Meningitis Case Discussion

8/13/2019 Meningitis Case Discussion

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ACUTE BACTERIAL MENINGITIS

Symptoms of Acute bacterial meningitis CASEFever

Headache

Neck stiffnessPhotophobia

Nausea and vomiting

Sleepiness

Confusion

Delirium

Coma


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Risk factors

Extremes of age (< 5 or>60 years)

Diabetes mellitus, renalor adrenal insufficiency,hypoparathyroidism, orcystic fibrosis

Immunosuppression,which increases the risk

of opportunisticinfections and acutebacterial meningitis


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HIV infection, which predisposes to bacterialmeningitis caused by encapsulated organisms,

primarily Streptococcus pneumoniae, andopportunistic pathogens

Crowding (such as that experienced by militaryrecruits and college dorm residents), which increases

the risk of outbreaks of meningococcal meningitis


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Splenectomy and sickle cell disease, which

increase the risk of meningitis secondary to

encapsulated organisms

Alcoholism and cirrhosis

Recent exposure to others with meningitis,

with or without prophylaxis

Contiguous infection (eg, sinusitis)


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Dural defect (eg, traumatic, surgical, or

congenital)

Thalassemia major

Intravenous (IV) drug abuse

Bacterial endocarditis

Ventriculoperitoneal shunt

Malignancy (increased risk of Listeriainfection)

Some cranial congenital deformities


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Epidemiology

Bacterial meningitis is the most common formof suppurative CNS infection

The organisms most often responsible for

community-acquired bacterial meningitis are: Streptococcus pneumoniae(50%),

Neisseria meningitidis(25%),

group B streptococci (15%), Listeria monocytogenes(10%).

Haemophilus influenzae (


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Etiology

S. pneumoniae is the most common cause ofmeningitis in adults >20 years of age,accounting for nearly half the reported cases

(1.1 per 100,000 persons per year). Otitis, mastoiditis, and sinusitis are

predisposing and associated conditions formeningitis due to Streptococcisp., gram-negative anaerobes, S. aureus, Haemophilussp., and Enterobacteriaceae.


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Pat

hophys

iology

S.pneumoniae/

N.meningitidis

Colonize the nasopharynx

Transported to the

bloodstream

Reach the intraventricularchoroid plexus

Avoid phagocytosis

by PMNs and

complement

Few WBCs, Igs and

complement

Fluid nature

of CSF

Prevents opsonization

of bacteria

Mutiply rapidly

within the CSF

Production of

inflammatory

cytokines and

chemokines

CSF

proteinleukocytosis

Meningeal inflammation


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Prognosis

Mortality rate is 3

7% for meningitis caused by H.influenzae, N. meningitidis, or group B streptococci;15% for that due to L. monocytogenes; and 20% for S.pneumoniae.

In general, the risk of death from bacterial meningitisincreases with decreased level of consciousness on admission,

onset of seizures within 24 h of admission,

signs of increased ICP,

young age (infancy) and age >50,

the presence of comorbid conditions including shockand/or the need for mechanical ventilation,

delay in the initiation of treatment.


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Meningitis Case Discussion

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