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Management of Acute Meningitis

By Dr Ammara Mushtaq Khan. House Officer MU II BBH

MENINGITIS
Meningitis also termed as leptomeningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the MENINGES. The inflammation may be caused by infection with
Viruses Bacteria Other microorganisms Less commonly by certain drugs.
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MENINGITIS

INTROUCTION
Meningitis can be life-threatening because of the inflammation's proximity to the brain and spinal cord, therefore the condition is classified as a medical emergency..
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AIM
To discuss about the management of ACUTE MENINGITIS.

SEQUENCE
Symptoms Causes Types Management Conclusion

SYMPTOMS
The most common symptoms of meningitis are: Fever upto 30-40(Centigrade) Headache Neck stiffness associated with fever Confusion Altered consciousness Vomiting An inability to tolerate light (photophobia) or loud noises (phonophobia)
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CHILDREN
Sometimes, especially in small children only nonspecific symptoms may be present, such as
Irritability Drowsiness

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INFECTIVE CAUSES OF MENINGITIS

Bacteria Neisseria meningitidis Streptococcus pneumoniae Staphylococcus aureus Streptococcus Group B Listeria monocytogenes Gram-negative bacilli Mycobacterium tuberculosis Treponema pallidum Viruses Enteroviruses Coxsackie Mumps Herpes simplex HIV Epstein-Barr virus Fungi Cryptococcus neoformans Candida Coccidioides immitis, Histoplasma capsulatum, Blastomyces dermatitidis
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TYPES
Meningitis has been divided into two categories
Bacterial Meningitis. Aseptic Meningitis.

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BACTERIAL MENINGITIS
Bacterial or pyogenic meningitis is an acute meningeal inflammation secondary to a bacterial infection that generally evokes a polymorphonuclear response in the CSF. Bacterial meningitis is the most common life threatening type of meningitis and can cause death within hours.

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PROBLEMS BACTERIAL MENINGITIS CAUSE

Blindness Speech loss Brain damage Seizures Paralysis

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2. ASEPTIC MENINGITIS
Aseptic meningitis refers to a meningeal inflammation without evidence of pyogenic bacterial infection on Grams stain or culture, usually accompanied by a mononuclear pleocytosis.

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TREATMENT
Treatment depends on the cause. Some general guidelines may include: VIRAL There is no specific treatment. Antibiotics are not needed. They may be given until the cause of the meningitis is known. Support care with rest, fluids and medicine for fever and headache. Bacterial Intravenous (IV) antibiotics and fluids. Steroids to help reduce the inflammation in the brain. Support care with rest, fluids, oxygen and medicine for fever and headache
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MANAGEMENT

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MANAGEMENT
Recognition and immediate treatment of acute bacterial meningitis is vital. Minutes save lives. Bacterial meningitis is lethal . The diagnostic test for meningitis is the lumbar puncture (LP). However, this test should not be undertaken until the patient has been resuscitated and stabilized.

The immediate management of suspected meningococcal infection is benzylpenicillin 2.4 g (adult dose) either by slow i.v. injection or intramuscularly, prior to investigations. Cefotaxime 1 g i.v. is an alternative in cases of penicillin allergy. In meningitis, minutes count: delay is unacceptable.

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INVESTIGATIONS
On arrival in hospital, routine tests including blood cultures should be carried out immediately. CT scan is performed prior to Lumbar puncture only if there is Immunocompromised state History of CNS disease Papilledema Abnormal level of consciousness Focal neurologic deficit
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MANAGEMENT
After stabilization of the patient (including airway, breathing, circulation), the priority in the treatment of acute bacterial meningitis is the Prompt administration of an appropriate bactericidal antibiotic(s) that has rapid entry into the subarachnoid space.

In some cases, an anti-inflammatory agent (e.g, dexamethasone, which suppresses the bodys usual inflammatory reaction).
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ANTIBIOTIC MANAGEMENT
Pathogen N. meningitis Regimen of choice Benzylpenicillin 2.4 g IV 4 hourly for 5-7 days

Strep. Pneumoniae (sensitive to b-lactams, MIC < 1mg/L) Strep. Pneumoniae (resistant to b-Lactams) Listeria monocytogenes

Cefotaxime 2g IV 6 hourly or ceftriaxone 2g IV 12 hourly for 10-14 days. Add Vancomycin 1g IV 12 hourly with ceftriaxone/cefotaxime Ampicilin 2g IV 4 hourly plus gentacin 5 mg/kg IV daily

H. Influezae

Cefotaxime 2g IV 6 hourly or ceftriaxone 2g IV 12 hourly for 10-14 days.

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USE OF BACTERICIDAL AGENTS

Bactericidal therapy is generally necessary to cure meningitis Bacteriostatic drugs, such as clindamycin and tetracycline, are inadequate for meningitis

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 The mortality rate of untreated bacterial meningitis approaches 100 percent and, even with optimal therapy, there is a high failure rate.

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CONCLUSION

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 In spite of the availability of antibiotics and the introduction of vaccines for immunoprophylaxis, bacterial meningitis remains a common disease worldwide, with high morbidity and mortality.
Meningitis can occur at any age and in previously healthy individuals, young children, especially infants; and elderly patients. Analysis of Cerebrospinal Fluid (CSF) remains the key to diagnosis.

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