CAUSES

Bacteria - S pneumoniae, a gram-positive coccus, is the most common

bacterial cause of meningitis.

Viruses - Enteroviruses account for of the majority of cases of aseptic

meningitis in children.

Fungi - Cryptococcus ,Coccidioides.

Parasite - Angiostrongylus cantonensis( the rat lungworm )

Gnatho stoma spini gerum, (a GI parasite of wild and domestic dogs
and cats).
 Clinical Manifestations
• Fever - The patient presents with fever at first, which ultimately grow worse.

• Seizures - As bacterial meningitis progresses, patients of any age may have seizures
(30% of adults and children; 40% of newborns and infants).
• Projectile Vomiting, headache
• Photophobia- sensitivity to light

• Neck stiffness - The patient feels stiffness of the neck as part of the triad of symptoms.

• Positive Kernig’s sign - When the patient is lying with the thigh flexed on the abdomen,
the leg cannot be completely extended.

• Positive Brudzinski’s sign - When the patient’s neck is flexed, flexion of the knees and
hips is produced; when the lower extremity of one side is passively flexed, a similar
movement is seen in the opposite extremity.
• High-pitched cry. Infants may present with high-pitched crying.

• Lethargy. An infant may appear only to be slow or inactive, or be irritable.

• Photalgia (photophobia). Discomfort when the patient looks into bright lights.

• Neurologic symptoms. Like irritability, confusion, coma

• Erythematous rashes

• Myalgia

• Arthralgia
CLINICAL MANIFESTATION IN INFANTS
 Assessment and Diagnostic Findings
• Lumbar puncture - examination of the cerebrospinal fluid (CSF) is the cornerstone of the
diagnosis.

• CT scan - A screening computed tomography (CT) scan of the head may be performed
before LP to determine the risk of herniation

• Blood studies - In patients with bacterial meningitis, a complete blood count (CBC) with
differential will demonstrate polymorphonuclear leukocytosis with a left shift.

• Chest radiography - As many as 50% of patients with pneumococcal meningitis also have
evidence of pneumonia on initial chest radiography.

• Cultures and bacterial antigen testing -

• Serum procalcitonin testing - increasing data suggest that serum procalcitonin (PCT)
levels can be used as a guide to distinguish between bacterial and aseptic meningitis in
children
MANAGEMENT
• Antivirals - Antiviral agents interfere with viral replication; they weaken or
abolish viral activity; they can be used in viral meningitis.
• Systematic antifungals - Antifungal agents are used in the management of
infectious diseases caused by fungi.
• Vaccines, inactivated - Inactivated bacterial vaccines are used to induce active
immunity against pathogens responsible for meningitis.
• Corticosteroids - The use of steroids has been shown to improve overall
outcome for patients with certain types of bacterial meningitis, such as H
influenzae, tuberculous, and pneumococcal meningitis.
• Osmotic diuretics - Mannitol may reduce subarachnoid-space pressure by
creating an osmotic gradient between CSF in the arachnoid space and plasma.
• Loop diuretics - Furosemide is a loop diuretic that increases the excretion of
water .
• Anticonvulsants - Anticonvulsants are used to help aggressively control seizures
(if present) in acute meningitis, because seizure activity increases ICP.
 NURSING MANAGEMENT
Assess neurologic status and vital signs constantly
Determine oxygenation from arterial blood gas values and pulse oximetry.
Insert cuffed endotracheal tube (or tracheostomy), and position patient on
mechanical ventilation as prescribed.
Assess blood pressure. (usually monitored using an arterial line) for incipient
shock, which precedes cardiac or respiratory failure.
Rapid IV fluid replacement may be prescribed, but take care not to
overhydrate patient because of risk of cerebral edema.
Reduce high fever to decrease load on heart and brain from oxygen demands.
Protect the patient from injury secondary to seizure activity or altered level of
consciousness (LOC).
Monitor daily body weight;.
• Check serum electrolytes
• urine volume, specific gravity, and osmolality.
• Prevent complications associated with immobility, such as pressure and
pneumonia.
• Institute infection control precautions until 24 hours after initiation of
antibiotic therapy (oral and nasal discharge is considered infectious).
• Inform family about patient’s condition and permit family to see patient at
appropriate intervals.
 NURSING DIAGNOSIS
1. Risk for Infection related to contagious nature of organism.

2. Acute Pain related to headache, fever, neck pain secondary to

meningeal irritation.

3. Impaired Physical Mobility related to intravenous infusion, nuchal

rigidity and restraining devices.

4. Activity Intolerance related to fatigue and malaise secondary to

infection.

5. Risk for Impaired Skin Integrity related to immobility, dehydration,

and diaphoresis.
 NURSING DIAGNOSIS
6. Risk for Injury related to restlessness and disorientation secondary to
meningeal irritation.

7. Interrupted Family Process related to critical nature of situation and

uncertain prognosis.

8. Anxiety related to treatment and risk of death.

9.Impaired growth and development