MENINGITIS

Galvez, Cindel Paulen Feliz

Go, Shiela May
Lamzon, Mary Pauline

 Meningitis is an inflammation of the

membranes (meninges) surrounding your
brain and spinal cord.
Common causes of meningitis may include:
Bacteria, Virus, Fungi and Parasites.
Most episodes of meningitis result from
hematogenous seeding of infection from
other sites to the meninges.

Causative Agents
Type

Pathogen (most Common)

Bacterial

Strep pneumoniae,Neisseria meningitis

Viral infection

Coxsackie Virus, Echovirus, Arbovirus,

HIV,

TB meningitis

M. Tuberculosis

Protozoal Infection Toxoplasma Gondii

Fungal infection

(toxoplasmosis)

Cryptococcus neoformans (cryptococcal

meningitis)

Signs and Symptoms

Fever
Severe, persistent
headache
Neck stiffness and pain
that makes it difficult to
touch your chin to your
chest
Nausea and vomiting
Confusion and
disorientation
Drowsiness or
sluggishness

Sensitivity to bright light

Poor appetite
More severe symptoms
include seizure and coma
In infants, symptoms may
include fever, irritability,
poor feeding, and
lethargy.
Skin rashRapid breathing

DIAGNOSTIC EXAM
1. 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

2. C-Reactive protein (CRP).

3. Blood culture and other cultures (urine,
abscess, and middle ear).
4. Full Blood Picture (CBC) and ESR.
5. Serum electrolytes, BUN, Creatinine.
6. Urine test, to check for infection in the
urinary tract.

6.Other examinations
Electro encephalogram (EEG) if seizures are
prominent.
Head imaging (CT). Indications for CT are:
(CT scan or MRI, to look for swelling of brain tissue or
for complications such as brain damage.)

Focal neurological examination findings,

Seizures,
Increasing head circumference,
Lack of improvement despite appropriate treatment
and
Suspected brain abscess.

CT should only be done when the patient is stable.

CHAIN OF TRANSMISSION
HUMAN
NASAL AND
BUCCAL
SECRETION
YOUNG CHILDREN ,
IMMUNOCOMPRO
MISED PERSON,
elderly people

NOSE
AND
MOUTH

DIRECTLY: touching,
kissing, coughing,
sneezing, etc
INDIRCTLY:
contaminating a formite
then handing it off

WHO ARE AT RISK?

Age -- Most cases of viral meningitis occur in children
younger than age 5. Bacterial meningitis commonly
affects people under 20, especially those living in
community settings.
Living in a community setting -- College students living
in dormitories, personnel on military bases, and
children in boarding schools and child care facilities are
at increased risk of meningococcal meningitis. This
increased risk likely occurs because the bacterium is
spread by the respiratory route and tends to spread
quickly wherever large groups congregate.

 Skipping vaccinations -- If you or your child

hasn't completed the recommended
childhood or adult vaccination schedule, the
risk of meningitis is higher.
Pregnancy -- If you're pregnant, you're at
increased risk of contracting listeriosis an
infection caused by listeria bacteria, which
also may cause meningitis. If you have
listeriosis, your unborn baby is at risk, too.

 Compromised immune system -- Factors that

may compromise your immune system
including AIDS, alcoholism, diabetes and use
of immunosuppressant drugs also make
you more susceptible to meningitis. Removal
of your spleen, an important part of your
immune system, also may increase your risk

PREVELANCE/INCIDENCE
Approximately 70 percent of meningitis cases occur in
children under the age of 5 and in people over the age of 60. In
the United States, bacterial meningitis affects about 4,000
people each year, and viral meningitis affects about 10 people
in 100,000.
Hib vaccine has reduced U.S. incidence of bacterial
meningitis caused by Haemophilus influenzae type b by
approximately 90 percent. The disease is more prevalent in
people between the ages of 15 and 24 who have not been
vaccinated.
Worldwide, bacterial resistance to penicillin and other
antibiotics and the lack of access to vaccines accounts for
rising rates of bacterial meningitis.

