Meningitis — Robbins Pathology

from reportlab.lib.pagesizes import A4
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import cm
from reportlab.lib import colors
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, Image, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
import urllib.request
import os

OUTPUT = "/home/daytona/workspace/meningitis-pdf/Meningitis_Pathology_Robbins.pdf"

# Download brain image
img_url = "https://cdn.orris.care/cdss_images/a1b43e7b5560ad74493828517fb67d7428a26b46f8b47d8fa140658ba8d75a8c.png"
img_path = "/home/daytona/workspace/meningitis-pdf/pyogenic_meningitis.png"
if not os.path.exists(img_path):
    urllib.request.urlretrieve(img_url, img_path)

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    rightMargin=2*cm, leftMargin=2*cm,
    topMargin=2.5*cm, bottomMargin=2.5*cm
)

styles = getSampleStyleSheet()

# Custom styles
title_style = ParagraphStyle(
    'CustomTitle',
    parent=styles['Title'],
    fontSize=22,
    textColor=colors.HexColor('#1a3a5c'),
    spaceAfter=6,
    alignment=TA_CENTER,
    fontName='Helvetica-Bold'
)
subtitle_style = ParagraphStyle(
    'Subtitle',
    parent=styles['Normal'],
    fontSize=10,
    textColor=colors.HexColor('#555555'),
    alignment=TA_CENTER,
    spaceAfter=16
)
h1_style = ParagraphStyle(
    'H1',
    parent=styles['Heading1'],
    fontSize=14,
    textColor=colors.white,
    fontName='Helvetica-Bold',
    spaceAfter=4,
    spaceBefore=14,
    leftIndent=0,
    backColor=colors.HexColor('#1a3a5c'),
    borderPad=(4, 6, 4, 6),
)
h2_style = ParagraphStyle(
    'H2',
    parent=styles['Heading2'],
    fontSize=12,
    textColor=colors.HexColor('#1a3a5c'),
    fontName='Helvetica-Bold',
    spaceAfter=4,
    spaceBefore=10,
    borderPad=0,
)
h3_style = ParagraphStyle(
    'H3',
    parent=styles['Heading3'],
    fontSize=10,
    textColor=colors.HexColor('#2c5f8a'),
    fontName='Helvetica-BoldOblique',
    spaceAfter=3,
    spaceBefore=7,
)
body_style = ParagraphStyle(
    'Body',
    parent=styles['Normal'],
    fontSize=10,
    leading=15,
    spaceAfter=6,
    alignment=TA_JUSTIFY,
    fontName='Helvetica'
)
caption_style = ParagraphStyle(
    'Caption',
    parent=styles['Normal'],
    fontSize=8.5,
    textColor=colors.HexColor('#444444'),
    alignment=TA_CENTER,
    fontName='Helvetica-Oblique',
    spaceAfter=8
)
bullet_style = ParagraphStyle(
    'Bullet',
    parent=styles['Normal'],
    fontSize=10,
    leading=14,
    leftIndent=16,
    spaceAfter=3,
    bulletIndent=4,
    fontName='Helvetica'
)

def H1(text):
    # Draw a colored banner
    return Paragraph(f"<font color='white'><b>&nbsp; {text}</b></font>", h1_style)

def H2(text):
    return Paragraph(text, h2_style)

def H3(text):
    return Paragraph(text, h3_style)

def P(text):
    return Paragraph(text, body_style)

def B(text):
    return Paragraph(f"• {text}", bullet_style)

def Sp(h=8):
    return Spacer(1, h)

def HR():
    return HRFlowable(width="100%", thickness=0.5, color=colors.HexColor('#cccccc'), spaceAfter=4, spaceBefore=4)

