PRESENTED BY :

CLASS 7B
Community medicine department
Objectives :-
1-Etiology of meningitis
2-Magnitude of the problem
3-Morbidity of meningitis
4-Mortality of meningitis
5-Risk factors of meningitis
6-Sign and symptoms of meningitis
7-Investigations for meningitis
8-Prevention and control
9-Vaccines for meningitis
 INTRODUCTION
➢Meningitis:
-Meningitis or inflammation of the meninges,
it is an acute specific disease caused by
meningococci.

-Meningococcal meningitis or cerebro-spinal

fever is "an acute communicable disease
caused by Neisseria meningitidis because of
its potential to cause epidemics".

-The disease can occur in endemic, epidemic

from or in sporadic cases.
CAUSES OF MENNIGITES
•Infectious:
• Viral meningitis
• Bacterial meningitis
• Fungal meningitis
• Parsitic meningitis

•Non infectious
 Viral meningitis

•Viral infections are the most common

cause of meningitis.
•Most cases in the United States are
caused by a group of viruses known as:
#enteroviruses, which are most
common in late summer and early fall.
#Viruses such as herpes simplex virus,
HIV, mumps virus, West Nile virus and
others also can cause viral meningitis.
 Bacterial meningitis

Bacteria that enter the bloodstream and travel to the

brain and spinal cord cause acute bacterial meningitis.
But it can also occur when bacteria directly invade the
meninges.
This may be caused by an ear or sinus infection, a
skull fracture, or — rarely — some surgeries
• Several strains of bacteria can cause acute bacterial
meningitis, most commonly:
• Streptococcus pneumoniae

• Neisseria meningitidis

• Haemophilus influenzae

• Listeria monocytogenes
•Streptococcus
pneumoniae(pneumococcus):
•This bacterium is the most common cause
of bacterial meningitis in infants, young
children and adults in the United States.
•Neisseria meningitidis(meningococcus):
•This bacterium is another leading cause of
bacterial meningitis. These bacteria
commonly cause an upper respiratory
infection but can cause meningococcal
meningitis when they enter the
bloodstream
•Haemophilus influenzae
(haemophilus):
•Haemophilus influenzae type b (Hib)
bacterium was once the leading cause
of bacterial meningitis in children. But
new Hib vaccines have greatly
reduced the number of cases of this
type of meningitis.
•Listeria monocytogenes (listeria).
•can cross the placental barrier, and
infections in late pregnancy may be
fatal to the baby
.
Chronic meningitis
• Slow-growing organisms (such as fungi and Mycobacterium
tuberculosis) that invade the membranes and fluid surrounding
your brain cause chronic meningi.
• Fungal meningitis
• . Cryptococcal meningitis is a common fungal form of the
disease that affects people with immune deficiencies, such as
AIDS. It‘s life-threatening if not treated with an antifungal
medication. Even with treatment, fungal meningitis may recur
Parasitic meningitis
• Parasites can cause a rare type of meningitis called eosinophilic
meningitis. Parasitic meningitis can also be caused by a
tapeworm infection in the brain (cysticercosis) or cerebral
malaria. Amoebic meningitis is a rare type that is sometimes
contracted through swimming in fresh water and can quickly
become life-threatening. The main parasites that cause
meningitis typically infect animals. People are usually infected
by eating foods contaminated with these parasites. Parasitic
meningitis isn‘t spread between people
Other meningitis causes
• Meningitis can also result from noninfectious causes, such as
chemical reactions, drug allergies, some types of cancer and
inflammatory diseases such as sarcoidosis
 MAGNITUDE OF THE
MENINGITIS
( THE EXTENT OF DISEASE )
• Meningococcal meningitis occurs worldwide in both epdemic and endemic
countries. It is estimated to be responsible for more than 500,000 cases and
approximately 135,000 deaths annually
• Over 1.2 million cases of bacterial meningitis are estimated to occur worldwide
each year (24). The incidence and case-fatality rates for bacterial meningitis vary
by region, country, pathogen, and age group
 EPIDEMIOLOGY OF N . MENINGITIS
• The worldwide distribution of serogroups of N. meningitidis is variable.
In the Americas, Europe, and Australia, serogroups B and C are the most
common, while serogroup A causes the majority of disease in Africa and
Asia . Sometimes serogroups can emerge, increasing in importance in a
specific country or region, like serogroup C in China or serogroup Y in
North America
 CONT.
• Worldwide, the incidence of meningitis due to N. meningitidis is highest
in a region of sub-Saharan African known as the “meningitis belt”
(Figure 1). This hyper-endemic region extends from Senegal to Ethiopia,
and is characterized by seasonal epidemics during the dry season
(incidence rate: 10-100 cases per 100,000 population), punctuated by
explosive epidemics in 8-12 year cycles (incidence rates can be greater
than 1,000 cases per 100,000 population)
 EPIDEMIOLOGY OF H. INFLUENZA
• H. influenzae meningitis is rare in adolescents and adults, rates of
meningitis due to Hib are highest in children less than five years of age,
with an estimated incidence rate of 31 cases per 100,000 . In young
children, the case-fatality rate for meningitis due to H. influenzae is
generally higher than that for meningitis due to N. meningitidis.
 EPIDEMIOLOGY OF
S.PNEUMONIAE
• Meningitis due to S. pneumoniae occurs most commonly in the very
young and the very old, with an estimated incidence rate of 17 cases per
100,000 population in children less than five years of age (14). The case
fatality rate for meningitis due to S. pneumoniae in children less than
five years of age exceeds 73% in some parts of the world
 MORBIDITY & MORTALITY
Morbidity and mortality rates from the disease remain high.
Apart from epidemics, at least 1.2 million cases of bacterial
meningitis are estimated to occur every year
• The overall case-fatality ratio of meningococcal disease is
10% to 15%, even with appropriate antibiotic therapy. As many
as 20% of survivors have permanent sequelae, such as hearing
loss, neurologic damage, or loss of a limb
 CONT.

