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Meningitis

Title               

Ñ    Meningitis

Definition

Ñ    Infective inflammation of the leptomeninges

Aetiology

Ñ    Bacteria:

Neisseria meningitidis

Streptococcus pneumoniae

Haemophilus influenzae

Staphylococcus aureus

Group B streptococcus

Listeria monocytogenes

Gram-negative bacilli

Mycobacterium tuberculosis

Treponema pallidum

Ñ    Viruses:

Enterovirus (ECHO, Coxsackie)

Mumps

Herpes simplex

HIV

Epstein-Barr

Ñ    Fungi:

Cryptococcus neoformans

Candida

Coccidioides immitis

Histoplasma capsulatum

Blastomyces dermatidis

Pathogenesis

Routes of infection

Ñ    Local spread:

Ear

Nasopharynx

Head injury

Meningeal leak

Ñ    Systemic spread:

·          Blood borne

Infective endocarditis

Osteomyelitis

Pyelonephritis

·          Lymphatic

Retropharyngeal abscess

Retroperitoneal abscess

Psoas abscess

Predisposing Factors

Ñ    Immunocompromised host:

Increased risk of unusual organisms

Pathological Process

Ñ    Pia-arachnoid inflamed

Ñ    Predominant cell type neutrophil

Ñ    Layer of pus forms

Ñ    Organisation may occur with formation of adhesions

This may result in:

Ñ    Cranial nerve palsies

Ñ    Hydrocephalus

Clinical Features

History

Ñ    Acute or chronic onset

E&M

Ñ    Fever

GIT

Ñ    Vomiting

CNS

Ñ    Headache

Ñ    Photophobia

Examination

IS

Ñ    Purpuric rash:

Meningococcal meningitis

CNS

Ñ    Neck stiffness

Ñ    Kernig’s sign

Complications

CNS

Ñ    Cranial nerve lesions

Ñ    Lateralising signs

Ñ    Dural venous thrombosis

Ñ    Cerebral oedema

Ñ    Hydrocephalus

Investigations

Fluids

CSF

Haematology

Ñ    White cells:

Increased

Microbiology

Ñ    Gram stain:

Identifies type of bacteria

Ñ    India ink stain:

Cryptococcus

Ñ    Antigens:

Cryptococcus

Biochemistry

Ñ    Glucose:

Low

Ñ    Protein:

Increased

Imaging

CT Scan

Ñ    Exclude intracranial mass lesion

Management

Cure

Drugs

Ñ    Appropriate antimicrobial agent

Control

Drugs

Ñ    Dexamethasone:

Pneumococcal meningitis:

Reduces inflammation and neurological sequelae

Surgery

Ñ    Indicated if there is an underlying cause

Prevention

Meningococcus

Ñ    Immunisation with Men C vaccine

Ñ    Treat contacts with rifampicin

Pneumococcus

Ñ    Immunisation for recurrent meningitis

Haemophilus

Ñ    Hib vaccine

Prognosis

Ñ    Approximately 15 % mortality

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