Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges.

[1] The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and less commonly by certain drugs.[2] Meningitis can be life-threatening because of the inflammation's proximity to the brain and spinal cord; therefore the condition is classified as a medical emergency.[1][3]

Signs and Symptoms of Meningitis

Nasopharynx
There is a presence of upper respiratory tract infections.

Bloodstream
Petechiae and ecchymosis (blotchy purpuric lesions) are observed.

Meninges
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Nuchal Rigidity. Is the pathognomonic sign of meningitis. The clients entire neck is rigid. Kernig sign. The nurse asks the patient to bend the knees at a Ninety (90) degree angle. Positive pain is or difficulty in extending after flexion of knees is observed. Brudzinski sign. It is the involuntary drawing up of the hip upon flexion of the neck. The nurse asks the patient to flex the neck towards the chest. Positive Brudzinski sign when the legs move upward. Increased Intracranial Pressure (ICP). Projectile vomiting, Convulsions, Increased Temperature, Decreased pulse rate and respiratory rate, Widening blood pressure (Increased systolic and normal diastolic), Diplopia, and Altered levels of consciousness.

Types of Meningitis
There are 4 types of meningitis which are classified by the causal agent. These 4 types of meningitis include: Viral Meningitis: Viral meningitis is more common then bacterial and generally less serious. The most common cause of viral meningitis is coxsackievirus and echovirus (also called enterovirus). Meningitis may also develop due to infection of measles, polio, chickenpox viruses or because of complications due to mumps (6). Bacterial Meningitis: Various types of bacterial meningitis include:

Meningococcal: One of the most common

causes of bacterial meningitis universally is meningococcal bacterium occurring in five groups namely A, B, C, W135 and Y. The bacteria live in the back of nose, throat or upper respiratory tract. About 10-25 percent of the population is a carrier of these bacteria without being affected at any given point of time (7).

Meningococcal Septicemia: The meningococcal bacterium is also the causal agent for Meningococcal septicemia. The meningococcus infects the meninges by entering through the blood stream. The bacterium multiplies in the blood stream simultaneously releasing toxins, thus poisoning the blood (septicemia). The septicemia is a medical emergency with fatality rates as high as 20 percent (8). Pneumococcal Meningitis: Pneumococcus or Streptococcus pneumonia causes this types of meningitis. People of any age group, especially babies and children under the age of 18 months, are susceptible to infection by this type of meningitis. Elderly people with a defective immune system are also at risk of being infected (9). Hib Meningitis: The causal agent for this type of meningitis is Haemophilus influenzae type B, generally affecting infants (10). TB Meningitis: The bacterium bacillus tubercle causes this type of meningitis. Normally, elderly people and those with underlying TB infection are susceptible to this type of infection. The lungs are usually infected first and later it travels to brain through the blood stream (11). Neonatal Meningitis: Meningitis affecting new-born babies is called neonatal meningitis. Premature babies are at a greater risk and fatality rates are as high as 20%. Escherichia coli and B streptococcal bacteria i.e., Streptococcus agalactiae cause neonatal meningitis (12). Fungal Meningitis: Fungal meningitis is rare and caused by Cryptococcus (Cryptococcus neoformans). Generally, immuno-compromised patients such as those suffering from AIDS and leukemia are most susceptible to this type of meningitis (13). Amoebic Meningitis: It is a very rare and very serious illness often leading to death. The infection is caused by amoeba living in geothermal pools and stagnating pools of fresh water at temperatures of 86-degree Fahrenheit, (30 C) (14).

Incubation Period

The incubation period depends on the causative agent. For example the incubation period of meningococcal meningitis is 2-10 days while the incubation for hemophilus meningitis is much shorter ranging from 2-4 days. However the range of incubation for most organisms causing meningitis is 2 days to 2 weeks.

What Causes Meningitis?

Edited by Guy Slowik MD FRCS. Last updated on January 31st 2011 There are two main forms of meningitis:

bacterial meningitis, and viral meningitis.