• The first isolated Neisseria meningitidis in 1887 was to infect

humans only with the human nasophrynx mucosa as their natural
habitat.
• Most cases of nasophrynx colonization are asymptomatic.
However, the invasion of the bloodstream by Neisseria
meningitidis can lead to meningitis and blood poisoning with
severe consequences. Even with appropriate treatment,
meningococcal meningitis has a mortality rate of about 10% and
about 15% of survivors due to residual damage to the central
nervous system.
 CONT.
• Global serogroups A, B and C represent the majority of
cases. The dominant serogroups in Asia and Africa are A and
C while serogroups B and C are responsible for the majority
of cases in Europe and the Americas. Recent outbreaks of
epidemics among pilgrims have been attributed to WI35
serogroups.
• Epidemic rates of meningococcal disease range from | - 3/
100,000 in many developed countries to 10 – 25 | 100,000 in
some developing countries.
 RISK FACTORS
• Skipping vaccinations: Risk rises for anyone who hasn’t completed the recommended
childhood or adult vaccination schedule.
• Age: Most cases of viral meningitis occur in children younger than age 5. Bacterial
meningitis is common in those under age 20.
• Living in a community setting: College students living in dormitories, personnel on military
bases, and children in boarding schools and child care facilities are at greater risk of
meningococcal meningitis.
• This is probably because the bacterium is spread through the respiratory route, and
spreads quickly through large groups.
• Pregnancy: Pregnancy increases the risk of listeriosis — an infection caused by listeria
bacteria, which may also cause meningitis.
 CONT.

• Listeriosis increases the risk of miscarriage, stillbirth and premature delivery.

•AIDS, alcoholism, diabetes, use of immunosuppressant drugs and other factors that affect
your immune system also make you more susceptible to meningitis.
•Having your spleen removed also increases your risk, and anyone without a spleen should get
vaccinated to minimize that risk.
•Travel:Travelers to the meningitis belt in sub-Saharan Africa may be at risk for
meningococcal disease.ithout
 SIGNS & SYMPTOMS

Meningococcal Meningitis Meningococcal Meningitis

without Meningococcemia with Meningococcemia
 SIGNS & SYMPTOMS
Meningitis without meningococcemia
1. Patients with meningococcalmeningitis have
usually been sick for >24 h before they seek
medical attention.
 SIGNS & SYMPTOMS
Meningitis without meningococcemia
1) Common presenting symptoms:
1. Fever ,Nausea and Vomiting
2. Headache.
3. Convulsions.
 SIGNS & SYMPTOMS
Meningitis without meningococcemiaMeningitis
2) Common presenting symptoms:
1. Lethargy and Confusion, maybe Coma.
2. Neck Stiffness.
 SIGNS & SYMPTOMS
Meningitis without meningococcemia

3) Petechial hemorrhages on skin and/or mucosa

may be seen.
 SIGNS & SYMPTOMS
Meningitis without meningococcemia

4) The signs and symptoms of Meningococcal

Meningitis cannot be distinguished from those
elicited by other meningeal pathogens.
 SIGNS & SYMPTOMS
Meningitis with meningococcemia

1. Pharyngitis.
2. Fever.
3. Weakness and Myalgia.
 SIGNS & SYMPTOMS
Meningitis with meningococcemia

4. May develop maculopapular rash before other

serious signs develop.
5. Vomiting and Diarrhoea.
6. Headache.
 SIGNS & SYMPTOMS
Meningitis with meningococcemia
7. Fulminate cases Rapid progression to shock characterized by:
I. 1Hypotension.
II. DIC.
III. Acidosis.
IV. Adrenal hemorhage.
V. Renal failure.
VI. Myocardial failure.
VII. Coma.
 SIGNS & SYMPTOMS
Other manifestations
1. Arthritis - Approx.10% patients.
2. Primary Meningococcal Pneumonia – Mainly in
adults.
 INVESTIGATION
1. Initial blood tests
1. Leukocytopenia
2. Thrombocytopen
3. Elevated ESR.
4. Hypoalbuminemia.
5. Hypocalcemia.
6. Elevated CRP.
7. Metabolic acidosis
 • laboratory findings CSF:

