Meningitis

MENINGITIS

1. MENINGITIS Ms.Keerthi.K Asst.Professor Vijay Marie Con

2. ANATOMY OF MENINGES

3. DEFINITION Meningitis (from Greek meninx , "membrane”) is an acute inflammation of the meninges caused by either bacteria or virus. Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The most common symptoms are fever, headache, and neck stiffness.

4. INCIDENCE Although meningitis is a notifiable disease, the exact incidence rate is unknown. In 2010 – 420, 000 deaths In 2013 - 303,000 deaths. n 2015, meningitis occurred in about 8.7 million people worldwide This resulted in 379,000 deaths—down from 464,000 deaths in 1990. With appropriate treatment the risk of death in bacterial meningitis is less than 15%. Outbreaks of bacterial meningitis occur between December and June each year in an area of sub-Saharan Africa known as the meningitis belt

5. Route of Entry in CNS

6. ETIOLOGY The causes can be classified into: Bacterial Infections Viral Infections Fungal Infections Inflammatory diseases (SLE) Cancer Trauma to head or spine

7. PATHOPHYSIOLOGY

8. BACTERIAL MENINGITIS Also known as septic meningitis, extremely serious that requires immediate care. Can lead to permanent damage of brain or disability and death. Spreads by:-coughing or sneezing Treatment available : antibiotics as per causative organism. Causative Agents: Streptococcus Pneumonia 30-80% Neisseria meningitis 15- 40% Hemophilus Influenza 2-7%

9. TUBERCULAR MENINGITIS TB meningitis is caused by Mycobacterium tuberculi that usually begins in the lungs 1 – 2% of cases the bacteria travel via the bloodstream. Unlike other types of meningitis its progresses very slowly and symptoms are vague

10. VIRAL MENINGITIS Also known as aseptic meningitis. More common than bacterial form and usually less serious. Less likely to have permanent brain damage after the infection resolves. Treatment: No specific treatment available. Most patients recover completely on their own Causative agents: Enterovirus , Adenovirus ,Arbovirus,Measles virus, Herpes simplex virus, Varicella

11. FUNGAL MENINGITIS It is much less common than the other two infections. It is rare in healthy people but it is more likely in persons who have impaired immune system. Risk factors are :Systemic infections , Viral RTIs , Tobacco use , Impaired Immune system , Over crowding,immunosuppressants (such as after organ transplantation), HIV/AIDS, and the loss of immunity associated with aging. The most common fungal meningitis is cryptococcal meningitis due to Cryptococcus neoformans . Other less common fungal pathogens which can cause meningitis include: Coccidioides immitis , Histoplasma capsulatum , Blastomyces dermatitidis , and Candida species.

12. PARASITIC MENINGITIS This type of meningitis is less common than viral or bacterial meningitis, and it’s caused by parasites that are found in dirt, feces, and on some animals and food, like snails, raw fish, poultry, or produce. One type of parasitic meningitis is rarer than others. It’s called eosinophilia meningitis (EM). Three main parasites are responsible for EM. These include: Angiostrongylus cantonensis Baylisascaris procyonis Gnathostoma spinigerum

13. PARASITIC MENINGITIS Parasitic meningitis is not passed from person to person. Instead, these parasites infect an animal or hide out on food that a human then eats. If the parasite or parasite eggs are infectious when they’re ingested, an infection may occur. One very rare type of parasitic meningitis, amebic meningitis , is a life-threatening type of infection. This type is caused when one of several types of ameba enters the body through the nose while you swim in contaminated lakes, rivers, or ponds. The parasite can destroy brain tissue and may eventually cause hallucinations, seizures, and other serious symptoms. The most commonly recognized species is  Naegleria fowleri .

14. CLINICAL MANIFESTATION

15. CLASSIC TRIAD OF SYMPTOMS However, all three features are present in only 44–46% of bacterial meningitis cases. If none of the three signs are present, acute meningitis is extremely unlikely. Other signs commonly associated with meningitis include photophobia (intolerance to bright light) and phono phobia (intolerance to loud noises). The fontanels can bulge in infants aged up to 6 months. Other features that distinguish meningitis from less severe illnesses in young children are leg pain, cold extremities, and an abnormal skin color.

