Bacterial Meningitis

Prof: Shanmuga Meenakshi.G.

MSN,RN QHCP
Bacterial Meningitis

Definition: - Meningitis is an acute inflammation of the meningeal

tissues surrounding the brain and the spinal cord.

Meningitis specifically refers to infection of the arachnoid mater

and the CSF.

Aetiology: -

• Upper respiratory tract injection.

• Direct extension from penetrating wound of the skull.

• Fractured sinuses-Basal Skull fractures.

• Winter fall /early spring older adult

• Secondary to viral respiratory disease

*Micro Organisms: -

• Streptococcus pneumonia.

• Neisseria meningitidis

• Haemophilus influenzae.

Pathophysiology: -
Clinical manifestations: -

• Fever

• severe headache

• Nausea ,vomiting
 Nuchal Rigidity
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• Positive Kernig's sign: Pain in the lower back and resistance to

straightening the leg at the knee is a sign of meningeal irritation.

(hip contraction and pain on extension off lower extremities from

a position of 90° hip flexion while

• Positive Brudzenske's sign: - Involuntary flexion of the hip and

knees is a sign of meningeal irritation, when the neck is flexed.

Photophobia, Decreased LOC
1)Signs of increased ICP.

• Decrease Level of Consciousness/ unconsciousness

• Coma

• Flattening of affect
• Change in orientation.

• Decrease in level of attention

• No response to painful Stimuli

• absent of Corneal and pupillary reflexes

• absent of swallowing/gag reflex

• Incontinence of urine and faeces.

 • Decreased / absent neuronal activity in EEG

2) Changes in vital signs: -

• Cushing's triad - Widened pulse pressure (increasing systolic and

decreasing diastolic), bradycardia and irregular respirations occurs.

3) Ocular signs: -
• dilation of the pupil on the same side/ ipsilateral

• sluggish or no response to light.

• inability to move the eye upward

• Ptosis

• Fixed, unilaterally dilated pupil.

• Blurred vision
 Diplopia

• Changes in extraocular eye movements

• Papilledema

4) Decreased motor function: -

• Changes in motor ability

• Contralateral hemiparesis/ hemiplegia

 Decorticate (flexor) / decerebrate (extensor) posturing

Plantar flexion Extension Flexion Adduction

5) Headache: -

Continuous but increase in the morning

 Strain / movement may accelerate the pain

6) Vomiting: - not preceded by nausea (unexpected projected

vomiting)

Skin rash / petechiae. (if meningococcal bacterial infection)

Complications: -

• IncreaseICP

• Residual neurologic dysfunction

• Cranial (3 oculomotor,4 trochlear,6 abducens, 7 facial, 8

vestibulocochlear ) nerves dysfunction.

• Hearing loss.
• Cranial nerves irritation

• Papilledema, blindness, ptosis, unequal pupils, diplopia, sensory

loss, facial paresis, tinnitus, vertigo

• Hemiparesis

• Dysphasia

• Hemianopsia
• Cerebral abscess

• Subdural empyema

• Subdural effusion

• persistent meningitis

• Seizures

• CN III palsy
Acute cerebral oedema

• Bradycardia

• Hypertensive coma

• Death

Non communicating hydrocephalus

Waterhouse Friderichser syndrome: - petechiae DIC, adrenal

haemorrhage and circulatory collapse shock.

Diagnostic Evaluations: -

• Blood culture and sensitivity to identify the microorganism causing

infection.
• LP & CSF analysis to assess the signs of infections
 CBC, coagulation profile, electrolyte levels, glucose, platelet

count

• To identify the cerebral lesions, intracranial infections,

abscess, tumors and ventricular displacement etc the studies

ruled out are: CT scan ,MRI , PET Scan , Skull X-ray studies
Management: -

• Bed rest

• IV fluids

• Dexamethasone

• clear liquids as desired or tolerated

• Fluid volume expanders to prevent dehydration & shock

Viral meningitis: -

Causative (microorganism) factors: -

• Enteroviruses

• Arboviruses

• Human immunodeficiency virus

• Herpes simplex virus.

Other pathophysiology , signs and symptoms are same as

bacterial meningitis

Diagnostic evaluation:

• CSF examination: clear/cloudy & the typical finding is

lymphocytosis.
 • Polymerase chain reaction - (gram stain/acid-fast smears are

absent means) PCR test to detect viral-specific DNA/RNA

Sensitive Symptoms
Common symptoms in children

• Fever

Irritability
• Poor eating

• Sleepiness or trouble waking up from sleep

• Lethargy (a lack of energy)

Common symptoms in children and adults

• Fever

• Headache
• Stiff neck

• Photophobia (eyes being more sensitive to light)

• Sleepiness or trouble waking up from sleep

• Nausea

• Irritability

• Vomiting
• Lack of appetite

• Lethargy (a lack of energy)

• brain damage, hearing loss, or learning disabilities

• Without early treatment, sepsis can quickly lead to tissue damage,

organ failure, and death.

Diagnostic evaluation

specific lab tests on specimens to identify the microorganism causing

infection
• Swabbing nose or throat for culture and sensitivity. (PCR test)

• Obtaining a stool sample for occult blood

• Complete Blood count

 CSF analysis

Management

• No specific treatment for viral meningitis, mild viral meningitis

usually recover completely in 7 to 10 days without treatment.

Antiviral medicine for herpes virus and influenza(Acyclovir)

• Antibiotics do not help viral infections
 People who develop severe illness, or are at risk for

developing severe illness, may need care in a hospital.

Prevention

• Wash hands often with soap and water for at least 20

seconds, especially after changing diapers or using the toilet

• Avoid close contact, such as touching and shaking hands, with

people who are sick

• Clean and disinfect frequently touched surfaces

• Stay home when sick and keep sick children out of school

• Vaccines can protect against some diseases, such as measles,

mumps, chickenpox, and influenza, which can lead to viral

meningitis. Avoid bites from mosquitoes and other insects that

carry diseases that can infect humans.

•Control mice and rats. If any rodent in or around your home,

follow appropriate cleaning and control precautions.

 Medical management of Meningitis

Sl Drug group Action Example Nurses responsibility

no
1 Antibiotics for Reduce theAmpicillin Follow strict aseptic technique for IV injection.
bacterial growth of bacteria Ceftriaxone Monitor the site of injection for drug reaction
meningitis Cefotaxime and thrombosis.

2 Antiviral forReduce the viralAcyclovir Follow strict aseptic technique for IV injection.
Viral DNA production. Monitor the site of injection for allergic reaction
meningitis and irritation.
3 Antifungal Antimicrobial Cephalosporins Assess the patient for ototoxicity, fever, sore

against gramvancomycin throat, eosinophilia and leukopenia. Report

positive and these symptoms to the physician immediately.
negative bacteria.
Effective with
fungal drugs
q Corticosteroi Reduce the Dexamethason Monitor the glucose level regularly.
d
inflammatory e Assess for Vital signs and BP.
reaction and Prednisolon
cerebral edema.

5 IV fluids Keep the patient

hydrated and
prevent shock.
Thank You

Prof: Shanmuga Meenakshi.G.

MSN,RN QHCP