meningitis

Causes and cilinical picture It is inflammation of meninges by bacteria, viruses or fungal. Most serious is bacterial M. Bacterial men.is life treatening infection so it need rapid diagnosis and prompt antibiotic therapy,any delay in suggestion and in antibiotic treatment will lead to serious mortality and morbidity states.It is medical emergency. features ; headache,fever, vomiting,irritability,seizures,neck stiffness,kerning sign and brudziniski sign are +ve. Liumber puncture should be done to diagnose the CSF finding, and should be early without delay for the start of antibiotics.fundoscopy should be done to exclude papillodema.or CT SCAN OF BRAIN but here should take blood culture and give first dose antibiotic before sending for CT scan.

complications Bacterial meningitis is serious condition and if not treated rapidly; may have mortality by 30%. Delay in treatment may lead to meningoccemia, DIC Multiorgans failure, or morbidity post meningitis problems as hydrocephalus, epilepsy ,cranial nerve palsy, subdural effusion,sensorineural hearing defect. Some misdiagnosed cases may be partially treated by outpatient doctors by oral antibiotics and lead to diagnostic confusion.

Lumber puncture Contraindicated in; Increased intracranial pressure as indicated by focal neurological sign and bradycardia and by papilloedema or persistent tense bulging fontanele in case of still open. or if the patient is depressed in mentation or be cardiorespiratory compromise, or if has infection at the lumber site

treatment Should be rapid by conservative fluid therapy and antibiotics; Imperical therapy combination of ceftriaxone+vancomycin+acyclovir if viral cause cannot excluded. Then specific antibiotic according culture &sensitivity result can be choosed. Steroid usually dexamethasone should be started soon; together or before the start of antibiotics to get benefit from its anti-inflamatory effect and to reduce adhesions in the meninges. Continue therapy for10-14 days. Bacteria agent are; N.meningitis, H.influenza b.,pneumococcus; are most common

Partially treated meningitis Partially treated bacterial meningitis It is due to wrongly antibiotics given before considering the real diagnosis in the patient as erroneously some doctors miss the diagnosis and give oral or injectable antibiotics on assumption of simple upper respiratory infection for at least 24 hours and so this will mask the CSF findings. Usually CSF will show normal pressure and normal sugar,proteins remain elevated for some days and cells may show lymphocytosis, and gram stain and culture may be negative.Diagnosis for bacterial antigens by latex agglutination test for CFS may detect positive finding for pneumococcus,meningococcus,or H,influenza

CSf finding in meningitis type Pressure in mm H2O 50-80 LEUKOC (cmm)<5./75%ympho Protein(mg/dl)20-40 Glucose(mg/dl)>50 ,75% of serum Gram stain and culture Acute bacterial Elevated100-300 100-10.000 PMN 100-500 DECREASED <40mg positive Partially treated m. normal 5-10 mostly mononuclear Same 100-500 sterile Viral men 80-150 slight increase <1000,mainly lymphocyte 50-200 Normal , except in mumps it decrease Tuberculous meningitis elevated 10-500 lymphocytes 100-3000 Decreased <50 Acid-fast or culture positive for Tb.bacterialculture;-ve