Emergency nursing management of a patient with? Meningitis and spinal abscess

Anandhi1*, Arputha Mary2, Esthar Rani3

1Nursing Incharge, Kauvery Hospital, Tennur, Trichy, Tamil Nadu

2Assistant Nursing Superintendent, Kauvery Hospital, Tennur, Trichy, Tamil Nadu

3Nursing Superintendent, Kauvery Hospital, Tennur, Trichy, Tamil Nadu

*Correspondence

Abstract

Meningitis is an acute inflammation of the meninges, the protective membranes covering the brain and spinal cord. It commonly results from infections caused by (bacteria, viruses, fungi or parasites), non-infectious triggers such as certain medications and autoimmune disorders may also contribute. Early recognition and prompt treatment are essential to prevent severe complications and improve patient outcomes.

Key words: Meningitis; Diabetic ketoacidosis (DKA); Acute flaccid paraplegia

Case presentation

A 54-year-old male, a known history of diabetes mellitus and chronic pancreatitis, presented with features suggestive of acute gastroenteritis, paraplegia and diabetic ketoacidosis (DKA). He had a history of traumatic injury to the lower back three weeks prior to admission. An outside evaluation suggested spinal compression which was initially managed conservatively.

On examination

The patient was found to have acute flaccid paraplegia without bowel or bladder involvement. Neck rigidity was present and the clinical impression was acute progressive flaccid paraplegia with associated meningitis. He was admitted for close monitoring and was started on intravenous fluids, insulin therapy for DKA, broad-spectrum antibiotics and supportive care.

 

USG abdomen scan report

  • Mild hepatomegaly.
  • Bilateral mild renal parenchymal changes.
  • Left renal calculus with mild hydronephrosis.

Echo cardiogram

  • Normal chambers.
  • No segmental wall motion abnormalities at rest.
  • Normal LV systolic function (ER -60%).
  • Grade I diastolic dysfunction.
  • Sclerotic aortic regurgitation.
  • Trivial aortic regurgitation.
  • Normal mitral, tricuspid and pulmonary valves.
  • Intact IAS, IVS.
  • No intracavitary masses, thrombus, vegetation’s.
  • No pericardial effusion.
  • Sinus rhythm during the study.

MRI of Brain and Whole spine and Screening

A neurosurgical opinion was obtained. MRI of Brain and Spine revealed a diffuse meningeal thickening with enhancing predominantly in left temporoparietal and bilateral frontal regions with enhancing hyper intensities within the lateral ventricles with mild ventricular wall thickening.

Diagnosis: To consider: Ventriculitis with Meningitis.

MRI Spine indicated Spondylodiscitis L4-L5 level with minimal pre and para vertebral soft tissue component with extradural component at L4-L5 level extending superiorly up to the L2 level causing significant thecal sac and nerve root compression with significant edema in the distal cord and conus region. The patient was started empirically on anti-tubercular therapy (ATT) on 21.08.25. Subsequently, on 22.08.25, he underwent L4 laminectomy with drainage of the abscess under general anaesthesia. The perioperative period was uneventful with no complications.

During hospitalization, he received medications including intravenous Meropenem 1 g three times daily, intravenous Cefazolin (Refilin) 1g three times daily, intravenous Pantocid 40 mg twice daily, intravenous Thiamine 100 mg twice daily and Neurobion injection once daily, along with other supportive treatments as indicated.

Further evaluation showed that TB PCR was negative. Pus culture grew Group B Streptococcus (Streptococcus agalactiae). Therefore, anti-tubercular therapy was discontinued, and intravenous antibiotics (ceftriaxone and vancomycin) were continued. Due to persistent low-grade fever spikes, antibiotics were later modified to ceftriaxone and ampicillin.

The patient was managed with intravenous antibiotics, steroids, anticoagulation therapy, physiotherapy and other supportive measures. Urine and blood cultures remained sterile. Gradually, the patient showed symptomatic improvement, remained afebrile, inflammatory markers decreased and neurological weakness improved. A voiding trial was attempted but failed and the patient was re-catheterized. He was later discharged with appropriate medical advice.

Condition at discharge

  • General condition good.
  • PR: 86/min.
  • BP: 110/70 mmhg.
  • Spo2: 96% RA.

Advice on discharge

Drug nameDosageFrequency
Tab. Augmentin 625 mg BD
Tab. Pantocid 40mg OD
Tab.Ativan 1mg Hs
Tab.Dolopar 525 mgSOS
Tab.Rocaltrol 0.25mg OD
Tab.Shelcal 250 mg BD
Inj. Human mixtard 30/70 20u -0- 20u
Tab.Praglin D 75/20Hs
Syp.Lactihep plus 5ml TDS
HS- Bedtime

At Present Patient Condition

The patient’s muscle power has improved from 4/5 to 5/5. Inititally, the patient showed good improvement. At present, the patient is able to walk with walker support. However, mild residual signs are still present.  The patient is on periodic follow-up and continues regular review at our hospital.

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