Case Presentation &

Discussion
on

BACTERIAL
MENNIGITIS
ASKALI, RANIA I.
ADZU SOM III
 PATIENT
DEMOGRAPHICS

This is a case of J.B, a 25-

year old right-handed male
from Tetuan, Zamboanga
City. He is a high school
graduate and a Roman
Catholic.
 CHIEF
COMPLIANT
Fever with decreasing
sensorium
 HISTORY OF PRESENT ILLNESS

• This prompted consult

• Drowsy and confused to the emergency room,
• With undocumented hence the admission.
fever and headache Hours
prior to
• Undocumented fever admission
• Moderate, non-
radiating frontal • Took paracetamol
headache, 500mg
• Body malaise • No consult was
• Loss of appetite done
Two days
prior to
admission
PERTINENT HISTORY

PAST MEDICAL FAMILY HISTORY PERSONAL AND

HISTORY SOCIAL HISTORY
• Patient had no previous • (+) Hypertension • 13-pack year cigarette
hospitalizations. • (-) Other heredofamilial smoker
• He also has no known diseases • Occasional Alcoholic
comorbidities such as Drinker
hypertension, diabetes
mellitus and asthma.
 (-) Weight Loss
GENERAL
(-) Fatigue
(-) Rashes (-) Lumps (-) Sores (-)
SKIN Itching
(+) Dryness (-) Color change
Head: (-) Injury (-) Dizziness
(-) Lightheadedness
Eyes: (-) Blurred vision (-) Pain (-) Excessive
tearing
HEAD, EYES, Ears: (-) Discharges (-) Earache (-) Tinnitus
EARS, NOSE Nose and Sinuses: (-) Epistaxis (-) Pain
REVIEW OF AND THROAT
(HEENT)
(-) Discharges
(-) Itching (-) Frequent colds

SYSTEMS Throat:(+) Sore throat(-) Hoarseness

Bleeding gums
(-)

(-) Dentures (-) Sore tongue (-) Dry

mouth
(+) Stiffness (-) Nape pain (-) Swollen glands
NECK
(-) Goiter
(-) Dyspnea (-) Wheezing (-) Cough
RESPIRATORY
(-) Hemoptysis (-) Pain
CARDIOVASCUL (-) Palpitations
AR
 CARDIOVASCU (-) Palpitations
LAR
GASTROINTES (-) Pain with defecation
TINAL (-) Rectal bleeding (-) Abdominal pain
(-) Claudication (-) Leg cramps (-)
PERIPHERAL Swelling (-) Tenderness
VASCULAR (-) Varicose veins
(-) Frequent urination (-) Burning or pain
during urination
REVIEW OF URINARY
(-) Hematuria (-) Flank pain

SYSTEMS (-) Muscle or joint pain

(-) Arthritis
(-) Stiffness

MUSCULOSKE (-) Backache (-) Pain (-)

LETAL Tenderness (-) Swelling
(-) Limitation of motion or action

(-) Slurred speech (-) Paralysis

NEUROLOGIC (-) Seizure
(-) Excessive sweating (-) Excessive thirst
ENDOCRINE or hunger
(-) Heat or cold intolerance
PHYSICAL EXAMINATION
Seen lying on bed, drowsy, weak-looking, and not in respiratory distress.
GENERAL
Temperature: 38.2˚C Pulse Rate: 111 bpm
VITAL SIGNS Respiratory Rate: 22/min O2 sat: 99% at room air
Blood pressure: 110/80 mmHg
No scars, jaundice or cyanosis noted. Skin is warm to touch with good skin turgor.
SKIN
Head: The head is normocephalic and atraumatic with equal hair distribution. No lumps or
areas of tenderness were palpated.
Eyes: Anicteric sclerae. Pupils equally reactive to light and accomodation; with pale
HEENT
palpebral conjunctiva.
Ears: No deformities or discharges noted.
Nose/Sinuses: No nasal discharges, no nasal flaring
NECK No swollen glands, no lymphadenopathies.
LUNGS AND THORAX: Equal chest expansion with no retractions. Palpation and
percussion not done. Clear breath sounds on both lung fields.
CARDIOVASCULAR: Adynamic precordium. PMI palpated at 5th ICS MCL. No heaves and
CHEST
thrills. S1 and S2 sounds distinct and regular, no murmurs.

Abdomen appears flat with no distention. Bowel sounds normoactive at 9 clicks per minute.
ABDOMEN Soft on palpation, no tenderness, no organomegaly.

Capillary refill time is less than 2 seconds, no edema.

