MENINGITIS ENCEPHALITIS

Presented by: Dr. Shaina G. Yusuf Facilitator: Prof. Matee

2/7/2011

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Definitions:
is inflammation of the delicate membranes (meninges) that cover the brain and spinal cord.  Encephalitis is an acute infection and inflammation of the brain itself. This is in contrast to meningitis, which is an inflammation of the layers covering the brain. Encephalitis is generally a ³viral´ illness. 
Meningitis:
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Features of encephalitis

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Types of meningitis Meningitis is almost always caused by a bacterial. such as in the ears. or upper respiratory tract. 2/7/2011 4 . viral or fungal infection that began elsewhere in the body. and most people recover completely. Viral meningitis tends to be less severe. sinuses. Bacterial meningitis can be serious and deadly. Fungal meningitis is a rare form and generally occurs in people with weakened immune systems.

Epidemiology   varies significantly over time and between locations over the world. Nigeria and Togo. Niger. Chad. 2/7/2011 5 . Côte d'Ivoire. the region that is affected the most is The Meningitis Belt. Burkina Faso. Mali. Ghana. countries that encompass the belt are Benin. the Belt. Ethiopia. the Central African Republic. Cameroon. the Democratic Republic of the Congo. In Africa.

most commonly found in West Africa. the one that is most prevalent is Meningococcal Meningitis. are affected by this epidemic. It is meningitidis. Meningitis. is caused by the microbe Neisseria meningitidis.000 people.year.  Meningococcal Meningitis. Although there are several strains of meningitis. mainly children. highly contagious and is transmitted via personal contact with an infected individual. about 200.  Each 2/7/2011 6 .

Bacterial Meningitis  Bacterial meningitis is an extremely serious illness that requires immediate medical care. If not treated quickly. 2/7/2011 7 . it can lead to death within hours or lead to permanent damage to the brain and other parts of the body.

 2/7/2011 8 . The bacteria then travel through the bloodstream to the brain.  The bacteria can spread from person to person through coughing and sneezing.  In many instances.Bacterial meningitis is caused by several bacteria. Haemophilus influenzae type b (Hib) was a common cause of meningitis in infants until the Hib vaccine was introduced for infants. bacterial meningitis develops when bacteria get into the bloodstream from the sinuses. ears. and Streptococcus pneumoniae or "pneumococcus" is another common cause in children and adults. sneezing. Neisseria meningitidis or "meningococcus" is common in children and young adults. or other part of the upper respiratory tract.

Viral meningitis Studies using polymerase chain reaction (PCR) show that 85%±95% of all cases of viral 85%± meningitis are caused by Enteroviruses (Coxsackieviruses. cytomegalovirus.  2/7/2011 9 . varicella± (HSVHSV. Epstein±Barr Epstein± virus and human herpesviruses 6. and feces. saliva. 7 and 8.varicella± zoster virus. Echoviruses and Enterovirus 71) that are present in mucus.  Less common causes include herpes simplex viruses 1 and 2 (HSV-1 and HSV-2). Primary HIV infection can also present as acute "aseptic" meningitis.

C. neoformans appears to be the most common isolate among meningitis cases (East Afr Med J. Kisenge et al).78(9):458-60 Matee et al). 7: 39. The risk of cryptococcal infection is highest when your CD4 cell <100. Sep. Overall. someone who has an impaired immune system is more likely to become infected with this form of meningitis. However.Fungal meningitis     FungusFungus-related meningitis is rare in healthy people.78(9):4582/7/2011 10 . 2001 Sep. Adult cases of meningitis were almost exclusively due to C. (BMC 2007. neoformans. Cryptococcus neoformans meningitis is common among Tanzanian HIV inpatients (BMC Infect Dis.

e. (diffuse). Encephalitis is a rare condition that affects approximately one person in every 100. Infection can involve one area of the brain (focal) or many scattered areas (diffuse).000 in the UK each year. More common in HIV endemic areas i.MENINGITIS ENCEPHALITIS Encephalitis is an inflammation of the brain. Sub Saharan Africa. 2/7/2011 11 . Only certain microbes have the capability to affect nerves and gain access to the central nervous system. and in most cases an infection by one of these viruses will not lead to encephalitis. which is usually due to infection of the brain by a virus but also few bacteria.

