DEFiNiTiON

MENiNGiTiS is an inflammation of the meninges, the membranes that cover the

brain and spinal cord. Most cases are caused by bacteria or viruses, but some can be
due to certain medications or illnesses.

SOURCES OF iNFECTiON

BACTERiAL MENiNGiTiS
is rare, but is usually serious and can be life-threatening if not treated right away.

ViRAL MENiNGiTiS
(also called aseptic meningitis) is relatively common and far less serious. It often
remains undiagnosed because its symptoms can be similar to those of the common flu.

FUNGAL MENiNGiTiS
Fungal infections that lead to meningitis are rare, and compromised immune systems
make them life threatening. Fungal meningitis is caused by Cryptococcus (found in soil),
Candida (the fungus that causes Thrush), Histoplasma (found in bird and bat feces) and
Coccidioides (found in soil in the Southwestern United States and Northern Mexico).
CHRONiC MENiNGiTiS
The rarest meningitis, chronic meningitis is caused by a slow-growing microorganism
that spreads the infection over a period of approximately one month.

OTHER CAUSES OF MENiNGiTiS

Diseases such as lupus, cancer and some drug allergies can cause meningitis. Head
injury and brain surgery have also been found to cause meningitis.

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 Infection Toxoplasma Gondii (toxoplasmosis)

Fungal infection Cryptococcus neoformans (cryptococcal

meningitis)
MODE OF TRANSMiSSiON

The bacteria are spread by direct close contact with the discharges from the nose or
throat of an infected person.

iNCiDENCE OF MENiNGiTiS

Most (approx. 70%) cases of meningitis occur in children under the age of 5 or in people
over the age of 60.

In the United States, bacterial meningitis affects about 3 in 100,000 people each year,
and viral meningitis affects about 10 in 100,000.

iNCiDENCE

The incubation period depends on the causative agent. For example the incubation
period of meningococcal meningitis is 2-10 days while the incubation for hemophilus
meningitis is much shorter ranging from 2-4 days. However the range of incubation for
most organisms causing meningitis is 2 days to 2 weeks.

PERiOD OF COMMUNiCABiLiTY

The period of communicability varies depending on the virus.

PATHOPHYSiOLOGY

The infectious agents (ie, bacteria, virus, fungus, parasite) enter the central nervous
system (CNS) from the nasopharynx and via the respiratory tract either through the
bloodstream or via the nerves or by direct contiguous spread from the adjoining
structures and replicate in uncontrolled fashion resulting in meningeal inflammation.

SiGNS AND SYMPTOMS OF MENiNGiTiS

Symptoms of bacterial meningitis are usually acute, developing within a few hours and
last 2 to 3 weeks. It is important to seek immediate medical attention when symptoms
occur, because acute bacterial meningitis can be fatal within hours.

Viral meningitis may develop suddenly or within days or weeks, depending on the virus
and the overall health of the patient.

Characteristic symptoms of both viral and bacterial meningitis are stiff neck, headache,
and fever. Symptoms may develop over the course a few hours (acute bacterial
meningitis) or a few days. Some patients experience cough, runny nose, and congestion
prior to developing other symptoms.
Other signs and symptoms of meningitis include the following:

• Confusion
• Drowsiness
• Joint pain
• Lethargy
• Nausea and vomiting
• Seizures
• Sensitivity to light (photophobia)
• Skin rash (commonly near the armpits and on the hands and feet)

Symptoms of meningitis in infants may be difficult to detect and include the following:

• Bulging of the soft spots (fontanels) in the head caused by increased intracranial
pressure
• Decreased activity
• Difficulty nursing or eating
• Excessive sleeping
• High-pitched cry
• Increased crying and irritability
• Vomiting

LABORATORY/DiAGNOSTiCS

Blood cultures.
Blood drawn from a vein is sent to a laboratory and placed in a special
dish to see if it grows microorganisms, particularly bacteria.A sample may also beplaced
on a slide to which stains are added (Gram's stain), then examined under amicroscope
for bacteria.

Imaging.
X-rays and computerized tomography (CT) scans of the head, chest or sinuses
may reveal swelling or inflammation.These tests can also help your doctor look for
infection in other areas of the body that may be associated with meningitis.
Spinal tap (lumbar puncture).
The definitive diagnosis of meningitis is often made by analyzing a sample of your
cerebrospinal fluid (CSF), which is collected during a procedure known as a spinal tap.
In people with meningitis, the CSF fluid often shows a low sugar (glucose) level along
with an increased white blood cell count and increased protein. CSF analysis may also
help your doctor identify the exact bacterium that’s causing the illness. It can take up to a
week to get these test results, If your doctor suspects meningitis, he or she may order a
DNA-based test known as a polymerase chain reaction (PCR) amplification to check for
the presence of viral causes of meningitis. This may provide results about your
meningitis in as little as four hours and help to determine proper treatment.

TREATMENT

Treating Bacterial Meningitis

Early treatment for bacterial meningitis is important for people with the disease.
Bacterial meningitis treatment involves strong doses of intravenous antibiotics.
Antibiotics may also be given to prevent other bacterial infections.

Treating Viral Meningitis

Unlike bacteria, viruses cannot be killed by antibiotics. Therefore most viral meningitis
treatment does not involve medications to kill the virus. An exception is the herpes virus,
which can be treated with the antiviral drug acyclovir.

