MENINGITIS

MIRITI M.D
ECCCO
MASTER OF CLINICAL MEDICINE: ACCIDENTS AND EMERGENCY (MKU)
BSCM (MKU)
MED 1-4 (SSU-UKRAINE)
KMTC LECTURE SERIES
3RD APRIL 2023
 Meningitis
•This describes inflammation of the
leptomeninges (pia + arachnoid mater) that
line the brain
– It is most commonly due to an infectious
agent which leads to an increase in ICP and
cerebral oedema
– If untreated, it can lead to hydrocephalus,
hearing loss, fibrosis and death by herniation
AETIOLOGY
•Infants under 3 months –> 1st group B
Streptococci, then E. Coli
•Children 3 months to age 60 –> 1st N.
Meningitidis, then S. Pneumoniae
•>60 years –> 1st S. Pneumoniae, then N.
Meningitidis
SYMPTOMS
•(Early) Classic triad of headache,
fever + nuchal rigidity (inability to
flex the neck)
•(Late) Altered mental status with low
GCS + Photophobia + Seizures
•Non-blanching rash
Diagnosis:
• Lumbar puncture (needle placed between L4/L5 as
spinal cord ends at L2)
• If bacterial –> Shows high neutrophils with
decreased CSF glucose –> follow up with Gram stain
and culture
• If viral –> Shows increased lymphocytes with normal
CSF glucose
• If fungal (atypical) –> Shows increased lymphocytes
with decreased CSF glucose 
Management:
• If in GP setting and suspected meningococcal bacteria –> give IM
benzylpenicillin + send to hospital
• If in hospital, take blood cultures first –> then perform lumbar puncture (when
stable)
Start sepsis 6 protocol with empirical IV antibiotics: 
• < 3months –> IV cefotaxime + Amoxicillin
•  3 months – 50 years –> IV ceftriaxone
• >50 years –> IV Cefotaxime + Amoxicillin
If penicillin allergic, give chloramphenicol
• Give IV dexamethasone to reduce ICP (unless <3 months)
• Offer prophylactic antibiotics to family members in contact with patient since
last 7 days
ENCEPHALITIS

MIRITI M.D
 DEFINITION 9

This refers to inflammation of the actual brain

tissue itself which can occur due to a variety of
causes.
– It gives similar symptoms to meningitis but
additional focal symptoms according to the part
of brain affected.
– Most common cause is Herpes Simplex Virus
(HSV-1) and classically gives neurological
symptoms
SYMPTOMS: 10

The virus classically affects the

temporal and inferior frontal lobes
giving specific features:
– Meningitis-like symptoms –> Fever +
Headache + Vomiting +
Confused/Drowsy
– Neurology–> Aphasia (due to speech
centres in temporal lobe) + Psychiatric
symptoms + Seizures
INVESTIGATIONS: 11

– Lumbar puncture –> CSF shows

elevated lymphocytes + high protein
(resembling viral meningitis)
– CSF analysis using PCR shows Herpes
Simplex virus DNA (diagnostic test)
– EEG –> shows lateralised periodic
discharges at 2Hz
– CT/MRI –> shows medial temporal lobe
and inferior frontal lobe haemorrhages
 12

MANAGEMENT:
IV ACYCLOVIR
REMEMBER HOW THE BELL FOR
LUNCH BREAK WAS INTRESTING IN
PRIMARY SCHOOL.