Acute Bacterial

Meningitis
Dr. Steven, M.Si.Med, Sp.S
n In most cases the infection causing meningitis :
Nasophariynx infection à intravascular
invasion (bacteraemia) à Penetration BBB à CSF

n Bacteria may invade the

subarachnoid space directly
à contiguous structure
(sinuses and fractures)
 Causative organisms

n In neonates : Gram – basilli (E. (E. coli, Klebsiella)

Klebsiella)
Haemophilus influenzae
n In children : Haemophilus influenzae.
influenzae.
Streptococcus pneumoniae,
pneumoniae,
Neisseria meningitidis
n In Adults : Pneumococcus, Meningococcus

Other bacteria : Listeria monocytogenes,

monocytogenes,
Streptococcus pyogenes and
Staphylococcus aureus
 Clinical
n The classical clinical triad is fever, headache and neck
stiffness
n Prodromal features (variable)
- a respiratory infection
- otitis media or pneumonia
n Meningitic symptoms
- severe frontal/occipital headache
- Stiff neck
- Photophobia
n Systemic signs
high fever, transient purpuric or petechial skin rash
à meningococcal meningitis
n Meningitic sign :
Neck stiffness , Kernig`s sign, Brudzinsky I-
I-IV

n Associated neurological signs :

- Impaired conscious level
- Focal or generalised seizures are frequent
- Cranial nerve sign occur in 15% of patients
- Sensorineural deafness – 20%
- Focal neurological sign: hemiparesis,
dysphasia, hemianopis, papilloedema
n Non -neurological complications
Non-
- Shock
- Coagulation disorders: trombositopeni – DIC
- Inappropriate secretion of ADH
- Acute bacterial endocarditis
- Arthritis (direct infection or immune complex
deposition
 Investigation
1. If the patient is coma / has papilloedema / focal
neurological sign à CT Scan à exclude an intracranial
mass
2. If above signs are absent or CT Scan excludes a mass
lesion à Lumbar Puncture
CSF : - moderate increase in pressure < 300 mmCSF
- Cell count is elevated,
100--10.000 cells/mm3 (80-
100 (80-90% PMN)
- Glucose is depressed
- Enzyme lactic dehydrogenase is elevated
- Culture CSF
 Serological/immunological tests :
Latex Agglutination test and Polymerase Chain
Reaction

Blood cultures
- Organism isolated in 80% of cases of Haemophilus
meningitis
- Pneumococcus and meningococcus in less than
50% of patients

3. Check serum electrolytes

4. Detect the source of infection
- Chest X-
X-ray - Skull X-
X -ray
- Sinus X-
X-ray
 Treatment
n Once meningitis is suspected, therapy must
immediately
n Initial therapy (before organism identification):

Neonates (> 1 month) ampicillin + aminoglycoside and cephalosporin

Children (< 5 years) ampicillin + cephalosporin

Adult penicillin G or cephalosporin

Immunoc ompromised patient ampicillin + cephalosporin

n Duration
Meningococcus & Haemophilus à AB continue
for at least 1 week after afebrile
Pneumococcus à AB continue for 10 – 14 days
after afebrile
n Steroids
- A four-
four -day regimen of dexamenthasone
10mg six hourly
- Starting before or with the first dose of
antibiotic