8. CSF INDICES IN MENINGITIS
Conditi CELl CELL Glucose protein -G
on Type Count stain
Normal Lymp 0-4 Normal -
>60%
B-G
Viral Lymp 10-2000 normal -
normal
Bacteri Poly 1000 Low /N +
al 5000 Increase
TB L/P,M 50-5000 Low Increase often
9. CHEMOTHERAPY OF BACTERIAL
MENINGGITIS
N-meningitidis Benzylpenicillin
Strep.pneumoniae Cefotaxime
Sensitive to B-lactams Ceftriaxone
Resistant +Vancomycin
H.Influenzae Cefotaxime
Ceftriaxone
10. Treatment of pyogenicmeningitis
unknown cause of
1-patients with a typical meningococcal rash
Benzylpenicillin 2.4 gIV.6-hourly
2-Adult aged 18-50 years without meningococcal rash
Cefotaxime 2 g IV.6-hourly
Ceftriaxone 2g IV.12-hourly
3-Patient in whome pencillin-resistant pneumococcal infection is
suspected
As 2 but add-Vancomycin 1g Iv,12-hourly or Rifampicin 600 mg
IV.12-hourly
4-Adult aged over 50 years and those in whome Listeria
monocytogees infection is suspected
As for 2 but add Ampicillin 2g IV.4-jourly or Co-trimoxazole
5-Patients with a clear history of anaphylaxis to B-lactams
Chloramphenicol 25 mg/kg IV.6-hourly plus Vancomycin 1g
IV.12-hourly
11. Recommendations for Empirical
antimicrobial therapy in adult with
community-acquired meningitis
Predisposing factor pathogen Drugs
16-50 yr N-St-pn Vancomycin +
3rd cephalosporin
>50 yrٍ St-pn, N, List Van+3rd Ceph+
Ampicillin
Presence of a risk St-pn, list, Van+3rd ceph+
H-infuenzae Ampicillin
www.NEJM.ORG ,N ENGL ,Jan-2006
12. Chemoprophylaxis for meningococcal
infection
Dose it reduce the incidence of clinical disease
among contact?
Observational data suggest that antibiotic
reduce the risk of disease
In adults a single dose of 500 mg ciprofloxacin
or oral rifampicin 600mg(12-hourly) for 2
days.
Vaccines for groups A&C but not B menigococci.
14. Major intracranial complications in
Bacterial meningitis in adult
-----------------------------------------
1-Transtentorial herniation
2-Hydrocephalus
3-Infarction
4-Seizures
15. CLINICAL FEATURES OF TB MENINGITIS
• Vomiting • Depression
• Low-grade • Confusion
fever • Behavior
• lassitude changes
16. Signs
Meningism (may be absent)
Ocular palsies
Papilloedema
Depression of conscious level
Focal hemispher signs
17. Viruses causing acute encephalitis
Common
Arboviruses
Enterovirsuses
HSV
Less common
CMV
EBV
HIV
Mumps
19. Practical points
• The typical profile is lymphocytic
pleocytosis(25-500 cells/uL.)
• A normal or slightly elevated protein
• A normal glucose concentration.
• PMN pleocytosis should always promt an
alternative diagnosis
• In both enterovirus &HSV,PCR is the
diagnostic procedure of choice