Meningitis

Learning Objective
To Know
• Meningitis
• PathoPhysiology
• Causes and symptoms
• Types of meningitis
• Treatments
• Physical therapy management
Introduction
• Meningitis is an inflammation (swelling) of the protective
membranes covering the brain and spinal cord.

• A bacterial or viral infection of the fluid surrounding the brain

and spinal cord usually causes the swelling.

• However, injuries, cancer, certain drugs, and other types of

infections also can cause meningitis.
Systemic Involvement
• Nervous
• Inflammation of subarachnoid space
• Spread of inflammation to parenchyma
• Focal ischemic lesions
• Hydrocephaly
• Impaired consciousness
• Stages include irritability, confusion, drowsiness, stupor, and coma
• (stupor: a condition of greatly dulled or completely suspended sense or sensibility.)

• • Hemiparesis
• Seizures
• Cranial nerve palsy
• Hypothalamic dysfunction in children

• Vascular
• Inflammation of small subarachnoid vessels
• Thrombotic obstruction of vessels
• Musculoskeletal
• Opisthotonic posture
• Infectious spread to joints
Cont..
• Sensory
• Impaired hearing
• Loss of vision
• Metabolic
• Dehydration
• Hyponatremia

• Gastrointestinal
• Vomiting
• Integumentary
• Petechial rash of skin (usually associated with bacteria infection)
• Petechial rash- pinpoint non-blanching spots that measure less
than 2 mm in size and affect the skin and mucous membranes that
result from areas of hemorrhage into the dermis.
Pathophysiology.
Bacteria enters blood stream/ trauma

Enters the mucosal surface/ cavity

Breakdown of normal barriers

Crosses the blood brain barrier

Proliferates in the CSF

Inflammation of the meninges

Increase in ICP
Risk Factors For Meningitis
 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 by
the respiratory route, and spreads quickly through large groups.

• Pregnancy. Pregnancy increases the risk of listeriosis — an infection caused by listeria

bacteria, which also may cause meningitis. Listeriosis increases the risk of miscarriage,
stillbirth and premature delivery.

• Compromised immune system. 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 patients without
a spleen should get vaccinated to minimize that risk.
Types
• Following are the types of Meningitis:
• Bacterial
• Viral
• Fungal
• Parasitic
• Amebic
• Non-infectious

Primary amebic meningoencephalitis (PAM) is a rare brain

infection that is caused by Naegleria fowleri and is usually fatal.
Bacterial meningitis
• Bacterial meningitis is very serious and can be deadly.

• Death can occur in as little as a few hours.

• Most people recover from meningitis.

• However, permanent disabilities (such as brain damage,

hearing loss, and learning disabilities) can result from the
infection.
Types
• There are several types of bacteria that can cause meningitis.
Leading causes include

• Streptococcus pneumoniae
• Group B Streptococcus
• Neisseria meningitidis
• Haemophilus influenzae
• Listeria monocytogenes

• These bacteria can also be associated with another serious

illness, sepsis
 Causes
• Common causes of bacterial meningitis vary by age group:

• Newborns: Group B Streptococcus, Streptococcus pneumoniae, Listeria

monocytogenes, Escherichia coli

• Babies and children: Streptococcus pneumoniae, Neisseria meningitidis,

Haemophilus influenzae type b (Hib), group B Streptococcus

• Teens and young adults: Neisseria meningitidis, Streptococcus

pneumoniae

• Older adults: Streptococcus pneumoniae, Neisseria meningitidis,

Haemophilus influenzae type b (Hib), group B Streptococcus, Listeria
monocytogenes
•
Symptoms
• Early meningitis symptoms may mimic the flu (influenza). Symptoms may
develop over several hours or over a few days.
• Possible signs and symptoms in anyone older than the age of 2 include:
• Sudden high fever
• Stiff neck
• Severe headache that seems different than normal
• Headache with nausea or vomiting
• Confusion or difficulty concentrating
• Seizures
• Sleepiness or difficulty waking
• Sensitivity to light
• No appetite or thirst
• Skin rash (sometimes, such as in meningococcal meningitis)
Cont..
• Signs in newborns
• Newborns and infants may show these signs:
• High fever
• Constant crying
• Excessive sleepiness or irritability
• Inactivity or sluggishness
• Poor feeding
• A bulge in the soft spot on top of a baby's head (fontanel)
• Stiffness in a baby's body and neck
• Infants with meningitis may be difficult to comfort, and may
even cry harder when held.
Viral meningitis
• Viral meningitis is the most common type of meningitis, an
inflammation of the tissue that covers the brain and spinal
cord.

