19738100 meningitis completed

8/4/2019 19738100 Meningitis Completed

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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, but

because it can be easily spread between

people living in close quarters, teens, college

students, and boarding-school students.


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Causative agent:

Cryptococcus neoformans(cryptococcal meningitis)

Fungal infection

Toxoplasma Gondii

(toxoplasmosis)

Protozoal

Infection

M. TuberculosisTB meningitis

Coxsackie Virus, Echovirus,

Enterovirus, Arbovirus, HIV, HSV-2

Viral infection

Strep pneumoniae, E-coli, Neisseriameningitis

Bacterial

Pathogen (most Common)Type


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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. cerebralblood flow

Vasogenicedema Interstitial edema(Inc. ECF)

CerebralCerebral

EdemaEdema

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 the noseor 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 by

bacteria.

Should be taken seriously.

Can be life threatening if not treated rightaway.


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Sign and Symptoms:

The sign and symptoms of meningitis vary and depend both on the ageof 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 monitored

frequently 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 4

hourly.


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Empirical Therapy For ABMAge Common Pathogen Anti microbial

< 1 month Streptococcus agalactiae, Escherichia coli, Listeria

monocytogenes, Klebsiella species

Ampicillin plus cefotaxime

or ampicillin plus an

aminoglycoside

4-12 weeks Streptococcus pneumoniae, Haemophilus

influenzae, Group B streptococcus,Listeria

monocytogenes.

Ampicillin plus either

cefotaxime or ceftriaxone.

12 weeks

and older

H. influenza, N. meningitidis, S. pneumoniae Ceftriaxone or cefotaxime

or ampicillin plus

chloramphenical.


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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 0.5

mg/kg/6hourly for 4 days .The dose should be

administered intravenously 15 minutes before first

parenteral antibiotic dose.

Adjunctive dexamethasone should not be given to

the patients who have already received

antimicrobial 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 permanent

deficits.

Subdural hematomas develop in approximately 50%

of children under 18 months, but most resolve without

treatment. Headaches may persists for varying period

of time.

15-20% of children may develop auditory nerve

deficit.

Even when children have defects,many children have

no 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 ofStreptococcus 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 United States.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 morbidity

and mortality in young children, occurs both in

epidemic and sporadic pattern.

It is commoner in neonates and infants than in older

children because their immune mechanism and

phagocytic functions are not fully matured.

It is life threatening situation and nursing care is very

important.

Treatment is possible but may develop auditory and

neurological 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 completed

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