BACTERIAL MENINGITIS

COMPILED & PRESENTED BY: KESHIA CHITHRAY

The brain and spinal cord are covered by connective tissue

layers called the meninges which form the blood-brain

barrier. 1-the pia mater (closest to the CNS) 2-the arachnoid mater 3-the dura mater (farthest from the CNS) The meninges contain cerebrospinal fluid (CSF). Meningitis is an inflammation of the meninges Caused by infection with viruses, bacteria and micro

organisms Acute, subacute and chronic Life threatening

WHAT IS BACTERIAL MENINGITIS?

WHAT IS BACTERIAL MENINGITIS?

WHAT IS BACTERIAL MENINGITIS?

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RISK FACTORS

Transmission by air-droplets

Meningitis is common in

children and young adults

Immuno-compromised

individuals

College students

Travellers eg: Hajj Technologists

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SIGNS AND SYMPTOMS

Head and neck stiffness Photophobia Phonophobia Children – irritability, drowsiness and rash

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SIGNS AND SYMPTOMS

SIGNS AND SYMPTOMS

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PATHOGENESIS

Nasopharyngeal colonization Direct extension of bacteria. Para meningeal foci (sinusitis, mastoiditis, or brain abscess) Across skull defects/fracture From remote foci of infection Eg: endocarditis, pneumonia, UTI

PATHOGENESIS

Diffuse bacterial infections Meningeal exudate of varying thickness

is found. Purulent material around veins and

venous sinuses, around the cerebellum,

and spinal cord Ventriculitis has been observed

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PATHOGENESIS

PATHOGENESIS

Invasion of the ventricular wall. Subdural empyema may occur. Hydrocephalus occurs Obstructive hydrocephalus Communicating hydrocephalus

PATHOGENESIS

Blood vessel walls infiltrated by inflammatory cells. Endothelial cell injury Vessel stenosis Secondary ischemia and infarction Ventricle dilatation associated with necrosis of cerebral

tissue due to the inflammatory process or to occlusion of

cerebral veins or arteries.

PATHOGENESIS

Inflammatory process results in cerebral edema

and damage of the cerebral cortex. Conscious disturbance Convulsion Motor disturbance Sensory disturbance

Meningeal irritation sign occurs because the spinal

nerve root is irritated. Cranial nerve damaged

CASE STUDY

Physical examination 19 years old, student Purpuric rash on legs, wrist, trunk Supple neck

CASE STUDY

19 year old male student with

normal health went to bed with a

fever/headache Fever of 40˚c Neck was supple Purpuric rash on legs, trunk and

wrists CSF glucose, protein and white

blood cell were increased. CSF sent to micro for gram, culture Blood culture grew the organism EDTA tube sent for FBC and diff.

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DIAGNOSIS

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Lumbar puncture –

collection of CSF is

used for the diagnosis

of meningitis CSF analysis – The

CSF can be

diagnostic, and every

patient with meningitis

should have CSF

obtained unless the

procedure is

contraindicated

DIAGNOSIS

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DIAGNOSIS

Laboratory examination

Chemistry CSF glucose, protein, and

white blood cell was

increased

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DIAGNOSIS

Laboratory examination

Haematology Low platelet count –

indicates the intravascular

coagulation FBC – neutrophilia,WBC

count is elevated ,shift

toward immature forms

co.monroe.mi.us

DIAGNOSIS

Microbiology

Isolation: Growth on chocolate agar with 5 - 10% CO2 Organism was cultured from blood – Gram Negative

Diplococci

Identification: Oxidase – Negative Catalase - Positive Nitrate Reduction – Positive Carbohydrate utilization tests - Glucose and Maltose

positive

DIAGNOSIS

Gram negative diplococci

DIAGNOSIS

Gram stain - Neisseria

meningitidis The organism had

disseminated to the blood

CONCLUSION

Patient was diagnosed with bacterial meningitis caused by

N. meningitidis Treatment - Penicillin, Chloramphenicol Prevention - Tetravalent vaccine

REFERENCES

Mahon .C, Donald .L and Manuselis.G. (2007) Textbook of

Diagnostic Microbiology. 3rd Edition. Saunders-Elsevier, St.

Louis, Missouri. Centers for Disease Control and Prevention (2007).

www.cdc.gov/ncidod/dbmd/diseaseinfo/meningococcalg.htm Harmening, D.M. (2002). Clinical Haematology and

Fundamentals of Haemostasis. 4th edition. Philadelphia USA:

F.A Davis Company Hoffbrand, A.V., Pettit, J.E. and Moss, P.A.H. (2003). Essential

Haematology. 3rd edition. USA: Blackwell Science Ltd

Thank you for your attention!

Any questions?