1. Meningitis, brain abscess. Encephalitis etc

3. Meningitis Inflammation of the meninges
Classified into aseptic and septic
Aseptic : not bacteria. Virus or secondary to lymphoma, leukemia or brain abscess
Septic : bacteria
Most common : Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae
Factors that increase the risk of meningitis : viral URI, otitis media, mastoiditis

4. Pathophysiology
Infection through the blood stream as a consequence of other infections
Or by direct extension – traumatic injury to the facial bones or secondary to invasive procedures
Aids may predispose to meninges – mostly S.pneumoniae
The bacteria in the blood stream cross the blood-brain barrier and cause inflammation of the meninges
Inflammatory cells from the meninges spill into the csf and the cell count in the csf increases

5. Complications of meningitis
Visual impairment
Deafness
Seizures
Paralysis
Hydrocephalus
septic shock

6. Clinical Manifestations
Headache (severe)
Fever (these two are initial symptoms)(high throughout the illness.)
Signs of meningeal irritation : neck rigidity positive Kernig’s sign positive Brudzinski’s sign photophobia
A rash – N.meningitidis infection. Skin lesions develop, ranging from a petechial rash with purpuric lesions to large areas of ecchymosis.
Disorientation
Memory impairment
Meningism is the triad of nuchal rigidity, photophobia (intolerance of bright light) and headache. It is a sign of irritation of the meninges, such as seen in meningitis, subarachnoid hemorrhages and various other diseases. "Meningismus" is the term used when the above listed symptoms are present without actual infection or inflammation;
Nuchal rigidity — the inability to flex the head forward due to rigidity of the neck muscles.
Brudzinski’s sign — the involuntary lifting of the legs in meningeal irritation when lifting a patient’s head.
Kernig’s sign — the resistance and pain when knee is extended with hips fully flexed. Patients may also show opisthotonus—spasm of the whole body that leads to legs and head being bent back and body bowed forward.
Also known as: Babinski's reflex Babinski’s test Associated persons: Joseph Jules François Félix Babinski Description: A pathological reflex where the great toe extends and flexes toward the top of the foot and the other toes fan out when the sole of the foot is firmly stroked. Normally, the great toe is flexed when the sole of the relaxed foot is stroked. Babinski’s reflex is normal in children up to about two years of age. The persistence in older people is a sign of damage to the corticospinal tract. Because this tract is right- and left-sided, a Babinski’s reflex can occur on one side or on both sides. An abnormal Babinski’s reflex can be temporary or permanent.

7. Behavioural changes
As the disease advances – lethargy
Unresponsiveness
Coma
Seizures
↑ ICP – decreased level of consciousness and focal motor deficits – later herniation and cranial nerve dysfunction and depression of centres of vital function
Septicemia – high fever, extensive purpuric lesions intravascular coagulopathy (DIC).
Death

8. Assessment and diagnostic findings
Lumbar puncture –
CSF culture and sensitivity, Gram’s staining, CSF analysis : the presence of polysaccharide antigen supports the diagnosis of bacterial meningitis.

9. Prevention
Vaccinating against meningococcal meningitis – college freshmen, people living in dormataries
Prophylactic treatment of people in contact with meningitis cases – rifampin, ciprofloxacin, ceftrioxone Na.

10. Medical Management Penicillin antibiotics
Cephalosporins (eg ceftrioxone Na., cefotaxime Na)
Vancomycin, in combination with rifampicin for resistant strains
Steroids 15 minutes befor the antibiotics
Dehydration and shock treated
Phenytoin for seizures
Increased ICP is treated as necessary

11. Nursing Management Patient is usually critically ill
Neurologic status and vital signs are continually assessed.
Pulse oximetry and arterial blood gas values monitored
Respiratory support if needed
Increasing ICP compromises the brain stem.
Arterial blood pressures monitored – to predict shock and prevent cardiac or respiratory failure

12. Nursing Management Rapid IV fluids may be needed
If fever + reduce temperature – (fever  increased metabolic demand)
Monitor body weight, serum electrolytes and urine volume, specific gravity and osmolarity, esp. if the syndrome of inappropriate antidiuretic hormone secretion is suspected.

13. Nursing Management
Protect from injury secondary to seizure activity or altered level of consciousness
Prevent complications associated with immobility, such as pressure ulcers and pneumonia
Institute droplet precautions until 24 hours after the initiation of antibiotic therapy (oral and nasal discharge is considered infectious)
Communicate with the patient’s family and allow them to see the patient. Give them moral support

17. The rash in meningitis caused by Neisseria meningitidis typically has petechial and purpuric components

24. The characteristic skin rash (purpura) of meningococcal septicemia, caused by Neisseria meningitidis