MENINGITIS

Presented by: Bijaya Rai

Roll no-12
B.Sc nursing (II year)
CONTENT
 Definition
 Incidence
 Causative agent
 Pathophysiology
 Classification
 Bacterial meningitis
 Causes
 Predisposing factors
 Sign and symptoms
 Investigation
 Nursing management
 Treatment
 Complication
 Outcome.
 Prevention

 Summary
Meningitis
 Meningitis is inflammation of
the protective membranes
covering the brain and spinal
cord, known collectively as
meninges.

 Inflammation may be caused

by infection with viruses,
bacteria, or other micro-
organism and less
commonly by certain drugs.

 It is classified as Medical
emergency.
Incidence:
 Kids of any age can get meningitis, but
because it can be easily spread between
people living in close quarters, teens, college
students, and boarding-school students.
Causative agent:
Type Pathogen (most Common)
Bacterial Strep pneumoniae, E-coli, Neisseria
meningitis

Viral infection Coxsackie Virus, Echovirus,

Enterovirus, Arbovirus, HIV, HSV-2

TB meningitis M. Tuberculosis
Protozoal Toxoplasma Gondii
Infection (toxoplasmosis)

Fungal infection Cryptococcus neoformans

(cryptococcal meningitis)
 PATHO PHYSIOLOGY
Microorganisms
Direct to
Via Blood
CSF
Subarachnoid
Immune Response
Space
from
Astrocytes+Micro
glia,
Cytokin Release
Inc. BBB Inc. no. of WBC in Vasculitis of cerebral
permeabilty CSF vessels
Fluid leakage from Inflammation of Dec. cerebral
vessels Meninges blood flow
Vasogenic Interstitial edema Ischemia, cytotoxic
edema (Inc. ECF) edema

Cerebral
Edema

Dec. Cerebral blood flow, Ischemia, apoptosis (Brain Death)

Classification:
 Acute pyogenic (bacterial) meningitis
 Acute aseptic (viral) meningitis
 Chronic bacterial infection (tuberculosis).
Causes/ Pathogens:
 In neonatal period- Escherichia coli, Streptococcus
pneumonae,Salmonella species,Pseudomonas
aeruginosa,Streptococcus fecalis and
Staphylococcus aureus.
 3 months to 3 years: Hemophilus influenza,
S.pnemoniae and meningococci(Neisseria
meningitidis).
 Beyond 3 years: S.pnemoniae and Neisseria
meningitis.
 Other: Accidental wound infection and iatrogenic
cause.
Mode Of Transmission: The bacteria are spread by
direct close contact with the discharges from the nose
or throat of an infected person.
Predisposing Factor:
 Prematurity
 Low birth weight baby
 Complicated labor
 Prolonged rupture of membrane
 Maternal sepsis
 Babies in artificial respiration or intensive
care.
BACTERIAL MENINGITIS
 Inflammation of meninges caused by
bacteria.
 Should be taken seriously.
 Can be life –threatening if not treated right
away.
Sign and Symptoms:
 The sign and symptoms of meningitis vary and depend both on the age
of the child and on the cause of the infection. Because the flu-like
symptoms can be similar in both types of meningitis, particularly in the
early stages, and bacterial meningitis can be very serious, it's important
to quickly diagnose an infection.
 The first symptoms of bacterial or viral meningitis can come on quickly
or surface several days after a child has had a cold and runny nose,
diarrhea and vomiting, or other signs of an infection. Common
symptoms include:
 fever
 lethargy (decreased consciousness)
 irritability
 headache
 photophobia (eye sensitivity to light)
 stiff neck
 skin rashes
 seizures
In newborns and infants, the typical symptoms of fever, headache,
and neck stiffness may be hard to detect. Other signs in babies
might be inactivity, irritability, vomiting, and poor feeding.

 symptoms of meningitis in infants can include:

 jaundice (a yellowish tint to the skin)
 stiffness of the body and neck (neck rigidity)
 fever or lower-than-normal temperature
 poor feeding
 a weak suck
 a high-pitched cry
 bulging fontanelles (the soft spot at the top/front of the baby's
skull)
 Viral meningitis tends to cause flu-like symptoms, such as fever
and runny nose, and may be so mild that the illness goes
undiagnosed. Most cases of viral meningitis resolve completely
within 7 to 10 days, without any complications or need for
treatment.
1) Acute Pyogenic Bacterial
Meningitis
Investigation:
 Physical Examination:
 Brudzinski’s & Kernig’s sign
 Nuchal rigidity

 Laboratory Investigation:

Specimen: CSF
Chemistry - glucose and protein.
Cytology – WBC and %PMN
Gram stain or Rapid diagnostic tests
Polymerase chain reaction: (N.meningitidis, S. pneumoniae, H.
influenzae, S. agalactiae, L. monocytogenes & enteroviruses).
Non- specific tests: including C-reative protein, lactic dehydrogenase,
and CSF lactic acid level .
Culture for pathogens.

