Meningitis An Update

1. Meningitis“An Update” Saad A. Alsaleh

2. Objectives Introduction Classification Can you exclude meningitis without an LP? When is a CT necessary? Bacterial meningitis scores? What antibiotics should I use? What about steroids? Complications Summary

3. Introduction Meningitis is the inflammation of the meninges. Caused by bacteria, viruses or rarely other causes. The WHO estimates that bacterial meningitis strikes 426,000 children younger than 5 years annually, with 85,000 deaths.

4. Introduction In History: Meningitis was first accurately identified by the Swiss Vieusseux (a scientific -literary association) during an outbreak in Geneva, Switzerland in 1805. In the 1st decade of the 20th century, meningococcal meningitis was associated with a mortality rate of 75 to 80 %.

5. Introduction In History: In the 1920s, at Boston Children's Hospital 77 of 78 children who had Haemophilus influenzae M. died and all patients (300) with pneumococcal M. died. In the past 15 years, mortality rates for: meningococcal meningitis 10 % H. influenzae meningitis 5 % Pneumococcal meningitis 20 % 1- so the MR in these pts was near to 100% and this was long before the introduction and the evolution of Abx and vaccines1- so the MR in these pts was near to 100% and this was long before the introduction and the evolution of Abx and vaccines

6. The "Meningitis Belt" is an area in sub-Saharan Africa which stretches from Senegal in the west to Ethiopia in the east in which large epidemics of meningococcal meningitis occur (this largely coincides with the Sahel region). It contains an estimated total population of 300 million people. The largest epidemic outbreak was in 1996, when over 250,000 cases occurred and 25,000 people died as a consequence of the disease.The "Meningitis Belt" is an area in sub-Saharan Africa which stretches from Senegal in the west to Ethiopia in the east in which large epidemics of meningococcal meningitis occur (this largely coincides with the Sahel region). It contains an estimated total population of 300 million people. The largest epidemic outbreak was in 1996, when over 250,000 cases occurred and 25,000 people died as a consequence of the disease.

7. Classification Infectious Bacterial Viral Fungal Non-infectious Drug-Induced Autoimmune Neoplastic

8. Bacterial meningitis in Canada (1994-2001). Deeks SL. Canadian Communicable Disease Report. Dec 2005.

9. Bacterial meningitis in Saudi Arabia: the impact of Haemophilus influenzae type b vaccination.Almuneef M, Alshaalan M, Memish Z, Alalola S. J Chemother. 2001 Apr;13 Suppl 1:34-9 A retrospective chart review of all cases of culture-proven bacterial meningitis in children was conducted in a tertiary care facility in the King Fahad National Guard Hospital (KFNGH), Riyadh. Sixty-seven patients with culture-proven meningitis were reviewed.A retrospective chart review of all cases of culture-proven bacterial meningitis in children was conducted in a tertiary care facility in the King Fahad National Guard Hospital (KFNGH), Riyadh. Sixty-seven patients with culture-proven meningitis were reviewed.

10. Viral Meningitis Prior to the introduction of the MMR vaccine mumps was the most common cause now the enterovirus group causes most of the casesPrior to the introduction of the MMR vaccine mumps was the most common cause now the enterovirus group causes most of the cases

11. Clinical Features(Can you exclude meningitis without an LP? )

12. Clinical Features:Symptoms As a general rule…As a general rule…

13. Clinical Features:Signs Signs of shock: ? BP, tachycardia, poor capillary refill, oliguria. Altered mental status, from irritability to somnolence, delirium, and coma. Meningeal signs: Photophobia. neck stiffness. positive Kernig’s or Brudzinski’s signs (sensitivity & specificity are uncertain). 1- Especially in meningococcal M. 3-2 you should also Examine skin over entire spine for dimples, sinuses, nevi, or tufts of hair, which may indicate a congenital anomaly communicating with the subarachnoid space 1- Especially in meningococcal M. 3-2 you should also Examine skin over entire spine for dimples, sinuses, nevi, or tufts of hair, which may indicate a congenital anomaly communicating with the subarachnoid space

14. Clinical Features:Signs Passive knee extension in supine patient elicits neck pain and hamstring resistance Passive knee extension in supine patient elicits neck pain and hamstring resistance

15. Clinical Features:Signs Passive neck or single hip flexion is accompanied by involuntary flexion of both hips Passive neck or single hip flexion is accompanied by involuntary flexion of both hips

16. Clinical Features:Signs Signs of ? ICP: papilloedema, anisocoria, ptosis, 6th nerve palsy, bradycardia with HTN. Focal neurological signs in up to 15% of patients and are associated with a worse prognosis. Generalized or focal seizures are observed in as many as 33% of patients. 1-… due to increase in vascular perm. 2- and a comp. LP 3- and if prolonged and uncontrolled this indicates a poor prognosis1-… due to increase in vascular perm. 2- and a comp. LP 3- and if prolonged and uncontrolled this indicates a poor prognosis

17. Clinical Features:Signs Skin findings: petechial or purpuric rash (meningococcal meningitis). Signs of DIC. Extracranial infection (eg, sinusitis, otitis media, mastoiditis, pneumonia, infective endocarditis) may be noted. 2- which is a comp. of sepsis like bleeding and bruises 3- As the source or the complication of sepsis so u should examine HEENT, chest, cvs2- which is a comp. of sepsis like bleeding and bruises 3- As the source or the complication of sepsis so u should examine HEENT, chest, cvs

18. Meningococcal Meningitis