Meningitis Bacterial

meningitis on cerebrospinal, piamater,

arachnoid, subarachnoid space, the superficial
tissues of the brain and medulla.
Etiology
-vetrikulitis
-subdural effusion
-electrolyte disturbances
-recurrent meningitis
Risk factors:

systemic or focal infection, such as septicemia and
pulmonary tuberculosis.
Trauma and certain actions, such as crania base
fracture.
Blood Diseases
Liver disease
The use of materials that inhibit the formation of
antibodies (antibody response)
imunosupresion related disorders, such as diabetes
mellitus
disorders or abnormalities of obstetric and gynecologic
Pathophysiology:

Germs enter the CNS are:
- Haematogenous/direct spread from dinasofaring abnormalities, lung, and heart
- Perkontinuitatum of organ or tissue inflammation near the lining of the brain.
Germs (meningokok, pneumococcal, haemophilus influenza, and stertokok)
go the subarachnoid chamber (a reaction and inflammation of the arachnoid
piamater, CSS, and system ventricles) meningeal blood vessels are so small and
hyperemesis polymorphonuclear leukocytes cells spread subarachnoid
chamber exudate (the inside and the outside of the macrophages are contained
polymorphonuclear leukocytes and fibrin) form of lymphocytes and
leukocytes form plasma cells (2 weeks later).
Selainpada arteries, inflammation can also occur in the cortex that can cause
venous thrombosis, cerebral infarction, cerebral edema, and degeneration of
neurons giving rise to superficial encephalitis.
Thrombosis and perineural exudate organization that fibrio-purulent nervi
cause cranial abnormalities (Ms. III, IV, VI, VII and VIII)
Organization of the subarachnoid space and impede the flow of absorption CSS
causing communicating hydrocephalus.
diagnosis:

The exact diagnosis of lumbar puncture by:
Indications: meningeal irritation can occur lasting several days
(especially) or with symptoms of meningitis, heat is not known why.
Contraindications: can cause brain abscess
Although it is a risk factor for meningitis, but absolutely necessary.
If there are signs of increased intracranial pressure, a lumbar
puncture done through the cisterna magna, point to avoid
decompression herniation below the foramen magnum and tosilar.
If the pressure above 200 mmH2O CSS starters, give mannitol 0.25-
0.5 mg / kg bw bolus immediately after lumbar puncture, point to
avoid brain herniation.
CSS taken in moderation. CSS generally 200-500 mmH2O pressure
was blurred, cloudy, or purulent.

Imunodiagnostik:
Counter immunoelectrophoresis of CSS: CSS determines the antigen germs
Examination of urine: if the CSS examination and negative blood
latex agglutination (antibody-coated latex particles or organisms stafilokokok A):
determine polysaccharide antigen.
Examination CSS enzyme (enzyme linked immunoassay)
Other tests: quelung reaction, staining the bacteria with immunofluoresens and
blood test with nitroblue tetrazolium.
Pneumo-angiography: can the narrowing of the arteries, retrograde flow or
blockage of blood flow becomes very slow.
Plain radiographs of the skull: determining fracture and infection-sinus disinus
paranasales
chest Photo: determining the presence of pneumonia, lung abscess, specific
processes, and brain mass.
An EEG: slow-wave can be seen in both hemispheres diffuse, the voltage drop due
to subdural effusion, or focal delta activity (if in conjunction with a brain abscess)
CT-Scan and MRI: brain edema, ventriculitis, hydrocephalus, and tumor mass.
Other tests:
- Test of tuberculin
- Examination of electrolyte
- Examination of peripheral blood (leukocyte count and cell count)
Differential diagnosis:
Meningism
Behcet's Disease
lymphocytic meningitis
Other infections (such as encephalitis and viral infections)
complications:
ventriculitis
subdural effusion
Electrolyte Disorders
recurrent meningitis
residual symptoms of epilepsy, cranial spiral disturbances,
focal brain abnormalities, and hydrocephalus.

.

Procedures

General treatment:
Rest absolute
For a fairly severe infection, patients should be treated diruang isolation
Note resperasi function, if respiratory distress occurs, plug the endotracheal tube or tracheostomy.
Monitor the administration of parenteral fluids
Fix dehydration, which in adults normally requires 3000 ml of fluid a day
Immediately overcome hyponatremia and hypokalemia
Consider the possibility of seizures, hyperpyrexia, cerebral edema, phlebitis, pressure sores, and
malnutrition.

Giving antibiotics:
In accordance with bacteria and in higher doses:
- Infection pneumokokok, streptokokok, and meningokok give penicillin G at a dose of 1-2 million units
every 2 hours.
- Air haemophilus infection chloramphenicol 4 x 1 g / 24 hours, or 4 x 3 g ampicillin / 24 hours
intravenously.
- Infection meningokok give sulfadiazine 12 x 500 mg in 24 hours for 10 days.
- Give gentamicin for E. coli, klebsiela, Proteus, and gram-negative germs. Namely premature infants given 5
mg / Kg BW / day in 2 divided doses, in neonates give 7.5mg / Kg BW / day in 3x provision, as well as in
infants, children and adults give 5 mg / Kg BW / day in 3x provision.
During the wait for culture results, provide a broad spectrum antibiotic for 10-14 days at least 7 days.
After freely given parenterally fever.

