Pediatric Case:

MENINGITIS
 MENINGITIS
• an inflammation of the thin membranes that
cover the brain and the spinal cord.

• It is most often caused by a bacterial or viral

infection that moves into the cerebral spinal
fluid (CSF) surrounding the brain and spinal
cord usually causes the swelling.
Classic Signs of Meningitis

●Fever
●Headache
●Stiff neck
●Altered mental status
ASSESSMENT & DIAGNOSIS:
● Lumbar puncture. In general, whenever the diagnosis of meningitis is strongly
considered, a lumbar puncture should be promptly performed; examination of
the cerebrospinal fluid (CSF) is the cornerstone of the diagnosis.
● CT scan. A screening computed tomography (CT) scan of the head may be
performed before LP to determine the risk of herniation.
● Blood studies. In patients with bacterial meningitis, a complete blood count
 (CBC) with differential will demonstrate polymorphonuclear leukocytosis with
a left shift.
● Chest radiography. As many as 50% of patients with pneumococcal meningitis
also have evidence of pneumonia on initial chest radiography.
● Cultures and bacterial antigen testing. The utility of cultures is most evident
when LP is delayed until head imaging can rule out the risk of brain herniation,
in which cases antimicrobial therapy is rightfully initiated before CSF samples
can be obtained.
● Serum procalcitonin testing. increasing data suggest that serum procalcitonin
(PCT) levels can be used as a guide to distinguish between bacterial and aseptic
meningitis in children.
 TYPES OF MENINGITIS
1. BACTERIAL 2. VIRAL 3. FUNGAL

Most common types

6. NON-
4. PARASITIC 5. AMEBIC INFECTIOUS
Bacterial
Meningitis
• Serious type of meningitis or a life-threatening
illness
• Usually more severe and may lead to long-term
complications or death
• Can be contagious and may require public health
action
Causes:
Several types of bacteria that causes meningitis:

Neonates and infants (up to 2 months):

● gram negative enteric bacilli ( E.Coli, meningococcal,
Hemophilus influenzae)

Infants and children (3 months to less than 5 years old):

● Hemophilus influenzae
● Streptococcus pneumoniae

Children (5 years and up):

● Mycoplasma pneumoniae
Transmissions:
Group B Streptococcus 
Neisseria meningitidis
E. coli

People spread these bacteria by

Mothers can pass these bacteria
sharing respiratory or throat
to their babies during birth.
secretions (saliva or spit). 

Haemophilus. influenzae
Mycobacterium tuberculosis E. coli
S. pneumoniae
People can get these bacteria by
People spread these bacteria by
eating food prepared by people
coughing or sneezing while in
who did not wash their hands well
close contact with others, who
after using the toilet.
breathe in the bacteria.
RISK FACTORS:

• Babies are at increased risk for bacterial

meningitis compared to people in other
age groups.

• Certain medical conditions, medications,

and surgical procedures put people at
increased risk
Clinical Manifestations:

Newborns and Babies: Children age 1 or older:

• Poor feeding • Stiff neck
• Irritability • Fever
• Vomiting • Headache
• Have a bulging fontanelle ( the • Nausea
“soft spot” on a baby’s head) • Vomiting
• Purple – red splotchy rash • Photophobia (eyes are
• Fever sensitive to light)
• seizures • Altered mental status
(confusion)
VIRAL
MENINGITIS
• The most common type of meningitis
• Rarely life-threaning
• Most people get better on their own without
treatment.
• Not considered to be contagious
 Causes:
Several types of virus causes
meningitis:
● Enterovirus (polio virus,
echovirus, coxsackievirus)
● Herpesvirus (varicella,
shingles)
● Paramyxovirus (mumps,
measles)
● Togavirus (rubella)
Risk Factors:
● Children younger than 5 years
old
● People with weakened
immune systems caused by
diseases, medications (such as
chemotherapy), and recent
organ or bone marrow
transplantations

Transmission:

Close contact of someone with viral meningitis can become

infected with the virus that made that person sick. However,
these close contacts are not likely to develop meningitis.
 CLINICAL
MANIFESTATIONS
Babies: Children & adult:
● fever
● Headache
● Fever ● Stiff neck
● Irritability ● Photophobia (eyes being more
● Poor eating sensitive to light)
● Sleepiness or trouble waking
● Sleepiness or trouble up from sleep
waking up from sleep ● Nausea
● Lethargy (lack of ● Irritability
● Vomiting
energy) ● Lack of appetite
● Lethargy (a lack of energy)
 Fungal
Meningitis
• can develop after a fungal infection spreads from somewhere
else in the body to the brain or spinal cord.
 Causes:
● Cryptococcus (lives in the
environment throughout the world)
● Histoplasma (lives in the
environment especially in soil that
contains birds or bat droppings)
● Blastomyces (lives in moist soils
and in decaying woods and leaves)
● Coccidioides (lives in soil)
● Candida (normally lives inside the
body and on the skin without causing
any problems. However, in certain
patients who are at risk, Candida can
enter the bloodstream or internal
organs and cause an infection.
Risk Factors
● Anyone can get fungal
meningitis
● People with weakened
immune systems are at risk
(HIV infection and cancer)
● Medications (steroids, meds
given after organ
transplantation, Anti-TNF
● Premature babies with low
birth weights
 Parasitic Meningitis
Various parasites can cause meningitis or can affect the brain or
nervous system in other ways. Overall, parasitic meningitis is much
less common than viral and bacterial meningitis.
 Some parasites can cause a rare form of
Causes: meningitis called eosinophilic meningitis,
eosinophilic meningoencephalitis, or EM.
The three main parasites that cause EM in some infected people
are:

