Bacterial meningitis


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Bacterial meningitis

  2. 2. <ul><li>- Knowing whether meningitis is caused by a virus or bacterium is important because the severity of illness and the treatment differ. Viral meningitis is generally less severe and resolves without specific treatment, while bacterial meningitis can be quite severe and may result in brain damage, hearing loss, or learning disability. For bacterial meningitis, it is also important to know which type of bacteria is causing the meningitis because antibiotics can prevent some types from spreading and infecting other people. </li></ul>
  3. 3. <ul><li>Meningitis </li></ul><ul><li>--is an infection of the fluid of a person's spinal cord and the fluid that surrounds the brain. People sometimes refer to it as spinal meningitis. Meningitis is usually caused by a viral or bacterial infection. </li></ul>
  4. 4. <ul><li>Haemophilus influenzae type b (Hib) </li></ul><ul><li>Streptococcus pneumoniae </li></ul><ul><li>Neisseria meningitidis </li></ul>
  5. 5. <ul><li>MODE OF TRANSMISSION </li></ul><ul><li>direct contact </li></ul><ul><li>indirect contact </li></ul><ul><li>droplets </li></ul><ul><li>INCUBATION PERIOD </li></ul><ul><li>5-10 days after breaking blood brain barrier, but lethal in 24 hours and shorter especially in young pt. </li></ul>
  6. 6. <ul><li>What are the signs and symptoms of meningitis? </li></ul><ul><li>Common symptoms of meningitis </li></ul><ul><li>High fever, </li></ul><ul><li>headache </li></ul><ul><li>stiff neck </li></ul><ul><li>These symptoms can develop over several hours, or they may take 1 to 2 days. </li></ul>
  7. 7. <ul><li>PERIOD OF COMMUNICABILITY </li></ul><ul><li>meningococci exist in the nasopharynx of about 5 % of the population and spread by respiratory droplets and close contact. </li></ul>
  8. 8. <ul><li>Other symptoms may include: </li></ul><ul><li>- nausea </li></ul><ul><li>-vomiting </li></ul><ul><li>-discomfort looking into bright lights </li></ul><ul><li>Confusion </li></ul><ul><li>-sleepiness. </li></ul>
  9. 9. <ul><li>In newborns and small infants, the classic symptoms of: </li></ul><ul><li>Fever </li></ul><ul><li>headache </li></ul><ul><li>neck stiffness may be absent or difficult to detect, and the infant may only appear slow or inactive, or be irritable, have vomiting, or be feeding poorly. As the disease progresses, patients of any age may have seizures. </li></ul>
  10. 10. <ul><li>How is meningitis diagnosed? </li></ul><ul><li>The diagnosis is usually made by growing bacteria from a sample of spinal fluid. The spinal fluid is obtained by performing a spinal tap, in which a needle is inserted into an area in the lower back where fluid in the spinal canal is readily accessible. </li></ul>
  11. 11. <ul><li>CSF finding in different forms of meningitis: </li></ul>
  12. 12. Condition    Glucose   Protein Cells Acute bacterial meningitis low high high, often > 300/mm³ Acute viral meningitis normal normal or high mononuclear , < 300/mm³ Tuberculous meningitis low high pleocytosis , mixed < 300/mm³ Fungal meningitis low high < 300/mm³ Malignant meningitis low high usually mononuclear
  13. 13. <ul><li>Is meningitis contagious? </li></ul><ul><li>Yes, some forms are bacterial meningitis are contagious. The bacteria are spread through the exchange of respiratory and throat secretions (i.e., coughing, kissing). Fortunately, none of the bacteria that cause meningitis are as contagious as things like the common cold or the flu, and they are not spread by casual contact or by simply breathing the air where a person with meningitis has been. </li></ul>
  14. 14. <ul><li>blood tests are performed for markers of inflammation </li></ul><ul><li>(e.g. C-reactive protein), as well as blood cultures. </li></ul><ul><li>The most important test in identifying or ruling out meningitis, however, is analysis of the cerebrospinal fluid through lumbar puncture (LP, spinal tap). </li></ul>
  15. 15. <ul><li>In such cases a CT or MRI scan is generally performed prior to the lumbar puncture to exclude these a CT or MRI is required before LP, or if LP proves difficult, professional guidelines suggest that antibiotics should be administered first to prevent delay in treatment, especially if this may be longer than 30 minutes. Often, CT or MRI scans are performed after the LP if not done previously to assess for complications of meningitis. </li></ul>
  16. 16. <ul><li>Bacteria </li></ul><ul><li>As a consequence there is an increase in brain water content and an increase in intracranial pressure. </li></ul>penetrate the blood-brain barrier, endotoxin and inflammatory mediators initiate a CSF inflammatory response causing leakage of protein and fluid out of the cerebral vasculature. the processes delineated in septicemia occur in brain blood vessels, causing cerebral edema and cerebral vascular thrombosis.