• It is often less severe than bacterial meningitis, and most

people get better on their own (without treatment.)
Causes
• Non-polio enteroviruses are the most common cause of viral
meningitis, especially from late spring to fall when these viruses
spread most often. However, only a small number of people who
get infected with enteroviruses will actually develop meningitis.
• Other viruses that can cause meningitis are
• Mumps virus
• Herpesviruses, including , herpes simplex viruses, and varicella-
zoster virus (which causes chickenpox and shingles)
• Measles virus
• Influenza virus
• Lymphocytic choriomeningitis virus
 People at Risk

• Children younger than 5 years old,

•
• People with weakened immune systems caused by diseases, medications
(such as chemotherapy), and recent organ or bone marrow
transplantations.
Symptoms

• Common symptoms in babies

• Fever
• Irritability
• Poor eating
• Sleepiness or trouble waking up from sleep
• Lethargy (a lack of energy)
• Common symptoms in adults
• Fever
• Headache
• Stiff neck
• Sensitivity to bright light
• Sleepiness or trouble waking up from sleep
• Nausea
• Vomiting
• Lack of appetite
• Lethargy (a lack of energy)

• Most people with viral meningitis usually get better on their own within 7 to 10 days.
Fungal meningitis
• Fungal meningitis is rare and usually caused by fungus
spreading through blood to the spinal cord.
• Although anyone can get fungal meningitis, people with
weakened immune systems, like those with an HIV infection
or cancer, are at increased risk.
• The most common cause of fungal meningitis for people with
weak immune systems is Cryptococcus.
• This disease is one of the most common causes of adult
meningitis in Africa.
How it Spreads

• Fungal meningitis is not spread from person to person.

• Fungal meningitis can develop after a fungus spreads through

the bloodstream from somewhere else in the body to the
brain or spinal cord or from an infection next to the brain or
spinal cord.
Cont..
• One can get fungal meningitis after taking
medications that weaken immune system.

• Examples of these medications include steroids (such as

prednisone), medications given after organ transplantation
sometimes given for treatment of rheumatoid arthritis or
other autoimmune conditions
 Risk Factors

• Certain diseases, medications, and surgical procedures may weaken the

immune system and increase your risk of getting fungal infection,
which can lead to fungal meningitis.

• Premature babies with very low birth weights are also at increased risk
for getting Candida blood stream infection, which may spread to the
brain.
Signs and Symptoms

Signs and symptoms of fungal meningitis may include the

following:
• Fever
• Headache
• Stiff neck
• Nausea and vomiting
• Photophobia (sensitivity to light)
• Altered mental status (confusion)
 Parasitic Meningitis
• Various parasites can cause meningitis or can affect the brain or
nervous system in other ways. Overall, parasitic meningitis is much
less common than viral and bacterial meningitis.

• Some parasites can cause a rare form of meningitis called eosinophilic

meningitis, eosinophilic meningoencephalitis, or EM, with increased
levels of eosinophils (a type of white blood cell) in the fluid around
the brain and spinal cord (the cerebrospinal fluid; CSF)
Cont..
• The three main parasites that cause EM in some infected
people are:

• Angiostrongylus cantonensis (neurologic angiostrongyliasis)

• Baylisascaris procyonis (baylisascariasis; neural larva migrans)
• Gnathostoma spinigerum (neurognathostomiasis)
How These Parasites Spread

• People can get infected by various ways, such as by eating raw

or undercooked freshwater fish , poultry, eggs, by eating
contaminated meat produce.
Cont..
• Meningitis caused by infections, develop symptomatic EM
from these parasites can have headache, stiff neck, nausea,
vomiting, photophobia (sensitivity to light), and/or altered
mental status (confusion).

• For example, people with EM caused by A. cantonensis often

have tingling or painful feelings in their skin and may have a
low-grade fever
Signs and Symptoms

• All three of these parasites sometimes infect the eye(s).

• All three parasites, but most commonly Baylisascaris, can
cause severe illness, such as with loss of coordination and
muscle control, weakness/paralysis, coma, permanent
disability, or death.
Non-Infectious Meningitis

• Non–infectious meningitis causes include:

• Cancers
• Systemic lupus erythematosus (lupus)
(SLE is an autoimmune disease in which the immune system
attacks its own tissues, causing widespread inflammation and
tissue damage in the affected organs. It can affect the joints,
skin, brain, lungs, kidneys, and blood vessels.)
• Certain drugs
• Head injury
• Brain surgery

• This type of meningitis is not spread from person to person.

Signs and Symptoms

• Meningitis infection is characterized by sudden onset of fever,

headache, and stiff neck. It is often accompanied by other
symptoms, such as:
• Nausea
• Vomiting
• Photophobia (sensitivity to light)
• Altered mental status (confusion)
Amebic Meningitis

• Causes
• Primary amebic meningoencephalitis (PAM) is a very rare form
of parasitic meningitis that causes a brain infection that is
usually fatal.

