meningitis

MENINGITISMENINGITIS

Dr. Carlos Azañero Inope


CausativeCausative organismsorganisms

bacterial bacterial viral viral occasionallyoccasionally fungalfungal

-- meningococcimeningococci,,-- pneumococcipneumococci, , -- Haemophilus Haemophilus influenzaeinfluenzae, , -- Listeria Listeria andand TBTB


ClinicalClinical featuresfeatures ofof bacterial meningitisbacterial meningitis

thethe classicclassic featuresfeatures

headacheheadache neckneck stiffnessstiffness


ClinicalClinical featuresfeatures ofof bacterial meningitisbacterial meningitis

thethe classicclassic featuresfeatures

photophobiaphotophobia feverfever andand drowsinessdrowsiness


……HoweverHowever, , thethe clinicalclinical diagnosis diagnosis ofof meningitis meningitis may be may be veryvery difficultdifficult in in earlyearly cases cases

NeonatesNeonates

anorexia, anorexia, apnoeaapnoea ororfitsfits


Meningitis may Meningitis may startstart as a as a ““fluflu--likelike”” illnessillness, , especiallyespeciallyin in thethe immunosuppressedimmunosuppressed oror elderlyelderly..


MeningococcalMeningococcal meningitismeningitis isis causedcausedby by NeisseriaNeisseria meningitidismeningitidis. . ItIt can can resultresultin in septicaemiasepticaemia, coma , coma andand deathdeathwithinwithin a a fewfew hrshrs ofof thethe firstfirst symptomssymptoms. .


TheThe characteristiccharacteristic skin skin rashrash ofof meningococcalmeningococcal septicaemiasepticaemia, , causedcaused by by NeisseriaNeisseria meningitidismeningitidis. (. (CourtesyCourtesy ofof WellcomeWellcome Trust Trust PhotographicPhotographicLibraryLibrary))

Skin Skin rashesrashes occuroccur in 50% in 50% ofof patientspatients, , oftenoften startingstarting as a as a maculopapularmaculopapularrashrash, , beforebefore thethe characteristiccharacteristic petechialpetechial rashrash developsdevelops. . ThereThere may be may be DIC DIC andand adrenal adrenal haemorrhagehaemorrhage (Waterhouse(Waterhouse--FriderichsenFriderichsen syndromesyndrome).).

http://srs.dl.ac.uk/Annual_Reports/AnRep99_00/Meningitis_Figure_1.jpg


-- ResuscitateResuscitate ifif necessarynecessary andandobtainobtain venousvenous accessaccess..

-- StartStart antibioticsantibiotics immediatelyimmediately((withoutwithout waitingwaiting forfor investigationsinvestigations) ) ifif::

**thethe patientpatient isis shockedshocked//deterioratingdeterioratingoror ifif therethere isis anyany suspicionsuspicion ofofmeningococcalmeningococcal infectioninfection ((especiallyespeciallya a petechialpetechial oror purpuricpurpuric rashrash))

Management


GiveGive IV IV cefotaximecefotaxime (2g in (2g in anan adultadult; 80mg/; 80mg/kgkg in a in a childchild) ) oror IVIV ceftriaxoneceftriaxone (2g (2g in in anan adultadult; 80mg/; 80mg/kgkg in a in a childchild).).

Management


Management

ChloramphenicolChloramphenicol isis ananalternativealternative ifif therethere isis a a historyhistory ofof anaphylaxisanaphylaxis totocephalosporinscephalosporins. .


LPLP isis requiredrequired ifif meningitis meningitis isis suspectedsuspected, , butbutensureensure CT CT scanscan isis performedperformed firstfirst ifif therethere are are focal focal neurologicalneurological signssigns oror suspicionsuspicion ofof ICP ICP ((confusionconfusion/coma, /coma, hypertensionhypertension, , bradycardiabradycardia ororpapilloedemapapilloedema). ).

meningitis

Health & Medicine

carlos azaero inope

fungal meningococci

haemophilus influenzae