2. MENINGITIS Definition: It is an inflammation
of the MENINGES, the three membranes that
envelope the brain and spinal cord
TYPES OF MENINIITIS:
1.Acute Pyogenic Meningitis
2. Acute Arpe Meningitis
3. Chronic Meningitis
3.
4. Clinical Manifestations
Severe Headache
Nuchal Rigidity(neck stiffness)
High fever,chills.vomiting
Photophobia
Phonophobia
A bulge in soft spot on top of a baby`s
head(fontanel)
Kernig sign(inability to straighten leg when
the hip is flexed to 90 degrees)
Young child: leg pain, cold
extremities,abnormal skin colour,seizures
5. Exposure to pathogen and colonization of
micro organism at Naso oropharnyngeal
mucosa
Entry into blood stream and inflammation of
meninges
Attachment to mucosal surface and changes in
CSF
Secondary brain damage
6. Result:
Vascular endothelial inflammation
Increase BBB permeability
Entry into blood component and
sub-arachnoid space
Cerebral edema
Increase CSF proteins and ICP
Decrease blood flow
Permanent neuronal injury
/dysfunction
7. 1. CSF-Lumbar puncture L3-L4 and L4-L5 –
cloudy appearance/purulent
2. Increase in Neutrophils[90,000/mm3]
3.Increase in Protein level[>100 or500]
4.Decrease Glucose levels [<50%]
Ranges in meningitis:
Lymphocyte Protein Glucose
Bacteria 50-2000 1-3 <50%
TB 100-600 1-6 <50%
Viral 5-500 0.5-1 Normal
Fungal 50-1000 1-3 <50%
8. SUBJECTIVE DATA
PATIENT NAME: XYZ
AGE: 27yrs
GENDER : Male
DOA:15/12/18
DEPT:General ward
PATIENT COMPLAINTS: Head ache
Fever on and off
Body pains(mild)
PRESNT ILLNESS: 27yr old male patient was
admitted with history of above complaints came
here for further evaluation and management
PAST MEDICAL HISTORY: Allergy to Pencillin
9. OBJECTIVE DATA
1.Day to day assesment and Vital signs
Day 1:
Temp:98.4˚F
bp:130/80mmHg
PR:58 bpm
RR:20bpm
Spo2:98%
O/E Pt conscious /cohrent
headache+
blurred vision on and off
11. Day 4
High protein diet recommended
No fresh complaints
2.LAB INVESTIGATION
Hematology
TEST RESULT NORMAL
RANGE
Hb 14.50gms% 12-15gms%
RBC 5.09Million/cumm
4.5-5.5
million/cumm
Platelet count 2.75lakhs/cumm 1.5-4.1
lakhs/cumm
PT-T 28sec 25-35sec
INR 1.09 0.9-1.2
12. Differential count
TEST RESULT Normal range
WBC 9,986 /microlitre 4k—10k/microlitre
Eosinophils 4.30% 1-6%
Monocytes 5.40% 2-10%
Basophils 0.60% 0.5-1%
Neutrophils 9,149/mm3 1500-8k/mm3
lymphocytes 1,990/microlitre 1k-4800/microlitre
13. Renal function tests
Liver function tests
TEST RESULT Normal Range
Sr.urea 14.00mg/dl 7-20mg/dl
Sr.creatinine 0.80mg/dl 0.6-1.2mg/dl
Blood urea
nitrogen
6.54mg/dl 9-20mg/dl
TEST RESULT Normal Range
Protein 17.3g/dl 6.8-8.3g/dl
glucose 52mg/dl 70-130mg/dl
14. CSF Results
Quantity -2ml
Appearance clear and colourless
Reaction alkaline
CSF FOR CYTOLOGY
Cellular smear shows lymphocytic
pleocytosis composed predominantly of
mature and transformed cells
Few monocytes, and pia archonoid
meningothelial cells are seen
IMPRESSION: Lymphocytic Meningitis
15. ACID FAST BACILLI SMEAR
Polymorphs few
No AFB seen
SMEAR FOR FUNGAL ELEMENTS
Negative
SMEAR FOR GRAM STAIN
Polymorphs few
No micro organism seen
ECG and X-RAY: normal
TB: not detected
16. ASSESMENT
Based on subjective and objective
data the patient is diagnosed with ACUTE
MENINGITIS
17. PLAN
Medication chart:
Drug Generic name dose frequ
ency
ROA Da
y 1
Da
y 2
Da
y 3
Da
y 4
Da
y 5
Inj monocef Ceftriaxone 2g BID IV + + + + +
