- Meningitis –
Inflammation of the thin membranes that surround the brain and spinal cord called the meninges (mostly of the pia mater and arachnoid mater) RISK GROUP AGE
>60 y.o and <5 y.o are at highest risk
BACTERIAL MENINGITIS
acute purulent infection of the meninges and subarachnoid space, followed by an inflammatory reaction in the subarachnoid space, the brain parenchyma, and the cerebral arteries - veins.
SOURCES OF INFECTIONS
ETIOLOGI
Listeria monocytogenes impaired cell-mediated immunity due to organ transplantation, chronic illness, pregnancy, AIDS, malignancy, immunosuppressive therapy, or age.
Streptococci sp., Gram (-)
anaerobes, S. aureus,
Haemophilus sp., or
Enterobacteriaceae acute otitis media, mastoiditis/ sinusitis.
Staphylococci, Gram (-) bacilli, or anaerobes post-neurosurgical patient and the patient with a ventriculostomy or other indwelling catheter.
GEJALA KLINIS
The symptoms develop within a few hours to a couple of days.
Neonates: irritability, lethargy, poor feeding,
vomiting, diarrhea,
temperature instability, respiratory distress, apnea, seizures, and a bulging fontanel.
Children, Adolescents, Adults: fever, vomiting, photophobia, headache, nuchal rigidity (tanda meningeal), penurunan kesadaran lethargy stupor
coma.
PX. FISIK
- Guillain Sign - Edelmann test - Bikele test
PX. PENUNJANG
GOLD STANDARD u/ Bacterial Meningitis :
Pungsi Lumbal: The classic abnormalities in BACTERIAL meningitis;
1. an opening pressure >
180mm H2O,
2. pe ↑ white blood cell count with a predominance of PMN leukocytes,
3. pe ↓ glucose concentration (<
40 mg/dL),
4. pe ↑ protein concentration 5. a Gram + stain and bacterial
culture.
Gram stain is + in identifying the organism in 60% - 90% of cases of bacterial meningitis.
The classic abnormalities in VIRAL meningitis;
1. a normal opening pressure 2. a lymphocytic pleocytosis, 3. a normal glucose
concentration,
4. a normal or slightly elevated protein
Viral immunoglobulin M (IgM) antibodies can be detected in CSF.
Examination of the spinal fluid will reveal red blood cells and xanthochromia, although it may take several hours to appear.
CT Scan: dilakukan bila ada ; - pe ↓ consciousness
- papilledema
- a focal neurologic deficit - new-onset seizure activity - immunocompromised state - a dilated or poorly reactive
pupil
- signs of a posterior fossa mass lesion (cranial nerve abnormalities, cerebellar deficit, and a wide-based ataxic gait)
TREATMENT
When bacterial meningitis is suspected, dexamethasone and empiric antimicrobial therapy is begun immediately.
- Refer to MMN Neurology page 80 –
MODES OF TRANSMISSION Bacteria are present in discharges from the nose and mouth and cause transmission through droplets.
COMPLICATIONS Diana Fadhilah Sari - Notes
The major complications of bacterial meningitis;
- focal and diffuse brain edema, - hydrocephalus, arterial
cerebrovascular
- complications (ischemic and/or hemorrhagic stroke) - septic sinus thrombosis with
thrombophlebitis
- hearing loss and
vestibulopathy, and seizures.
Skin discoloration or rash may be present
PROGNOSIS Dubia ad Bonam.
Some people with the infection die and death can occur in as little as a few hours. However, most people recover from bacterial meningitis. Those who do recover can have permanent disabilities, such as brain damage, hearing loss, and learning disabilities.
ASEPTIC MENINGITIS
a disorder in which the characteristic symptoms and findings of meningeal irritation are present, and cerebrospinal fluid (CSF) analysis is suggestive of meningitis but without evidence of bacterial infection.
Diana Fadhilah Sari - Notes
Diana Fadhilah Sari - Notes