PERIPHERAL VASCULAR
NEUROLOGIC EXAMINATION
Patient is lethargic, able to follow some commands, not
MENTAL STATUS oriented to 3 spheres.
 
CN I – Not assessed.
CN II – Pupils equally and briskly constrict to light; Fundoscopy not
done.
CN III, IV, VI – Intact extraocular movements
CN V – Corneal reflex present
CN VII – No nasolabial flattening
CRANIAL NERVES CN VIII – Hearing intact bilaterally
CN IX, X –  Gag reflex intact
CN XI – Cannot follow command
CN XII – Tongue at midline on protrusion
 

No atrophy, fasciculations and tremors noted

MOTOR Motor Strength on all extremities: 4/5
 
REFLEXES Not Assessed
MENINGEAL SIGNS (+) Nuchal Rigidity; (+) Kernig’s sign; (-) Brudzinki sign
CASE DISCUSSION
 DIAGNOSIS
Patient History Physical
Demographics Examination
 25-year-old  Acute onset of fever,  Fever at 38.2˚C
Male headache, body malaise,  Tachycardia at
and changes in the level 11bpm
of consciousness  Decrease in
sensorium
(Lethargy)
 Disorientation
 Nuchal Rigidity
 Kernig’s sign

Primary Clinical Diagnosis: Bacterial Meningitis

Secondary Clinical Diagnosis: Viral Meningoencephalitis

Given the clinical history and physical examination of the patient, the most probable diagnosis is
bac-erial meningitis. First, the classic clinical triad of the said condition – fever, headache and nuchal
rigidity are present, along with a decreased level of consciousness. In addition, although not entirely
specific to bacterial meningitis alone, Kernig’s sign is also positive, which signifies meningeal irritation.
PARACLINIAL DIAGNOSTIC PROCEDURE

The diagnosis of bacterial meningitis is made by examination of the cerebrospinal fluid through a lumbar puncture.
Ne-urological imaging studies should also be conducted to rule out other conditions and contraindications for LP.

Cranial CT Brain MRI Lumbar Puncture

Costs less More sensitive CSF exam can

Faster compared to CT rule-in bacterial
Available meningitis

Not done for this Patient’s Results:

patient. Hypoglycorrhachia
Patient’s Results: Pleocytosis
Unremarkable Elevated protein levels.
Treatment Goals
To sustain Blood Pressure
Appropriate intravenous fluid therapy and other necessary drugs

To treat Septic Shock

To begin Antibiotic Therapy

Should be initiated with empirical therapy for bacterial meningitis; then altered
depending on the results of CSF culture

To stabilize blood-brain barrier

Done through giving the patient Dexamethasone (10 mg IV 10-20 minutes before
first dose of antibiotics; then q6h for 4 days)
Antibiotic
Treatment
Treatment should begin while awaiting the results
of diagnostic tests and may be altered later in
acc-ordance with the laboratory findings.

Most cases of bacterial meningitis should be

treated for a period of 10 to 14 days. They should
be administered in full doses parenterally
(preferably intravenously) throughout the period of
treatment.

To evaluate treatment outcome, repeated lumbar

punctures are not necessary, so long as there is
progressive clinical improvement.
 Health Education and Prevention

1. Treat minor infections 2. Vaccines.

appropriately. FINAL
Meningococcal vaccines help protect
DIAGNOSIS: against N. meningitidis, Pneumococcal
Most cases of this CNS infection are
caused by the normal flora of the vaccines help protect against S.
nasopharynx, such as S.pneumoniae. pneumoniae and Hib vaccines help
BACTERIAL protect against Hib.
Patients usually had a history of
pneumonia, otitis or sinusitis prior to MENINGITIS
meningitis.

3. Prophylaxis. 4. Seek Medical Care

A single dose of ciprofloxacin or a daily Since bacterial meningitis can be fatal
dose of rifampin 600 mg q12h for 2 if left untreated, patients should seek
days for adults and 10mg/kg for medical care immediately if the have
children is effective. signs and symptoms.
 REFERENCES
 Jameson, J. L., Kasper, D. L., Longo, D. L., & Fauci, A. S. (2018). Harrison’s Principles of Internal

Medicine (20th ed.). New York: McGraw Hill Education

 Klein, J. P., Ropper, A. H., & Samuels, M. A. (2014). Adams and Victor's Principles of

Neurology (10th ed.). McGraw-Hill Education.

 Meningitis. (2019, August 6). Retrieved from https://www.cdc.gov/meningitis/bacterial.html

Thank you!