- Angiostrongylus cantonensis - Amoebic meningitis (freshwater swimming)

- affects all ages - infants and immunocompromised at higher risk of serious disease - 10,000 cases annually. - common in summer and early fall.

- Cryptococcal meningitis is most common in immunocompromised adults, especially in those with AIDS - candida species most common in premature infants and other immunocompromised adults - NOT CONTAGIOUS - rare

Naegleria fowleri - most common in southern US. freshwater lakes/rivers, poorly maintained swimming pools, hot springs, soil - parasite enters through nose or via nasal rinses - Almost all are fatal, even with treatment

Neuro chapter 11 Meningitis Flashcards by Sean McIntosh

Description

inflammation of brain and spinal cord meninges, from bacteria, viruses, or fungi
- occassionally, parasites, or disorders such as SLE or Kawasaki disease are responsible

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Etiology

Bacterial Meningitis

Group B or D streptococcus
E. Coli
Staphylococcus species
Streptococcus pneumoniae (most common in adults, children and adolescents)
Haemophilus influenzae (incidence greatly diminished with advent of Hib vaccine)
Listeria monocytogenes (unpasteurized dairy or deli meats)

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Etiology

Viral Meningitis

Enterovirus is the most common cause; includes Coxsackie A and B, polioviruses, echoviruses
herpes simplex virus

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Etiology

Fungal Meningitis

Candida species
Aspergillus
Cryptococcus neoformans
histoplasmosis

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Parasitic meningitis

Angiostrongylus cantonensis

- Amoebic meningitis (freshwater swimming)

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Noninfectious meningitis

cancers
SLE
secondary to medications
brain surgery
head injury

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3 most common bacterial causes

Neisseria meningitidis
streptococcus pneumoniae
haemophilus influenzae

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Bacterial Meningococcal meningitis is highly contagious:

2,600 cases/year
high-risk groups: infants younger than 1 year, immunocompromised patients, travelers to endemic areas, college students in dorms.
10-15% of cases are fatal.
10-15% of infections cause brain damage or other serious side effects.

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Viral Incidence

affects all ages
infants and immunocompromised at higher risk of serious disease
10,000 cases annually.
common in summer and early fall.

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Fungal incidence

Cryptococcal meningitis is most common in immunocompromised adults, especially in those with AIDS
candida species most common in premature infants and other immunocompromised adults
NOT CONTAGIOUS
rare

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Parasitic incidence

Naegleria fowleri - most common in southern US. freshwater lakes/rivers, poorly maintained swimming pools, hot springs, soil

parasite enters through nose or via nasal rinses
Almost all are fatal, even with treatment

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Meningitis

Risk Factors

young children
young adults
crowded living conditions
college and military dormitories
coexisting viral infections
immunocompromised (asplenia, diabetes, HIV)
active or passive smoking
close contact with patient with meningitis

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Bacterial Assessment findings

recent URI
becomes ill quickly
pyrexia
nausea / vomiting
irritable / unsettled mood
ill appearance
poor appetite / poor feeding
fatigue
Nuchal rigidity
headache
myalgia or arthalgia
respiratory symptoms, dyspnea
decreased LOC, seizures
meningococcal septicemia rash
bulging or full fontanel
positive Kernig and Brudzinski signs
paresis
neurological deficits
shock symptoms

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Kernig sign

Complete extension of leg causes neck pain and flexion.

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Brudzinski sign

flexion of hips and knees if neck is passively flexed.

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Viral assessment findings

incubation period is +/- 3 weeks
headache
malaise
fever
stiff neck
photophobia
rash
seizures
illness lasts 2-6 days

Fungal assessment findings

worsening headaches over a period of days

- vomiting for days or weeks

Parasitic assessment findings

same as bacterial

Noninfectious assessment findings

same as bacterial plus symptoms from causative factors

Meningitis

Differential Diagnosis

bacterial vs viral vs fungal vs tuberculous meningitis
meningitis caused by other infectious agents (syphilis, amoeba)
seizure disorder
encephalopathy
brain abscess
VIRAL MENINGITIS IS RARE IN OLDER ADULTS. STRONGLY CONSIDER OTHER DIFFERENTIAL IN THIS POPULATION.

Diagnostic tests

Lumbar puncture: CSF will show…

may be turbid, protein levels elevated, CSF pressure elevated.

If bacterial, CSF will show…

decreased glucose

CSF Ziehl-Nielsen staining for acid-fast bacilli will to rule out…

tuberculous meningitis

CBC will show

elevated WBC

CMP will show

electrolyte imbalance

Blood cultures will be positive in...

80% of bacterial meningitis patients

Meningitis | Prevention

- strict aseptic technique during neurosurgical dressing changes - treat URI infections promptly - meningococcal immunization as part of routine immunizations - Hib immunizations according to schedule - pneumococcal and influenza vaccines - avoid contact with known causes if possible

Meningitis | Nonpharmacologic management

- vigorous supportive care - measures to prevent dehydration - good handwashing - isolation procedures may be warranted - minimize external stimulation, specifically light - anticipatory guidance for family - frequent neurological examinations

Meningitis | Pharmacologic management

- antibiotics specific for culture result - high-dose anti-fungals for fungal meningitis - antibiotics urgently; if cultures prove viral, d/c - Dexamethasone: may decrease M&M - O2 therapy - treat shock if present - antipyretics - analgesics for headache - antiemetics - anticonvulsants as needed - sedatives for restlessness - antiviral agents not recommended - noninfectious causes require treating underlying disease - DEPENDING ON ETIOLOGY, PROPHYLAXIS FOR CONTACTS

Meningitis | Consultation / Referral

- refer to ED / neurologist immediately | - refer to ID

Meningitis | Follow-up

- depends on severity

Meningitis Expected Course Bacterial

- fatality rate 14% - afebrile in 7-10 days - headache and other symptoms persist intermittently for 2 weeks. - prognosis dependent on timing of antibiotic initiation

Meningitis Expected Course Viral

- recovery in 4-10 days - headache and other symptoms may persist intermittently for 2 weeks - in most cases, not fatal.

Meningitis Expected Course Fungal

- poor prognosis usually related to overall health of patient.

Meningitis Expected course parasitic

- high mortality rate

Meningitis Expected course noninfectious causes

- dependent on cause

Meningitis Possible Complications Epilepsy and seizures common in....

- common in bacterial | - but rare in viral

Possible complications

- septic shock - bacteremia, resulting in gangrene - cerebral edema - problems with concentration and memory - sensorineural hearing loss - irritability - hydrocephaly - renal impairment - bone and joint problems - stroke - motor disability - cognitive dysfunction - behavioral disorders.