NERVOUS SYSTEM NERVOUS SYSTEM INFECTIONS INFECTIONS MENINGITIS MENINGITIS Acute infection of the meninges Acute infection of the meninges presents with the characteristic presents with the characteristic combination: combination: pyrexia Headache Meningism
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Medicine 5th year, 5th lecture/part one (Dr. Mohammed Tahir)
The lecture has been given on May 21st, 2011 by Dr. Mohammed Tahir.
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NERVOUS SYSTEMNERVOUS SYSTEMINFECTIONSINFECTIONS
MENINGITISMENINGITIS
Acute infection of the meninges Acute infection of the meninges presents with the characteristic presents with the characteristic combination:combination:
Treatment of Treatment of pyogenicmeningitis of pyogenicmeningitis of
unknown cause unknown cause1-patients with a typical meningococcal rash1-patients with a typical meningococcal rash Benzylpenicillin 2.4 gIV.6-hourlyBenzylpenicillin 2.4 gIV.6-hourly2-Adult aged 18-50 years without meningococcal rash2-Adult aged 18-50 years without meningococcal rash Cefotaxime 2 g IV.6-hourlyCefotaxime 2 g IV.6-hourly Ceftriaxone 2g IV.12-hourlyCeftriaxone 2g IV.12-hourly3-Patient in whome pencillin-resistant pneumococcal infection 3-Patient in whome pencillin-resistant pneumococcal infection
is suspectedis suspected As 2 but add-Vancomycin 1g Iv,12-hourly or Rifampicin 600 As 2 but add-Vancomycin 1g Iv,12-hourly or Rifampicin 600
mgmg IV.12-hourlyIV.12-hourly4-Adult aged over 50 years and those in whome Listeria 4-Adult aged over 50 years and those in whome Listeria
monocytogees infection is suspectedmonocytogees infection is suspected As for 2 but add Ampicillin 2g IV.4-jourly or Co-trimoxazoleAs for 2 but add Ampicillin 2g IV.4-jourly or Co-trimoxazole5-Patients with a clear history of anaphylaxis to B-lactams5-Patients with a clear history of anaphylaxis to B-lactams Chloramphenicol 25 mg/kg IV.6-hourly plus Vancomycin 1g Chloramphenicol 25 mg/kg IV.6-hourly plus Vancomycin 1g
IV.12-hourly IV.12-hourly
Recommendations for Empirical Recommendations for Empirical antimicrobial therapy in adult with antimicrobial therapy in adult with
community-acquiredcommunity-acquired meningitismeningitis Predisposing factor pathogen DrugsPredisposing factor pathogen Drugs16-50 yr N-St-pn Vancomycin 16-50 yr N-St-pn Vancomycin
++ 33rdrd cephalosporin cephalosporin>50 yr>50 yr ٍ ٍ St-pn, N, List Van+3St-pn, N, List Van+3rdrd Ceph+ Ceph+ AmpicillinAmpicillinPresence of a risk St-pn, list, Van+3Presence of a risk St-pn, list, Van+3rdrd ceph+ ceph+ H-infuenzae AmpicillinH-infuenzae Ampicillin
Chemoprophylaxis for meningococcal Chemoprophylaxis for meningococcal infection infection
DoseDose it reduce the incidence of clinical it reduce the incidence of clinical disease among contact?disease among contact?
Observational dataObservational data suggest that antibiotic suggest that antibiotic reduce the risk of disease reduce the risk of disease
In adults a single dose of In adults a single dose of 500 mg 500 mg ciprofloxacinciprofloxacin or oral or oral rifampicin rifampicin 600mg(12-hourly)600mg(12-hourly) for 2 days. for 2 days.
VaccinesVaccines for groups A&C but not B for groups A&C but not B menigococci.menigococci.
COMPLICATIONS COMPLICATIONS OF MININGOCOCCAL OF MININGOCOCCAL SEPTICEMIASEPTICEMIA• MenigitisMenigitis
Major intracranial Major intracranial complications in Bacterial complications in Bacterial meningitis in adultmeningitis in adult----------------------------------------------------------------------------------1-Transtentorial herniation1-Transtentorial herniation2-Hydrocephalus2-Hydrocephalus3-Infarction3-Infarction4-Seizures4-Seizures
CLINICAL FEATURES OF TB CLINICAL FEATURES OF TB
MENINGITISMENINGITIS
•VomitingVomiting
•Low-grade Low-grade feverfever
•lassitudelassitude
•DepressionDepression
•ConfusionConfusion
•Behavior Behavior changeschanges
SignsSigns
Meningism (may be Meningism (may be absent)absent)
Ocular palsiesOcular palsies
PapilloedemaPapilloedema
Depression of conscious Depression of conscious levellevel
Focal hemispher signsFocal hemispher signs
Meningism (may be Meningism (may be absent)absent)
Ocular palsiesOcular palsies
PapilloedemaPapilloedema
Depression of conscious Depression of conscious levellevel
• The typical profile is lymphocytic The typical profile is lymphocytic pleocytosis(25-500 cells/uL.)pleocytosis(25-500 cells/uL.)
• A normal or slightly elevated proteinA normal or slightly elevated protein• A normal glucose concentration. A normal glucose concentration. • PMN pleocytosis should always promt PMN pleocytosis should always promt
an alternative diagnosisan alternative diagnosis• In both enterovirus &HSV,PCR is the In both enterovirus &HSV,PCR is the
diagnostic procedure of choicediagnostic procedure of choice