  17. 17. <ul><li>Both the increased pressure and thrombosis </li></ul><ul><li>may lead to a reduction in cerebral perfusion, and consequently cerebral infarction </li></ul><ul><li>Brain death </li></ul>
  18. 18. <ul><li>Vaccines against meningitis: </li></ul><ul><li>By age 6 months of age, every infant should receive at least 3 doses of an Hib vaccine. A fourth dose (&quot;booster&quot;) should be given to children between 12 and 18 months of age. </li></ul>
  19. 19. NURSING INTERVENTION <ul><li>Observe standard precautions to prevent dse. transmission. </li></ul><ul><li>administer TSB prn. </li></ul><ul><li>administer antibiotics with strict administration schedule. </li></ul><ul><li>provide mouth care. </li></ul><ul><li>after seizure roll pt. to side/semiprone-to facilitate gravity, drainage of secretions. </li></ul><ul><li>reduce noise env’t. </li></ul>
  20. 20. <ul><li>encourage fluid intake as appropriate. </li></ul><ul><li>keep pt’s room darken and ask family to bring sunglasses for photophobia. </li></ul>
  21. 21. <ul><li>Treatment: </li></ul><ul><li>ceftriaxone, one of the third-generation cefalosporin antibiotics recommended for the initial treatment of bacterial meningitis. </li></ul><ul><li>High-flow oxygen should be administered as soon as possible, along with intravenous fluids if hypotension or shock are present </li></ul><ul><li>Mechanical ventilation may be needed if the level of consciousness is very low, or if there is evidence of respiratory failure </li></ul>
  22. 22. <ul><li>Prevention </li></ul><ul><li>A quadrivalent vaccine - Meningococcus vaccines exist against groups A, C, W135 and Y </li></ul><ul><li>Pneumococcal polysaccharide vaccine </li></ul><ul><li>Prophylaxis </li></ul><ul><li>In cases of meningococcal meningitis, prophylactic treatment of close contacts with antibiotics (e.g. rifampicin, ciprofloxacin or ceftriaxone) can reduce their risk of contracting the condition, but does not protect against future infections. </li></ul>
  23. 24. VIRAL MENINGITIS <ul><li>It is the inflammation of the meninges or cases of meningeal irrigation from other causes such as brain abscess, encephalitis, lymphoma, leukemia or blood in the subarachnoid space. </li></ul><ul><li>CAUSATIVE AGENT: </li></ul><ul><li>Enterovirus 71 & 70 </li></ul><ul><li>polioviruses types 1,2,&3 </li></ul>
  24. 25. <ul><li>epstein-barr virus </li></ul><ul><li>coxsackievirus type A(23 serotypes) and type B (6 serotypes) </li></ul><ul><li>HIV </li></ul><ul><li>measles </li></ul><ul><li>variola virus </li></ul><ul><li>rubella viruses </li></ul><ul><li>rhinovirus </li></ul><ul><li>varicella zooster virus </li></ul><ul><li>arbovirus </li></ul>
  25. 26. MODE OF TRANSMISSION <ul><li>Enteroviruses are spread via direct contact with respiratory secretion of an infected person and through feces. other viruses (mumps, herpes, chicken pox) are spread through personal contact via air. </li></ul>
  26. 27. INCUBATION PERIOD <ul><li>Enteroviruses usually present between 3-7 days from the time you are infected until you develop symptoms. Symptoms develops 7-10 days. </li></ul><ul><li>PERIOD OF COMMUNICABILITY </li></ul><ul><li>a person can usually spread the virus to someone else beginning about 3 days after you are infected until about 10 days after you develop symptoms. </li></ul>
  27. 28. INITIAL SYMPTOMS <ul><li>headache </li></ul><ul><li>fever </li></ul><ul><li>nochal rigidity </li></ul><ul><li>CLINICAL FINDINGS </li></ul><ul><li>Fever </li></ul><ul><li>poor feeding </li></ul><ul><li>irritability </li></ul><ul><li>seizure </li></ul><ul><li>rash </li></ul><ul><li>tachypnea </li></ul>
  28. 29. <ul><li>jaundice </li></ul><ul><li>bulging of fontanel </li></ul><ul><li>vomiting </li></ul><ul><li>diarrhea </li></ul><ul><li>Pathognomonic signs: </li></ul><ul><li>Brudzinki’s sign- place the patient in a dorsal recumbent position then pt your hands behind his neck & bend it forward. Pain & resistance may indicate meningeal inflammation, neck injury </li></ul>