MENINGITIS

By:- Saqlain Arbar

MEDS20-3B
Age - 14 years addidtional history-
• h/o of breathlessness
• Eye discharge
gender - Female • redness of eyes

Chief complaint – no past medical history-

• Persistant headache since 2 months

• On and off fever since 1 month past medication -
• treatment for fever
• Cough and cold since 1 week
OTHER DIAGNOSTIC TEST

 MRI scan- MRI shows minimal diffuse leptomeningial enhancements

 CT- rt maxillary sinusitis and ethamoidal sinusitis

 PCR M.Tuberculosis- Negative

 Confirmatory diagnosis- Acute meningitis

 CNS INFECTION : MENINGITIS

• 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.
 CAUSATIVE ORGANISM

Bacterial Meningitis

• 0-2 months: Gram -ve bacteria like Klebsiella, E. coli.

• 2-24 months: Strep. Pneumoniae > H. Influenza
• >2 years: Strep. Pneumoniae > N. meningitis.

 Overall m/c bacterial cause in children: Strep. pneumoniae.

 FEATURES
• Fever.
• Generalized seizures
like GTCS.
• Iritability.
• Headache.
• Photophobia.
• Signs of raised
intracranial tension
(ICT) seen as bulging
of anterior fontanelle.
 MENINGEAL IRRITATION SEEN AS

1. Neck stiffness/neck rigidity.

2. Brudzinski sign: Reflex flexion of hip & knee in response to passive neck
flexion.
3. Kernig's sign: Hip & Knee are flexed → Passive extension of knee, while hip
remains flexed → Resistance to this movement b/c of pain.

 Signs of meningeal irritation are uncommon in children < 2 years of age.

 INVESTIGATION

Gold standard:
CSF analysis by Lumbar Puncture (P) In cases of
ventriculoperitoneal shunt with suspected shunt associated
meningitis, shunt tapping is done.

• LP contraindicated → raised ICT patients → Herniation.

• CE-CT → shows meningeal enhancement, in case of inc. ICP.
 Culture of CSF can be done to isolate the bacteria.
 PCR-CSF test to detect the bacterial antigen.
 This is a sensitive test & is highly recommended.
 COMPLICATION
 M/C acute complication –

• Seizures
 Other complication -
• Subdural efussion / empyema
• Hydrocephalus
• brain abcess
• Sensori neural hearing loss
 TREATMENT
 IV antibiotics empirical treatment protocol :
• 3rd gen cephalosporins (Cefotaxime/Ceftriaxone) → No
response in 48-72 hrs → Add Vancomycin.
• Duration of treatment is around 10 days and in neonates for 3 weeks.
 Steroids :
Dexamethasone :
• 0.15 mg/kg/dose every 6 hrs for a days and usually started along with first dose of
antibiotic.
• It decreases the inflammatory edema → decreases ICT.
• It also decreases the incidence of complications, especially SNHL.
TB MENINGITIS
 Characteristic Feature - Thick exucates at the basal Cisterns

TB meningitis - 3 phases

 Prodromal phase - duration 1-4 weeks, Fever, Irritability, Vomiting
 meningitis- high grade fever, meningial irritation, headache, photophobia
 Coma
 DIAGNOSIS
 Inc. CSF pressure  Other test
 Inc. Cells (lumphocytes)
 Chloride levels - very low
 Inc. Protein upto 3000 mg/dl
 inc. ADA levels
 Dec. Sugar
 CSF Culture

 Gene expert or CBNAAT test

(cartridge based neuclic acid
amplification technique)
Neuro imaging
basal exudates + hydrocephalus
 TREATMENT

• ATT drugs for 10 months

• steroids
 VIRAL
Causative organism CSF analysis
 Japnese  clear
encephalitis B  inc. Pressure
 inc. Cells
 Enterovirus  inc proteins slightly
 HSV 1>>2  sugar levels normal
 INVESTIGATION

PCR ( IOC) Treatment

JE virus specific Igm antibodies
on EEG- PLED (periodic IV Acyclovir 20mg/kg every
lateralizing epileptiform
discharge)
8 hours for 14-21 days
REFRENCES

 Epomedicine
 Pediatrics A case based review- Michaela kreckmann
 Nelsons textbook of pediatrics
 Mayoclinic
 Medscape
 Stanfordchildrens.org