2. Lumbar puncture 1. Hypoglycemia( <45 mg/dl) ·

• It is necessary for a definitive
diagnosis, but if clinical suspicion is
high, diagnostic tests should not delay
antibiotic administration.
2. Elevated protein level ( >45 mg/dl)
·
3. Neutrophilic Leukocytosis ·
4. Gram’s Stain of CSF reveals intra-
or extra-cellular organisms in
approximately,

• Lumbar Puncture: Diagnosis can be

made from bacterial isolation of N.
meningitidis from cerebrospinal fluid,
blood, and skin lesions. CSF can be
obtained via lumbar puncture.
CSF fluid should also be sent for Gram staining, standard culture, and
polymerase chain reaction (PCR). Gram staining is diagnostic in 85% of
patients with meningococcal meningitis.
3-Bacteriologic culture establishes a definitive diagnosis. These should be
grown on chocolate blood agar
• CSF studies with PCR can also be obtained, although these commonly tend
to yield false-negative results. PCR has more advantages than culture
• That allows doctors to know the specific type of bacteria that is causing the
infection and identify the serogroups and susceptibility to best anntibiotics.
• Imaging: Imaging studies, specifically CT scans, can also be performed
if the patient meets the criteria for CT before LP. The criteria include age
greater than 60, presence of focal neurologic deficits, altered mental
status, immunodeficiency, new-onset seizures, history of central nervous
system disease, and papilledema.
 Prevention and control:
Cases:
Treatment with antibiotics can save lives of 95% of
cases , provided that the treatment is started within the
first 2 days of illness penicillin is the drug of choice.in
penicillin_ allergic patients; Chloramphenicol and
other 3rd generation Cephalosporins should be
substituted.
Prevention and control
cont.
Carriers:
Treatment with penicillin doesn't
eradicate carriers state .Powerful
antibiotic like Rifampicin is
needed for eradication.
 Contacts:-
Chemoprophylaxis is the preferred means of
prevention of disease among close
contacts.Household contacts, contacts at day care
centres and anyone else directly exposed to an
infected patient’s oral secretions should be
administered chemoprophylaxis as soon as
possible (ideally within 24 hours). Antibiotics that
can be used for chemoprophylaxis are rifampin,
ciprofloxacin, ceftriaxone, minocycline, ofloxacin,
and spiramycin.
Control of Meningococcal meningitis
-Notification to the local health authority
-Isolation in hospital is recommended for better
medical care.
-Prompt treatment using general and specific
chemotherapy.
-The early treatment ofthe case will eliminate
infection within 24 hours and can be released after
thatbased on the general condition of the case, and
his clinical cure

-Disinfection.
 Control of Meningococcal meningitis cont.

-Measures to contacts:
1-Listing of all contacts.
2-Chemoprophylaxis and active
immunization.
3- Health education.
-Measures to environment:
1-Terminal disinfection.
 MENINGOCOCCAL VACCINES

All 11 to 12 year olds should get a MenACWY vaccine,

with a booster dose at 16 years old. Teens and young
adults (16 through 23 years old) also may get a MenB
vaccine. CDC also recommends meningococcal
vaccination for other children and adults who are at
increased risk for meningococcal disease
Meningococcal vaccine refers to any
of the vaccines used to prevent
infection by Neisseria meningitidis.
Different versions are effective
against some or all of the following
types of meningococcus: A, B, C, W-
135, and Y. The vaccines are between
85 and 100% effective for at least two
years.
 At present two types of meningococcal
 vaccines are licensed; meningococcal polysaccharide vaccines
(bivalent and quadrivalent) and meningococcal conjugated
polysaccharide vaccine.

 1. Polysaccharide Vaccines :

 Bilvalent polysaccharide vaccines provide protection against

serogroups A and C, trivalent against A,C,W-135, while the
quadrivalent polysaccharide vaccines provide protection against
serogroups A, C, Y and W - 135.
The dose for primary vaccination for both adults and children older than
two years is a single 0. 5 - ml subcutaneous injection .

2.Conjugated polysaccharide
vaccine
• Monovalent (A or C),
quadrivalent A, C, Y and W - 135
conjugate vaccine has been
licensed since January 2005.
• Conjugate vaccine should be
given as intramuscular injection,
preferably in the deltoid muscle in
children younger than 2 years.