Pathophysiology and Treatment of Bacterial Meningitis is a disease of the nervous system.

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The meninges and subarachnoid space are the most vulnerable parts of the body.The findings include headaches, fever, and nuchal rigidity.The diagnosis is based on theCSF analysis.Antibiotics and steroids are given as soon as possible.

The subarachnoid space and meninges are usually reached bybacteria via hematogenous spread.The meninges may be reached from nearby infections or from a congenital or acquired defect in the skull or spine.

White blood cells (WBCs), immunoglobulins, and complement are normally sparse or absent from the cerebrospinal fluid.Escherichia coli release endotoxins, teichoic acid, and other substances that cause an inflammatory response.Due to the fact that less glucose is transported into the CSF, the levels of glucose decrease.Brain parenchyma can be affected by a variety of infections.

Infarcts are caused by inflammation and thrombosis of arteries and veins in superficial and deep areas of the brain.

Systemic complications can be fatal, such as septic shock, disseminated DIC, or hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion.

N. meningitidis can cause death within hours.Sepsis caused by N. meningitidis can result in coagulopathy and bilateral adrenal infarction.

In the US and Western Europe, the most common cause of Meningitis in children is Haemophilus influenzae type B, which is a rare cause.In areas where the vaccine is not widely used, H. influenzae is still a common cause.

Middle-aged and older adults are less likely to be affected by N. meningitidis.Patients may develop Meningitis due to L. monocytogenes or gram-negativebacteria as their host defenses decline.

The H. influenzae type B vaccine is not widely used in developed countries.

Severe Meningitis can sometimes be caused by S. aureus in patients of all ages.After a penetrating head wound, it is the most common cause of Meningitis.

Infections in or around the head can be associated with a CSF leak.

Infections in or around the head can be caused by a leak of cerebrospinal fluid.

Defects in cell-mediated immunity can be caused by L. monocytogenes or mycobacteria.

S. pneumoniae and N. meningitidis can cause fulminant meningitis if they are defects in humoral immunity.

In very young infants and older adults, T-cell immunity may be weak due to L. monocytogenes.

3 to 5 days of nonspecific symptoms are the norm in most cases.One of the few disorders in which a previously healthy young person may go to sleep with mild symptoms and never awaken is bacterial meningitis, which is more rapid in onset and can be fulminant.

Neonates and infants may not have fever, headaches, and nuchal rigidity.It is suggested that cuddling and consoling by a parent irritates rather than comforts the baby.

Seizures can occur early in up to 40% of children with acute Bacterial Meningitis.Up to 12% of patients are in a coma.

papilledema may be absent early or be mitigated because of age-related factors, but it's usually caused by Severe Meningitis, which increases intracranial pressure.

In immunocompromised or older patients and alcoholics, nuchal rigidity may be absent or mild.The only sign of dementia in older patients is confusion in those who were previously alert.In neonates, the threshold for doing a puncture should be low.If focal neurologic deficits are present or increased, brain scans should be done.

Symptoms can take days to develop after a surgical procedure.

Blood cultures and lumbar punctures can be done as soon as acutebacterialmening is suspected.Blood should be analysed when the puncture is done.Treatment should begin as soon as possible.

Antibiotics and corticosteroids are given immediately if the patient is very sick, even before the puncture.

Antibiotics and corticosteroids should be started after blood cultures, but before neuroimaging is done, if there is a suspected case of Bacterial Meningitis.

Clinicians should look for patients with typical symptoms and signs, such as a high temperature, changes in mental status, and nuchal rigidity.Neonates and infants have different symptoms and signs than older patients, alcoholics, and immunocompromised patients.In the following patients, diagnosis can be difficult.

There are people who have had a procedure that can cause changes in their mental status.

Older patients and alcoholics may have changes in mental status due to falls and subdural hematomas.

If there is a small chance of meningitis, tests should be done.In infants, older patients, alcoholics, immunocompromised patients and patients who had a surgical procedure, testing is helpful.

If clinical findings are not specific for the disease, you should do a puncture.

The mainstay of diagnosis is to get CSF for analysis immediately after the puncture.

There are signs that indicate increased ICP or an intracranial mass effect when there is a puncture to the back.

If there is a brain injury caused by a lumbar puncture, it is deferred until neuroimaging is done to check for increased ICP or a mass effect.After blood sampling for culture and before neuroimaging, treatment should begin when the puncture is deferred.If no mass effect or obstructive hydrocephalus is detected, a lumbar puncture can be done.

There are a number of tests that should be sent for analysis of the CSF.Cryptococcus neoformans can be screened with a new multiplex film-array panel.This test is used to supplement, not replace, culture and traditional tests.A blood sample should be drawn and sent to be analyzed.White blood cells can adhere to the walls of the collecting tube and result in a low cell count.

The table shows the CSF findings in Meningitis.

There is a bloodglucose level of 50%.A CSF:blood glucose ratio of 0.23 is very suggestive of a disease.Changes in bloodglucose may lag behind changes in the CSF.A blood-brain barrier injury is caused by an elevatedprotein level.

It's not always typical for patients with acute Bacterial Meningitis to have a high CSF cell count.It is possible that atypical CSF findings include.

In neonates with gram-negative meningitis, patients with L. monocytogenes, and some patients who have been treated with antibiotics, there is a high incidence of predominance of lymphocytes.

If the initial findings are equivocal, a repeat puncture 12 to 24 hours later can clarify which direction the changes are heading or if there is a laboratory error.

