MENINGITIS

Dr. Takdir Setiawan Sp.S

Meningitis
Definition
Bacterial meningitis is an inflammatory response to
bacterial infection of the pia-arachnoid and CSF of
the subarachnoid space

Epidemiology
Incidence is between 3-5 per 100,000
More than 2,000 deaths annually in the U.S.
Relative frequency of bacterial species varies with
age.

Bacterial
Viral ( aseptic)
TB
Fungal
Chemical
Parasitic
? Carcinomatous

Meningitis
Epidemiology
Neonates (< 1 Month)
Gm (-) bacilli 50-60%
Grp B Strep 20-40%
Listeria sp. 2-10%
H. influenza 0-3%
S. pneumo 0-5%

Meningitis
Epidemiology
Children (1 month to 15 years)
H. influenzae

40-60%

Declining dramatically in many geographic

regions

N. meningitidis 25-40%
S. pneumo
10-20%

Meningitis
Epidemiology
Adults (> 15 years)
S. pneumo 30-50%
N. Meningitidis
10-35%
Major cause in epidemics

Gm (-) Bacilli

1-10%

Elderly

S. aureus
5-15%
H. influenzae
1-3%

>60 include Listeria, E. coli, Pseudomonas

Bakteri Pada Meningitis Bayi

Streptococcus agalactiae

Listeria monocytogenes

E. coli

Pseudomonas aeruginosa

Staphylococcus Sp.

Citrobacter

Bakteri pada meningitis dewasa

Streptococcus Pneumonia

Neisseria meningitides

Haemophilus influenzae

Meningitis
Pathogenesis
Majority of cases are hematogenous in
origin
Organisms have virulence factors that
allow bypassing of normal defenses
Proteases
Polysaccharidases

Meningitis
Pathology and Pathogenesis
Sequential steps allow the pathogen into the
CSF

Nasopharyngeal colonization
Nasopharyngeal epithelial cell invasion
Bloodstream invasion
Bacteremia with intravascular survival
Crossing of the BBB and entry into the CSF
Survival and replication in the subarachnoid space

The wall of the venule

L - lumen,
E - endothelium,
M - smooth muscle cell,
C - collagen fibres in the perivascular space of Virchow-Robin.

Meningitis
Pathology
Hallmark
Exudate in the subarachnoid space
Accumulation of exudate in the dependent areas of the
brain
Large numbers of PMNs
Within 2-3 days inflammation in the walls of the small
and medium-sized blood vessels
Blockage of normal CSF pathways and blockage of the
normal absorption may lead to obstructive hydrocephalus

Meningitis
Clinical Manifestations

Headache
Fever
Meningismus
Cerebral dysfunction
Confusion, delirium, decreased level of
consciousness

N/V
Photophobia

Meningitis
Clinical Manifestations Nuchal rigidity
Kernigs
Pt supine with flexed knee has increased pain with passive
extension of the same leg

Brudzinskis
Supine pt with neck flexed will raise knees to take pressure
off of the meninges
Present in 50% of acute bacterial meningitis cases

Cranial Nerve Palsies

IV, VI, VII

Seizures

KELUMPUHAN SARAF OTAK PADA

MENINGITIS

Lumbal
Pungsi

Tuberculosis of the brain

with cerebritis and tuberculoma formation.
MRI scans of a patient are shown
including post-contrast T1WI (A) and T2WI (B)

Empiric Therapy of CNS Infections

Acute Bacterial Meningitis (ABM)

(contd)

Pengobatan TBC pada orang dewasa

Kategori 1 : 2HRZE/4H3R3
Selama 2 bulan minum obat INH, rifampisin, pirazinamid, dan etambutol
setiap hari (tahap intensif), dan 4 bulan selanjutnya minum obat INH dan
rifampisin tiga kali dalam seminggu (tahap lanjutan).
Diberikan kepada:
Penderita baru TBC paru BTA positif.
Penderita TBC ekstra paru (TBC di luar paru-paru) berat.
Kategori 2 : HRZE/5H3R3E3
Diberikan kepada:
Penderita kambuh.
Penderita gagal terapi.
Penderita dengan pengobatan setelah lalai minum obat.
Kategori 3 : 2HRZ/4H3R3
Diberikan kepada:
Penderita BTA (+) dan rontgen paru mendukung aktif.