# ---- TABLE HELPER ----
TABLE_HEADER_BG = colors.HexColor('#1a3a5c')
TABLE_ROW_BG    = colors.HexColor('#eaf2fb')
TABLE_ALT_BG    = colors.white

def make_table(data, col_widths=None):
    n_cols = len(data[0])
    if col_widths is None:
        w = (A4[0] - 4*cm) / n_cols
        col_widths = [w] * n_cols

    style = TableStyle([
        ('BACKGROUND', (0,0), (-1,0), TABLE_HEADER_BG),
        ('TEXTCOLOR',  (0,0), (-1,0), colors.white),
        ('FONTNAME',   (0,0), (-1,0), 'Helvetica-Bold'),
        ('FONTSIZE',   (0,0), (-1,0), 9),
        ('ALIGN',      (0,0), (-1,-1), 'LEFT'),
        ('VALIGN',     (0,0), (-1,-1), 'MIDDLE'),
        ('ROWBACKGROUNDS', (0,1), (-1,-1), [TABLE_ROW_BG, TABLE_ALT_BG]),
        ('FONTNAME',   (0,1), (-1,-1), 'Helvetica'),
        ('FONTSIZE',   (0,1), (-1,-1), 9),
        ('GRID',       (0,0), (-1,-1), 0.4, colors.HexColor('#aaaaaa')),
        ('LEFTPADDING',(0,0), (-1,-1), 6),
        ('RIGHTPADDING',(0,0),(-1,-1), 6),
        ('TOPPADDING', (0,0), (-1,-1), 4),
        ('BOTTOMPADDING',(0,0),(-1,-1), 4),
    ])

    formatted_data = []
    for i, row in enumerate(data):
        formatted_row = []
        for cell in row:
            fs = 9
            fn = 'Helvetica-Bold' if i == 0 else 'Helvetica'
            fc = colors.white if i == 0 else colors.black
            p = Paragraph(str(cell), ParagraphStyle('tc', fontSize=fs, fontName=fn, textColor=fc, leading=13))
            formatted_row.append(p)
        formatted_data.append(formatted_row)

    return Table(formatted_data, colWidths=col_widths, style=style, repeatRows=1)

# ===================== CONTENT =====================
story = []

# --- Cover ---
story.append(Sp(20))
story.append(Paragraph("Meningitis", title_style))
story.append(Paragraph("Pathology — From Robbins &amp; Kumar", subtitle_style))
story.append(HR())
story.append(Paragraph(
    "<i>Sources: Robbins &amp; Kumar Basic Pathology (9th Ed.) &nbsp;|&nbsp; "
    "Robbins, Cotran &amp; Kumar Pathologic Basis of Disease</i>",
    caption_style
))
story.append(Sp(10))

# --- Definition ---
story.append(H1("1.  Definition"))
story.append(Sp(6))
story.append(P(
    "<b>Meningitis</b> is an inflammatory process involving the <b>leptomeninges and CSF within the "
    "subarachnoid space</b>, typically caused by infection. When inflammation extends into the brain "
    "parenchyma, it is termed <b>meningoencephalitis</b>."
))
story.append(P("Non-infectious forms include:"))
story.append(B("<b>Chemical meningitis</b> — response to irritants (e.g., debris from a ruptured epidermoid cyst)"))
story.append(B("<b>Carcinomatous meningitis</b> — metastatic cancer cells spreading to the subarachnoid space"))
story.append(B("<b>Autoimmune meningitis</b> — associated with systemic autoimmune disease"))
story.append(Sp(4))

# --- Classification Table ---
story.append(H1("2.  Classification"))
story.append(Sp(6))
story.append(P("Infectious meningitis is classified into three subtypes based on etiology and clinical evolution:"))
story.append(Sp(4))

class_data = [
    ["Type", "Usual Cause", "CSF Pattern"],
    ["Acute Pyogenic", "Bacterial", "Neutrophilic pleocytosis, ↑↑ protein, ↓↓ glucose"],
    ["Aseptic (Viral)", "Enteroviruses (80% of cases)", "Lymphocytic pleocytosis, ↑ protein (moderate), normal glucose"],
    ["Chronic", "TB, spirochetes, fungi", "Mixed cellularity, ↑ protein, ↓ or normal glucose"],
]
story.append(make_table(class_data, col_widths=[4.5*cm, 5.5*cm, 7.5*cm]))
story.append(Sp(10))