Angiostrongylus Gnathostoma
Baylisascaris procyonis
cantonensis spinigerum

● People can get ● People get infected by ● People can get

infected by eating raw accidentally ingesting infected by eating raw
or undercooked snails infectious parasite or undercooked
or slugs or eggs. freshwater fish or
contaminated eels, frogs, poultry, or
produce. snakes.

Generally, people also do not spread parasitic meningitis or the parasites that
cause it to other people.
 Clinical Manifestations
Pt wt EM caused by Baylisascaris cause
Symptomatic EM A. cantonensis severe complications

● Headache ● tingling or
● Loss of
● Stiff neck painful feelings
coordination and
● Nausea in their skin
muscle control
● Vomiting ● low-grade fever.
● Weakness/
● Photophobia
paralysis
(eyes being more
● Coma
sensitive to light)
● Permanent
● Altered mental
disability
status
● Death
(confusion)
 Amebic
Meningitis
 Sources of Infection and
Transmission:
Cause: Can be found:
• Bodies of warm freshwater,
Naegleria Fowleri such as lakes and rivers
• Geothermal (naturally hot)
● Free-living ameba water, such as hot springs
● A single-celled living • Warm water discharge from
industrial plants
organism that is too
• Untreated geothermal
small to be seen without
(naturally hot) drinking water
a microscope
sources
• Swimming pools that are
poorly maintained or
minimally-chlorinated
• Water heaters
• Soil
Transmission:
• infects people by entering the
body through the nose, usually
while swimming. The ameba
travels up the nose to the brain
where it destroys the brain
tissue.
•
People cannot get infected
with Naegleria fowleri from
drinking water contaminated
with Naegleria. People also do
not spread the ameba or PAM
to others.
Risk Factor:
occur when contaminated water from other
sources enters the nose. For example, when
people submerge their heads or cleanse their
noses during religious practices. People have also
become infected after irrigating their sinuses
(nose) using contaminated tap water.
 Clinical Manifestation
• Headache
• Fever
• Nausea
• Vomiting
• Stiff neck

Early Stage of PAM Initial symptoms of Later symptoms

PAM start 1 to 9 days
Similar to symptoms of after infection ● Altered mental status
bacterial meningitis (confusion)
● Lack of attention to
people and surroundings
After the start of symptoms, the disease progresses rapidly ● Loss of balance
and usually causes death within about 5 days. ● Seizures
● Hallucinations
Non-Infectious
Meningitis
 Causes:

Systemic Lupus Certain

Cancers
erythematosus medicines
(lupus)

Head injury Brain surgery

Nursing Management :
1. Frequent / continual assessment including vital sign and
LOC
2. Protect patient from injury related to seizure activity or
altered LOC
3. Monitor daily weight, serum electrolytes, urine volume,
specific gravity, and osmolality
4. Prevent complications associated with immobility
5. Infection control precautions
6. Supportive care
7. Measure to facilitate coping of patient and family
Nursing Interventions:
• Assess neurologic status and vital signs constantly.
Determine oxygenation from arterial blood gas values and
pulse oximetry.
• Insert cuffed endotracheal tube (or tracheostomy), and
position patient on mechanical ventilation as prescribed.
• Assess blood pressure.  (usually monitored using an arterial
line) for incipient shock, which precedes cardiac or respiratory
failure.
• Rapid IV fluid replacement may be prescribed, but take care
not to overhydrate patient because of risk of cerebral edema.
• Reduce high fever to decrease load on heart and brain from
oxygen demands.
Nursing Interventions:
• Protect the patient from injury secondary to seizure activity
or altered level of consciousness (LOC).
• Monitor daily body weight; serum electrolytes; and urine
 volume, specific gravity, and osmolality, especially if
syndrome of inappropriate antidiuretic hormone (SIADH) is
suspected.
• Prevent complications associated with immobility, such as
pressure and pneumonia.
• Institute infection control precautions until 24 hours after
initiation of antibiotic therapy (oral and nasal discharge is
considered infectious).
• Inform family about patient’s condition and permit family to
see patient at appropriate intervals.