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92: BACTERIAL MENINGITIS

Mollie Venglar, DSc, MSPT, NCS

CONDITION/DISORDER SYNONYMS

  • Meningitis

  • Haemophilus meningitis

ICD-9-CM CODES

  • 320 Bacterial meningitis

  • 320.0 Haemophilus meningitis

  • 320.1 Pneumococcal meningitis

  • 320.2 Streptococcal meningitis

  • 320.3 Staphylococcal meningitis

  • 320.7 Meningitis in other bacterial diseases classified elsewhere

  • 320.89 Meningitis due to other specified bacteria

  • 321.0 Cryptococcal meningitis

ICD-10-CM CODES

  • A48.8 Meningitis in other bacterial diseases classified elsewhere

  • G00.8 Meningitis due to other specified bacteria

  • G00.9 Bacterial meningitis

PREFERRED PRACTICE PATTERNS1

  • 5A: Primary Prevention/Risk Reduction for Loss of Balance and Falling

  • 5C: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System—congenital origin or acquired in infancy or childhood

  • 5D: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System—acquired in adolescence or adulthood

  • 5I: Impaired Arousal, Range of Motion and Motor Control Associated with Coma, Near Coma, or Vegetative State

FIGURE 92-1

The pathophysiology of the neurologic complications of bacterial meningitis. CSF, cerebrospinal fluid; SAS, subarachnoid space. (From Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 18th ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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FIGURE 92-2

Pathophysiological alterations leading to neuronal injury during bacterial meningitis. BBB, blood–brain barrier; CBV, cerebral blood volume. (Redrawn with permission from Koedel U, Scheld WM, Pfister HW. Pathogenesis and pathophysiology of pneumococcal meningitis. Lancet Infect Dis. 2002;2:731.)

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PATIENT PRESENTATION

An otherwise healthy 19-year-old man is brought to the emergency department (ED) by his roommate who states that he has “not been acting right” for the past 24 hours. As per the roommate, the patient had complained of a headache and fever for 2 days prior to arrival, and has been progressively somnolent and confused since then. His roommate states that the patient is a college student who does not use any illegal drugs and occasionally drinks alcohol. The patient has a fever of 38.5°C (101°F), a heart rate of 120 beats per minute, blood pressure of 114/69, and respiratory rate of 20 breaths per minute. His oxygen saturation is 98% on room air. The head and neck examination are significant for dry mucous membranes and nuchal rigidity. His skin is noted to be warm and without any rash. In the ED, he has a Glasgow Coma Score (GCS) of 10 (eyes open to voice [3], patient moans to painful stimuli [2], and localizes painful stimuli [5]). The motor examination is symmetric, and the patient appears to be sensate in all extremities. His reflexes are 2+ bilaterally throughout the upper and lower extremities with a negative Babinski. Blood work reveals a leukocytosis of 24,000/mm but is otherwise unremarkable. A computed tomography (CT) scan is ...

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