Meningitis is an inflammation of the meninges that cover the brain and spinal cord. It is most commonly caused by bacteria, viruses, and fungi. The document discusses the various causes of meningitis including the typical bacteria that cause bacterial meningitis. It also outlines the signs and symptoms, methods of diagnosis including lumbar puncture, and treatment approaches which involve antibiotics for bacterial meningitis and antivirals for viral meningitis. Nursing care aims to maintain a clear airway, prevent complications, and maintain good nutrition.

1. MENINGITIS
BY LUPOTE PHILIP

2. INTRODUCTION
Meningitis is the inflammation of the meninges covering the
brain and the spinal cord.
There are many causes of meningitis, e.g bacterial, viral,
fungal, chemicals and injury.
Rarely TB, protozoa and leukemic cells may cause meningitis
It is most common in children of ages 1 month to 2 years.
It is much less common in adults unless they have a special
risk factor such as HIV/AIDS when the immunity is
depressed.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
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3. INTRODUCTION CONTIN..
Bacteria and other infectious organisms can reach the
meninges and other areas of the brain from distant sites
in several ways.
They can be carried in the bloodstream, or they can
enter the brain by penetration – for example from an
injury or surgery.
Abscesses can spread from infected structures adjoining
the brain such as the sinuses.
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BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST

4. DEFINITION OF MENINGITIS
It is the inflammation of the meninges covering the
brain and spinal cord caused by bacteria, viruses or fungi
characterised by fever, neck stiffness and altered level of
consciousness.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
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5. MENINGES
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
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6. TYPES/CAUSES OF MENINGITIS
Meningitis is caused by bacteria, viruses and fungi,
chemicals injected in the spinal cord, can be a side effect
of some medication such as ibuprofen, etc.
TYPES OF MENINGITIS ARE AS FOLLOWS:
1. BACTERIAL/SEPTIC MENINGITIS
• Haemophilus influenza, Neisseria meningitidis and
Streptococcus pneumoniae account for more than 80%
of all cases of meningitis.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
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7. CAUSES CONTIN..
All these 3 are normally present in the environment and
may even reside in a person’s respiratory system
without causing harm (normal flora).
However, infection may follow a head injury or may
result from abnormality in the immune system.
Rarely, Other types of bacteria such as Staphylococcus
aureus, Escherichia coli, Mycobacterium tubercle,
Klebsiella, Proteus, Pseudomonas, Listeria monocytogen
and Meningococci cause Meningitis.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
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8. TYPES/CAUSES CONTIN..
Types of meningitis can also be according to the actual
bacteria causing the condition e.g Meningococcal
Meningitis caused by meningococci.
Small epidemics of meningococcal meningitis may occur
in such environments as military training camps, a
college dormitory, prisons, etc.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
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9. TYPES/CAUSES CONTIN..
2. VIRAL/ASEPTIC MENINGITIS
Different types of viruses cause meningitis; for example of
measles, small pox, herpes simplex virus, etc. It presents
with fever, headache, neck stiffness, blurred vision,
convulsions and confusion.
It is the most common type of meningitis as compared to
bacterial and fungal meningitis, but it is not fatal or deadly.
 It can resolve on its own without treatment. It usually
attacks young and old aged people.
Malnourished children, HIV positive and patients on
cytotoxic drugs are predisposed to this type of meningitis
because of their compromised immunity.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
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10. TYPES/CAUSES CONTIN..
3. FUNGAL/CRYPTOCOCCAL MENINGITIS
This is caused by fungi called Cryptococcus neoformans.
PREDISPOSING FACTORS OF FUNGAL MENINGITIS
Cryptococcosis is an opportunistic infection for HIV/AIDS.
Other conditions that may cause this condition are:
Certain lymphomas, for example hoddgkin and lymphoma.
Sarcoidosis, liver cirrhosis.
Patients on long-term corticosteroids therapy.
People who come in contact with pigeon droppings or are
contaminated with those droppings.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
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11. MODE OF TRANSMISSION OF MENINGITIS
Meningitis is generally transmitted through one of the
following four ways:
Airborne droplets or contact with oral secretions from
infected individuals.
From direct contamination from a penetrating skull
wound or skull fracture.
Via the blood stream such as pneumonia, endocarditic,
rotten tooth, otitis media
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
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12. PATHOPHYSIOLOGY OF MENINGITIS
Most cases of bacterial meningitis are caused by an
infectious agent that colonises or establishes a localised
infection elsewhere in the host body. Potential sites of
colonisation or infection include the skin, the nasal-
pharynx, the respiratory tract and the genitourinary
tract.
A bacteria agent can gain access to the central nervous
system and cause meningeal disease through the
invasion of bacteria in the bloodstream and subsequent
haematogenous seeding of the CNS.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
12

