H INFLUENZAE MENINGITIS

OVERVIEW:

Haemophilus influenzae meningitis disease involves the inflammation of the protective membranes that
cover the brain and spinal cord. It is a name collectively used for any kind of infection caused by the
bacteria called Haemophilus influenzae. They are broadly classified into encapsulated and non-
encapsulated types. The encapsulated bacterium is further subdivided into ‘a’ through ‘f’ subtypes based
on capsule type. The most familiar and predominant form is H. influenzae type b (Hib), which infects
mostly children and immunocompromised individuals. Other types such as type a, e and f are also
isolated but less commonly than type b. Only rarely type c and d are identified. All of the serotypes,
particularly type b, are common etiological agents in lower respiratory tract infections such as
pneumonia. They can also cause many other types of serious infections such as meningitis, epiglottitis,
cellulitis, septic arthritis, and even empyema and bacteremia.

The Hib conjugate vaccine is effective for protection against capsular polysaccharide type ‘b’ and has
decreased the rate of Hib infections to a greater extent. Currently, non-encapsulated H. influenzae, also
called non-typeable H. influenzae (NTHi), is responsible for the majority of cases of otitis media, sinusitis,
and pneumonia in patients that have already been immunized with the vaccine. The mode of
transmission is through inhalation of respiratory secretion droplets from infected individuals or by direct
close contact.

Causes

H influenzae meningitis is caused by Haemophilus influenzae type b bacteria. This illness is not the same
as the flu (influenza), which is caused by a virus.

Before the Hib vaccine, H influenzae was the leading cause of bacterial meningitis in children under age
5. Since the vaccine became available in the United States, this type of meningitis occurs much less often
in children in the United States.

H influenzae meningitis may occur after an upper respiratory infection. The infection usually spreads
from the lungs and airways to the blood, then to the brain area.

Symptoms

Symptoms usually come on quickly, and may include:

 Fever and chills

 Mental status changes
  Nausea and vomiting
 Sensitivity to light (photophobia)
 Severe headache
 Stiff neck (meningismus)

Other symptoms that can occur include:

 Agitation
 Bulging fontanelles in infants
 Decreased consciousness
 Poor feeding and irritability in children
 Rapid breathing
 Unusual posture, with the head and neck arched backwards (opisthotonos)

Kernig's sign: Position the patients supine with their hips flexed to 90°. This test is positive if there is pain
on passive extension of the knee. Brudzinski's sign: Position the patients supine and passively flex their
neck. This test is positive if this maneuver causes reflex flexion of the hip and knee.

Brudzinski's sign Kernig's sign

Risk factors:

 Attending day care

 Cancer
 Ear infection (otitis media) with H influenzae infection
 Family member with an H influenzae infection
 Native American race
 Pregnancy
 Older age
 Sinus infection (sinusitis)
 Sore throat (pharyngitis)
 Upper respiratory infection
 Weakened immune system

Pathophysiology

Most cases of meningitis are caused by an infectious agent that has colonized or established a localized
infection elsewhere in the host.

The organism invades the submucosa at these sites by circumventing host defenses (eg, physical barriers,
local immunity, and phagocytes or macrophages).

Invasion of the bloodstream and subsequent seeding is the most common mode of spread for most
agents.

Meningeal seeding may also occur with a direct bacterial inoculation during trauma, neurosurgery, or
instrumentation.

The blood-brain barrier can become disrupted; once bacteria or other organisms have found their way to
the brain, they are somewhat isolated from the immune system and can spread.

When the body tries to fight the infection, the problem can worsen; blood vessels become leaky and
allow fluid, WBCs, and other infection-fighting particles to enter the meninges and brain; this process, in
turn, causes brain swelling and can eventually result in decreasing blood flow to parts of the brain,
worsening the symptoms of infection.

Replicating bacteria, increasing numbers of inflammatory cells, cytokine-induced disruptions in

membrane transport, and increased vascular and membrane permeability perpetuate the infectious
process in bacterial meningitis.

Diagnostic Procedure

The health care provider will perform a physical exam. Questions will focus on symptoms and possible
exposure to someone who might have the same symptoms, such as a stiff neck and fever.

If the doctor thinks meningitis is possible, a lumbar puncture (spinal tap) is done to take a sample of
spinal fluid for testing.

Other tests that may be done include:

  Blood culture Obtaining cultures before instituting antibiotics may be helpful if the diagnosis is
uncertain. The utility of cultures is most evident when the lumbar puncture is delayed until head
imaging can rule out the risk for brain herniation, in which cases adjunctive dexamethasone and
antimicrobial therapy are rightfully initiated before CSF samples can be obtained.
 Complete Blood Count In clients with bacterial meningitis, a complete blood count (CBC) with
differential will demonstrate polymorphonuclear leukocytosis with a left shift. A coagulation
profile and platelet count are indicated in cases of chronic alcohol use, chronic liver disease, or
suspected disseminated intravascular coagulation (DIC).
 CT scan of the head Computed tomography (CT ) scans of the head and magnetic resonance
imaging (MRI) of the brain generally does not aid in the diagnosis of meningitis. Imaging may be
useful in finding complications of meningitis and in determining parameningeal causes of
abnormal CSF.
 Gram stain or other special stains, and culture of the spinal fluid A definitive diagnosis of

meningitis requires a spinal tap to collect CSF. In clients diagnosed with meningitis, the fluid
often shows a low glucose level along with an increased white blood cell count and increased
protein.

