1.1. Everyone is susceptible to meningitis however it is more common in infants , and adults whom are older than 60. <1 Month of age are susceptible to s. agalactia, e. coli, listeria monocytogenese, and kiebsiella species. 1 -23 months are more susceptible to: - S. pneumoniae, and N meningitidis. 2 - 50 years are more susceptible to: - S. pneumoniae, and N meningitidis. > 50 years or alcoholism or immunocompromised are more susceptible to: - S. pneumoniae, N. meningitidis, Listeria monocytogenes, aerobic gram-negative bacilli. Head trauma; post neurosurgery are more susceptible to: - S. pneumoniae, S. aureus, aerobic gram-negative bacilli.
1.2. Other factors that can influence the risk of meningitis include: - Geography and environment - chronic nose/ ear infection - corticosteroids - spinal surgery
2. History
2.1. Meningitis can spread rapidly and conclude with death within the first 24 hours or it can spread slowly. Early stage of meningitis can include fever and irritability, which can progress to rash which is common in advanced stages of the disease and in the late late stages of the disease can lead to sever long term disability or death.
3. Treatment
3.1. When it comes to meningitis treatment should always start promptly, imaging and lumbar puncture can assist in slowing down the diagnosis. This then followed by multiple medications, however medications does differs from patient to patient due to age, gender, allergies, and the type of meningitis being diagnosed to the patient.
3.2. Empiric antibiotics - this includes a variation of ampicillin, cefotaxime, vancomycin, dexamethasone, cefepime, ceftazidime. medications do differ from each individual: < 1 month years of age - ampicillin and cefotaxime 1 - 23 months years of age - cefotaxime or ceftriaxone and vancomycin and/or dexamethasone 2 - 50 years - cefotaxime or ceftriaxone and vancomycin and/or dexamethasone > 50 years of age or alcoholism or immunocompromised - cefotaxime and ceftriaxone or ceftriaxone and vancomycin and/or dexamethasone Head trauma; post neurosurgery Vancomycin and cefepime or ceftazidime.
4. pathophysiology
4.1. Meningitis is defined as the entry of bacteria into CSF, which then leads to accumulation of bacterial and in response the inflammatory system is activated leading to leukocyte extraversion into the subarachnoid space, forcing an increase in CSF outflow resistance, and concluding with inflammation of brain meninges and oedema.
5. Physical Exam
5.1. Common sings and symptoms of meningitis include: - neck soreness - headache - sudden high ever - Headache with nausea or vomiting - seizures - No appetite or thirst - Skin Rash - Confusion
5.2. Signs in new-borns - Vomiting - High fever - Constant crying - Excessive sleepiness - Stiffness in the body and neck
6. Testing
6.1. CSF Evaluation. - This process consists of counting the WBC, Glucose and protein in the cerebrospinal fluid (CSF). A normal count of CSF should have <5 of WBC per (cells/mm) and a glucose value of 50-to 66% per (mg/dL) and protein levels of <50 (mg/dL). however if there is a viral infection then we can see an increase in WBC (50-1000) per (cells/mm) and >45% of glucose is found per (mg/dL), and the protein levels increasing to <200 per (mg/dL) thus if there is a bacterial infection we can see a significant increase of WBC of 1000 - 5000(cells/mm) and <40% of glucose levels, and an increase in proteins, 100-500 (mg/dL). This primarily due to bacteria being a protein cell.
6.2. Blood Cultures Usually positive for bacterial meningitis 50 - 90%
6.3. Gram Stain. Gram stain is the process of staining for the preliminary identification of bacteria, which include a violet dye, followed by a decolorizing agent , and then followed by a red dye. the final result will help us to determine what type of bacteria the patient have. Gram stain has a high accuracy and an immediate diagnose of up to 60 to 90%, however if a patient has already received antibiotic therapy this will decrease to 40 to 60%.
