Cerebrospinal Meningitis; Types, Diagnosis, Predisposing factors, Clinical features, Management and Prevention

Meningitis is an inflammation to the meninges covering the brain and spinal cord. The inflammation may result from the invasion of the meninges by bacteria or virus. Meningitis that is caused by bacterial and viral invasion include;

Types

• Meningococcal meningitis
• Haemophilus meningitis
•    Pneumococcal meningitis
• Viral meningitis

Meningococcal Meningitis

This type of meningitis (commonest cause of outbreaks is the type A strains) has and incubation period of 2 – 10 days with the mode of transmission or spread being direct contact with droplets from the respiratory passages of an infected person. OR indirect being coming into contact with articles infected with the discharges of an infected person. This mode of transmission is not common since the causative organism does not survive for long outside the body.

Haemophilus Meningitis

This is the most common form of bacterial meningitis caused by haemophilus influenza especially type B. The mode of Spread is direct contact with droplets from respiratory passages.

Pneumococcal Meningitis

This type of meningitis is more fatal hence patient suffering from this infection must be given extra attention and care. The incubation period is between 1 and 3 days. The causative agent is streptococcus pneumonia and is transmitted via direct or indirect contact with discharges from the respiratory passage.

Viral Meningitis

This is caused by most viruses eg mumps virus, herpes and polio virus. The incubation period depends on the type of virus causing the meningitis.

Predisposing Factors

• Excessive hot weather conditions.
• Overcrowding situations where there is impaired ventilation.
• People leaving in the northern regions of Ghana are prone due to hot weather conditions.

Pathophysiology

The causative agent gets into the body of the susceptible (vulnerable) host when they inhale the infected droplets. The blood then circulates the organism to the meninges (transparent membrane) of the brain and spinal cord. Bacteria in the meninges elites an inflammatory response leading to production of exudates which consists of leucocytes (white blood cells), fibrin and the bacteria.

These makes the cerebrospinal fluid look cloudy or become thick and have plaque-like accumulation of and high levels of leukocytosis with the majority of the leucocytes being neutrophils.

Clinical Features 

1. Stiffness of the neck 
2. Constant and persistent headache 
3. High fever accompanied by rigor or convulsions 
4. Photophobia (fear of light) 
5. Increase intracranial pressure 
6. Delirium
7. Deafness 
8. Kerning’s sign is positive (pain and resistance on passive knee extension when hips are flexed) 
9. Restlessness
10. Brudzinki’s sign is positive (hips flexed when bending head forward).

Diagnosis 

The common investigative procedure is the Lumbar Puncture which involves passing a spinal needle through or in between the 3^rd and 4^th lumbar vertebrae/intervertebral space and cerebrospinal fluid(CFS) obtained.

• Blood culture 
• CSF examination
• Positive Kerning’s and Brukzinki’s signs.

Medical Management

• Treated with chloramphenicol plus crystalline penicillin.

• Other drugs used are ceftriaxone, ampicillin, gentamycin etc

• Avoid chloramphenicol in neonates.

• Analgesic for headache or fever.
• Anticonvulsants eg diazepam

Nursing Management 

• Isolate patient.
• Administer drugs as ordered and monitor for side effects. 
• Maintain adequate nutrition and elimination.
• Maintain quiet environment since clients are usually irritable. 
• Nurse in a dark room to decrease photophobia 
• Provide reassurance and support to patient and relatives.
• Nurse client on a bed with side rails

8.     Observe;

a.      For deterioration in client’s condition

b.      For level of consciousness and watch for onset of seizures

c.       For temperature increase (be alert for this) and give tepid sponging to reduce temperature

d.      Maintain adequate fluid intake to avoid dehydration but avoid fluid overload because of the damager of cerebral oedema.

Prevention

• Proper and early diagnosis and treatment of infected persons.
• Isolate all infected cases to avoid further spread.
• CSM immunization from two years and above
• Trace contacts and give treatment
• Adequate fluid intake during epidemics and during high whether temperatures
• Sleep in a well-ventilated room and avoid cooking or setting fire in sleeping rooms.
• Health education on the disease especially its high infection and death rates.
  

Complications 

• Mental retardation
• Cerebral oedema
• Deafness
• Death