1. meningitis

2. complications Bacterial meningitis is serious condition and if not treated rapidly; may have mortality by 30%. Delay in treatment may lead to meningoccemia, DIC Multiorgans failure, or morbidity post meningitis problems as hydrocephalus, epilepsy,cranial nerve palsy, subdural effusion,sensorineural hearing defect. Some misdiagnosed cases may be partially treated by outpatient doctors by oral antibiotics and lead to diagnostic confusion.

3. Causes and cilinical picture It is inflammation of meninges by bacteria, viruses or fungal. Most serious is bacterial M. Bacterial men.is life treatening infection so it need rapid diagnosis and prompt antibiotic therapy,any delay in suggestion and in antibiotic treatment will lead to serious mortality and morbidity states.It is medical emergency. features ; headache,fever, vomiting,irritability,seizures,neck stiffness,kerning sign and brudziniski sign are +ve. Liumber puncture should be done to diagnose the CSF finding, and should be early without delay for the start of antibiotics.fundoscopy should be done to exclude papillodema.or C t SCAN but here should take blood culture and give first dose antibiotic before sending for CT scan.

4. Lumber puncture Contraindicated in; Increased intracranial pressure as indicated by focal neurological sign and bradycardia and by papilloedema or persistent tense bulging fontanele in case of still open. or if the patient is depressed in mentation or be cardiorespiratory compromise, or if has infection at the lumber site

5. treatment Should be rapid by conservative fluid therapy and antibiotics;Imperical combination of ceftriaxone+vancomycin+acyclovir if viral cause cannot excluded. Then specific antibiotic according culture &sensitivity result can be choosed. Steroid as early as possible should be started to get benefit from its antinflamatory effect and reduce adhesion in meninges. Continue therapy for10-14 days. Bacteria agent are; N.meningitis, H.influenza b.,pneumococcus; are most common

6. CSf finding in meningitis typePressure in mm H2O 50-80 LEUKOC (cmm)<5./75% ympho Protein( mg/dl)20 -40 Glucose(mg/ dl)>50,75% of serum Gram stain and culture Acute bacterial Elevated100 -300 100-10.000 PMN 100-500DECREASED <40mg positive Prtially treated m. normal5-10 mostly mononuclear Same 100-500 normalsterile Viral men80-150 slight increase <1000,mainly lymphocyte 50-200Normal, except in mumps it decrease sterile Tuberculous meningitis elevated10-500 lymphocytes 100-3000Decreased <50 Acid-fast or culture positive for Tb.bacterial culture;-ve