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Prof. P. S.

Singh sir
(Head of Department) Medicine

Guided by

Good Afternoon

Ranwant singh
Roll no. :-93 Batch:-2008


(1) Acute Bacterial Meningitis

(2) Acute Viral Meningitis

Acute Bacterial Meningitis

It is an acute purulent infection within the subarachnoid space.

Acute Bacterial Meningitis

Associated with a CNS inflammatory reaction that may result in decreased consciousness seizures, raised intracranial pressure and stroke.
In which meninges ,subarachnoid space, brain parenchyma are involved in the inflammatory reaction .

Bacterial meningitis top 10 10infectious infectious Bacterial meningitisis is1 1 of the top causes of deathworldwide worldwide causes of death

Bacterial meningitis is endemic in INDIA

There was 650 deaths were reported in 6386 cases in the year 2009 in India .

Acute viral meningitis

The epidemiology of bacterial meningitis has changed in recent year because use of vaccines for N. meningitidis and H. influenzae which are the common organisms. There are 1.2 million cases annually worldwide, in which approximately 135,000 deaths occurs per year.

Common bacteria :---

Streptococcus pneumoniae

Neisseria meningitidis

Haemophilus influenzae (type B)

Uncommon bacteria
Staphylococcus aureus

Staphlylococcous epidermidis

Group B streptococci

E. coli


Listeria monocytogens

Rare bacteria


Clostridium perfingens

Neisseria gonorrhoeae

Age group



E.Coli , Listeria monocytogenes beta heamolytic streptococci

H.influenzae, N.meningitidis, S.pneumoniae

Children (<12 yrs) Adults

N.meningitidis, S.pneumoniae

Elderly or immunocompromised

S.pneumoniae, Listeria monocytogenes,

Pathophysiology of Bacterial Meningitis

Routs of infection
(1) : - Hematogenous spread :- Eentry into the SAS

through the choroid plexus or

blood vessels.

(2): Direct spread :- From an infected site like middle ear

(otitis media).
(3):- Anatomic defect of CNS:- Like surgery and trauma . (4):- Direct intraneural:- Organism like rabies virus it

travel along with peripheral nerve end reaches to brain .


Clinical features
Fever Headache Vomiting Seizure Impairment of consciousness Photophobia Stiff neck & back Sixth nerve palsy

Three patterns of onset are documented

(1):-Fulminant onset The patient become seriously ill within 24 hrs without RTI (25%) (2):-Meningitis developing over 1-7 days and associated with respiratory symptoms (50%)

(3):-Meningeal symptoms after 1-3 weeks of respiratory symptoms (20%)

Signs:Neck rigidity

Kernig's sign
Kernigs sign:-

Brudzinskis neck sign:-

Brudzinskis leg sign:-

Rashes in lower extremities

Aseptic meningitis is not an emergency

condition as bacterial . Although it is usually caused by certain viruses.

The incidence is very low , about 1 case reported per 1 lack population per month .

Common viruses


Coxsackie virus


Herpes simplex virus 2


Arthropod borne virus

Varicella zoster virusa

Epstein-Barr virus

Lymphocytic choriomeningitis virus

Headache is usually frontal or retro orbital Fever Photophobia Pain on moving eye Neck rigidity Myalgia Anorexia Nausea Vomiting Abdominal pain Diarrhea Mild lethargy Altered consciousness Seizures

Difference between Meningitis,Encephalitis and Cerebral malaria

Features Fever Level of consciousness Focal neurological sign Episode of flu like illness Sign of meningial irritation History of endemicity Meningitis Usually high Gradual detoriation over a period Usually present Encephalitis Usually low Rapidly detoriation of consciousness present Cerebral malaria high Rapidly detoriation absent

Usually absent Frequently present

Present usually absent

Absent may present



high risk zone

Feature Sign of heamolysis (Dark urine) Blood for malaria parasite CSF finding



Cerebral malaria

May present

Neutrophils pleocytosis, lymphocyte normal Protein increases predominant Glucose-decrease Protein increase glucose

18 th Edition of Harrisons
Principles of Internal Medicine.

Thank You