13. PATHOPHYSIOLOGY OF MENINGITIS
The brain is naturally protected from the body’s immune
system by the barrier that the meninges create between the
bloodstream (Blood brain barrier - BBB) and the brain.
However, in bacterial meningitis, the BBB can be disrupted
and blood vessels could become leaky and allow fluid, white
blood cells and other infection-fighting particles to enter the
meninges and brain causing them to swell.
• The infection could spread quickly through the CSF that
circulates around the brain and spinal cord. The
inflammatory process may remain confined to the
subarachnoid space.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
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14. PATHOPHYSIOLOGY OF MENINGITIS
In less severe forms, the pia matter is not penetrated
and the underlying parenchyma remains intact.
However, in more severe forms of bacterial meningitis,
the pia matter is breached and the underlying
parenchyma is invaded by the inflammatory process.
This leads to obstruction of CSF flow and decreased
reabsorption causing increased intracranial pressure,
severe headache and fever.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
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15. CLINICAL FEATURES OF MENINGITIS
In meningococcal meningitis, a pink macular rash, petechiae
will appear.
Kening’s signs with the hip joint flexed, extension at the
knee causes spasm in the hamstring muscles (the flexors of
the knee joint that are situated at the back of the thigh)
Brudzink’s sign whereby passive flexion of the neck causes
flexion of the thighs and knees.
Confusion due to increased ICP.
Restlessness due to headache and neck stiffness.
Convulsions due to interruption of normal cerebral
functions.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
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16. CLINICAL FEATURES OF MENINGITIS CONTIN..
Fever due to systemic infection.
Headache due to increased intracranial pressure as a
result of infection of CSF.
Neck stiffness due to meningeal irritation.
Photophobia due to damage and irritation to the optic
nerve.
Vomiting due to autonomic disturbances.
Cerebral hypoxia which result from reduced blood flow
to the brain.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
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17. MANAGEMENT
DIAGNOSIS AND INVESTIGATIONS
History shows the signs and symptoms e.g. neck
stiffness.
Physical examination – when the patient’s head is pulled
down towards the chest, the hip and knees may flex.
Lumbar puncture done and cerebrospinal fluid (CSF)
taken to the lab for culture and sensitivity which is
positive of meningitis.
Moderately elevated CSF pressure.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
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18. CONT
Elevated white blood cell count – normal 100- 10
000mmc with predominately nuclear leucocytes.
Cryptococcal antigen test (CAT) – test for Cryptococcal
meningitis – blood sample.
Gram staining in TB suspected cases
Blood slide/RDT to rule out cerebral Malaria
Elevated CSF protein level normal 15-45mg/dl proteins
Increased glucose CSF levels – normal 60-80mg/dl
glucose
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BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST

19. MANAGEMENT CONT
TREATMENT
a. BACTERIAL MENEINGITIS
Chloramphenicol 500 - 1000mg QID for 7/7 plus.
Benzyl penicillin four to eight mega units QID for 7/7.
Cephotaxime injection 1g by injection every 12 hours
increased in severe infections to 8g daily in four divided
doses (meningitis). Higher doses may be required up to
12g daily in three to four divided doses.
Antipyretic will be given for example Paracetamol 1g
TDS for three to seven days to reduce fever
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
19

