Bacterial Meningitis

Meningitis- is a infection of the cerebral meninges.

Organisms most frequently seen are:

1. Streptococus pneumonia or goup B streptococcus

- This type of bacteria is the most common cause of bacterial meningitis in adults. It is the second most
common cause of meningitis in children older than age 2.

Risk factors include:

Alcohol use

Diabetes

-E. coli

-the most cases of E. coli meningitis occur in newborn babies or babies yonger than 2 months of age.

- E. coli -causes about 20% of cases of neonatal meningitis, but less than 2% of cases of meningitis at all
other ages.

-infection in babies may occur during delivery, or from bacteria acquired in hospital, or in the home.
Premature and low-birth-weight babies are at higher risk of contracting meningitis.

Pseudomonas infection-is the causative agent when children with myelomeningocele develop meningitis.

-Children who have had splectonomy are particularly susceptible to pneumococcal meningitis unless
they received pneumococcal vaccine.

Pneumococal meningitis-is infectious disease that causes inflammation of the layers that surround the
brain and spinal cord. These layers are called the meninges - they help to protect the brain from injury and
infection.

-Symptoms of Pneumococcal Meningitis

chest pain.

chills.

confusion.

a cough.

a headache.

a high fever.

vomiting.
weakness.

-Treatment

-ceftriaxone

penicillin.

benzylpenicillin

Haemoplilus influenza

Haemoplilus influenza can cause severe infections of both the lining of the brain and spinal cord
(meningitis) and the bloodstream.

-once a major cause of meningitis,is now rarely seen because of routine immunization against this
organism.

-spread by infected droplets of fluid dispersed when infected people cough or sneeze

*Pathologic organisms usually spread to the meninges from upper respiratory tract infections by
lymphatic drainage possibly through the mastoid or frontal sinuses or by direct introduction through
lumbar puncture and skull fracture. Once organism enter the meningeal space, they multiply rapidly and
the spread throughout the CSF to invade brain tissue through the meningeal folds,which extended down
into the brain itself.Brain invasion of the infection into cranial nerves can result in blindness,hearing
impairment,or facial paralysis .

If a thick exudate accumulates in the narrow aqueduct of sylvius, It can cause obstruction leading to
hydrocephalus

Symptoms of hydrocephalus

Unusual large head size.

Rapidly increasing head circumference.

Bulging and tense fontanelle or soft spot.

-Brain tissue edema can put pressure on the pituitary gland,causing increased production of antidiuretic
hormone resulting in the syndrome of inappropriate antiduretic hormone secreation (SIADH),causing
hyponatremia

Assessment
-Children usually have had 2 or 3 days days of upper respiratory tract infection
prior to the development of meningitis.They then grow increasingly irritable
because of an intence head ache.They experience sharp pain when they bend their
head forward.In the newborn,symtoms such as poor sucking,weak cry,or lethargy
develop.As the deaseases progresess,signs of meningeal irritability then occur,as
evidenced by positive Brudzinski and kerrnig signs.

Brudzinski sign

One of the physically demonstrable symptoms of meningitis is Brudzinski's sign. Severe neck stiffness
causes a patient's hips and knees to flex when the neck is flexed. The Brudzinski's sign is positive when
passive forward flexion of the neck causes the patient to involuntarily raise his knees or hips in flexion.

Kerrnig sign

Kernig's sign is one of the physically demonstrable symptoms of meningitis.

-The test involves flexing the thighs at the hip, and the knees, at 90 degree angle, and assessing whether
subsequent extension of the knee is painful (leading to resistance), in which case it is deemed positive

-The pain felt on Kernig's sign is due to meningeal irritation caused by movement of the spinal cord
within the meninges.

*Children may hold their back arched and their neck hyperextended(opisthotonos)

Opisthotonus is a type of abnormal posture where the back becomes extremely arched due to muscle
spasms. The condition is usually a sign of serious brain conditions, such as meningitis, tetanus, and
trauma.

-If the third and sixth cranial nerve paralysis occurs,a child will not be able to follow a light through full
visual field.If the fontanelles are open ,they bulge upward and feel intense;if they are closed,papilledema
may develop.

-If the meningitis caused by H.influenzae,,the child may develop septic arthritis.

-If it caused by Neisseria meningitis,apapular or purple skin rash may occur(Pace&pollard,2012)

After this beginning of a myriad of general symtoms, sudden cardiovascular shock,seizure,nuchal

ridigity,or apnea.Because the infant has open fontanelles,nuchal redigity appears late and is not as useful
a sign for diagnosis as in the other child.As a rule ,a child with a high temp. who then has a seizure is
assumed to have meningitis until CSF finding proven otherwise.

CSF analysis obtained by lumbar puncture confirms the diagnosis.

CSF results indicative of meningitis include:

-Increased of white blood cells

The WBC increased as infection-causing bacteria in the blood, our bone marrow produces more white
blood cells to fight off the infection. Infection can also lead to inflammation, which can in turn cause the
number of white blood cells to increase

-Increased protein level

The elevation in protein is thought to be due to damage to the blood-brain barrier and leakage of serum
proteins into the CSF. CSF proteins are usually highest in bacterial meningitis and can reach 1,000
mg/diciliter.

-A glucose level less than 60% of blood glucose(because bacteria have fed on the glucose).

Increased ICP
Meningitis causes an imbalance between the water content of the brain parenchyma, CSF volume, and
cerebral blood flow (CBF), resulting in an increase of ICP.

-If the child has contact with someone with tuberculosis,a tuberculin skin test to rue out tuberculosis
meningitis will be done.

-a CT scan,MRI,or ultrasound study will be prescribed to examine for brain abscess

Therapeutic management

Antibiotic therapy as indicated by sensitivity studies is the primary therapy

Intrathecal injection(direactly into the CSF)

Corticosteroid such as deaxamethasone or the osmotic diuretic mannitol-can administered to reduce

ICP and help prevent hearing loss

-Respiratory precautions-children with meningitisare placed on respiratory precautions for 24 hours

after the start of antibiotic theraphy.