CONFIRMING DIAGNOSIS Stains and cultures (of sputum, cerebrospinal fluid, urine, drainage from abscess, or pleural fluid) show heat-sensitive, nonmotile, aerobic, acid-fast bacilli.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
West Nile encephalitis:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
The immunoglobulin (Ig) M antibody capture enzyme-linked immunosorbent assay (MAC-ELISA) is the test of choice for rapid definitive diagnosis. The major advantage of MAC-ELISA laboratory analysis is the high probability of accurate diagnosis of WNV infection when performed with acute serum or cerebrospinal fluid specimens obtained while the patient is still hospitalized.
A new diagnostic test, the WNV MAC-ELISA, was recently approved by the Food and Drug Administration. This test detects levels of IgM antibodies in a patient's ser-um and is intended for use in patients with clinical symptoms consistent with viral encephalitis.
Other conditions to consider include St. Louis encephalitis, which is symptomatically similar.
Encephalitis can be caused by numerous viral and bacterial infections; all data must be examined to determine a definitive diagnosis.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Brudzinski's sign:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Continue your neurologic examination by evaluating the patient’s cranial nerve function and noting any motor or sensory deficits. Be sure to look for Kernig’s sign (resistance to knee extension after flexion of the hip), a further indication of meningeal irritation. Also look for signs of central nervous system infection, such as fever and nuchal rigidity.
Ask the patient—or his family if necessary—about a history of hypertension, spinal arthritis, or recent head trauma. Also ask about dental work and abscessed teeth (a possible cause of meningitis), open-head injury, endocarditis, and I.V. drug abuse. Ask about the sudden onset of headaches, which may be associated with subarachnoid hemorrhage.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Nuchal rigidity:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Obtain a patient history, relying on family members if altered LOC prevents the patient from responding. Ask about the onset and duration of neck stiffness. Were there any precipitating factors? Also ask about associated signs and symptoms, such as headache, fever, nausea and vomiting, and motor and sensory changes. Check for a history of hypertension, head trauma, cerebral aneurysm or arteriovenous malformation, endocarditis, recent infection (such as sinusitis or pneumonia), or recent dental work. Then, obtain a complete drug history.
If the patient has no other signs of meningeal irritation, ask about a history of arthritis or neck trauma. Can the patient recall pulling a muscle in his neck? Inspect the patient’s hands for swollen, tender joints, and palpate the neck for pain or tenderness.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Tuberculosis:
Diagnosis
(Handbook of Diseases)
Diagnostic tests include chest X-rays, a tuberculin skin test, and sputum smears and cultures to identify M. tuberculosis. The following procedures aid diagnosis:
❑ Auscultation detects crepitant rales, bronchial breath sounds, wheezes, and whispered pectoriloquy.
❑ Chest percussion detects a dullness over the affected area, indicating consolidation or pleural fluid.
❑ Chest X-ray shows nodular lesions, patchy infiltrates (mainly in upper lobes), cavity formation, scar tissue, and calcium deposits; however, it may not be able to distinguish active from inactive TB.
❑ Tuberculin skin test detects TB infection. Intermediate-strength purified protein derivative or 5 tuberculin units (0.1 ml) are injected intracutaneously on the forearm.
The test results are read in 48 to 72 hours; a positive reaction (induration of 5 to 15 mm or more, depending on risk factors) develops 2 to 10 weeks after infection in active and inactive TB. However, severely immunosuppressed patients may never develop a positive reaction.
❑ Stains and cultures (of sputum, cerebrospinal fluid, urine, drainage from abscess, or pleural fluid) show heat-sensitive, nonmotile, aerobic, acid-fast bacilli.
UNDER STUDY: Newer testing uses deoxyribonucleic acid probes to confirm disease in days rather than weeks. A novel heminested IS6110 polymerase chain reaction assay shows promise as a rapid and sensitive method for early diagnosis of pediatric TB.
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Source: Handbook of Diseases, 2003
Encephalitis:
Diagnosis
(Handbook of Diseases)
During an encephalitis epidemic, diagnosis is easily based on clinical findings and patient history. Sporadic cases are difficult to distinguish from other febrile illnesses, such as gastroenteritis and meningitis. When possible, identification of the virus in cerebrospinal fluid (CSF) or blood confirms the diagnosis.
The common viruses that also cause herpes, measles, and mumps are easier to identify than arboviruses. Arboviruses and herpesviruses can be isolated by inoculating young mice with specimens taken from patients. In herpes encephalitis, serologic studies may show rising titers of complement-fixing antibodies. Virus-specific indirect fluorescent antibody assays have improved diagnosis.
In all forms of encephalitis, CSF pressure is elevated, and despite inflammation, the fluid is clear in many cases. White blood cell and protein levels in CSF are slightly elevated, but the glucose level remains normal. An EEG reveals abnormalities. Occasionally, a computed tomography scan may be ordered to rule out cerebral hematoma.
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Source: Handbook of Diseases, 2003
West Nile encephalitis:
Diagnosis
(Handbook of Diseases)
The immunoglobulin M antibody capture–enzyme-linked immunosorbent assay is the test of choice for rapid definitive diagnosis. It has a high probability of accurate diagnosis of WNV infection when performed with acute serum or cerebrospinal fluid specimens obtained while the patient is hospitalized.
Encephalitis can also be caused by numerous viral and bacterial infections, so data must be carefully examined to determine a definitive diagnosis. St. Louis encephalitis, which is symptomatically similar to West Nile encephalitis, should be considered.
