SRIMATHI SUNDARAVALLI MEMORIAL SCHOOL

Biology Investigatory Project

Meningitis- A Study

Submitted By:
Rohetha Saravanan
12126
XII-A
 Table of Contents

1. Introduction 2

2. Types of Meningitis 3

3. Signs and Symptoms 7

4. Complications 9

5. Diagnosis 10

6. Treatment 11

7. Prevention 12

8. Case Study 13

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Introduction

Meningitis is the infection and inflammation of the membranes

protecting the brain and spinal cord, known as the meninges
(singular: meninx). The most common symptoms are fever,
severe headache, and an inability to move or stiffness of the
neck and upper back. Other observed symptoms
include photosensitivity, intolerance towards sound, altered
state of consciousness, and confusion.

There are five broad categories of meningitis- bacterial, viral,

parasitic, fungal and non-infectious. Meningitis can be life-
threatening because of the inflammation's proximity to the
brain and spinal cord; therefore, the condition is treated as an
emergency.

Some forms of meningitis are preventable by

vaccination. Antibiotics are used in the treatment of bacterial
meningitis. The first line of treatment in acute meningitis
consists of a combination of antibiotic, antiviral, and
sometimes antiparasitic drugs when the exact cause of
infection has not been determined. Corticosteroids can also be
used to prevent complications from excessive inflammation.
Meningitis can lead to serious long-term consequences such
as deafness, epilepsy, hydrocephalus, or cognitive deficits,
especially without timely diagnosis and treatment.

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In the last 20 years, close to one million cases of meningitis
have been recorded. The disease is fairly rare in India, with
fewer than 20,000 cases being reported every year.

India has no national policy on vaccination against

preventable streams of meningitis.

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Types of Meningitis

Bacterial Meningitis

The most common types of bacteria that cause bacterial

meningitis are:

 Streptococcus pneumonia (vaccine available)

 Neisseria meningitides (vaccine available)

 Haemophilus influenza (vaccine available)

 Listeria monocytogenes

 Staphylococcus aureus

Bacterial meningitis is
the most severe type
of meningitis in terms
of symptom intensity
and fatality rates.
Death can occur in a
matter of hours after
appearance of first
Figure 1: Neisseria meningitides
symptoms. The risk of
permanent disability is imminent.

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Viral Meningitis

It is the most common type of meningitis. It is often less

severe than bacterial meningitis and resolves without much
need for treatment.

It is mainly caused by non-polio enteroviruses. However, not

all people infected with enteroviruses will actually develop
symptoms of meningitis.

Other causative viruses include mumps virus, varicella-zoster

virus (chicken-pox virus), measles virus and influenza virus.

These viruses are communicable. Modes of transmission

include bodily fluid exchange, touch, air, and the faecal-oral
route.

Fungal Meningitis

Fungal meningitis is exceedingly rare. It is not spread from

person to person directly. It develops when fungi from an

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infection elsewhere in the body move to the spinal cord/brain
via the bloodstream.

Meningitis-causing fungi such as

Cryptococcus, Histoplasma,
Blastomyces, and Coccidioides are
mainly found in soil contaminated
by bird and bat droppings.
Disturbing infected soil can lead
Figure 2: Cryptococcus neoformans
to the inhalation of spores.

Parasitic Meningitis

Parasites such as Angiostongylus, Baylisascaris, and

Gnathostoma cause a rare form of meningitis known as
eosinophilic meningitis (EM) characterized by increased levels
of eosinophils in the cerebrospinal fluid.

These parasites cause infections in animals more commonly

than in humans and are not considered communicable from
person to person directly. Ingestion of contaminated meat
such as snails, fish, poultry and snakes transmits the infective
agent from animal to human.

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Amoebic Meningitis
Amoebic meningitis or primary amoebic meningoencephalitis
(PAM) is a very rare form of parasitic meningitis causing a
brain infection with a fatality rate above 95%.

It is caused by the “brain-

eating” amoeba, Naegleria
fowleri, which lives in warm
fresh water. It can only
infect humans via the nasal
passage, meaning that the
most frequent mode of
contraction is swimming in
infested waters. It cannot,

Figure 3: Naegleria fowleri however, be transmitted by

drinking the same water.

It causes necrosis of brain tissue, consuming astrocytes and

neurons.

Non-infectious Meningitis

Causes of non-infectious meningitis are:

 Cancer
 Lupus
 Drugs

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  Head Injuries including but not limited to Traumatic
Brain Injuries (TBIs)
 Brain Surgery


Signs and Symptoms of Meningitis

The main signs and symptoms of meningitis are:

 Severe frontal headache

 Stiff neck
 High fever
 Confusion
 Nausea/vomiting
 Photosensitivity
 Sleepiness/stupor

With bacterial meningitis, there is the possibility of coma and

death in the later stages of infection. Sepsis is yet another
complication that may develop. Petechiae (rashes that do not
fade when pressed upon) are a characteristic sign.

Parasitic meningitis (EM) may cause tingling or pain in the

skin along with a low-grade fever. These parasites may also
infect the eyes. Loss of muscle control and coordination,
paralysis, permanent disability and death may be caused.

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Initial symptoms of PAM are identical to that of bacterial
meningitis. However, the symptoms progress extremely
rapidly. It usually causes death within 5 days.

Complications of Meningitis

 Partial/total hearing and/or vision loss

 Epilepsy and movement issues
 Memory and concentration problems, learning disorders
 Amputation may be necessary to remove damaged tissue
 Arthritis
 Kidney problems

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Diagnosis of Meningitis

The most common confirmatory test for meningitis is a lumbar

puncture or spinal tap, in which cerebrospinal fluid is
extracted using a needle inserted between two lumbar
vertebrae. It enables the detection of increased pressure in the
central nervous system as well as the presence of pathogens in
the CSF itself. A throat swab may be done. Kerning’s sign can
be used preliminarily to detect meningeal irritation.