# --- Acute Pyogenic ---
story.append(H1("3.  Acute Pyogenic (Bacterial) Meningitis"))
story.append(Sp(6))

story.append(H2("Causative Organisms by Age"))
age_data = [
    ["Age Group", "Common Organisms"],
    ["Neonates", "Escherichia coli, Group B Streptococci"],
    ["Adolescents / Young Adults", "Neisseria meningitidis"],
    ["Elderly", "Streptococcus pneumoniae, Listeria monocytogenes"],
    ["Immunosuppressed", "Klebsiella, anaerobes (atypical course)"],
]
story.append(make_table(age_data, col_widths=[6*cm, 11.5*cm]))
story.append(Sp(6))
story.append(P(
    "Note: <i>Haemophilus influenzae</i> was formerly a major cause in infants; widespread immunization "
    "has dramatically reduced its incidence."
))

story.append(H2("Clinical Features"))
story.append(B("Systemic: fever, malaise"))
story.append(B("Meningeal irritation: headache, photophobia, neck stiffness"))
story.append(B("Neurologic: irritability, clouding of consciousness"))
story.append(Sp(4))

story.append(H2("CSF Findings"))
csf_data = [
    ["Parameter", "Bacterial"],
    ["Appearance", "Turbid / frankly purulent"],
    ["Cells", "Neutrophils ↑↑"],
    ["Protein", "Elevated ↑↑"],
    ["Glucose", "Markedly reduced ↓↓"],
    ["Pressure", "Increased"],
]
story.append(make_table(csf_data, col_widths=[6*cm, 11.5*cm]))
story.append(Sp(8))

story.append(H2("Morphology"))
story.append(H3("Gross Pathology"))
story.append(B("<b>Exudate</b> within leptomeninges on brain surface; meningeal vessels engorged and prominent"))
story.append(B("<b>Tracts of pus</b> extend along blood vessels"))
story.append(B("Distribution varies: <i>H. influenzae</i> → basal; pneumococcal → cerebral convexities near sagittal sinus"))
story.append(B("Fulminant cases: inflammation extends to ventricles (<b>ventriculitis</b>); choroid plexus acts as portal of entry"))
story.append(Sp(4))

story.append(H3("Microscopic Pathology"))
story.append(B("<b>Neutrophils fill the subarachnoid space</b> (severe) or surround leptomeningeal vessels (mild)"))
story.append(B("<b>Gram stain</b> reveals bacteria, especially in untreated cases"))
story.append(B("Fulminant: inflammatory cells infiltrate leptomeningeal vein walls → extend into brain parenchyma (<b>cerebritis</b>)"))
story.append(B("Secondary <b>vasculitis</b> and <b>venous thrombosis</b> → <b>hemorrhagic cerebral infarction</b>"))
story.append(Sp(6))

# Brain image
try:
    img = Image(img_path, width=12*cm, height=8*cm, kind='proportional')
    img.hAlign = 'CENTER'
    story.append(KeepTogether([
        img,
        Paragraph(
            "<i>Fig. 21.16 / Fig. 28.23 — Pyogenic meningitis. A thick layer of suppurative exudate covers "
            "the brain surface and thickens the leptomeninges. (Robbins Pathology)</i>",
            caption_style
        )
    ]))
except Exception as e:
    story.append(P(f"[Image not available: {e}]"))

story.append(Sp(6))
story.append(H3("Sequelae"))
story.append(B("<b>Leptomeningeal fibrosis</b> → <b>hydrocephalus</b>"))
story.append(B("Pneumococcal meningitis: capsular polysaccharide → gelatinous exudate → <b>chronic adhesive arachnoiditis</b>"))
story.append(B("<b>Waterhouse-Friderichsen syndrome</b>: septicemia + hemorrhagic infarction of adrenal glands (meningococcal/pneumococcal)"))
story.append(Sp(8))