• PAM is caused by the microscopic ameba (a single-celled

living organism) Naegleria fowleri when water containing the
ameba enters the body through the nose.
•
Risk Factors

• Naegleria fowleri is found around the world. In the United

States, the majority of infections have been linked to :

• Bodies of warm freshwater, such as lakes and rivers

• Geothermal (naturally hot) water, such as hot springs
• Warm water discharge from industrial plants
• Untreated geothermal (naturally hot) drinking water sources
• Swimming pools that are poorly maintained, minimally-
chlorinated, and/or un-chlorinated
Signs and Symptoms

• Naegleria fowleri causes the disease primary amebic

meningoencephalitis (PAM), a brain infection that leads to
the destruction of brain tissue. In its early stages, symptoms
of PAM are similar to symptoms of bacterial meningitis.
• Initial symptoms of PAM start 1 to 7 days after infection.

• The initial symptoms include headache, fever, nausea,

vomiting, and stiff neck. Later symptoms include confusion,
lack of attention to people and surroundings, loss of balance,
seizures, and hallucinations. After the start of symptoms, the
disease progresses rapidly and usually causes death within
about 5 days (range 1 to 12 days).
Diagnosis

• Meningitis can only be diagnosed by doing specific lab tests on

specimens from a person suspected of having meningitis.

• swabbing your nose and/or throat,

• swabbing your rectum,
• taking some blood, or
• drawing fluid from around your spinal cord.
• From a stool sample.
• brain scans
 Treatment
 Bacterial meningitis is treated with a number of antibiotics. It is
important to start treatment as soon as possible, due to fatality of
the disease.

 In most cases, there is no specific treatment for viral meningitis. Most

people who get viral meningitis completely recover on their own
within 7 to 10 days. However, people with meningitis caused by
certain viruses such as herpes virus and influenza, will usually need
and get better from treatment such as an antiviral medicine.

 Fungal meningitis is treated with long courses of high dose antifungal

medications, usually given through an IV in the hospital. The length of
treatment depends on how strong the immune system is and the type
of fungus that caused the infection. For people with weak immune
systems, like those with AIDS, diabetes, or cancer, treatment is often
longer.
Treatment
• The most common types of treatment for Parasitic Meningitis
EM caused by these parasites are for the symptoms—such as
pain medication for headache or medications to reduce the
body’s reaction to the parasite—rather than for the infection
itself. However, treatment for the infection might help some
people.

• Several drugs are effective against Amebic Meningitis,

Naegleria fowleri in the laboratory. However, their
effectiveness is unclear since almost all infections have been
fatal, even when people were treated.
Prevention
• Proper vaccination.
• Wash your hands often with soap and water, especially after changing
diapers, using the toilet, or coughing or blowing your nose.
• Avoid touching your face with unwashed hands.
• Avoid close contact such as kissing, hugging, or sharing cups or eating
utensils with people who are sick.
• Cover your coughs and sneezes with a tissue or your upper shirt sleeve,
not your hands.
• Clean and disinfect frequently touched surfaces, such as toys and
doorknobs, especially if someone is sick.
• Stay home when you are sick.

• Don’t smoke and avoid cigarette smoke

• Get plenty of rest
• Avoid close contact with people who are sick
Role of Physiotherapy In
Meningitis
Cont..
• Meningitis causes inflammation of the meningeal membranes;
as a result nerve roots may endure tension as they pass
through these inflamed membranes.

• Passive ROM of the neck into flexion will gradually become

painful and limited. Also, neck extension and rotation may be
painful as well, however not to the extent of flexion
Cont..
• Range of motion exercise should be intiated as soon as safely
possible in the acute phase.
• Proper positioning with pillows and towels will protect the
skin integrity and prevention of contractures.
• Maintaining mobility of the trunk and neck are important to
sustain functional mobility.
• The earlier therapy is initiated with a patient, the chances of
secondary impairments are decreased allowing for a better
prognosis.
Cont..
• Strengthening exercises to help improve muscle function. This
can be in the form of simple exercises such as sit to stand or
walking. Your child may find these tasks difficult after having
Meningitis.
• Stretching exercises as your child may experience a stiff neck.
• Balance exercises such as standing with their eyes closed,
standing on a wobble board or standing on one leg. This is
important as they need balance for tasks such as walking,
running and cycling.
• Co-ordination exercises such as catching balls, juggling and
kicking a football.
Parents Counselling
• Providing the patient and family with education on the
disease, stages of the disease, secondary complications,
warning signs and resources can encourage the patient and
family to become more involved in the treatment.

• It is very important to educate on the effects from different

systemic involvement and how the time line of recovery may
vary.
THANKS