2/7/2011 12 . The initial symptoms  may simply suggest ¶flu or a similar viral infection.g. drowsiness or confusion) ‡ changes in memory or personality ‡ epileptic fits ‡ mild to moderate neck stiffness.The early signs of encephalitis are: ‡ headache ‡ fever ‡ a general feeling of being unwell  These symptoms develop over hours or a day or two. The headache becomes severe and can be linked with: ‡ vomiting ‡ altered awareness (e.

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Imaging such as CT scan or MRI is only useful in brain involvement.e. PCR 2/7/2011 15 . as meningitis is common in patients with <100 CD4 levels.different WBC raise in different infection. RBGRBG.Investigations          CSF analysis. Sometimes where the infection originated from blood. sensitivity. CSF culture and sensitivity. ICP involvementCXR & throat swabs in cases with Pneumonia-if Pneumoniaoriginated from LRTI. levels. protein and analysiscytology.i. CBCCBC.to compare with the CSF taken. sugar. in sero positive patients.appearance. blood cultures as well can be useful.

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Depending on cause of Meningitis and symptomatic Cefotaxime (child. 3.or cephalosporin-intermediate or -resistant isolates before susceptibility results are available. 50 mg/kg up to) 2 g intravenously. daily in 1 or 2 divided doses for 7 to 10 days plus benzyl penicillin (child. 100 mg/kg up to) 4 g intravenously. Vancomycin (15 mg/kg up to) 500 mg four times daily intravenously or rifampicin (20 mg/kg up to) 600 mg daily should be added if Streptococcus pneumoniae is suspected on Gram stain. 60 mg/kg up to) 1.cephalosporinpenicillin.8 g intravenously 4-hourly for 7 to 10 days (if aged under 3 4months or over 50 years).Treatment:  1. 66hourly or ceftriaxone (child. 2/7/2011 18 . to ensure adequate cover for penicillin. 2.

v acyclovir if viral is suspected (though viral is self-limiting 3days .v fluconazole or amphotericin B if fungal meningitis is suspected i. i.4. i.g. Mannitol may be given 2/7/2011 19 . 7. 5. 8. 6.v diazepam Corticosteroid such as i.2weeks) selfIVF if dehydrated. dexamethasone diuretics like i. 9.v.due to semi or dehydratedunconsciousness AntiAnti-convulsions in patients having convulsions e.v.

12. such as labs. electrolytes who have feeding problems.10. input-output for comatose inputpatients. RBG. NGT feeding to prevent aspiration Change position every few hours to prevent bed/pressure sores 2/7/2011 20 . AntiAnti-pyretic for fever Continuous monitoring for labs. 11. especially when reno-toxic drugs renoare used. 13.

deafness. aspiration pneumonia>respiratory distress>death 2/7/2011 21 . poor vision.  hydrocephalus due to blockage of CSF drainage if CSF purulent/thick  Brain edema>convulsions (epilepsy)  Death due to underlying effects e.Complications:  Neurological deficits e.g. facial palsy depend on location of nerve damage.g.

.  There are vaccines for three bacteria that can cause meningitis: Neisseria meningitidis.Can Meningitis Be Prevented?  Apart from vaccination. Streptococcus pneumoniae and Haemophilus influenzae type b (Hib) 2/7/2011 22 . people in close contact with a person infected with bacterial meningitis. As a preventative measure. there is no known way to protect against meningitis.

routine childhood vaccinations against mumps and polio have virtually eliminated infection from those viruses. may be given to older children and adults. People in close contact with the infected person are often given antibiotics such as rifampicin to keep them from acquiring the dangerous germ. 2/7/2011 23 . Another antibiotic . ciprofloxacin. However.  There is no immunization available against viral meningitis. ciprofloxacin. which cause the most serious types of viral meningitis.

the best way to prevent it is to prevent viral infections. There are no vaccines for the most common causes of viral meningitis. There is little evidence that specific activities can lead to developing fungal meningitis. although avoiding exposure to environments likely to contain fungal elements is prudent. HIVHIV-infected people cannot completely avoid exposure. 2/7/2011 24 . Thus.   People with certain viral infections can sometimes develop meningitis. Some guidelines recommend that HIVHIVinfected people receive antifungal prophylaxis if they live in a geographic area where the incidence of fungal infections is very high.

