Study of Bacterial Meningitis - Essay Example

Running Head: BACTERIAL MENINGITIS Bacterial Meningitis Name Institution Date Introduction Bacterial meningitis The case study below is of Tatum, a two year old girl who was diagnosed with bacterial meningitis. Meningitis is a disease that is characterized by inflammation of the brain and spinal cord membranes. The disease is either caused by bacteria or virus (Kneib, 2005, p 15). This disease affects people of all ages from children to adults. When it affects children, it may hinder them form attaining their normal growth and development process. The normal growth and development that is acceptable for a child of two years of age Child growth and development entails the biological and psychological changes that take place in the bodies of children since the time of birth until they reach adolescence. Rene, (2010, p 657) says that every child takes the growth and development path in a unique way but there are certain traits that are common to children at a particular stage. Some of the developments that are expected in a child of two years include the ability to walk freely on the ground. The child can also stand in an upright position on his or her own. The child, at this stage, is always moving and grows cognitively such that she can be able to use objects for their right purposes (Rene, 2010, p 654). Children at this stage also understand the importance of language in explaining something to others (Santrock, 2008, p 411). The child is able to use negative language in expressing negative statements. The child is also able to use singulars and plurals. At two years the child is no longer a baby and can feed by himself or herself. However, the child cannot reason but does new things or learns new words every day (Kail, 2006, p.50).The child also attains social and emotional growth and she or he is able to show signs of empathy and care. She can comfort another child who is crying and can also use physical aggression when she is frustrated. This is an indication that the child is developing their emotions (Kail, 2006, p.54). Some factors such as disease can affect the normal growth and development of a child and may slow down the development process hindering it from attaining the required growth at a particular age. A disease such as meningitis can make the child unable to play, eat well or even drink. This may affect the general aspects of growth and development of a child who is affected by meningitis (Volpe, 2008, p. 114). Pathophysiology of Bacterial meningitis Bacterial meningitis is caused by several types of bacteria which include Haemophilus influenzae type b (Hib). Other types are Streptococcus pneumonia and Neisseria meningitides and are the most common (Klosterman, 2006, p. 22).The bacteria that commonly causes meningitis is found in the environment but can also live in the nose and the respiratory tract of human beings without causing any harm. Meningococcal meningitis is the disease that is responsible for more than half of the bacterial meningitis cases in the United States, also caused by Neisseria meningitides (Klosterman, 2006, p. 22). Bacterial meningitis is mostly common among children between the age of one month and two years. It only affects adults who are at risk factors such as those who take alcohol or those suffering nose or ear infections and those with head injuries (Bakay, & Lee, 2006, p.122).The bacteria that causes meningitis reaches the meninges through various means which include the blood stream, contact between the affected and non affected meninges, and also through the nasal cavity. Once the bacteria enter the blood stream, they travel along the subarachnoid space up to places where the barrier of brain and blood is weak such as in the choroid plexus (Routh, 2006, p. 41).Extensive inflammation therefore takes place in the subarachnoid space which is not directly due to infection of bacteria, but also as a result of the response by the immune system to the entrance of the bacteria into the central nervous system (Routh, 2006, p. 41). When cells related to the immune system recognise the cell membrane of the bacteria, they react by releasing cytokines in large amounts. Cytokines are the mediators, inform of hormones that initiate other immune cells to participate in the response mechanism. (Bauer, 2009, p21).The barrier that separates the brain from blood responds by becoming more permeable leading to cerebral oedema. This is swelling of the brain due to too much leakage from the blood vessels. This happens due to a difference in osmolarity between the cerebral-spinal fluid and that of the blood plasma (Bakay, & Lee, 2006, p.120). The white blood cells pass into the