The meninges are the protective membranes surrounding the brain and spinal cord. Meningitis is an inflammation of the meninges. It most commonly affects infants under 5 years old. There are bacterial, viral, fungal and parasitic causes. Common bacterial causes include pneumococcus, meningococcus, and H. influenzae. Symptoms include fever, headache, stiff neck, and altered mental status. A lumbar puncture examines the CSF for signs of infection. Treatment involves intravenous antibiotics for 10-14 days. Supportive care and monitoring for complications are also important. Vaccines can help prevent certain causes of meningitis.

1. DHANYA VJ
ASSISSTANT PROFESSOR
SUM NURSING COLLEGE

2. 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

3. DEFINITION
Meningitis is an inflammation of the
meninges, the protective membranes that
surround the brain and spinal cord.

4. INCIDENCE
 Meningitis can occur at all ages but
it is commonest in infancy. While
95% of the cases take place between
1 month- 5 years of age.
 It is more common in males than
females

5. TYPES
 Bacterial meningitis/ pyogenic
meningitis
 Viral (aseptic) meningitis
 Tuberculous meningitis

6. Pyogenic Meningitis
 It is caused by a wide variety of
pyogenic bacteria like hemophilius
influenza, meningococcus,
pneumococcus and streptococcus.
Tuberculous meningitis
 It is caused by mycobacterium
tuberculosis.

7.  The viral agents for aseptic meningitis
include the following:
 Enterovirus (polio virus, Echovirus,
 Coxsackievirus )
 Herpesvirus (Hsv-1,2, Varicella.Z,EBV )
 Paramyxovirus (Mumps, Measles)
 Togavirus (Rubella)
 Rhabdovirus (Rabies)
 Retrovirus (HIV)

8. ETIOLOGY
 Common causes of meningitis may include:
Bacteria, Virus, Fungi and Parasites
1. Newborn to 3 months of age:
 E. coli and other coliforms, group B Streptococci,
 Listeria monocytogenes, Strep pneumoniae,
 H. influenza type b, Neisseria meningitidis
2. Age 3 months to adolescence:
 N. meningitidis, S pneumoniae, H influenza type b
(in young children)
 Mycobacterium tuberculosis is most common in
young children, but can affect children of any age.

9. ETIOLOGY
Viral Causes (aseptic meningitis) include:-
 Mumps
 Enterovirus (coxackie, polio)
 Adenovirus and
 Herpes simplex

10. PATHOPHYSIOLOGY

11. CLINICAL FEATURES
 Young infants < 3 months: The signs and
symptoms are non specific and may
include:
 Fever or hypothermia
 Bulging fontanelle or acute increase in
head circumference
 Convulsions / seizures
 High-pitched cry, irritability
 Lethargy, altered mental state
 Apnoea
 Poor feeding, vomiting

12.  Children > 3 months to adolescents:
 Fever is present in about 50% of patients.
 Headache, photophobia, stiff neck,
irritability or lethargy, vomiting and altered
level of consciousness.
 Convulsions in 20 – 30% of cases.
 Focal neurological deficits due to
vasculitis or thrombosis of blood vessels.
 Papilledema (Swelling of the optic disc)
CLINICAL FEATURES

13. Kernig’s sign - is assessed with the patient lying
supine, with the hip and knee flexed to 90
degrees. In a patient with a positive Kernig's
sign, pain limits passive extension of the knee

14. Brudzinski signs -A positive Brudzinski's
sign occurs when flexion of the neck
causes involuntary flexion of the knee and
hip.

15. LABORATORY INVESTIGATIONS
 CSF- Lumbar puncture or a shunt tap is
performed As soon as the diagnosis of
meningitis is suspected.
CSF should be examined for:
 Microbiology and
 Biochemistry
 Polymerase chain reaction

16. LABORATORY INVESTIGATIONS
 C-Reactive protein (CRP).
 Blood culture and other cultures (urine, abscess,
and middle ear).
 Full Blood Picture (CBC) and ESR.
 Serum electrolytes, BUN, Creatinine
 Electro encephalogram (EEG) if seizures are
prominent.
 Head imaging (CT).

17. MANAGEMENT
 Give antibiotic treatment as soon as
possible:
Infants < 3 month old:
 Ampicillin 200 mg/kg/day IV div q6hr,
 Cefotaxime 200 mg/kg/day IV div q6hr
for 10 to 14 days

18. MANAGEMENT
 Age 3 months to < 18 years; choose on of the
following regimens:
 Chloramphenicol 25 mg/kg IV (or IM) 6 hourly,
plus Ampicillin 50 mg/kg IV (or IM) 6 hourly
 Chloramphenicol 25 mg/kg IV (or IM) 6 hourly,
plus Benzyl penicillin 6o mg/kg (100,000 IU /kg) IV
or IM 6 hourly

19. Supportive treatment
 Give paracetamol 15 mg/kg 6 – 8 hrly for
fever (>38.50 C)
 IV fluids: isotonic fluids at maintenance
rate (250 ml/24hrs).
 Feeding according to age requirement
(75– 100 kcal/kg/day).
 Give anticonvulsant if convulsing
 Correct hypoglycemia if present
 NGT for feeding
 Physiotherapy

20. NURSING MANAGEMENT
 Monitor vital signs 2-4 hrly (Temperature
Pulse rate, Oxygen saturation, BP, and
Respiratory Rate)
 Monitor Input/output
 Give treatment as prescribed.
 Maintain a clear airway
 Turn the patient every 2 hours.
 Do not allow the child to lie in a wet bed.
 Monitor IV fluids very carefully and
examine frequently for signs of fluid
overload.

21. PREVENTION
 The vaccines against Hib, measles, mumps, polio,
 meningococcus, and pneumococcus can protect
against
 Meningitis
 Hib vaccine: all infants should receive at 2,4,6
months of age & booster 1 year later.
 After 1 year 1 dose is given till the age of 5
years.
 Pneumococcal vaccine: 0.5 ml is given IM