Meningitis is an infection of the meninges that covers the brain and spinal cord. It can be caused by bacteria like Neisseria meningitidis or viruses. Symptoms include headache, fever, and nuchal rigidity. Diagnosis involves lumbar puncture and imaging. Treatment involves antibiotics, steroids, and IV fluids. People remain contagious until 24-48 hours after antibiotics. Vaccines prevent certain bacterial causes.

1. Submitted by: Submitted to:
Rimando, Maria Clarita Tondy A. Ms. Shalimaar Dimaandal
BSN3-d2 Clinical Instructor

3.  Meningitis is the infection and inflammation
of the meninges (covering of the brain and
spinal cord: duramater, arachnoid and
piamater) and the cerebrospinal fluid.

5.  Causative agents
 Neisseria meningitides
▪ Incubation period: 2-10 days
 Haemophilus influenzae
▪ Incubation period: 1-4 days
 Enteroviruses
▪ Incubation period: 3 to 7 days

6.  Nuchal rigidity:
 It is the inability to
flex the head forward
due to rigidity of the
neck muscles; if
flexion of the neck is
painful but full range
of motion is present,
nuchal rigidity is
absent.

7.  Kernig's sign:
 It is positive when the
leg is bent at the hip
and knee at 90
degree angles, and
subsequent extension
in the knee is painful
(leading to
resistance).

8.  Brudzinski's signs
 It is the appearance
of involuntary lifting
of the legs in
meningeal irritation
when lifting a
patient's head off the
examining
couch, with the
patient lying supine.

9.  Antibiotics:
 Ampicillin, Third-generation Cephalosporin such
as Ceftriaxone or Ampicillin and an
Aminoglycoside.
 Other drugs include Digitalis glycoside such as
Digoxin (to control arrythmias), Mannitol (to
decrease cerebral edema) or a Sedative (to
reduce restlessness) and Aspirin or
Acetaminophen (to relieve headache and fever).

10.  Rifampacin and Ciprobay
 Anti-fungal, Antibiotic, Mannitol
 Corticosteroid (Dexamethasone/Solucortef)
 Anti-convulsant (Phenytoin) (to reduce
restlessness)

11.  A person can pass the infection to others for
as long as the bacteria are present in
discharges from the nose and mouth. A
person is no longer infectious within 24 to 48
hours after starting antibiotic treatment.

12.  Encourage personal hygiene especially the practice of hand
washing. Keep hands clean and wash hands properly. Wash
hands when they are dirtied by respiratory secretions e.g. after
sneezing. Cover nose and mouth while sneezing or coughing
and dispose of nasal and mouth discharge properly.
 Do not share eating and drinking utensils and wash them
before use by others.
 Avoid going to overcrowded places.
 For Neisseria meningitidis meningitis, household contacts and
others who have had close personal contact with infected
persons are recommended to receive a preventive antibiotic
which kills bacteria living in nose and throat secretions.
 For contacts of Haemophilus influenzae meningitis, antibiotics
may also be recommended
 Effective vaccines against Haemophilus influenzae type b, and
some types of Neisseria meningitidis are available.

13.  Haemophilus Influenzae type B
 Haemophilus influenzae type b (Hib) is a bacterium
that can infect the outer lining of the brain causing
meningitis. Hib disease occurs most often at three
months to three years of age, peaking at six to seven
months of age. The disease is uncommon after age
five years.
▪ Children should get Hib vaccine at:
▪ 2 months of age
▪ 6 months of age
▪ 4 months of age
▪ 12-15 months of age

14.  Vaccines against four strains of N.
meningitidis
 Meningococcal Conjugated vaccine are
given to adolescents entering high school and
to college freshmen living in dormitories.

15.  Assess neurologic status.
 Monitor vital signs especially temperature frequently or continuously.
 Pulse oximeter and arterial blood gas (ABG) are use to quickly identify
the respiratory support for increasing ICP
 Institute other cooling measures such as TSB.
 Monitor I & O closely.
 Encourage adequate fluid intake.
 Darken the room if photophobia is present.
 Assist with position to comfort neck stiffness and turn patient slowly and
carefully with head and neck in alignment.
 Elevate the head of the bed to decrease intracranial pressure and reduce
pain.
 Administer vaccines against H. influenza type B for children; N.
meningitides for patients at high risk; and S. pneumonia for patients with
chronic illnesses and the elderly.
 Inform patients about the importance of vaccination.

16.  Vancomycin Hydrochloride in combination
with one of the Cephalosporins is
administered IV.
 Dexamethasone (Decadron)
 Dehydration and shock are treated with fluid
volume expanders.
 Phenytoin (Dilantin)- treatment for seizures
if occurs.

17.  Lumbar Puncture (Increase Protein and
WBC, Low Sugar level)
 A lumbar puncture takes samples of the fluid around
the spine and brain, known as cerebral spinal fluid
(CSF). A culture of the spinal fluid is done to check for
organisms known to cause illness.
 Blood Culture
 A blood culture is a test on a sample of blood to check
for bacteria in the bloodstream; it may be done if a
doctor suspects a blood infection. A blood culture
may be helpful in determining the specific bacteria
causing an infection and selecting the appropriate
antibiotic to treat it.

18.  Imaging (X-rays and CT scans)
 X-rays and computerized tomography (CT) scans
of the head, chest or sinuses may reveal swelling
or inflammation. These tests can also help your
doctor look for infection in other areas of the body
that may be associated with meningitis.

19.  Both viral meningitis and bacterial meningitis
can be transmitted through direct contact
with nose and throat secretions of infected
person (Droplet).
 Healthy persons, who have no signs of
illness, can carry these bacteria in their nose
or throat (Upper respiratory tract infection).
 Viral meningitis can also be transmitted
through fecal-oral route.

