Meningitis

Introduction
Meningitis is inflammation of the thin tissue that surrounds the brain
and spinal cord, called the meninges. There are several types of meningitis.
The most common is viral
meningitis, which you get when a virus enters
the body through the nose or mouth and travels to the brain. Bacterial
meningitis is rare, but can be deadly. It usually starts with bacteria
that
cause a cold-like infection. It can block blood vessels in the brain and lead
to stroke and brain damage. It can also harm other organs.
Etiology
Etiology of neonatal meningitis: Staphylococcus epidermidis and
Candida species are
uncommon butt greater frequency in neonates. L
monocytogenes. Etiology of meningitis
in infants and children: In children
older than 4 weeks, S pneumoniae and N meningitidis
are
the
most
common etiologic agents. H influenzae type b has essentially disappeared
in countries where the conjugate vaccine is routinely used.
Causes
Staphylococcus epidermidis and Candida, L monocytogenes, Serratia
marcescens,
Pseudomonas
aeruginosa,
and
Proteus
species,
Staphylococcus epidermidis and
Pseudomonas,
Citrobacter,
and
Bacteroides species.
S pneumoniae colonizes the upper respiratory tract of healthy
individuals; however, disease often is caused by a recently acquired
isolate. Transmission is person-to-person,
usually by direct contact, and
secondary cases are rare. The incubation period varies
from 1-7 days,
and infections are more prevalent during the winter when viral
respiratory
disease is prevalent. The disease often results in sensorineural hearing
loss, hydrocephalus, and other CNS sequelae. Prolonged fever despite
adequate therapy is common in patients with meningitis caused by this
organism.
N meningitidis are gram-negative, kidney beanshaped organisms
and frequently are
found intracellularly. The upper respiratory tract
frequently is colonized with meningococci, and transmission is person-to-

person by direct contact through infected

droplets
of
secretions, often from asymptomatic carriers. The incubation
generally less than 4 days, with a range of 1-7 days.

respiratory
period
is

H influenzae type b meningitis Mode of transmission is person-toperson by direct contact through infected droplets of respiratory secretions.
The incubation period generally is less than 10 days.
L monocytogenes meningitis: L monocytogenes causes meningitis
in newborns,
immunocompromised children, and pregnant women. The
disease also has been associated with the consumption of contaminated
foods (eg, milk, cheese). Most cases
are caused by serotypes Ia, Ib, and
IVb. Signs and symptoms in patients with listerial
meningitis tend to be
subtle, and diagnosis often is delayed. In the laboratory, this
pathogen
can be misidentified as a diphtheroid or as hemolytic streptococci.
S epidermidis and other coagulase-negative staphylococci frequently
cause meningitis and CSF shunt infection in patients with hydrocephalus or
following neurosurgical procedures.
Immunocompromised children can develop meningitis caused by
species of Pseudomonas, Serratia, Proteus, and diphtheroids.
Signs and Symptoms
Symptoms of neonatal bacterial meningitis are nonspecific and include the
following:
Poor feeding

Fever

Shock

Lethargy

Hypothermia

Hypotonia

Irritability

Seizures

Shrill cry

Apnea

Jaundice

Hypoglycemia

Listlessness

Bulging fontanelle

Apathy

Pallor

Intractable metabolic
acidosis

The following symptoms are readily recognized as associated with meningitis

in infants and children:

Nuchal rigidity
Opisthotonos
Bulging fontanelle

Alterations of the
sensorium
Irritability

Vomiting
Coma

Nausea

Fever (generally
present, although
some severely ill
children present with
hypothermia)

Shock

Mental retardation

Cognitive defects

Death

Permanent hearing loss

Dehydration

Permanent brain
damage

Hydrocephalus

Electrolyte imbalances

Convulsions
Photophobia
Headache

Lethargy
Anorexia

Complications

Epilepsy

Pathophysiology of Meningitis
Infectious Agents like parasite,
virus, bacteria, and fungus.

Initially, the infectious agent colonizes

or establishes a localized infection in
the host.
Through infecting

invasion of the
bloodstream like
bacteremia, viremia,

Skin, nasopharynx,
respiratory tract,
gastrointestinal tract,
or genitourinary tract.
From this site, the organism invades the
submucosa
by circumventing
host direct contiguous spread
a retrograde
neuronal
defenses,
like
physical
barriers,
pathway
like
like olfactory
and local like sinusitis, and otitis media
M E N I N GI T I S
immunity, phagocytes/macrophages
by
peripheral nerves