Bacterial Meningitis Case Study & Nursing Management

Bacterial meningitis is characterized by inflammation of the meninges, the membranes lining the brain and spinal cord. Bacterial, viral, fungal, and parasitic organisms can all cause meningitis, but bacterial meningitis is by can cause meningitis, but bacterial meningitis is by far the most common and this discussion will focus on bacterial meningitis.

In a recent survey by the Hib and Pneumococcal Working Group, the incidence of meningitis in 2000 varied from regions across the world. The overall incidence of pneumococcal meningitis was 17 cases per 100,000, with the highest incidence in Africa at 38 cases per 100,000 and the lowest incidence in Europe at 6 cases per 100,000. The overall death rate was 10 cases per 100,000. The highest death rate was 28 cases per 100,000 in Africa, and the lowest death rates were 3 cases per 100,000 in Europe and Western Pacific regions. (Hom, 2009)

Bacterial meningitis more frequently occurs in black and Hispanic children. This is thought to be related to socioeconomic rather than racial factors. Prevalence of bacterial meningitis is higher in males. A recent report from Finland showed males more often had mumps and varicella encephalitis, whereas females had adenoviral and Mycoplasma encephalitis more often. For both meningitis and encephalitis, the greatest occurrence is in children younger than 4 years with a peak incidence in those aged 3-8 months. (Hom, 2009)

Morbidity and mortality rates depend on the infectious agent, age of the child, general health, and prompt diagnosis and treatment. Despite improvement in antibiotic and supportive therapy, a significant mortality and morbidity rate remains. (Hom, 2009)

The brain and spinal cord are remarkably resistant to infection, but when they become infected, the consequences are usually very serious. Infections may be caused by bacteria, viruses, fungi, and occasionally protozoa or parasites. The most common type of CNS infection is Bacterial Meningitis which is characterized by inflammation of the meninges, the membranes lining the brain and spinal cord. (Hom, 2009)

Almost any bacteria entering the body can cause meningitis. The most common are meningococci, pneumococci, and Haemophilus influenzae. These organisms are often present I the nasopharynx. S. pneumoniae and N. meningitidis are found most often in adults. Factors predisposing to bacterial meningitis include any circumstance where the dura has been compromised, such as open brain injury or brain surgery, systemic infection, anatomic defects of the skull, immune-compromise, and other systemic illness. (Joyce M. Black, 2008)

Bacterial Meningitis Definition

The brain and spinal cord are remarkably resistant to infection, but when they become infected, the consequences are usually very serious. Infections may be caused by bacteria, viruses, fungi, and occasionally protozoa or parasites.

Bacterial meningitis is characterized by inflammation of the meninges, the membranes lining the brain and spinal cord. Bacterial, viral, fungal, and parasitic organisms can all cause meningitis, but bacterial meningitis is by can cause meningitis, but bacterial meningitis is by far the most common and this discussion will focus on bacterial meningitis.

Almost any bacteria entering the body can cause meningitis. The most common are meningococci (Neisseria meningitidis), pneumococci (Streptococcus pneumonia), and Haemophilus influenza. Thtese organisms are often present in the nasopharynx. S. pneumonia and N. meningitides are found most often in adults. Factors predisposing to bacterial meningitis include any circumstance where the dura has been compromised, such as open brian injry or brain surgery, systemic infection, anatomic defects of the skull, immunocompromise, and other systemic illnesses. Close quarters, poor hygiene, and malnutrition also place people at risk.

Predisposing/Precipitating Factors of Bacterial meningitis

Incidence of meningitis is high among Blacks and Native American. Male infants have a high incidence of gram-negative neonatal meningitis.

Children under age 5, young people ages 18 to 24 and older adults are more likely to develop meningitis than the rest of the population. Black, Eskimo and American Indian children are especially at risk of meningitis caused by the bacteria H. influenzae and Streptococcus pneumoniae. People with weakened or suppressed immune systems also are at higher risk.

People who work with domestic animals (e.g., dairy farmers, ranchers) and pregnant women are at increased risk for meningitis associated with listeriosis (disease transmitted from animals to humans via soil). Listeriosis can be transmitted from mother to fetus through the placenta, causing spontaneous abortion. The disease is usually fatal in newborns.

College students living in dormitories, personnel on military bases and children in boarding schools and child-care facilities are at increased risk of meningococcal meningitis, mainly because infectious diseases tend to spread quickly wherever large groups of people congregate.

If you’re pregnant, you’re 20 times more likely to contract listeriosis, an infection that may cause meningitis. If you have listeriosis, your unborn baby is at risk too. Also at higher risk of listeriosis are people who work with domestic animals, including dairy farmers and ranchers.

Some studies have linked increased risk to smoking and drinking alcohol, which may suppress your body’s immune system. Other factors that may compromise your immune system – including AIDS, diabetes and use of immunosuppressant drugs – also make you more susceptible to meningitis. Removal of your spleen, an important part of your immune system, may also increase your risk.

Signs & Symptoms of Bacterial Meningitis

The classic manifestations of meningitis are nuchal rigidity (rigidity of the neck), Brudzinski’s sign and Kernig’s sign, and photophobia.

