1. What is it? What is it? Causes What’s Happening What’s Happening Symptoms Treatments Diagnosis Research

2. What is it? Inflammation of the meninges or Swelling of the Cerebrospinal Fluid (CSF) Back to Menu

3. Causes Bacterial Pneumococcal Meningitus (S. Pneumonia) Meningococcal Meningitis (N meningitidis) Very contagious (college, military, etc) Viral Most common Typically mild and non-lethal Fungal Back to Menu

4. Symptoms Early symptoms are flu-like leading to delayed diagnosis Severe headache Sudden fever Stiff neck Nausea Later symptoms Seizures Stupor Coma Death Back to Menu

5. What’s happening Pathogen enters bloodstream Survives host immune system Invades Blood Brain Barrier (BBB) Science not sure how it does this (PhD anyone?) Replicate in subarachnoid space http://jid.oxfordjournals.org/content/186/Supplement_2/S22 5.long Back to Menu Next slide Illustration found at http://www.daviddarling.info/encyclopedia

6. More details Back to Menu Next slide The exposure of cells to pathogens can trigger increased production of Cytokines, TNF, and other inflammatory agents http://jid.oxfordjournals.org/content/186/Supplement_2/S225.long

7. More details Inflammatory agents will degrade BBB allowing intake of leukocytes and other fluids. Increased pressure may physically press hind brain into brain stem causing death 1 Back to Menu Next slide Illustration found at: http://jid.oxfordjournals.org/content/186/Supplement_2/S225.lon: Journal of Infectious DiseasesJournal of Infectious Diseases Volume183, Issue12 Pp. 1749-1759Volume183, Issue12 1 – Personal communication with Dr. David R. Boulware

8. More Details Bacterial wall may trigger iNOS to release NO leading to metabolic pathways that trigger greater inflammatory responses and glucose depletion. This leads to cell necropsy. Back to Menu Journal of Infectious DiseasesJournal of Infectious Diseases Volume183, Issue12 Pp. 1749-1759Volume183, Issue12 Lymphokine Cytokine Res.Lymphokine Cytokine Res. 1992 Dec;11(6):293-8

9. Diagnosis Neurological exam strength, coordination, speech, vision Lab screening of blood, urine, body secretions Looking for antibodies, foreign proteins Throat culture for bacteria Spinal tap Looking for blood, bacteria, WBC, low glucose CT scan or MRI looking for swelling of meninges Back to Menu National Institute of Neurological Disorders and Stroke

10. Treatment All: EARLY TREATMENT ESSENTIAL Corticosteroids to reduce swelling and potential damage Bacterial Antibiotics, intravenously in severe cases Sinuses drained Viral Bed rest, fluids, dark room Fungal Anti-fungal medication Back to Menu Personal communication with Dr. David R. Boulware National Institute of Neurological Disorders and Stroke

11. Research CNS response to inflammation Role of T-cell in suppression of infection in the brain How the BBB is initially breached Role of NOS isoforms in inflammatory response Biochemical pathways of inflammatory response Neuroprotective compounds that block post infection damage that leads to loss of cognitive function and dementia Back to Menu National Institute of Neurological Disorders and Stroke Personal communication with Dr. David R. Boulware Journal of Infectious Diseases Volume183, Issue12 Pp. 1749-1759Journal of Infectious DiseasesVolume183, Issue12