Question

1. Why does a patient who had a URI that developed into mengitis have hypertension , high RR and high pulse rate?

2. Explain the pathophysiology behind this patient's lymphadenopathy who has meningitis

3. How do you treat bacterial menigitis and for how long?

4. What is the pathophys behind a bug bite that causes swelling on the eye to eventuall shut the lids.

5. With 96 hours after being bit , what TWO encephalitis can be seen in that incubation period?

6. What are the reasons one might see laser scars in the eys w/o hemmorage and with occasional exudate.

7. why would a enchaphilitis patient be checked for foot lesions?

Answer 1

3. How do you treat bacterial menigitis and for how long?

Bacterial meningitis

Meningitis is an inflammation of the membranes (meninges) surrounding your brain and spinal cord.
The swelling from meningitis typically triggers symptoms such as headache, fever and a stiff neck.

Bacteria that enter the bloodstream and travel to the brain and spinal cord cause acute bacterial meningitis. But it can also occur when bacteria directly invade the meninges. This may be caused by an ear or sinus infection, a skull fracture, or, rarely, after some surgeries.

Several strains of bacteria can cause acute bacterial meningitis, most commonly: Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), Haemophilus influenzae (haemophilus), Listeria monocytogenes (listeria).

Bacterial meningitis is serious, and can be fatal within days without prompt antibiotic treatment. Delayed treatment increases the risk of permanent brain damage or death.

Treatment

• Antibiotics
• Corticosteroids to decrease cerebral inflammation and edema

Antibiotics are the mainstay of therapy. In addition to antibiotics, treatment includes measures to decrease brain and cranial nerve inflammation and increased ICP.

Most patients are admitted to an ICU.

Antibiotics

Antibiotics must be bactericidal for the causative bacteria and must be able to penetrate the blood-brain barrier.

If patients appear ill and findings suggest meningitis, antibiotics and corticosteroids are started as soon as blood cultures are drawn and even before lumbar puncture. Also, if lumbar puncture is delayed pending neuroimaging results, antibiotic and corticosteroid treatment begins before neuroimaging.
Appropriate empiric antibiotics depend on the patient's age and immune status and route of infection . In general, clinicians should use antibiotics that are effective against S. pneumoniae, N. meningitidis, and S. aureus. Sometimes (eg, in neonates and some immunosuppressed patients), herpes simplex encephalitis cannot be excluded; thus, acyclovir is added. Antibiotic therapy may need to be modified based on results of culture and sensitivity testing.

Commonly used antibiotics include

3rd-generation cephalosporins for S. pneumoniae and N. meningitidis

Ampicillin for L. monocytogenes

Vancomycin for penicillin-resistant strains of S. pneumoniae and for S. aureus

Corticosteroids

Dexamethasone is used to decrease cerebral and cranial nerve inflammation and edema; it should be given when therapy is started. Adults are given 10 mg IV; children are given 0.15 mg/kg IV. Dexamethasone is given immediately before or with the initial dose of antibiotics and q 6 h for 4 days.

Use of dexamethasone is best-established for patients with pneumococcal meningitis.

Other measures
The effectiveness of other measures is less well-proved.

Patients presenting with papilledema or signs of impending brain herniation are treated for increased ICP:

Elevation of the head of the bed to 30˚

Hyperventilation to a PCO2 of 27 to 30 mm Hg to cause intracranial vasoconstriction

Osmotic diuresis with IV mannitol

Usually, adults are given mannitol 1 g/kg IV bolus over 30 min, repeated prn q 3 to 4 h or 0.25 g/kg q 2 to 3 h, and children are given 0.5 to 2.0 g/kg over 30 min, repeated prn.

Additional measures can include

IV fluids

Anticonvulsants

Treatment of concomitant infections

Treatment of specific complications (eg, corticosteroids for Waterhouse-Friderichsen syndrome, surgical drainage for subdural empyema)

4.

A reaction to the insect's spit causes swelling. The loose eye tissues swell easily. The most common bite is from a mosquito. The initial contact of a bite may be painful. It’s often followed by an allergic reaction to venom deposited into your skin through the insect’s mouth or stinger.

Most bites and stings trigger nothing more than minor discomfort, but some encounters can be deadly, especially if you have severe allergies to the insect venom.