 Blood, Urine, & Sputum Cultures

CSF Detail Report:

Changes in CSF Normal Pyogenic (Bacterial)

Appearance Crystal-clear Turbid/purulent

WBC < 5 mm3 > 1000 mm3

Mononuclear cells < 5 mm3 <50 mm3

Polymorph cells Nil 200-300/ mm3

Protein 0.2- 0.4 g/L 0.5-2.0 g/L

Glucose 40-80 mg/dl <40 mg/dl

Nursing management:
 Vital signs are obtained and monitored
frequently depending on child’s condition.
 In infant, the nurses should monitor the
fontanel and maintain a record of the daily
head circumference.
 Input/ output charting should be done.
 Daily weight of child should should be taken.
 Positioning should be maintained every 4
hourly.
 Empirical Therapy For ABM
Age Common Pathogen Anti microbial

< 1 month Streptococcus agalactiae, Escherichia coli, Listeria Ampicillin plus cefotaxime
monocytogenes, Klebsiella species or ampicillin plus an
aminoglycoside

4-12 weeks Streptococcus pneumoniae, Haemophilus Ampicillin plus either

influenzae, Group B streptococcus,Listeria cefotaxime or ceftriaxone.
monocytogenes.

12 weeks H. influenza, N. meningitidis, S. pneumoniae Ceftriaxone or cefotaxime

and older or ampicillin plus
chloramphenical.
 Duration OF Therapy For ABM
Microorganism Duration of therapy, days

Neisseria meningitidis 7

Haemophilus influenzae 7

Streptococcus pneumoniae 10-14

Streptococcus agalactiae 14-21

Aerobic gram-negative bacillia 21

Listeria monocytogenes >21

Duration of Antimicrobial Therapy for Bacterial Meningitis Based on Isolated Pathogen (A-III)
a
Duration in the neonate is 2 weeks beyond the first sterile CSF culture or >3 weeks, whichever is longer.
 Adjunct Steroid Therapy for Infants,
Children
• Dexamethasone is given in a dose 0.5
mg/kg/6hourly for 4 days .The dose should be
administered intravenously 15 minutes before first
parenteral antibiotic dose.

• Adjunctive dexamethasone should not be given to

the patients who have already received
antimicrobial therapy, because administration of
dexamethasone in this circumstance is unlikely to
improve patient outcome
Complication:
 Subdural effusion or empyema
 Ventriculities
 Arachnoiditis
 Brain abscess
 Hydrocephalous
 Hemiplegia
 Aphasia
 Ocular palsies
 Hemianopsia
 Blindness
 Deafness
 Mental retardation
 Shock
 Status epilepticus
Outcome:
 The majority of children recover without permanent
deficits.
 Subdural hematomas develop in approximately 50%
of children under 18 months, but most resolve without
treatment. Headaches may persists for varying period
of time.
 15-20% of children may develop auditory nerve
deficit.
 Even when children have defects,many children have
no evidence of the defects 2 years after discharge.
Prevention:
 Vaccines -- There are vaccines against Hib, some strains of Neisseria
meningitidis, and many types of Streptococcus pneumoniae.

 The vaccines against Hib are very safe and highly effective. By age 6
months of age, every infant should receive at least three doses of an Hib
vaccine. A fourth dose (booster) should be given to children between 12
and 18 months of age.

 The vaccine against Neisseria meningitidis (meningococcal vaccine) is not

routinely used in civilians in the United States and is relatively ineffective
in children under age 2 years. The vaccine is sometimes used to control
outbreaks of some types of meningococcal meningitis in the United States.
New meningococcal vaccines are under development.

 The vaccine against Streptococcal pneumoniae (pneumococcal vaccine) is

not effective in persons under age 2 years but is recommended for all
persons over age 65 and younger persons with certain medical problems.
New pneumococcal vaccines are under development.
 Disease reporting -- Cases of bacterial meningitis should be
reported to state or local health authorities so that they can
follow and treat close contacts of patients and recognize
outbreaks.

 Treatment of close contacts -- People who are identified as

close contacts of a person with meningitis caused by Neisseria
meningitidis can be given antibiotics to prevent them from
getting the disease. Antibiotics for contacts of a person with Hib
disease are no longer recommended if all contacts 4 years of
age or younger are fully vaccinated.

 Travel precautions -- Although large epidemics of bacterial

meningitis do not occur in the United States, some countries
experience large, periodic epidemics of meningococcal disease.
Overseas travelers should check to see if meningococcal
vaccine is recommended for their destination. Travelers should
receive the vaccine at least 1 week before departure, if possible.
 Summary:
 Acute bacterial meningitis, a major cause of morbidity
and mortality in young children, occurs both in
epidemic and sporadic pattern.
 It is commoner in neonates and infants than in older
children because their immune mechanism and
phagocytic functions are not fully matured.
 It is life threatening situation and nursing care is very
important.
 Treatment is possible but may develop auditory and
neurological defects.
Reference:
 Ghai O.P.; Essential Pediatrics; 6th edition 2005;CBS
Publishers and distributors ,New Delhi : Page no:517-20

 Parthasarathy A, “ IAP Textbook of Pediatrics” ; 3rd Edition,

Jaypee Brothers Medical Publishers (P) Ltd; Page no: 336-
40.

 Dorothy R. Marlow, Barbara A. Redding, “Textbook of

Pediatric Nursing”, 6th Edition, 2009, ELSEVIER

 Retrieved on google.com on 7th and 24th July 2009.