19738100 Meningitis Complete

7/31/2019 19738100 Meningitis Complete

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MENINGITIS

Presented by: Bijaya Rai

Roll no-12B.Sc nursing (II year)


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CONTENT

Definition Incidence Causative agent Pathophysiology Classification

Bacterial meningitis Causes Predisposing factors Sign and symptoms

Investigation Nursing management Treatment Complication Outcome. Prevention

Summary


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Meningitis

Meningitis is inflammation ofthe protective membranescovering the brain and spinalcord, known collectively asmeninges.

Inflammation may be causedby infection with viruses,bacteria, or other micro-organism and lesscommonly by certain drugs.

It is classified as Medicalemergency.


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Incidence:

Kids of any age can get meningitis, butbecause it can be easily spread betweenpeople living in close quarters, teens, college

students, and boarding-school students.


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Causative agent:

Type Pathogen (most Common)

Bacterial Strep pneumoniae, E-coli, Neisseriameningitis

Viral infection Coxsackie Virus, Echovirus,

Enterovirus, Arbovirus, HIV, HSV-2

TB meningitis M. Tuberculosis

ProtozoalInfection

Toxoplasma Gondii(toxoplasmosis)

Fungal infection Cryptococcus neoformans(cryptococcal meningitis)


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Vasculitis of cerebralvessels

Ischemia, cytotoxicedema

Immune Responsefrom

Astrocytes+Microglia,Cytokin Release

Inc. BBBpermeabilty

Inc. no. of WBC inCSF

Fluid leakage fromvessels

Inflammation ofMeninges

Dec. cerebral bloodflow

Vasogenicedema

Interstitial edema (Inc.ECF)

Cerebral

Edema

SubarachnoidSpace

Microorganisms

Via BloodDirect to

CSF

PATHO PHYSIOLOGY

Dec. Cerebral blood flow, Ischemia, apoptosis (Brain Death)


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Classification:

Acute pyogenic (bacterial) meningitis

Acute aseptic (viral) meningitis

Chronic bacterial infection (tuberculosis).


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Causes/ Pathogens:

In neonatal period- Escherichia coli, Streptococcuspneumonae,Salmonella species,Pseudomonasaeruginosa,Streptococcus fecalis andStaphylococcus aureus.

3 months to 3 years: Hemophilus influenza,S.pnemoniae and meningococci(Neisseriameningitidis).

Beyond 3 years: S.pnemoniae and Neisseriameningitis.

Other: Accidental wound infection and iatrogeniccause.

Mode Of Transmission:The bacteria are spread bydirect close contact with the discharges from thenose or throat of an infected person.


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Predisposing Factor:

Prematurity

Low birth weight baby

Complicated labor

Prolonged rupture of membrane

Maternal sepsis

Babies in artificial respiration or intensive

care.


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BACTERIAL MENINGITIS

Inflammation of meninges caused bybacteria.

Should be taken seriously.

Can be lifethreatening if not treated rightaway.


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Sign and Symptoms:

The sign and symptoms of meningitis vary and depend both on theage of the child and on the cause of the infection. Because the flu-likesymptoms can be similar in both types of meningitis, particularly in theearly stages, and bacterial meningitis can be very serious, it's importantto quickly diagnose an infection.

The first symptoms of bacterial or viral meningitis can come on quickly

or surface several days after a child has had a cold and runny nose,diarrhea and vomiting, or other signs of an infection. Commonsymptoms include:

fever lethargy (decreased consciousness) irritability headache photophobia (eye sensitivity to light) stiff neck skin rashes seizures


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In newborns and infants, the typical symptoms of fever, headache,and neck stiffness may be hard to detect. Other signs in babiesmight be inactivity, irritability, vomiting, and poor feeding.

symptoms of meningitis in infants can include:

jaundice (a yellowish tint to the skin)

stiffness of the body and neck (neck rigidity)

fever or lower-than-normal temperature

poor feeding

a weak suck

a high-pitched cry

bulging fontanelles (the soft spot at the top/front of the baby'sskull)

Viral meningitis tends to cause flu-like symptoms, such as feverand runny nose, and may be so mild that the illness goesundiagnosed. Most cases of viral meningitis resolve completelywithin 7 to 10 days, without any complications or need fortreatment.


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1) Acute Pyogenic BacterialMeningitis


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Investigation:

Physical Examination: Brudzinskis & Kernigs sign Nuchal rigidity

Laboratory Investigation:

Specimen: CSF Chemistry - glucose and protein. Cytology WBC and %PMN Gram stain or Rapid diagnostic tests Polymerase chain reaction: (N.meningitidis, S. pneumoniae, H.

influenzae, S. agalactiae, L. monocytogenes & enteroviruses). Non- specific tests: including C-reative protein, lactic dehydrogenase,and CSF lactic acid level .

Culture for pathogens.

Blood, Urine, & Sputum Cultures


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CSF Detail Report:

Changes in CSF Normal Pyogenic (Bacterial)

Appearance Crystal-clear Turbid/purulent

WBC < 5 mm3 > 1000 mm3

Mononuclear cells < 5 mm3


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Nursing management:

Vital signs are obtained and monitoredfrequently depending on childs condition.

