Bacterial Meningitis

By LeAnna Ceglia

What is Bacterial Meningitis?

Acute inflammation of
the meningeal tissues
that surround and
protect the brain and
spinal cord
More specifically, refers
to infection of the
arachnoid mater and the
cerebral spinal fluid

Etiology
According to the Center
for Disease Control and
Prevention, there were
4,100 cases in the United
States, with 500 deaths
between 2003-2007
(2014)
According to the National
Institute of Neurological
Disorders and Stroke,
about 6,000 cases are
reported of pneumococcal
meningitis in the U.S.
while 2,600 cases are
reported of meningococcal
meningitis

Pathophysiology
The bacterial organism
gains entry to the CNS
through the bloodstream
or upper respiratory tract
Inflammatory response
to infection causes
increase of CSF
productions and
moderate increase in ICP.
This increased purulent
secretion production
spreads quickly to other
areas of the brain via
CSF, covering cranial
nerves and other
intracranial structures
causing neurological
problems

Causes and Risk Factors

Causes
Streptococcus
pneumonia

Risk Factors
Occur usually in the fall,
winter, or early spring

Neisseria meningitidis

Often secondary to viral

respiratory disease

Haemophilus influenzae

Older adults

Now decreased due to

H. influenza vaccine

Debilitation
Living in confined spaces
with multiple people
(prison, college dorms,
etc.)
Immunosuppression
Invasive procedures
Skull fracture

Penetrating head wound

Signs and Symptoms

Common clinical
manifestations
Fever

Severe headache
Nausea/vomiting
Neck stiffness
Photophobia
Decreased LOC
Signs of increased ICP

Other possible
manifestations
Coma
occurs in 5-10% of
patients with a poor
prognosis

Seizures
Occurs in 1/3 of all
cases

Skin rash and petechiae

If infecting organism is
meningococcus

Complications
ICP
Most common
complication
Most common cause for
altered mental status

Cranial Nerve Dysfunction

occurs with CN III, IV, VI,
VII, or VIII

Acute Cerebral Edema

Causes seizures, CN III
palsy, hypertensive coma,
bradycardia, and death

Hemiparesis
Dysphasia

Hemianopsia
Headaches that continue
until swelling and
inflammation has been
completely resolved
Noncommunicating
hydrocephalus
Waterhouse-Friderichsen
syndrom
Petechiae, disseminated
intravascular coagulation,
adrenal hemorrhage, and
circulatory collapse

Assessment/Diagnostics
Patient history and
physical exam

A blood culture
CT scan, MRI, and PET
scan
Lumbar puncture to
analyze cerebrospinal
fluid
Assess CSF for protein,
WBC, glucose, Gram
stain, and culture

CBC-coagulation profile,
electrolyte levels,
glucose levels, and
platelet count
Skull x-ray

Results for Positive Bacterial Meningitis

Cerebrospinal fluid
appears cloudy
WBCs elevated

Protein levels
elevated
Glucose levels
decreased

Cerebrospinal fluid
pressure increased
Increased intracranial
pressure shown with
CT scan or MRI

Collaborative Care
Place patient in isolation
as soon as meningitis is
suspected
Maintain hospital
precautions per hospital
policy
Implement droplet
precaution until antibiotics
have been administered
for 24 hours

Use fever-reduction
measures
Report infection to the
public health department
Decrease environmental
stimuli to ensure rest

Maintain bedrest with HOB

at least 30
Maintain safety and
seizure precautions
Maintain fluid and
electrolyte therapy as
indicated by lab results
Administer antibiotics

Treatment
Rocephen or Claforan
Antibiotic given until
sensitivity and culture
results are available

Ampicillin or penicillin
Antibiotic given to treat
bacterial meningitis

Decadron
To prevent neurological
complication of bacterial
meningitis (septic shock,
acute respiratory distress,
disseminated
intravascular coagulation

Mannitol
A diuretic to decrease ICP

Dilantin
Anticonvulsant given if
patient experiences a
seizure or the ICP
increases

Acetaminophen, ibuprofen
Analgesic to help with
headaches and/or fever A
nonopioid to prevent
masking any changes in
level of consciousness

Ciprofloxan, rifampin
A prophylactic antibiotic
given to individuals who
have had close contact
with patient

Preventative Measures
Always wash your hands

Haemophilus influenzae
type b (Hib) vaccine as
an infant
Meningococcal vaccine
(MCV4) as an adolescent
prior to living in dorms
or other communal living
conditions such as
military

Pneumococcal
polysaccharide vaccine
(PPSV) if
immunocompromised,
have chronic disease,
smoke cigarettes, live in
long-term care facility

Resources
Center for Disease and Control Prevention (2014, April 1).
Bacterial Meningits [Web log post]. Retrieved from
http://www.cdc.gov/meningitis/bacterial.html
Knippa, A., Sommer, S., Ball, B., Churchill, L., Elkins, C.,
Janowski, M. J, Roberts, K, & Wright, M. (2012). RN
adult medical surgical nursing edition 8.0. Menigitis
(pp.59-63). Assessment Technologies Institute, LLC.
Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., &
Camera, I. (2011). Medical-surgical nursing:
assessment and management of clinical problems.
Acute Intracranial Problems (pp.1425-1458). St. Louis,
MI: Elsevier Mosby
National Institute of Neurological Disorders and Stroke
(2014). Meningitis and encephalitis fact sheet.
Retrieved from
http://www.ninds.nih.gov/disorders/encephalitis_menin
gitis/detail_encephalitis_meningitis.htm

Review Questions
What vaccine is appropriate for a freshman in college to
receive?
A.) Haemophilus influenzae type b (Hib)
B.) Meningococcal vaccine (MCV4)
C.) Pneumococcal polysaccharide vaccine (PPSV)

Review Questions

Which bacteria are responsible for causing bacterial

meningitis? (select all that apply)
A.) Streptococcus pneumonia
B.) Escherichia coliare
C.)Neisseria meningitidis
D.) Bacillus anthracis

Review Questions
Signs and symptoms of bacterial meningitis include flu-like
symptoms accompanied by
A.) tinnitus
B.) neck stiffness
C.) bloody stool
D.) decreased temperature