MG I 2011-2012 English course, 1st semester Aostacioaei Filip Home assignment I (Medical Terminology) Meningitis

Meningitis:
Causes: - Viral (caused by the enteroviruses, herpes simplex virus type 2, varicella zoster virus ,mumps virus, HIV) - Bacterial (group B streptococci, Escherichia coli, Neisseria meningitides, Streptococcus pneumonia) - Parasitical (Angiostrongylus cantonensis, Gnathostoma spinigerum, Schistosoma) - Various types of fungus Clinical features: In most cases the patient will experience severe headaches (present almost in every case), followed by nuchal rigidity (stiff neck, the patient is unable to flex his neck muscles). The patient will have very high fever, over 39 C . Also, the patient might present photophobia (intolerance to bright light) and sometimes phonophobia (intolerance to loud noise). The classical way to determine the presence of meningitis is by asking the patient to lie on a bed, and try to flex his neck. If he tends to flex his knees while doing so, he is likely to have meningitis. The swelling of brain tissue causes the increase of intracranial pressure, leading to obstruction of blood veins, which can lead to apoptosis of nervous cells. Another effect of intracranial pressure is the brain herniation, which is lethal. It also leads to abnormalities of the brain nerves, leading to effects such as hearing, damage of sight or even sever forms of movement dysfunctions, and mental retardation, depending on the site of the inflammation. Diagnosis: The most common method of setting a diagnostic is through lumbar puncture, which is done by positioning the patient, usually lying on the side, applying local anesthetic, and inserting a needle into the dural sac (a sac around the spinal cord) to collect cerebrospinal fluid (CSF). When this has been achieved, the "opening pressure" of the

CSF is measured using a manometer. In bacterial meningitis the pressure is typically elevated. The initial appearance of the fluid may prove an indication of the nature of the infection: cloudy CSF indicates higher levels of protein, white and red blood cells and/or bacteria, and therefore may suggest bacterial meningitis. This procedure has only 60% accuracy, the percentage can drop even more, if the patient took antibiotics before test. The sample can be microbiologically processed and obtain answers of the nature of the infection, but it takes more time to receive the result. There are several other ways of determining of the infection, such as the latex agglutination test, to determine is the infection is bacterial or viral. Treatment: If the result is positive on meningitis, empiric antibiotics must be administered immediately, because the disease acts very fast. After the result come, the medication will be differ according to the type pathogenic agent. In case of bacterial meningitis, antibiotics will be administered according to the nature of the bacteria. The treatment will continue even after the signs of the disease would have passed, to prevent a return of the infection. We can administrate vancomycin, ceftriaxone, peniciln, amphicillin etc. In case of viral meningitis, only supportive therapy can be applied, because viruses are not amenable to specific treatment. Antiviral medication can be administrated (such as aciclovir) and in mild cases viral meningitis can be treated home, with rest and analgesics. The fungal meningitis is treated with anti-fungal drugs such as amphotericin B and flucytosine.

The dialogue: In the saloon of infectious diseases hospital, a patient with high fever and severe headaches, almost unconscious, arrives. He is placed in an empty saloon and he is administrated an analgesic and an antibiotic. He gets better and the doctor enters the saloon to examine him. Good evening, sir, I m Doctor Filip Ao and I m here to examine your health problems, if you agree, of course. But first, what is your name and birth date? Hello doctor, my name is John Cooper and I m born on the 7th august 1989. And I think I have no reasons to deny this examination. Thank you, Mister Cooper. I hope you now stay comfortably and I guess that the headache is a little better now. Is there something you require? It seams I have a problem with light, doctor, do you mind if you pull the curtain? It would be much better! Sure, no problem at all, is that better now? Yes, doctor, thank you very much! You are welcome, Mister Cooper. Now, can you tell me what is wrong? It all started 3 days ago, when I had a terrible headache. This happened just after I came back from a team building meeting with the board of my company, we went to a camp deep in the mountains to talk about our future as a corporation. I woke up with it, but didn t pay much attention, because I though that I was just tierd. But in as time passed, it got even worse, I couldn t even keep my head up. I went home earlier that day and tried to sleep. But every time I woke up, the headache was there. I tried a lot of solutions, but the next day, I woke up with high fever, it was almost 40 C. I ve never had such temperature! And for some reasons, I couldn t look too much on the window because the light was bothering me. And after all this, I felt like my neck was put in a cast. I can barely move it now, look. I see, let me see if I got this right: you had terrible headaches first, high fever second, you can stay in the light and you can t move you re neck, right? Can I ask you if you

