Pyogenic Meningitis Symptoms

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Describe briefl clinical features and management of pyogenic meningitis.

Answer. Inflmmation of the meninges is called as meningitis.

Pyogenic meningitis occurs due to Streptococcus pneumoniae, staphylococcus aureus, hemophilus inflenzae.

Pathology: Infection once it reaches the protective wall of meninges, rapidly spread over the surface of brain,spinal cord and ependymal lining of ventricles.

• Brain and spinal cord are swollen and congested.
• Cortical veins become conjusted and convolutions on the surface of brain become flttned because of internal hydrocephalus which is due to inflmmatory adhesions obstructing outflw of CSF from fourth ventricle, whole of CSF become turbid and purulent.

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Pyogenic Meningitis Clinical Features

Pyogenic Meningitis Symptoms

• Fever coming with rigors.
• Headache which is very severe (bursting in character) mainly in frontal region radiating down to back.
• Vomiting
• Convulsion in children
• Malaise
• Severe photophobia
• Ptosis: Due to raised intracranial tension
• Stiffess in neck and back
• Pain in neck
• Impairment of consciousness i.e. confusion, delirium and coma.

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Pyogenic Meningitis Signs

• Head retraction is present in infants and children.
• Neck rigidity, i.e. bending of neck causes pain and spasm of neck muscles or it is diffilt to bend the neck.
• Kernig’s sign is positive
• Brudzinski’s sign is also positive if patient is conscious.
• Presence of papilledema
• Presence of cranial nerve palsies

Pyogenic Meningitis Investigation

Blood count: Leukocytosis with rise in polymorph count.

CSF examination

• CSF pressure is raised.
• It is turbid and purulent pus like.
• Formation of coagulum
• Protein content is markedly increased.
• Glucose content is decreased.
• CSF protein is raised
• Gram staining of CSF is positive

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CSF examination Complications

• Cranial nerve paralysis
• Deafness
• Mental retardation
• Epilepsy.

CSF examination Treatment

Emperical treatment should be given before CSF culture and Gram stain report.

Treatment should be directed to the most common microorganism present in particular age group.

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CSF examination Antibiotic Treatment

• Ceftriaxone or cefotaxime is given against S. pneumonia,H. inflenz, Group B streptococci and N. meningitides.
  In this vancomycin can be added to cover cephalosporin resistant S. pneumonia. Ampicillin can be added to cover L.monocytogens in neonates of less than 3 months and more than 55 years of age.
• Ceftazidime is active against P. aeuroginosa and is preferred over ceftriaxone or cefotaxime in hospital acquired meningitis.
• Choice of empirical antibiotics in pyogenic meningitis is:

• In neonates or infants ofless than 3 months: Ampicillin 100 to 50 mg/dL + Ceftriaxone 500 to 1000 mg/kg/day or cefotaxime 50 mg/kg
• In children and adults: Ceftriaxone 500 to 1000 mg/kg/ day or cefotaxime 50 mg/kg + vancomycin 60 mg/kg
• Adults more than 55 years: Ampicillin 3 gm tds or QDS + Ceftriaxone 2 gm BD or cefotaxime 50mg/kg + vancomycin 1gm 8 hourly
• In hospital acquired meningitis, post­traumatic or post­surgical, immunocompromised patients—Ampicillin 3 gm tds or qds + Ceftazidime 2gm 8 hourly+ vancomycin 1 gm 8 hourly.

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Duration of Antibiotic Therapy

• One week for H. inflenzae and N. meningitides infection
• S. pneumonia for two weeks
• L. monocytogenes and Gram­negative bacilli infections for 3 weeks.

Adjunctive Therapy

Dexamethasone 0.4mg/kg BD for 4 days with fist dose of antibiotic.

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Supportive Therapy

• Patients having raised intra­cranial pressure should be treated in ICU.
• IV mannitol, hyperventilation and elevation of patient’s head to 30° is done to decrease raised intra-cranial pressure.