Professional Documents
Culture Documents
Meningitis
Dr. Dinesh kumar Reddy
What We'll
Discuss
TOPIC OUTLINE
Definition
Common Organisms and Etiology
Pathogenesis
Clinical features and Pathophysiology
Management
Treatment
BACTREIAL MENINGITIS
DEFINITION
MENINGITIS IS AN ACUTE
INFLAMMATION OF THE
MENINGES COVERING THE
BRAIN AND SPINAL CORD.
BACTERIAL MENINGITIS IS AN ACUTE PURULENT INFECTION
WITHIN THE SUBARACHNOID SPACE (SAS)
H,influenza type B
7.4%
Listeria monocytogenes
Common
9.3%
Group B Pneumococcus
Streptococcus Pneumococcus
Meningococcus Pneumococcus
N.meningitidis
Escherichia coli H.influenza Meningococcus
Type B
Listeria L.monocytogenes
monocytogenes
# Endocarditis
#Asplenia
PATHOGENESIS OF
MENINGITIS
Bulging fontanelles
Bones of the skull do not form sutures until age 2
↑ ICP → meninges protrude through gaps in skull bones
Jaundice
Impaired bilirubin excretion
Exact mechanism unclear, associated with sepsis
This classic triad may not be present in every person with Meningitis
NOT to be confused
with MENINGISM
MENINGISMUS OR
PSEUDOMENINGITIS
Non meningitic irritation of the meninges, usually
associated with acute febrile illness.
The triad is nuchal
rigidity, photophobia and headache
MANAGEMENT OF
BACTERIAL MENINGITIS IN
ADULTS AND CHILDREN
Initial Management approach
Once there is suspicion of acute bacterial meningitis, blood
samples must be obtained for culture and a lumbar puncture
performed immediately to determine whether the CSF is
consistent with the clinical diagnosis.
BACTERIAL MENINGITIS
Suspicion for bacterial meningitis
A puncture
Dexamethasone + Dexamethasone +
emperical AMT Targeted AMT
L
lumbar Puncture STAT
Dexamethasone +
D
Dexamethasone + emperical AMT
emperical AMT
Negaative CT scan of
R CSF findings c/w
bacterial Meningitis
the head
E Continue Therapy
Perform Lumbar
Puncture
N
Clinical Infectious Diseases, Volume 39, Issue 9, 1 November 2004
Specific CSF Diagnostic Tests Should Be Used
to Determine the Bacterial Etiology of Meningitis
The diagnosis of bacterial meningitis rests on CSF examination performed after
lumbar puncture
Latex agglutination.
They utilize serum containing bacterial antibodies or commercially
available antisera directed against the capsular polysaccharides of
meningeal pathogens
Limulus lysate.
PCR.
OTHER DRUGS
GOAL OF TREATMENT
&
BACTERIAL MENINGITIS
PREDISPOSING FACTOR ANTIMICROBIAL
THERAPY
Age
Ampicillin + Cefotaxime
< 1 month or Ampicillin + an
Aminoglycoside
Vancomycin + a third-
1-23 months generation
Cephalosporin
Vancomycin + a third-
2-50 years generation
Cephalosporin
Vancomycin + ampicillin
>50 years + a third-generation
cephalosporin
PREDISPOSING FACTOR ANTIMICROBIAL
THERAPY
Head trauma
Vancomycin + a third-
Basilar skull fracture gen cephalosporin
Vancomycin +cefepime,
vanc + ceftazidime, or
Penetrating trauma vancomycin +
meropenem
BACTERIAL MENINGITIS
ORGANISM STANDARD
THERAPY
Streptococcus pneumoniae
Penicillin G
Penicillin-sensitive
Ceftriaxone /
Penicillin-intermediate cefotaxime / cefepime
Ceftriaxone or
Penicillin-resistant cefotaxime or cefepime
Nisseria Meningitidis
Penicillin-sensitive Penicillin G or ampicillin
Gram-negative bacilli
Ceftriaxone /cefotaxime
(except Pseudomonas spp.)
Ceftazidime /
Pseudomonas aeruginosa meropenem
Staphylococci spp
Methicillin-sensitive Penicillin G or ampicillin
BACTERIAL MENINGITIS
WHEN TO REFER
BACTERIAL MENINGITIS
References
JAMA. 1999 Jul 14;282(2):175-81.