1. meningitis

2. 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.

3. 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.

4. 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

5. 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

6. 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

7. 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
Elevated
PMN
DECREASED <40mg
positive
Partially treated m.
normal
5-10 mostly mononuclear
Same
sterile
Viral men
80-150
slight increase
<1000,mainly lymphocyte
50-200
Normal , except in mumps it decrease
Tuberculous meningitis
elevated
lymphocytes
Decreased
<50
Acid-fast or culture positive for Tb.bacterialculture;-ve