Table 75.

1 Causes of meningitis
Bacteria Virus (Aseptic meningitis) Fung Parasites
Neonates and infants Enteroviruses (ECHO, Coxsackie. Polio)
Cryptococcus vatamoeba histolvtico
Ecoli Paramyxoviruses (Mumps, Measles) neoformans toegleria
Group BStreptococci Herpesviruses (Herpes simplex Candida albicans Acanthamoeba
(Streptococcus Varicella zoster) vAspergillusspecies OMOplasma gondii
agalactiae) Adenoviruses wHIstoplasmo
Staphylococcus aureus Arboviruses(Flavivirus, Buniyavirus) capsulatum
H.infiuenzae Coccidioides immitis
Streptococcus pneumonige
Klebsiella species
Usteria monocytogenes
( FP U e e

Children
Haemophilus influenzae EPHOO
Neisseria meningitidis
Streptococcus pneumoniae
Adults
Neisseria meningitidis
Streptococcus pneumoniae
Elderly
Streptococcus pneumoniae
Staphylococcus enteric
Gram-negative
aureus bacilli
676 art VIl CLINICAL MICROBIOLOGY

Naked eye Turbidity

Whitecell Polymorph,
cOunt lymphocytes
cSF
Gram stain

en

Microscopy Staining
Neelsen

ndia in

Quellung
reaction pneumoniae

Positive Antibiotic
Cuiture sensitivity
CA BA BHI
Broth Positive Antibiotic
sensitivityy
Cture
Subculture
Negative
Culture Culture rom o
broth Negative growtn
Blood Meningococcal Cunure
infections

Spnuemoniae
Adults H.infiuenzae
N.meningibidis
Latex agglutination
for Ag detection
Group B
Children streptococus
Serology LmonocyOgenes

Blood dn Viruses

Bacterial Limulus lysate

Endotoxin st

Molecular
memod PCR
UrineH S.pneumoniee
Cneofomans
e dlognosis of mening
Approl
 INTRODUCTION influenzae, Mycobacterium tuberculosis, Herpes
Meningitis is an inflammation of the meninges, the simplex virus (aseptic meningitis) and poliovirus 1
membrane covering the brain and spinal cord. When a (aseptic meningitis) have been described earlier.
microorganism (usually abacterium or virus) enters the
Subarachnoid space) there is an inflammatory response Etiology
in the meninges. Etiological agents of meningitis are listed in Table 75.1.
Clinical presentation
Meningitis may be of bacterial origin -pyogenic
(Caused by pyogenic organisms) and
tuberculous
Symptoms: Headache, fever and
altered sensorium (caused by M.tuberculasis). Aseptic meningitis is
Signs: Neck rigidity and
positive signs for meningism caused by viruses.
Suchas Kernig's and BrudinskYs Sign older children Pyogenic meningitis is
further classified as that
and adults develop a stiff neck, usually with fever and which occurs in neonates, in children,in.adultsand in
headache. Infants and young the
children may have a high elderly.Aseptic meningitis is categorised according
or
low body temperature, be irritable or drowsy, or to viral and
non-microbial causes.
have
a poor appetite.
Clinical case presentations of Approach to diagnosis of meningitis
meningitis due to
Streptococcus pneumonia, Neisseria meningitidis, Figure 75.1 describes the approach to the diagnosis of
Bacteroides fragilis (brain abscess), Haemophilus meningitis.