# --- Aseptic Viral ---
story.append(H1("4.  Aseptic (Viral) Meningitis"))
story.append(Sp(6))
story.append(P(
    "Aseptic meningitis is a <b>clinical term</b> for meningitis manifestations (meningeal irritation, "
    "fever, altered consciousness) <b>without organisms identifiable by bacterial culture</b>. "
    "It is generally viral in etiology; may be rickettsial or autoimmune. "
    "<b>Enteroviruses</b> account for ~<b>80%</b> of identified cases. Usually self-limited."
))

story.append(H2("CSF Findings"))
vcsf_data = [
    ["Parameter", "Viral (Aseptic)"],
    ["Cells", "Lymphocytic pleocytosis"],
    ["Protein", "Moderately elevated"],
    ["Glucose", "Normal (key distinguishing feature)"],
]
story.append(make_table(vcsf_data, col_widths=[6*cm, 11.5*cm]))
story.append(Sp(4))

story.append(H2("Morphology"))
story.append(B("Leptomeningeal infiltration by <b>lymphocytes and monocytes</b> (not neutrophils)"))
story.append(B("No suppurative exudate"))
story.append(B("Less dramatic changes than bacterial meningitis"))
story.append(Sp(8))

# --- Chronic Meningitis ---
story.append(H1("5.  Chronic Meningitis"))
story.append(Sp(6))
story.append(P(
    "Caused by <b>mycobacteria, spirochetes, and fungi</b>. These infections often also involve "
    "the brain parenchyma."
))

story.append(H2("A. Tuberculous Meningitis"))
story.append(B("Symptoms: headache, malaise, mental confusion, vomiting"))
story.append(B("CSF: moderate ↑ cellularity (mononuclear or mixed), ↑↑ protein, ↓ or normal glucose"))
story.append(B("<b>Tuberculoma</b>: well-circumscribed intraparenchymal mass; may coexist with meningitis"))
story.append(B("Complication: <b>arachnoid fibrosis</b> at base of brain → <b>hydrocephalus</b> (impaired CSF resorption)"))
story.append(Sp(6))

story.append(H2("B. Spirochetal Infections (Neurosyphilis)"))
story.append(P(
    "Occurs in ~10% of untreated <i>Treponema pallidum</i> infection (tertiary syphilis). "
    "HIV co-infection increases risk and aggressiveness."
))
syphilis_data = [
    ["Pattern", "Description"],
    ["Meningovascular neurosyphilis", "Chronic meningitis (basal) + obliterative endarteritis → strokes"],
    ["Paretic neurosyphilis (General paresis)", "Progressive dementia from direct parenchymal invasion"],
    ["Tabes dorsalis", "Degeneration of posterior spinal columns and dorsal nerve roots"],
    ["Lyme neuroborreliosis (B. burgdorferi)", "Meningitis, cranial nerve palsies, radiculopathy"],
]
story.append(make_table(syphilis_data, col_widths=[6.5*cm, 11*cm]))
story.append(Sp(6))

story.append(H2("C. Fungal Meningitis"))
story.append(B("<b>Cryptococcus neoformans</b>: most important fungal cause; especially in HIV/immunocompromised"))
story.append(B("Produces <b>gelatinous meningitis</b> as organisms fill the subarachnoid space"))
story.append(B("Characteristic <b>'soap-bubble' lesions</b> (pseudocysts) in basal ganglia/cortex"))
story.append(Sp(8))

# --- CSF Comparison Table ---
story.append(H1("6.  CSF Summary — Comparison Table"))
story.append(Sp(6))

csf_comp = [
    ["Parameter", "Bacterial", "Viral", "TB / Fungal"],
    ["Appearance", "Turbid/purulent", "Clear", "Clear/viscous"],
    ["Predominant cells", "Neutrophils ↑↑", "Lymphocytes ↑", "Lymphocytes/mixed ↑"],
    ["Protein", "↑↑", "Mildly ↑", "↑↑"],
    ["Glucose", "↓↓", "Normal", "↓ or normal"],
]
story.append(make_table(csf_comp, col_widths=[4.5*cm, 4.5*cm, 4.5*cm, 4*cm]))
story.append(Sp(10))

# Footer note
story.append(HR())
story.append(Paragraph(
    "<i>Robbins &amp; Kumar Basic Pathology (Robbins Pathology), Chapter 21 &nbsp;|&nbsp; "
    "Robbins, Cotran &amp; Kumar Pathologic Basis of Disease, Chapter 28</i>",
    caption_style
))

# Build
doc.build(story)
print("PDF generated successfully:", OUTPUT)