Submitted by: Submitted to:Rimando, Maria Clarita Tondy A. Ms. Shalimaar DimaandalBSN3-d2 Clinical Instructor
Meningitis is the infection and inflammation of the meninges (covering of the brain and spinal cord: duramater, arachnoid and piamater) and the cerebrospinal fluid.
Causative agents Neisseria meningitides ▪ Incubation period: 2-10 days Haemophilus influenzae ▪ Incubation period: 1-4 days Enteroviruses ▪ Incubation period: 3 to 7 days
Nuchal rigidity: It is the inability to flex the head forward due to rigidity of the neck muscles; if flexion of the neck is painful but full range of motion is present, nuchal rigidity is absent.
Kernigs sign: It is positive when the leg is bent at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful (leading to resistance).
Brudzinskis signs It is the appearance of involuntary lifting of the legs in meningeal irritation when lifting a patients head off the examining couch, with the patient lying supine.
Antibiotics: Ampicillin, Third-generation Cephalosporin such as Ceftriaxone or Ampicillin and an Aminoglycoside. Other drugs include Digitalis glycoside such as Digoxin (to control arrythmias), Mannitol (to decrease cerebral edema) or a Sedative (to reduce restlessness) and Aspirin or Acetaminophen (to relieve headache and fever).
A person can pass the infection to others for as long as the bacteria are present in discharges from the nose and mouth. A person is no longer infectious within 24 to 48 hours after starting antibiotic treatment.
Encourage personal hygiene especially the practice of hand washing. Keep hands clean and wash hands properly. Wash hands when they are dirtied by respiratory secretions e.g. after sneezing. Cover nose and mouth while sneezing or coughing and dispose of nasal and mouth discharge properly. Do not share eating and drinking utensils and wash them before use by others. Avoid going to overcrowded places. For Neisseria meningitidis meningitis, household contacts and others who have had close personal contact with infected persons are recommended to receive a preventive antibiotic which kills bacteria living in nose and throat secretions. For contacts of Haemophilus influenzae meningitis, antibiotics may also be recommended Effective vaccines against Haemophilus influenzae type b, and some types of Neisseria meningitidis are available.
Haemophilus Influenzae type B Haemophilus influenzae type b (Hib) is a bacterium that can infect the outer lining of the brain causing meningitis. Hib disease occurs most often at three months to three years of age, peaking at six to seven months of age. The disease is uncommon after age five years. ▪ Children should get Hib vaccine at: ▪ 2 months of age ▪ 6 months of age ▪ 4 months of age ▪ 12-15 months of age
Vaccines against four strains of N. meningitidis Meningococcal Conjugated vaccine are given to adolescents entering high school and to college freshmen living in dormitories.
Assess neurologic status. Monitor vital signs especially temperature frequently or continuously. Pulse oximeter and arterial blood gas (ABG) are use to quickly identify the respiratory support for increasing ICP Institute other cooling measures such as TSB. Monitor I & O closely. Encourage adequate fluid intake. Darken the room if photophobia is present. Assist with position to comfort neck stiffness and turn patient slowly and carefully with head and neck in alignment. Elevate the head of the bed to decrease intracranial pressure and reduce pain. Administer vaccines against H. influenza type B for children; N. meningitides for patients at high risk; and S. pneumonia for patients with chronic illnesses and the elderly. Inform patients about the importance of vaccination.
Vancomycin Hydrochloride in combination with one of the Cephalosporins is administered IV. Dexamethasone (Decadron) Dehydration and shock are treated with fluid volume expanders. Phenytoin (Dilantin)- treatment for seizures if occurs.
Lumbar Puncture (Increase Protein and WBC, Low Sugar level) A lumbar puncture takes samples of the fluid around the spine and brain, known as cerebral spinal fluid (CSF). A culture of the spinal fluid is done to check for organisms known to cause illness. Blood Culture A blood culture is a test on a sample of blood to check for bacteria in the bloodstream; it may be done if a doctor suspects a blood infection. A blood culture may be helpful in determining the specific bacteria causing an infection and selecting the appropriate antibiotic to treat it.
Imaging (X-rays and CT scans) X-rays and computerized tomography (CT) scans of the head, chest or sinuses may reveal swelling or inflammation. These tests can also help your doctor look for infection in other areas of the body that may be associated with meningitis.
Both viral meningitis and bacterial meningitis can be transmitted through direct contact with nose and throat secretions of infected person (Droplet). Healthy persons, who have no signs of illness, can carry these bacteria in their nose or throat (Upper respiratory tract infection). Viral meningitis can also be transmitted through fecal-oral route.
Encephalitis is irritation and swelling (inflammation) of the brain parenchyma, most often due to infections. Encephalitis with meningitis is known as meningoencephalitis.
