meningitis PHARMD-3rd-year

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MENINGITIS : 

MENINGITIS Sai kumar katam Bharat institute of technology

LEARNING OBJECTIVES : 

LEARNING OBJECTIVES At the end of lecture, the participants will be able to ; Describe meningitis with its numerous causes. Discuss the pathophysiology of meningitis. Enlist the types of meningitis. Interpret the CSF findings in meningitis. Discuss the different organisms ivolved in meningitis. Define the different laboratory tests to diagnose meningitis. REVOLUTIONPHARMD.COM

CONTENTS : 

CONTENTS Meningitis Overview of brain’s membranes & CSF Etiology Pathophysiology Clinical features Diagnosis REVOLUTIONPHARMD.COM

MENINGITIS : 

MENINGITIS “Inflammation of brain & spinal cord membranes (meninges) & CSF in contact with these membranes” REVOLUTIONPHARMD.COM

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MENINGITIS BACTERIAL (Acute) VIRAL (Aseptic) CRYPTOCOCCAL (Chronic) REVOLUTIONPHARMD.COM

ETIOLOGY : 

ETIOLOGY Most common & dangerous – bacterial meningitis Most common bacterial organisms causing meningitis; S. pneumoniae N. meningitidis Grp. B Streptococcus L. monocytogenes H. influenzae S. aureus Coagulase –ve staph REVOLUTIONPHARMD.COM

Cocci Causing Meningitis : 

Cocci Causing Meningitis REVOLUTIONPHARMD.COM

RISK FACTORS : 

RISK FACTORS Environmental Recent infection Immunosuppression Surgery, trauma Non infectious causes REVOLUTIONPHARMD.COM

Bacterial Meningitis : 

Bacterial Meningitis REVOLUTIONPHARMD.COM

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PATHOPHYSIOLOGY : 

PATHOPHYSIOLOGY REVOLUTIONPHARMD.COM

CNS RESPONSE TO INFECTION : 

CNS RESPONSE TO INFECTION INCREASED ICP DECREASED CEREBRAL BLOOD FLOW VASOGENIC EDEMA OXYGEN DEPLETION INCREASED CSF PROTEIN CNS ISCHEMIA REVOLUTIONPHARMD.COM

EDEMATOUS & NORMAL BRAIN : 

EDEMATOUS & NORMAL BRAIN REVOLUTIONPHARMD.COM

Clinical Presentation of meningitis : 

Clinical Presentation of meningitis Evaluate risk factors & exposures Signs & symptoms REVOLUTIONPHARMD.COM

SIGNS & SYMPTOMS : 

SIGNS & SYMPTOMS Headache Fever Nuchal rigidity Nausea Altered mental status Focal neurologic defects (brudzinski’s & kernig’s sign) Seizures Malaise, restlessness Photophobia Skin lesions (petecheal rash) Papilledema Young children  altered feeding, sleep patterns, resp. distress, bulging fontanel REVOLUTIONPHARMD.COM

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Brudzinski neck sign : 

Brudzinski neck sign flexion of the lower limbs induced by passive flexion of the head on the chest REVOLUTIONPHARMD.COM

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KERNIG’s SIGN : 

KERNIG’s SIGN performed with the patient supine with hips and knees in flexion. Extension of the knees is attempted the inability to extend , the patient’s knees beyond 135 degrees without causing pain. REVOLUTIONPHARMD.COM

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DIAGNOSIS : 

DIAGNOSIS Lumber Puncture (LP or Spinal Tap) CT scan PCR C- reactive protein Blood Cultures Skin lesion Scrapping for direct microscopy Other cultures (sputum) TLC Fungal meningitis – CSF culture, CSF & serum cryptococcal antigen titers, CSF Examination TB meningitis – CSF culture, PCR, AFB REVOLUTIONPHARMD.COM

LUMBER PUNCTURE : 

LUMBER PUNCTURE REVOLUTIONPHARMD.COM

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CSF EXAMINATION : 

