Meningitis

Meningitis is an inflammation of the pia mater and arachnoid membranes that surround
the brain and the spin al cord. The SAS between these two meninges contains CSF that
may reflect the signs and symptoms of the meninges.

Pathophysiology and Etiology:

• The organisms causing these infections seem to vary depending on the age and
immune status of the patient. The mortality is 5% for children who recovermay
have long term neurologic problems (eg. Hearing deficit). These organisms may
have epidemic potential.
• Viral meningitis is the most common form and is usually self limiting.
Management is supportive. It is usually caused by a nonpolio enterovirus(90%).
It targets children and the elderly. This organism is spread by the fecal-oral route
and through sewage.
• Bacterial meningitis may cause damage to the CNS from the inflammatory
process rather than the pathogen. Bacterial meningitis is usually more serious
than the viral meningitis. It is typically caused by streptococcus pneumoniae
(pneumococcal meningitis), a gram positive diplococci, and Neisseria meningitis
(meningococcal meningitis), a gram negative diplococci.

o With a mortality of 30%, S. pneumoniae is the leading cause of bacterial

meningitis in children younger than age 5. it is spread by droplet.
o Most bacteria that cause meningitis begin by colonizing the nasopharynx,
then invade the circulation and CSF, causing inflammatory response
mediated by cytokines.
o Bacterial meningitis can result in brain damage due to chemicals released
by bacteria that kill or damage neurons, purulent exudates that may result
in vascilitis and vasospasm, and increased ICP that causes cerebral edema.
• Fungal meningitis, particularly Cryptococcus neoformans, affects
immunosuppressed patients 9eg Human immunodeficiency virus [HIV] through
soil contaminated with excrement from pigeons and chickens. Cryptococcal
antigen, or culture, is found in the CSF, but meningeal signs may be minimal. In
HIV-positive patients, tuberculous meningitis, tuberculomas, and atypical
mycobacteria infections of the brain may be noted.
• Parasitic meningitis is usually cause by flukes, worms, or amoeba.
• Hospital-acquired postcraniotomy meningitis by gram-negative bacilli, can result
in mortalities of 30%, multiple craniotomy operations place the patient at even
risk. It develops approximately 7 to 8 days postoperatively.
• Neoplastic meningitis affects approximately 3% to 8% of patients who have
systemic cancers. The mean survival time is approximately 5 to 8 months. In
neoplastic meningitis, malignant cells infiltrate the leptomeninges as a
complication of breast cancer, lung cancer, malignant melanoma, non-hodgkin’s
lymphoma, and acute leukemia.
• Meningitis is the primary intracranial complication of acute and chronic sinusitis
(sphenoid sinusitis most common). S. pneumonia and Staphylococcus aureus are
the most common organism.
• Listeria monocytogenes, a gram-positive bacillus, may cause meningitis through
contaminated hotdogs, cold meats anunpasteurized dairy products.
• The incidence of Haemophilus influenza meningitis has decreased due to the
Haemophilus b vaccine.