Definition

• Meningitis – inflammation of the meninges• Encephalitis – infection of the brain

parenchyma

Signs and symptoms

• Fever• Altered consciousness, irritability,

photophobia• Vomiting, poor appetite• Seizures 20 - 30%• Bulging fontanel 30%• Stiff neck or nuchal rigidity• Meningismus (stiff neck + Brudzinski + Kernig

signs)

Clinical clues in meningitis

CSF FINDINGS IN ENCEPHALITIS+

CSF FINDINGS

Diagnosis – lumbar puncture

Bacterial meningitis - Organisms

Neonates• Most caused by Group B Streptococci• E coli, enterococci, Klebsiella, Enterobacter,

Samonella, Serratia, Listeria

Older infants and children• Neisseria meningitidis, S. pneumoniae,

tuberculosis, H. influenzae

Increased intracranial pressure (ICP)

• Papilledema CUSHING’S TRIAD• Bradycardia• Hypertension• Irregular respiration• ICP monitor (not routine)• Changes in pupils

Meningitis - Fluid management

• Restore intravascular volume & perfusion.• RESTRICTED I/V fluids to 2/3rd of

maintainance.• Monitor serum Na+ (osmolality, urine Na+)• If severely hyponatremic, give 3% NaCl • SIADH 4 - 88% in bacterial meningitis 9 - 64% in viral meningitis

• Diabetes insipidus• Cerebral salt wasting

Bacterial Meningitis - TreatmentNeonatal (<3 mo)

• Ampicillin (covers Listeria) +

• Cefotaxime.• Corticosteroids therapy (Dexametazon

0.6мg/kg /dose every 4 hrs for 2 days. The first doses is prescribe 10-15 min before a/b injections

Pneumococcal meningitis – Mgmt

• Vancomycin + cefotaxime or ceftriaxone, if > 1 month old.

• If hypersensitive (allergic) to beta-lactam antibiotics, use vancomycin + rifampin.

Antibiotic use inPneumococcal meningitis

• PenG 250,000 - 400,000 U/kg/day … Q 4 - 6 h• Ceftriaxone 100 mg/kg/day ..Q 12 - 24 h• Cefotaxime 200 - 300 mg/kg/day .. Q 8 h• Chloramphenicol 50 - 100 mg/kg/day .. Q 6 h

Vancomycin use inpneumococcal meningitis

• Vancomycin 60 mg/kg/day …Q 6 h

Complications of meningitis

• Hydrocephalus• Cranial nerve palsies• Mental retardation• Subdural effusion• Deafness• Blindness• Epilepsy

PROPHYLAXIS

• Meningococcal infection with rifampicin or ciprofloxacin.

• MenC, a meningococcal C conjugate vaccine. • A combined A and C meningococcal vaccine is

sometimes used prior to travel to endemic regions, e.g. Africa, Asia; and a quadrivalent ACWY vaccine .

• pneumococcal vaccine is used after recurrent meningitis, e.g. after a CSF leak following skull fracture. • Hib (Haemophilus influenzae).vaccine.rifampin

prophylaxis.

ENCEPHALITIS

• Encephalitis means inflammation of brain parenchyma, usually viral.

Acute viral encephalitis: The usual organisms are• herpes simplex,• ECHO,• Coxsackie, • mumps and• Epstein-Barr viruses• Adenovirus, varicella zoster, influenza, measles and

other viruses are rarer.

CLINICAL PICTURE

• Many encephalitides are mild . • In a minority, serious illness develops with

high fever, headache, mood change and drowsiness over hours or days.

• Focal signs, seizures and coma ensue. Death, or brain injury follows.

INVESTIGATIONS

• CT and MR imaging show diffuse areas of oedema, often in the temporal lobes.

• EEG.• CSF.• Viral serology .• Brain biopsy

TREATMENT

• Acyclovir.• Supportive measures • Prophylactic immunization against Japanese

encephalitis is advised for travelers to endemic areas in Asia.