Patients with mild viral meningitis may be allowed to stay at home, while those who have
a more serious infection may be hospitalized for supportive care.

Patients with mild cases, which often cause only flu-like symptoms, may undergo a
treatment regimen that includes:

• Fluids
• Bed rest (preferably in a quiet, dark room)
• Analgesics for pain and fever.

The physician may prescribe anticonvulsants such as Dilantin® (phenytoin) to

prevent seizures and corticosteroids to reduce brain inflammation. If inflammation is
severe, pain medicine and sedatives may be prescribed to make the patient more
comfortable.
Fungal meningitis treatment involves intravenous antifungal medications.
Treating Fungal Meningitis
Fungal meningitis treatment involves intravenous antifungal medications.

PROGNOSiS

Bacterial meningitis is fatal in as many as 25% of cases. Patients with

meningitis caused by Streptococcus pneumoniae and patients younger than
2 years old or over the age of 60 have a poor prognosis. Prompt medical
treatment (i.e., antibiotics) reduces the risk for dying from bacterial
meningitis to less than 15%.

COMPLiCATiON

Complications such as the following can develop during the course of meningitis:

• Disseminated intravascular coagulation (DIC; blood-clotting disorder)

• Encephalitis
• Persistent fever
• Seizures
• Syndrome of inappropriate antidiuretic hormone (SIADH; causes fluid build-up)

Prompt medical treatment decreases the risk for brain damage and long-term
complications, including these:

• Behavioral and personality changes

• Vision loss (partial or total)
• Cerebral palsy
• Hearing loss (partial or total)
• Learning disabilities or mental retardation
• Paralysis (partial or total)
• Speech loss (partial or total)

Severe bacterial meningitis also may cause the head and heels to bend backward and
the body to bow forward (called opisthotonos), coma, and death.

Newborns and young children may develop heart, liver, intestinal problems, or
malformed limbs.
PREVENTiON

Meningitis typically results from contagious infections. Common bacteria or viruses that
can cause meningitis can spread through coughing, sneezing, kissing, or sharing eating
utensils, a toothbrush or a cigarette. You’re also at increased risk if you live or work with
someone who has the disease.

These steps can help prevent meningitis:

Wash your hands. Careful hand washing is important to avoiding exposure to infectious
agents. Teach your children to wash their hands often, especially before they eat and
after using the toilet, spending time in a crowded public place or petting animals. Show
them how to wash their hands vigorously, covering both the front and back of each hand
with soap and rinsing thoroughly under running water.

Stay healthy. Maintain your immune system by getting enough rest, exercising
regularly, and eating a healthy diet with plenty of fresh fruits, vegetables and whole
grains.

Cover your mouth. When you need to cough or sneeze, be sure to cover your mouth
and nose.

If you're pregnant, take care with food. Reduce your risk of listeriosis if you're pregnant
by cooking meat thoroughly and avoiding cheeses made from unpasteurized milk.

IMMUNIZATIONS
Some forms of bacterial meningitis are preventable with the following vaccinations:

Hemophilus influenzae type b (Hib) vaccine. Children in the United States routinely
receive this vaccine as part of the recommended schedule of vaccines, starting at about
2months of age. The vaccine is also recommended for some adults, including those who
have sickle cell disease or AIDS and those who don't have a spleen.

Pneumococcal conjugate vaccine (PCV7). This vaccine is also part of the regular
immunization schedule for children younger than 2 years in the United States. In
addition, it's recommended for children between the ages of 2 and 5 who are at high risk
of pneumococcal disease, including children who have chronic heart or lung disease or
cancer.

Pneumococcal polysaccharide vaccine (PPSV). Older children and adults who need
protection from pneumococcal bacteria may receive this vaccine. The Centers for
Disease Control and Prevention recommends the PPSV vaccine for all adults older than
65, for younger adults and children who have weak immune systems or chronic illnesses
such as heart disease, diabetes or sickle cell anemia, and for those who don't have a
spleen.
Meningococcal conjugate vaccine (MCV4). The Centers for Disease Control
and Prevention recommends that a single dose ofMCV4 be given to children ages 11 to
12 or to any children ages 11 to 18 who haven't yet been vaccinated. However, this
vaccine can be given to younger children who are at high risk of bacterial meningitis or
who have been exposed to someone with the disease. It's approved for use in children
as young as 2 years old. It's also used to vaccinate healthy people who have been
exposed in outbreaks but have not been previously vaccinated

NURSiNG MANAGEMENT

• Respiratory isolation 24- 72 hours after onset of anti biotic therapy

• Room protected against bright lights
• Avoid close contacts
• Safety: side-lying position and raised side rails
• Neurological and Vital sign must continually assessed
• Pulse oximetry and ABG should be assessed to identify respiratory support and
to watch for increasing ICP.
• Monitory body weight. Serum electrolytes and urine volume, specific gravity and
osmolality especially the syndrome if inappropriate antidiruetic hormone (SIADH).
• Protect patient from injury secondary to seizure activity or altered level of
consciousness.
• Preventing complication associated with immobility, such as pressured ulcer and
pneumonia.
• This is critical illness can be devastating to the family because of the patients
condition the family needs to be informed about the patients condition and
permitted to see the patient at intervals
 University of the Assumption
City of San Fernando
College of Nursing

MENiNGiTi
S

Submitted by:
Pia Angelica G. Medina
BSN III-A
 Submitted to:
Mrs. Cynthia Rivera, R.N.,R.M.,M.N.