Question

Case Study 2

Ms. J, a 19-year-old college student, has been living in a dormitory on campus. She began experiencing severe headaches, neck pain, and nuchal rigidity, along with irritability and nausea. She noticed that when lying with her hips flexed, she found it very hard to stretch out her legs. Within a day her condition deteriorated, she experienced a tonic-clonic seizure, and she was quickly admitted to the hospital. Tests revealed increased intracranial pressure, fever, and leukocytosis. Bacterial meningitis was suspected, and a lumbar puncture was scheduled.

Discussion Questions

Describe the pathophysiologic changes associated with bacterial meningitis. (See Meningitis—Signs and Symptoms.)
Discuss the causes of meningitis and select the microbe most likely to be the cause in this case. Discuss the transmission of bacterial meningitis and recommendations to protect other students and family. (See Meningitis—Pathophysiology, Etiology.)
Discuss the diagnostic tests available for identifying meningitis. (See Diagnostic Tests.) What are the likely characteristics of the CSF to be found in this case?
Explain the rationale for each manifestation present at this stage. Which manifestation(s) is (are) most significant in the diagnosis of bacterial meningitis? Why are no focal signs present?
Which signs indicating elevated intracranial pressure are likely to be present?
Discuss the treatments available to help this patient and possible long-term complications. (See Treatment.)

Answer 1

Describe the pathophysiologic changes associated with bacterial meningitis

• The organism enters the host as a conseqence of any other infections throgh blood stream or any injury or secondary to any invasive procedures.
• The organism crosses the blood brain barrier leading to infammation(cerebral edema) involving layers of meninges.Inflammation is seen in subarachnoid space and piameter .Neural structures starts to damage
• Inflammation increases the intracranial pressure leading to headache, nuchal rigidity, photosensitivity
• The leucocytes in CSF increases to fight against the infection.
• Cerebral herniation may occur due to increased intracranial pressure.
• Metabolic disturbances and cerebral ischemia occurs leading to paralysis, visual impairment, seizures
• If untreated may lead to septic shock,circulatory collapse and death.

Discuss the causes of meningitis and select the microbe most likely to be the cause in this case.

• Bacterial ( Neisseria meningitidis, hemophilus influenza, Streptococcus pneumoniae),
• Listeria monocytogenes (L. monocytogenes)
• Viral (Coxsackie or Echovirus groups of enteroviruses)

Neisseria meningitidis may be causative organism as it is most likely to occur in dense community area like college campus and military regimens.

Discuss the transmission of bacterial meningitis and recommendations to protect other students and family

• Through direct contact from infected person
• Droplet transmission from infected person to normal person
• Untreated otitis media
• Newborn babies may get meningitis from mothers during delivery

Discuss the diagnostic tests available for identifying meningitis. (See Diagnostic Tests.) What are the likely characteristics of the CSF to be found in this case?

• Gram staining and Bacterial culture of CSF after extracting through Lumbar puncture

CSF may show low glucose levels and increased leucocytes

Presence of polysaccharide antigen in CSF supports bacterial meningitis.

Explain the rationale for each manifestation present at this stage. Which manifestation(s) is (are) most significant in the diagnosis of bacterial meningitis? Why are no focal signs present

• Severe headache and irritability because of increased intracranial pressure. Steps should be taken to reduce ICP by providing sedation, Medications like mannitol to enhance the flow of water from brain tissues into interstitial fluid and plasma.
• Nuchal rigidity because of irritation of lining of brain
• Nausea is because of severe headache , so giving sedation may be helpful to calm the patient
• Kernig's sign and leucocytosis are peculiar signs of bacterial meningitis.

Which signs indicating elevated intracranial pressure are likely to be present?

• Severe headache
• Nausea and vomiting
• Irritability
• Seizures
• Confusion
• Double vision
• Photosensitivity