Meningitis, Clinical features, investigation, treatment.

 Meningitis refer to the inflammation of protective Meninges of brain and spinal cord, Pyogenic meningitis is a serious condition which can lead to brain damage and death especially in younger children
Bacteria may invade the subarachnoid space directly by spread from continues structure eg:- sinus & fractures. 
In more cause, the infection causing meningitis arise in the nasopharynx, intravascular invasion & penetrate the blood- brain barrier follow mucosal involvement & enter into CSF
Causative Organisms:-
In neonatal-- Grame negative bacilli, eg. E coli, klebsiella, Haemophilus influence
In Children-- Haemophilus influence, Pneumococcus, Meningococcus. 
In adult-- pneumococcus, Meningococcus
Other bacteria -- listeria monocytogenes,Staphylococcus aurelia are responsible

Pathology:
Infection extends throughout the subarachnoid space
Underlying brain, although not invading by bacteria becomes congested, oedematous and ischaemic
Bacteria multiplies - inflammation
Cytokines, interleukin, are released as part of acute inflammatory response
Cranial nerves get compressed and suffer direct damage. 
Hydrocephalus can result from CSF obstruction

Clinical features:-
  • Fever
  • Headache
  • Neck Stiffness
  • Respiratory infection
  • Otitis media Or pneumonia with muscle pain
  • Photophobia
  • Severe frontal / occipital headache
Signs:-
  • Neck stiffness- Gentle flexion of the neck 
  • Kernig's sign - Stretching the lumbar root produce pain
  • Skin rash in meningococcal meningitis. 
Investigation:-
  • CT scan is done if patient  has altered consciousness, focal signs, papilloedema, recent seizure. 
  • Lumbar puncture is done
  • Chest  X- ray -- Pneumonia
  • Sinus X-ray -- Sinusitis
  • Skull X-ray --- fracture
  • Petrous views -- Mastoiditis
Treatment
Once meningitis is suspected, treatment must commence immediately
Initial therapy -- Antibiotics (Before organism identification) 
  • Neonatal (above 1month) -- Ampicillin, Cephalosporin, Aminoglycoside. 
  • Children (under 5years) -- Vancomycin, 3rd generation cephalosporin
  • Immunocompromised patients-- Vancomycin, Ampicillin, Cephalosporin. 
Steroids - A 4 day regimen of dexamethasone along with antibiotics. 

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