Iv vancomycin (1 g twice daily) was added to the treatment regimen. but not dexamethasone. glucose. protein 2. twophotophobia.4 g/L.Case report ² meningitis unresponsive to standard empirical therapy  Presentation: A 62-year-old woman recently returned from 62-yearSouth Africa presented with a two-day history of headache. 20%. 2/7/2011 25 . CSF : serum glucose ratio. neck stiffness and fever. CT of the brain was normal.  Management: Treatment was begun with ceftriaxone and acyclovir in a peripheral hospital.  Examination: She had a fever and evidence of meningism but was initially alert. The patient became increasingly confused over the following 24 hours and was transferred to a tertiary referral centre. 1.  Investigations: CSF examination showed white cell count.2 mmol/L. 100 x 106 cells/L (predominantly neutrophils).

leaving no long-term longsequelae. Clues suggesting antibiotic-resistant antibioticS. Acyclovir therapy was stopped.  2/7/2011 26 .pneumoniae as the cause were:  Poor response to initial therapy with ceftriaxone. ceftriaxone. mg/L for cefotaxime. pneumoniae.Course and outcome: CSF culture yielded Streptococcus pneumoniae with minimum inhibitory concentrations (MICs) of 4 mg/L for penicillin and 2 stopped. and  Exposure in a country (South Africa) with high prevalence of multiresistant S. The patient's condition responded slowly to therapy over the subsequent four days.

Case report ² sudden onset of seizures and loss of consciousness  Presentation: A 70-year-old man was taken to 70-yeara hospital emergency department in a comatose state. computed tomography revealed no hemorrhage or focal lesion. ventilated and treated with 2/7/2011 27 intravenous acyclovir. which did not respond to 3. intravenous glucose or phenytoin. He had become ill very suddenly while talking on the telephone ² stopping in mid-sentence and having a midseizure. .  Management: He was admitted to the intensive care unit. Initial phenytoin. generalized seizure. acyclovir.  Examination: The patient had a Glasgow Coma Score of 3.

showing hyperintense lesions in both temporal lobes (T2-weighted image with (T2gadolinium enhancement).MRI of the brain on Day 4 after presentation. 2/7/2011 28 .

HSVbut positive for HSV-1. glucose level 9 mmol/L and CSF : serum ratio 80%. An electroencephalogram showed periodic lateralizing epileptiform discharges in the left temporal lobe. Diagnosis: Encephalitis caused by herpes simplex virus (HSV). on polymerase chain reaction testing. for enteroviruses and Murray Valley encephalitis virus. no red blood cells.61 g/L. Magnetic resonance imaging on Day 4 showed bilateral temporal lobe abnormalities (Figure).  Investigations: Initial analysis of CSF showed 7 x 106 lymphocytes/L. 2/7/2011 29 . protein level 0. CSF was negative for cryptococcal antigen and.

Temporal lobe sequelae (memory disturbance and behavioral abnormality) are characteristic of HSV encephalitis. he was able to be discharged home on Day 50. Features suggesting encephalitis were cortical signs (coma and seizure) and cerebrospinal fluid profile Patients presenting with encephalitic syndromes should receive empirical therapy with acyclovir to cover the possibility of HSV infection until an etiological cause is identified.    Course and outcome: Acyclovir treatment was continued. identified. 2/7/2011 30 . and the patient's condition improved gradually after successful treatment of complications that included aspiration pneumonia. He was transferred from the intensive care unit on Day 21. Although the patient's rehabilitation was complicated by inappropriate behavior and memory disturbance.

24th Edition by Vishal 2/7/2011 31 .org. & Adelberg's Medical Microbiology.nlm.gov/pubmed/11921576 http://www.webmd.com/recognizing-bacterialhttp://www.edu/offices/uhs/education/meningitis.html  Jawetz.brainandspine.com/m/meningitis/intro.ht m http://www.cortlandtforum.com/search/  http://www.ncbi. Melnick.bc.References      http://www.cortlandtforum.uk/information/p ublications/brain_and_spine_booklets/meningit is_and_encephalitis/what_is_1.nih.wrongdiagnosis.ht ml http://www.com/recognizing-bacterialmeningitis/article/123578 http://www.

THANKING YOU ALL FOR LISTENING 2/7/2011 32 .

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