Prognosis

Depending on the type of bacteria, terrible
disease at the outset, age, duration of
symptoms / illness before treatment, enforced
speed based on diagnosis, antibiotics are given,
as well as pathological conditions that
accompany meningitis

Rabies


Also called hydrophobia, lyssa, and rage
It is an acute viral infection of the CNS caused by rabies virus; an RNA
virus
The rabies virus is present in the saliva of animals that have been
infected through bites, scratches, and scrapings taken into the human
body. Thus, cases of rabies occur as a result of the inoculation of the
virus through the skin that has been exposed. Animals that are often
experienced dogs, foxes, wolves, cats, bats, and monkeys. But there
are also cases of animal rabies without a bite, only with air containing
meghirup rabies, such as in caves, where there are many bats are
suffering from rabies, or laboratory because of lack of caution.
pathophysiology:

Rabies incubation period is between 10 days to 1 year / more. Generally
range between 1-3 months, in certain cases can be more quickly is 10-21
days, especially when there are a lot of bites or bite on the face. Bites on the
upper arm is more dangerous than the forearm and lower leg, especially
when there is a bite to the face, because it is closer to the medulla oblongata
and contains many fine nerve fibers and small.

Incubation time, in addition to relying on the inoculation also depend on the
patient's body resistance and virulence of rabies virus. The rabies virus has
been isolated at day 4 after bite. In addition to inoculation, rabies virus into
muscle cells, then spread to the CNS via axonal transport of sensory nerves
and motor and cause encephalomyelitis.

The process of inflammation can occur throughout the central nervous
system, especially in the dorsal root ganglion, the jugular, the ganglion
gasseri, and the nucleus dentatus, the lower part of the medulla oblongata,
the hypothalamus and the nucleus tuberalis.

diagnosis:

Anamesis about when bitten, the bite location
and by what animal. With this can be taken to
prevent the onset of rabies tinadakn.
Laboratory tests: includes profiles CSS, skin and
brain biopsy, rabies antibodies in serum, isolation of
the virus in saliva, throat and CSS. CSS colored clear,
erratic cell number ranging from 5-500 / ml,
increased levels of protein, glucose and chloride
levels to normal.

management:

Preventive : if someone is bitten by a dog / animal suspected of rabies, the
animal must be observed. Fed and watered as usual for 10 days and the
animals were tied. When there is not anything, it means that the person does
not need to be vaccinated. But when it shows signs of rabies, the person must
be vaccinated and the dog was killed, and the brain examined veterinary
laboratory services.
Curative: wounds, bites / scratches dog / animal suffering from rabies
dibersihkandengan soapy water and disinfectant (as nitrate / chloride solution
benzolkonium 2% or benzylammonium chloride / zephiran): these materials
can stop the virus activity.
Patients with rabies infection, immediately given anti-rabies serum
treatment. During the maintenance of fluid and electrolyte needs note, the
amount of calories should be enough, including vitamins. Seizures must be
addressed, in respiratory disorders should be given oxygen and help
breathing, the patient should be admitted to intensive care
A seizure is:
A sudden, brief disruption of the normal
functioning of neurons in the brain
A seizure may appear as:
A sudden cry and fall, followed by
Convulsive movements of all limbs
Shallow/interrupted breathing - cyanosis
Loss of bowel/bladder control
Slow return to consciousness, post-seizure
confusion and/or fatigue
or a seizure may be
Blank staring, chewing, other repetitive
purposeless movements
Wandering, confusion, incoherent speech
Crying, screaming, running, flailing
A sudden loss of muscle tone and fall
Picking at clothes, disrobing
Seizure Causes
High fever, especially in infants
Drug use, alcohol withdrawal
Near-drowning or lack of oxygen from
another cause
Metabolic disturbances
Head trauma
Brain tumor, infection, stroke
Complication of diabetes or pregnancy

Loss of consciousness, fall and stiffening of
limbs, followed by rhythmic shaking.
Breathing may stop temporarily - skin,
nails, lips may turn blue
Loss of bladder/bowel control may occur
Generally lasts 1 to 3 minutes
Followed by confusion, sleepiness

Tonic-Clonic Seizure -grand mal
In a partial seizure
the electrical
disruption involves a
limited area of the
brain.
Seizure activity in the brain causing:

Rhythmic movements -
isolated twitching of arms, face, legs
Sensory symptoms -
tingling, weakness, sounds, smells, tastes,
feeling of upset stomach, visual distortions
Psychic symptoms -
dj vu, hallucinations, feelings of fear or anxiety

Usually last less than one minute
May precede a generalized seizure
Simple Partial Seizure
Characterized by altered awareness
Confusion, inability to respond
Automatic, purposeless behaviors such as picking
at clothes, chewing or mumbling.
Emotional outbursts
May be confused with:
Drunkenness or drug use
Willful belligerence, aggressiveness

Complex Partial Seizure
Anti-epileptic Medications
Depakote (Valproic acid)
Felbatol (felbamate)
Gabatril (tiagabine)
Keppra (levetiracetam)
Lamictal (lamotrigine)
Dilantin (phenytoin)
phenobarbitol

Neurontin (gabapentin)
Tegretol (carbamezepine)
Trileptal (oxcarbazepine)
Topamax (topiramate)
Zonegran (zonisamide)
Lyrica (pregabalin)
Surgical treatment
Factors influencing decision:
Ability to identify focus of seizures
Area of brain involved can be
safely removed without resulting in a
significant deficit
Other treatments have been unsuccessful