MENANGITIS
By DR. Maeen Gamal AL-Hadhrami
❖ definition: is the inflammation of the membranes covering the brain
and spinal cord.
❖ There are three layers of
meninges:
1- Dura mater
2- Arachnoid mater
3- Pia mater
❖ Types:
1- Bacterial (pyogenic).
2- Aseptic (viral or fungal)
3- TB
4- Fungal
Acute bacterial (pyogenic) meningitis:
➢ Definition: is acute inflammation of the membranes covering the brain
and spinal cord caused by bacteria and is one of the medical
emergencies.
➢ Incidence:
• Occur at all age group but common in infants.
• May result in death within hours if not treated.
➢ Etiology:
• Depends of the age of the patient
o 0-2 months: E-coli
o 2 months – 2 years: Hemophilus inflenzae type B.
o 2 years – 21year: Neisseria meningitides and streptococcus
pneumonia.
• Neisseria meningitides: is the most common cause and spread by
air-born routs.
1
➢ Pathology:
• The Pia-arachnoid matter is congested and inflamed thin
layer of pus is formed later if not treated organize and
fibrosis adhesion between meninges hydrocephalus.
➢ Clinical picture:
• Neonate and infants:
o Fever.
o Poor feeding.
o Vomiting.
o Irritability.
o Lethargy.
o Convulsion.
o Bulging of anterior fontanelle.
o High-pitched cry.
• Older children and adults:
o Non- specific symptoms: as fever and rush (rose spot) in trunk and
limbs.
o Symptoms of increased intra-cranial tension (ICT): as headache,
blurring of vision,
projectile vomiting and
convulsion.
o Symptoms of
meningeal irritation: as
neck rigidity, Kernig’s
sign and Brudzinski
sign (leg and neck).
o Neurological signs:
altered level of
consciousness,
confusion, delirium
and coma.
2
➢ Complications:
1- Increased intra cranial tension.
2- Cranial nerves palsies
3- convulsion.
4- Mental retardation.
5- Epilepsy.
6- Deafness.
7- Syndrome of inappropriate anti-
diuretic hormone (SIADH) secretion
➢ Investigations:
• CBC: increase neutrophil.
• Lumber puncture and CSF
examination:
o Elevated protein.
o Low glucose.
o Culture.
o CSF polymerase chain reaction (PCR).
• Blood culture.
• Chest X-ray.
• Kidney function test and serum electrolytes.
3
➢ Treatment:
• Refer to pediatrics if child or to internal medicine if adult.
• General measures:
o Bed rest.
o I.V fluids.
• Measures to decrease ICT:
o Mannitol 0.5 gm / kg IV.
o Furosemide 1mg / kg IV.
• Anti-biotics:
o Neonate and infant: ampicillin + cefotaxime.
o Pre-school: ceftriaxone.
o Older children and adults: penicillin G + ceftriaxone.
• Steroid: dexamethasone.
viral and aseptic meningitis:
➢ no bacteria
➢ causes:
• mostly viral: mumps, HIV and herpes simplex virus.
• Protozoa; malaria, toxoplasma
➢ Diagnosis: CSF analysis and vial isolation.
➢ Treatment: supportive + antiviral.
