Infection Meningitis

Infection Meningitis

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Infection of the meninges, with viral disease typically being self-limiting, but bacterial cases being potentially fatal.


  • Neonates: Streptococcus.B, E.coli
  • Adults: Strep. pneumoniae, N. meningitidis
  • Elderly: Listeria
  • Other: Viral infections and TB


Fever, chills, headache, photophobia, neck stiffness, vomiting, changes in mental state, and a non-blanching rash.


  • Kernig’s Sign Positive: Thigh flexed at hip and knee to 90 degree, and subsequent knee extension is painful.
  • Brudzinski Sign Positive: Hip and knee flexion on neck flexion.


  • Imaging: CT or MRI brain
  • Other: Lumbar puncture, gram stain, PCR, and blood cultures.


  • Medical: IV ceftriaxone immediately in suspected cases.
  • IV vancomycin and ampicillin in elderly and immunocompromised.
  • Four days dexamethasone in pneumococcal meningitis alongside antibiotics.
  • If viral cause potential IV acyclovir should be given.


  • Meningococcal and Pneumococcal vaccine.
  • Chemoprophylaxis (ciprofloxacin, rifampicin) in close contacts.


  • Acute: Seizures, cerebral abscess, stroke, DIC, gangrene, coma, death.
  • Long term: Deafness, cognitive impairment and focal deficits.


Prognosis is dependent on early diagnosis and commencement of antibiotic therapy.

Increased Risk of Mortality and Morbidity

There is an increased risk of mortality around 10% and morbidity of around 30%. These risks are associated with the following:

  • Viral
  • Bacterial
  • TB

CSF White Cell Count

  • Raised Lymphocytes
  • Raised Polymorphs
  • Raised Lymphocytes

CSF Glucose

  • Normal or Decreased
  • Low
  • Very Low

CSF Protein

  • Normal or Increased
  • Increased
  • Very High

Figure 6.2 Classical Meningococcal Rash

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