MENINGITIS

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INTRODUCTION-

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.

Most cases of meningitis in the United States are caused by a viral infection, but bacterial, parasitic and fungal infections are other causes. Some cases of meningitis improve without treatment in a few weeks. Others can be life-threatening and require emergency antibiotic treatment.

Seek immediate medical care if you suspect that someone has meningitis. Early treatment of bacterial meningitis can prevent serious complications.

CAUSES-

Meningitis is almost always caused by a bacterial or viral infection that begins somewhere else in your body, like your ears, sinuses, or throat.

Less common causes of meningitis include:

Autoimmune disorders
Cancer medications
Syphilis
Tuberculosis

Bacterial Meningitis

It’s an extremely serious illness. You or your child will need to get medical help right away. It can be life-threatening or lead to brain damage unless you get quick treatment.

Several kinds of bacteria can cause bacterial meningitis. The most common ones in the U.S. are:

Streptococcus pneumoniae (pneumococcus)
Neisseria meningitidis (meningococcus)

Listeria monocytogenes (in older people, pregnant women, or those with immune system problems)

A bacteria called Haemophilus influenzae type b (Hib) was a common cause of meningitis in babies and young children until the Hib vaccine became available for infants. There are also vaccines for Neisseria meningitidis and Streptococcus pneumoniae. Experts recommend that all children get them, as well as all adults who are at a higher risk for the disease.

In many cases, bacterial meningitis starts when bacteria get into your bloodstream from your sinuses, ears, or throat. The bacteria travel through your bloodstream to your brain.

The bacteria that cause meningitis can spread when people who are infected cough or sneeze. If you or your child has been around someone who has bacterial meningitis, ask your doctor what steps you should take to avoid catching it.

Viral Meningitis

Viral meningitis is more common than the bacterial form and generally — but not always — less serious. A number of viruses can trigger the disease, including several that can cause diarrhea.

Fungal Meningitis

Fungal meningitis is much less common than the bacterial or viral forms. Healthy people rarely get it. Someone with a problem with their immune system — because they have AIDS, for example — is more likely to become infected with this form of meningitis.

Meningitis Diagnosis

Your doctor will ask about your medical history and do a physical exam, including checking your neck for stiffness and looking for a skin rash that might suggest a bacterial infection. They will also need to do tests that can include:

Blood tests to find bacteria
CT or MRI scans of your head to find swelling or inflammation
Spinal tap, in which a health care worker uses a needle to take fluid from around your spinal cord. It can tell what’s causing your meningitis.

SYMPTOM-

The symptoms of viral and bacterial meningitis can be similar in the beginning. However, bacterial meningitis symptoms are usually more severe. The symptoms also vary depending on your age.

Viral meningitis symptoms

Viral meningitis in infants may cause:

decreased appetite
irritability
sleepiness
lethargy
fever

In adults, viral meningitis may cause:

headaches
fever
stiff neck
seizures
sensitivity to bright light
sleepiness
lethargy
nausea and vomiting
decreased appetite

Bacterial meningitis symptoms

Bacterial meningitis symptoms develop suddenly. They may include:

altered mental status
nausea
vomiting
sensitivity to light
irritability
headache
fever
chills
stiff neck
purple areas of skin that resemble bruises
sleepiness
lethargy

Seek immediate medical attention if you experience these symptoms. Bacterial and viral meningitis can be deadly. There’s no way to know if you have bacterial or viral meningitis just by judging how you feel. Your doctor will need to perform tests to determine which type you have.

Fungal meningitis symptoms

Symptoms of fungal meningitis resemble the other types of this infection. These may include:

nausea
vomiting
sensitivity to light
fever
headache
confusion or disorientation

Each type of meningitis has some distinguishing symptoms.

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Risk factors

Risk factors for meningitis include:

Skipping vaccinations. Risk rises for anyone who hasn’t completed the recommended childhood or adult vaccination schedule.
Age. Most cases of viral meningitis occur in children younger than age 5. Bacterial meningitis is common in those under age 20.
Living in a community setting. College students living in dormitories, personnel on military bases, and children in boarding schools and child care facilities are at greater risk of meningococcal meningitis. This is probably because the bacterium is spread by the respiratory route, and spreads quickly through large groups.
Pregnancy. Pregnancy increases the risk of listeriosis — an infection caused by listeria bacteria, which may also cause meningitis. Listeriosis increases the risk of miscarriage, stillbirth and premature delivery.
Compromised immune system. AIDS, alcoholism, diabetes, use of immunosuppressant drugs and other factors that affect your immune system also make you more susceptible to meningitis. Having your spleen removed also increases your risk, and anyone without a spleen should get vaccinated to minimize that risk.

Complications

Meningitis complications can be severe. The longer you or your child has the disease without treatment, the greater the risk of seizures and permanent neurological damage, including:

Hearing loss
Memory difficulty
Learning disabilities
Brain damage
Gait problems
Seizures
Kidney failure
Shock
Death

With prompt treatment, even patients with severe meningitis can have good recovery.

Prevention

Common bacteria or viruses that can cause meningitis can spread through coughing, sneezing, kissing, or sharing eating utensils, a toothbrush or a cigarette.

