Meningitis brain abscess Encephalitis etc 1 2 Meningitis

Meningitis, brain abscess. Encephalitis etc 1

2

Meningitis • Inflammation of the meninges • Classified into aseptic and septic Aseptic : not bacteria. Virus or secondary to lymphoma, leukemia or brain abscess Septic : bacteria • Most common : Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae • Factors that increase the risk of meningitis : viral URI, otitis media, mastoiditis 3

Pathophysiology • Infection through the blood stream as a consequence of other infections • Or by direct extension – traumatic injury to the facial bones or secondary to invasive procedures • Aids may predispose to meninges – mostly S. pneumoniae • The bacteria in the blood stream cross the bloodbrain barrier and cause inflammation of the meninges • Inflammatory cells from the meninges spill into the csf and the cell count in the csf increases 4

Complications of meningitis • • • Visual impairment Deafness Seizures Paralysis Hydrocephalus septic shock 5

Clinical Manifestations • Headache (severe) • Fever (these two are initial symptoms)(high throughout the illness. ) • Signs of meningeal irritation : neck rigidity positive Kernig’s sign positive Brudzinski’s sign photophobia • A rash – N. meningitidis infection. Skin lesions develop, ranging from a petechial rash with purpuric lesions to large areas of ecchymosis. • Disorientation • Memory impairment 6

• • • Behavioural changes As the disease advances – lethargy Unresponsiveness Coma Seizures ↑ ICP – decreased level of consciousness and focal motor deficits – later herniation and cranial nerve dysfunction and depression of centres of vital function • Septicemia – high fever, extensive purpuric lesions intravascular coagulopathy (DIC). • Death 7

Assessment and diagnostic findings • Lumbar puncture – CSF culture and sensitivity, Gram’s staining, CSF analysis : the presence of polysaccharide antigen supports the diagnosis of bacterial meningitis. 8

Prevention • Vaccinating against meningococcal meningitis – college freshmen, people living in dormataries • Prophylactic treatment of people in contact with meningitis cases – rifampin, ciprofloxacin, ceftrioxone Na. 9

Medical Management • Penicillin antibiotics • Cephalosporins (eg ceftrioxone Na. , cefotaxime Na) • Vancomycin, in combination with rifampicin for resistant strains • Steroids 15 minutes befor the antibiotics • Dehydration and shock treated • Phenytoin for seizures • Increased ICP is treated as necessary 10

Nursing Management • Patient is usually critically ill • Neurologic status and vital signs are continually assessed. • Pulse oximetry and arterial blood gas values monitored • Respiratory support if needed • Increasing ICP compromises the brain stem. • Arterial blood pressures monitored – to predict shock and prevent cardiac or respiratory failure 11

Nursing Management • Rapid IV fluids may be needed • If fever + reduce temperature – (fever increased metabolic demand) • Monitor body weight, serum electrolytes and urine volume, specific gravity and osmolarity, esp. if the syndrome of inappropriate antidiuretic hormone secretion is suspected. 12

Nursing Management • Protect from injury secondary to seizure activity or altered level of consciousness • Prevent complications associated with immobility, such as pressure ulcers and pneumonia • Institute droplet precautions until 24 hours after the initiation of antibiotic therapy (oral and nasal discharge is considered infectious) • Communicate with the patient’s family and allow them to see the patient. Give them moral support 13