Meningitis

Definition/Etiology:

The meninges is the lining of the brain and spinal cord. When that gets infected, either by a virus or a bacteria, it’s not good. Now viral meningitis isn’t that bad. The symptoms are usually mild and it resolves with supportive care.

Now bacterial on the other hand is the one we all freak out about! This is the one that kills people if not treated.

Pathophysiology:

The patho behind meningitis is fairly simple. Basically, a virus or bacteria enters the CSF and growth of that organism leads to inflammation within the CSF. Some of the common bugs that cause bacterial meningitis are Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis and meningococcal (which is most common in young adults). It would be a good practice to get vaccine history, like the meningitis vax. While viral meningitis is usually not contagious, bacterial is by droplets and secretions.

Clinical Presentation:

• Headache, fever, malaise
• Irritability, restlessness, altered LOC in severe cases
• Nausea and vomiting
• Petechial rash (usually a sign of meningococcal meningitis)
• Stiff neck, PHOTOPHOBIA!

2 textbook signs you need to know!

• Kernig’s sign: Position the patients supine with their hips flexed to 90°. This test is positive if there is pain on passive extension of the knee. 
• Brudzinski’s sign: Position the patients supine and passively flex their neck. This test is positive if this maneuver causes reflex flexion of the hip and knee.

Collaborative Management:

Basic lab work, CBC, CMP, but the one that is most diagnostic is the lumbar puncture. The results will tell us if it’s viral or bacterial. If it’s viral, the glucose will be normal, protein slightly increased and a negative gram stain. With bacterial, the glucose is decreased, the protein is elevated, and the gram stain is positive. For our part, while we don’t do the actual tap, we assist the doc here. Set up the area, prep the patient, and take the samples to the lab. Most facilities want these hand delivered.

With the alteration in LOC, a CT head may be indicated.

Treatment for viral, like we said, is supportive care. Treatment for bacterial is urgent antibiotic therapy (probably rocephin), anti-epileptics and antiemetics if necessary and of course Tylenol to bring that fever down.

Evaluation | Patient Monitoring | Education:

• Hemodynamic monitoring as usual
• Serial neuro checks
• Monitor for seizures
• Isolation (bacterial, not viral…. Iso until not iso)

Linchpins: (Key Points)

• Textbook signs: Kernig’s and Brudzinski
• Iso until not iso
• Bacterial vs viral