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Source: Handbook of Diseases, 2003
Kernig's sign:
History
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
If you suspect meningitis, ask the patient about recent infections, especially tooth abscesses. Ask about exposure to infected persons or places where meningitis is endemic. Meningitis is usually a complication of another bacterial infection, so blood cultures are needed to determine the causative organism. If subarachnoid hemorrhage is the suspected diagnosis, ask about a history of hypertension, cerebral aneurysm, head trauma, or arteriovenous malformation. Check the patient’s pupils for dilation, and assess him for signs of increasing intracranial pressure, such as bradycardia, increased systolic blood pressure, and widening pulse pressure.
If you don’t suspect meningeal irritation, ask the patient if he feels any back pain that radiates down one or both legs. Does he also feel leg numbness, tingling, or weakness? Ask about other signs and symptoms, and find out if he has a history of cancer or back injury.
Physical examination
Perform a physical examination, concentrating on motor and sensory function. Assess motor function by inspecting the muscles and testing muscle tone and strength. Perform cerebellar testing. Cerebellar deficits affect the patient’s voluntary movements, equilibrium, integration of sensations, and sense of position. Assess sensory function by checking the patient’s sensitivity to pain, light touch, vibration, position, and discrimination.
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Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Brudzinski's sign:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Ask the patient or his family, if necessary, about a history of hypertension, spinal arthritis, or recent head trauma. Also ask about dental work and abscessed teeth (a possible cause of meningitis), open-head injury, endocarditis, and I.V. drug abuse. Ask about sudden onset of headaches, which may be associated with subarachnoid hemorrhage.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Kernig's sign:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If you elicit a positive Kernig’s sign and suspect life-threatening meningitis or subarachnoid hemorrhage, immediately prepare for emergency intervention. (See When Kernig’s sign signals CNS crisis, page 392.)
If you don’t suspect meningeal irritation, ask the patient if he feels back pain that radiates down one or both legs. Does he also feel leg numbness, tingling, or weakness? Ask about other signs and symptoms, and find out if he has a history of cancer or back injury.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Nuchal rigidity:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Obtain a patient history, relying on family members if altered LOC prevents the patient from responding. Ask about the onset and duration of neck stiffness. Were there any precipitating factors? Also ask about associated signs and symptoms, such as headache, fever, nausea and vomiting, and motor and sensory changes. Check for a history of hypertension, head trauma, cerebral aneurysm or arteriovenous malformation, endocarditis, recent infection (such as sinusitis or pneumonia), or recent dental work. Then obtain a complete drug history.
If the patient has no other signs of meningeal irritation, ask about a history of arthritis or neck trauma. Can the patient recall pulling a muscle in his neck?
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Brudzinski's sign:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Continue your neurologic examination by evaluating the patient's cranial nerve function, noting motor or sensory deficits. Be sure to look for Kernig's sign (resistance to knee extension after flexion of the hip), which is a further indication of meningeal irritation. Look for signs of central nervous system infection, such as fever and nuchal rigidity.
Ask the patient or his family, if necessary, about a history of hypertension, spinal arthritis, or recent head trauma. Ask about dental work and abscessed teeth (a possible cause of meningitis), open-head injury, endocarditis, and I.V. drug abuse. Ask about sudden onset of headaches, which may be associated with subarachnoid hemorrhage.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Kernig's sign:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If you elicit Kernig's sign and suspect life-threatening meningitis or subarachnoid hemorrhage, immediately prepare for emergency intervention. (See When Kernig's sign signals CNS crisis.)
If you don't suspect meningeal irritation, ask the patient if he feels back pain that radiates down one or both legs. Does he also feel leg numbness, tingling, or weakness? Ask about other signs and symptoms, and find out if he has a history of cancer or back injury. Then perform a physical examination, concentrating on motor and sensory function.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Nuchal rigidity:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Obtain a patient history, relying on family members if an altered LOC prevents the patient from responding. Ask about the onset and duration of neck stiffness. Were there precipitating factors? Also ask about associated signs and symptoms, such as headache, fever, nausea and vomiting, and motor and sensory changes. Check for a history of hypertension, head trauma, cerebral aneurysm or arteriovenous malformation, endocarditis, recent infection (such as sinusitis or pneumonia), or recent dental work. Then, obtain a complete drug history.
If the patient has no other signs of meningeal irritation, ask about a history of arthritis or neck trauma. Can the patient recall pulling a muscle in his neck? Inspect the patient's hands for swollen, tender joints, and palpate the neck for pain or tenderness.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
NUCHAL RIGIDITY:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The workup of nuchal rigidity requires a good history, but if one is
unobtainable, no spinal tap should be performed until the cervical spine is
x-rayed and the eyegrounds are examined. Even with a good history, a spinal
tap should be withheld if there is papilledema: A neurosurgeon should be
consulted immediately under these circumstances. In a patient with fever,
nuchal rigidity, no papilledema, and no focal neurologic signs (particularly
a dilated pupil), a spinal tap can be performed for diagnosis and immediate
therapy. It is preferable, however, to have CT scan results in hand first.
Meningitis or a subarachnoid hemorrhage is frequently found in these
circumstances. CT scans and x-rays of the cervical spine and skull will
still be indicated in cases where the diagnosis remains obscure.
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Source: Differential Diagnosis in Primary Care, 2007
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