I.

ETIOLOGY
 Bacterial (most common) – Neisseria meningitides, Haemophilus influenza,
Streptococcus pneumonia or Escherichia coli
 Viral (most common) – Angiostrongylus cantonensis and Gnathostoma
spinigerum. Tuberculosis, syphilis, cryptococcosis, and coccidiodomycosis
 Protozoal – Toxoplasma Gondii (Toxoplasmosis)
 Fungal – cryptococcal meningitis
 Various non-infectious causes. – spread of cancer to the meninges (malignant
meningitis) and certain drugs (mainly non-steroidal anti-inflammatory drugs,
antibiotics and intravenous immunoglobulins).

II. MANIFESTATION
The cardinal signs and symptoms of meningitis are those of infection and
increased ICP:
 Headache
 Stiff neck and back
 Malaise
 Chills
 Photophobia
 Phonophobia
 Fever
 Vomiting
 Twitching
 Seizures
 Altered Level of Consciousness, such as confusion or delirium

Signs and symptoms in infants and children may also include:

 Fretfulmes
 Bulging of the fontanels (infants)
 Refusal to eat
 III. PATHOPHYSIOLOGY

 Age
 Education
MICROORGANISMS
al
(bacteria, fungal, virus,
Enter to the nasal cavity or to the skin Attainmen
protozoa)
t
 Gender
 Environm

Reach the meninges through direct Reach the meninges through the
contact between the meninges bloodstream

Subarachnoid Space

Immune Response from

Astrocytes+Microglia=Cytokines
Release

Inc. blood-brain barrier Inc. no. of WBC in CSF Vasculitis of cerebral vessels
permeablity

Fluid leakages from vessels Inflammation of Meninges Dec. cerebral blood flow
(MENINGITIS)

Vasogenic edema Interstitial edema (Inc. ECF) Cytotoxic edema

Inc.cranial pressure.
Dec. Cerebral blood
flow, Ischemia,
apoptosis (Brain
Death
 IV. MANAGEMENT AND COMPLICATION
Nursing Management:
 Administered prescribed medications, which include I.V. antibioitics. If
seizures occur, anticonvulsants are prescribed. If cerebral edema occurs,
osmotic diuretics are prescribed.
 Prevent respiratory complications resulting from altered consciousness.
Implement such measures as oxygen therapy, arterial blood gases,
pulmonary toileting, and pulse oximetry.
 Apply a hypothermia blanket to relieve hyperthermia as prescribed.
 Promote measures to help prevent recurrence of meningitis.
o Persons in close contact with the client should be considered for
prophylactic antibiotic therapy if appropriate.
o Administer vaccinations as indicated. A vaccination can be administered
to prevent meningitis in pediatric clients; one type is currently prescribed
for military recruits.
 Intervene as appropriate to reduce increased ICP.

Preventions:
 For some causes of meningitis, prophylaxis can be provided in the long term
with vaccine, or in the short term with antibiotics
 Have immunization against Streptococcus pneumoniae with the
pneumococcal conjugate vaccine (PCV), which is active against seven
common serotypes of this pathogen, significantly reduces the incidence of
pneumococcal meningitis. Childhood vaccination with Bacillus Calmette-
Guérin has been reported to significantly reduce the rate of tuberculous
meningitis
 Short-term antibiotic prophylaxis is also a method of prevention, particularly
of meningococcal meningitis. In cases of meningococcal meningitis,
prophylactic treatment of close contacts with antibiotics (e.g. rifampicin,
 ciprofloxacin or ceftriaxone) can reduce their risk of contracting the condition,
but does not protect against future infections.

Potential complications of meningitis include:

 Vision impairment
 Optic neuritis
 Cranial nerve palsies
 Deafness
 Personality changes
 Headache
 Paresis or paralysis
 Endocarditis
 Coma
 Vasculitis
 Cerebral infarction

Complications in infants and children may also include:

 Fever – High
 Poor feeding
 Vomiting
 Cold hands and feet
 Dislike being handled
 Marked irritability
 Frequent seizures accompanied by high pitched cry “Meningeal Cry”
 Bulging fontanel the significant finding
 Nuchal rigidity may or may not be present
 No Brudzinski or Kernig Sign – not appropriate
 When changing diaper, baby may cry when lifting legs

Complications neonates may also include:

 Extremely difficult to diagnose
 Vague and nonspecific signs such as:
o Poor feeding
o Poor sucking ability
o May vomit
o May have diarrhea
o Poor tone
o Lack of movement
o Poor cry
 Highest incidence between 6 months and 12 months
 Other symptoms may be present
o Hypothermia
o Fever
o Jaundice
o Irritability
o Drowsiness
o Seizures
o Resp irregularity or apnea
o Weight loss

References:
 Hargrove-Huttel,Ray A. (2005). Lippincott’s Reviewer Series. The Ideal
Study Aid. Medical Surgical Nursing.(4th Ed.) pp.360-361.
 Lippincott William and Wilkins. Pathophysiology made Incredibly Easy!
(3rd ed.) pp. 272-276.
 www.wikipedia.com