Definition of meningitis
Inflammation of the leptomeninges in the brain and spinal cord.
Definition of encephalitis
Inflammation of the brain parenchyma.
Causes?
Infective
non-infective
What kind of bacteria can cause meningitis?
- Streptococcus pneumoniae (Pneumococcus)
- Neisseria meningitidis (Meningococcus)
- Listeria monocytogenes
Pathway of infection?
Direct infection
Indirect infection
Indirect infection?
- Dissemination of the blood.
- continuous spread of infection in nose, eyes, ears.
3.Retrograde transport along or within peripherial or cranial nerves.
Direct infection?
Due to trauma or surgery
Clinical features of bacterial meningitis?
- classic triad of meningitis: fever + headache + neck stiffness.
- nausea, vomiting
- photophobia
- fatigue
- altered mental status
- seizures
- skin lesion, rashes
- may lead to increased intracranial pressure
Clinical features of viral meningitis?
- Flu like symptoms: low-grade fever, fatigue, muscle pain, upper respiratory symptoms (e.g. sore throat)
- classic triad of meningitis
- nausea, vomiting
- photophobia
What’s the 3 examination wich you can detect meningitis?
- Laboratory tests
- Lumbar puncture and CSF analysis
- Head CT
CSF analysis in acut bacterial meningitis?
(1.macroscopic appearance, 2. cell count (cell/µL), 3. cell type, 4. protein (g/L), 5. glucose)
- cloudy, purulent fluid
- significantly increased >1000
- Polymorphonuclear cells
(granulocytes) - significantly increased
>1 - significantly decreased
~1/3 of blood glucose level
CSF analysis in viral meningitis or encephalitis?
(1.macroscopic appearance, 2. cell count (cell/µL), 3. cell type, 4. protein (g/L), 5. glucose)
- clear fluid
- increased
100-1000 - lymphocytes
- normal or increased
0,4-1 - normal or sightly decreased
What’s the difference of bacterial and viral meningitis prognosis?
Bacterial prognosis: fatal if left untreated.
Viral prognosis: usually resolves spontaneously in most cases.
Treatment of bacterial meningitis?
- intravenous antibiotics
- combination therapy (e.g. ceftriaxone, ampicillin, vancomycin)
- corticosteriod to reduce inflammation (e.g. dexamethason)
- fever and pain management
Treatment of viral meningitis?
usually only symptomatic therapy (fever and pain management)
Two types of meningitis prevention?
- Preexposure prophylaxis- vaccination
- Postexposure measures-chemoprophylaxis
Vaccination to prevent meningitis?
- Hemophilus influaenzae B: obligatory at 2,3,4 and 18 months
- Streptococcus pneumoniae: obligatory at 2, 4 and 12 months (PCV13)
- Neisseria meningitidis- not obligatory
Nimenrix- against Meningococcus A,C,W135,Y
Bexsero- against Meningococcus B
Postexposure measures?
- Antibiotic therapy
- Public measures: notification, reporting, isolation
Indicated for all individuals exposed to an index case (close contacts) if caused by: -Neisseria meningitidis
- Hemophilus
influaenzae
Risk factors?
- crowded living condition (e.g. kindergarten)
- close contact with an infected person
- otitis media, sinusitis, mastoiditis, pneumonia, spesis
- drain, shunt in the brain
- cancer, chronic illness (e.g. diabetes, chirrosis)
- AIDS, removal of spleen