Treatment

Antibiotics will be given as soon as possible. Ceftriaxone is one of the most commonly used antibiotics.
Ampicillin may sometimes be used.

Corticosteroids may be used to fight inflammation.

Unvaccinated people who are in close contact with someone who has H influenzae meningitis should be
given antibiotics to prevent infection. Such people include:

 Household members
 Roommates in dormitories
 Those who come into close contact with an infected person

Nursing Interventions

Collaborative:

Managing the airway, maintaining oxygenation, giving sufficient intravenous fluids while providing fever
control are parts of the foundation of meningitis management.
Intravenous crystalloids. If the client is in shock or hypotensive, crystalloid is infused until euvolemia is
achieved.

Seizure precautions. If the client’s mental status is altered, seizure precautions are considered. Seizures
should be treated according to the usual protocol, and airway protection should be considered.

Antibiotic therapy. It is vital to institute empiric antimicrobial therapy as soon as possible. The choice of
agents is usually based on known predisposing factors, initial CSF Gram stain results, or both. Once the
pathogen has been identified and antimicrobial susceptibilities determined, the antibiotics may be
modified for optimal targeted treatment.

Steroid therapy. The use of corticosteroids as an adjunctive treatment for bacterial meningitis improves
outcomes by attenuating the detrimental effects of host defenses. The use of steroids has been shown to
improve the overall outcome of clients with certain types of bacterial meningitis, including h. Influenzae,
tuberculous, and pneumococcal meningitis.

Independent:

Place in a comfortable position. The client may feel pain when the head is flexed forward, therefore,
they are usually more comfortable without a pillow. Avoid flexing the neck forward when turning or
positioning the client.

Provide accurate and honest information. Make certain that the client and caregiver receive a good
explanation of everything that is happening and provide extra attention from the healthcare team so
that the client may feel secure, especially during painful procedures. Explain that changes in mental
status are caused by the disease process.

Reduce environmental stimulation. Promote rest by keeping stimulation in the room to a minimum.
Organize care so that the client is disturbed as little as possible. The room should be dimly lit and the
noise kept to a minimum. Avoid startling the client by using a soft voice and gentle touch these measures
ensure that the client will not continue having an increased ICP which could lead to seizures.

Monitor vital signs closely. Frequent monitoring of vital signs is necessary. A slow pulse rate, irregular
respirations, and increased blood pressure should be reported immediately because they could indicate
increased ICP.

Institute measures to decrease hyperthermia. Antipyretics, a sponge bath, or a cooling mattress may be
provided to control fever.

Monitor intake and output. Carefully observe the client’s intake and output and document them.
Provide strict attention to the maintaining IV line to avoid overhydration and increased ICP. Promptly
report a decrease in urine output, which could signal urinary retention.

Provide appropriate dietary measures. As the client’s condition improves, the diet may progress from
clear fluids to an age-appropriate diet. A special formula may be given when nasogastric feedings are
necessary.

Monitor the client’s neurological status. The nurse should continue to monitor the client’s neurological
status and record and report findings such as weakness of the limbs, speech difficulties, mental
confusion, and behavior problems.
Observe seizure precautions. Remove items from surroundings that can be dangerous. Ensure that
cardiac monitoring and oxygen are readily available, and padding may be applied to the bed frame as
appropriate.

Prognosis:

Meningitis is a dangerous infection and it can be deadly. The sooner it is treated, the better the chance
for recovery. Young children and adults over age 50 have the highest risk for death.
 Infectious Agent
(H. Influenzae Bacteria)

Submucosal invasion
(Circumventing local
immunity)

Direct bacterial Blood stream invasion Direct bacterial

inoculation (trauma and (Seeding process) inoculation
neurosurgery) (instrumentation)

Disrupted blood-brain
barrier

Brain
(Meningeal seeding)

Activation of antibodies
(Penetrates the
meninges and the
brain)

Replication of bacteria Increase number of Decrease blood flow

inflammatory cells (brain)

Disruption in
 University of Saint Anthony
(Dr. Santiago G. Ortega Memorial)
City of Iriga

SCHOOL OF GRADUATE STUDIES AND RESEARCH

SUBJECT: N230 Advance Pathophysiology

TOPIC: INFLUENZA MENINGITIS
SEMESTER: 1st Sem (SY 2023-2024)
STUDENT: Maria Vernadette M. Florece, RN
PROFESSOR: Dr. Jane Briones Tagum

Answer the following question briefly and based on your own understanding.

1. It is said that H Inlfuenzae bacteria type “b” is the main cause of Influenza Meningitis, what is
the the name of the type of non-encapsulated H. influenzae bacteria that still can be acquired
even the person has H. Influenzae type b vaccine already? And what are the possible diseases
the patient can get from these bacteria?
2. What is the mode of transmission of Influenza Meningitis? Explain what nursing interventions
should be done to prevent its transmission from person to person.
3. What is the most definitive diagnostic test to rule out Influenza Meningitis? What are the things
to consider in preparing the patient in this kind of procedure? Explain briefly.
4. Give at least 3 independent nursing intervention for patients with Influenza Meningitis and
briefly explain each intervention.
5. Why do you think that very young children and adults above the age of 50 is the highest risk of
death in this disease? Explain.