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MENINGITIS

MENINGITIS

▪ An inflammation of the pia mater, the arachnoid and the

subarachnoid space
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MENINGITIS

CLASSIFICATIONS
1. Septic Meningitis
 Caused by bacteria
 Most common pathogens: S. pneumoniae & N.
meningitides, H. influenzae type B
Risk Factors:
▪ Tobacco use and viral URTI
▪ Otitis media and mastoiditis
▪ Immune deficiency
2. Aseptic Meningitis
 Caused by viral or secondary to lymphoma, leukemia or
HIV
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MENINGITIS

Waterhouse-Friderichsen Syndrome
▪ Adrenal gland failure due to bleeding
▪ An acute fulminant presentation
▪ A result of endothelial damage and vascular necrosis

CLINICAL MANIFESTATIONS
1. Headache & fever
2. Meningeal irritation:
 Nuchal rigidity
 (+) Kernig’s sign
 (+) Brudzinski’s sign
 Photophobia
3. Rashes
4. Skin lesions
5. Disorientation & memory impairment
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MENINGITIS
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MENINGITIS

6. Behavioral changes
7. Lethargy, unresponsiveness & coma
8. Seizures
9. Increased ICP
10. Decreased LOC & focal motor deficits
11. Appearance of acute fulminant infections
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MENINGITIS

ASSESSMENT AND DIAGNOSTIC FINDINGS

▪ Bacterial culture
▪ Gram staining of CSF and blood (key diagnostic test)

PREVENTION
1. Vaccination
✓ H. influenzae – Conjugate Hib vaccine
✓ N. meningitides – Non-conjugate polysaccharide (A, C, Y & W135);
Conjugate MCV4
✓ S. Pneumoniae – Polysaccharide vaccine (elderly); Conjugate
vaccine (routine childhood immunization)
2. Antimicrobial chemoprophylaxis (Antibiotic therapy) – for people
exposed to meningococcal meningitis
▪ Rifampicin (Rifadin, Rifampin)
 Meningococcal:
600mg BID PO x 2days (adults)
10mg/kg (children)
5mg/kg (infant)
 Hib:
Rifampin 20mg/kg/day single dose x 4 days
 S. Pneumoniae (none)
▪ Ciprofloxacin HCl (Cipro)
▪ Ceftriaxone Na (Rocephin)
▪ Should be started w/in 24 hours
▪ Vaccination is given as an adjunct to antibiotic chemoprophylaxis
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MENINGITIS

MEDICAL MANAGEMENT
1. Penicillin antibiotics
Penicillin G – 1st line (N. meningitides & S. pneumoniae)
▪ Ampicillin
▪ Piperacillin
▪ Chloramphenicol + Gentamicin
2. Cephalosporins
▪ Ceftriaxone Na
▪ Cefotaxime Na
3. Vancomycin HCl (alone or with Rifampicin)
For resistant strains
High doses IV
4. Dexamethasone
Used as an adjunct therapy for acute bacterial meningitis &
pneumococcal meningitis if administered 15 to 20 minutes
before the first dose of antibiotic & every 6 hours for the next
4 days
5. Volume Expanders – for DHN & shock
6. Phenytoin (Dilantin) – for seizures

NURSING MANAGEMENT
Assessment
▪ Neurologic status and V/S
▪ Pulse oximetry & ABG values
▪ Arterial blood pressure
▪ Fever
Interventions
1. Protect from injury
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MENINGITIS

2. Monitor daily weight, serum electrolytes and urine volume, specific gravity &
osmolality
3. Prevent complications: pressure ulcers and pneumonia
4. Institute infection control precautions until 24 hours after initiation of antibiotic
therapy
5. Inform the family members about the patient’s condition
6. Prevent any sudden, critical illness
7. Periodic family visits
8. Facilitate referral system