Bacterial Meningitis PDF

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Bacterial Meningitis -inflammation of the meninges tissues surrounding the brain and spinal cord. -usually occurs in the fall, winter, or early spring. **often r/t viral respiratory disease** -Older people, college students, prisoners more so affected. -untreated meningitis have 50-100% mortality rate Etiology and Physiology: -Streptococcus pneumoniae and Neisseria meningitidis -Gain entry to the CNS through upper respiratory tract or bloodstream**, may also enter through fractured sinuses in basilar skull fractures. -inflammatory response to the infection tends to INCREASE CSF production with a moderate increase in ICP. **pus spreads to other areas of the brain through CSF and cover cranial nerves and other intracranial structures. -if this process extends into the brain parenchyma or if concurrent encephalitis is present cerebral edema and increased ICP will be a bigger problem. **CLOSELY OBSERVE ALL PATIENTS FOR MANISFESTATIONS OF INCREASED ICP, WHICH CAN OCCUR FROM SWELLING AROUND THE DURA AND INCREASED CSF VOLUME** Clinical manifestations: -fever, SEVERE HEADACHE, n/v, and nuchal rigidity (KEY SIGNS) -photophobia, a decreased LOC, and signs of increased ICP may be present **COMA IS USUALLY GOING TO END UP IN A POOR PROGNOSIS** -seizures occur in 1/3 of patients -HEADACHE COMES PROGRESSIVELY WORSE AND MAY BE ACCOMPANIED BY VOMITING AND IRRITABILITY -if infecting organism is meningococcus, skin rash common -petechiae may be seen on trunk, lower extremities and mucous membranes *TUMBLER TEST: PRESSING BASE OF DRINKING GLASS AGAINST THE RASH, RASH DOES NOT BLANCH OR FADE UNDER PRESSURE* Complications: -INCREASED ICP (MOST COMMON) -major cause of altered mental status -residual neurologic dysfunction -often involves many cranial nerves -OPTIC NERVE (CN II) compressed by increased ICP. -papilledema is often present, and blindness may occur -CN III, CN IV, CN VI: irritated, ocular movements are affected. -ptosis, unequal pupils, and diplopia are common -CN V: irritation results in sensory losses and loss of the corneal reflex -CN VII: irritation results in facial paresis.

-CN VIII: irritation causes tinnitus, vertigo, and deafness. -dysfunction usually disappears w/in a few weeks, but hearing loss could be permanent. -Hemiparesis, dysphasia, and hemianopsia may occur (usually resolve over time) -if they do not resolve suspect a cerebral abscess, subdural empyema, subdural effusion, or persistent meningitis. -Acute cerebral edema, may cause seizures, CN III palsy, bradycardia, HTN coma, and death. -Headache may occur for months after the diagnoses of meningitis until the irritation and inflammation have completely resolve. **PAIN MANAGEMENT FOR CHRONIC HEADACHES** -Noncommunicating hydrocephalus may occur if the exudate causes adhesions that prevent the normal flow of CSF from the ventricles. -CSF reabsorption by the arachnoid villi may be obstructed by the exudate, -surgical implantation of a shunt is the only treatment -Waterhouse-Friderichsen syndrome: a complication of meningococcal meningitis. -manifested by petechiae, disseminated intravascular coagulation (DIC), adrenal hemorrhage, and circulatory collapse. -DIC and shock, most serious complications of meningitis, are associated with meningococcemia. Dx studies:...