1. Unit 5 Meningitis
7/14/05

2. Bacterial (pyogenic) Meningitis
Causes include:
Haemophilus influenzae b (vacine)
Streptococcus pneumoniae
Neisseria meningitidis (meningococcus)-readily transmitted via droplet infectiion
Most common in newborn
B-hemolytic strep., E. coli, Listeria monocytogenes.
Three types of causes are:
Bacterial
Viral
Tuberculosis
Other bacterial Include: B-hemolytic streptococcus, staphylocuccus aureus, Escherichia coli.
N meningitidis: more prominent in school-age, and adolescents because of contact spread.

3. Meningitis Predisposition and susceptibility 10-15% fatality
awilt:
10-15% fatal
Predisposition and susceptibility
10-15% fatality
Clinical Manifestations –age related
children & adolescents
infants & young children
Neonates
Predisposition: males more than females, especially during neonatal period.
Greatest morbidity under 4 year of age. Immune deficiencies may influence in the NB
immunoglobulin deficienceis
CNS anomalies
surgical procedures
maternal infections, premature rupture of membranes
infections elsewhere in the body
Children & adolescents
Abrupt with fever, chills, H/A, vomiting, alterations in LOA, seizures, irritable agitated photophobia, confusion, hallucinations, drowiness, stupor, coma
Nuchal rigidity, opisthotonos, Kernig and Brudzinski are positive, Hyperactive reflexes
Petechial or purpuric rashes occur it some cases of meningococcal infection
Infants & young children
3 mo-2 yrs.
Fever, vomiting marked irritability, restlessness seizures
High pitched cry, Bulging fontanel is the most significant finding and nuchal rigidity and Brudzinski and Kernig signs may occur
Neonates
Vague signs, appear ill, refuse feedings poor sucking, may vomit, poor muscle tone, lock of movement poor cry.
Full and tense fontanels may not be present or may not appear until late
Highest mortality

4. Pathophysiology Focus of infection elsewhere Direct extension
Implantation
Release of TNF -> meningeal inflammation
Purulent exudate
May extend into ventricles
Spread via blood
Direct extension from sinuses
Direct implantation: penetrating wounds, skull fractures, openings in skin, lumbar puncture or surgical procedures. Once implanted they spread.
Tissue necrosis factor (TNF)
Exudate in ventricles may obstruct ventircles -> obstruction to CSF

5. Pathophysiology Focus of infection elsewhere Direct extension
Implantation
Release of TNF -> meningeal inflammation
Purulent exudate
May extend into ventricles
Spread via blood
Direct extension from sinuses
Direct implantation: penetrating wounds, skull fractures, openings in skin, lumbar puncture or surgical procedures. Once implanted they spread.
Tissue necrosis factor (TNF)
Exudate in ventricles may obstruct ventircles -> obstruction to CSF

6. Kernig’s Sign
KERNIG’S SIGN

7. Brudzinski’s Sign

8. Complications Reduced with earlier & appropriate Tx. Hydrocephalus
Subdural effusions
Brain abscess
Damage to cerebral cortex
Damage to cranial nerves
Seizures
Cranial nerves deafness, blindness, weakness or paralysis of facial or other muscles of the head and neck

9. Complications Meningococcemia Waterhouse-Friderichsen Syndrome
Long-term problems
cerebral palsy
mental handicaps
seizures
Waterhouse-Friderichsen – severe, sudden, rapid overwhelming septic shock, disseminated intravascular coagulation, massive bilateral adrenal hemorrhage and purpura with mortatility as high as
90%

11. Diagnosis Lumbar puncture Blood culture Culture (ID organism)
Gram stain
Cell count ( elevated WBC, low Gl)
Blood culture
LP dangerous under high pressures. CT scan first.

12. Treatment Isolation Antimicrobial therapy Hydration Decrease ICP
Control seizures, and temperature
Manage complications
awilt:
Respiratory isolation X 24 hours post antibiotics
Early recognition
Hydration IV fluids
Drugs:
antibiotics
start STAT may be changed after culture reports
may use Dexamethason to redure ICP
Manage shock

13. Nursing Prevention Environment Fluids and hydration Family support
Prevention; H. influenzae b vaccination beginning at 2 months of age.
Pneumococcal conjugate at 2 months of age
Head of bed slightly elevated
No pillows
Avoid actions that cause pain
Quiet, darken room
Pain relief Tylenol with codiene (LOC??)
Observe for signs of ICP
Observe for signs of complications.
NPO if sensorium is decreased
Careful monitoring and recording of I&O, too little too much
Support, may feel quilty
reasurrance that onset is sudden
acted responsibly in seeking assestamce
Openly discuss their feelings to minimize blame and guilt
Keep informed of child’s condition

14. Other Meningitis Aseptic or viral Tuberculosis Meningitis
Varies in onset
Manifestations: fever, H/A, GI symptoms
Tx: symptomatic
Tuberculosis Meningitis
Young immunosuppressed child
May tx. With antibiotics in case its bacterial
TB menigitis:
desiminated most likely
early diagnosis to prevent hydrocephalus