1. MENINGITIS Felix K. Nyande

2. Meningitis O An acute inflammation of the meninges or coverings of the brain and spinal cord. O It is an infection of the arachnoid mater and the CSF.

3. Causes Bacteria e.g. Streptococcus pneumoniae, Neisseria meningitidis, Viruses e.g. herpes simplex, herpes zoster, mumps viruses Fungi Irritants

4. Mode of transmission O The spread depends on the causative organism. The spread from meningococcal and haemophillus influenza are by droplet infection. Others like the tuberculos organism and staphylococcal organism are spread through septicaemia. O The organism usually gain entry into the CNS through the upper respiratory tract or bloodstream. O The septicaemic infection is usually from local foci like middle ear infections, sinuses, lungs and other parts of the body.

5. Predisposing factors Fracture of the skull Brain and spinal cord surgeries Infection of the sinuses Other respiratory tract infections Middle ear infections Immuno-compromised states Dental procedures

6. types Pyogenic meningitis [bacterial meningitis]: It is characterised by inflammation and pus formation.  TB meningitis.  Meningococcal meningitis [a.k.a. CSM]  Peumococcal meningitis

7. Bacterial meningitis O Meningococcal meningitis - Causative organism: Neisseria meningitidis. it is the most dangerous type. It is the commonest pyogenic meningitis. It is very fatal and is spread by droplet infection. O Peumococcal meningitis- Causative organism: Streptococcus pneumonae O TB meningitis: Mycobacterium tuberculosis --onset is gradual and recovery is also --prolonged. It only responds to anti- TB medications

8. Types cont’d Viral meningitis: also called aseptic meningitis because it is not associated with pus formation. Fungal meningitis: the commonest organisms are cryptococcal. Common in the immunocompromised patients. Meningism: [a.k.a. sterile meningitis]: meningeal irritation that arises from certain systemic conditions e.g. pneumonia, otitis media. It is not necessarily an inflammation of the meninges but an irritation. It is usually caused by fever.

9. Pathophysiology O Organism enters the central nervous system, through circulation from infectious foci, or direct route, such as penetrating trauma, or surgical procedures on the skull. O The organism settles or enter the arachnoid space and initiate an inflammatory process which affects the layers of the meninges, CSF and ventricles of the brain. O Inflammatory response to the infection tends to increase CSF production with moderate increase in ICP. O In bacterial meningitis, the inflammatory exudates spread to affect other cranial and spinal nerves which causes the neurological symptoms.

10. Clinical features It has a sudden onset except the tuberculos meningitis Severe unrelenting headache Fever Nuchal rigidity Nausea and vomiting Tachycardia Red macula rashes, usually associated with meningococcal meningitis Irritability Delirium

11. Manifestations cont’d Generalised muscle aches and pains Photophobia Decreased level of consciousness Positive Kernig’s sign [inability to stretch flexed legs] Positive Brudzinski’s sign [flexing the neck causes involuntary flexion of the limbs] Seizure

12. Kernig’s sign

13. Brudzinski’s sign

14. Diagnostic investigations Lumbar puncture to obtain CSF for analysis [colour, consistency, pressure, composition] CSF culture and sensitivity Blood culture FBC CT scan MRI X-ray of the skull (may show infected sinuses

15. Management O Medical Bed Rest IV fluids Medications: Antimicrobial drugs according to sensitivity test or organisms involved e.g. ampicillin, penicillin, cephalosporins (ceftriaxone) Anticonvulsants e.g. phenytoin Analgesics e.g. codeine, paracetamol, aspirin, Mannitol (for cerebral oedema) Corticosteroids: e.g. dexamethasone

16. Nursing diagnosis O Risk for spread O Fluid volume deficit O Altered body temperature (fever) O Pain O Risk for injury O Risk for complications O Self care deficit O Altered thought processes O Ineffective cerebral tissue perfusion

17. Nursing management Isolation Nurse in a darkened room Barrier nursing Fever management Headaches management Observation because sometimes they have fits Activities must be preceded by medications Personal hygiene Catheterisation NG tube feeding Maintain a fit chart

18. Subsequent care O After the acute phase has passed, the patient requires several weeks of convalescence before normal activities can be resumed. Adequate nutrition Exercise Adequate rest Monitoring for complications Review

19. Prevention Proper ventilation Avoiding over crowding Early treatment of infections Adequate post surgical ATBs cover Immunisation against bacterial meningitis/meningococcal meningitis Strict isolation and adoption of infection prevention measures during invasive procedures

20. Complications Hydrocephalus Deafness Encephalitis Paralysis Blindness