Meningitis is an inflammation of the meninges (pia, arachnoid, and dura mater) and CSF, usually caused by bacteria, viruses, fungi, or other pathogens.
Mnemonic: "M.E.N.I.N.G.I.T.I.S. = Meningeal Inflammation Needs
Immediate Neurological & General Intensive Treatment In Septic cases"
TYPES OF MENINGITIS
- Bacterial (Most Severe, Medical Emergency)
- Viral (Aseptic, Self-Limiting, Commonest Type)
- Tuberculous (TB Meningitis, Chronic & Dangerous)
- Fungal (Seen in Immunocompromised – HIV, Cancer Patients)
- Chemical (Due to Drug Reactions, Toxins, Bleeding in CSF)
- Parasitic & Carcinomatous (Rare Causes – Cancer, Amoeba Infections)
Mnemonic: "B.V.T.F.C.P. = Bacterial, Viral, TB, Fungal,
Chemical, Parasitic"
CAUSES & RISK FACTORS
- Neonates (<1 Month): E. coli, Group B Strep, Listeria
- Children (1 Month – 15 Years): H. influenzae, N. meningitidis, S. pneumoniae
- Adults (>15 Years): S. pneumoniae, N. meningitidis, Staphylococcus, Gram (-) Bacteria
- Elderly (>60 Years): Listeria, E. coli, Pseudomonas
Mnemonic: "N.C.A.E. = Neonates, Children, Adults,
Elderly"
PATHOLOGY OF MENINGITIS
- Nasopharyngeal Colonization → Bacteria attach to mucosa.
- Bloodstream Invasion → Enter blood, causing bacteremia.
- Crossing the Blood-Brain Barrier → Bacteria reach CSF.
- Meningeal Inflammation → Exudate Formation, Brain Swelling.
Mnemonic: "N.B.C.M. = Nasopharynx, Bloodstream, CSF Entry,
Meningeal Swelling"
SYMPTOMS OF MENINGITIS
- Classic Triad → Fever, Headache, Neck Stiffness
- Cerebral Dysfunction → Confusion, Delirium, Altered Consciousness
- Photophobia & Phonophobia → Sensitivity to Light & Sound
- Seizures, Cranial Nerve Palsies (IV, VI, VII)
- Skin Rash (Meningococcemia – Purple Rash on Extremities)
Mnemonic: "F.H.N.C.P.S. = Fever, Headache, Neck Stiffness,
Confusion, Photophobia, Seizures"
CLINICAL SIGNS OF MENINGITIS
1. Nuchal Rigidity (Stiff Neck)
- Inability to flex the neck forward without pain.
2. Kernig’s Sign
- Pain when extending the knee while the hip is flexed at 90°.
3. Brudzinski’s Sign
- Flexing the neck causes involuntary hip and knee flexion.
Mnemonic: "K.B.N. = Kernig, Brudzinski, Nuchal Rigidity"
DIAGNOSIS OF MENINGITIS
1. Lumbar Puncture (LP) & CSF
Analysis
- Tube 1 → Protein & Glucose
- Tube 2 → Gram Stain & Culture
- Tube 3 → Cell Count & Differential
- Tube 4 → PCR, Viral Studies
CSF Findings in Meningitis:
|
Type |
WBC Count |
Protein |
Glucose |
Gram Stain |
|
Bacterial |
↑ PMNs (>1000) |
↑ (>100 mg/dL) |
↓ (<40 mg/dL) |
Positive |
|
Viral |
↑ Lymphocytes (<500) |
Normal |
Normal |
Negative |
|
TB |
↑ Lymphocytes (<500) |
↑ |
↓ |
May be Positive |
|
Fungal |
↑ Lymphocytes |
↑ |
↓ |
Positive in Cryptococcus |
Mnemonic: "B.V.T.F. = Bacterial (↑PMNs), Viral (↑Lymphocytes),
TB (↑Lymphocytes, ↓Glucose), Fungal (↑Lymphocytes, Fungal Positive)"
2. Additional Tests
- Blood Cultures → To Detect Bacteria in Blood.
- CT/MRI Brain → If ↑ ICP (Papilledema, Focal Signs).
- Rapid Tests → PCR, Latex Agglutination.
Mnemonic: "B.C.R. = Blood, CT/MRI, Rapid Tests"
TREATMENT OF MENINGITIS
1. EMPIRIC ANTIBIOTIC THERAPY
(Start Immediately!)
|
Age Group |
First-Line Antibiotics |
|
Neonates |
Ampicillin + Gentamicin/Cefotaxime |
|
Children |
Ceftriaxone/Cefotaxime + Vancomycin |
|
Adults |
Ceftriaxone + Vancomycin |
|
Elderly |
Ceftriaxone + Vancomycin + Ampicillin (Covers Listeria) |
Mnemonic: "N.C.A.E. = Neonates (Amp + Gent), Children (Cef +
Vanc), Adults (Cef + Vanc), Elderly (Cef + Vanc + Amp)"
2. SUPPORTIVE MANAGEMENT
- IV Fluids (For Hydration & Shock).
- Oxygen Therapy (For Hypoxia).
- Dexamethasone (Reduces Brain Swelling in Bacterial Meningitis).
- Seizure Control (If Present – Use Anticonvulsants).
Mnemonic: "F.O.D.S. = Fluids, Oxygen, Dexamethasone,
Seizures"
3. PREVENTION – VACCINES
- H. influenzae Type B (Hib Vaccine).
- Pneumococcal Vaccine (PCV13, PPSV23).
- Meningococcal Vaccine (MenACWY, MenB).
Mnemonic: "H.P.M. = Hib, Pneumococcal, Meningococcal"
HOMOEOPATHIC MANAGEMENT OF MENINGITIS
- For Sudden Onset High Fever, Stiff Neck, & Headache:
- Belladonna, Aconite, Glonoinum.
- For Slow Onset, Weakness, & Delirium:
- Helleborus, Bryonia, Opium.
- For Post-Meningitis Weakness & Neuralgia:
- Gelsemium, Zincum Met, Stramonium.
Mnemonic: "B.A.G. = Belladonna, Aconite, Glonoinum for Acute
Meningitis"
FINAL REVISION WITH MNEMONICS
- Definition = "M.E.N.I.N.G.I.T.I.S. = Meningeal Inflammation Needs Immediate Neurological & General Intensive Treatment In Septic cases"
- Types = "B.V.T.F.C.P." (Bacterial, Viral, TB, Fungal, Chemical, Parasitic)
- Causes = "N.C.A.E." (Neonates, Children, Adults, Elderly)
- Pathology = "N.B.C.M." (Nasopharynx, Bloodstream, CSF Entry, Meningeal Swelling)
- Symptoms = "F.H.N.C.P.S." (Fever, Headache, Neck Stiffness, Confusion, Photophobia, Seizures)
- Clinical Signs = "K.B.N." (Kernig, Brudzinski, Nuchal Rigidity)
- CSF Findings = "B.V.T.F." (Bacterial, Viral, TB, Fungal Differences)
- Treatment = "N.C.A.E." (Neonates, Children, Adults, Elderly - Empiric Therapy)
- Prevention = "H.P.M." (Hib, Pneumococcal, Meningococcal Vaccines)
- Homeopathy = "B.A.G." (Belladonna, Aconite, Glonoinum for Acute Cases)
