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Encephalitis
Bacterial meningitis
Bacterial meningitis is an acute purulent
infection within the subarachnoid space.
It is most common form of suppurative CNS
infection.
But it can also occur when bacteria directly
invades the meninges.
This may be caused by an ear or sinus
infection, URTI ,skull fracture or rarely after
some surgeries.
Etiology
The bacteria can spread person to person through
coughing and sneezing, sharing utensils and hand
to hand contact.
lymphocytes.
Culture: Negative Opening Pressure
Usually normal
DNA-based test known as a polymerase
chain reaction (PCR) amplification.
Meningitis of lyme disease may have:
History of tick bite (20%)
Migratory type of joint involvement
Rash bulls eye rash / Target / red
outside pink inside rash
Meningitis of RMSF: (rocky mountain spotted
fever)
Camping / hiking history
History of tick bite (60%)
Rashes start peripherally and moves
centrally (centripetal)
RMSF
Treatment
Lyme disease meningitis :
Ceftriaxone
RMSF :
Doxycycline
Nisseria meningitis:
Ciprofloxacin and rifampicin.
Rifampicin is given to all in close contacts
Fungal meningitis
Fungal meningitis
Fungal meningitis is relatively uncommon . It
may mimic acute bacterial meningitis .
Fungal meningitis isn't contagious from person
to person .
Cryptococcal meningitis is a common fungal
form of the disease that affects people with
immune deficiencies, such as AIDS.
It's life-threatening if not treated with an
antifungal medication .
Pathogenesis
Fungi reach the CNS by hematogenous spread
from:
Lungs
Heart
GI or genitourinary tract
Skin
by direct extension from para-meningeal sites:
Orbit
Paranasal sinus
symptoms
Common symptoms include:
Headache
Lethargy or confused
Nausea and vomiting
Photophobia
Seizure
Nuchal rigidity
Careful examination of the skin, orbits, sinuses,
and chest may reveal evidence of systemic
fungal infection.
Neurologic examination may show signs:
Meningeal irritation
Papilledema
Ptosis
Visual loss
Focal neurological abnormalities e.g
hemiparesis
exopthalamus
Investigations
Lab: blood culture, CBC, RBS, Electrolytes,
LFT, RFT, urinalysis (candida).
Chest X-Ray: may show hilar
lymphadenopathy, or miliary infiltrates,
cavitation, or pleural effusion.
CT or MRI: may demonstrate intracerebral
mass lesions associated with cryptococcus or
other organisms, a contiguous infectious
source in the orbit or paranasal sinuses, or
hydrocephalus.
Lumbar Puncture (LP): CSF pressure is
usually elevated, and the fluid is usually clear.
Hilar lymphadenopathy lung cavitation
CSF findings:
Glucose :<40 mg/dL (Low)
Protein :(moderate to marked increase) 25 -500
mg/dL
WBCs (cells/L) :Variable (10 -1000 cells/L)
<500cells/L.
Cell differential: Predominance of Lymphocytes
Culture: Positive (fungal)
Opening Pressure : Variable
Gram stain and india ink preparation may
reveal the infective organism.
Treatment
Amphotericin B :
1 mg intra-venous as a test dose given over 20-
30 minutes.
followed the next day by 0.3 mg/kg
intravenously in 5% dextrose, given over 2-3
hours. The dose is then increased daily in 5- to
10-mg increments until a maxi-mal dose of 0.5-
1.5 mg/kg/d is reached.
Nephrotoxicity is common.
Flucystocin :
Cryptococcus meningitis.
100mg/kg/d orally, added to amphotericin B
and given in four divided dose.
reduces the duration of therapy from 12wks to
6 weeks.
Side effects :bone marrow suppression
(reversible).
Dose should be adjusted in case of renal
failure.
Not used in patients with AIDS.
Fluconazole :
Not responding to amphotericin B alone.
initial dose of 400mg, followed by 200 mg/d,
orally or intravenously, for at least 10-12
weeks after CSF cultures are negative.
Long-term maintenance therapy with
fluconazole, 100-200 mg/d orally,
may also reduce the likelihood of recurrence
following successful treatment of cryptococcus
meningitis in patients with AIDS.
Tubercular meningitis
Tubercular meningitis is mycobaterium
tuberculosis infection of meninges.
It is the most common form of central nervous
system tuberculosis (TB).
has very high morbidity and mortality.
Severe confusion
Papilledema
Seizure
Treatment
Acyclovir : most effective drug.
10-15 mg/kg every 8 hours, with each dose
given over 1 hour (to prevent nephro toxicity).
Treatment is continued for 14-21 days.
Acyclovir is relatively nontoxic but can cause :
liver function abnormalities
speaking issues
Follow up therapy
Physiotherapy : to improve strength, flexibility,
balance, motor co-ordination and mobility.
Occupational therapy: to develop everyday
skill and to use adaptive products that help
with everyday life.
Speech therapy: to relearn muscle control and
co-ordination to produce speech.
Psychotherapy : to learn coping strategies and
new behavioral skills to improve mood
disorders or address personality change- with
medication management if necessary.
Prognosis
Recovery from viral encephalitis may take a
very long time.