MENINGITIS MENINGITIS OUTCOME OUTCOME VARIABLE VARIABLE Acute Acute Benign Benign Form of Viral Form of Viral TO TO Rapidly Rapidly Fatal Fatal Bacterial Meningitis Bacterial Meningitis WITH WITH Local Progressive mental Local Progressive mental deterioration deterioration and death and death
60
Embed
MENINGITIS MENINGITIS OUTCOME VARIABLE Acute Benign Form of Viral TO Rapidly Fatal Bacterial Meningitis WITH Local Progressive mental deterioration and.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
MENINGITISMENINGITIS
OUTCOMEOUTCOME VARIABLEVARIABLE
Acute Acute BenignBenign Form of Viral Form of Viral
CAUSES OF MENINGITISCAUSES OF MENINGITISINFECTIOUSINFECTIOUS NON-INFECTIOUSNON-INFECTIOUS
ViralViral Aseptic MeningitisAseptic Meningitis
BacteriaBacteria MalignancyMalignancy
MycobacterialMycobacterial SarcoidSarcoid
BrucellaBrucella behcet diseasebehcet disease
FungalFungal SLESLE
Viral Meningitis Generally benign, rarely fatal Enterovirus: around 80% of cases Other viruses: mumps, Epstein-Barr virus, Rare but serious forms: Herpes group viruses No specific preventive or curative treatment
for most except Herpes viruses Clears up on its own with no treatment in 3 to 8 days
A.)A.) Global emergence andGlobal emergence and Prevalence Prevalence of of Penicillin- Resistant Strain of Strep. Penicillin- Resistant Strain of Strep.
pneumonia.pneumonia.
B.)B.) Dramatic Reduction in invasive H.Dramatic Reduction in invasive H.
influenza disease secondary to use of influenza disease secondary to use of conjugate conjugate Haemophillus Type B- Haemophillus Type B- vaccinevaccine..
CC.).) Group B – Streptococci Group B – Streptococci Neonate Neonate Now Now > 50 > 50 also.also.
IV. IV. COMPLEXITIESCOMPLEXITIES OFOFEMPIRIC MANAGEMENTEMPIRIC MANAGEMENT
I FI F Focal SignFocal Sign PappiledemaPappiledema OR OR Focal Neurological Focal Neurological
– High CSF levelsHigh CSF levels– Less toxicity than Less toxicity than
aminoglycosidesaminoglycosides– No drug levels to followNo drug levels to follow
Management Algorithm for Management Algorithm for AdultsAdultsSuspicion of bacterial
meningitisYES
new onset seizure, papilledema, altered level of consciousness, or focal neurological deficit or delay in performance of diagnostic L.P
NO YESBlood c/s & Lumbar
punctureB/C stat
Dexamethasone + empirical Abx
Dexamethasone + empirical Abx
-ve CT-scan of the headCSF is abnormal
NO YES
YESPerform L.P+ve CSF gram stain
Dexamethasone + empirical Abx
Dexamethasone + targeted Abx
CASE ICASE IA 12 year old Nigerian boy A 12 year old Nigerian boy
who has arrived to Riyadh 2 days who has arrived to Riyadh 2 days prior to presentation - C/O prior to presentation - C/O severe headache & Photophobia?severe headache & Photophobia?
How do you approach & manage How do you approach & manage him?him?
Presence of fever & neck Presence of fever & neck stiffness.stiffness.
EPIDEMIOLOGICAL FEATURESEPIDEMIOLOGICAL FEATURES OF OF MENINGOCOCCAL MENINGITISMENINGOCOCCAL MENINGITIS 1.1. Affect children + young Affect children + young
adult adult 2 – 20 years2 – 20 years
2.2. Epidemic usually sero group A & Epidemic usually sero group A & CC
7.7. D. O. Choice D. O. Choice Penicillin Penicillin I.VI.V..
CASE 2CASE 2A 26 YEAR OLD Saudi female who A 26 YEAR OLD Saudi female who has been C / O unwell & fever & has been C / O unwell & fever & cough and headache for the last 3 cough and headache for the last 3 days. Examination revealed ill – days. Examination revealed ill – looking women with sign of looking women with sign of consolidation consolidation R R Lung base.Lung base.
DIAGNOSISDIAGNOSIS::
Bacteria Pneumonia.Bacteria Pneumonia.
Organism?Organism?
Six (6) hours after admission, her Six (6) hours after admission, her headache became worse and she headache became worse and she became obstunded.became obstunded.
Epidemiological Features ofEpidemiological Features ofPneumococcal meningitisPneumococcal meningitis
The most common.The most common. CauseCause
The most killing. The most killing. 20 - 30 % 20 - 30 % DEATHDEATH
May be associated with other May be associated with other Focus:Focus:
a.a. PneumoniaPneumonia 25%25%
b.Otitis Media b.Otitis Media 30%30% c.c. SinusitisSinusitis 15 %15 % d. Head Trauma & CSF Leakd. Head Trauma & CSF Leak
10%10%.. E. splenectoy and SS disease..E. splenectoy and SS disease.. Global emergence of Penicillin – Global emergence of Penicillin –
Resistant.Resistant.
