W.H.O - NEW AIMS & STRATEGIES to save millions of lives from meningitis. # URGENT ACTION of W.H.O on meningitis # MENINGITIS INTRODUCTION , CAUSES ,RISK FACTORS ,PREVENTIONS , TREATMENT ,STRATEGIES BY W.H.O for the patients of meningitis.
MENINGITIS
It is an acute inflammation of the delicate membranes of the brain & spinal cord.
It can be life-threatening & spreads between people in close contact with each other.
It can also be explained as acute infection or inflammation of the pia mater and arachnoid mater surrounding the brain.
MENINGES
It is a system of membranes that envelopes the CENTRAL NERVOUS SYSTEM.
It has 3 layers
1.Dura mater
2.Arachnoid mater
3.Pia mater
SUBARACHNOID SPACE
It is a space between the arachnoid and pia mater, which is filled with cerebrospinal fluid.
CURRENT SCENARIO OF MENINGITIS (AS PER VIEW OF W.H.O )
World Health Organization (WHO) and partners launched the first-ever global strategy to defeat meningitis - a debilitating disease that kills hundreds of thousands of people each year.
By 2030, the goals are to eliminate epidemics of bacterial meningitis – the most deadly form of the disease – and to reduce deaths by 70% and halve the number of cases.
Wherever it occurs, meningitis can be deadly and debilitating; it strikes quickly, has serious health, economic and social consequences, and causes devastating outbreaks,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
“It is time to tackle meningitis globally once and for all –by urgently expanding access to existing tools like vaccines, spearheading new research and innovation to prevent, detecting and treating the various causes of the disease, and improving rehabilitation for those affected.”
CAUSES / ETIOLOGY OF MENINGITIS
1.Bacterial infection
2.Viral infection
3.Chronic infection
4.Fungal infection
Other causes are :
1.Chemical reactions
2.Drug allergies
3.Parasitic
4.Head injuries
5.Cancer
6.Middle ear infections
7.Cerebral abscess
main causes of acute bacterial meningitis:
1.Neisseria meningitides (meningococcus)
2.Streptococcus pneumonia (pneumococcus)
3.Haemophilus influenzae
PATHOPHYSIOLOGY
Bacteria enter the bloodstream/trauma.
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Enters the mucosal cavity
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Breakdown of normal barriers
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Crosses the blood-brain barrier
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Proliferates in the CSF
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Inflammation of the meninges
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Increases in ICP
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CSF flows in subarachnoid space
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CSF cloudiness or infected
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CSF cell count increases
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Meningitis.
SIGNS & SYMPTOMS
1.severe headache
2.Nausea and vomiting
3.stiff or painful neck
4.high fever
5.avoiding bright light
6.drowsy, confused, comatose
7.convulsions
8.rash
9.joint pain
10.cold hands and feet
11.Nuchal rigidity
12.Positive kernig's sign
13.A decreased level of consciousness
14.Disorientation
15.Phonophobia
16.Coma
17.Tachycardia
18.Altered mental status
19.Malaise
20.Irritability
21.Sleeplessness
Who is at risk?
Young children are most at risk.
Newborn babies are at most risk from Group B streptococcus, young children are at higher risk from meningococcus, pneumococcus and Haemophilus influenza.
Adolescents and young adults are at particular risk of meningococcal disease while the elderly are at particular risk of pneumococcal disease.
Young children- less than 5 years of age
Use of immunosuppressive agents.
Chronic malnutrition
Aids
Chronic alcoholism
CSF shunt
Diabetes
Pneumonia
DIAGNOSTIC EVALUATION
Blood culture
CT scan
Spinal tap
CSF analysis
MRI
History collection
Physical examination
According to W.H.O,
1.Initial diagnosis of meningitis can be made by clinical examination followed by a lumbar puncture.
2.The bacteria can sometimes be seen in microscopic examinations of the spinal fluid.
3.The diagnosis is supported or confirmed by growing the bacteria from specimens of cerebrospinal fluid or blood, by rapid diagnostic tests or by polymerase chain reaction (PCR).
