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Meningitis and encephalitis (Viral encephalitis (VE) (Pathogenesis…

- - - - Neonates <1month
        Gram-negative bacilli > Streptococci > Listeria species > Staphylococci > Streptococcus pneumoniae
      - Children 1month – 15years:
        Haemophilus influenzae > Neisseria meningitidis > Streptococcus pneumoniae
      - Adults >15 years
        Streptococcus pneumoniae > Neisseria meningitidis > Staphylococci
      - 0 – 4 weeks: Streptococcus agalactiae, E.coli, Listeria monocytogenes, Klebsiella pneumoniae, Enterococcus sp, Salmonella sp.
        
        4 – 12 weeks: Streptococcus agalactiae, E.coli, Listeria monocytogenes, Haemophilus influenzae, Streptococcus pneumoniae, Neisseria monocytogenes
        
        3 month - 18 years: Haemophilus influenzae, Neisseria monocytogenes, Streptococcus pneumoniae
        
        18 – 50 years: Streptococcus pneumoniae, Neisseria meningitidis
        
        !> 50 years: Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes, G (-) rods
  - - - Enterovirus: Poliovirus I, II, III , Echovirus, Coxsackievirus
        
        Togaviridae: Alphaviruses, Flaviviridae, Rubella
        
        Paramyxovirus: Mumps, Measles
        
        Rabies virus
    - - Herpesvirus: Herpes simplex virus types 1 and 2 , Cytomegalovirus, Varicella- zoster virus , EBV
        
        Smallpox
        
        Adenoviruses
- - - - Meningitis: bacterial, mycobacterial, viral, fungal
        Follow-up therapy of meningitis
        Intrathecal administration of antibiotics or antineoplastic chemotherapeutic agents
        Subarachnoid hemorrhage
        Administration of spinal anesthetics
        Diagnosis multiple sclerosis, Guillain-Barre sydrome
    - - Sings of increased intracranial pressure – definite contraindication:
        neurological sings from posterior cranial fossa, Papilloedema, Abnormal CT scan
        
        Coagulation disorders, Severe shock
        
        Local infection: Bacterial skin leasions, Spinal osteomyelitis, Tattoo
    - - Post-lumbar puncture headache/neausea
        Herniation
        Hematomas
        Iatrogenic meningitis
  - - - Normal: Clear, colorless, 0 – 5 cells lymphocytes
        
        Purulent: Turbid/cloudy discolored, 1000 – 10 000 neutrophils
        
        Viral /Lyme diseases/ syphilis: Clear, colorless, 30 – 300 cells
        lymphocytes
        
        Tuberculosis: Clear/cloudy, 30 – 500 cells lymphocytes 2018
    - - By hematogenous spread (bacterial, viral…)
        Neuronal transmission (viral: herpes simples, herpes-zoster, rabies)
        By extension from cranial structures (bacterial): Ears, Paranasal sinuses , Penetrating cranial injuries
        Iatrogenic (bacterial):
        cerebral surgery,
        the placement of a ventriculoperitoneal shunt,
        by a lumbar puncture needle
- - - - Appearance: Turbid, cloudy, discoloured Cell count: 1000-10000/mm3 (high) Glucose: 0-45 mg/100mL (low) Protein: 100-1800 mg/100mL (high) Chloride: 100-120 mmol/L
  - - - Empiric: Penicillin, Ceftazidime/Ceftriaxone, Amikacin, Ampicillin, Vancomycin
        
        Drug-resistance testing
    - - Anti-cerebral edema: corticosteroids, Mannitol, osmotic diuretics
        
        anticonvulsants, Anti-vomiting (antiemetic), sedatives
        
        Anti-inflammatory agents: steroid and non-steroid, Immunoglobulins
        
        treatment DIC-anticoagulants
    - - Traditionally 10-14 days
        Meningococcal meningitis - 7-10days
        S. pneumoniae meningitis -10-14 days
        Listeria monocytogenes meningitis-14-21 days
        Enteric Gram negative bacilli - 21 days
- - - - entry of virus into host -->
        primary replication: respiratory or gastrointestinal tract,skin,muscle --> Secondary replication: vascular endothelium,reticuloendothelial system or muscle --> Persistent viremia --> Crosses from blood to brain
      - Viruses
        
        HSV-primary infections, HIV, CMV, Mumps, EBV, Echovirus, Poliovirus, Togaviruses, Coxsackievirus
    - - Penetration and replication of virus at muccocutaneous site--> Replication et dorsal root ganglia
      - Viruses
        
        HSV, VZV, Rabies virus
    - - Viruses
        
        HSV, Enterovirus- rarely
  - - - Incidence – mainly children and young adults
        More common in men rather than women
  - - - Anti-cerebral edema: Dexamethason, 20% Mannitol, Diuretics
        
        Other: Anti-inflammatory agents: steroid and non-steroid, Anti-vomiting, Anti-convulsants, Sedatives, Respiratory therapy
    - - Aciclovir, Ganciclovir