Case presentationCase presentation
30 years old sudanese male who 30 years old sudanese male who was to the ER in confusional state was to the ER in confusional state for few hours befor for few hours befor presentation ..history revealed presentation ..history revealed presence of two attacks of presence of two attacks of seizures in the same day with seizures in the same day with high fever…high fever…
Neiseria meningitidisNeiseria meningitidis Eradication of Eradication of
nasopharyngeal carriagenasopharyngeal carriage..(post exposure ) for :..(post exposure ) for :
1)house hold contact1)house hold contact 2)Treating doctor who has 2)Treating doctor who has
examined patient very closelyexamined patient very closely
What drugs are recommonded:What drugs are recommonded:
Rifampicin 600 X 2 d Rifampicin 600 X 2 d Ciprofloxacin 500X1Ciprofloxacin 500X1
Ceftriaxon 125mg I.M X1 Ceftriaxon 125mg I.M X1
VACCINE TOVACCINE TO 1. Hib Type B vaccine 1. Hib Type B vaccine
1.Protection1.Protection
2. Eliminate 2. Eliminate
2.2. Meningococcal vaccine: A, C, Meningococcal vaccine: A, C, Y, W135Y, W135
- Up to 3 years adult - - Up to 3 years adult - Does not affect N. ph. Carriage Does not affect N. ph. Carriage …Does not provide …Does not provide herdherd immunity.immunity.
SupportiveSupportive No antibioticsNo antibiotics AnalgesiaAnalgesia Fever controlFever control Often feel better after LPOften feel better after LP No isolation - Standard No isolation - Standard
Caes Caes 56 years saudi women presented to 56 years saudi women presented to
the infectious disease clinic c/o low the infectious disease clinic c/o low grade fever and night sweating for grade fever and night sweating for the last 6 wks…on detailed inquires the last 6 wks…on detailed inquires she admitted to have headache for 4 she admitted to have headache for 4 wks improving on analgesics..wks improving on analgesics..
TREATMENTTREATMENT:: A.A. Principles of TherapyPrinciples of Therapy:: 1.1. Multiple drugs. ( INH& Rif.)Multiple drugs. ( INH& Rif.) 2.2. Educate the patient Educate the patient Long Long
therapy therapy 6/12 6/12
3. Tell about Potential side effects 3. Tell about Potential side effects
aa.. Orange sweat & tears with Orange sweat & tears with Rifampicin.Rifampicin.
700,000---2.7,000,000 death/year700,000---2.7,000,000 death/year more in rural area..more in rural area.. more during rainy seasonmore during rainy season
Human Human ---- --------- ----- Another Another
MosquitoMosquito
TransmissionTransmission
BITE OF FEMALE ANOPHELESBITE OF FEMALE ANOPHELES BETWEEN DUSK AND DAWNBETWEEN DUSK AND DAWN BLOOD TRANSFUSIONBLOOD TRANSFUSION CONTAMINATED NEEDLESCONTAMINATED NEEDLES CONGENITAL.CONGENITAL.
ETIOLOGYETIOLOGY Four species. Four species.
Death is mostly due to ..? Death is mostly due to ..?
An 18 years old Saudi An 18 years old Saudi pregnant young women pregnant young women originally from Jazan came C/O originally from Jazan came C/O Fever and headache.Fever and headache.
Exam: Exam: Pale, jaundiced, Pale, jaundiced,
Temp. - 39°CTemp. - 39°C
Spleen enlarged Spleen enlarged NEXT?NEXT?
CBC:CBC: WBC - 8000 WBC - 8000
Hb - 9.0Hb - 9.0
Platelets: Platelets: 90 90 MCU : 98MCU : 98
CXR:CXR: NormalNormal
DIAGNOSISDIAGNOSIS1.1. Index of suspicionIndex of suspicion
2.2. ? Malaria? Malaria 3.3. Blood smear :Thin & thickBlood smear :Thin & thick 4.4. Special DrugSpecial Drug
COMPLICATION:COMPLICATION: 1.1. CerebralCerebral MalariaMalaria encephalopathyencephalopathy SeizureSeizure Death 20%Death 20% 2.2. Black. Water FeverBlack. Water Fever non immunenon immune High degree High degree
of F.M.of F.M. HemolysisHemolysis
Malaria & Pregnancy:Malaria & Pregnancy:
1.1. Risk of low birth & abortion. Risk of low birth & abortion. 2.2. Risk of glucose , pulm. Risk of glucose , pulm.
Blood glucose test, Blood glucose test, parasitemia, Hct.parasitemia, Hct. 4.4. Antimalaria. Antimalaria. a.a. Chloroquine p.o.Chloroquine p.o. b.b. MefloquineMefloquine C .C . Quinine AND DOXYCYCLINE Quinine AND DOXYCYCLINE D. ARTEMISININSD. ARTEMISININS E . ATOVAQUONE PLUS E . ATOVAQUONE PLUS
QUININE : Bitter taste , GIT upset QUININE : Bitter taste , GIT upset , cinchonism ( nausea, vomiting , , cinchonism ( nausea, vomiting , tinnitus , high tone deafness )tinnitus , high tone deafness )
Doxycycline ..GIT upset, vaginal Doxycycline ..GIT upset, vaginal candidiasis..( use antifungal ) candidiasis..( use antifungal )
PREVENTIONPREVENTION
Avoid mosquitoAvoid mosquito Wear long sleeved clothingWear long sleeved clothing Sleep in well – screened roomsSleep in well – screened rooms Use mosquito nettingUse mosquito netting Use insect repellents (e.g. Use insect repellents (e.g.
DEET)DEET) Chemoprophylaxis..Chemoprophylaxis..
1) CHLOROQUINE1) CHLOROQUINE ONE TABLET EVERY WK..ONE TABLET EVERY WK.. DAILY WILL LEED TO DAILY WILL LEED TO
Chloroquine-sensitive areas Chloroquine-sensitive areas Drug of choice Drug of choice Chloroquine 500 mg (300 mg base)Chloroquine 500 mg (300 mg base) : :