BADER ALMASAAD

BACTERIAL MENINGITIS

INTRODUCTION

AGE

Acute, Subacute, Chronic

Geography

Immune status

INTRODUCTION

Nasopharnyngeal colonization that becomes invasive

Streptococcus pneuomonia, haemophilus influenzae

Via contaminated food Listeria monocytogenes

As a complication of a systemic infectionFrom a neurosurgical procedureSpread from a contiguous focus of infection Skin, sinuses or middle ear infections

EPIDEMIOLOGY

Incidence is 5 per 100,000 per year in developed countries

Approximatley 200 per year in kuwait

Hib vaccineHeptavalent pneumococcus vaccineTetravalent menningococcus vaccine (A,C,W-

135 and Y)

CLINICAL PRESENTATION

Headache (87%)Neck stiffness (83%)Fever (77%)Altered mental status (69%)

95% of patients have 2 out of the 4.Only 1% have none.Petechial rash characteristic of meningococcus

although has been reported with pneumococcus also.Seizures reported in 20% of patients with bacterial

meningitis

• Blood cultures should be taken urgently at the very start, and will be positive in 50% of cases

•Normal CRP in a patient with acute meningitis has a negative predictive value of 97%.

•Procalcitonin levels increase in severe bacterial infection, and levels greater than 5 μg/L in children and greater than 2 μg/L in adults have sensitivities and specificity above 90% for bacterial meningitis

• opening pressure is typically elevated above 18 cmH2O, and can be more that 40 in comatose patients

•2-5 ml is enough for biochem and cell count(approx 10 drops)

• for culture approximately 8-10ml

•For TB culture and staining needs high volume csf collection , around 25 ml.

Imaging

Neuroimaging required in the following:

Altered level of consciousness Focal neurological deficit New onset seizure Pappilledema (or other signs of high ICP) Immunocompromised