1. In the name of God

2. MENINGITIS MeningitisMaster:Dr.KermaniBy:Shaghayegh NooraniFaezeh Sheikolvaezin 3. ? What is meningitiso The brain and spinal cord are covered by connectivetissue layers collectively called the meninges whichform the blood-brain barrier.(the pia mater (closest to the CNS-1the arachnoid mater-2(.the dura mater (farthest from the CNS-3The meninges contain cerebrospinal fluid (CSF).Meningitis is an inflammation of the meninges, which, ifsevere, may become encephalitis, an inflammation. of the brain 4. ? W is Meningitis hat Meningitis can be caused by many differentorganisms including viruses and bacteria. Meningitis, caused by a bacteria, is lifethreatening and requires urgent medical attentionand treatment with antibiotics. Meningitis caused by a virus is very rarely lifethreatening but can cause the body to becomevery weak. When bacteria invade the body they can causemeningitis, septicaemia or meningitis andsepticaemia together 5. Causes of MeningitisBacterial Infections-Viral Infections-Fungal Infections-Cry p to c o c c us ne o fo rm a ns )(Co c c id io d e s im m itusInflammatory diseases-(SLE)Cancer.Trauma to head or spine- 6. Bacterial meningitis..: Etiological Agents Pneumococcal, Stre p to c o c c us p ne um o nia e ((3 8 % (Meningococcal, N is s e ria m e ning itid is (1 4%e (Ha e m o p hilus influe nz a e (4% (Staphylococcal, Sta p hy lo c o c c us a ure us (5 % Tuberculous, M c o ba c te rium tube rc ulo s is y 7. Bacterial Meningitis.Potentially life threatening disease.One million cases per year world wide. 200,000 die annually. Can affect all age groups but some are at higher riskTreatment available : antibiotics as per causative organism .Humans are the reservoirPneumococcal meningitis is the most common type. Approximately6,000 cases/yrHaemophilus meningitis: Since 1985 Incidence has declined by.95% due to the introduction of Ha e m o p hilus influe nz a b vaccineOther bacterial meningitis caused by E-Co li K-1, Kle bs ie lla speciesand Ente ro ba c te r species are less common overall, but may bemore prevalent in newborns, pregnant women, the elderly and.immunocompromised hosts 8. ? W is Meningococcal diseasehatEtiological Agent: N is s e ria m e ning itid iseClinical Features: sudden onset. F,H,N,VReservoir: Humans only. 5-15% healthy carriersMode of transmission: direct contact with patients oral or nasal.secretions. SalivaIncubation period: 1-10 days. Usually 2-4 daysInfectious period: as long as meningococci are present in oral secretions or until 24 hrs of effective antibiotic therapy: Epidemiology. Sporadic cases worldwide.Meningitis belt sub-Saharan Africa into India/Nepal.In US most cases seen during late winter and early springChildren under five and adolescent most susceptible. Overcrowding e.g.dormitories and military training camps predispose to spread of 9. Aseptic MeningitisDefinition: A syndrome characterized by acute onset of meningealsymptoms, fever, and cerebrospinal fluid pleocytosis, with. bacteriologically sterile cultures:Laboratory criteria for diagnosis CSF showing 5 W cu mm BC/. No evidence of bacterial or fungal meningitisCase classificationConfirm a clinically compatible illness diagnosed by a physician ased:aseptic meningitis, with no laboratory evidence of bacterial or fungalmeningitisCommentAseptic meningitis is a syndrome of multiple etiologies, but most casesare caused by a viral agent 10. Viral Meningitis : Etiological Agents. Enteroviruses (Coxsackies and echovirus): most commonAdenovirus-Arbovirus-Measles virus-Herpes Simplex Virus-Varicella-: ReservoirsHumans for Enteroviruses, Adenovirus, Measles, Herpes Simplex, and-Varicella. Natural reservoir for arbovirus birds, rodents etc-:Modes of transmissionPrimarily person to person and arthopod vectors for Arboviruses-: Incubation PeriodVariable. For enteroviruses 3-6 days, for arboviruses 2-15 days-. Treatment: N s p e c ific tre a tm e nt a v a ila ble o.Most patients recover completely on their own 11. Non Polio Enteroviruses: Types:62 different types known, Coxsackie A viruses 23 -, Coxsackie B viruses 6 -echoviruses, and 5 other 28 - ? H com onowmof all viral meningitis is caused by Enteroviruses 90% -. Second only to "common cold" viruses, the rhinoviruses-Estimated 10-15 million/more symptomatic infections/ in US-yr. W is at risk? Everyone hoH does infection spread? ow. Virus present in the respiratory secretions & stool of a patient. Direct contact with secretions from an infected personParents, teachers, and child care center workers may also become infected by. contamination of the hands with stool 12. The difference between Meningitisand SepticaemiaWhen bacteria cause disease i.e.meningococcal disease the body can be:affected in different ways Meningitis - bacteria enter the blood streamand travel to the meninges and causeinflammation. Septicaemia - when bacteria are present in theblood stream they can multiply rapidly andrelease toxins that poison the blood. (The rashassociated with meningitis is due tosepticaemia.) 