Meningitis

Meningitis

Inflammation of the Pia mater and arachnoid, and infection of the cerebrospinal fluid (CSF) that fills the subarachnoid space

Bacterial or Viral

Meningitis is typically due to ____ __or__ _____ infection in the CSF

(May also be due to tuberculosis, chemicals, or idiopathic)

Meningitis epidemic

Tend to occur in large group settings

\-Military

\-Daycare centers

\-College dorms (Especially with community dining)

Type of meningitis

Bacterial

Viral

Fungal

Parasitic

Non-infectious

Bacterial meningitis

Caused by bacteria

\-Neisseria meningitidis

\-Streptococcus pneumoniae

\-Staphylococcus aureus

\-Tuberculosis

Viral Meningitis

Caused by viruses:

\-Arboviruses (transmitted by primary arthropod vector)

\-Enteroviruses (contamination through fecal matter or respiratory secretions from infected)

\-Herpes simplex

\-Mumps, measles

\-COVID-19 maybe

Fungal Meningitis

Caused by fungi:

\-Cryptococcus

\-Histoplasma

Parasitic Meningitis

Angiostrongylus cantonensis (found in contaminated food, water and soil):

\-cryptococcus neoformans

\-Candida albicans

\-Aspergillus species and others

Non-infectious Meningitis

Caused by cancers:

AKA Neoplastic Mengingitis

\-Systemic lupus erythematosus (SLE) and certain drugs

\-Head injury and brain surgery

Enteroviruses

Most common cause of viral meningitis

Can bacterial meningitis treated with antibiotics still result in death?

Yes

Are many fungal meningitis cases associated with immune deficiencies?

Yes

Risk factors fungal meningitis

• AIDS

• Immunosuppressant drugs

  • Often prescribed after an organ transplant

African Belt

2012 outbreak related to contaminated steroid drug injections sickened \~750 and killed 64 across 20 states forming what is referred to as the _____ ________ on a map.

Tuberculous Meningitis (TBM)

Deposit of tuberculous granulations (**tuberculomas**) accompanied with meningeal inflammation

Tuberculous Meningitis

______ is hard to differentiate from bacterial meningitis

100 & 30

Untreated TMB fatality is ______ % and ______ % are fatal despite antituberculosis chemotherapy.

Hydrocephalus

TBM complication that results from the blockage of CSF abroprion and can also effect efferent CNs

Recent TB exposure

Evidence of TB in the body

HIV

==Indicators of tuberculosis meningitis:==

0\.25 - 1 / 1000

2\.5 / 1000

==Neonatal bacterial meningitis incidence:==

Live births = ____ to _____

Premature births = __________

5,000 to 7,000

Bacterial meningitis in adults occurs in \~ ____ to ___ in the US each year (Fluctuates!)

Spring to autumn

Meningitis is more common in ____ to ____ months.

meningococcal conjugate vaccination

\-All preteens and teens at 11 to 12 years old with a booster dose at 16 years old

\-Children and adults at increased risk for meningococcal disease

People older than 10 at increased risk for meningococcal disease

According to the CDC who should receive the serogroup B meningococcal vaccination?

PATH and WHO

Meningitis Vaccine Project created by partnership between ___ and ___.

Mission = eliminating meningitis as a public health problem in sub-Saharan Africa through the development, testing, introduction, and widespread use of conjugate meningococcal vaccines (1 to 29-year-olds received a single dose of MenAfriVac)

Risk factors

Infants, children, and elderly

Day care centers

Cancer patients:

\-Immunosuppressive chemotherapy

\-Indwelling ventricular devices

\-Indwelling vascular catheters

\-Neurosurgical procedures

Overcrowded conditions

Upper respiratory infection

Certain surgical procedures (cochlear implants)

Untreated conditions

Exposure to rodents and mice

Direct contact with someone with meningitis

Viral meningitis symptoms

\-Asymptomatic or less severe ==(viral only)==

\-High fever

\-Chills

\-Nausea and vomiting

\-Photophobia (Sensitivity to light)

Bacterial meningitis symptoms

\-High fever

\-Chills

\-Nausea and vomiting

\-Photophobia

\-Severe headaches

\-Stiff neck @@(meningismus)@@

\-Rapid breathing

\-Increased drowsiness

\-Agitation

\-Bulging fontanelles

\-Decreased consciousness

\-Poor feeding or irritability in children

\-Opisthotonos (Unusual posture, with the head and neck arched backwards)