Multiplex or conventional panels are used to check for enteroviruses.

Patients who have recently spent time in an endemic area should be tested for Coccidioides immitis.

CSF acid-fast staining can be sensitive, and culture can take up to 8 weeks.There are positive tests for tuberculous meningitis, but the tests are only for prior infections.It is difficult to confirm a diagnosis of tuberculous Meningitis if it is strongly suspected.

Xpert MTB/RIF is an automated test that can be used to detect M. Tuberculosis.

Gram staining is one of the methods used to identify the bacteria in the CSF.The information is limited because of Gram staining.To be reliably detected with Gram stain, 105bacteria must be present.If any of the following occur, results may be false.

Before samples are plated for cultures, clinicians should tell the laboratory if they suspect an anaerobic infection.Gram staining and culture can be reduced by prior antibiotic therapy.If available, latex agglutination tests may be useful in patients who have already received antibiotics.

There are other tests that can be done to check for other causes of meningitis, such as viruses and cancer cells, if the cause is confirmed.

The urinary or respiratory tract samples should be cultured as well.

The mortality rate for children under the age of 19 years may be as low as 3% but can be higher if they are treated with antibiotics.The mortality rate is up to 37% for people over the age of 60, even with antibiotic treatment.The mortality rate for community-acquired Meningitis is 43%.

The mortality rate is related to the depth of obtundation or coma.There are factors associated with a poor outcome.

There is a low Glasgow coma score at admission.

Acute Bacterial Meningitis can be treated with antibiotics.Treatments include antibiotics and measures to decrease brain and cranial nerve inflammation.

Antibiotics need to penetrate the blood-brain barrier to be effective.

As soon as blood cultures are drawn and the results of a lumbar puncture are in, antibiotics and corticosteroids can be started.If the puncture is delayed, antibiotic and corticosteroid treatment begins.

As soon as blood for cultures is drawn, treat patients with antibiotics and corticosteroids.

Appropriate antibiotics depend on the patient's age and immune status.Antibiotics that are effective against S. pneumoniae should be used by clinicians.It is possible in pregnant women, neonates, older patients, and immunocompromised patients.acyclovir is added to the Herpes Simplex encephalitis formula.Culture and sensitivity testing can be used to modify antibiotic therapy.

When the route is a penetrating head wound or a surgical procedure, S. aureus is an uncommon cause of Meningitis.All patient groups can be affected by it.If clinicians think that vancomycin or other antibiotics are a possibility, they should give them.

Children with no record of H. influenzae type b conjugate vaccine should be considered.

The most common cause of acute otitis is S. pneumoniae.It is possible to treat such patients with vancomycin and ceftriaxone.In such cases, initial treatment should include vancomycin plus ceftazidime, as otherbacteria, such as P. aeruginosa or Bacteroides, may also be present.The empyemas should be drained quickly.

After sensitivities are known, penicillin G may be used.Ceftriaxone and cefotaxime may not cover strains that are resistant to penicillin.Up to 50% of community-acquired infections can be attributed to these strains.

After sensitivities are known, nafcillin or oxacillin may be used.

There are areas where gentamicin resistance is common.Because they don't have good penetration of the fluid in the brain, they are rarely used for the treatment of Meningitis.They may have to be given in a way that's convenient for them.The use of aminoglycosides should be monitored.

The Recommended Dosages of Selected Parenteral Antibiotics for Neonates is a table.

When therapy is started, dexamethasone should be given to decrease cerebral and cranial nerve inflammation.Adults and children are given the same amount of IV.Immediately before or with the initial dose of antibiotics, dexamethasone is given every 6 hours for 4 days.

Patients with papilledema or signs of brain herniation are treated for increased ICP.

Adults and children are usually given mannitol 1 g/kg IV bolus over 30 minutes, repeated as needed every 3 to 4 hours, or 0.25g/g every 2 to 3 hours.

Treatment of specific problems, such as surgical drainage for subdural empyema.

The use of vaccines for H. influenzae type B and N. meningitidis has reduced the incidence of the disease.

Keeping patients in respiratory isolation for the first 24 hours of therapy can help prevent the spread of Meningitis.Gloves, masks, and gowns are used.

A vaccine that protects against 13 different types of pneumococcal disease is recommended for all children.

Older children, college students, and military recruits have not had the vaccine before.

College students and small towns must be identified and their size determined before mass vaccinations are given.The effort is expensive and requires public education, but it saves lives and reduces morbidity.

The meningococcal vaccine doesn't protect against Meningitis B, so it's important to keep this information in mind when you get a vaccine.

If you have face-to-face contact with a patient who has Meningitis, you should be given postexposure Chemprophylaxis.

Rifampin is taken every 12 hours for 4 doses.

A fluoroquinolone is 400 for 1 dose.

The maximum dose of rifampin for 4 days is 600.There is no consensus on whether children need prophylactics for exposure at day care.

Chemoprophylaxis isn't usually needed for patients with other types of meningitis.

Infections of children and adults include N. meningitidis and S. pneumoniae.

In infants, alcoholics, older patients, immunocompromised patients and patients who develop Meningitis after a neurosurgical procedure, typical features may be absent or subtle.

If patients have focal neurologic deficits, obtundation, seizures, or papilledema, they should not have a lumbar puncture.

3rd- generation cephalosporins, ampicillin, and vancomycin are commonly used antibiotics.

The vaccine for H. influenza, S. pneumoniae, and N. meningitidis is recommended.