Meningitis

Introduction

Meningitis is inflammation of the thin tissue that surrounds the brain and spinal cord,
called the meninges. There are several types of meningitis. The most common is viral
meningitis, which you get when a virus enters the body through the nose or mouth and
travels to the brain. Bacterial meningitis is rare, but can be deadly. It usually starts with
bacteria that cause a cold-like infection. It can block blood vessels in the brain and lead
to stroke and brain damage. It can also harm other organs.

Etiology

Etiology of neonatal meningitis: Staphylococcus epidermidis and Candida species are

uncommon butt greater frequency in neonates. L monocytogenes. Etiology of meningitis
in infants and children: In children older than 4 weeks, S pneumoniae and N meningitidis
are the most common etiologic agents. H influenzae type b has essentially disappeared
in countries where the conjugate vaccine is routinely used.

Causes

Staphylococcus epidermidis and Candida, L monocytogenes, Serratia marcescens,

Pseudomonas aeruginosa, and Proteus species, Staphylococcus epidermidis and
Pseudomonas, Citrobacter, and Bacteroides species.

S pneumoniae colonizes the upper respiratory tract of healthy individuals; however,

disease often is caused by a recently acquired isolate. Transmission is person-to-person,
usually by direct contact, and secondary cases are rare. The incubation period varies
from 1-7 days, and infections are more prevalent during the winter when viral
respiratory disease is prevalent. The disease often results in sensorineural hearing
loss, hydrocephalus, and other CNS sequelae. Prolonged fever despite adequate
therapy is common in patients with meningitis caused by this organism.

N meningitidis are gram-negative, kidney bean–shaped organisms and frequently are

found intracellularly. The upper respiratory tract frequently is colonized with
meningococci, and transmission is person-to-person by direct contact through infected
droplets of respiratory secretions, often from asymptomatic carriers. The incubation
period is generally less than 4 days, with a range of 1-7 days.
 H influenzae type b meningitis Mode of transmission is person-to-person by direct
contact through infected droplets of respiratory secretions. The incubation period
generally is less than 10 days.

L monocytogenes meningitis: L monocytogenes causes meningitis in newborns,

immunocompromised children, and pregnant women. The disease also has been
associated with the consumption of contaminated foods (eg, milk, cheese). Most cases
are caused by serotypes Ia, Ib, and IVb. Signs and symptoms in patients with listerial
meningitis tend to be subtle, and diagnosis often is delayed. In the laboratory, this
pathogen can be misidentified as a diphtheroid or as hemolytic streptococci.

S epidermidis and other coagulase-negative staphylococci frequently cause meningitis

and CSF shunt infection in patients with hydrocephalus or following neurosurgical
procedures.

Immunocompromised children can develop meningitis caused by species of

Pseudomonas, Serratia, Proteus, and diphtheroids.

Signs and Symptoms

Symptoms of neonatal bacterial meningitis are nonspecific and include the following:

Poor feeding Fever Shock

Lethargy Hypothermia Hypotonia

Irritability Seizures Shrill cry

Apnea Jaundice Hypoglycemia

Listlessness Bulging fontanelle Intractable metabolic

acidosis
Apathy Pallor

The following symptoms are readily recognized as associated with meningitis in infants and
children:

Nuchal rigidity Convulsions Alterations of the

sensorium
Opisthotonos Photophobia
Irritability
Bulging fontanelle Headache
Lethargy
Anorexia Coma children present with
hypothermia)
Nausea Fever (generally present,
although some severely ill
Vomiting

Complications

Shock Permanent hearing loss Dehydration

Death Hydrocephalus Electrolyte imbalances

Permanent brain damage Epilepsy

Mental retardation Cognitive defects

 Pathophysiology of Meningitis

Infectious Agents like parasite, virus,

bacteria, and fungus.

Initially, the infectious agent colonizes or

establishes a localized infection in the host.

Through infecting

Skin, nasopharynx,
respiratory tract,
gastrointestinal tract, or
genitourinary tract.

From this site, the organism invades the submucosa

by circumventing host defenses, like physical
barriers, local immunity, phagocytes/macrophages
by

invasion of the bloodstream a retrograde neuronal pathway direct contiguous spread like
like bacteremia, viremia, like like olfactory and peripheral sinusitis, and otitis media
fungemia, parasitemia nerves

M E N I N GI T I S