Meningitis | diagnosis | symptoms | treatment |contagious| wiki

WHAT IS MENINGITIS?

        NEURO-ANATOMY

General appearance

§Infant is lethargic and appears ill

§Whenever the mother would shift her way of her baby’s carry the baby would cry inconsolably.

§There is bulging fontanelles and stiff neck.

§Laboratory result shows abnormal CSF protein and CSF glucose level.

§Normal CSF glucose level is 40-70 mg/dl but in laboratory result it’s 35 mg/dl.

§Normal CSF protein level is 20-50 mg/dl but result shows elevated level with 65 mg/dl.

§Bulging fontanelles and stiff neck also seems.

§So according to laboratory result and sings shows that infant is suffering from meningitis.

WHAT IS MENINGITIS?

Meningitis is inflamation of the meningis. Meningisare three layer protecting brain and spinal cord.

TYPES OF MENINGITIS

Meningitis infiltrated by virus

§Bacterial meningitis:

Bacteria infiltrates the blood stream and travel to brain or spinal cord and cause acute bacterial meningitis or it can also occur if bacteria directly invade meningitis.

Bacterial meningitis is very serous illness . most common bacteria that can cause meningitis are neisseria meningitis , streptococcus pnemonia etc.

v Fungal meningitis:

Occur when fungi infiltrate the meningitis.

Anatomy of meningitis

§Meningitis refer to the membranous coverings of the brain and spinal cord . there are three layer of meningitis known as the dura mater , arachnoid mater and pia mater.

How the disease reaches the brain?

§The organism that cause meningitis colonize the nasopharynx and from there they get into the blood stream

§They enter the subarachnoid space by passing through the endothelial cells, getting across the porpus choroid plexus capillaries or being carried by granulocytes.

§The csf is an ideal medium for the spread of bacteria because it provides enough nutrients for their multiplication and has few phagocytic cells and low levels of antibodies and complement.

PATHOPHYSIOLOGY OF MENINGITIS

ØThemostcommoncauseofmeningealinflammationisbacterialorviralinfection.

ØTheorganismsusuallyenterthemeningesthroughthebloodstreamfromotherpartsofthebody.

ØBacterialmeningitisconsistsofpyogenicinflammationofthemeningesandtheunderlyingsubarachnoidCSF.

vItcangainaccesstotheCNSandcausemeningealdiseaseviaanyofthe3followingmajorpathways:

(1).Invasionofthebloodstreamie,bacteremia,viremia,fungemia,orparasitemiaandsubsequenthematogenousseedingoftheCNS

(2).A retrograde neuronal (eg,olfactory and peripheral nerves)pathway eg,Naegleria fowleri or Gnathostoma spinigerum

(3).Direct contiguous spread:

eg,sinusitis,otitis media,congenital malformations,trauma,or direct inoculation during intracranial manipulation.

§Rarely,meningitisarisesfrominvasionviasepticthrombiorosteomyeliticerosionfrominfectedcontiguousstructures.

§Meningealseedingmayalsooccurwithadirectbacterialinoculateduringtrauma,neurosurgery,orinstrumentation.

§Meningitisinthenewbornmaybetransmittedvertically,involvingpathogensthathavecolonizedthematernalintestinalorgenitaltract,orhorizontally,fromnurserypersonnelorcaregiversathome.

vPossiblepathwaysforthemigrationofpathogensfromthemiddleeartothemeningesincludethefollowing:

I.The bloodstream

II.Preformed tissue planes(eg,posterior fossa)

III.Temporal bone fractures

IV.The oval or round window membranes of the labyrinths

§Replicatingbacteria,increasingnumbersofinflammatorycells,cytokine-induceddisruptionsinmembranetransport,andincreasedvascularandmembranepermeabilityperpetuatetheinfectiousprocessinbacterialmeningitis.

§TheseprocessesaccountforthecharacteristicchangesinCSFcellcount,pH,lactate,protein,andglucoseinpatientswithmeningitisdisease.

§ExudatesextendthroughouttheCSF,particularlytothebasalcisterns,resultinginthefollowing:

I.Damage to cranial nerves(eg,cranial nerve VIII,with resultant hearing loss)

II.Obliteration of CSF pathways(causing obstructive hydrocephalus)

III.Induction of vasculitis and thrombophlebitis(causing local brain ischemia)

ØA neurological  disorder  is  any  of  the  nervous  system. Structur, biochemical   or  electrical  abnormalities . Newborns   and  infants may  show  these  sign:

§high fever

§constant crying

§excessive sleepinees or irrtability

§inactivity  or  sluggishness

§poor feding

§a bulge in the soft on top of a baby s  head ( fontanel )

§stiffness in a baby s and neck

§infants  with  meningitis  may  be  difficult  to  comfort, and  may  even  cry  harder  when  heldes  in  the brain, spine  cord  other nerves  can  result  in  a  range  of  symptoms.

ØThe  presented patient shows most of the following  symptoms and brain  lesions   like  bulge  in  fontanel

ØChildmayundergothefollowingdiagnostictests:

•Blood cultures.Blood samples are placed in a special dish to see If it grows

microorganisms,particularly bacteria.Asamplemayalsobeplacedonaslide

Andstained(Gram's stain),then studied under a microscope for bacteria imaging

Computerized tomography(CT) or magnetic resonance imaging

(MRI)scans of the head may show swelling or inflammation.

X-rays or CT scans Of the chest or sinuses also may show infection in other areas that may be Associated with meningitis.

CSF analysis may also help doctor identify which bacterium caused the meningitis.

If doctor suspects viral meningitis, he or she may order a DNA-based test known as a

Polymerase chain reaction(PCR) amplification or a test to check for antibodies against

Certain viruses to determine the specific cause and determine proper treatment.

v MEDICAL TREATMENTS FOR MENINGITIS

ØMeningococcal vaccine

ØLumbarpuncture

ØPneumococcal vaccine

ØCeftriaxone

ØCefotaxime

ØAmpicillin

ØVancomycin

§Acute Bacterial meningitis must be treated immediately with intravenous antibiotics and corticosteroids

§Antibiotics can’t cure Viral meningitis ,and  most cases improve on their own in several weeks

Acute bacterial meningitis. This axial non enhanced computed  tomography scan shows mild ventriculomegaly and sulcal effacement

Pneumococcal meningitis in a patient with alcoholism

GROUP MEMBERS:

Jani Aditya

Kyada Harsh

Kanzariya Amit

Jadeja yuvrajsinh

Keshwala nalin

Joshi ayush

Jagtap shardul

Jagadessan

OUR CASE IS ABOUT A TWO MONTH OLD INFANT WHO BROUGHT TO ER FOR PEDIATRIC EVALUATION BECAUSE OF HIGH FEVER AND REFUSING TO FEED.

thank you;