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Introduction
Types
Layers of meninges
Epidemology
Mechanism
Mode of transmission
Signs and symptoms
Diagnosis
Treatment
Prevention
3
Condition where the brain and the spinal cord meningesbecome inflamed
Fluid of a person's spinal cord and the fluid that surrounds the brain
Can be further classified as aseptic, septic, or tuberculous.
•Due to virus
•Less severeVIRAL MENINGITIS
•Severe
•Brain demage.Lossof hearing
•Learning disability
BACTERIAL MENINGITIS
5
6
CNS
BRAINSPINAL CORD
MENINGS
8
3 MEMBRANES MENINGES
• fibrous
•Connective tissue
DURA MATTER
•delicate
•Serous membrane
ARACHNOID
•Vascular membranePIA MATTER
9
IT CAN BE CAUSED BY THREE
TYPES OF BACTERIA
Haemophilusinluenza type b
Streptococcus pneumoniae
Neisseriameningitidis
EPIDEMOLOGY
. 3 people per 100,000 anually in western world
Meningitis belt 500 cases per 100,000 sub-saharan africa
Meningococcal ,people living
together
12
Mechanism
Blood brain barrier
Normally the brain is protected by the blood brain barrier
Thick membrane that filters out impurities from blood
Does not allow entry into the brain.
In some persons with decreased immunity the infection
crosses the blood brain barrier.
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The subarachnoid space
Once bacteria have entered the bloodstream, they enter
the subarachnoid space.
Swelling of the meninges
This leads to activation of the immune system that leads
to swelling of the meninges
To stop the spread of the infection.
This swelling damages the brain and the nervous system.
Cerebrospinal fluid
The organism may also affect the CSF.
This adds to the injury and there is increased pressure on
the brain and on the skull.
This is called raised intracranial pressure.
14
The immune response
With the inflammation, the immune system identifies the
bacteria by its cell wall
The immune cells of the brain (astrocytes and microglia),
respond by releasing large amounts of cytokines
are hormone-like mediators that recruit other immune cells. This
stimulates other tissues to participate in an immune response.
The blood-brain barrier becomes more permeable, leading to
"vasogenic" cerebral edema (swelling of the brain due to fluid
leakage from blood vessels)
The blood vessels are also inflamed leading to
cerebral vasculitis which leads to a decreased blood flow another
type of edema, "cytotoxic" edema.
MODE OF TRANSMISSION direct contact
indirect contact
droplets
INCUBATION PERIOD
5-10 days after breaking blood brain barrier, but
lethal in 24 hours and shorter especially in young
pt.
1515
1. Signs of infection
Fever
Chills
Malaise
2. Signs of increased intracranial pressure
Headache
Vomiting
3. Signs of meningeal irritation
Nuchal rigidity (stiff neck)
Opisthotonos (backward arching
of the body in muscle spasms)
Photophobia (sensitivity to light)
Diplopia (double vision)
Delirium, stupor, coma: indicates
a decreasing level of
consciousness, an agitated state
followed by a progressive decrease
in consciousness, and ultimately a
lack of any response.
Other symptoms may include:
- nausea
-discomfort looking into bright
lights
- Confusion
-sleepiness.
NEW BORN SYMPTOMS
FEVER
HEADACHE
NECK STIFNESS
SEIZERS
Assessment and stabilization
BACTERIA FROM
SAMPLE FLUID
SPINAL TAP
NEEDLE INSERTED
SPINAL CANAL
FLUID ACESSIBLE
BLOOD TEST
• MARKERS
• INFLAMMATION
C-REACTIVE
• PROTEIN
• BLOOD CULTURES
CEREBROSPINAL FLUID
• LUMBAR PUNCTATE
A CBC will indicate acute infection. Bacterial antigen testing
may also be done.
A Gram’s stain will determine the presence of bacteria. A full
culture should be done with sensitivity.
Radiography skull and spine x-rays used to identify sinus
infections, fracture, or osteomyellitis; chest x-rays may be used
to identify respiratory infections, abscesses, lesions, orgranulomas.
CT scan will usually be normal in uncomplicated cases of
meningitis, but can show diffuse enhancement in some types or
show hydrocephalus.
Electroencephalogram may be performed to show slow wave
activity.
Bacteria
penetrate the blood-brain barrier, endotoxin
and inflammatory mediators initiate a CSF
inflammatory response
causing leakage of protein and fluid out of
the cerebral vasculature.
the processes delineated in septicemia
occur in brain blood vessels, causing
cerebral edema and cerebral vascular
thrombosis.
Both the increased pressure and thrombosis
may lead to a reduction in cerebral perfusion, and consequently cerebral infarction
Brain death
12 to 18 month 4th dose
3DOSES OF Hib
6MONTH AGE
VACCINES
Treatment:
ceftriaxone, one of the third-generation
cefalosporin antibiotics recommended for the
initial treatment of bacterial meningitis.
High-flow oxygen should be administered as soon
as possible, along with intravenous fluids if
hypotension or shock are present
Mechanical ventilation may be needed if the level
of consciousness is very low, or if there is evidence
of respiratory failure
Prevention
A quadrivalent vaccine -Meningococcus
vaccines exist against groups A, C, W135 and
Y
Pneumococcal polysaccharide vaccine
Prophylaxis
meningococcal meningitis, prophylactic
treatment of close contacts with antibiotics
(e.g. rifampicin, ciprofloxacin or ceftriaxone)
can reduce their risk of contracting the
condition, but does not protect against future
infections.