Physical examination, nasopharyngeal smear, and antigen tests are used to diagnose meningitis. Fungal meningitis requires CSF cultures for treatment. Bacterial and fungal meningitis require antibiotic therapy for treatment while aseptic meningitis is managed with antiviral drugs and steroids (McCance & Heuther, 2008).
Vaccination is recommended by the Food and Drug Administration and the Centers for Disease Control to prevent meningitis (McCance & Heuther, 2008). Our patient would benefit from antibiotic treatment, anti-nausea medication, intra venous or oral hydration, Tylenol Motrin, a quiet environment and plenty of rest. According to Nins et al., isolation is not necessary after the first day or two of infection (2008). Our patient needs to have her vital signs monitored every hour to assess for signs of shock. Hypotension is a late sign of shock in children (Nins et al., 2008).
Meningitis and the
inflammatory response
“Meningitis is an inflammation of the pia mater, the arachnoid, and the CSF-filled subarachnoid space.” (Porth, 2005, p. 1253). This inflammation is most often caused by infection and spreads very quickly because of cerebrospinal fluid (CSF) circulation surrounding the brain and spinal cord (Porth,2005 ). Infection colonizes locally, invades the submucosa, and then enters the central nervous system. Meningococcal meningitis most often colonizes in the nasopharynx (Razonable & Keating, 2007). The inflammation is not a direct result of bacteria. It is the result of the bacteria causing the activation of the body’s inflammatory response. When the bacteria penetrate the central nervous system they reproduce very rapidly (Saez-Liorens & McCracken, Jr., 2003).
Understanding the inflammatory response is key to understanding meningitis. “Inflammation is the reaction of vascularized tissue to local injury.” (Porth, 2005, p. 387). It is the earliest response to injury (Porth). Inflammation at the cellular stage is manifest by the movement of phagocytic white blood cells into the injury. These white blood cells are called leukocytes. There are two types of leukocytes involved in the inflammatory response: granulocytes and monocytes. Granulocytes are further divided into neutrophils, eosinophils, and basophils. The neutrophil is first on the scene of the injury. The neutrophil contains enzymes and antibacterial particles that destroy the invading particles. Monocytes are the largest white blood cells. They last longer than granulocytes. They help destroy the invading or insulting agent and signal the immune system. They eventually become macrophages, which can destroy larger invaders than the neutrophils can destroy. (Porth)
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