4. Acute bacterial meningitis
This form of meningitis should be seen as a medical
emergency as the disease can quickly progress and a
devastating chain of events may occur that may lead
to death or disability.
5. Chronic meningitis
When signs and symptoms of meningeal
inflammation have been present for a month or
more then the condition can be defined as chronic.
6. Meningococcal disease
It has two main clinical presentation.-
meningitis and septicaemia- that often occur
together. Patients with meningococcal
septicaemia have a higher mortality rate than
patients with meningococcal meningitis.
8. INCIDENCE
The bacteria Streptococcus pneumonia and Neisseria
meningitides are responsible for 80% of cases of meningitis in
adults.
Haemophilus influenza was once a common cause of
meningitis in children.
Out breaks of N. meningitides infection are most likely to occur
in dense community groups, such as college campuses and
military installations. Peak incidence is in winter and early
spring.
9. RISK FACTORS
Tobacco use
Viral upper respiratory tract infection
Otitis media
Mastoiditis
immune system deficient people
10. PATHOPHYSIOLOGY
Meningeal infections generally originate in one of two
ways:
1. Through blood stream as a complication of other
infections
2. Direct spread; occur after traumatic injury to the
facial bones or secondary invasive procedures.
11. PATHOPHYSIOLOGY (Cont.…)
once the causative organism enters the blood stream
↓
crosses blood brain barrier
↓
proliferates in the CSF
↓
stimulate immune response in host
↓
release of cell wall fragments and lipopolysaccharides
12. PATHOPHYSIOLOGY (cont.…)
↓
Inflammation of subarachnoid and pia mater facilitated-
Increased ICP
↓
CSF circulates through the subarachnoid space, where
inflammatory cellular materials from the affected meningeal
tissue enter and accumulate.
13. PROGNOSIS
Depends on the causative organism, the severity of infection
and the time of treatment.
Acute fulfillment presentation may include adrenal damage,
circulatory collapse and wide spread
hemorrhage.(Waterhouse Friderichsen syndrome). This
syndrome is the result of endothelial damage and vascular
necrosis caused by bacteria.
22. Other Signs And Symptoms
In Neisseria meningitides infection
Rashes
Skin lesions:- ranging from a petechial rash with purpuric
lesions to large areas of ecchymosis.
23. Other Signs And Symptoms
Disorientation and memory impairment
Behavioural manifestations:- Lethargy,
unresponsiveness, coma
Seizure
Initial signs of increased ICP secondary to diffuse brain
swelling or hydrocephalus
Brain herniation
24. Other Signs And Symptoms
Meningococcal meningitis:
Septicaemia
high fever
extensive purpeuric lesions
shock and signs of DIC
Death may be occurring within a few hours of infection.
25. Development of signs and symptoms of meningococcal disease
SEPTICEAMIA
rash anywhere in the body
tachycardia
tachypnoea
cyanosis
poor capillary refill
rigors
oliguria
arthralgia
MENINGITIS
severe headache
neck stiffness
photophobia
drowsiness
abnormal responses
impaired consciousness
death from central nervous system failure
26. Development of signs and symptoms of meningococcal disease
(cont.….)
SEPTICEAMIA(cont.…)
myalgia
abdominal pain
diarrhoea
impaired consciousness
hypotension
Death from Cardiovascular
failure
27. Development of signs and symptoms of meningococcal
disease (cont.….)
Viral meningitis
Head ache
Low grade fever
Neck stiffness
Signs and symptoms of upper respiratory tract infection
28. Diagnosis
•history, physical examination, laboratory data. A history of
recent infections, such as those involving the ears, sinuses or
respiratory tract, is of particular interest.
•Examination of CSF is the gold standard for the diagnosis of
bacterial meningitis.
29. Comparison of CSF culture:
CSF
characteristics
Acute bacterial meningitis Acute aseptic(viral)
meningitis
Appearance Turbid, cloudy Clear,; sometimes
turbid
Cells Increased WBC, mostly
polymorph nuclear neutrophils
Increased WBC; mostly
mononuclear
Protein level Increased(100-500 mg/ dL) Normal or slightly
increased
30. Comparison of CSF culture:
CSF characteristics Acute bacterial meningitis Acute aseptic(viral)
meningitis
Glucose level Decreased (<40mg/dL or 40% of
blood glucose level)
Normal
Smear and culture Bacterial presence on gram stain
and culture
Virus may demonstrated by special
techniques, and no bacteria
Pressure on LP Elevated(>180mm of water Variable
37. Dexamethasone as adjunct therapy for the tratement
of acute bacterial meningitis and pneumococcal
meningitis.
It is administered 15-20 minutes before 1st dose of
antibiotics and then every 6hrs for 4days.
39. Assessment
VITAL SIGNS :-TPR, BP
ICP: bradycardia and raised systolic BP
GCS
LOC: restless, lethargy, stupor, coma
Signs and symptoms of meningeal irritation
Seizure
Intake/output
Electrolyte level: hyponatremia
Dehydration : profuse sweating, oliguria and dry skin(IV fluid
replacement)
Respiratory parameters: auscultate chest, observe chest movement
40. Basic Supportive Care
MAINTAIN AIRWAY
POSITION: for drainage
SUCTION
TEMPERATURE CONTROL MEASURES
OXYGEN THERAPY
BASIC HYGIENIC CARE: mouth care every 2hr
PROTECTION FROM INJURY: side rails, observe frequently, protecting
IV lines and any tubing, keeping the bed low when patient is alone.
Assess for dyspnoea and cyanosis
Monitor blood gases
41. Basic supportive care
Elevated temperature: antipyretic-aminophen 650mg,remove excess
cloths, cool room temperature, tepid bath, hypothermia blanket
Control pain and head ache: elevate head end 30degree, ice cap, quite
dark room
Medications
Antibiotics
Analgesics
Antipyretics
42. Prevention of Complication
PREVENTING BEDSORE
SKIN CARE:
linen change
care over bony prominences
2 HOURLY POSITION CHANGE
ELASTIC HOSE: if patient is on bed rest
OBSERVE FOR ADRENAL INSUFFICIENCY (hypotension, respiratory
collapse, petechial lesion )
43. REFERENCES
Smeltzer SC, Bare BG, Hinkle JL, Cheever KH. Text book of medical
surgical nursing. 12th edition. New Delhi: Lippincott; 2011. 1950-52
Chintamani. Medical surgical nursing. Haryana: Elsevier; 2011. 1457-59
Hickey JV. The clinical practice of neurological and neurosurgical nursing.
Jalandhar: S Vikas and company;2014. 339-40
