Meningitis

Definition

• An infection caused by bacterial invasion into the CNS that results in

inflammation of the subarachnoid and ventricular spaces of the CNS,
unrelated to a neurosur­gical procedure, neurotrauma, or hospitalization.

• An inflammatory process usually involving the meninges and

cerebrospinal fluid, without involvement of brain tissue, due to the
presence of a bacterial or viral pathogen.
 :Classification
Community-acquired
meningitis:
Predisposing factors include •
preexisting diabetes mellitus,
otitis media, sinusitis,
pneumonia, and alcohol abuse
Nosocomial meningitis
and ventriculitis:
Most commonly related to •
infections associated with CSF
shunts, CSF drains, intrathecal
drug therapy, deep brain
stimulation hardware,
neurosurgery procedures, and
head trauma
Causative Pathogens
Streptococcus spp (ex
Strept. Pneumoniae,
Strept. pyogenes,
Strept. agalactiae

Gram-negative bacilli Haemophilus

(Pseudomonas or influenzae type B
enteric pathogens)

Staphylococcus (S. Neisseria

aureus or coagulase- meningitidis
negative (serogroups A, B, C,
staphylococcus) W135, and Y)

Listeria
monocytogenes
 Diagnosis
Bacterial meningitis is associated with CSF that is pre­dominantly
neutrophilic and has lower glucose concentration.
Individual strong predictors of bacterial meningitis include:
a) CSF glucose < 34 mg/dL
b) CSF/blood glucose ratio < 0.23
c) CSF protein > 220 mg/dL
d) CSF leukocyte count > 2000 cells/mm3
e) CSF neutrophil count > 1180 cells/mm3
Diagnosis
 Treatment:

When one or more of the following are present, treatment

should begin:
i. Positive CSF Gram stain
ii. Seizure
iii. Serum absolute neutrophil count of 10000 cells/mm3 or more
iv. CSF neutrophil count of 1000 cells/mm3 or more
Treatment:
Treatment:
Treatment:
 Duration:

Patients should be treated for a duration of 10 to 14 days.

Duration of therapy depends on identified pathogen and clinical status