Meningitis p 885/p 902 PCCM p 223 o Causes o Classification o Assessment and common findings p 885/p 903 Clinical features, infants, adults o Pathophysiology o Management PCCM 223 o Complications

1. By C Settley

2. Meningitis- pg.885
■ Inflammation of brain and spinal cord membranes, typically
caused by an infection.
■ Non infectious meningitis (caused by something other than the
bacteria that typically cause acute meningitis)
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3. Meningitis
Causes
■ Invasion of the cerebrospinal fluid by an infectious
agent.
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4. Meningitis
Classification
■ Septic meningitis
– Due to bacterial infection
– Often characterised by pus formation
– Pneumococci (infection can result in pneumonia, infection of the
blood (bacteremia/sepsis), middle-ear infection (otitis media), or
bacterial meningitis) and Haemophilus influenza (include
pneumonia, meningitis, epiglottitis, septic arthritis, cellulitis, otitis media, and
pericarditis)
– Occurs mainly following trauma and CSF leak
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5. Meningitis
Classification
■ Aseptic meningitis
– The inflammation of the meninges and spinal cord in patients
whose cerebral spinal fluid test result is negative with routine
bacterial cultures.
– Caused by viral infections e.g. mumps / chickenpox / polio
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6. Meningitis
Classification
■ Non infectious meningitis
– These include tumours, CVA’s, multiple sclerosis,
reaction to intrathecal injections, lead poisoning,
vaccine reactions & leukaemia.
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7. Meningitis
Assessment and common findings
■ Early meningitis symptoms may mimic the flu (influenza). Symptoms
may develop over several hours or over a few days. Possible signs
and symptoms in anyone older than the age of 2 include:
– Sudden high fever
– Stiff neck
– Severe headache that seems different than normal
– Headache with nausea or vomiting
– Confusion or difficulty concentrating
– Seizures
– Sleepiness or difficulty waking
– Sensitivity to light
– No appetite or thirst
– Skin rash
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8. Meningitis
Assessment and common findings
■ New-borns and infants may show these signs:
– High fever
– Constant crying
– Excessive sleepiness or irritability
– Inactivity
– Poor feeding
– A bulge in the soft spot on top of a baby's head
(fontanel)
– Stiffness in a baby's body and neck
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Blood brain barrier
Signalling molecules –immune response-
stimulates movement of cells
Matrix Metalloproteinase (enzymes related to tissue
healing/remodeling and cancer cell metastasis)

10. Pathophysiology summarised
■ The meninges become swollen and inflamed
■ Inflammatory exudate increases ICP
■ The infection causes an increase in CSF production and pressure that is measurable
on lumbar puncture
■ The inflammatory reaction causes irritation of cerebral tissues and may cause
convulsions
■ The inflamed and irritated meninges cause neck stiffness and headache
■ Healing may leave scar tissue in the meninges, which may give rise to epilepsy
■ Inflammatory scar tissue may also block the CSF drainage channels causing
hydrocephalus
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11. Clinical features and pathophysiology
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Symptom Sign Mechanism
Chills, rigors Fever (T>38°) Cytokines (released during the
immune response to the invading
pathogens) affect the thermoregulatory
neurons of the hypothalamus,
changing the central regulation of body
temperature.
Nuchal rigidity (neck stiffness) Brudzinski sign and Kernig sign In meningitis, traction on the inflamed
meninges is painful, resulting in limited
range of motion through the spine
(especially in the cervical spine).

12. Clinical features and pathophysiology
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13. Clinical features and pathophysiology
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Symptom Sign Mechanism
Altered mental status Decreased Glasgow Coma Scale (GCS) ↑ ICP → brain herniation → damage to the reticular
formation (structure in the brainstem that governs
consciousness)
Focal neurological deficits Examples: hemiparesis Cytotoxic edema and ↑ ICP lead to neuronal
damage.
Signs or symptoms depend on the affected area
(cerebrum, cerebellum, brainstem, etc.)
Seizures Inflammation in the brain alters membrane
permeability, lowering the seizure threshold.
Headache Worsen when patient vigorously shakes
head
Bacterial exotoxins, cytokines, and ↑ ICP stimulate
nociceptors in the meninges (cerebral tissue itself
lacks nerve endings that generate pain sensation).

14. Clinical features and pathophysiology
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Symptom Sign Mechanism
Photophobia
(not a morbid fear or phobia, but an
experience of discomfort or pain to the
eyes due to light exposure or by presence
of actual physical sensitivity of the eyes)
Due to meningeal irritation.
Mechanisms unclear; pathways are
thought to involve the trigeminal nerve.
Nausea and vomiting ↑ ICP stimulates the area
postrema (vomiting centre), causing
nausea and vomiting.
Petechial rash Meningococcemia- dissemination of
meningococci (Neisseria meningitidis)
into the bloodstream

15. Meningitis
Management
■ Appropriate antibiotic or antiviral agent.
■ IV route for rapid effect.
■ Supportive measures to maintain circulation, nutrition and hydration.
■ Anticonvulsants can be given to prevent and control seizures.
■ In the case of meningococcal meningitis, all contacts must be given prophylactic
antibiotics to stop the spread of disease.
■ Nursing management includes careful observation of the patient’s neurological status
and prevention of further deterioration.
■ Manage high fevers.
■ Pain relieve.
■ Nursed in quiet environment.
■ Encourage sleeping and rest.
■ Isolation precautions according to institutional protocol.
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16. Meningitis: Medical management
According to SA guidelines
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17. Meningitis:Medical management
According to SA guidelines
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18. Meningitis:Medical management
According to SA guidelines
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19. Meningitis:Medical management
According to SA guidelines
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20. Meningitis
Complications
■ Convulsions
■ Cerebral oedema
■ Raised intracranial pressure
■ Hydrocephalus
■ Cerebral infarction (necrotic tissue in
the brain resulting from a blockage or
narrowing in the arteries supplying
blood and oxygen to the brain)
■ Neurological deficits
■ Hearing loss
■ Memory difficulty
■ Learning disabilities
■ Brain damage
■ Gait problems (balance)
■ Seizures
■ Kidney failure
■ Shock
■ Death
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21. Meningitis
Prevention
■ Wash hands
■ Hygiene
■ Stay healthy
■ Cover mouth when coughing
■ Immunizations
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22. Reference list
■ http://www.eyeradio.org/samples-imatong-test-negative-meningitis/
■ JAMA. 1999 Jul 14;282(2):175-81. N Engl J Med 2004; 351:1849-1859. Pediatrics.
2010 Nov;126(5):952-60.
■ https://medlineplus.gov/ency/imagepages/9240.htm
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