Bacterial meningitis affects fewer people than the viral form, but it often results in more serious health consequences. Bacterial meningitis is fatal in 1 in 10 cases and leaves 1 in 7 survivors with a severe disability caused by brain injury. Bacterial meningitis Viral meningitis

Bacterial Meningitis
There are several types of bacterial meningitis. Two types represent the majority of bacterial meningitis cases: 1. meningococcal 2. pneumococcal The bacteria that cause these cases are common and live in the back of the nose and throat, or in the upper respiratory tract. The bacteria are spread among people by coughing, sneezing and kissing. These bacteria cannot live outside the body for long, so they cannot be picked up from water supplies, swimming pools, or a building's air-conditioning system. Individuals can carry these bacteria for days, weeks, or months without becoming ill. In fact, about 25 percent of the population carries the bacteria. Only rarely do the bacteria overcome the body's defenses and invade the cerebra spinal fluid, causing meningitis. Meningococcal meningitis accounts for more than half of all cases of bacterial meningitis in the United States. Meningococcal disease is caused by bacteria called

Neisseria meningitidis. There are several strains of Neisseria meningitidis. Strain B causes about 75 percent of the meningococcal cases and has the highest fatality rate. Pneumococcal meningitis is caused by pneumococcus bacteria, which also cause several diseases of the respiratory system, including pneumonia. It has a fatality rate of about 20 percent. It also results in a higher incidence of brain damage than other forms of the disease. Other types of bacterial meningitis include: Neonatal meningitis: This form affects mostly newborn babies and is caused by Group B streptococcus bacteria, commonly found in the intestines. Staphylococcal meningitis: This is a rare, but deadly form caused by staphylococcus bacteria. It usually develops as a complication of a diagnostic or surgical procedure. Haemophilus influenza type B (Hib) is caused by haemophilus bacteria. It was once the most common form of bacterial meningitis, and one of the deadliest childhood diseases. However, in 1985, an Hib vaccine was introduced into the routine immunization program for U.S. children and virtually eliminated Hib meningitis in the United States.

Viral Meningitis
Viral meningitis is far more common than the bacterial form and, in most cases, much less debilitating. Most people exposed to viruses that cause meningitis experience mild or no symptoms and fully recover without complications. ' The disease can be caused by many different viruses. Some of the viruses are transmitted by coughing or sneezing or through poor hygiene. Other viruses can be found in sewage polluted waters. Occasionally, viral meningitis will develop following the mumps or chicken pox. Mosquito-born viruses also account for a few cases each year. Approximately half of the viral cases in the United States are due to common intestinal viruses, or enteroviruses. These viruses are shed in the feces and in discharges from the mouth and nose. Most people who become infected with the virus contract it through hand-to-mouth contact.

PERIOD OF COMMUNICABILITY Bacterial

A person can pass the infection to others for as long as the bacteria are present in discharges from the nose and mouth. A person is no longer infectious within 24 to 48 hours after starting antibiotic treatment. Viral Incubation Period The incubation period varies depending on the virus involved. Enteroviral meningitis has an incubation period of 3-6 days.

Treating Bacterial Meningitis

Early treatment for bacterial meningitis is important for people with the disease. Bacterial meningitis treatment involves strong doses of intravenous antibiotics. Antibiotics may also be given to prevent other bacterial infections. Corticosteroids such as prednisone may be used to relieve brain pressure and swelling, and to prevent hearing loss that is common in patients with Haemophilus influenzae meningitis. Pain medicine and sedatives may be given to make patients more comfortable.

Depending on the source of infection, infected sinuses may need to be drained as part of treating meningitis. Appropriate treatment for most types of meningitis can reduce the risk of dying from the disease to below 15 percent.

Treatment for Viral Meningitis

Unlike bacteria, viruses cannot be killed by antibiotics. Therefore most viral meningitis treatment does not involve medications to kill the virus. An exception is the herpes virus, which can be treated with the antiviral drug acyclovir. Patients with mild viral meningitis may be allowed to stay at home, while those who have a more serious infection may be hospitalized for supportive care. Patients with mild cases, which often cause only flu-like symptoms, may undergo a treatment regimen that includes:

Fluids Bed rest (preferably in a quiet, dark room) Analgesics for pain and fever.

