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by: drlok

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1 : Bacterial Meningitis By: Lok
2 : Meningitis The word “meningitis” usually describes inflamation of the meninges owing to the infective agents.
3 : Types of meningitis Acute pyogenic (usually bacterial meningitis), Aseptic (usually acute viral meningitis), and Chronic (usually tuberculous, spirochetal, or cryptococcal) The above classification is based on the characteristics of inflammatory exudate on CSF examination and the clinical evolution of the illness
4 : Bacterial meningitis -is caused by any one of several bacteria.  -is the leading cause of acute confusional state and one of which early diagnosis greatly improves the outcome -Primary causative agents 1. Haemophilus influenzae type b 2. Neisseria meningitidis or "meningococcus" 3. Streptococcus pneumoniae or "pneumococcus"
5 : Secondary causative agents Staphylococcus aurues Sterptococcus group B Listeria monocytogenes Gram-negative bacilli Mycobacterium tuberculosis Treponema pallidum Eischerichia coli
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7 : Three main routes by which microbes enter the nervous system 1. Hematogenous spread (most common means of entry) 2. Direct implantation (trauma, congenital malformations) 3. Local extension (otitis media and sinuisitis)
8 : Signs and Symptoms Physical examination shows: 1. fever 2. neck stiffness 3. thigh flexion upon flexion of the neck (Brudzinski’s sign)
9 : 4.resistance to the passive extension of the knee with the hip flexed (kernig’s sign) 5. Vomiting, photophobia may be seen 6. Patients always like to lie still 7. petechial rashes is seen in 50-60% patients 8. Meningial irritation is seen is 80% patients
10 : 1.Acute confusional state 2. Seizures and cranial nerve palsy 3. Coma in severve cases Neurological examination shows:
11 : Lab Diagnosis -when meningococcal meningitis is diagnosed clinically by petechial rashes accompained by other stymptoms, immediate parenteral antibiotics should be given before any further investigations. (benzylpenicilin 1200 mg, alternative : cefotaxime) -the causative organisms can be cultured from blood in 40-90% cases -if there is any suspecion of the intracranial lesion, CT scan or MRI can be done
12 : -Although these studies may be helpful, the most essential test in all suspected case is promt lumbar puncture and CSF examination. {in case of meningococcal meningitis, CSF is usually not performed since it may result cerebellar tonsils, so blood culture is main in this case}
13 : CSF examination
14 : CSF pressure is elevated in about 90% of the cases Appearance of fluid ranges from slightly turbid to grossly purulent WBC count 90,000 /mm3 consisting of chiefly polymorphonuclear leukocytes (predominantly in L monocytogenes meningitis)
15 : -CSF protein rises to 0.5-2 g/L ( normal 0.2-0.4 g/L) -CSF glucose level is lower than half of normal blood glucose level -Gram stained smears of CSF indentify the causative organism is 80% cases.
16 :
17 : Differential diagnosis -it may be difficult to distinguish between the sudden headache of SAH, migraine and meningits -neck stiffness should be considered carefully -cerebral malaria often mimics bacterial meningitis
18 : Prevention Children should be routinely immunized against H influezae by vaccination N meningitidis vaccine is recommended for military recruits, college students and travelers to areas of ongoing epidemics
19 : Treatment
20 : Nonpyogenic bacteria associated with aseptic meningitis Mycobacterium tuberculosis Leptospira Treponema pallidum Borrelia Nocardia Bartonella Atypical mycobacteria Brucella
21 : TUBERCULOUS MENINGITIS Considered in patients who present with a confusional state specially if there is history of pulmonary tuberculosis, alchoholism, corticosteroid treatment, HIV infection or any other conditon associated with impaired immune responses. Patients usually have symptoms of headache, malaise, mental confusion, and vomiting
22 : CSF findings A moderate CSF pleocytosis made up of mononuclear cells or a mixture of polymorphonuclear and mononuclear cells The protein level is elevated (strikingly), and The glucose content is moderately reduced or normal
23 : Neonatal Meningitis Neonatal meningitis is inflammation of the meninges due to bacterial invasion in the 1st 90 days of life. Neonatal meningitis occurs in 2/10,000 full-term and 2/1,000 low-birth-weight (LBW) neonates, with a male predominance
24 : Etiology Primary causative agents(75%) Group B streptococcus (—predominantly type III) Escherichia coli (particularly those strains containing the K1 polysaccharide) Listeria monocytogenes Secondary causative agents a-hemolytic streptococci gram-negative enteric organisms (eg, Klebsiella sp, Enterobacter sp, Citrobacter diversus) Haemophilus influenzae type b, Neisseria meningitidis, and Streptococcus pneumoniae
25 : Symptoms

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