PREVELANCE/INCIDENCE
Childhood meningitis in the conjugate vaccine
era: a prospective cohort study
Manish Sadarangani1, Louise Willis1, Seilesh Kadambari2, Stuart Gormley3, Zoe
Young1, Rebecca Beckley1, Katherine Gantlett1, Katharine Orf4, Sarah
Blakey4, Natalie G Martin1, Dominic F Kelly1, Paul T Heath2, Simon
Nadel3, Andrew J Pollard1

 Abstract
Bacterial conjugate vaccines have dramatically changed
the epidemiology of childhood meningitis; viral causes are
increasingly predominant, but the current UK epidemiology is
unknown. This prospective study recruited children under
16years of age admitted to 3 UK hospitals with suspected
meningitis. 70/388 children had meningitis13 bacterial, 26
viral and 29 with no pathogen identified. Group B
Streptococcus was the most common bacterial pathogen.
Infants under 3months of age with bacterial meningitis were
more likely to have a reduced Glasgow Coma Score and
respiratory distress than those with viral meningitis or other
infections. There were no discriminatory clinical features in
older children. Cerebrospinal fluid (CSF) white blood cell
count and plasma C-reactive protein at all ages, and CSF
protein in infants <3months of age, distinguished between
bacterial meningitis and viral meningitis or other infections.
Improved diagnosis of non-bacterial meningitis is urgently
needed to reduce antibiotic use and hospital stay.

PATHOPYSIOLOGY

Modifiable Risk Factors:

Environment

Non-Modifiable Risk Factors:

-

Immune system

Age

Poor hygiene
Entry of virus/bacteria to the
nasopharyngeal area
Invasion of virus/bacteria to the
respiratory tract: cough
Accumulates to blood stream going
to the brain and spine
Virus/bacteria colonize in the
Cerebro Spinal Fluid and Meninges

Release pyrogenic cytokines

Goes to blood vessle and signals the brain

Stimulates hypothalamus to
increase thermostats

Fever

Destruction of cells in the meninges

Release of chemical mediators: cytokin,

pyrogen
Menigeal irritabil ity
Pain: headache

Entry of basophils and

macrophages
Accumulation of fluid
and pus
Inflamation

Increased Intracrainal
pressure
Compression of brain and
Spine: Altered motor activity
Compressed
Cervical 2 (C2)
Stiff neck

Compressed
Thoracic 6 (T6)

Stomach
upset:vomitting

Compression of Pons,
hypothalamus,
cerebrum
Drowziness

Blank
Staring

coma

MEDICAL INTERVENTION
1)Give antibiotic treatment as soon as possible ( e.g.
Ampicillin plus Cefotaxime, Chloramphenicol plus
Ampicillin,Chloramphenicol plus Benzyl penicillin)
2)Give antipyretic drug if fever is present.
3)IV Fluids
4)Anticonvulsant if convulsing<Phenytoin
(Dilantin).Phenobarbital (Luminal)>.
5)Medicines to treat pressure on the brain.(mannitol,
dexamethasone)

NURSING DIAGNOSIS
Deficient fluid volume related to increase
intracranial pressure as evidenced by
vomiting, altered level of consciousness, poor
skin turgor, dry lips, dry buccal mucosa.

 Monitor vital signs(temp.,RR,PR)

Monitor Input/output
Monitor IV fluids very carefully and examine
frequently for signs of fluid overload
Increase fLuid intake
Oral care
Observe standard precautions to prevent dse.
transmission.

NURSING DIAGNOSIS
Hyperthermia related to inflammation of
meninges as evidenced by skin is warm to
touch, irritability, weak in appearance,
increase CSF WBC

NURSING INTERVENTION

Monitor vital signs(temperature)

Provide tepid sponge bath and cold compress
Increase fluid intake
Change clothing to loose and comfortable ones
after seizure roll pt. to side/semiprone-facilitate
gravity, drainage of secretions.
administer antibiotics with strict administration
schedule.