Causative agents Specifically to rural areas are Arboviruses or Arthropod-borne Viruses (viruses carried by arthropods, such as mosquitoes and tick), while in urban areas it is most frequently caused by Enteroviruses (Coxsackievirus, Poliovirus and Echovirus) Enteroviruses Incubation Period is most oftenly 3-5 days
Severe headache Fever Altered consciousness Confusion or agitation Personality changes Seizures Loss of sensation or paralysis in certain areas of the body Muscle weakness Hallucinations Double vision Perception of foul smells Problems with speech or hearing Loss of consciousness
Antiviral medications, such as Acyclovir (Zovirax) and Foscarnet (Foscavir) -- to treat herpes encephalitis or other severe viral infections (however, no specific antiviral drugs are available to fight encephalitis) Antibiotics -- if the infection is caused by certain bacteria Anti-seizure medications (such as Phenytoin) -- to prevent seizures Steroids (such as Dexamethasone) -- to reduce brain swelling (in rare cases) Sedatives -- to treat irritability or restlessness Acetaminophen -- for fever and headache
The period of communicability varies by etiologic agent, and some of them are not transmitted from person to person (e.g., histoplasmosis and toxoplasmosis). Enteroviruses may be shed in feces for several days to many weeks after symptoms have resolved. Enteroviruses may also be shed in respiratory secretions, usually for no longer than one week following symptoms.
Dress to protect yourself. Wear long-sleeved shirts and long pants if youre outside when mosquitoes are most active and when youre in a wooded area with tall grasses and shrubs where ticks are more common. Apply mosquito repellent. To repel mosquitoes. Keep mosquitoes out of your home. Repair holes in screens on doors and windows.
Monitoring pupils and vital signs frequently for increased intracranial pressure(ICP; irregular pupils, widening pulse pressure, tachycardia, irregular breathing hyperthermia). Monitor neurologic status closely. Watch for subtle changes, such as behavior or personality changes, weakness, or cranial nerve involvement Maintain adequate fluid intake to prevent dehydration, but avoid fluid overload, which may increase cerebral edema. Maintain adequate nutrition. Give small, frequent meals, or supplement meals with nasogastric tube or parenteral feedings. To prevent constipation and minimize the risk of increased ICP resulting from straining at stool, provide a mild laxative or stool softener.
Carefully positioned the patient to prevent joint stiffness and neck pain, and turn the patient often. Provide thorough mouth care. Maintain a quiet environment. Darkening the room may decrease headache. If the patient has seizures, take precautions to protect him from injury. Measure and record intake and output. If the patient becomes delirious or confused, try to reorient him often. Teach the patient and his family about the disease and its effects. Teach eradication of the source of infection: Use insecticide or insect repellent and placement of screens to doors and windows.
Antiviral agent Acyclovir given I.V. for 10 days to 3 weeks for herpes simplex virus. Blood cultures and foscarnet I.V. for CMV encephalitis. Anticonvulsants to treat seizures, corticosteroids to reduce cerebral edema, and sedatives and analgesics as supportive therapy.
Spinal fluid analysis ▪ By doing a lumbar puncture (also called a spinal tap), your doctor can check the spinal fluid for an increase in white blood cells and protein.
Electroencephalography (EEG) This can identify abnormal brain waves by monitoring electrical activity in the brain through the skull. Among its many functions, EEG is used to help diagnose certain seizure disorders, brain damage from head injuries, specific viral infections such as herpes virus, and inflammation of the brain and/or spinal cord. Blood tests. These tests can show what type of virus is causing encephalitis.
Computer-assisted imaging (Computed tomography: CT SCAN and Magnetic resonance imaging: MRI) This can reveal signs of brain inflammation, internal bleeding or hemorrhage, or other brain abnormalities.
Breathing in respiratory droplets from an infected person Skin contact Mosquito, tick, and other insect bites Tick of Horses Migratory Birds Contaminated food or drink
ARTHROPOD-BORNE VIRUS Mosquito bite ↓ Inadequate Host Immune Response ↓ Viremia ↓ Cerebral Capillaries ↓ Central Nervous System ↓Cortical Gray Matter, The Brain Stem and Thalamus ↓ Meningual Exudates ↓ Irritating The Meninges ↓ Increasing Intracranial Pressure
FUNGAL ENCEPHALITIS Fungal Spores (enter body through inhalation) ↓ Infect the Lungs ↓ Vague Respiratory Symptoms or Pneumonitis ↓ Bloodstream ↓ Fungemia ↓ Central Nervous System ↓ Encephalitis ↓Fever, Malaise, Headache, Meningeal signs and change in Cranial Nerve Dysfunction