Meningitis is an inflammation of the meninges, the protective membranes covering the brain and spinal cord. It is commonly caused by bacterial or viral infections.
Types of Meningitis
- Meningococcal meningitis
- Haemophilus influenzae meningitis
- Pneumococcal meningitis
- Viral meningitis
Meningococcal Meningitis
Caused mainly by type A strains, this form has an incubation period of 2–10 days. It spreads through respiratory droplets from infected individuals or contact with contaminated objects, although the organism does not survive long outside the body.
Haemophilus Influenzae Meningitis
Most commonly caused by Haemophilus influenzae type B. It spreads via respiratory droplets through direct contact.
Pneumococcal Meningitis
Caused by Streptococcus pneumoniae. It is highly fatal and requires urgent attention. Incubation period is 1–3 days. Transmission occurs through respiratory secretions.
Viral Meningitis
Caused by viruses such as mumps, herpes, and poliovirus. Incubation period varies depending on the virus.
Predisposing Factors
- Hot weather conditions
- Overcrowding and poor ventilation
- Living in hot regions such as northern Ghana
Pathophysiology
Infection occurs when droplets are inhaled by a susceptible host. The pathogen spreads via the bloodstream to the meninges, triggering an inflammatory response. This leads to exudate formation containing white blood cells, fibrin, and bacteria.
The cerebrospinal fluid (CSF) becomes cloudy due to increased leukocytes, mainly neutrophils.
Clinical Features
- Neck stiffness
- Severe persistent headache
- High fever with rigors or convulsions
- Photophobia
- Increased intracranial pressure
- Delirium
- Deafness
- Positive Kernig’s sign
- Restlessness
- Positive Brudzinski’s sign
Diagnosis
Diagnosis is mainly through lumbar puncture, where cerebrospinal fluid is collected from the L3–L4 space for analysis.
- Blood culture
- CSF examination
- Physical signs (Kernig’s and Brudzinski’s signs)
Medical Management
- Chloramphenicol + crystalline penicillin
- Alternatives: ceftriaxone, ampicillin, gentamicin
- Avoid chloramphenicol in neonates
- Analgesics for pain and fever
- Anticonvulsants such as diazepam
Nursing Management
- Isolate the patient
- Administer prescribed medications and monitor side effects
- Maintain adequate nutrition and elimination
- Provide a quiet, low-stimulation environment
- Keep patient in a dark room to reduce photophobia
- Offer emotional support to patient and relatives
- Use bed with side rails for safety
- Monitor:
- Level of consciousness and seizures
- Temperature (use tepid sponging if high)
- Signs of deterioration
- Fluid balance (avoid dehydration and fluid overload)
Prevention
- Early diagnosis and treatment
- Isolation of infected patients
- Vaccination (CSM immunization from age 2 and above)
- Contact tracing and prophylaxis
- Adequate hydration during outbreaks and hot weather
- Good ventilation and avoid overcrowding
- Health education on transmission and prevention
Complications
- Mental impairment
- Cerebral oedema
- Hearing loss
- Death
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