SOLIS, NIÑA ANTONET

Name the different types of Bacterial and Fungal Meningitis and their:
a. Mode of transmission
b. Clinical findings
c. Laboratory Diagnosis
d. Treatment and Prevention
 BACTERIAL MENINGITIS

Neisseria meningitidis

This bacteria is also known as Meningococcus. A gram-negative, coffee-bean-shaped

diplococcus that is transient flora of the nasopharynx. The encapsulated types are virulent.

A. Mode of Transmission
Inhalation of droplets among contacts is the main mode of transmission of menigococcus.
Carriers also transmit the infection through respiratory aerosols or droplets.

B. Clinical Findings
This begins as throat infection. The microorganism will enter the bloodstream causing
bacteremia and go into meninges causing meningitis. Meningococcemia wiith or without
menigitis is a life -threatening infection. Thrombosis of small blood vessels and multi-organ
involvement are charactersitic. Petechiae or purpuric skin lesions over the trunk and the lower
extremities is an important presumptive sign of menigococcal infection. The disease may
progress to massive disseminated intravascular coagulopathy with destruction of the adrenal
glands called the Waterhouse-Friderichsen syndrome.

C. Laboratory Diagnosis
Blood and the CSF are the most useful specimens for culture of N. meningitidis. Gram stain
used as preliminary examination would show gram-negave, coffee bean-shaped diplococci
inside polymorphonuclear cells. Counter-immunoelectrophoresis agglutination, or latex
particles coated with specific antibodies can also be used to detect polysaccharide antigen.

D. Treatment and Prevention

Penicillin is the drug of choice but resistance to this drug is significantly increasing. Alternative
antibiotics are broad-spectrum cephalosporins and chloramphenicol. For the treatment of
carriers, minocycline and rifampicin are recommended. For contacts, the prophylaxis includes
sulfonamides and rifampicin for sulfonamide-resistant strains.

Listeria monocytogenes
L. Monocytogenes are short, motile, gram-positive bacilli that appear individually, in pairs or
chains. The bacteria are cold-loving but are also capable of growth at 45 degrees celsius and
in high salt concentration. In healthy adults, disease is usually mild or asymptomatic. L.
monocytogenes mainly infects immuno compromised individuals.

A. Mode of Transmission
The primary source of infection is ingestion of contaminated food products but transplacental
transmission is also common during pregnancy or at birth. It has a special affinity for growth in
the CNS and the placenta. Infection during pregnancy may lead to spontaneous abortion or
stillbirth.

B. Clinical Findings
In newborns, it may present as early-onset listeriosis when acquired transplacentally or late-
onset listeriosis when acquired during or right after after delivery. A severe form of early-onset
listeriosis which present with granuloma and abscess formation in several formation in several
organs, is granulomatosis infantiseptica. Late onset infection presents as meningitis or a
combination of meningitis and encephalitis with septicemia.

C. Laboratory Diagnosis

Diagnosis is through culture of blood, spinal fluid, or the placenta in selective media with cold
enrichment. Observation of tumbling end-to-end motility in liquid or semi-solid media is also
useful in initial identification.

D. Treatment and Prevention

Penicillin or ampicillin either singly or combined with gentamicin is the treatment of choice for
listeriosis. Prevention is by avoiding eating contaminated food products and thorough washing
of raw vegetables.

Tuberculous Meningitis

Tuberculous meningitis most commonly affects children younger than 6 years old, however, it
is rarely seen in less than 4 months of age. It usually appears 3-6 months after initial infection
and accompanies miliary tuberculosis in 50% of cases. Unrelenting headache, stiff neck,
fever, fatigue and night sweats are characteristics of tuberculous meningitis. These
manifestations together with the CSF picture are suggestive of the infection.

Aids in the diagnosis include a history of contact with an adult with tuberculosis, a positive
tuberculin skin test (including siblings), and a CSF examination to include acid-fast staining of
the CSF. Treatment involves giving of quadruple anti-TB regimen.

A. Mode of Transmission
Tuberculosis bacteria enter the body by droplet inhalation i.e. breathing in bacteria from the
coughing/sneezing of an infected person.

B. Clinical Findings
Tuberculous Meningitis involves the central nervous system. Headaches and behavioral
changes may be noticed initially. Fever, headache, a stiff neck, and vomiting may also occur.
Symptoms among older children and adults may progress from irritability to confusion,
drowsiness, and stupor, possibly leading to coma.

C. Laboratory Diagnosis
Definitive diagnosis of tuberculous meningitis can be made by demonstration of mycobacteria
in cerebrospinal fluid (CSF), by direct staining or culture. However, these tests are time
consuming and seldom positive.

D. Treatment and Prevention

Meningitis is usually treated with antibiotic drugs used against the bacteria causing the
infection. These may include isoniazid, rifampin, streptomycin, and ethambutol. Treatment
should last for at least 9 months to one year. Corticosteroid drugs such as prednisone may
also be of benefit.

Granulomatous Meningitis
Granulomatous meningitis is characterized by the formation of granulomas. It is a chronic
type of meningitis commonly caused by Mycobacterium tuberculosis and Cryptococcus
neoformans. It is characterized by remissions and relapses.

A. Mode of Transmission
Usually through the oral-fecal route, but also sometimes through the respiratory route.
Arboviruses-Via blood-sucking arthropods, usually mosquitoes.

B. Clinical Findings
Typical symptoms of GAE include low-grade fever and focal neurologic signs, such as cranial
nerve palsies, hemiplegia, ataxia, aphasia, diplopia, and seizures. Patients with GAE may
also exhibit behavioral changes, stiff neck, signs of increasing intracranial pressure (ICP),
stupor, or coma.

C. Laboratory Diagnosis
a kind of inflammation affecting the brain, the spinal cord and the meninges (the covering of
the spinal cord and brain).

D. Treatment and Prevention

Treatment of GME relies primarily on corticosteroid therapy and the use of other
immunosuppressive drugs but is typically incompletely effective and most dogs become
refractory to treatment fairly rapidly. Radiation therapy may be effective for treating some
cases of focal GME.

 FUNGAL MENINGITIS
Cryptococcus neoformans and Cryptococcus gatti are the most common causes of fungal
meningitis. Other causes are Histoplasma capsulatum and Coccidiodes immitis.

C. neoformans is an encapsulated yeast, a common saprophyte of the soil particularly soil

enriched with pigeon droppings. It is monomorphic (exists only as yeast) and of low virulence.
It is distributed worldwide. The fungus is opportunistic and only cause infection in
immunocompromised individuals and infections tend to be severe and fatal. Its virulence is
mainly due to its capsule and its ability to produce melanin, both of which protect C.
neoformans from phagocytosis. It is able to grow at 37°C.

A. Mode of Transmission

Cryptococcal meningitis is acquired by inhalation of the fungus from the environment.

Infection spreads from the lungs into the blood, affecting the CNS.

B. Clinical Findings
The patients may experience headaches, nausea, vomiting, loss of vision, and other focal
neurologic findings of several weeks' duration. The classical manifestation of meningismus is
usually absent in cryptococcosis.

C. Diagnosis
Diagnosis is made by direct examination of the CSF fluid stained with India ink or Nigrosin to
demonstrate the capsule of the fungus (Figure 22.2). CSF examination will show high opening
pressure, mononuclear cell pleocytosis, increased protein concentration and low glucose
concentration.

D. Treatment and Prevention

Treatment consists of Amphotericin B and Flucytosine for 4-8 weeks followed by fluconazole
Lifelong maintenance therapy with fluconazole is required.