cerebrospinal fluid leading to inflammation of the meninges, thus bacterial meningitis. Children with weakened immune systems are at most risk of developing bacterial meningitis. Others who are at risk include those people who had a spinal injury and those who had extensive blood infection. People get meningitis by getting into close contact with discharges from nose and throat of the affected patients. However, the bacterial type is not highly contagious (Bauer, 2009, p21). Clinical manifestation of Bacterial meningitis The manifestation of bacterial meningitis may differ according to the age of the person affected. Children below the age of two years may present non specific symptoms especially at the early stages of the disease. But for children with two years and above, clinical manifestation may be clearly seen. Bacterial meningitis mostly occurs in adults of twenty five years and the occurrence cases are equal for both men and women (Beek, 2008, p.1852). The most common manifestation of bacterial meningitis includes high fever, headache and stiff neck. Confusion, drowsiness and irritability may be seen in both the older children and adults. Young children may vomit due to the high fever and most of them refuse to eat. They may get more irritable and keep crying. Those infected may also have seizures. The head may also swell due to the accumulated fluid around the skull (Griffiss, 2005, p 1788). Other manifestations of bacterial meningitis are photophobia and phonophobia. This means intolerance to bright light and loud noises respectively Klosterman, 2006, p22). Meningitis that is caused by Neisseria maningitidis appears different from that caused by other bacteria due to a characteristic rapid spreading red rash that may head other symptoms. The rash may appear on the lower extremities, on the palms and sores of feet. Symptoms of bacterial meningitis appear very fast within twenty four hours. If not treated immediately, it may result to death of the infected person (Klosterman, 2006, p23). Initial treatment of Bacterial meningitis Early diagnosis and treatment of bacterial meningitis are vital. Immediately the symptoms are noticed, the person should be taken to the doctor. Diagnosis is done by extracting spinal fluid from the lower back in which a bacterium is grown. This helps in deciding on the medication to be used. Since bacterial meningitis is an emergency medical case, prompt use of antibiotics is necessary. However, for those who are suspected of the disease but are not showing severe symptoms, lumbar puncture can be done first (Heyderman 2008, p.74). Initial treatment involves use of wide spectrum antibiotics while awaiting the confirmatory results. If the patient’s blood pressure is low or has experienced shock, intravenous fluids should be administered (Heyderman 2008, p.74). After the confirmation of bacterial meningitis, corticosteroids and antibiotics should be started immediately. Corticosteroids help in preventing loss of hearing and other pathological conditions since it helps in inhibiting the release of cytokines that cause inflammation. They also prevent the buildup of pressure in the cranial cavity that leads to swelling. Antibiotics help in fighting the bacteria that has caused the disease. A wide range of antibiotics should be used from the first generation to fourth generation (Ginsberg, 2007, p 20) This helps to completely fight against pathogens that cause meningitis. Fluids should also be given to replace those lost from diarrhea and vomiting. Proper treatment ends the condition completely but it can recur for those people with genetic defects especially those with deficiency of C5 and C6 (compliment 5 and 6). The two are genes responsible for enhancing protein binding. (Ginsberg, 2007, p 20) Possible complications of Bacterial meningitis Although most people recovery completely from bacterial meningitis, there may be some after effects some of which may be permanent and others temporary (Beek, 2008, 1857). The severity of the complications depends on the time that one stays without treatment of bacterial meningitis. Possible complications of bacterial meningitis include brain damage, hearing loss, loss of speech and blindness (Beek, 2008, 1858). The most common of the complications is loss of hearing. This affects more than ten percent of children who recovers from bacterial meningitis. According to Aschoff, (2006, p 83), loss of hearing occurs from the direct effect of the bacterial infection on the brain and also from the mechanism taken by the body in response to the infection. Strong reactions by the body results in permanent brain damage and this are most common in pneumococcal meningitis (Aschoff, 2006, p 85). The