Bacteria Meningitis

Question 1

WHAT IS MENINGITIS?

Answer 1

The brain and spinal cord are covered by connective tissue layers collectively called the meninges which form the blood- brain barrier.
• 1-the pia mater (closest to the CNS)
• 2-the arachnoid mater
• 3-the dura mater (farthest from the CNS).
• The meninges contain cerebrospinal fluid (CSF).
• Meningitis is an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain.

Question 2

CAUSES OF MENINGITIS

Answer 2

• -Bacterial Infections
• -Viral Infections
• -Fungal Infections
• (Cryptococcus neoformans • Coccidiodes immitus)
• -Inflammatory diseases
• (SLE)
• Cancer
• -Trauma to head or spine.

Question 3

ETIOLOGY/CAUSE
• The five most common causes of bacteria meningitis are

Answer 3

a) Streptococcus pneumonia (pneumococcus)

b) Neisseria meningitides (meningococcus) - very contagious they can be contracted through touch, kissing and coughing

c) Streptococcus agalactiae ( group B streptococcus) - found in the birth canal, baby can be infected during birth ( common in newborns)

d) Listeria monocytogen - takes advantage of weak immune system (immune compromised patients and patients taking steroids)

e) Haemophilus Influenzae

Question 4

CAUSES BASED ON AGE : NEW BORN

Answer 4

S. agalatiae(70%)
L.Monocytogenes
S.Pneumoniae

Question 5

1 MONTH-23 MONTHS

Answer 5

1 MONTH-23 MONTHS
S.Pneumoniae(45%)
N.Meningitidis
S.Agalatiae

Question 6

2 TO 17 YEARS

Answer 6

2 TO 17 YEARS
N.meningitides (60%) S.pneumoniae
H.influenzae

Question 7

18-50 YEARS

Answer 7

18-50 YEARS
S.pneumonia(60%)
N.meningitides (20%)
H.influenza
L.monocytogenes
S.agalatiae

Question 8

18-50 YEARS

Answer 8

18-50 YEARS
S.pneumonia(60%)
N.meningitides (20%)
H.influenza
L.monocytogenes
S.agalatiae

Question 9

CLINICAL MANIFESTATION

Answer 9

Toxic symptom all over the body – Hyperpyrexia
– Headache
– Photophobia
– Painful eye movement
– Fatigued and weak
– Malaise, myalgia, anorexia,
– Vomiting, diarrhea and abdominal pain – Cutaneous rash
– Petechiae, purpura

Question 10

CLINICAL MANIFESTATION OF CNS

Answer 10

Meningeal irritation sign
• Neck stiffness
• Positive Kernig’s sign
• Positive Brudzinski’s sign

Question 11

• Laboratory Findings

Answer 11

• Rout examination of cerebrospinal fluid (CSF)
– Increased pressure of cerebrospinal fluid
– Cloudiness
– Evident Increased total WBC count (>1000×109/L)
– Evident Increased neutrophils in leukocyte differential count – Evident Decreased glucose (<1.1mmol/l)
– Evident Increased protein level
– Decreased or normal chlorinate
– CSF film preparation or cultivation : positive result

• Especial examination of CSF
– Specific bacterial antigen test
• Countercurrent immuno-electrophoresis
• Latex agglutination
• Immunoflorescent test
– Neisseria meningitides (meningococcus)
– Haemophilus influenza
– Streptococcus pneumoniae ( pneumococcus) – Group B streptococcus

• Especial examination of CSF • –Other test of CSF
• LDH
• Lactic acid
• CRP
• TNF and Ig
• Neuron specific enolase (NSE)

Question 12

TREAMENT Younger than 1 month

Answer 12

Ampicillin plus cefotaxime or Ampicillin plus amino glycosides(gentamycin or tobramycin)

Ceftriaxone is contraindicated in children

Ampicillin covers for listeria

Question 13

Treatment 1-24 MONTHS

Answer 13

1-24 MONTHS
Vancomycin plus a third generation cephalosporin’s Alternative a carbapenem plus vancomycin

Vancomycin + ceftriaxone 100mg/kg od/ 75mg/kg bd or ceftaxime 75mg/kg qid

Question 14

Treatment- 2 -50 YEARS.

Answer 14

2 -50 YEARS.
Vancomycin plus a third generation cephalosporin Alternative a carbapenem plus vancomycin

Children- Vancomycin 15mg/kg qid + ceftriaxone 100mg/kg od/ 75mg/kg bd or ceftaxime 75mg/kg qid

Adults- Vancomycin 15mg/kg tds + ceftriaxone 2g bd or ceftaxime 2g qid

Question 15

Treatment 50 and above

Answer 15

Ampicillin 2g qid + vancomycin 15mg/kg tds + ceftriaxone 2g bd or ceftaxime 2g qid

Question 16

Vancomycin is given as I’ve infusion not bolus , if given fast it can cause _______

Answer 16

Redman Syndrome

Red man syndrome is an adverse reaction characterized by flushing and erythema. It often occurs after the administration of certain medications, particularly vancomycin. It’s primarily due to an allergic reaction to medications involving the release of histamine and other inflammatory mediators.

Question 17

Use of adjunctive dexamethasone in patients with community acquired meningitis is recommended ________

Answer 17

Regardless of aetiology

Question 18

Corticosteroids reduce inflammation and restore BBB ( may reduce CSF penetration of antibiotics). Significantly reduces ________

Answer 18

Rate of mortality , sever hearing loss and neurological squelae (speech and paralysis loss)

Question 19

Recommended prophylaxis against meningococcal infection

Answer 19

Ciprofloxacin 500mg po as a single dose
Rifampin 600mg bd po on 2 consecutive days
Azithromycin , pregnant woman, 500mg po as a single dose
Ceftriaxone 250mg im as a Single Dose