Introduction

Meningitis is an infection of the meninges (the protective membranes that surround the brain and spinal cord). The infection is mostly caused by bacteria and viruses, which leads to the meninges becoming inflamed (swollen). It can damage the nerve and brain.

Definition

An inflammation of meninges (outer covering membrane of brain and spinal cord) of brain and spinal cord.

Causes / Etiology

  • Meningococcal Neisseria.
  • Haemophilus influenzae.
  • Staphylococcus.
  • Middle ear infection.
  • Cerebral abscess.
  • Mycobacterium tuberculosis.
  • Pneumococcal - pneumococcus.
  • Salmonella.
  • Head injury.
  • Droplet infection from nasopharynx, sinuses and mastoid.

Risk Factors

  • Age: children younger than 5 years.
  • Chronic malnutrition.
  • AIDS.
  • CSF shunts.
  • Chronic alcoholism.
  • Use of immunosuppressive drugs.
  • Overcrowding.
  • Diabetes.
  • Pneumonia.
  • Splenectomy.

Pathophysiology

Causative organism enters the bloodstream.
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Crosses the blood-brain barrier.
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Inflammatory reaction in meninges.
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Inflammation of subarachnoid space and pia mater occurs.
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Inflammation may cause increased ICP.
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CSF flows in subarachnoid space.
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CSF cloudiness or infection occurs.
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CSF cell count increases.

Types

Bacterial Meningitis
Fungal Meningitis
Neoplastic Meningitis
Viral Meningitis
Parasitic Meningitis
Hospital-acquired / Post-craniotomy Meningitis

Clinical Manifestations

Confirmative Signs

1. Positive Kernig's Sign:

When the patient is lying with the thigh fixed on the abdomen, the patient cannot completely extend the legs. The patient feels severe pain and stiffness in the hamstring muscles of the legs.

2. Brudzinski's Sign:

To elicit Brudzinski's sign, place the patient supine and flex the head upward. Resulting flexion of both hips, knees and ankles with neck flexion indicates meningeal irritation.

Common Signs and Symptoms

  • Severe headache.
  • Irritability.
  • Stiffness of neck.
  • Malaise (feeling of discomfort, illness or not well-being).
  • Restlessness.
  • Vomiting.
  • Nausea.
  • High-grade fever.
  • Disorientation.
  • Tachypnoea.
  • Tachycardia.
  • Seizures.
  • Coma.
  • Photophobia (sensitivity to light).
  • Sleeplessness.
  • Altered mental status (confusion).
  • Phonophobia (fear or sensitivity to loud sounds).

Diagnostic Evaluations

  • Positive signs.
  • History collection.
  • Lumbar puncture.
  • Physical examination.
  • Blood test.
  • CBC.
  • Blood cultures (to indicate the organism).
  • CSF evaluation for pressure, protein, glucose and leukocytes.
  • MRI / CT scan (to detect abscesses).

Complications

  • Increased ICP may cause severe visual loss, cerebral edema and tissue damage.

Management

Medical Management

  • Antimicrobial therapy, e.g.: Ceftriaxone.
  • Cefotaxime.
  • Antibiotics, e.g., Penicillin G, Ampicillin, Amoxy-clav 625 mg.
  • Antiviral: If viral infection, e.g., Acyclovir.
  • Symptomatic drugs, e.g., antipyretics, analgesics and antiemetics (Domperidone).
  • Antiseizure / anticonvulsants (Phenytoin).
  • Anti-inflammatory agents, e.g., dexamethasone.

Nursing Management

  • Management of shock by IV therapy.
  • Management of airway by administering O₂.
  • To eliminate infection with antimicrobial therapy.
  • Provide supportive care to the patient.
  • To control body temperature.
  • Monitor regular vital signs.
  • Maintain personal hygiene of patient.
  • Provide comfort and rest.

Nursing Diagnosis

  • Altered body temperature / hyperpyrexia related to infectious process.
  • Risk for imbalanced fluid volume R/T fever and less intake of fluid.
  • Ineffective tissue perfusion (cerebral) related to infectious process and cerebral edema.
  • Potential for altered skin integrity related to impaired mobility.
  • Acute pain related to neurologic effects from the disease process.
  • Risk for injury related to seizure.
Study Note: This article is provided as a nursing education and study resource for ANM, GNM and BSc Nursing students.