CSF EXAMINATION REVOLUTIONPHARMD.COM

Acute bacterial meningitis : 

Acute bacterial meningitis Pathology: Meningeal exudates around cerebral veins venous sinuses convexity of the brain basal cisterns and spinal cord Ventriculitis,subdural Effusion ,rarely empyema, Perivascular inflammatory exudates & infiltrates Cerebral infarction Inflammation of spinal nerves---meningeal signs. Inflammation of cranial nerves--cranial neuropathies. cerebritis REVOLUTIONPHARMD.COM

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Neisseria meningitidis : 

Neisseria meningitidis Leading cause of bacterial meningitis Gm negative cocci. 5 serogroups ( A,B , C, Y & W) Hematogenous seeding , contagious spread. Behavioral changes Meningococcal Sepsis Seizure, coma - uncommon Permanent deafness ( sensorineural damage ) Petecheae or purpuric lesions DIC  Thrombosis Meningococcal disease REVOLUTIONPHARMD.COM

Petecheal rash & purpura : 

Petecheal rash & purpura REVOLUTIONPHARMD.COM

STREPTOCOCCUS PNEUMONEAE : 

STREPTOCOCCUS PNEUMONEAE Most common cause. Secondary infection ( paranasal infection, pneumonia, CSF leaks) Coma & seizures Risk factors (cochlear implants, splenectomy, elderly, alcohalics) vaccination REVOLUTIONPHARMD.COM

HEMOPHILLUS INFLUENZA : 

HEMOPHILLUS INFLUENZA Gm negative bacilli. Contagious spread or hematogenous seeding. Close contact - risk factor Vaccination REVOLUTIONPHARMD.COM

LISTERIA MONOCYTOGENES : 

LISTERIA MONOCYTOGENES gram-positive diphtheroid-like organism Food contaminant in healthy individuals - extremely rare Lead to cerebritis REVOLUTIONPHARMD.COM

Post operative infections & shunt infections : 

Post operative infections & shunt infections High risk (epidural cathetors, intraspinal pumps, shunts) Most likely pathogens in post operative infection. Implant malfunction or post –op wound infection. Brain abscess Surgical removal REVOLUTIONPHARMD.COM

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CRYPTOCOCCAL MENINGITIS : 

CRYPTOCOCCAL MENINGITIS most common form of fungal CNS infection Common in HIV patients. REVOLUTIONPHARMD.COM

TUBERCULOUS MENINGITIS : 

TUBERCULOUS MENINGITIS Paralysis of VI cranial IREP use. REVOLUTIONPHARMD.COM

VIRAL MENINGITIS & ENCEPHALITIS : 

VIRAL MENINGITIS & ENCEPHALITIS Can follow any viral infection Clinical features – same as in bacterial. Hematogenous seeding or neuronal spread. Most are self limiting. HSV1 & HSV2 REVOLUTIONPHARMD.COM

CASE STUDY : 

CASE STUDY Age = 11th DOL Weight = 1.8 kg Present complaints ; focal fits, headache, nausea. Clinical assesment ; Sepsis, persistent Hypoglycemia Provisional diagnosis ; Meningitis TLC = 14.2 * 103 / mm3 K+ =2.9 meq/l REVOLUTIONPHARMD.COM

CASE STUDY : 

CASE STUDY CSF D/R Wbc = 60 Neutrophils = 4300 Rbc = 40 Glucose = 56 C/S org ; _____ REVOLUTIONPHARMD.COM

REFERENCES : 

REFERENCES Pathologic basis by ROBBINS. Principles & practices of medicine by DAVIDSON. Pharmacotherapy by DIPIRO. Clinical pharmacy and therapeutics by ROGER WALKER. www.emedicine.com http://www.med.unc.edu/medicine/web/meningitis.htm www.youtube.com (csf shunt insertion & bacterial meningitis) REVOLUTIONPHARMD.COM

THANK YOU : 

THANK YOU

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