16. CARDINAL SIGNS

17. CLINICAL MANIFESTATIONS Nuchal rigidity: Inability to flex the neck forward due to rigidity of neck muscles, if flexion of the neck is painful but full ROM is present then NR is absent Jolt accentuation : Exacerbation of existing headache with rapid head rotation

18. CLINICAL MANIFESTATIONS Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees. Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed

19. ASSESSMENT AND DIAGNOSIS

20. CSF FINDING

21. COMPLICATION S Sensory-neural hearing loss Epilepsy/ seizures Memory loss Paralysis Learning difficulty Behavioral difficulty Decreased intelligence Septicemia Death

22. MEDICAL MANAGEMENT BACTERIAL MENINGITIS: Third-generation cefalosporin such as cefotaxime or ceftriaxone Vancomycin is added in the regime in case of resistance Dexamethasone Dehydration and shock can be treated with fluid therapy. Phenytoin for seizure management

23. TUBERCULAR MENINGITIS: ATT medications are started: Isoniazid; rifampacin ; pyrazinamide and streptomycin. Second line drugs: Aminoglycosides; Fluroquinolones Conventional therapy is given for 6-9 months In children BCG vaccine offers ( approx 64%) protective effect

24. VIRAL MENINGITIS Treatment is mostly supportive and no medicines are prescribed. Seizure prophylaxis :Lorazepam or phenytoin or barbiturate. Increased ICP : Inj. Mannitol 1g/kg followed by 0.25- 0.5g/kg Q6H or/and dexamethasone Rest is advised offers ( approx 64%) protective effect In case hydrocephalus is present VP or LP shunt is required. Adequate hydration is to be maintained Antipyretics Anti emetics

25. QUESTIONS A patient being treated for viral meningitis arrives at the hospital reporting a persistent severe headache. Which nursing intervention is  most  appropriate for the patient? a.Telling the patient to use analgesics b.Informing the patient that headaches can occur after recovery c.Informing the patient that a headache is not a major complication d.Informing the patient that a full recovery from viral meningitis is not possible RATIONALE: he patient should be informed that headaches will occur post recovery, even though they are a rare manifestation. The patient should be treated symptomatically, based on the reason for developing the headache. A complete recovery is expected. A severe headache might be a major complication.) a

26. QUESTIONS 2.The nurse is assessing the client diagnosed with bacterial meningitis. Which clinical manifestations would support the diagnosis of bacterial meningitis a.Positive Babinski's sign and peripheral paresthesia . b.Negative Chvostek's sign and facial tingling. c.Positive Kernig's sign and nuchal rigidity. d.Negative Trousseau's sign and nystagmus . Rationale: (. A positive Kernig's sign (client unableto extend leg when lying flat) and nuchal rigidity (stiff neck) are signs ofbacterial meningitis, occurring becausethe meninges surrounding the brainand spinal column are irritated.)

27. QUESTIONS The nurse is caring for a client diagnosed with meningitis. Which collaborative intervention should be included in the plan of care? A.Administer antibiotics. B.Obtain a sputum culture. C.Monitor the pulse-oximeter. D.Assess intake and output. Rationale: A nurse administering antibiotics is a collaborative intervention because the HCP must write an order for the intervention; nurses cannot prescribe medications unless they have additional education and licensure and are nurse practitioners with prescriptive authority.)

28. QUESTIONS Which statement best describes the scientific rationale for alternating a nonnarcotic antipyretic and a nonsteroidal anti-inflammatory drug (NSAID) every two (2) hours to a female client diagnosed with bacterial meningitis? 1. This regimen helps to decrease the purulent exudate surrounding the meninges. 2. These medications will decrease intracranial pressure and brain metabolism. 3. These medications will increase the client's memory and orientation. 4. This will help prevent a yeast infection secondary to antibiotic therapy. Rationale: Fever increases cerebral metabolism and intracranial pressure. Therefore, measures are taken to reduce body temperature as soon as possible, and alternating Tylenol and Motrin would be appropriate.)

29. QUESTIONS A 29-year-old client is admitted to the medical floor diagnosed with meningitis. Which assessment by the nurse has priority? 1. Assess lung sounds. 2. Assess the six cardinal fields of gaze. 3. Assess apical pulse. 4. Assess level of consciousness..) Rationale: Meningitis directly affects the client's brain. Therefore, assessing the neurological status would have priority for this client.) CDC recommends meningococcal vaccine between ages___ to ____ and booster at ___ Ans:11 12 16