association with hydrocephalus. Conjunctivitis and cornea! ulcers (d) Rash - Erythematous macules when soon become

adults, more often during winter epidemics Transmission - by way of nasopharynx Carriers are the principal source of transmission Acquisition is followed by meningitis and seplticemia. Incubation period - 1 to 5 days Clinical features - 1 STAGE OF INVASION - Abrupt onset with severe headache, vomiting of cerebral type, fever, pains in neck and back, rigors or in children convulsions, restlessness, insomnia, delirium 2 MENINGEAL STAGE - (a) More severe headache, intense lumbar pain (b) Muscular rigidity - Neck rigidity, head retraction Kemig's and Brudzinski's signs, sometimes muscular twitchings and tremors (c) Ocular symptoms - Include optic neuritis, uveitis or purulent choroiditis usually unilateral Optic atrophy may result particularly in association with hydrocephalus. Conjunctivitis and cornea! ulcers (d) Rash - Erythematous macules when soon become petechial (spotted fever) Petechiae in the conjunctivae. (e) Temperature variable, usually more than 30°C [f] Exaggeration of deep jerks (g) Retention of urine and constipation (h) Herpes febrilis (i) Pulse - slow in relation lo temperature, may be irregular [j) Rapid emaciation DIAGNOSIS - (a] Leucocytosis - 20.000-30.000 per c mm. (b) CSF • Turbid or purulent, under pressure, large number of pus cells mainly polymorphs . and presence of meningococci on smear or culture (c) Polymerase chain reaction-(PCR)-based identification of bacterial pathagens in cellular CSF increases menigococcal diagnostic rates Complications and sequelae - 1. Septicerria - Meningitis is associated with meningococcal septicemla and the organism may setlle in lungs, bones, joints or eyes causing local infection 2 Arthritis - either purulent occurring early in the illness, or arthritis ol later onset, possibty due to immune reaction 3. Neurological - (a) Cerebral oedema of severe degree causing fluctuating neurological signs (b) Focal neurological damage - e.g.. deafness (c) Psychiatric problems and mental retardation (d) Hydrocephalus - rare 4 Cardivascular Myocarditis 5 Waterhouse-Friderichsen syndrome - from haemorrhage necrosis of both adrenals Circulatory failure, cyanosis and widespread petechiae or purpura. Circulating steroid levels are usually high 6 DIC - often present Treatment - BenzyIpenicillin 20-30 mg/kg 4-hour!y for 5-7 days if pentaiilln allergy Cephalosporin(e.g cefotaxlme 1 -2g i.v. 12 hrly) PROPHYLAXIS - Penicillin does not eradicate the organism from nasopharynx Patient, and any close contacts should be given rilarrplcin 10 mg/kg b.d. for 2 days Clprofloxacin 500 mg in a single dose. If rlfampicin la canlralndtcated Menigococcal vaccine (A and C and W 135) can be given 2 Pneumtcoccal meningitis - asaocialed with lobar pneumonia, rarely with chronic at it is media, sinusitis or head injury Muscular spasms common More severe loxemla CSF ihtek greenish lluid. Gram positive diplococci in CSF and blood, or detection o) pneumococcal antigen In CSF Tr - PenicllHn or cefotaxirne/ceflriaxone for atleast 7 days and continued till patient is apyrexial for 48 hrs VACCINATION -Vaccine is effective and should be given to all patients in high-risk groups, other than neonates, in whom it is of limited efficacy Patients undergoing splenectomy snould be immunized before surgery 3. Hemophilus Influenzae meningitis -common in children under 5. Preceding or accompanying infection of respiratory or ear infection The illness often develops insidiously with drowsiness and irritability Subdural effusion is a common complication and may cause convulsions or become infected. CSF purulent with a high protein and polymorph count and low sugar.