cochlea, which is the auditory section of the inner ear, is the highly affected site in the permanent loss of hearing. This takes place during the first days of the disease attack. The damage of the hearing highly depends on the age of the individual affected by the disease. New born babies are at most risk of losing their hearing following the attack of bacterial meningitis. The child therefore grows with impaired development in social skills and may also fail to properly develop the language skills (Aschoff, 2006, p 85). . The child may also develop tinnitus which means hearing sounds in the head or in the ears. Delayed treatment may also result in loss of hearing as in the case of Tatum since it is due to lack of treatment that the body immune system starts to take its action in responding to the entry of bacteria. A form of blindness referred to as Cortical Visual Impairment (CVI), may result due to attack of bacterial meningitis. This is caused by damage to the central nervous system that occurs when blood the blood-brain barrier is affected as in the case of bacterial meningitis. In most cases, total blindness does not occur but there is visual impairment (Pillitteri, 2009, p 26).Loss of speech also occurs due to brain damage. This is because when the central nervous system is affected, there is loss of coordination between the sight, the speech and the hearing. The brain damage occurs due to increased permeability of the brain-blood barrier that allows the bacteria to enter into the central nervous system (Pillitteri, 2009, p 26). The permeability also leads to cerebral oedema when there is leakage from the blood vessels into the brain. This is the main cause of most of the complications that comes with infection of the bacterial meningitis. The brain may also develop a condition known as hydrocephalus characterized by buildup of cerebrospinal fluid in the cavities of the brain (Aschoff, 2006, p 85). Dehydration may also be common with bacterial. This is due to loss of fluids from vomiting. It is therefore necessary to give intravenous fluids to patients to avoid fluid loss. Nevertheless, these complications can be prevented by early treatment. Care for Tatum, her mother and family during the illness in hospital Bacterial meningitis is a highly fatal disease that requires proper supportive care especially in the hospital setting. Studies have indicated that inappropriate care for patients with bacterial meningitis leads to poor outcomes which include complications such as loss of hearing and sight (Pillitteri, 2009, p 26).Some of the aspects of critical care in the hospital include proper hygiene. This involves caring for their mouths. When one has a bacterial infection, the mouth may have bad smell and this need to be taken care of. Physical comfort is also very important for a patient with bacterial meningitis patient. A child with meningitis needs support of the mother especially due to their irritable condition. Those experiencing stiffness in the neck needs to be placed in a comfortable position and a comfortable bed. Physical comfort is also important due to headache. Soft pillows should be availed in the hospital bed (Pillitteri, 2009, p 26). Nutritional care is also very important in meningitis patients. Tatum was experiencing difficulties in eating and drinking. This condition was therefore compromising her nutritional status. Tatum therefore needs soft food, which is easy to eat and appetizing. To replace the lost fluids, she also needs plenty of water. If Tatum cannot drink anything at all, fluids should be given intravenously. Small frequent meals are important for Tatum to improve in her feeding ability. High energy meals are also necessary especially due to fever that is experienced by Tatum (Marotz, 2008, p94). For the mother and the family of Tatum, it is important for them to protect themselves while handling Tatum because the bacteria that cause meningitis can be spread through respiratory secretions (Johnson, 2008, p 17). The mother should ensure that she throws away anything that Tatum uses to blow her nose. The most contagious is meningitis that is caused by Neisseria meningitides (Johnson, 2008, p 17). Impacts of hospitalization to children and their families Hospitalization of a child is very stressful to her and the mother. A normally growing child in her normal environment progresses each day and learns new skills. Hospitalization changes the environment of the child and this may inhibit the normal growth and development (Wright, 2008, P 165). Appetite of the child may also become worse due to hospitalization. The unfamiliar hospital environment may inhibit the child from proper feeding. The many activities of a hospitalized