict


outcome including several variables. Including:
• Older age , Increased heart rate.
• Lower Glasgow Coma Scale score.
• Cranial nerve palsies.
• What is the most important complication? And what is the
percentage ?

• Bacterial meningitis is fatal in 1 in 10 cases and 1 of every 7


survivors left with impediment like defenses.
• Characteristic clinical signs and
symptoms can be absent

•Blood cultures
•Imaging
•Spinal tap (lumbar puncture)
Blood cultures
• Blood samples are placed in a special dish to see if it grows microorganisms, particularly
bacteria
• limitation : Pretreatment with antibiotics decreases the yield.

Cranial Imaging
(Normally computed tomography, CT) scans of the head may show swelling
or inflammation.
• May lead to a substantial delay in the initiation of antibiotic treatment,
which leads to poor outcome.
Spinal tap (lumbar puncture)
This fluid is sent to the lab
and analyzed to determine
if there is an infection.

“We determine:”
1- WBC(leukocyte) count
2- protein concentration
3- glucose concentration
Is the procedure of taking fluid
then we perform CSF from the spine (CSF) in the lower
culture and Gram stain. back through a hollow needle.
Limitation : Pretreatment with antibiotics decreases the
yield.
Signs and symptoms
older than 2 years
infants (<2years)
Complications
• Advanced bacterial meningitis may cause brain damage and death. 50% of
patients may have a serious complications within a week, however in 30% of
survivors long term sequlae are seen.
• Complications include hearing loss, cortical blindness, other cranial nerve
dysfunction, paralysis, muscular hypertonia, ataxia, multiple seizures, mental
motor retardation, focal paralysis, subdural effusions, hydrocephalus and
cerebral atrophy.
New Biomarker

• The differentiation between acute bacterial and non bacterial meningitis


is challenging because they share many similar clinical symptoms, such
as fever and headache.

• A new biomarker (Procalcitonin) has been studied for the diagnosis of


bacterial meningitis.
• Procalcitonin (PCT) is a 116-amino-acid protein that is produced primarily by
the C cells of the thyroid gland and secreted from leukocytes in the
peripheral blood.

• In healthy individuals, PCT is secreted at levels that are below the detectable
limit. However, serum PCT levels increase markedly in patients suffering from
bacterial infections.
• Comparison of the serum and CSF PCT levels between the BM and non-BM
patients.

Gram stain of N.
meningitidis in CSF has high
specificity but the sensitivity is
poor. Furthermore, bacterial
culture is time-consuming.
Management
• Delay in treatment has been
associated with a poorer outcome.

First: After identification


we should start of the pathogen
treatment with antibiotic therapy
wide-spectrum as appropriate for
antibiotics while patient age and
confirmatory tests condition

Rapid transport to the emergency department (ED) because


of the early severe complications.
Treatment
Vaccination

• Pneumococcal Vaccination.

• Hib Vaccination (Haemophilus influenzae type b (Hib)).

• Three types of Meningococcal Vaccines used:


• Meningococcal conjugate vaccine (MCV4).
• Meningococcal polysaccharide vaccine (MPSV4) .
• Serogroup B Meningococcal B.
• New vaccines were developed against Group A Neisseria meningitidis :

• MenAfriVac 10 µg of purified Men A polysaccharide antigen conjugated


with tetanus toxoid (PsA-TT) per dose . ( 1-29 years ).
• MenAfriVac 5 µg for use in infants and children (3–24 months).
Patient Education
• Meningitis may require education regarding the need for prophylaxis. All contacts
should be instructed to come to the emergency department immediately at the
first sign of fever, sore throat, rash, or symptoms of meningitis.
Patient Education

• These steps can help prevent meningitis:

1. Wash your hands.


2. Practice good hygiene.
3. Stay healthy.
4. Cover your mouth.
5. If you're pregnant, take care with food.
Thank you

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