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Case Report Meningitis
Case Report Meningitis
Case Report Meningitis
B Y : B E L I N DA O R L I N E O. S .
Gender : Female
• Smoking (-)
• Alcohol (-)
PHYSICAL EXAMINATION
• General Appearance : severely ill
• Level of Consciousness : comatose
• GCS : E2V2M4
• Blood Pressure : 110/70 mmHg
• Pulse : 120 bpm, regular
• Axillary Temperature : 38º C
• Respiratory Rate : 28 times/min, regular
• O2 Sat : 95% suppl. nasal cannula with O2 3lpm
GENERAL STATUS
Head :
• Normocephalic
Neck :
• Swollen lymph node (-)
Eye :
• Pale conjunctiva (-/-), icteric sclera (-/-), palpebra swelling (-) , pupil reflex(+/+) isocor 3mm/3mm
ENT :
• Ear : discharge -/-
• Nose : discharge -/-, deviation (-)
• Oropharyngeal : not able to be evaluated
Lips :
• Cyanosis (-), dry lips (-)
GENERAL STATUS CON’T
Thorax :
• Inspection : symmetrycal
• Palpation : symmetrical
• Auscultation :
• Heart : S1S2 N regular murmur (-)
• Lungs : bronchovesicular/bronchovesicular, coarse
crackles +/+, Wheezing -/-
GENERAL STATUS CON’T
Abdomen :
• Inspection : distention (-), flat
• Auscultation : peristaltic (+) N
• Palpation : tenderness (-), liver 1 cm below costae, spleen not palpable, skin
turgor snaps rapidly back to normal position
• Percussion : tympanic
Ekstremities : warm, cyanosis (-), pale (-), CRT <2“
• MENINGEAL SIGNS :
– Nuchal Rigidities :+
– Brudzinski I :+
– Brudzinski II : +/-
– Kernig : -/-
• MOTORIC FUNCTION
– There is no lateralization
• SENSORIC FUNCTION
– Can not be evaluated
NEUROLOGICAL STATUS CON’T
• PHYSIOLOGIC REFLEXES
– Biceps : +2/+2
– Triceps : +2/+2
– Patellar : +2/+2
– Achilles : +2/+2
• PATHOLOGIC REFLEXES
– Babinski : +/- - Gordon : -/-
– Chaddock : +/- - Schaeffer : -/-
– Oppenheim : -/-
LABORATORY FINDINGS
Tests Name Results Reference Range
Leucocyte 7.340 uL 4.000 – 10.000
Erythrocyte 4,19 x 106 uL 4,20 - 5,40 x 106
Haemoglobin 12,4 g/dL 12,0 – 16,0
Haematocryte 36,6 % 37,0 – 47,0 %
Thrombocyte 215.000 uL 150.000 – 400.000
• Meningoencephalitis
• Pneumonia
THERAPY
• IVFD Normal Saline 20 dpm
• Oxygen suppl. Nasal cannula 3lpm
• Methylprednisolone 2 x 62,5 mg (IV)
• Esomeprazole 1 x 40 mg (IV)
• Citicoline 2 x 500 mg (IV)
• Ceftriaxone 2 x 2 g (IV)
• Cefotaxime 3 x 1 g (IV)
• Paracetamol 2 x 500 mg (PO)
• Monitoring general appearance, vital signs, respiratory distress signs
FOLLOW UP
17/09/18 18/09/18
S : unconscious, productive cough, fever, dyspnea S : unconscious, productive cough, fever, dyspnea
O : comatose, GCS : E2M2V4 O : comatose, GCS : E2M2V4
BP : 130/90 mmHg BP : 140/80 mmHg
HR : 120 bpm HR : 105 bpm
RR : 28 times/min RR : 28 times/min
Temp : 38 Temp : 37,1
Lung : coarse crackles +/+ Lung : coarse crackles +/+
Meningeal signs (+) Meningeal signs (+)
Pathologic reflexes (+) Pathologic reflexes (+)
A : meningoencephalitis + pneumonia
P : IVFD Normal Saline 20 dpm
Oxygen suppl. Nasal cannula 3lpm NRM 8lpm
Methylprednisolone 2 x 62,5 mg (IV) day-3
Esomeprazole 1 x 40 mg (IV)
Citicoline 2 x 500 mg (IV)
Moxifloxacin 1 x 400 mg (IV) day-2
Paracetamol 3 x 500 mg (PO) 3 x 1 g (IV)
Diet : milk suppl. Nasogastric tube 3 times a day
Monitoring general appearance, vital signs, respiratory distress signs
Monocyte 75%
Poly 25%
Erythrocyte 8
Shape normal
Cell 34 cell/uL 0–5
• Organism : no growth
• comment : no growth of any bacterias; could be caused by:
– Infection caused by fastidious bacterias (Heamophilus influenza,
M. TB) or
– virus
MENINGITIS
DEFINITION
• Bacterial infections
• Viral infections
• Fungal infections
ROUTE OF ENTRY IN CNS
Breakdown of
normal barriers
Proliferates in the
CSF
Inflammation of the
meninges
increase in ICP
BACTERIAL MENINGITIS
30 – 80 % • Streptococcus pneumoniae
15 – 40 % • Neisseria meningitidis
CAUSATIVE AGENTS :
• Enterovirus
• Adenovirus
• Arbovirus
• Measles virus
• Herpes simplex virus
• varicella
FUNGAL MENINGITIS
• History taking
• Physical examination
• Imaging CT scan and MRI
• Blood culture
• Lumbar puncture
CSF FINDING
TREATMENT
BACTERIAL MENINGITIS
VACCINATION AGAINST BACTERIAL
MENINGITIS
Altered level
febrile of seizures
consciousness
• Supportive therapy
– Monitoring ICP
– Fluid restriction
– Avoidance of hypotonic solutions
– Suppression of fever
– Anticonvulsant regimens
TREATMENT CON’T