Meningitis

1. Meningitis
Clinical description
• Meningitis is the inflammation of the protective membranes covering the brain and spinal
cord known as the meninges.
• The inflammation is usually caused by an infection of the fluid surrounding the brain and
spinal cord.
• Meningitis can be life-threatening because of the inflammation's proximity to the brain
and spinal cord; therefore, the condition is classified as a medical emergency.
Meninges
The meninges is the system of membranes which envelops the central nervous system. It
has 3 layers:
1. Dura mater
2. Arachnoid mater
3. Pia mater
Subarachnoid space - is the space which exists between the arachnoid and the pia mater,
which is filled with cerebrospinal fluid.
Causes of Meningitis
• Bacterial
• Viral
• Fungal
• Parasitic/ protozoal
• Physical injury
• Cancer - Certain drugs (mainly, NSAIDs)
• Head injury
• Cerebral abscess
• Middle ear infection
Bacterial
• Haemophilus influenzae
• Listeria
• Meningococcus
• Mumps
• Pneumococcus
• Certain Streptococcus
Viral
• Enterovirus (coxsackie, echovirus)
• Arboviral (mosquito-borne diseases)
• Influenza
• Herpes simplex virus type 2 (especially in infants)
• Varicella zoster
• HIV
• Mumps
• Measles

2. Fungal
• Cryptococcus
• Coccidiodes
• Histoplasma
• Mucormycosis
• Aspergillus
• Candida (yeasts)
Parasitic/protozoal
• Angiostrongylus
• Toxoplasma
• Hydatid
• Amoeba
• Plasmodium
• Cysticercosis
Risk factors
• Age - children younger than 5 years
• Use of immunosuppressive drugs
• Chronic malnutrition
• AIDS
• CSF Shunt
• Chronic alcoholism
• Diabetes
• Pneumonia
Pathophysiology
Causative organism enters the blood stream
↓
Cross the blood barriers
↓
Inflammatory reactions in meninges
↓
Inflammation of subarachnoid space and pia meter occur
↓
Inflammation may cause increase in ICP (Intra-Cranial Pressure)
↓
CSF flows in subarachnoid space
↓
CSF cloudness or infected
↓
CSF cell count increase
Sign and symptoms
• Severe headache
• Irritability
• Restlessness
• Stiffness of neck
• Malaise
• Nausea / vomiting

3. • High grade fever
• Tachypnoea
• Seizures
• Disorientation
• Tachycardia
• Coma
• Sleeplessness
• Phonophobia
• Photophobia
• Altered mental status (confusion)
Diagnostic evaluation
• By +ve signs
• Physical examination
• History collection
• CSF evaluation for pressure, proteins, glucose and leukocytes.
• Blood test
• CBC
• Blood culture
• MRI
• CT scan
Clinical manifestation
Confirmative signs:
• Positive kernig’s sign
• Brudzinski’s Sign
Complications
• Brain damage
• Cerebral edema
• Hearing loss
• Tissue damage
Treatment
• Antibiotics for bacterial meningitis: Type vary depending on the bacteria causing the
infection.
• Antibiotics are not effective in viral meningitis.
• Other medications and intravenous fluids will be used to treat symptoms such as brain
swelling, shock, and seizures.

4. Prevention
• Haemophilus vaccine (HiB vaccine) in children.
• The pneumococcal conjugate vaccine is now a routine childhood immunization and is
very effective at preventing pneumococcal meningitis.
• Household members and others in close contact with people who have meningococcal
meningitis should receive preventive antibiotics.
Nursing management
Diagnosis 1
• Altered body temp. related to infectious process.
Interventions:
• Monitor temperature continuously
• Administer antipyretic drugs as prescribed.
• Switch on fan and open the windows.
• Cold sponge
Diagnosis 2
• Ineffective tissue perfusion r/t infectious process and cerebral edema.
Interventions:
• Assess level of consciousness
• Assess inc. ICP signs
• Provide calm and quit environment
• Prepare patient for LP for CSF evaluation.