Supplementary tests include:

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  Blood Culture- To identify bacteria in blood. This is useful
in cases where sepsis is a risk such as N. meningitides and
S. pneumonia infections.

 Complete Blood Count – It gives the general health status.

In meningitis, elevated white blood cells are expected.

 Chest X-Ray- In the case of secondary meningitis

infections, the primary infection may be pneumonia,
tuberculosis, or fungal infections which can be detected in
this way.

 CT Scan- Again used in the case of secondary meningitis,

where the primary infection is a brain abscess or sinusitis.

Treatment of Meningitis

Time is of essence when dealing with meningitis. Upon

suspicion of meningitis, the patient is started on a
combination of antibiotic and antiviral drugs. Once the
causative pathogen has been identified, the course of
treatment is modified as per requirements.

Most strains of viral meningitis do not require medical

attention and the case resolves itself within 7-10 days.

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However, certain strains may need to be treated using antiviral
medications. Hospitalization is rarely required.

Fungal meningitis is treated with high dosages of antifungal

medications, usually administered via an intravenous line. The
type and severity of infection determine the length of the
course.

In the case of parasitic meningitis, focus is on control of

symptoms such as pain rather than treating the actual
infection, as no drugs have proven to be very efficient in
treatment.

Amoebic meningitis is believed to respond to a variety of

drugs. Concrete evidence of their effectiveness is not available
as almost all cases end in death of the patient.

Prevention of Meningitis

The most effective protection against bacterial meningitis is

vaccination. As of now, vaccines are available against three
strains of bacterial meningitis- N. meningitides, S. pneumoniae,
and H. influenza-b. It is recommended that pregnant women
undergo tests for meningitis-causing bacteria and take
necessary antibiotics so as to prevent the spread of meningitis
to the newborn.

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No vaccinations are available yet against viral meningitis.
General hygiene and etiquette with regards to coughing and
sneezing can reduce the spread of the disease.

PAM can be prevented by ensuring that no water enters one’s

nose during swimming in potentially infested waters. Public
drinking water systems must be carefully regulated to prevent
outbreaks.

Fungal meningitis is to be avoided by not coming in contact

with potentially infested soil.

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Case Study

ONSET OF SYMPTOMS AND INITIAL MEDICAL RESPONSE:

A 14-year old male complaining of malaise with a headache,

dizziness, nausea, and feeling very weak was brought to a
local clinic sfter a rise in his body temperature, an increase in
the severity of his headache, and the development of a rash.
Upon examination, it was noted that the patient also
complained of stiffness in his neck and nausea. The patient
had a temperature of 103.5 and an increased heart rate. A
rash had developed on parts of the patient's extremities and
wrists.

Upon further examination, a complete blood count (CBC),

blood for culture and lumbar puncture (LP) were performed
since there was a strong clinical suspicion of bacterial
meningitis. The LP examination included tests for the presence
of bacteria (Gram stain), cell count and differential, glucose
and protein. A culture of the fluid is also a standard test and
detects the type of bacteria, if any, that may be present.
Radiology was called to perform a CAT scan on the patient.

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 CBC AND CSF ANALYSIS:

Spinal Fluid Analysis

Test Parameter Patient Normal Values

Appearance Hazy Clear

Glucose 16 mg/dl 50-80 mg/dl

Total Protein 88 mg/dl 15-45 mg/dl

White Blood Cells 2300 mm3 0-3 mm3

Cell Differential 96% neutrophils 0-1 neutrophils

neutrophils and
no bacteria should be present. DSF is a
Gram Stain gram negative
sterile fluid
diplococci

Intracranial
174 mm/H20 < 140 mm/H20
Pressure

CBC

CBC Value Patient Normal Value *

White Blood
24,000 mm3 5000-10,000 mm3
Cell

Neutrophils 87% 65%

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NEXT STEPS: Diagnosis and Treatment

From the information provided, coupled with the patient's

clinical symptoms, the diagnosis of acute bacterial meningitis
was made by the medical team. The morphological
characteristics of the bacteria and the clinical picture strongly
suggests an infection due to Neisseria meningitidis.

The patient was administered intramuscular antibiotic

therapy, as well as a steroid medication, called dexamethasone
to reduce inflammation around the brain and its associated
seizure risk. The patient was promptly admitted to the
hospital's critical care unit as bacterial meningitis is a serious,
life-threatening disease that requires prompt and intensive
therapy. The rash seen on the initial exam was identified to be
petechiae which are
small hemorrhages
(localized areas of
bleeding) from the
capillaries present in
about 50-60% of patients
with this form of acute
bacterial meningitis.

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Once the patient had been admitted to the hospital's critical
care unit, intravenous fluids were started. Included were
penicillin G, steroids, and essential fluid and nutrient
replacements. Nursing care is intensive to include monitoring
neurologic parameters for seizures, blood pressure,
temperature, fluid replacement, administration and others.

The neurologist ordered a standard radiograph (X-ray), as well

as a computerized axial tomography (CAT) scan of the patient's
cranium to determine the extent of swelling caused by the
inflammatory presence of the bacteria.

48 hours after the lumbar puncture, spinal fluid and blood

cultures confirmed the presence of Neisseria meningitidis

The patient responded well to all medications and supportive

care. He was kept in the hospital's intermediate care unit for
several days and then discharged.

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