septic thrombosis of intracranial venous sinuses, osteomyelitis of spine or skull,

figures for clorides and glucose,absence of residual lesions (c) Aseptic meningeal reaction -(i) Parameningeal suppuration -Due to septic or necrotic focus within the skull or spinal canal - e.g. septic thrombosis of intracranial venous sinuses, osteomyelitis of spine or skull, intracraniaI abscess or septic cerebral emboli. Symptoms are those associated with the primary infection and only occasionally symptoms and signs of meningeal imitation (I) Due to introduction of foreign substances into the subarachnoild space -Fever, headache and stiffness CSF- Increase in pressure, slight to moderate Increase in protein, normal sugar, varying degree of pleocytosis (polymorphs - if fluid purulent, lymphocytes if normal), and absence of organisms on cutlure (d) Cryptocacoal - caused by cryptococcus neoformans mainly in patients with depressed immunity e.g. corticosteroids, diabetes. lymphoproliferative disorders, AIDS and infection in immuno-compromised patients Symptoms occur Intermittently over weeks and meaningism is less common than confusion and depressed consciousness Diagnosis by presence of C neoformans in CSF,or detection of cryptococcal(antigen Tr -Amphotencin B O 6-1 mg/kg/day iv or combination of arnphotericin B O 3 mg/kg/day plus flucytosine 150 rng/kg/day Fluconazole for cryptococcal meningitis in AIDS (e) Acute syphilitic meningitis - (a) Mosty young men. (b) history of primary infection 1-2 years ago, (c) may follow inadequate treatrnent or occur during specific therapy, (d) CSF- 1,000 or l .500 cells, 30% or more polymorphs CSF and blood serological tests for syphilis positive.(f) Leptospiral meningitis - (a) History occupational relationship to rats, (b) Liver may be enlarged (c) Jaundice may appear (d) Conjunctiva! injecton (e) Hemorrhages common (f) CSF - Leptospira may be demonstrated by culture (g) Brucellosis - Meningitis is an uncommon complication of acute brucellosis. CSF besides lymphocytoesis shows elevated protein and reduced sugar level (h) Lyme disease - due to Infection with spirochetal bacteriun - Borrelia burgdorfeh Meningitis may be associated with erythematous rash called erythema chronicum migrans. Tr. Tetracycline or penicillin.(i) Carcinomatous meaningitis - more common in leukernias and lympnomas Combination of altered mental state (e.g. confusion}, cranial nerve signs (commonly optic, facial and those supplying eye muscles) Papillcedema common Back and limb pain due to radiculopathy Also depressecl reflexes, muscle wasting and sensory loss Defferential Diagnosis of menigitis A Meningism- Neck stiffness in presence of normal CSF May be seen occasionally usually at onset, in typhoid fever, apical pneumonia, acute exanthema, acute pyogenic tonsilitis. pyelo-nephritis or cervical lymphadenopathy duration, Meningealsigns not marked, hyperaesthesiae common, paralysie common and more extensjve. Lumbar puncture at once differentiates.2 Acute drsseminated meningoenceptrialitis - due commonly to HSV. Begins with fetures of acute menngitis and progresses rapidly to irritablity, confusion, focal fits. coma and death 3. Post-infectious meningo-encephalitis-Rare sequel of measles or influenza, or less frequently chicken pox, mumps or rubella, and vaccinese Reccurent meningitis Predisposing causes - (a) CSF leakage from prior head injury or congenital malformaion predispose to recunent pneumococcal meningits (b)immunological defects may predispose to meningococcal disease (c) Patitent with primary antibodydeficiency have susceptibility to enterovirus infections of CNS (d) Echovirus infection may cause a progressive chronic meningoencephalitis. INFLUENZA Etiology - Causetive agent - There are three immunological types of influenza viruses - two subtypes of, A,A(H3H2) and (h3n2) and type B The type A subtypes can be distinguished from each other by differences in their haemagglutinin(H) an neuraminidase (N) surface antigens pattern of infection -major out breaks can be caused by any of the three types or subtypes, but type A(H3N2) cause large scale mortality individuals of al ages may be affected by this subtypes, but type B viruses principally infect children, adults less frequently. In each patient, characteristics of Influenza caused by different virus types overlap such an extent, that determination of the virus involved rs possible only through laboratory studies or knowledge of the virus curculating in the population influenza virus has thus been described as an unvarying disease caused by a varying virus incubation period -1 (o 3 days clinical picture -Onset - Sudden with fever, chilly sensations, and prostraton catarrhal syrnotoms. headache, pans and dry cough Somttmes erythematous rash.CLNlCAL TYPES-1 Febrile type- Only constitutfonal symprorns- fever,malaise, headache,severe bodyache, catarrh, congesion of eves and throat, rapid piostralon. Dry cough with few or no sic/is r chest. Fever lasts for 4 to 6 days.there may be relative bradycaidia 2. Respiratory type - (a) Brcnchits and bronchopneumonia. (b) Pleurisy, ernpyema not uncommon (c) Pneumonia' (i) Fulmriaing rapidly fatal form in which pneumonia is present from the onset. (ii) Progressive form in which on the 2nd or 4th day signs of pneumonia begin to develop with copious fine crepitations usuaity basal. The sputum may be pinkish, frothy and copious, or tenacious mucus of several hues (iii) Late form in winch often after apparent recovery frcm the primary influenza, pneumonia suddenty supervenes on the 4th to 10th day atler the onset 3 01 Temperaiure rarely above 37 5*C,severe anorexia and vomiting. abdominal discomtort and general prostration diarrhoea and continued fever may simutale typhoid fever. 4. Malignant type - Severe toxemia, cyanosis and rapid cariac failure. Always fatal.5. Nervous type - Headache scmetmes very severe, delirium, ntense depressor which may continue after the acute iliness. a true meningitis may occur.Compucattons and sequelae -1 Respiratory - Bacterial broncho-pneurnona or lobar pneumonia, less often pure viral pneumonia These may be concurrent with inltal viral infection or follow after an interval Staphytococcal pneumona is a serious segue! and may be fatal, less severe infections may result in lung abscess. 2. Nervous system - Post inluenzai psychoses, nsomnia, irrttabilty poryneuntis. neuraslienlaH menngits and hemorrhagic encephalits. 3. Circulatory system- Cardiac dilatation, irregularities, pericarditis, endocarditis 4 suppuration -otitis media.mastoicditis.sinusitts. 5. Miscellaneous- Thrombophlebitis, arthritis. orchitis, mvositis. nephritis. hemormage Management-1 Complete rest in bed 2 Analgesics and sedatves 3. Nose drops