child changes because of the emotional distress that children experience while in hospital. The children are denied the opportunity to be together with the others and this may affect her emotionally (Wright, 2008, P 165). The hospital procedures involved in treating meningitis are also severe and may cause pain to the child. For example when tapping the spinal fluid in testing for bacterial meningitis, the extraction of the fluid is very painful and this may subject the child to too much pain. The child may feel depressed and she may get into a very desperate situation. Hospitalization also separates the child from the family members especially the mother. This may psychologically disturb the child and may have long time emotional impacts on the child (Oremland, 2009, p 27). The health and nutritional status of the child may also be affected. This is because the environment is unfamiliar and may affect the feeding habits of the child. Vomiting and fever may also result to loss of nutrients and may compromise the nutritional status of the child. The drugs taken in the hospital may also prevent the child form proper feeding.Separation of the child from the peers may also affect the growth and development of the child. According to the child growth and development chart, the child learns new terms and new things every day while in the normal environment. Hospitalizing a child therefore hinders the normal growth and development of the child (Mainous, & Pomeroy, 2010, p 34). Hospitalization may also impact the family especially due to the proper care required for the patient. A child suffering from bacterial meningitis needs a lot of support from the mother and may require the presence of the mother at all times. This may force the mother to stop her job and activities to give attention to the child. It is therefore costly in terms of time. Hospitalization also affects the family financially. This is because of the hospital bills and other special requirements that the sick child requires such as special diets which are high in energy when in hospital(Mainous, & Pomeroy, 2010, p 34). Conclusion Bacterial meningitis is associated with many complications that may affect the normal life of the affected individual. However, proper treatment has been shown to cure the disease. The most important aspect of treatment is early treatment which should be sought with indication of the first symptom. It would have therefore been important for the mother to take her to hospital on Sunday after she noticed the first symptoms. References Aschoff, A. et al. (2006). "The scientific history of hydrocephalus and its treatment". Neurosurgical Review 22 (3): 67–93. Bakay, L. & Lee, J. (2006). Cerebral oedema. Melbourne: C.C. Thomas. Bauer, A. (2009). Contagious diseases: a guide for parents. London: SAGE. Beek D, et al. (2008). "Clinical features and prognostic factors in adults with bacterial meningitis". The New England Journal of Medicine 351 (18): 1849–59. Ginsberg, L. (2009). "Difficult and recurrent meningitis". Journal of Neurology, Neurosurgery, and Psychiatry 75 (1): 16–21. Griffiss, J. (2005).Bactericidal activity of meningococcal antisera. Blocking by IgA of lytic antibody in human convalescent sera. Journal of Immunology. 114(6):1779– 1784. Heyderman, R., et al. (2008). Early management of suspected bacterial meningitis and meningococcal septicaemia in adults. Journal of Infections; 46:75–7. Johnson, J. (2008). Contagious diseases. New York: Willey Science. Kail R., (2006). Children and Their Development (4 Ed.). London: Prentice Hall. Klosterman, L. (2006). Meningitis. Boston: Marshall Cavendish. Mainous, A. & Pomeroy, C. (2010). Management of Antimicrobials in Infectious Diseases: Impact of Antibiotic Resistance. New York: Springer. Marotz, L. (2008). Health, Safety, and Nutrition for the Young Child. New York: Cengage Learning Kneib, M. (2005). Meningitis. Albany: The Rosen Publishing Group. Oremland, E. et al. (2009). The Effects of hospitalization on children: models for their care. Oxford: Oxford University Press. Pillitteri, A. (2009). Maternal and Child Health Nursing: Care of the Childbearing and Childrearing Family. New York: Lippincott Williams & Wilkins. Santrock, J (2008). A topical Approach to Life-Span Development. New York: McGraw-Hill Higher Education. Rene, P., et al. (2010). Pain expression in children with an intellectual disability. European Journal of Pain. 14(6). 654-660. Routh, K., (2006). Meningitis. Sheffield: Heinemann Library. Wright, M. (2008). Behavioral effects of hospitalization in children.Journal of Paediatrics and Child Health. 31(3): 165–167. Volpe, J. (2008). Neurology of the newborn. New York: Elsevier Health Sciences. Read More