CAUSATIVE MICROORGANISMS
Escherichia coli and the group B streptococci in neonates
Streptococcus pneumoniae and Neisseria meningitidis in adolescents and young adults
Listeria monocytogenes in the elderly
2. PORTALS OF ENTRY OF INFECTION INTO CNS
• Hematogenous spread –Most common
• Direct implantation- Traumatic or congenital malformations (e.g.,
meningomyelocele)
• Local extension can originate from infected adjacent structures,
such as air sinuses, teeth, skull, or vertebrae.
• Viruses - Rabies and herpes zoster viruses.
3. INTRODUCTION
• Leptomeningitis- Inflammation of subarachnoid and pia
• Meningitis –Inflammation of leptomeninges and CSF within
the subarachnoid space.
• Meningoencephalitis- Inflammation of meninges and brain
parenchyma
6. CAUSATIVE MICROORGANISMS
• Escherichia coli and the group B streptococci in neonates
• Streptococcus pneumoniae and Neisseria meningitidis in
adolescents and young adults
• Listeria monocytogenes in the elderly
9. CSF
• Cloudy or frankly purulent CSF
• Many as 90,000 neutrophils per cubic millimeter
• Increased protein concentration, and markedly reduced glucose
content.
11. MORPHOLOGY
• The anatomic distribution of the exudate varies; in H. influenzae
meningitis it is usually basal
• Pneumococcal meningitis it is often dense over the cerebral
convexities near the sagittal sinus.
12. MICROSCOPY
• Neutrophils fill the subarachnoid space in severely affected areas
and are found predominantly around the leptomeningeal blood
vessels in less severe cases.
• Gram stain reveals variable numbers of bacteria.
16. ASEPTIC VIRAL MENINGITIS
• Aseptic meningitis is a misnomer
• It is a clinical term used for an absence of organisms by bacterial
culture
• Manifestations of meningitis, including meningeal irritation, fever,
and alterations of consciousness of relatively acute onset.
17. CSF
• Less fulminant than that of pyogenic meningitis
• CSF is sterile
• Increased number of lymphocytic (pleocytosis)
• The protein elevation is only moderate, and the glucose content is
nearly always normal.
18. ETIOLOGY
• Enterovirus (80%)
• An aseptic meningitis-like picture may also develop subsequent to
rupture of an epidermoid cyst into the subarachnoid space or the
introduction of a chemical irritant (chemical meningitis).
19. MORPHOLOGY
• No distinctive macroscopic picture except for brain swelling seen
only in some instances
• On microscopic examination there is either no recognizable
abnormality or mild to moderate infiltration of the leptomeninges
by lymphocytes
21. FUNGAL MENINGITIS
• Primarily in immunocompromised individuals.
• Hematogenous dissemination of fungi;
• The most frequent offenders are Candida albicans, Mucor species,
Aspergillus fumigatus, and Cryptococcus neoformans
22. MORPHOLOGY
• The three main forms of injury in CNS fungal infection are
chronic meningitis, vasculitis, and parenchymal invasion.
• Vasculitis- Mucormycosis and Aspergillosis
23. CRYPTOCOCCAL MENINGITIS
• Most common opportunistic infection
• May be fulminant and fatal in as little as 2 weeks or indolent,
evolving over months or years.
24. CSF
• The CSF may contain few cells but usually has a high
concentration of protein.
• The mucoid-encapsulated yeasts can be visualized in the CSF with
special stains or detected indirectly using assays for cryptococcal
antigens
27. TUBERCULOUS MENINGITIS
• Tuberculosis of the CNS may be part of active disease elsewhere in
the body, or appear in isolation following seeding from silent
lesions elsewhere, usually the lungs.
28. CSF
• Pleocytosis made up of mononuclear cells or a mixture of
neutrophils and mononuclear cells
• Protein concentration (often strikingly so), and a moderately
reduced or normal glucose
32. TUBERCULOMA
• Well circumscribed intraparenchymal mass
• Rupture of tuberculoma into subarachnoid space cause Tuberculous
meningitis
• Tuberculoma maybe upto several centimeters causing significant mass
effect
• Always occurs after hematogenous dissemination of organism from
pulmonary infection.
, gelatinous material and a focal, 0.5 cm diameter, gelatinous mass at the left caudate nucleus.
Parenchymal aggregates of Cryptococcal organisms are typically found within expanded perivascular (Virchow-Robin) spaces and are associated with minimal to no inflammation or gliosis.
Histopathology of lung shows numerous extracellular yeasts of Cryptococcus neoformans within an alveolar space. Yeasts show narrow-base budding and characteristic variation in size.