Meningitis in Pediatrics ,

1. Meningitis
Presenter: Dr.Hardik Shah
Guide: Dr.Mahesh Kamate
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2. Scheme of Presentation
• Introduction & Definition
• Types
• Etiology Dr.Hardik
• Predisposing/ Risk factor
• Pathophysiology
• Clinical features
• Diagnosis
• Treatment
• Complication Dr.Nishant
• Prognosis
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3. Introduction
• Meningitis: Inflammation of leptomeninges,
with variable involvement of encephalons
• Encephalitis: Inflammation of Brain
Parenchyma.
• Meningoencephalitis:
Inflammation of meninges and
Brain Parenchyma.
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4. • Ventriculitis: Inflammation of the ventricles in the
brain,
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5. Meningitis / Encephalitis
• Classical triad of Meningitis
-Fever
-Headache
-Neck Stiffness
• Length and Progression of Symptoms are
Slower than encephalitis.
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6. Encephalitis
• Acute or subacute onset of Symptoms and
Present with Neurological deficit
• Loss of consciousness on presentation,
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7. Classification
• Based on etiology
– Infectious
– Non infectious
• Based on Duration
– Acute
– Subacute
– Chronic
• Based on culture report
– Septic
– Aseptic
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8. Etiology Based
Infectious Non Infectious
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9. Infectious
• Bacterial
• Viral
• Fungal
• Ricketsial
• Parasitic/ protozoal
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10. Bacterial
• Most Common
– Neisseria Meningitidis (B, C, Y, W 135, Epidemic
strain A)
– Streptococcus Pneumoniae ( 1,5,6,7,14,19 serotype)
– Hemophilus Influenzae (Commonest , Endemic)
• Less Common
– Staphylococcus Coagulase –ve and +ve
– E.coli , Pseudomonas , Proteus , Enterobacter
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12. Viral
• Non-polio enteroviruses
• Mumps virus
• Herpesviruses, including , herpes simplex
viruses,
• Measles
• Influenza
• Arboviruses such as West Nile
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13. Non Infectious
• meningitis can be caused by exposure to
certain medications, such as the following:
– Immune globulin
– Levamisole
– Metronidazole
– Mumps and rubella vaccines
– Nonsteroidal anti-inflammatory drugs (e.g.,
ibuprofen, diclofenac, naproxen.
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14. • Collagen vascular disease
– SLE
– Wegner’s Granulomatosis
– Polyarteritis Nodosa
– Sarcoidosis
• Chemotherapeutic agents
• Malignancies
– Leukemia
– Lymphoma
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15. Based On Duration Of illness
• Acute : Duration of illness <7days
• Sub Acute : 1 to 4weeks
• Chronic : >4weeks
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16. Chronic Meningitis
•
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17. Septic Vs Aseptic
• Aseptic meningitis or sterile meningitis :
• the layers lining the brain, the meninges,
become inflamed
• absence of detectable pyogenic
bacterial infection.
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18. Bacterial Meningitis
• Most Potential serious Infection In infant and
older Children.
• High rate of acute complication and long term
morbidity
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19. Predisposing Factors
• Septicemia
• Septic focus in Skin , Lung , Bones
– Trauma
– Pilonidal Sinus
– Fracture Base of Skull
– Neural tube Defect
– Suppurative ear Or mastoid Infection
– VP shunts
– Occult bacteremia
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20. • Sickle cell predisposes pneumococcal
meningitis
• Immunocompromised States
– HIV
– A/Hypogamma globulinemia
– Complement Deficeiency
• Malnutrition
• Overcrowding
– Transmission usually by droplets/ Saliva
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21. Pathogenesis
• Nasopharyngeal Colonisation
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23. Pathophysiology
1. Heavy Bacteraemia :
• Cerebral vein , venous sinuses , Micro
arterioles
• Cerebrum , cerebellum , basal cisterns and
Spinal cord With Internal and external
Changes
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24. 2. Ventriculitis with Inflammatory cells in CSF
Vascular AND Parenchymal Involvement :
- Perivascular Inflammatory infiltrates
- Disruption of ependymal Membrane
- Poly morphonuclear infiltrates
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25. • Vasculitis , small cortical vein thrombosis,
• Occlusion of major venous sinuses
• Necrotising arteritis
• Sub arachnoid haemorrhage , cerebral cortical
Necrosis, cerebral infarction
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26. Now,
• Why??
- Meningeal Signs
• Why?
- Raised ICT
• Why
-Hydrocephalus
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27. • What is a cause of Raised CSF Protein?
• What is a cause of Low Glucose in CSF
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28. Raised ICP
• Cytokine induces increased capillary vascular
permeability ( vasogenic Cerebral Oedema)
• Cellular Death Due to cytotoxic cerebral
oedema
• Obstructed reabsorption of CSF or obstructed
its pathway  Increased Hydrostatic pressure
(Interstitial cerebral oedema)
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29. Hydrocephalus
• M/C Communicating Hydrocephalus
• Adhesive thickening of arachnoid villi
•
• Interfere with reabsorption of CSF
• Followed by gliosis and fibrosis will cause
obstructive type of hydrocephalus.
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30. Raised CSF Protein
• Because of increase vascular permeability
of Blood brain Barrier,
• Loss of albumin rich fluids from the capillaries
and veins traversing the subdural space
• Continuous transudation  Subdural effusion
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31. Low Glucose in CSF
• Decreased glucose transport by cerebral tissue
• This all will lead to clinical menifestations.
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32. Why Meningeal signs?
• Inflammation of spinal nerves and roots
produces meningeal irritation,
• Inflammation of cranial nerves produces
cranial nerve neuropathies
• like optic, oculomotor , facial , Auditory
nerves
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33. • Temporal lobe compression due to tentorial
herniation will cause oculomotor nerve palsy
• Abducent Nerve palsy will be caused by raised
ICT.
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35. Clinical Features
• When to suspect ??
• Any sick Child with High grade fever
• With following features :
• Constitutional Symptoms:
• Lethargy / Irritability / Neurological symptoms like
photophobia , Inconsolable cry
• Anorexia, Nausea , vomiting
• Fever may be variable
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36. Symptoms
• Fever
• Headache
• Photophobia
• Vomiting (without nausea, Projectile)
• Seizures, partial or generalised
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37. Signs
• Bulging anterior Fontanelle, If open
• Sign for meningeal irriatation
• Neurological focal deficit
• Papiloedema
• Hypertonia
• Extensor plantars
• Altered sensorium, Drowsy , Stupor
• Neck rigidity
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38. Signs for Meningeal Irritation
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39. • Brudzinski Sign :
– Leg Sign
– Neck Sign
– Symphysial sign
– Cheek Sign
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40. • Benda Sign :
• TBM
• Turning the head and chin to one side
• Observe the shoulder : If upward and forward
movement  Positive sign
• It is because of spasm of trapezius musle.
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41. Features of Parenchymal
involvement
• Altered sensorium
• Seizures
• Focal Neurological signs
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42. Extra CNS menifestation
• Rashes
• Patechiae
• Arthralgia
• DIC
• Shock
• Pneumonia
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43. • Thank You..!!
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