A. Definitions
Meningitis is an inflammation of the meningen (membrane that surrounds the brain and spinal cord) and is caused by viruses, bacteria or fungi organs (Smeltzer, 2001).
Meningitis is an acute infection of the meninges, usually caused by one of the microorganisms pneumokok, Meningokok, Stafilokok, Streptokok, Hemophilus influenza and materials aseptic (viral) (Long, 1996).
Meningitis is an inflammation of the membrane meningen, cerebrospinal fluid and spinal column that causes the infection in the central nervous system (Suriadi & Rita, 2001).
B. Etiology
1.Bakteri; Mycobacterium tuberculosa, Diplococcus pneumoniae (pneumokok), Neisseria meningitis (meningokok), Streptococus haemolyticuss, Staphylococcus aureus, Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae, Peudomonas aeruginosa
Other
2.Penyebab Lues, Virus, Toxoplasma gondhii and Ricketsia
3.Predisposing factors: gender men, more often than women
4.maternal factor : fetal membrane rupture, maternal infections during the last week of pregnancy
5.immunology factors : immune mechanism deficiency, immunoglobulin deficiency.
6.Kelainan central nervous system, surgery or injury associated with the neural system
C. Classification
Meningitis is divided into 2 groups based on changes in brain fluid, namely:
1.Meningitis serous
Meningitis is araknoid and pia mater of the brain accompanied by a clear fluid. The cause is terseringnya Mycobacterium tuberculosa. Other causes Lues, Virus, Toxoplasma gondhii and Ricketsia.
2.Meningitis purulenta
Purulent inflammation is arakhnoid and the pia mater covering the brain and spinal cord. The reasons include: Diplococcus pneumoniae (pneumokok), Neisseria meningitis (meningokok), Streptococus haemolyticuss, Staphylococcus aureus, Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae, Peudomonas aeruginosa.
C. Pathophysiology
Begins as a bacterial meningitis infection from oroaring and followed by septicemia, which meningen spread to the brain and upper spinal cord.
Predisposing factors include infection of the upper airway, otitis media, mastoiditis, sickle cell anemia and other hemoglobinopatis, a new neurosurgical procedures, head trauma and immunological effects. Venous channels through the posterior nasopharynx, middle ear and mastoid channel close to the brain and the veins channel meningen; all of this link which underpins the development of bacteria.
Organisms into the bloodstream and cause inflammation in the meningen and under the cortex, which can cause a thrombus and decreased cerebral blood flow. Cerebral tissue due to impaired metabolism meningen exudate, vasculitis and hipoperfusi. Purulent exudate may spread to the base of the brain and spinal cord. Inflammation also spread to the membrane walls of cerebral ventricles. Bacterial meningitis associated with intracranial physiological changes, which consisted of increased permeability of the blood, brain defense areas (barrier oak), cerebral edema and improvement of ICT.
In acute infection patients died of bacterial toxins before the meningitis. Most infections of patients with adrenal damage, circulatory collapse and associated with widespread hemoragi (at sindromWaterhouse-Friderichssen) as a result of endothelial damage and necrosis of blood vessels caused by the meningococcus.
D. Clinical Manifestations
Symptoms of meningitis resulting from infection and increased ICT:
1.head pain and fever (often initial symptoms)
2.Changes at the level of consciousness can occur letargik, unresponsive, and coma.
3.Iritasi meningen caused some signs as follows:
a) nukal rigidity (stiff neck). Attempts to head flexion in difficulty due to spasm of the neck muscles.
b) kernik positive sign: when the patient lay with the state of flexion of the thigh towards the abdomen, legs can not be in perfect ekstensikan.
c) Signs brudzinki: if the patient's neck in flexion produced reflect the knees and hips. When done on passive flexion of the lower limb on one side of the same movement seen bike ektremita opposite side.
4. get photo phobias, or excessive sensitivity to light.
5.Kejang due to focal cortical areas are sensitive and improvement of ICT by purulent exudate and cerebral edema with signs of the characteristic changes of vital signs (pulse pressure and widening bradikardi), irregular breathing, headaches, vomiting and decreased level of consciousness.
6.conspicuous rash is characteristic of meningococcal meningitis.
7.fulminating infections with septikimia signs: high fever suddenly appeared, lesions that spread purpura, shock and signs of disseminated coagulopathy intravaskuler
E. Diagnostic Examination
CSS 1.Analisis of lumbar function:
a) Bacterial meningitis: increased pressure, the liquid cloudy / foggy, white blood cell count and protein increased glucose increased, a positive culture for several types of bacteria.
b) viral meningitis: the pressure varies, CSS is usually clear liquid, white blood cells, glucose and protein is usually normal, the culture is usually negative, viral culture is usually with a special procedure.
2.Glukosa serum: increased (meningitis)
3.LDH serum: increased (bacterial meningitis)
White blood 4.Sel: slightly increased with the increase in neutrophils (bacterial infection)
Blood 5.Elektrolit: Abnormal.
6.ESR/LED: increases in meningitis
Blood 7.Kultur / nose / throat / urine: may indicate the central region indicates the type of infection or infectious
8.MRI / CT scan: may be helpful in localize lesions, see the size / location of the ventricles; regional cerebral hematoma, hemorrhagic, or tumors
9.Ronsen chest / head / sinus; be no indication of the source of intra-cranial infection.
F. Complications
1.Hidrosefalus obstructive
2.MeningococcL septicemia (mengingocemia)
3.Sindrome water-friderichen (septic shock, DIC, bilateral adrenal hemorrhage)
4.SIADH (Syndrome Inappropriate Antidiuretic hormone)
5.Efusi subdural
6.Kejang
7.Edema and cerebral herniation
8.Cerebral palsy
Mental 9.Gangguan
10.Gangguan learning
11.Attention deficit disorder