Other general manifestations related to infection may also be present, such as headache, fever, tachycardia, prostration, chills, fever, nausea, and vomiting. The client may be irritable at first, but, as the infection progresses, the client appears acutely ill and confused, stuporous, or comatose. Seizures may occur. A petechial or hemorrhagic rash may develop. Diagnosis is made by lumbar puncture. The CSF is cloudy. Gram stain of the CSF reveals organisms in 70% to 80% of all cases. When the organisms cannot be identified, bacterial antigens can be determined. H. influenza is frequently detected with this technique. Clients with bacterial meningitis demonstrate the following:

• Moderately elevated CSF pressures
• Elevated CSF protein level (normal, 15 to 45 mg/dl)
• Decreased CSF glucose level (normal, 60 to 80 mg/dl, or two thirds of the serum glucose value)
• Elevated white blood cell count, usually increased (100 to 10, 000/cm3), with predominantly polymorphonuclear leukocytes.

Medical diagnosis is made by assessment of clinical manifestations and is confirmed by isolating the causative organism from the CSF. Empirical therapy in bacterial meningitis includes cephalosporins, rifampin, and vancomycin. The empirical use of penicillin or ampicillin in the treatement of CNS infection is avoided because of the beta-lactamase-producing H. influenza and N. meningitides. It is believed that the cephalosporins are more potent against the beta-lactamase organisms. Chloramphenicol and trimethoprim-sulfamethoxazole are recommended for clients allergic to penicillin. Once the organism is known, antibiotics with greater sensitivity ma are used. High doses of the appropriate antibiotic are usually prescribed for at least 10 days. Factors contributing to development of meningitis also need to be addressed.

Health Promotion and Preventive Aspects for Bacterial Meningitis

Bacterial meningitis constitutes a medical emergency. Prognosis varies according to the causative organism. The use of antibiotics has reduced the death rate to less than 5% for all types of bacterial meningitis. If untreated, it can be fatal within hours to days. Deaths most often occur in newborn infants and in older adults. Complications are rate but may include septic shock, vasomotor collapse, seizures, and increased ICP attributable to hydrocephalus, brain swelling, and fluid overload. Residual neurologic deficits are rare in adults.

A unique problem in treating CNS infection is that an intact blood-brain barrier prevents complete penetration of the antibiotic. However, inflammation inhibits the blood-brain barrier, so for short time antibiotics penetrate the CNS. Antibiotics are given intravenously; the blood-brain barrier recovers as inflammation subsides, and high doses are required to reach the CSF.

Adequate fluid and electrolyte balance must be maintained. Frequent assessment of the neurologic status is indicated to detect early manifestations of increasing ICP and seizures. Anticonvulsants may be prescribed for seizure prevention.

Patient must be watched carefully for changes in neurologic function or other signs of worsening condition.

Nursing Considerations for Bacterial Meningitis

1. Assess neurologic function often. Observer level of consciousness (LOC) and signs of increased ICP (plucking at the bedcovers, vomiting, seizures, and a change in motor function and vital signs). Watch for signs for cranial nerve involvement (ptosis, strabismus, and diplopia).
2. Be especially alert for a temperature increase up to 38. 9o Celsius (102 F), deteriorating LOC, onset of seizures, and altered respirations, all of which may signal an impending crisis.
3. Monitor fluid balance. Maintain adequate fluid intake to avoid dehydration, but avoid fluid overload because of the danger of cerebral edema. Measure central venous pressure and intake and output accurately.
4. Watch for adverse effects of I.V. antibiotics and other drugs. To avoid infiltration and phlebitis, check I.V. site often and change the sites according to hospital policy.
5. Position the patient carefully to prevent joint stiffness and neck pain. Turn him often, according to planned positioning schedule. Assist with range-of-motion exercises.
6. Maintain adequate nutrition and elimination. It may be necessary to provide small, frequent meals or to supplement meals with nasogastric tube or parenteral feedings. To prevent constipation and minimize the risk of increased ICP resulting from straining at stool, give the patient a mild laxative or stool softener.
7. Ensure the patient’s comfort. Provide mouth care regularly. Maintain a quiet environment. Darkening the room may decrease photophobia. Relieve headache with a nonopioid analgesic, such as aspirin or acetaminophen as ordered.
8. Provide reassurance and support. The patient may be frightened by his illness and frequent lumbar punctures. If he’s deliberious or confused, attempt to reorient him often. Reassure his family that the delirium and behavior changes caused by meningitis usually disappear. However, fi a severe neurologic deficit appears permanent; refer the patient o a rehabilitation program as soon as the acute phase of this illness has passed.
9. To help prevent development of meningitis, teach patients with chronic sinusitis or other chronic infections and the importance of proper medical treatment. Follow strict sterile technique when treating patients with head wounds or skull fractures.
10. Prevention:
11. Give haemophilus influenza type B and pneumococcal vaccins to children.
12. Give meningocococcal vaccine to college students.
13. Give prophylactic antibiotics to those who have been exposed to a patient with meningitis.

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