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In the name of God
Shaghayegh Noorani
Faezeh Sheikolvaezin
What is meningitis?……
The brain and spinal cord are covered by connective tissue
layers collectively called the meninges which form the
blood-brain barrier.
1-the pia mater (closest to the CNS)
2-the arachnoid mater
3-the dura mater (farthest from the CNS).
The meninges contain cerebrospinal fluid (CSF).
Meningitis is an inflammation of the meninges, which, if severe,
may become encephalitis, an inflammation of the brain.
What is Meningitis?
Meningitis can be caused by many different organisms
including viruses and bacteria.
Meningitis, caused by a bacteria, is life threatening and
requires urgent medical attention and treatment with
Meningitis caused by a virus is very rarely life
threatening but can cause the body to become very
When bacteria invade the body they can cause
meningitis, septicaemia or meningitis and septicaemia
Causes of Meningitis
-Bacterial Infections
-Viral Infections
-Fungal Infections
(Cryptococcus neoformans
Coccidiodes immitus)
-Inflammatory diseases
-Trauma to head or spine.
Bacterial meningitis…..
Etiological Agents:
Pneumococcal, Streptococcus pneumoniae (38%)
Meningococcal, Neisseria meningitidis (14%)
Haemophilus influenzae (4%)
Staphylococcal, Staphylococcus aureus (5%)
Tuberculous, Mycobacterium tuberculosis
Bacterial Meningitis
Potentially life threatening disease.
One million cases per year world wide. 200,000 die annually.
Can affect all age groups but some are at higher risk.
Treatment available : antibiotics as per causative organism
Humans are the reservoir .
Pneumococcal meningitis is the most common type. Approximately 6,000
Haemophilus meningitis: Since 1985 Incidence has declined by 95% due to
the introduction of Haemophilus influenza b vaccine.
Other bacterial meningitis caused by E-Coli K-1, Klebsiella species and
Enterobacter species are less common overall, but may be more
prevalent in newborns, pregnant women, the elderly and
immunocompromised hosts.
What is Meningococcal disease?
Etiological Agent: Neisseria meningitidis
Clinical Features: sudden onset. F,H,N,V
Reservoir: Humans only. 5-15% healthy carriers
Mode of transmission: direct contact with patients oral or nasal secretions. Saliva.
Incubation period: 1-10 days. Usually 2-4 days
Infectious period: as long as meningococci are present in oral secretions or until
24 hrs of effective antibiotic therapy
Sporadic cases worldwide.
“Meningitis belt” –sub-Saharan Africa into India/Nepal.
In US most cases seen during late winter and early spring.
Children under five and adolescent most susceptible. Overcrowding e.g.
dormitories and military training camps predispose to spread of infection.
Aseptic Meningitis
Definition: A syndrome characterized by acute onset of meningeal symptoms,
fever, and cerebrospinal fluid pleocytosis, with bacteriologically sterile
Laboratory criteria for diagnosis:
CSF showing ≥ 5 WBC/cu mm
No evidence of bacterial or fungal meningitis.
Case classification
Confirmed: a clinically compatible illness diagnosed by a physician as aseptic
meningitis, with no laboratory evidence of bacterial or fungal meningitis
Aseptic meningitis is a syndrome of multiple etiologies, but most cases are
caused by a viral agent
Viral Meningitis
Etiological Agents:
Enteroviruses (Coxsackie's and echovirus): most common.
-Measles virus
-Herpes Simplex Virus
-Humans for Enteroviruses, Adenovirus, Measles, Herpes Simplex, and Varicella
-Natural reservoir for arbovirus birds, rodents etc.
Modes of transmission:
-Primarily person to person and arthopod vectors for Arboviruses
Incubation Period:
-Variable. For enteroviruses 3-6 days, for arboviruses 2-15 days
Treatment: No specific treatment available.
Most patients recover completely on their own.
Non Polio Enteroviruses
Types:62 different types known:
-23 Coxsackie A viruses,
-6 Coxsackie B viruses,
-28 echoviruses, and 5 other
How common?
-90% of all viral meningitis is caused by Enteroviruses
-Second only to "common cold" viruses, the rhinoviruses.
-Estimated 10-15 million/ more symptomatic infections/yr in US
Who is at risk? Everyone.
