Every thing you want to know about Meningitis

Meningitis 

Definition of Meningitis

-          inflammation of the meninges of the brain and spinal cord as a result of viral and bacterial infection. (dura mater, the arachnoid & the pia mater)

Etiologic Agent: Neisseria meningitides

Incubation Period: 1 to 10 days

Mode of Transmission of Meningitis

1. Respiratory droplets through nasopharyngeal mucosa

2. Direct invasion through otitis media

3. After skull fracture, a penetrating head wound, lumbar puncture & ventricular shunting procedures.

Diagnostic Procedures of Meningitis

1. Lumbar puncture

a.       Diagnostic purposes

-          to obtain specimen, the CSF

-          to take x-ray of the spinal canal and cord

b.       Therapeutic purposes

-          to reduce intra-cranial pressure

-          to introduce serum and other medications

-          to inject an anesthetic agent

2. Gram staining

3. Smear and blood culture

4. Smear from petechiae

5. Urine culture

Classifications of Meningitis:

1. Acute meningococcemia

a.       invade the bloodstream without involving the meninges

b.      usually starts with nasopharyngitis followed by sudden onset of high grade fever with chills, nausea, vomiting, malaise, and headache.

c.       petechial, purpuric, or ecchymotic hemorrhages scatter over the entire body and mucous membrane.

d.      adrenal lesions start to bleed into the medulla which extends to the cortex.

e.      Waterhouse-friderichsen syndrome – combination of meningococcemia and the adrenal medullary hemorrhage; rapid development of petechiae to purpuric, & ecchymotic spots in association with shock.

f.        short course & usually fatal.

2. Aseptic meningitis

·         benign syndrome characterized by headache, fever, vomiting, and meningeal symptoms.

·         begins suddenly with fever, alterations in consciousness, neck & spine stiffness.

·         Characteristic sign of meningeal irritation:

Ø  Stiff neck or nuchal rigidity

Ø  Opisthotonos

Ø  (+) Brudzinski’s sign

Ø  (+) Kernig’s sign

Ø  Exaggerated and symmetrical deep tendon reflexes

·         Sinus arrythmia, irritability, photophobia, diplopia, & other visual problems

·         Delirium, deep stupor, and coma

·         Signs of intra-cranial pressure:

Ø  bulging fontanel in infants

Ø  nausea & vomiting (projectile)

Ø  severe frontal headache

Ø  blurring vision

Ø  alteration in sensorium

Modalities of Treatment of Meningitis

1. Antibiotic therapy & vigorous supportive therapy

- ampicillin

- cephalosporin (ceftriaxone)

- aminoglycosides

2. Digitalis glycoside (Digoxin) is administered to control arrythmias

3. Manitol is given to decrease cerebral edema.

4. Anticonvulsant or sedative is needed to reduce restlessness & convulsions.

5. Acetaminophen is helpful to relieve headache & fever.

Nursing Management of Meningitis

1. Assess neurologic signs often. Observe patient’s level of consciousness and check for increased intra-cranial pressure.

2. Monitor fluid balance.

3. Watch for adverse reactions of antibiotics & other drugs.

4. Maintain adequate nutrition & elimination.

5. Ensure patient’s comfort.

6. Provide reassurance and support to the patient and the family.

7. Follow strict aseptic technique when treating patients with head wounds or skull fractures.

8. Isolation is necessary if nasal culture is positive.