In infant, the nurses should monitor the

fontanel and maintain a record of the dailyhead circumference.

Input/ output charting should be done.

Daily weight of child should should be taken.

Positioning should be maintained every 4hourly.


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Empirical Therapy For ABMAge Common Pathogen Anti microbial

< 1 month Streptococcus agalactiae, Escherichia coli, Listeriamonocytogenes, Klebsiella species

Ampicillin plus cefotaximeor ampicillin plus anaminoglycoside

4-12 weeks Streptococcus pneumoniae, Haemophilusinfluenzae, Group B streptococcus,Listeriamonocytogenes.

Ampicillin plus eithercefotaxime or ceftriaxone.

12 weeksand older

H. influenza, N. meningitidis, S. pneumoniae Ceftriaxone or cefotaximeor ampicillin pluschloramphenical.


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Microorganism Duration of therapy, days

Neisseria meningitidis 7

Haemophilus influenzae 7

Streptococcus pneumoniae 10-14

Streptococcus agalactiae 14-21

Aerobic gram-negative bacillia 21

Listeria monocytogenes >21

Duration of Antimicrobial Therapy for Bacterial Meningitis Based on Isolated Pathogen (A-III)a Duration in the neonate is 2 weeks beyond the first sterile CSF culture or >3 weeks, whichever is longer.

Duration OF Therapy For ABM


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Dexamethasone is given in a dose 0.5mg/kg/6hourly for 4 days .The dose should beadministered intravenously 15 minutes before firstparenteral antibiotic dose.

Adjunctive dexamethasone should not be given tothe patients who have already receivedantimicrobial therapy, because administration of

dexamethasone in this circumstance is unlikely toimprove patient outcome

Adjunct Steroid Therapy for Infants,Children


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Complication:

Subdural effusion or empyema

Ventriculities

Arachnoiditis

Brain abscess

Hydrocephalous

Hemiplegia

Aphasia

Ocular palsies

Hemianopsia

Blindness Deafness

Mental retardation

Shock

Status epilepticus


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Outcome:

The majority of children recover without permanentdeficits.

Subdural hematomas develop in approximately 50%of children under 18 months, but most resolve withouttreatment. Headaches may persists for varying periodof time.

15-20% of children may develop auditory nervedeficit.

Even when children have defects,many children haveno evidence of the defects 2 years after discharge.


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Prevention:

Vaccines -- There are vaccines against Hib, some strains of Neisseriameningitidis, and many types of Streptococcus pneumoniae.

The vaccines against Hib are very safe and highly effective. By age 6months of age, every infant should receive at least three doses of an Hibvaccine. A fourth dose (booster) should be given to children between 12and 18 months of age.

The vaccine against Neisseria meningitidis(meningococcal vaccine) is notroutinely used in civilians in the United States and is relatively ineffectivein children under age 2 years. The vaccine is sometimes used to controloutbreaks of some types of meningococcal meningitis in the UnitedStates. New meningococcal vaccines are under development.

The vaccine against Streptococcal pneumoniae(pneumococcal vaccine) isnot effective in persons under age 2 years but is recommended for allpersons over age 65 and younger persons with certain medical problems.New pneumococcal vaccines are under development.


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Disease reporting -- Cases of bacterial meningitis should bereported to state or local health authorities so that they canfollow and treat close contacts of patients and recognizeoutbreaks.

Treatment of close contacts -- People who are identified as

close contacts of a person with meningitis caused by Neisseriameningitidis can be given antibiotics to prevent them fromgetting the disease. Antibiotics for contacts of a person with Hibdisease are no longer recommended if all contacts 4 years ofage or younger are fully vaccinated.

Travel precautions -- Although large epidemics of bacterialmeningitis do not occur in the United States, some countriesexperience large, periodic epidemics of meningococcal disease.Overseas travelers should check to see if meningococcalvaccine is recommended for their destination. Travelers shouldreceive the vaccine at least 1 week before departure, if possible.


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Summary:

Acute bacterial meningitis, a major cause of morbidityand mortality in young children, occurs both inepidemic and sporadic pattern.

It is commoner in neonates and infants than in olderchildren because their immune mechanism andphagocytic functions are not fully matured.

It is life threatening situation and nursing care is veryimportant.

Treatment is possible but may develop auditory andneurological defects.


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Reference:

Ghai O.P.; Essential Pediatrics; 6th edition 2005;CBSPublishers and distributors ,New Delhi : Page no:517-20

Parthasarathy A, IAP Textbook of Pediatrics ; 3rd Edition,Jaypee Brothers Medical Publishers (P) Ltd; Page no: 336-

40.

Dorothy R. Marlow, Barbara A. Redding, Textbook ofPediatric Nursing, 6th Edition, 2009, ELSEVIER

Retrieved on google.com on 7th and 24th July 2009.


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19738100 Meningitis Complete

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