Inj acyclovir Acyclovir 500µg BID IV + + + + +
Inj PCM paracetamol 100ml SOS IV + + + + +
Inj PAN Pantoprazole 40mg PO IV + + + + +
Inj mannitol mannitol 20% BID IV + + + + +
IVF DNS Dextrose
normal saline
30ml/
hr
IV + + + + +
18. DRUG Generic
Name
Dose Frequ
ency
ROA Da
y 1
Da
y2
Da
y 3
Da
y 4
Da
y 5
Inj zofer ondansetro
n
40mg SOS IV + + + + +
Inj optineuron Vit B1, B2,
B3,B5 B6,
B12,
1g OD IV - + + + +
Inj dexona dexamethas
one
4mg BID IV - + + + +
syp duphalac lactulose 30ml HS PO - - - + +
19. Drug Class MOA Side effects Uses
Inj Monocef 3rd gen
cephalspori
n
Inhibit mucopeptide
synthesis in bacterial
cell wall resulting in
cell death
Allergic rxns
Diarrhea
Seizures
leukopenia
To treat bact
infection
InjAcyclovir Antiviral
drug
Inhibits viral DNA
polymerase results in
viral replication
N,V,D,
Visual
changes,hair
loss
Viral
infection
treated
Inj PCM Antipyretic
analgesic
Selective cox-2
inhibition
Constipation
Inj site rxn
To reduce
pain and
fever
Inj Mannitol Osmotic
diuretic
Elevates blood
plasma osmolarity
causing enhanced
flow of water from
tissues, brain and csf
VolumThrom
bophlebitis,
Hypernatrem
ia
tachycardia
e
Lowers ICP,
CSF
20. DRUG CLASS MOA Side effects uses
Inj zofer Anti
emetic
Blocks serotonin
receptors in CTZ
reuces communication
with vomitting center
QT prologantion
Otototxicity
Allregic rxn
Nausea and
vomiting
Inj
Optineur
on
Multi -
Vitamin
vitB2 may lead to
slight improvements in
motor function,
cognitive behavior, and
diarrhea in this
disorder.
Increase blood
sugar levels
N, D
VITAMIN B
deficency
Inj PAN PPI Inhibits gastric acid Arthralgia
flacutence
Decreases
acidity
21. Drug class MOA Side effects Uses
Inj Dexona corticosteroid unclear HTN,
Dyspepsia
Cataract(10%
)
Regulate
inflammation
response and
cover CSF
pressure
Syp Duphalac Laxative Increase in
stool water
and soft stool
[bcoz
constipation
may lead to
fever]
Bleaching
Excessive
bowel activity
Treat
constipation
22. Goals of treatment
Eradication of infecting organism
Management of CNS and systemic
complications
Reduce the fever, headache, and body
pain
Photophobia and phonophobia should be
treated
23. PATIENT COUNSELLING
Advice the patient that prophylactic
treatment may be indicated and they
should visit their health care providers
Encourage patient to follow medication
regimen as directed
Prompt attention to infection in future
24. Monitoring parameters
Neutrophils levels should be monitored
Glucose levels should be monitored
Protein levels should be monitored
Vitals should be checked regularly
ICP pressure(normal range 5-15mmHg)
25. LIFE STYLE MODIFICATIONS
Regular Exercise:
Eg: stretching exercises due to stiff neck
Balancing exercises such as standing
with eyes closed, standing on one leg.
This is important as they need balance
for tasks such as walking,running etc.
Co-ordination exercise such as catching
balls,kicking football.
26. DIET
Food to be taken
Fruits like watermelon, berries, grape fruit,
papaya.
Vegetable like broccoli, red capsicum,
carrot, cabbage, leafy green vegetables.
Adequate fluid intake
27. FOODS TO BE AVOIDED
Sugary food
White flour food
Processed food
Smoked fish
Alcohol/caffeinated beverages
28. PRECAUTIONS
Follow the medication as per the
prescription
Do not miss the dose
Do not double the missed dose
If any side effects/ADR`s seen report
it to physician