\-Seizures

\-Stroke

Viral complications

\-Fatigue

\-Lightheadedness

\-Encephalitis (rare)

Bacterial complications

\-Brain damage

\-Coma

\-Death ( \~10% fatal and > elderly)

\-Hearing loss (20%)

\-Paralysis

\-Seizures

\-Kidney damage

\-Learning disabilities

Viral meningits Dx

Flat rash all over the body

Bacterial meningitis Dx

\-Typical purpura ( blood vessels get inflamed, they can bleed into the skin, causing a reddish-purple rash)

\-Petechiae rash -- round spots that appear on the skin as a result of bleeding

Petechiae

\-Small (1–3 mm)

\-Red

\-Non-blanching lesions caused by bleeding into the skin.  

Purpura

\-Larger (>3-1-mm)

\-Typically raised lesions resulting from bleeding within the skin

\-Do not blanch when applying pressure (Glass test)

Glass test

If rash does not change colors then medical referral should be given.

Brudzinski’s Sign

Checking for neck stiffness may include tilting the head is tilted forward and the knees will bend in result (AKA positive) indicative of:

\-Severe meningeal inflammation

\-Evidence of microbiological CSF infection

Lumbar puncture

==Culture of CSF to determine:==

\-Type of bacteria

\-Cell count

\-Glucose

\-Protein

Diagnosis

•X-rays

•Ultrasounds

•CT scans

•MRIg

Septicaemia

________ blood poising caused by the same germs as meningitis.

\[Could occur with meningitis or on its own\]

2 weeks

How long does it typically take to completely recover from viral meningitis

Viral Meningitis Tx

Antibiotics are not helpful

Recommended:

\-Plenty of fluids

\-Rest

\-Medicine to relieve headache

Pharmacological AND prevention

==Bacterial Tx:==

___________:

•Hospitalization (life-threatening)

•Antibiotics (corticosteroid, intravenous)

(Some are ototoxic -- ask if they have been in the hospital)

AND

___________:

Some forms are contagious!

\-Stay away from direct contact with saliva

\-Get vaccinated

antituberculous chemotherapy

==TBM tx:==

___________ ___________

•Choice of 4 drugs for two months

-Then a choice of 2 drugs for months nine to twelve after the infection

•Dexamethasone is given regardless of age or disease severity

-(only to HIV-negative patients)

Otitis media

Viral meningitis is not typically associated with HL but a mild HL may be present if it occurs with ____ _____

rapid bilateral fever

==Sings of bacterial meningitis on case history:==

___________ onset of symptoms (HL or dizziness)

Most likely ___________ auditory symptoms

High ___________

Photophobia

mild to profound

==Bacterial Meningitis Audiogram:==

______ to _______ SNHL

Progressive or fluctuating

7-36

5-30

4

Bacterial meningitis HL incidence:

• ____ - ____% of meningitis survivors

• ____ - ____% of bacterial meningitis and __% develop permanent bilateral HL

Ossification

OHC

cochlear aqueduct

Bacterial Meningitis Hearing Loss Pathophysiology:

1. _________ of the cochlea tend to occur most at the basal turn of the S. Tympani.

2. ______ are thought to be damaged by the inflammatory by-products (oxidants), ischemia (poor blood supply), and disruption of the blood-labyrinth barrier (BLB)

3. The route of infection from the meninges to the membranous labyrinth of the inner ear is under debate:

   1. ______ _____(most obvious)

   2. Along the cochlear nerve,

   3. Through blood

   4. etc.

elevated absent

increased

WIII

Bacterial Meningitis test results:

• Middle ear muscle reflex would be ____ or _____

• Decay testing is not possible if MEMR is elevated or absent

• ABR = poor morphology or absent response

• ________ interpeak latencies

• May have delayed ________

• ENG = nystagmus present

25-30 dB

35-40 dB

==Bacterial Meningitis OAES:==

•Transient Evoked:

•Absent if > _________ HL

•Distortion Product:

•Absent if > ________ HL

HA CI

==Bacterial Meningitis Habilitation/Rehabilitation:==

• ________

• ________

• Timely intervention is necessary to minimize the risk of cochlear ossification

• Bilateral simultaneous implantation is the treatment of choice for this special population

• Communication considerations:

•Auditory/Oral

•Manual

•Total communication

Referral needs

• Emergency room

  • Untreated bacterial meningitis can cause death

• Otolaryngologist/otologist

• Audiologist

  • Amplification

  • Monitoring