1. Bacterial Infection of Central Nerve System 3 rd Year Medical Students Prof. Dr Asem Shehabi Faculty of Medicine, University of Jordan

2. Meningitis & Encephalitis-1 Infections of the brain and spinal cord can cause dangerous inflammation.. Encephalitis or Meningitis Infections of the brain and spinal cord can cause dangerous inflammation.. Encephalitis or Meningitis Meningitis results from infection of meninges.. the membranes that surround the brain and spinal cord.Meningitis results from infection of meninges.. the membranes that surround the brain and spinal cord. Encephalitis is inflammation of the brain itself.Encephalitis is inflammation of the brain itself. Myelitis is infection of the spinal cord alone.Myelitis is infection of the spinal cord alone. Encephalomyelitis includes inflammation of both the brain and the spinal cord..Common cause virusesEncephalomyelitis includes inflammation of both the brain and the spinal cord..Common cause viruses Acute meningitis can be caused by Viruses, Bacteria, Fungi, Viruses.. produce a wide range of symptoms, including fever, headache, neck stiffness, confusion, vomiting, photophobia..Mild non-specific symptoms.Acute meningitis can be caused by Viruses, Bacteria, Fungi, Viruses.. produce a wide range of symptoms, including fever, headache, neck stiffness, confusion, vomiting, photophobia..Mild non-specific symptoms.

3. Meningitis & Encephalitis-2 Meningitis & Encephalitis-2 Any delay in treatment menigitis may cause brain damage, stroke, seizures, death.Any delay in treatment menigitis may cause brain damage, stroke, seizures, death. Any CNS inflammation can harm or destroy nerve cells and cause bleeding in the brain.Any CNS inflammation can harm or destroy nerve cells and cause bleeding in the brain. Acute Meningitis & Encephalitis are mostly caused by viruses (95%), bacteria ( 2-5%), Fungi (1-2%).. Affect all ages.. majority children aged < 5 years.Acute Meningitis & Encephalitis are mostly caused by viruses (95%), bacteria ( 2-5%), Fungi (1-2%).. Affect all ages.. majority children aged < 5 years. Most CNS Pathogens acquired through the blood stream.. travel to the spinal cord.. brain.. Following Resp. Tract Infections, sepsis, Brain Surgery or any surgical procedure.Most CNS Pathogens acquired through the blood stream.. travel to the spinal cord.. brain.. Following Resp. Tract Infections, sepsis, Brain Surgery or any surgical procedure. Aseptic meningitis caused mostly by viruses.. Less clinical sings & symptoms.Aseptic meningitis caused mostly by viruses.. Less clinical sings & symptoms.

4. Common Cause of Acute Bacterial Meningitis Pneumococcal meningitis / S. pneumoniae.. Gram+ve diplococcus.. Alpha-Hemolytic.. Pneumococci are spread by personal contact, commonly by sneezing, coughing or close personal contact.Pneumococcal meningitis / S. pneumoniae.. Gram+ve diplococcus.. Alpha-Hemolytic.. Pneumococci are spread by personal contact, commonly by sneezing, coughing or close personal contact. Major virulence factor: Capsule (90 Serotypes),IgA-1 protease, cytotoxin pneumolysin. Respiratory Healthy carriers.. Prevalence Up to 70%.. More in winter months.. More children.. Mostly endogenous infection. Common cause of meningitis.. most serious form of all bacterial meningitis.. High fatality.Major virulence factor: Capsule (90 Serotypes),IgA-1 protease, cytotoxin pneumolysin. Respiratory Healthy carriers.. Prevalence Up to 70%.. More in winter months.. More children.. Mostly endogenous infection. Common cause of meningitis.. most serious form of all bacterial meningitis.. High fatality. Pneumococcal meningitis follow acute /sub acute pneumonia, septicemia, ear and sinus infections.Pneumococcal meningitis follow acute /sub acute pneumonia, septicemia, ear and sinus infections.

5. S. pneumoniae- High risk children under age 3-year, elderly, persons with immunodeficiencies, malignancy, diabetes melitlitus, asplenia, ischaemic heart disease, sickle cell anaemia,..High risk children under age 3-year, elderly, persons with immunodeficiencies, malignancy, diabetes melitlitus, asplenia, ischaemic heart disease, sickle cell anaemia,.. Following severe viral infections.. Measles, MumpsFollowing severe viral infections.. Measles, Mumps Late treated pneumococcal meningitis often causes neurological damage..deafness to severe brain damage.Late treated pneumococcal meningitis often causes neurological damage..deafness to severe brain damage. Treatment: Most S. pneumoniae strains are Highly resistance to penicillin.. less to erythromycin and tetracycline.. Highly susceptible to vancomycin & Cefotaxime / ceftriaxoneTreatment: Most S. pneumoniae strains are Highly resistance to penicillin.. less to erythromycin and tetracycline.. Highly susceptible to vancomycin & Cefotaxime / ceftriaxone Prevention: polyvalent polysaccharide vaccine includes 23 polysaccharides serotyptes (pneumovax).. adults.. protective efficacy about 60%–70%.. Each year.Prevention: polyvalent polysaccharide vaccine includes 23 polysaccharides serotyptes (pneumovax).. adults.. protective efficacy about 60%–70%.. Each year. A second Pneumococcal conjugate vaccine (Prevenar), contains 13- selected polysaccharides serotypes bound to a protein.. used in 2-months infants – children.. less than 2-year.. Two-doses.. Protection > 90%A second Pneumococcal conjugate vaccine (Prevenar), contains 13- selected polysaccharides serotypes bound to a protein.. used in 2-months infants – children.. less than 2-year.. Two-doses.. Protection > 90%

