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:
_________ of the cochlea tend to occur most at the basal turn of the S. Tympani.
______ are thought to be damaged by the inflammatory by-products (oxidants), ischemia (poor blood supply), and disruption of the blood-labyrinth barrier (BLB)
The route of infection from the meninges to the membranous labyrinth of the inner ear is under debate:
______ _____(most obvious)
Along the cochlear nerve,
Through blood
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