20. MANAGEMENT CONT
For cerebral oedema, can give Mannitol an osmotic
diuretic drug, 200mg/kg body weights.
To suppress the inflammation, give dexamethasone
0.5mg/kg body weight for four days.
Vomiting, give antiemetic’s such as promethazine 25mg
od for three days.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
20

21. MANAGEMENT CONT
b. VIRAL MENINGITIS
Acyclovir can be given e.g. for herpes simplex virus, give
200mg TDS for five days.
For headache give analgesia for example paracetamol 1g
TDS for three days.
Vomiting, give antiemetic’s such as promethazine 25mg od
for three days.
For cerebral oedema give Mannitol an osmotic diuretic
drug, 200mg/kg body weights.
To suppress the inflammation, give dexamethasone
0.5mg/kg body weight for four days.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
21

22. MANAGEMENT CONT
c. CRYPTOCOCCAL MENINGITIS
FIRST LINE DRUGS
The drug of choice for treatment of fungal meningitis is
Amphotericin B. Dose includes the following:
Amphotericin B 0.7-1.0 milligram per kg body weight
per day intravenously plus flucytosine (5-fc) 100mg/kg
body weight per day orally divided over four doses for two
weeks.
The maintenance dose is fluconazole 400mg/day for
eight weeks.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
22

23. CONT
Second line drugs and their dosages are described
as follows: Amphotericin B 0.7-1mg/kg/day
intravenous plus flu cytosine 100mg/kg body
weight/day per oral divided over 4 doses for six to
ten weeks.
23
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST

24. MANAGEMENT CONT
Amphotericin B 0.7-mg/kg body weight/day/per
oral for six to ten weeks.
Fluconazole 400-800mg in day per oral for 10-12
weeks.
Fluconazole 400-800mg/day per oral with 5-fc
100-150mg/kg body weight/day per oral divided
over four doses for six weeks.
Prophylaxis: fluconazole 200mg/kg body weight
until CD4 count goes up to 200 then stop
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
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25. MANAGEMENT CONT
NURSING CARE
AIMS
To maintain a clear airway
To prevent complications e.g. Pressure sore formation
(in cases where patient is unconscious)
To Maintain good nutrition status
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
25

26. MANAGEMENT CONT
Environment
Nurse in a clean and well ventilated room to prevent
infection e.g. in cases where the immunity is depressed.
Have equipment within the environment that might be
required e.g. suction machine, oxygen cylinder etc.
Provide a quiet environment and a darkened room.
Restrict visitors as necessary to reduce noise.
Sun shields may be used to promote comfort from
photophobia.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
26

27. MANAGEMENT CONT
If the patient is unconscious, promote bed rest and
assist the patient with activities of daily living as needed
to reduce movements that may cause pain.
Respiratory isolation is required for meningococcal
infections only until the pathogen can no longer be
cultured from nasol-pharynx.
The patient may need to be in a railed bed to prevent
falls during seizures.
Elevate the head of bed to promote venous drainage.
This helps to reduce cerebral oedema.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
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28. MANAGEMENT CONT
MANITENANCE OF A CLEAR AIRWAY AND POSITION
If patient is unconscious, position in semi prone or
lateral position with head tilted to the side to help in
drainage of secretions and clear the airway.
If there are secretions, suction to remove secretions and
clear the airway.
Administer oxygen if needed 4 to 6 litres per minute.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
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29. MANAGEMENT CONT
Comfort Measures
Apply ice bag to the head or cool cloth to the eyes to
help diminish the headache.
Support patient in a position of comfort.
The head of bed should be elevated slightly to promote
venous return.
Keep the neck in alignment during position changes.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
29

