MENINGITIS

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Meningitis refers to the inflammation of the protective membranes covering the brain and spinal cord (meninges). Meningitis can occur when fluid surrounding the meninges becomes infected. 

CAUSATIVE AGENTS
There are 3 different organisms which can cause meningitis. They are;
  •  Neisserria meningitides
  • Streptococcus pneumoniae (in adults)
  • Haemophilus influenzae (in children) 
These organisms enter into certain parts of the body and cause meningitis. Such routes include;
  •  Respiratory tract
  • Through the ear
  • Head trauma 
  • Neurosurgical procedures (lumber puncture) 
RISK FACTORS
  • Age
  • Race
  • Poverty
  •  Overcrowding
  • Malnutrition
  •  Head injury 
  • Basal skull fractures 
  •  Otitis media (ear infection) 
  •  Sinusitis (inflammation of the sinuses)
  •  Immunosuppression (partial or complete suppression of the immune response of an individual) 
PATHOPHYSIOLOGY
Bacteria reach the meninges by one of the following routes: 
  •  Through the bloodstream. 
  •  Through direct contact between the meninges and the nasal cavity [head injury]. 
  •  It crosses the blood-brain barrier and proliferates in the CSF and causes an inflammatory reaction. CSF cell count increase in the subarachnoid space as inflammatory cellular material accumulates. Cerebral oedema results from inflammation, all contributing to increased intracranial pressure. Cerebral vasculitis which leads to a decreased blood flow and oedema causing apoptosis (cell death)

SIGNS AND SYMPTOMS            
The clinical features are divided into two categories.
  1.      MENINGEAL SIGNS: These are the signs of meningeal irritation. These signs include;
  • Nuchal rigidity or Stiff neck
  •  Headche
  •   Positive kernig’s sign (painful and resistance on passive knee extension when thigh is flex on the abdomen)
  •  Brudzinski’s sign (When the neck is flexed, flexion of the knee and hip is produced)
  •  Opisthotonos [spasm of the muscles causing backward arching of the head, neck, and spine}
  •  Irritability
  •  Vomiting
  •    Mental status changes, such as lethargy, drowsiness, delirium, hallucinations
  •   Photophobia (extreme sensitivity to light)
  •  Frequent seizures
  •    Coma as a result of cerebral edema
  •    Disorientation or stupor
  •  Irregular respiration
  •  Signs of increased intracranial pressure (altered level of consciousness, papilloedema) 
2.       SEPTIC SIGNS: It includes
  •   Rash/ lesions
  •  Fever
  •    Jaundice
  •  Damage of eye and facial nerves

SYMPTOMS IN LESS THAN ONE YEAR OLD MAY INCLUDE;
  • Drowsiness
  • Irritability
  •  Poor feeding
  •  Vomiting
  •    Neck may be retracted and back arched
  •    Focal or generalized convulsions
  •    May/may not have fever
  •  Blank staring expression
  •  High pitch cry
  •  Bulging fontanels in infants
  •  Coma  
COMPLICATIONS OF MENINGITIS
  •  Brain damage
  • Cerebral palsy
  • Cerebral vein thrombosis
  •  Buildup of fluid between the skull and brain (subdural effusion usually in neonates; Hydrocephalus)
  •  Hearing loss
  •  Seizures/Epilesy
  •   Endocarditis
  •   Pneumonia
  •  Arthritis 
Ø
TREATMENT
  •   Antibiotics eg Ceftriaxone, chloramphenicol and Penicillin as soon as lumber puncture is done.
  •  Phenytoin for seizures
  •  I.V fluids for dehydration
  •  Analgesics
  •  Antipyretic

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Special Thanks: Stella B. Addo
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