wait~there is a vaccine for that right?
Meningitis is an infection of the meninges. Okay-got that. It can be viral or bacterial. Let's explore that.
This is Eve. She lives in rural north Georgia (just go with it.). Her parents do not believe in vaccines. They think the best decision is for her to grow up in a natural, healthy environment with a perfect organic diet and she should never get more than a little cold. Besides-all the other people vaccinate their children so she should have "herd immunity" just in case.
This is the varicella virus (not really-but just go with it)- although Eve could have been exposed to a lot of different viruses and bacteria since she is relying totally on her immune system to fight off any infections (you know like the 1700's when people lost 7 of their 13 kids to infections) this is the one that was sitting on her unwashed organic blueberry that morning.
By lunch time-Eve does not feel well. She tells her mother "Sky" that she feels like she might throw up (nausea). She is pale, and has clammy skin. Her mother puts her to bed and rubs lavender essential oil on her feet. By late that afternoon Eve is dehydrated from so many small frequent vomits (frequent emesis). She demanded all the lights be turned out in her room (photophobia) and is running a high fever.
Sky is concerned. This seems like more than a cold to her. She doesn't want to be overly concerned but decides to call the pediatrician to make an appointment for first thing tomorrow morning .
Eve has a very violent seizure(febrile seizure). Sky hears the strange breathing sounds coming from her room and shrieks in horror. What is this!?? She immediately calls 911. It takes them 35 minutes to get to Eve because they live in such a remote area. Sky is in a panic. Her husband, Raven is not home and she has 8 other children as she does not find birth control to be "natural". She puts her oldest daughter Rainbow, who is 12 ,in charge of the other children. Rainbow is scared and promises to do her best.
The EMT's recognize that Eve is in very grave danger as she is extremely dehydrated and limp. She is unconscious but breathing on her own. She is lucky because one of her first responders is a former PICU nurse from Children's Healthcare of Atlanta and calls the transport team to activate the life flight 'copter to save this kid. She'll never make it in an adult facility.
Eve is lucky because her nurse today is a graduate from UNG. Sarah was a very bright student who paid attention to lecture and never looked at pictures of wedding dresses when she was being taught about cerebral dysfunction.Sarah is a new grad who has been working at CHOA for just over 1 year. She is new to PICU, and is excited and nervous to receive a life-flight patient. Her SBAR report from the Nurse Addie in the chopper was thorough and very helpful. Both of the nurses shake their head over the mother's decision not to vaccinate her children. Sarah says-"It's just so frustrating to me. This didn't have to happen".
Here is what we know-
If Sky had vaccinated Eve- she would have received --> Haemophilus influenza type B, and pneumococcal vaccines.
The CDC says she she should have had theses:
- Neisseria meningitidis (meningococcus),
- Streptococcus pneumoniae (pneumococcus), and
- Haemophilus influenzae type b (Hib).
Wait though- Eve has viral meningitis! So even if Sky had got her vaccines this could have happened.
No- because there is a vaccine for varicella. That is why it can be tricky to remember.
The vaccines that exist for bacterial meningitis protect against the bacteria that commonly caused bacterial meningitis in the past.
Viral meningitis is rare but can still occur even if you have been vaccinated. This disease is not eradicated, just reduced. The chances of a viral infection are greatly reduced by getting vaccinated for the viruses that can cause these infections.
Dr. Model and Sarah put their heads together (collaboration!) and do the following:
1) contact droplet precaution
2) Labs-CBC, CRP and a lumbar puncture
3) antipyretics- tylenol
4) symptom management 20ml/kg of isotonic crystaloid infusion (fluid bolus) to correct hypovolemia.
5) breathing support if needed. Consider seizure meds, but not ordered at this time.
After 3 days in the hospital Eve is doing better. The fluids enabled her body to fight off the infection. She barely missed going into hypovolemic shock. She is able to sit up now, and eat a little food. She has the chicken pox. She will not go home on any seizure meds since she experienced a febrile seizure. Her mother is ready to take her home now. Sky tells the nurse she doesn't want her daughter to get sick from the hospital, and also she doesn't want to miss the opportunity for her other children to get the chicken pox all at the same time.