These steps can help prevent meningitis:

Wash your hands. Careful hand-washing helps prevent the spread of germs. Teach children to wash their hands often, especially before eating and after using the toilet, spending time in a crowded public place or petting animals. Show them how to vigorously and thoroughly wash and rinse their hands.
Practice good hygiene. Don’t share drinks, foods, straws, eating utensils, lip balms or toothbrushes with anyone else. Teach children and teens to avoid sharing these items too.
Stay healthy. Maintain your immune system by getting enough rest, exercising regularly, and eating a healthy diet with plenty of fresh fruits, vegetables and whole grains.
Cover your mouth. When you need to cough or sneeze, be sure to cover your mouth and nose.
If you’re pregnant, take care with food. Reduce your risk of listeriosis by cooking meat, including hot dogs and deli meat, to 165 F (74 C). Avoid cheeses made from unpasteurized milk. Choose cheeses that are clearly labeled as being made with pasteurized milk.

Characteristics/Clinical Presentation

Headache, fever, vomiting, and rigidity of the neck are the most common symptoms that present with the onset of meningitis. Early symptoms include nausea, drowsiness and confusion. Pain in the posterior thigh or lumbar region may also be noted. Later symptoms can include seizures, photophobia and rapid breathing rate. In addition, a rash on the skin, scanty petechial (red or purple non-blanching macules smaller than 2mm in diameter) ,or a purpuric (larger than 2mm) appears on approximately 80-90% of individuals with bacterial meningitis.

Meningitis causes inflammation of the meningeal membranes; as a result nerve roots may endure tension as they pass through these inflamed membranes. Passive ROM of the neck into flexion will gradually become painful and limited. Also, neck extension and rotation may be painful as well, however not to the extent of flexion. In severe cases, Brudzinki’s sign, or Kernig’s may be presented.

Brudzinki’s sign is caused by passive neck flexion producing flexion of the hips or knees. Kernig’s sign presents, as restrictive passive extension of the knee while the hip is flexed. In cases when meningitis is not treated immediately (especially bacterial meningitis), the parenchyma within the brain may be involved. As a result i,ndividuals may present with lethargy, vomiting, seizures, papilledema, confusion, coma, focal deficits, and cranial nerve palsies.

Immunizations

Some forms of bacterial meningitis are preventable with the following vaccinations:

Haemophilus influenzae type b (Hib) vaccine. Children in the United States routinely receive this vaccine as part of the recommended schedule of vaccines, starting at about 2 months of age. The vaccine is also recommended for some adults, including those who have sickle cell disease or AIDS and those who don’t have a spleen.
Pneumococcal conjugate vaccine (PCV13). This vaccine also is part of the regular immunization schedule for children younger than 2 years in the United States. Additional doses are recommended for children between the ages of 2 and 5 who are at high risk of pneumococcal disease, including children who have chronic heart or lung disease or cancer.
Pneumococcal polysaccharide vaccine (PPSV23). Older children and adults who need protection from pneumococcal bacteria may receive this vaccine. The Centers for Disease Control and Prevention recommends the PPSV23 vaccine for all adults older than 65; for younger adults and children age 2 and older who have weak immune systems or chronic illnesses such as heart disease, diabetes or sickle cell anemia; and for anyone who doesn’t have a spleen.
Meningococcal conjugate vaccine. The Centers for Disease Control and Prevention recommends that a single dose be given to children ages 11 to 12, with a booster shot given at age 16. If the vaccine is first given between ages 13 and 15, the booster is recommended between ages 16 and 18. If the first shot is given at age 16 or older, no booster is necessary. This vaccine can also be given to children between the ages of 2 months and 10 years who are at high risk of bacterial meningitis or who have been exposed to someone with the disease. It’s also used to vaccinate healthy but previously unvaccinated people who have been exposed in outbreaks.

physical therapy management-

According to the American Physical Therapy Association’s Guide to Physical Therapist Practice infectious disorders of the central nervous system fall under the following preferred practice patterns; 5D: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System- Acquired in Adulthood or Adolescence and 5I: Impaired Arousal, Range of Motion, and Motor Control Associated with Coma, Near Coma, or Vegetative State.

Typically physical therapy treatment is initiated in the intensive care unit. While initiating a plan of care, it is crucial to keep in mind a patient’s chart information or contraindications to therapy such as intracranial pressure, cerebral perfusion pressure, and other lab values that determine rehabilitation guidelines. Meningitis may present with similar symptoms to brain injuries, neurological complications, immunological deficiency, vascular compromise, and additional secondary impairments.

Additionally understanding the various stages of consciousness or behavioural changes a patient with secondary complications may go through can guide the approach to treatment. The therapist should create an environment that would ease the patient’s hypersensitivity to sensory input such as light or sound thus creating a structured environment to eliminate behaviural outbursts. Close monitoring of the vital signs will allow the therapist to gauge the patient’s receptiveness to therapy. The therapist should be familiar with the Glasgow Coma Scale and monitor the patient’s progression through the levels of consciousness.

Proper positioning and range of motion exercise should be initiated as soon as safely possible in the acute phase. Proper positioning with pillows and towels will protect the skin integrity and prevention of contractures. Maintaining mobility of the trunk and neck are important to sustain functional mobility. The earlier therapy is initiated with a patient, the chances of secondary impairments are decreased allowing for a better prognosis.

A primary key component to treating a patient recovering from bacterial meningitis is proper education not only to the patient, but to the family and caregivers as well. Providing the patient and family with education on the disease, stages of the disease, secondary complications, warning sign,s and resources can encourage the patient and family to become more involved in the treatment. It is very important to educate on the effectsofm different systemic involvement and how the timeline of recovery may vary.