Meningitis

Inflammation of the Pia mater and arachnoid, and infection of the cerebrospinal fluid (CSF) that fills the subarachnoid space

Meningitis is typically due to ____ or _____ infection in the CSF

(May also be due to tuberculosis, chemicals, or idiopathic)

Tend to occur in large group settings

-Military

-Daycare centers

-College dorms (Especially with community dining)

Bacterial

Viral

Fungal

Parasitic

Non-infectious

Caused by bacteria

-Neisseria meningitidis

-Streptococcus pneumoniae

-Staphylococcus aureus

-Tuberculosis

Caused by viruses:

-Arboviruses (transmitted by primary arthropod vector)

-Enteroviruses (contamination through fecal matter or respiratory secretions from infected)

-Herpes simplex

-Mumps, measles

-COVID-19 maybe

Caused by fungi:

-Cryptococcus

-Histoplasma

Angiostrongylus cantonensis (found in contaminated food, water and soil):

-cryptococcus neoformans

-Candida albicans

-Aspergillus species and others

Caused by cancers:

AKA Neoplastic Mengingitis

-Systemic lupus erythematosus (SLE) and certain drugs

-Head injury and brain surgery

Most common cause of viral meningitis

Yes

Yes

• AIDS

• Immunosuppressant drugs

  • Often prescribed after an organ transplant

2012 outbreak related to contaminated steroid drug injections sickened ~750 and killed 64 across 20 states forming what is referred to as the _____ ________ on a map.

Deposit of tuberculous granulations (tuberculomas) accompanied with meningeal inflammation

______ is hard to differentiate from bacterial meningitis

Untreated TMB fatality is ______ % and ______ % are fatal despite antituberculosis chemotherapy.

TBM complication that results from the blockage of CSF abroprion and can also effect efferent CNs

Indicators of tuberculosis meningitis:

Neonatal bacterial meningitis incidence:

Live births = ____ to _____

Premature births = __________

Bacterial meningitis in adults occurs in ~ ____ to ___ in the US each year (Fluctuates!)

Meningitis is more common in ____ to ____ months.

-All preteens and teens at 11 to 12 years old with a booster dose at 16 years old

-Children and adults at increased risk for meningococcal disease

According to the CDC who should receive the serogroup B meningococcal vaccination?

Meningitis Vaccine Project created by partnership between ___ and ___.

Mission = eliminating meningitis as a public health problem in sub-Saharan Africa through the development, testing, introduction, and widespread use of conjugate meningococcal vaccines (1 to 29-year-olds received a single dose of MenAfriVac)

Infants, children, and elderly

Day care centers

Cancer patients:

-Immunosuppressive chemotherapy

-Indwelling ventricular devices

-Indwelling vascular catheters

-Neurosurgical procedures

Overcrowded conditions

Upper respiratory infection

Certain surgical procedures (cochlear implants)

Untreated conditions

Exposure to rodents and mice

Direct contact with someone with meningitis

-Asymptomatic or less severe (viral only)

-High fever

-Chills

-Nausea and vomiting

-Photophobia (Sensitivity to light)

-High fever

-Chills

-Nausea and vomiting

-Photophobia

-Severe headaches

-Stiff neck (meningismus)

-Rapid breathing

-Increased drowsiness

-Agitation

-Bulging fontanelles

-Decreased consciousness

-Poor feeding or irritability in children

-Opisthotonos (Unusual posture, with the head and neck arched backwards)

-Seizures

-Stroke

-Fatigue

-Lightheadedness

-Encephalitis (rare)

-Brain damage

-Coma

-Death ( ~10% fatal and > elderly)

-Hearing loss (20%)

-Paralysis

-Seizures

-Kidney damage

-Learning disabilities

Flat rash all over the body

-Typical purpura ( blood vessels get inflamed, they can bleed into the skin, causing a reddish-purple rash)

-Petechiae rash -- round spots that appear on the skin as a result of bleeding

-Small (1–3 mm)

-Red

-Non-blanching lesions caused by bleeding into the skin.

-Larger (>3-1-mm)

-Typically raised lesions resulting from bleeding within the skin

-Do not blanch when applying pressure (Glass test)

If rash does not change colors then medical referral should be given.

Checking for neck stiffness may include tilting the head is tilted forward and the knees will bend in result (AKA positive) indicative of:

-Severe meningeal inflammation

-Evidence of microbiological CSF infection

Culture of CSF to determine:

-Type of bacteria

-Cell count

-Glucose

-Protein

•X-rays

•Ultrasounds

•CT scans

•MRIg

________ blood poising caused by the same germs as meningitis.

[Could occur with meningitis or on its own]

How long does it typically take to completely recover from viral meningitis

Antibiotics are not helpful

Recommended:

-Plenty of fluids

-Rest

-Medicine to relieve headache

Bacterial Tx:

___________:

•Hospitalization (life-threatening)

•Antibiotics (corticosteroid, intravenous)

(Some are ototoxic -- ask if they have been in the hospital)

AND

___________:

Some forms are contagious!

-Stay away from direct contact with saliva

-Get vaccinated

==TBM tx:==

___________ ___________

•Choice of 4 drugs for two months

-Then a choice of 2 drugs for months nine to twelve after the infection

•Dexamethasone is given regardless of age or disease severity

-(only to HIV-negative patients)

Viral meningitis is not typically associated with HL but a mild HL may be present if it occurs with ____ _____

Sings of bacterial meningitis on case history:

___________ onset of symptoms (HL or dizziness)

Most likely ___________ auditory symptoms

High ___________

Photophobia

Bacterial Meningitis Audiogram:

______ to _______ SNHL

Progressive or fluctuating

Bacterial meningitis HL incidence:

• ____ - ____% of meningitis survivors

• ____ - ____% of bacterial meningitis and __% develop permanent bilateral HL

Bacterial Meningitis Hearing Loss Pathophysiology:

1. _________ of the cochlea tend to occur most at the basal turn of the S. Tympani.

2. ______ are thought to be damaged by the inflammatory by-products (oxidants), ischemia (poor blood supply), and disruption of the blood-labyrinth barrier (BLB)

3. The route of infection from the meninges to the membranous labyrinth of the inner ear is under debate:

   1. ______ _____(most obvious)

   2. Along the cochlear nerve,

   3. Through blood

   4. etc.

Bacterial Meningitis test results:

• Middle ear muscle reflex would be ____ or _____

• Decay testing is not possible if MEMR is elevated or absent

• ABR = poor morphology or absent response

• ________ interpeak latencies

• May have delayed ________

• ENG = nystagmus present

Bacterial Meningitis OAES:

•Transient Evoked:

•Absent if > _________ HL

•Distortion Product:

•Absent if > ________ HL

==Bacterial Meningitis Habilitation/Rehabilitation:==

• ________

• ________

• Timely intervention is necessary to minimize the risk of cochlear ossification

• Bilateral simultaneous implantation is the treatment of choice for this special population

• Communication considerations:

•Auditory/Oral

•Manual

•Total communication

• Emergency room

  • Untreated bacterial meningitis can cause death

• Otolaryngologist/otologist

• Audiologist

  • Amplification

  • Monitoring