4.The identification of the serogroups and susceptibility to antibiotics are important to define control measures.
5.Molecular typing and whole-genome sequencing identify more differences between strains and inform public health responses.
MANAGEMENT
Meningitis is fatal in up to half of patients, when left untreated, and should always be viewed as a medical emergency.
Admission to a hospital or health centre is necessary. Isolation of the patient is not usually advised after 24 hours of treatment.
Appropriate antibiotic treatment must be started as soon as possible in bacterial meningitis.
Ideally, lumbar puncture should be done first as antibiotics can make it more difficult to grow bacteria from the spinal fluid.
However, blood sampling can also help to identify the cause and the priority is to start treatment without delay.
A range of antibiotics is used to treat meningitis, including penicillin, ampicillin, and ceftriaxone.
During epidemics of meningococcal and pneumococcal meningitis, ceftriaxone is the drug of choice.
To manage inflammation: DEXAMETHASONE
Corticosteroids
Temozolomide
Antiviral agents (tenofovir )
Antifungal agents ( fluconazole )
COMPLICATIONS
Deafness
Spasticity
Paresis
Seizures
Brain damage
Tissue damage
Cerebral edema
Characteristics of normal spinal fluid are below:
Total volume: 150 mL
Color: Colorless, clear, like water
Opening pressure - 90-180 mm H 2O (with patient lying in lateral position)
Osmolarity at 37°C: 281 mOsm/L
Specific gravity: 1.006 to 1.008
Acid-base balance:
pH: 7.28-7.32
Pco2: 47.9 mm Hg
HCO3-: 22.9 mEq/L
Sodium: 135-150 mmol/L
Potassium: 2.7-3.9 mmol/L
Chloride: 116-127 mmol/L
Calcium: 2.0-2.5 mEq/L (4.0 to 5.0 mg/dL)
Magnesium: 2.0-2.5 mEq/L (2.4 to 3.1 mg/dL)
Lactic acid: 1.1-2.8 mmol/L
Lactate dehydrogenase: Absolute activity depends on testing method; approximately 10% of serum value
Glucose: 45-80 mg/dL
Glutamine - 8-18 mg/dL
Lactate dehydrogenase (LDH) - <2.0-7.2 U/mL
Proteins: 20-40 mg/dL
At different levels of spinal tap:
Lumbar: 20-40 mg/dL
Cisternal: 15-25 mg/dL
Ventricular: 15-45 mg/dL
Normal CSF proteins concentration in children:
Up to 6 days of age: 70 mg/dL
Up to 4 years of age: 24 mg/dL
Electrophoretic separation of spinal fluid proteins (% of total protein concentrations)
Prealbumin: 2-7%
Albumin: 56-76%
a1-Globulin: 2-7%
a 2-Globulin: 3.5-12%
b-and g-globulin: 8-18%
g-Globulin: 7-12%
Oligoclonal bands - absent
Immunoglobulins
IgG: 10-40 mg/L
IgA: 0-0.2 mg/L
IgM: 0-0.6 mg/L
k/l ratio: 1
Erythrocyte count:
Newborn: 0-675/mm3
Adult: 0-10/mm3
Leukocyte count:
Children:
Younger than 1 year: 0-30/mm3
Age 1-4 years: 0-20/mm3
Age 5 years to puberty: 0-10/mm3
Adult: 0-5/mm 3
Antibodies, viral DNA – None
Bacteria (Gram stain, culture, VDRL) – Negative
Cancerous cells – None
Cryptococcal antigen – None
The new Roadmap details the following priorities for meningitis response and prevention:
(As per the recent report of W.H.O )
1.Achievement of high immunization coverage, development of new affordable vaccines, and improved prevention strategies and outbreak response;
2.Speedy diagnosis and optimal treatment for patients;
3.Good data to guide prevention and control efforts;
4.Care and support for those affected, focusing on early recognition and improved access to care and support for after-effects.
5.Advocacy and engagement, to ensure high awareness of meningitis, accountability for national plans, and affirmation of the right to prevention, care and after-care services.
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