13. Symptoms of Meningitis andSepticemiaMeningitis and meningococcal septicaemia maynot always be easy to detect, in early stagesthe symptoms can be similar to flu. They maydevelop over one or two days, but sometimesdevelop in a matter of hours.It is important to remember that symptoms donot appear in any particular order and some.may not appear at all 14. Symptoms for meningitis andmeningococcal septicaemia:Babies and Young Children:-High temperature, fever, possibly with cold hands and feetVomiting or refusing feeds-High pitched moaning, whimpering cry-Blank, staring expression-Pale, blotchy complexion-Stiff neck-Arched back-Baby may be floppy, may dislike being handled, be fretful-Difficult to wake or lethargic-The fontanelle (soft spot on babies heads) may be tense or-.bulging 15. Older Children and AdultsHigh temperature, fever, possibly with cold hands and-.feet.Vomiting, sometimes diarrhoea-.Severe headache-.Joint or muscle pains, sometimes stomach cramps-(Neck stiffness (unable to touch the chin to the chest -.Dislike of bright lights-.Drowsiness-The patient may be confused or disorientated. Fitting may.also be seen.A rash may develop 16. One of the physicallydemonstrable symptomsof meningitis is Kernigssign. Severe stiffness ofthe hamstrings causesan inability to straightenthe leg when the hip is .flexed to 90 degrees 17. Another physicallydemonstrable symptomsof meningitis isBrudzinskis sign.Severe neck stiffnesscauses a patients hipsand knees to flex when. the neck is flexed 18. In the early stages, signs andsymptoms can be similar tomany other more commonillnesses, foe example flu. Earlysymptoms can include fever,headache, nausea (feeling sick),.vomiting and general tirednessThe common signs and symptomsof meningitis and septicaemiaare shown above. Others caninclude rapid breathing,diarrhoea and stomach cramps.In babies, check if the soft spot(fontanelle) on the top of the.head is tense or bulging 19. One sign of meningococcal septicaemia is arash that does not fade under pressure((see Glass testThis rash is caused by blood leaking -under the skin. It starts anywhere on thebody. It can spread quickly to look like. fresh bruisesThis rash is more difficult to see on darker -skin. Look on the paler areas of the skin.and under the eyelids 20. Glass TestA rash that does not fadeunder pressure will stillbe visible when the sideof a clear drinking glassis pressed firmly against.the skinIf someone is ill orobviously getting worse,do not wait for a rash. Itmay appear late or not.at allA fever with a rash thatdoes not fade underpressure is a medical.emergency 21. What to do if you suspect meningitis or:septicaemia Contact your GP immediately. If you GP is notavailable, go straight to your nearest accidentand emergency department. Describe the symptoms carefully and say thatyou think it could be meningitis or septicaemiaEarly diagnosis can be difficult. If you have seena doctor and are still worried, dont be afraid toask for medical help again 22. Be aware, be preparedMeningitis and meningococcal septicaemia (bloodpoisoning) are serious diseases that can affectanyone at any time. Teenagers and studentsinparticular, are at increased risk.Most youngpeople in the UK have already had the MenCvaccine. If you havent or cant remember,gettingvaccinated now is a good way to protectyourself. But remember, vaccines cant preventall forms ofmeningitis and septicaemia.So it is very importantthat you are aware of the signs and symptoms sothat you can get medical help urgently if you 23. Public Health Importance: ChallengesEducating public-Timely reporting and records keeping-.Updating information daily-Alleviating public anxiety and concerns-Collaborating with health partners-: OpportunitiesEducating public-Communication-Strengthening partnerships- 24. The End