30. MANAGEMENT CONT
Provide gentle passive range of movement and massage
to the neck and shoulder joints and muscles to help
relieve stiffness.
If the patient is afebrile, apply moist heat to the neck
and back to promote muscle relaxation and reduce pain.
Keep communication simple and direct in a soft and
calm tone of voice. Loosen constricting bed clothing and
avoid restraining the patient.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
30

31. MANAGEMENT CONT
Observations
Monitor the input and output using the fluid balance
chart.
Check vital signs; that is temp, pulse, respirations and
BP 4 hourly depending on the condition. Temp may be
high to show presence of infection, so monitor to see if
subsiding or not.
The patient usually will have an indwelling catheter
especially if they are unconscious. Weigh the patient on
alternate days to monitor the nutritional status.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
31

32. MANAGEMENT CONT
Observe the level of consciousness and the mental
status using the Glasgow Coma scale.
Observe and record the status of the skin for any
pressure sores.
Monitor the patient for symptoms of increased
intracranial pressure and maintain fluid restriction as
prescribed.
Administer hypertonic saline (3%) as prescribed.
Hypotonic intravenous solutions such as 5% dextrose in
water are avoided because they increase cerebral
oedema.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
32

33. CONT
The urine specific gravity and electrolyte serum studies
should be recorded and reported. Vital signs should be
observed every four to six hours and gradually reduced
as the patient’s condition improves.
33
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST

34. MANAGEMENT CONTIN..
Nutritional Support and Fluids
Parenteral or enteral feeding or modified diet,
depending on patient’s LOC and ability to swallow.
Prevent constipation, by giving stool softeners and
laxatives to avoid increased intracranial pressure when
straining at stool.
Give intravenous fluids to maintain a balanced
electrolyte status. Generally, fluids are limited to
1,500mls to a state of under hydration.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
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35. MANAGEMENT CONT
Psychological Care
Explain the disease process to the patient and
significant others to alley anxiety.
Explain the specific respiratory precautions to prevent
the spread of infection to others. If they must leave the
room for a procedure or test, explain that a mask must
be worn to protect others from contact with airborne
droplets.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
35

36. CONT
Reassure the patient that the special respiratory
precautions are temporary and will be discontinued
once the patient has been on the appropriate antibiotic
for 24 to 48 hours.
36
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST

37. CONT
Hygienic Measure
Assist the patient with activities of daily living,
such as, bed baths oral toilet, pressure area care,
among others.
Turning of the patient should be done twice
hourly. Perform catheter care as necessary.
Ensure that the patient is lying on dry linen to
avoid skin peeling off.
37
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST

38. MANAGEMENT CONT
Health Education
Give the patient and relatives information in writing
and verbal on the following:
Transmission and preventive measures
Importance of avoiding overcrowded areas
especially in meningococcal meningitis
Completion of medication so as to avoid
resistance
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
38

39. CONT
Early treatment of any infection including
respiratory tract infection
Importance of meningococcal vaccine in
epidemic period
Importance of hemophilus influenza vaccine
39
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST

40. COMPLICATIONS OF BACTERIAL MENINGITIS
DIC, that is, disseminated intravascular coagulation.
Hydrocephalus due to adhesions formed after
inflammation causing CSF blockage.
Impaired hearing due to compression of the
vestibulocochlear ear nerve by the inflamed meninges.
Brain abscess due to presence of the bacteria.
Mental retardation due to severe inflammation of the
brain tissue.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
40

41. COMPLICATIONS CONT
Brain damage due to dissemination of the infection to
the brain from the meninges.
Optic neuritis due to the infection to the optic nerve.
Paralysis due to nerve damage.
Gangrene due to toxins or poisons produced by bacteria
when they enter the blood that kill healthy tissues.
Cerebral oedema due to some exudate that can seep
away from the blood vessels.
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST
41

42. CONT
Encephalitis due to invasion of bacteria in the brain
tissue.
Visual impairment due to compression of nerves by the
inflamed meninges.
42
BY PHILIP CHIKELETE LUPOTE,BSC NUR,MED AND
SURG SPECIALIST