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What is Meningitis?

Inflammation of the meninges over-lying the brain and spinal cord. (Strictly,the term meningitis is a misnomer scinence it is virtually impossible that inflammation is that inflammation is limited to the meninges only,meningo-encephalitis is a better nomenclature).

Types of meningitis:

1. Pyogenic meningitis(bacterial)
2. Tuberculous meningitis
3. Viral meningitis

Causes of Pyogenic(Bacterial)meningitis:

1. Gram negative bacilli(E.coli,proteus etc).
2. Group B streptococci.
3. Listeria monocytogenes.
4. Haemophilus influenzae.
5. Neisseria meningitidis.
6. Streptococcus pneumoniae
7. Cryptococcus neoformans(in immunosuppressed).

Clinical features of Pyogenic (bacterial) meningitis/Syndrome:

New born. Older children & adult.
Vacant stare. Headache.
Fever/Hypothermia. Drowsiness.
Convulsion. Coma,convulsion.
Neck rigidity-absent. be positive.
Vomiting. Fever
Reluctance to feed. Restlessness.
Fontanelle-may bulge. cranial nerve palsies.
Poor tone and poor cry. Irritability.

Investigations:

1. CSF examination
2. Blood culture may be positive and
3. CT brain:to exclude a mass lesion.

Table:CSF findings in different meningitis.

Character Normal Pyogenic
Colour Crystal clear Cloudy/purulent
Pressure 50-100mm CSF Normal/increased
Cell count/cmm 0-4(lymphocytes) Polymorphs 1000-50000/cmm
Glucose 40-80mg/dl. Decreased
Protein 20-40mg/dl. Decreased
Chloride 720-750mg/dl. Decreased

Treatment/Management:

For Unknown cause:
1. Neonate:Ampicillin 300/400mg/kg/day in 2divided doses + Gentamicin 5mg/kg/day in 2 divided doses or Cefotaxime (third generation cephalosporin).
2. Pre-school child:Cefotaxime 60-75mg/kg/day.
3. Older child and adult:Cefotaxime 2g I/V 6-hourly or Cefriaxone 2g I/V 12-hourly.

For known cause:

Cause Drug of Choice Alternative drug
N.neningitidis Benzylepenicillin Cefotaxime,Chloramphenicol
Stre.pneumoniae Cefotaxime,Ceftriaxone Chloramphenicol
Influenzae Cefotaxime,Ceftriaxone Chloramphenicol
Neonatal(Gm-ve bacilli) Cefotaxime Gentamicin+Ampicillin
Group-B,Streptococci Gentamicin+Ampicillin Chloramphenicol
Listeria Monocytogenes Gentamicin+Ampicillin Ampicillin+Cotrimoxazole
Cryptococcus neoformans Amphotericin+Flucytozine Fluoconazole

Note:

1. Duration of treatment is 2-3 weeks until the patient is afebrile at least 3 days.
2. Dosage of common drug (I/Vmg/kg/day).
* Benzylepenicillin 300,000 units/kg/day in 4-6 divided doses.
* Chloramphenicol 100-150mg/kg/day in 4-6 divided doses.
* Cefotaxime 40-75mg/kg/day in 4 divided doses.
1. Fluid and electrolyte balance.
2. Convulsion is controlled by I/v diazepam or phenobarbitone.
3. Good nursing care.
4. Prevention and treatment of complication.

Prophylaxis:

In meningococcal infection:Family contacts (esp. children) should receive Rifampicin (600mg 12-hourly for) adult and 5-10mg/kg/day 12-hourly for children) for 2 days.

Tuberculous Meningitis (Click here)