The physician may prescribe anticonvulsants such as Dilantin (phenytoin) to prevent seizures and corticosteroids to reduce brain inflammation. If inflammation is severe, pain medicine and sedatives may be prescribed to make the patient more comfortable. MENINGITIS Nursing Management. (1) Administer intravenous fluids and medications, as ordered by the physician. (a) Antibiotics should be started immediately. (b) Corticostertoids may be used for the critically ill patient. (c) Drug therapy may be continued after the acute phase of the illness is over to prevent recurrence. (d) Record intake and output carefully and observe patient closely for signs of dehydration due to insensible fluid loss. (2) Monitor patient's vital signs and neurological status and record. (a) Level of consciousness. Utilize GCS for accuracy and consistency. (b) Monitor rectal temperature at least every 4 hours and, if elevated, provide for cooling measures such as a cooling mattress, cooling sponge baths, and administration of ordered antipyretics. (3) If isolation measures are required, inform family members and ensure staff compliance of isolation procedures in accordance with (IAW) standard operating procedures (SOP). (4) Provide basic patient care needs. (a) The patient's level of consciousness will dictate whether the patient requires only assistance with activities of daily living or total care. If patient is not fully conscious, follow the guidelines for care of the unconscious patient (Part 5). (b) Maintain dim lighting in the patient's room to reduce photophobic discomfort. (5) Provide discharge planning information to the patient and family. (a) Follow up appointments with the physician. (b) Discharge medication instruction. (c) Possible follow-up with the community health nurse.

Prevention
By Mayo Clinic staff Meningitis typically results from contagious infections. Common bacteria or viruses that can cause meningitis can spread through coughing, sneezing, kissing, or sharing eating utensils, a toothbrush or a cigarette. You're also at increased risk if you live or work with someone who has the disease. These steps can help prevent meningitis:

Wash your hands. Careful hand washing is important to avoiding exposure to infectious agents. Teach your children to wash their hands often, especially before they eat and after using the toilet, spending time in a crowded public place or petting animals. Show them how to wash their hands vigorously, covering both the front and back of each hand with soap and rinsing thoroughly under running water. Stay healthy. Maintain your immune system by getting enough rest, exercising regularly, and eating a healthy diet with plenty of fresh fruits, vegetables and whole grains. Cover your mouth. When you need to cough or sneeze, be sure to cover your mouth and nose. If you're pregnant, take care with food. Reduce your risk of listeriosis if you're pregnant by cooking meat thoroughly and avoiding cheeses made from unpasteurized milk.

Immunizations Some forms of bacterial meningitis are preventable with the following vaccinations:

Haemophilus influenzae type b (Hib) vaccine. Children in the United States routinely receive this vaccine as part of the recommended schedule of vaccines, starting at about 2 months of age. The vaccine is also recommended for some adults, including those who have sickle cell disease or AIDS and those who don't have a spleen. Pneumococcal conjugate vaccine (PCV7). This vaccine is also part of the regular immunization schedule for children younger than 2 years in the United States. In addition, it's recommended for children between the ages of 2 and 5 who are at high risk of pneumococcal disease, including children who have chronic heart or lung disease or cancer. Pneumococcal polysaccharide vaccine (PPSV). Older children and adults who need protection from pneumococcal bacteria may receive this vaccine. The Centers for Disease Control and Prevention recommends the PPSV vaccine for all adults older than 65, for younger adults and children who have weak immune systems or chronic illnesses such as heart disease, diabetes or sickle cell anemia, and for those who don't have a spleen. Meningococcal conjugate vaccine (MCV4). The Centers for Disease Control and Prevention recommends that a single dose of MCV4 be given to children ages

11 to 12 or to any children ages 11 to 18 who haven't yet been vaccinated. However, this vaccine can be given to younger children who are at high risk of bacterial meningitis or who have been exposed to someone with the disease. It's approved for use in children as young as 9 months old. It's also used to vaccinate healthy people who have been exposed in outbreaks but have not been previously vaccinated.