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Original Editors - Iris Partin from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Meningitis is an infectious disease of the central nervous system that causes inflammation of the meningeal membranes. The prevalence of meningitis has greatly decreased over the last fifteen years due to the development of vaccines.[1] The second most common bacteria that causes acute bacterial meningitis, meningocicci, is present in the nasopharynx of approximately 5% of the population. In cases when meningitis is not treated immediately (especially bacterial meningitis), the parenchyma within the brain may be involved. Many colleges raise awareness about meningitis to their students secondary to the increased incidence meningitis. Quick introduction of antibiotics is crucial when acute meningitis is suspected to prevent progression of the disease and increase the chance of recovery.[1] If a patient presents with the cardinal signs and symptoms of meningitis antibiotics are immediately started after blood cultures are drawn. In addition to antibiotics, medications to control and relieve the symptoms of meningitis are introduced as well. The gold standard for diagnosing meningitis is a lumbar puncture.[1] CSF obtained from a lumbar puncture is used to culture cells, glucose level, protein, cell count and differential, and to begin a Gram stain. While lumbar puncture is the gold standard, other diagnostic tests and lab tests are performed when meningitis is suspected. In children and infants treatment usually consist of six or more days of inpatient antimicrobial therapy followed by close follow-up outpatient management.
Currently there are vaccines available that are highly effective and safe for some serogroups of N. The vaccine for Streptococcus pneumoniae is known and the pneumococcal polysaccharide vaccine (PPSV) and is recommended for individuals between the ages 19-64 with asthma or who smoke and individuals older than 65 and at least 2 years of age with certain medical problems. It is important for the physical therapist to understand the various stages of consciousness a patient with a brain injury may go through.
Learn about the shoulder in this month's Physiopedia Plus learn topic with 5 chapters from textbooks such as Magee's Orthopedic Physical Assessment, 2014 & Donatelli's Physical therapy of the shoulder 2012.
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Robert asks… How can you have a baby with your partner if you have herpes simplex 2 and your partner doesn’t? We would appreciate you taking a moment and clicking the share button of your favorite social network, if not, just click the (x) to continue. Aseptic meningitis is usually a result of fungi, viruses, parasites, bacteria, or in some cases a noninfectious inflammation.
These conditions may require specialized treatment.[1] Damage or removal of the spleen increases the risk of pneumococcal disease which may lead to acute bacterial meningitis.


If the patient is not severely ill and the diagnosis of meningitis is questionable, introduction of antibiotics is held until results from CSF stains are determined.[2] Once CSF gram stains are determined targeted antimicrobial treatment may begin.
In situations when the patient presents with papilledema, seizures, focal deficits, or deterioration in consciousness an MRI or CT scan are performed to rule out a brain abscess or infarction. Enteroviruses (echovirus and coxsackievirus) and herpes simplex virus are the most common viruses representing 40% of the cases of meningitis in individuals 30-60 years old and 20% of all individuals with meningitis, respectively. In order to provide effective treatment and minimize the patient’s agitation, the therapist should create an environment that would ease the patient’s hypersensitivity to light and sound and difficulty integrating sensory input.
To maintain mobility of the trunk and neck it is important to initiate positioning and range of motion exercises in the acute phase. A 46-year-old male presented to ER with 7 week history of headache, fatigue, and nausea as well as altered mental status over the last 2 days. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. Most cases of viral meningitis are relatively mild, with symptoms of headache, fever and general ill feeling, and those affected recover without medical treatment. If you have a cold sore around your mouth, and you touch your eye (for example) will your eye become infected?
The first two layers of the cortex and the spinal cord become inflamed as well.[1] As a result of the inflammation many complications may occur.
Of the population that has the bacteria, only a small fraction develops meningitis and the most prevalent age range is from birth to one year.[2] As individuals move through the late adolescence development stage, they experience a second period of increased vulnerability. Duration of antimicrobial treatment is determined by CSF sterilization.[1] Organism specific antibiotics used to treat acute bacterial meningitis may be found in Table 1. Inflammation of the subarachnoid space that is linked to mortality and morbidity is reduced with the use of dexamethasone.
Gram stains are positive 80% of the time in bacterial meningitis, inexpensive, fast, and are 90% accurate. A brain abscess or infarction must be ruled out prior to the lumbar puncture to the risk of cerebral herniation. Neonates receive antibodies via placenta for bacteria such as Listeria monocytogenes, Escherichia coli, and group B streptococcus.
Individuals in late adolescence and early adulthood who develop meningitis usually came in contact with the Epstein-Barr virus (EBV). It is recommended that the meningococcal conjugate vaccine be given between the ages of 11-18 due to the increased prevalence during adolescence. The patient may present in a variety of manners similar to other brain injuries including symptoms similar to focal brain damage (comparable to symptoms of a neoplasm or stroke), brain damage not of infectious origin, and the patient may present with diffuse symptoms often seen with brain trauma.


Close monitoring of the vital signs will allow the therapist to analyze the patient’s ability to sensory integrate and allow the therapist to gain insight into which activities may agitate the patient. Maintain a calm environment during treatment to decrease patient agitation and a dark room may help decrease headache complaints. Case report following a 77 year-old man who was admitted into the hospital for difficulty speaking, ear pain, fever, and altered mental status proceeding fall several days earlier.
I’m assuming I got it from a family member or when I shared a drink with somebody or something. In some cases passive neck flexion may produce flexion of the hips or knee, this is known as Brudzinki’s sign and is usually only seen in the most severe cases. Lumbar punctures are performed immediately in patients with suspected meningitis to diagnosis and identify the causative organism.
A combination of laboratory tests may be needed in addition to the lumbar puncture when the gram culture and stains are negative, but the CSF results suggest bacterial meningitis.
With age, these antibodies decline resulting in increased susceptibility especially in ages 1 to 2 for meningococcus, pneumococcus, and Haemophilus influenzae type b (Hib).
The Advisory Committee on Immunization Practices (ACIP) suggests the vaccines be given at the earliest. The therapist should be familiar with the Glasgow Coma Scale and monitor the patient’s progression through the levels of consciousness. Viral meningitis is not as severe as bacterial and most patients recover within one to two weeks. Further lab tests are needed to examine glucose, protein, and white blood cell levels as well as close monitoring of pressure. Geriatric and the adult population are more affected by Neisseria meningitis and Streptococcus pneumoniae. Providing the patient and family education on the disease and disease stages can encourage the patient and family to become more involved in the treatment. Pneumococci infections are especially common in adults who suffer from alcoholism, CSF leaks, chronic otitis, mastoiditis, sinusitis, sickle cell disease, pneumococcal pneumonia, and asplenia.




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Comments
  1. Voyn_Lyubvi 24.04.2014 at 17:24:14
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  2. KAROL_CAT 24.04.2014 at 11:55:32
    The world, it?affects around 20% recurrent genital herpes nearer to discovering.