MENINGITIS

(Cerebrospinal Fever)

 Definition:
Meningitis is the inflammation of the meninges of the brain and spinal cord as a result of
viral or bacterial infection. Such inflammation may involve the three (3) meningeal
membranes—the dura matter, the arachnoid membrane and the pia matter.

According to international journal of infection, Among 53 patients with meningitis (47%

females; 53% males with mean age of 36 years) 47 cases (83%) had acute meningitis and six
cases (17%) had chronic meningitis (four cases of tuberculosis and two cases of brucellosis).
From 47 cases with acute meningitis, only one case had a positive cerebrospinal fluid (CSF)
culture for meningococci and 46 patients had negative CSF culture.

According to World Health Organization, Meningitis is a devastating disease and remains a

major global public health challenge. Together with sepsis it is estimated to cause more deaths in
children under 5 years of age than malaria. Survivors can suffer severe sequelae with
considerable social and economic costs.

 Infectious Agent:
The disease can be caused by several kinds of organism, including pneumococcus,
staphylococcus, streptococcus and the tubercle bacillus. The species Neisseria meningitis
(meningococcus) is the organism causing most epidemics of meningitis.
  Occurrence:
According to News Medical Life Science:
Meningitis outbreak was first recorded in Geneva in 1805. Gaspard Vieusseux (1746-
1814) and Andre Matthey (1778-1842) in Geneva, and Elisa North (1771-1843) in
Massachusetts, described epidemic (meningococcal) meningitis. Several other epidemics in
Europe and the United States were described shortly afterward.

In Africa the first outbreak was described in 1840. African epidemics became much more
common in the 20th century. The first major one was reported in Nigeria and Ghana in 1905–
1908. In early reports large number of people died of the disease.

The first evidence that linked bacterial infection as a cause of meningitis was written by
Austrian bacteriology Anton Vaykselbaum who described meningococcal bacteria in 1887.

Heinrich Quincke (1842-1922) utilized his new technique of lumbar puncture (1891) to
provide an early analysis of cerebrospinal fluid (CSF). William Mestrezat (1883-1929), and
H. Houston Merritt (1902-1979) compiled large series of CSF profiles in meningitis.

According to Krysta Peterson

Vieusseux first discovered Meningococcal meningitis in 1805 during an outbreak in

Switzerland, though it wasn’t until 1887 that the causative agent was identified by Anton
Weichselbaum. It was given the name Neisseria intracellularis due to the nature of the
intracellular oval micrococci of the organism. Due to the characteristics of the bacterium and
its close relation to Neisseria gonorrhoeae, it was placed in the Neisseria genus, and later
named Neisseria meningitidis, for the discovering bacteriologist Albert Ludwig Sigesmund
Neisser and the area of the body it affects, the meninges

According to Indian Journal of Medical Microbiology

Description of illness resembling meningococcal disease dates back to the 16th century.
Meningococcal disease was described by Vieusseux in 1805 during an outbreak with 33
deaths in the vicinity of Geneva, Switzerland. The Italian pathologists Marchiafava and Celli
first described intracellular oval micrococci in a sample of CSF. The Italian pathologists
Marchiafava and Celli (1884) first described intracellular oval micrococci in a sample of
CSF. However, Anton Weichselbaum in 1887 first identified bacterium causing
meningococcal disease in the CSF of six of eight patients of bacterial meningitis and the
bacterium was named Neisseria intracellularis.

 Reservoir:
Humans are the only known reservoir for N. meningitis. The organism is spread
primarily through intimate contact with the nasopharyngeal secretions of an infected
person (i.e., through kissing, mouth to mouth resuscitation, sharing eating utensils,

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 sharing smoking materials, sharing beverages). N. meningitis is extremely sensitive to
drying and cooling and rarely survives outside the body for more than a few minutes. If
the organism is coughed onto a desk and remains there for a minute or longer, it will dry
out and die.

 Sign and symptoms:

Early meningitis symptoms may mimic the flu (influenza). Symptoms may develop over several
hours or over a few days.

Possible signs and symptoms in anyone older than the age of 2 include:

 Sudden high fever

 Stiff neck
 Severe headache that seems different than normal
 Headache with nausea or vomiting
 Confusion or difficulty concentrating
 Seizures
 Sleepiness or difficulty waking
 Sensitivity to light
 No appetite or thirst
 Skin rash (sometimes, such as in meningococcal meningitis)

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  Mode Of Transmission:
a. Meningitis is transmitted by respiratory droplets through the nasopharyngeal mucosa.
b. This infection can also be transmitted by direct invasion through otitis media.
c. Meningitis may result after a skull fracture, a penetrating head wound, lumbar
puncture or ventricular shunting procedures.

 Incubation Period:
The incubation period varies, the extreme limits being set from one (1) to ten (10)
days.

 Period Of Communicability:

The period of communicability lasts until the bacteria are no longer present in
discharges form the nose and mouth. Meningococci usually disappear from the throat and
nose within 24 hours after institution of treatment with antibiotics to which the organisms
are sensitive

 Susceptibility:

Meningitis occurs in people of all age groups, but very young individuals (infants
and young children) and elderly individuals (>60 yrs) are more predisposed to the
infection. Depending on their ages, individuals are also predisposed to certain etiologic
agents.

 Diagnostic Procedures:

1) CSF analysis through lumbar puncture, the purposes of which are:

a) Diagnostic purposes
i) Obtaining the CSF specimen
ii) Taking x-rays of the spinal canal and cord
b) Therapeutic purposes
i) Reducing intracranial pressure
ii) Introducing serum and other medications
iii) Injecting an anesthetic agent
2) Gram-staining
3) Smear and blood culture
4) Smear from petechiae
5) Urine culture

 Complications
o subdural effussiom
o hydrocephalus
o deaf-mutism
o blindness of either one or both eyes
o otitis media and mastoiditis
o pneumonia or bronchitis

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  Common nursing diagnosis:

1. Altered cerebral perfusion

2. Altered nutrition: less than body requirements
3. High risk for injury
4. Altered sensory perception
5. Fluid volume deficit
6. Knowledge deficit
7. Altered body temperature

 Prevention:
a. Several vaccines are available to protect against certain types of meningitis.
b. Teach clients with chronic sinusitis or other chronic infections the importance of
proper and prompt medical treatment.
c. Give rifampicin as prophylaxis, as ordered by the physician.
d. Implement the universal precaution.

 Reference:

 https://www.dhhs.nh.gov/dphs/cdcs/meningitis/index.htm
 https://emedicine.medscape.com/article/1168529-overview
 http://intjinfection.com/en/articles/14716.html
 https://www.who.int/immunization/research/Defeating_meningitis_2030_TTFJuly2018_r
eport.pdf
 https://www.news-medical.net/health/History-of-
Meningitis.aspx?fbclid=IwAR3W5hJt5eLf1TeOwEC6PzXGQ-
CSWmvfkWjci6ylNTAEvfIyYugwqRrXJ3E
 https://www.austincc.edu/microbio/2704w/nm
 http://www.ijmm.org/article.asp?issn=0255-
0857;year=2006;volume=24;issue=1;spage=7;epage=19;aulast=Manchanda

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