MENINGITIS &

ENCEPHALITIS
 Definition:

MENINGITIS - an inflammatory condition of the

meninges by infectious agents such
as bacteria, virus or fungus.
 - Possibilities from the ENT
infection.
A. Any types of bacterium:
- neonate:

ETIOLOGY - “Gram Negative (-) bacilli”:

- E. Coli
- Proteus
- “Group B Streptococcus”.
 - Children:
- Hemophilus influenzae
- Neisseria meningitidis
ETIOLOGY
- Streptococcus pneumoniae
- Mycobacterium tuberculosis.
 - Adult:
- Neisseria meningitidis
- Streptococcus pneumoniae
ETIOLOGY
- Staphylococcus aureus
- Mycobacterium tuberculosis
- Hemophilus influenzae.
 B. Viral infection:
- enterovirus:
- echovirus
ETIOLOGY - coxsackie virus
- polio virus
- herpes simplex virus
- mumps virus.
 - influenza virus
- Japanese encephalitis virus
- HIV
- arbovirus
ETIOLOGY
C. Fungus:
- Cryptococcus neoformans
- Coccidioides immitis.
PATHOPHYSIOLOGY

- Infected by causative agent

- Spreading from ENT infection
- Infectious agent carried by the bloodstream to the
meninges
- Meningeal inflamation.
- Meningeal irritation.
PATHOPHYSIOLOGY

- Exudates production and spread to the subarachnoid

space
- Possibilities for venoustasis
- Thrombosis occur and reduction of cerebral blood flow
- Cerebral edema - hydrocephalus
- ICP ↑
 1. Fever (persistent)
2. Headache (worse)
3. Neck stiffness

SIGNS & 4. Vomiting

SYMPTOMS 5. Photophobia
6. Seizure
7. Lethargy
8. ICP ↑ sign
 9. Children:
- restlessness
- high pitch crying

SIGNS & 10. Changes in level of

consciousness:
SYMPTOMS
- early stages:- disorientation &
memory disturbance
- late stages:- lethargy, drowsy,
coma.
 11. Physical Examination:
- neck stiffness (early sign)
- Kernig’s sign: (+) positive

SIGNS & - Brudzinski’s sign: (+) positive

SYMPTOMS - papilledema
- cranial nerve palsy
- petechiae
 1. Lumbar puncture (LP):
- CSF for C&S
- CSF:
INVESTIGATIONS - protein ↑ (bacterial)
- glucose ↓(bacterial)
- ↑ CSF pressure
2. CT scan.
 3. Blood: - C&S
- serology
INVESTIGATIONS
4. Skull x-ray
 - Meningeal iritation sign :
- neck stifness
- Kernig’s sign (+) positive
DIAGNOSIS
- High fever
- History of ENT infection few days
before.
DIFFERENTIAL DIAGNOSIS

1. Encephalitis
- Sign of meningeal irritation obscure
- moderate fever
2. Febrile convulsion
- no meningeal irritation sign
- lab. Ix - negative
MANAGEMENT

- Emergency Intervention
1. Rest and reassurance patient.
2. Drug:
antibiotic:
- IV Benzyl Penicillin
- Chloramphenicol.
- Gentamicin + ampicillin
- Co-trimoxazole
- Rifampicin
anti-piretic:
- Tab. Paracetamol.
- anti-convulsion:
- IV Diazepam 10-20 mg or;
- infusion Diazepam 10-50mg/hour
- steroid:
- IV or oral Dexamethasone 4mg / 6 hourly
- severe case: IV Dexamethasone 16-20 mg.
3. Prevent injury during seizures attack
4. Nursing care:
- “tepid sponging”
- unconscious patient – care for hygiene etc.
- I/O chart.
5. Health education:
- taken medicine as prescribe
- follow-up treatment
- get early treatment for infection of ENT
 1. Brain damage
COMPLICATION 2. Hydrocephalus
PROGNOSIS

- Good if early treatment is given

 ENCEPHALITIS

Definition:
- Encephalitis, an inflammation of the brain
parenchyma, presents as diffuse and/or focal
neuropsychological dysfunction.
 ETIOLOGY

Transmission agent:
- mosquito
Causal agent:
- virus (most)
- bacteria
- fungus
- parasite
 PATHOPHYSIOLOGY

- Virus attack (or other causal agent) to cerebrum

- Inflammation to cerebrum parenchyma
- Cerebral edema
- inflammation spread to cerebrum cortexs, white mater, grey mater
& meninges
- Neuron degeneration, necrosis,  ICP
- Brain function disorder.
 SIGN & SYMPTOM

1. Fever
2. Headache
3. Changes in level of consciousness
4. Seizure
5.  ICP sign:
- headache
- vomiting
 - bradycardia
- arterial hipertension
- papiledema
6. Cranial nerves palsy.
 INVESTIGATION

1. blood:
- FBC
- Serology
2. CT scan
3. EEG
4. Lumbar puncture (LP).
 DIFFERENTIAL DIAGNOSIS

Meningitis:
- acute headache
- high fever
- meningeal irritation sign (+ ve)
 MANAGEMENT

1. Warded & rest

- isolation
2. drugs:
- anti-pyretic:
- Tab Paracetamol
- anti-convulsion:
- IV Diazepam 10-20 mg and/or,
 - infusion Diazepam 10-50mg/h
- steroid:
- IV or oral Dexamethasone 4mg / 6 hourly
- severe case: IV Dexamethasone 16-20 mg.
3. Nursing care:
- unconscious patient – care for hygiene etc.
- IV infusion
- I/O chart
4. Health education:
- avoid mosquito bite:
* wearing long sleeves
* mosquito net
- drugs taken as prescribe
- follow-up treatment
- ACYW-135 injection for prevention (prophylaxis
immunization)
 COMPLICATION

1. Brain damage
 PROGNOSIS

- Satisfactory because the virus attacks will

typically recover on its own (self-limiting).
`