6. S.pneumoniae Lab diagnosis Blood culture-Optochin/ Gram-stain

7. Neisseria meningitides- Meningococcal meningitis: N. meningitides.. Gram- negative diplococci..Serotypes A, B. C, Y,W-135.. Nasopharynx.. Human only host.. Few% Respiratory Healthy carriers.. common in late winter.. More common in children than adults.. highly contagious disease.. Causing outbreak in schools, military camps.Meningococcal meningitis: N. meningitides.. Gram- negative diplococci..Serotypes A, B. C, Y,W-135.. Nasopharynx.. Human only host.. Few% Respiratory Healthy carriers.. common in late winter.. More common in children than adults.. highly contagious disease.. Causing outbreak in schools, military camps. Endemic in tropics & subtropics countries in Africa and South America.Endemic in tropics & subtropics countries in Africa and South America. Major virulence factor: Pili, Capsule, Lipooligo- saccharides, Outer-membrane proteins, IgA Protease.Major virulence factor: Pili, Capsule, Lipooligo- saccharides, Outer-membrane proteins, IgA Protease. High-risk groups include infants & children aged of 6 months - 3 year, persons with suppressed immune systems.. travelers to endemic countries in Africa, South America.. Non-pathogenic Neisseria species.. contribute to host protectionHigh-risk groups include infants & children aged of 6 months - 3 year, persons with suppressed immune systems.. travelers to endemic countries in Africa, South America.. Non-pathogenic Neisseria species.. contribute to host protection

8. /2 Acute disease.. Headache, high Fever, Neck stiffness, vomiting, Septicemia-Meningitis.. Thrombosis small blood vessel, Skin hemorrhagic rash, comma within few hours.Acute disease.. Headache, high Fever, Neck stiffness, vomiting, Septicemia-Meningitis.. Thrombosis small blood vessel, Skin hemorrhagic rash, comma within few hours. Complication: Adrenal hemorrhage.. Water-house Friderichsen syndrome.. Disseminated Intravascular coagulation, circulatory collapse, Death. Between 10 - 15 % of cases are fatal.. another 10-15 % causing brain damage and other serious side effects..Complication: Adrenal hemorrhage.. Water-house Friderichsen syndrome.. Disseminated Intravascular coagulation, circulatory collapse, Death. Between 10 - 15 % of cases are fatal.. another 10-15 % causing brain damage and other serious side effects.. Capsular polysaccharide vaccine > 2 years.. AdultCapsular polysaccharide vaccine > 2 years.. Adult Treatment: Penicillin-R low, Cefotaxime / ceftriaxone. Rifampicin only for carriers/contact personsTreatment: Penicillin-R low, Cefotaxime / ceftriaxone. Rifampicin only for carriers/contact persons

9. N.meningitidis-Pili Gram-stain/intracellular

10. Haemophilus influenzae H. influenzae b.. normal flora Nasopharynax.. Low % Healthy carriers encapsulated type b.. Virulent & invasive.. capsule.. High-risk children ages 5 months-5 years.. Rare adults.. Other H. influenzae serotypes less virulent..H. influenzae b.. normal flora Nasopharynax.. Low % Healthy carriers encapsulated type b.. Virulent & invasive.. capsule.. High-risk children ages 5 months-5 years.. Rare adults.. Other H. influenzae serotypes less virulent.. Acute onset disease: Mild sore throat / pneumonia, chronic brochitis, empyema, sinusitis, otitis media, conjunctivitis..Acute onset disease: Mild sore throat / pneumonia, chronic brochitis, empyema, sinusitis, otitis media, conjunctivitis.. Lack bactericidal specific antibodies result in septicemia, meningitis in children.Lack bactericidal specific antibodies result in septicemia, meningitis in children. Before 1990.. Use of Hib vaccine.. was the most common form of bacterial meningitis among young children worldwide.Before 1990.. Use of Hib vaccine.. was the most common form of bacterial meningitis among young children worldwide. Haemophilus b conjugate vaccine reduced the incidence of meningitis up to 95% & carrier rate.. Immunization children up 2 months.. > 95% protection.Haemophilus b conjugate vaccine reduced the incidence of meningitis up to 95% & carrier rate.. Immunization children up 2 months.. > 95% protection. Treatment: Ampicillin-R 25-50%, Third G-CephalosprinTreatment: Ampicillin-R 25-50%, Third G-Cephalosprin

11. Virulence of Common Pathogens H. Influenzae Type b N.meningitidis S. pneumonia VirulenceFactors + Thin + Large Capsule +++ IgA Protease ++-Pili ++- Endotoxin- outermembrenes proteins

12. H. influenzae/ Coccobacilli-Short filaments - Listeria monocytogenes

13. Less Common bacterial Meningitis Group B Streptococci (GBS):Group B Streptococci (GBS): Colonize 10-30% adult women vagina/ intestine.. Rectum.. common cause of acute fatal neonatal sepsis & meningitis.Colonize 10-30% adult women vagina/ intestine.. Rectum.. common cause of acute fatal neonatal sepsis & meningitis. Infection is spread to infants before or during delivery.. membrane rupture before delivery.. swallowing contaminated amniotic fluid during delivery.Infection is spread to infants before or during delivery.. membrane rupture before delivery.. swallowing contaminated amniotic fluid during delivery. New born baby may develop pneumonia, sepsis, acute meningitis.. Mothers developing Endometritis, Septicemia, Puerperal fever/ bedchild fever..New born baby may develop pneumonia, sepsis, acute meningitis.. Mothers developing Endometritis, Septicemia, Puerperal fever/ bedchild fever.. Lab Diagnosis+ Treatment: Blood Culture.. Ampicillin, 2G Cephalosporins.. CefiximeLab Diagnosis+ Treatment: Blood Culture.. Ampicillin, 2G Cephalosporins.. Cefixime