Infectious Diseases: MENINGITIS, BRAIN ABSCESS, ENCEPHALITIS, CREUTZFELDT-JAKOB DISEASE, vCJD,

INFECTIOUS DISEASES

MENINGITIS• Inflammation involving the

arachnoid, pia mater & the interposed CSF in

the subarachnoid space• Extends throughout the

subarachnoid space around the brain, spinal cord & ventricles

CLASSIFICATION1. BACTERIAL2. VIRAL3. ASEPTIC4. NON-INFECTIOUS

1. SEPTIC MENINGITIS• MOST COMMON PATHOGENS Streptococcus pneumoniae Listeria monocytogenes Group B strep H. influenzae N. meningitidis

• CLASSIFICATIONS (ACCDG TO TYPE OF SPREAD) 1.DIRECT 2. INDIRECT

RISK FACTORS

• Extremes of age• Crowded conditions• Splenectomy• Sickle cell disease• Alcoholism• Cirrhosis• CSF leak• CSF shunt• Sinusitis, Otitis media, Mastoiditis

• Recent neurosurgical procedure

CAUSATIVE AGENT

INVASION THROUGH BLOOD BRAIN BARRIER

BACTERIAL PROLIFERATION

MENINGEAL IRRITATION

LIPOPOLYSACCHARIDES, CELL WALL FRAGMENTS

INFLAMMATION: SUBARACHNOID & DURA MATER

ICP CSF : SUBARACHNOID SPACE

CSF : CHON

HEADACHE GLUCOSE FEVER WBC NUCHAL RIGIDITY + KERNIG’S SIGN + BRUDZINSKI’S SIGN PHOTOPHOBIA

PATHOPHYSIOLOGY :

BRUDZINSKI’S SIGN KERNIG’S SIGN

COMMON CLINICAL MANIFESTATIONSNUCHAL RIGIDITYBRUDZINSKI’S SIGNKERNIG’S SIGNPHOTOPHOBIAHEADACHEFEVER

LETHARGYUNRESPONSIVENESSCOMA

DIAGNOSTIC EVALUATION

BLOOD TESTS BACTERIAL CULTUREGRAM STAIN ( CSF, BLOOD)LUMBAR PUNCTURE CT SCAN MRISEROLOGY

MANAGEMENTNURSING1. CLOSE MONITORING: V/S AND NEUROVITAL SIGNS2. PROVIDING SAFETY3. PREVENTING COMPLICATIONS4. UNIVERSAL + RESPIRATORY PRECAUTIONS5. ADMINISTERINGG PRESCRIBED MEDICATION REGIMEN

MEDICAL1. PENICILLIN2. CEPHALOSPORINS3. VANCOMYCIN4. RIFAMPIN5. DEXAMETHASONE6. FLUID VOLUME EXPANDERS7. DILANTIN

BRAIN ABSCESS• caused by inflammation and

collection of infected material

SOURCES OF INFECTION1. Local a. ear infection b. dental abscess c. infection of paranasal

sinuses d. infection of the mastoid air

cells of the temporal bone e. epidural abscess2. Remote 3. Trauma

Clinical Manifestations1. Headache2. fever3. vomiting4. focal neurologic deficits5. increased ICP6. Seizures

Diagnostic evaluation1. MRI2. CT SCAN ( with contrast)3. aspiration biopsy4. blood culture

MANAGEMENTNURSING1. CLOSE MONITORING 2. ADMINISTERING PRESCRIBED MEDICATION3. PREVENTING COMPLICATIONS4. SUPPORTIVE CARE5. MAINTAINING PATIENT SAFETY

MEDICAL1. ANTI-MICROBIAL THERAPY2. ANTI-SEIZURE MEDICATION3. SURGICAL DRAINAGE OF ABSCESS4. MANAGEMENT OF ICP

ENCEPHALITIS• ACUTE INFLAMMATION

OF THE BRAIN

CAUSES1. BACTERIAL2. VIRAL A. HSV -1 B. HSV -2 C. ARTHROPOD-BORNE3. FUNGAL

CLINICAL MANIFESTATIONS• Fever• headache• Photophobia• Weakness • Seizures • Stiffness of the neck• slowness in movement • Clumsiness • Drowsiness • coughing

DIAGNOSTIC EVALUATION1. LUMBAR PUNCTURE2. MRI3. POLYMERASE CHAIN REACTION

MANAGEMENTNURSING 1. CLOSE MONITORING OF V/S, NVS2. PREVENTING INJURY3. HEALTH TEACHING4. PROMPT REPORTING OF IDENTIFIED CASES

MEDICAL1. SYMPTOMATIC

CREUTZFELDT-JAKOB DISEASE• degenerative infectious neurological disorder that is very

rare, incurable, and invariably fatal• type of transmissible spongiform encephalopathy found in

humans• types 1. sporadic 2. variant 3. familial• theories on mode of transmission : 1) ingestion of beef contaminated with infected neurologic tissue containing prions 2) blood-borne5 % of cases 1. contaminated neurosurgical insruments 2. cadaver-derived growth factor 3. corneal transplant

vCJD• human variation of

BOVINE SPONGIFORM ENCEPHALOPATHY ( BSE)

• PRIONS – PROTEINACEOUS PARTICLES SMALLER THAN A VIRUS AND ARE RESISTANT TO STANDARD METHODS OF STERILIZATION

CLINICAL MANIFESTATIONS

• rapidly progressive dementia• memory loss• personality changes • hallucinations• speech impairment• jerky movements • balance and coordination dysfunction • changes in gait• rigid posture• seizures

Diagnostic Evaluation

• Biopsy of brain tissue• Electroencephalography• Cerebrospinal fluid analysis• MRI• Diffusion Weighted Imaging • Neuron-specific enolase (NSE)• Tonsillar biopsy

ManagementNURSING1. Supportive and palliative - psychological and emotional support2. Providing a dignified death3. Sterility and transmission precautions4. Proper disposal of instruments5. Health teaching

MEDICAL1. Supportive and palliative2. prevention of injury r/t mobility and dementia

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