Meningitis pathophysiology: Difference between revisions

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{{Meningitis}}
{{Meningitis}}


{{CMG}}; '''Associate Editor(s)-In-Chief:'''  {{CZ}}
{{CMG}}; '''Associate Editor(s)-In-Chief:'''  {{CZ}}
==Overview==


==Pathophysiology==  
==Pathophysiology==  
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*:* The interaction of beta-2 integrin (CD18) and ICAM-1 is largely responsible for PMN diapedesis.
*:* The interaction of beta-2 integrin (CD18) and ICAM-1 is largely responsible for PMN diapedesis.
* Additionally, patients get [[cerebral edema]] that is mediated by an increase in capillary permeability, the inflammatory response from the neutrophils, and CSF outflow resistance.
* Additionally, patients get [[cerebral edema]] that is mediated by an increase in capillary permeability, the inflammatory response from the neutrophils, and CSF outflow resistance.
* The above pathophysiologic processes are not only important in producing the symptoms associated with meningitis, but the understanding of the underlying disease process is necessary to guide therapy (see below).
* The above pathophysiologic processes are not only important in producing the symptoms associated with meningitis, but the understanding of the underlying disease process is necessary to guide therapy.


===Mechanism===
===Mechanism===
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==References==
==References==
{{reflist|2}}
{{Reflist|2}}


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[[Category:Needs overview]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Infectious disease]]
[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Diseases involving the fasciae]]
[[Category:Inflammations]]
[[Category:Neurological disorders]]

Latest revision as of 22:42, 29 July 2020

Meningitis Main Page

Patient Information

Overview

Causes

Classification

Viral Meningitis
Bacterial Meningitis
Fungal Meningitis

Differential Diagnosis

Diagnosis

Treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Pathophysiology

The clinical picture of meningitis largely arises from the host response to the inciting organism in the CSF.

  • It seems that the subcapsular components (the cell wall and lipopolysaccharide) of bacteria are more important in determining inflammation than the surface components (pili and polysaccharide capsule).
  • The primary site of breakdown of the blood-brain barrier is the cerebral microvascular endothelium.
    • Electron microscope (EM) studies have shown complete separation of the intercellular tight junctions
  • It appears that there is a final common pathway, mediated by TNF-alpha, IL-1 and IL-6, that results in meningeal inflammation and loss of the blood-brain barrier.
    • One of the major roles of these cytokines is to facilitate the migration of neutrophils across the vascular endothelium into the CSF.
    • A key initial step in this process is obviously adhesion of the PMN to the endothelial surface.
      • This is mediated by the expression of specific transmembrane glycoproteins expressed on the endothelial surface that interact with specific counterparts on the neutrophils.
      • These adhesion molecules fall into three large categories: the immunoglobin superfamily (including the antigen-specific T and B cell receptors, ICAM-1 and ICAM-2), the integrin family (beta-1, beta-2, and beta-3) and the selectin family (including ELAM-1).
    • The interaction of beta-2 integrin (CD18) and ICAM-1 is largely responsible for PMN diapedesis.
  • Additionally, patients get cerebral edema that is mediated by an increase in capillary permeability, the inflammatory response from the neutrophils, and CSF outflow resistance.
  • The above pathophysiologic processes are not only important in producing the symptoms associated with meningitis, but the understanding of the underlying disease process is necessary to guide therapy.

Mechanism

  • In order to gain access to the CNS, the pathogen needs to colonize mucosal epithelium, invade and survive in the intravascular space, cross the blood-brain barrier and survive in the CSF.
  • Colonization of the nasopharynx is usually asymptomatic, and during peak seasons, approximately 20% of the population are colonized with N. meningitidis.

Gross Pathology

Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission. © PEIR, University of Alabama at Birmingham, Department of Pathology






Microscopic Pathology

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References


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