20. Nasopharyngeal Colonization
↓
Local Invasion
↓
Bacteremia
↓
Endothelial Cell Injury
↓
Meningeal Invasion
↓
Sub arachnoid Space Inflammation
↓
Increased CSF outflow resistance
↓
Interstitial Edema
↓
Increased Intracranial Pressure
↓
Decreased Cerebral Blood Flow

22.  Encephalitis is irritation and swelling
(inflammation) of the brain
parenchyma, most often due to infections.
 Encephalitis with meningitis is known
as meningoencephalitis.

23.  Causative agents
 Specifically to rural areas are Arboviruses or
Arthropod-borne Viruses (viruses carried by
arthropods, such as mosquitoes and tick), while in
urban areas it is most frequently caused by
Enteroviruses (Coxsackievirus, Poliovirus and
Echovirus)
 Enteroviruses Incubation Period is most oftenly
3-5 days

24.  Severe headache
 Fever
 Altered consciousness
 Confusion or agitation
 Personality changes
 Seizures
 Loss of sensation or paralysis in certain areas of the body
 Muscle weakness
 Hallucinations
 Double vision
 Perception of foul smells
 Problems with speech or hearing
 Loss of consciousness

25.  Antiviral medications, such as Acyclovir (Zovirax) and
Foscarnet (Foscavir) -- to treat herpes encephalitis or
other severe viral infections (however, no specific
antiviral drugs are available to fight encephalitis)
 Antibiotics -- if the infection is caused by certain
bacteria
 Anti-seizure medications (such as Phenytoin) -- to
prevent seizures
 Steroids (such as Dexamethasone) -- to reduce brain
swelling (in rare cases)
 Sedatives -- to treat irritability or restlessness
 Acetaminophen -- for fever and headache

26.  The period of communicability varies by etiologic
agent, and some of them are not transmitted from
person to person (e.g., histoplasmosis and
toxoplasmosis). Enteroviruses may be shed in feces
for several days to many weeks after symptoms
have resolved. Enteroviruses may also be shed in
respiratory secretions, usually for no longer than
one week following symptoms.

27.  Dress to protect yourself. Wear long-sleeved
shirts and long pants if you're outside when
mosquitoes are most active and when you're in a
wooded area with tall grasses and shrubs where
ticks are more common.
 Apply mosquito repellent. To repel mosquitoes.
 Keep mosquitoes out of your home. Repair
holes in screens on doors and windows.

28.  Monitoring pupils and vital signs frequently for increased
intracranial pressure(ICP; irregular pupils, widening pulse
pressure, tachycardia, irregular breathing hyperthermia).
 Monitor neurologic status closely. Watch for subtle
changes, such as behavior or personality changes,
weakness, or cranial nerve involvement
 Maintain adequate fluid intake to prevent dehydration,
but avoid fluid overload, which may increase cerebral
edema.
 Maintain adequate nutrition. Give small, frequent meals,
or supplement meals with nasogastric tube or parenteral
feedings.
 To prevent constipation and minimize the risk of
increased ICP resulting from straining at stool, provide a
mild laxative or stool softener.

29.  Carefully positioned the patient to prevent joint stiffness
and neck pain, and turn the patient often.
 Provide thorough mouth care.
 Maintain a quiet environment. Darkening the room may
decrease headache.
 If the patient has seizures, take precautions to protect
him from injury.
 Measure and record intake and output.
 If the patient becomes delirious or confused, try to
reorient him often.
 Teach the patient and his family about the disease and its
effects.
 Teach eradication of the source of infection: Use
insecticide or insect repellent and placement of screens
to doors and windows.

30.  Antiviral agent Acyclovir given I.V. for 10 days
to 3 weeks for herpes simplex virus.
 Blood cultures and foscarnet I.V. for CMV
encephalitis.
 Anticonvulsants to treat
seizures, corticosteroids to reduce cerebral
edema, and sedatives and analgesics as
supportive therapy.

31.  Spinal fluid analysis
▪ By doing a lumbar puncture (also called a spinal
tap), your doctor can check the spinal fluid for an
increase in white blood cells and protein.

32.  Electroencephalography (EEG)
 This can identify abnormal brain waves by monitoring
electrical activity in the brain through the skull.
Among its many functions, EEG is used to help
diagnose certain seizure disorders, brain damage
from head injuries, specific viral infections such as
herpes virus, and inflammation of the brain and/or
spinal cord.
 Blood tests.
 These tests can show what type of virus is causing
encephalitis.

33.  Computer-assisted
imaging (Computed
tomography: CT
SCAN and Magnetic
resonance imaging:
MRI)
 This can reveal signs
of brain
inflammation, internal
bleeding or
hemorrhage, or other
brain abnormalities.

34.  Breathing in respiratory droplets from an
infected person
 Skin contact
 Mosquito, tick, and other insect bites
 Tick of Horses
 Migratory Birds
 Contaminated food or drink

36. ARTHROPOD-BORNE VIRUS
Mosquito bite
↓
Inadequate Host Immune Response
↓
Viremia
↓
Cerebral Capillaries
↓
Central Nervous System
↓
Cortical Gray Matter, The Brain Stem and Thalamus
↓
Meningual Exudates
↓
Irritating The Meninges
↓
Increasing Intracranial Pressure

37. FUNGAL ENCEPHALITIS
Fungal Spores (enter body through inhalation)
↓
Infect the Lungs
↓
Vague Respiratory Symptoms or Pneumonitis
↓
Bloodstream
↓
Fungemia
↓
Central Nervous System
↓
Encephalitis
↓
Fever, Malaise, Headache, Meningeal signs and change in Cranial Nerve
Dysfunction