experienced a problem with noise? Like a loud noise, did it bother you more than usually? Now, that I m thinking about this yes, It actually bother me more than usually. I see. I would like to ask you to try something for me. As you lie straight in the bead, please face the ceiling and try to touch your move your chin over your chest. If it gets to painful, you don t have to do it. Mister Cooper tries to touch his chest, but every time he tries, his knees tend to bend as if the two regions are connected. It does hurt, but I did it. Thank you for doing this for me, Mister Cooper. I hope you noticed that when you tried to touch your chest with your chin, your knees bent a little bit. That means that there is a pressure on you neck muscles. From all you told me so far, I think you have meningitis. We can t be sure until further analysis is done. It is a dangerous disease, but only if it s not treated. Fortunately for you, you came in the right place, in the right time. There are two methods to determine if you are sick and if so what kind of meningitis you got. Would you like me to tell you about the two? Yes, I would like to hear the first choice. The first one is called lumbar puncture and it s quite easy to describe. You have to lean on your side, while we will insert a needle in your back to collect the fluid that we need. I told you straight so that you know exactly what to expect. The advantage is that this test is a lot more precise than the other choice you got and will help us determine what kind of infection you got. It doesn t sound too good. What about the other choice? it s a x-ray test, allowing us to see if you really have meningitis. The problem is we don t know what kind of meningitis, so we can t be sure what medication to use. think I ll go for the first one, even if it hurts, I think it s better, so you can know for sure what do I have and help me.

Ok, then in two hours from now we come and make the lumbar puncture. Is that ok by you? Would you like to make it later? Sure not! In two hours is fine. Fine, I will speak with the nurses to take special care of you, because the headaches might come back even stronger. I would recommend you to try to sleep and let your body heal himself. I will be back in two hours and check your situation and make the analysis. Have a good rest, Mister Cooper, thank you so much for your cooperation! No, doctor, I thank you for the effort you do for me. See you in 2 hours! The doctor leaves the saloon and lets Mister Cooper rest.
PATIENT FILE ATTENDING PHYSICIAN: Dr. Filip Ao PATIENT NAME: John Cooper WEIGHT: 73 kg PRESENTING COMPLAINT(S): Severe headaches, high fever. HISTORIES: Past medical history: the patient presents no medical history Surgical history: the patient has no surgical history Medication history: antibiotics administrated before the physical exam Family history: nothing relevant for this case Social history: he works in a company and came back from a trip. The source of the disease must have been there. PHYSICAL EXAM: The patient said that he got headaches for almost 3 days and today he almost lost his consciousness. Photophobia and phonophobia were present and he presented a positive Brudzinski's sign. DATE OF BIRTH: 08.07.1989 HEIGHT: 1.75 DATE OF ADMISSION: 04.07.2020 GENDER: Male

The reason I have chosen meningitis is because I had when I was 7 years old. Now, I only remember fragments from that time, sure I didn t forget the lumbar puncture, and the fact that I almost died or how close I was of living a whole life as a mentally retarded person. And surely I ll never forget the efforts of the medic who did his best and allowed me to continue my journey without a scar. I did this dialogue, with it s mistakes (and I know that there were many ) but it helped me remind me why I m here, at UMF.