How does infection spread?
Virus present in the respiratory secretions & stool of a patient.
Direct contact with secretions from an infected person.
Parents, teachers, and child care center workers may also become infected by
contamination of the hands with stool.
The difference between Meningitis
and Septicaemia
When bacteria cause disease i.e. meningococcal
disease the body can be affected in different ways:
 Meningitis - bacteria enter the blood stream and
travel to the meninges and cause inflammation.
 Septicaemia - when bacteria are present in the
blood stream they can multiply rapidly and release
toxins that poison the blood. (The rash associated
with meningitis is due to septicaemia.)
Meningitis and septicaemia often occur together.
Symptoms of Meningitis and
Meningitis and meningococcal septicaemia may not
always be easy to detect, in early stages the
symptoms can be similar to flu. They may develop
over one or two days, but sometimes develop in a
matter of hours.
It is important to remember that symptoms do not
appear in any particular order and some may not
appear at all.
Symptoms for meningitis and
meningococcal septicaemia:
Babies and Young Children:
-High temperature, fever, possibly with cold hands and feet
-Vomiting or refusing feeds
-High pitched moaning, whimpering cry
-Blank, staring expression
-Pale, blotchy complexion
-Stiff neck
-Arched back
-Baby may be floppy, may dislike being handled, be fretful
-Difficult to wake or lethargic
-The fontanelle (soft spot on babies heads) may be tense or bulging.
Older Children and Adults
-High temperature, fever, possibly with cold hands and feet.
-Vomiting, sometimes diarrhoea.
-Severe headache.
-Joint or muscle pains, sometimes stomach cramps.
-Neck stiffness (unable to touch the chin to the chest)
-Dislike of bright lights.
The patient may be confused or disorientated. Fitting may also
be seen.
A rash may develop.
One of the physically
demonstrable symptoms of
meningitis is Kernig's sign.
Severe stiffness of the
hamstrings causes an
inability to straighten the
leg when the hip is flexed
to 90 degrees.
Another physically
demonstrable symptoms of
meningitis is Brudzinski's
sign. Severe neck stiffness
causes a patient's hips and
knees to flex when the neck
is flexed.
In the early stages, signs and
symptoms can be similar to many
other more common illnesses, foe
example flu. Early symptoms can
include fever, headache, nausea
(feeling sick), vomiting and general
The common signs and symptoms of
meningitis and septicaemia are
shown above. Others can include
rapid breathing, diarrhoea and
stomach cramps. In babies, check if
the soft spot (fontanelle) on the top
of the head is tense or bulging.
One sign of meningococcal septicaemia is a rash
that does not fade under pressure (see ‘Glass
-This rash is caused by blood leaking under the
skin. It starts anywhere on the body. It can
spread quickly to look like fresh bruises.
-This rash is more difficult to see on darker skin.
Look on the paler areas of the skin and under
the eyelids.
‘Glass Test’
A rash that does not fade
under pressure will still be
visible when the side of a
clear drinking glass is
pressed firmly against the
If someone is ill or obviously
getting worse, do not wait
for a rash. It may appear
late or not at all.
A fever with a rash that does
not fade under pressure is
a medical emergency.
What to do if you suspect meningitis or
Contact your GP immediately. If you GP is not
available, go straight to your nearest accident and
emergency department.
 Describe the symptoms carefully and say that you
think it could be meningitis or septicaemia
Early diagnosis can be difficult. If you have seen a
doctor and are still worried, don’t be afraid to ask
for medical help again
Be aware, be prepared
Meningitis and meningococcal septicaemia (blood
poisoning) are serious diseases that can affect anyone
at any time. Teenagers and studentsin particular, are at
increased risk.Most young people in the UK have
already had the MenC vaccine. If you haven’t or can’t
remember, gettingvaccinated now is a good way to
protect yourself.
But remember, vaccines can’t preventall forms of
meningitis and septicaemia.So it is very important that
you are aware of the signs and symptoms so that you
can get medical help urgently if you become ill.
Public Health Importance
-Educating public
-Timely reporting and records keeping
-Updating information daily.
-Alleviating public anxiety and concerns
-Collaborating with health partners
-Educating public
-Strengthening partnerships
The End