Meningitis is an inflammation of the meninges or the inflammation of the meninges covering the brain and spinal cord that specifically appear in the subarachoid matter due to bacteria, virus or chemical irritation of the meningis. It is common in children because of their susceptibility to respiratory infection. Transmission is by direct contact including droplet spread. It crosses the blood brain barrier to the brain.




Meningitis can be sterile or infective (bacteria)

  • Sterile Meningitis: (Viral meningitis) This is found in conditions of secondary malignant cancer deposit without any organism inside the meningis. There may be signs of meningeal irritation (meningism). In certain condition, there may be signs of meningeal irritation accompanied by otitis media in children, severe fever and pneumonia.
  • Infective Meningitis (Bacterial, Septic Meningitis): Due to specific organism which affect the meningis such as Neisseria meningitidis (meningococcus)

This is the commonest causative organism (meningitis causes) of the cerebro-spinal meningitis. Other organisms include: staphylococcus, streptococcus, pneumo-coccus, tuberculosis, Escherichia coli, salmonella, Treponema palludium, pseudomonas euroginosa

  • Purulent or Pyogenic Meningitis: This infective meningitis occurs due to Neisseria meningitidis. It is the commonest and most crucial type
  • Tuberculos meningitis: occurs due to micro bacterium tuberculosis
  • Influenzal Meningitis: occurs due to haemophilius influenza
  • Pneumococcal meningitis due to pneumococcus
  • Staphylococcal meningitis: occurs due to staphylococcus group


Meningitis is often asymptomatic initially. It may start as an infection of naso-pharyn or tonsil from where the infection may spread to the meningis of the brain and upper part of the spinal cord. Overcrowding favors the spread of the disease. The spread is usually by droplet method while the portal of entry are the mucous membrane of the nose and tonsils. Some of those exposed may become carries that are suffering from the disease. It is a worldwide disease affecting both adult and children but rare after the age of 23. It has the highest incidence in the tropics and may occur in epidemics. For example in a tropical country like Nigeria the incidence is highest in Northern part because of the extremely hot temperature.

In summary Meningitis causes or Risk factors includes:

  • Bacteria e.g. Streptococcus pneumonia, Neisseria or Hemophilic influenza (Bacterial meningitis which common in infant)
  • Viral infection (Aseptic meningitis)
  • Fungal and Protozoa
  • Neurosurgical procedures
  • High population density
  • Crowded living areas
  • Prisons
  • Skull fracture
  • Upper respiratory infections
  • Use of nasal spray
  • Compromised immune system
  • Lumber puncture
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The pathology is similar in all infective cases it may be acute, sub-acute or chronic. The affected meningitis are hyperaemic(excess blood in anywhere) and are infiltrated by polymorph leucocytes which form exudate that is rich in protein.

These exudates enter the cerobro spinal fluid and cause significant changes that are of diagnostic important. The cerebral tissue is metabolically impaired by the presence of the meningeal exudates vasiculities. Under perfussion and cerebral oedema.

A prulent exudates may spread over the base of the brain and spinal cord. Inflammation also spread to the membranes lining the ventricles. Intrameningeal abscess which may rupture to endue the cranium may occur. Meningeal adhersions may result. In acute conditions bacteria toxins may kill the patient even before the features of meningitis become obvious, such case is accompanied by adrenal damage, circulatory failure and wide spread haemorrhages due to endoterial damage and vascular necrosis (water house-friderichsen syndrome)


Meningitis symptoms from the onset may be abrupt or insidious, The symptom are associated with the infection and raise intra-cranial pressure. Sometimes patient has generalized symptoms which does not refer to meningitis such as unexplained fever, severe headache, weakness, severe throat pain, pain in the ear or pneumonia. The manifestation of signs and symptom may appear different in children and adult because of age difference the prominent meningitis symptoms include:

  1. Headache located frontally and occipitally and made worse by sudden movement
  2. Nuchal rigidity: Neck becomes rigid and resistant to flexion due to inflammation at the base of the brain, the rigidity becomes more tense as the disease progresses
  3. Kerning Sign: This consist of pain and resistance on extending the leg at the after flexing the thigh upon the It indicates the meningeal irritation of lumbar-sacral nerve route. It is the classical signs for meningitis
  4. Brudzinski's sign: This is a positive sign of meningeal irritation. It consist of the flexion of the lower limb on passive flexion of the leg on the chest. It is always present in meningitis.
  5. Fever is always present to some extent. Other meningitis symptoms include opisthotonous which is common in children. This is an arched body position caused by tetanic spasm with the head and feet on a surface, Nausea and vomiting, anorexia, exaggerated deep flexes cranial nerve disfunction, hyperesthesia of the skin, photophobia (intolerance of light), delirium, muscular twiching, spasms and crams as well as signs of intracranial pressure coma may occur.
  6. Carphologia: Picking of bed cloth

In summary common meningitis symptoms includes:

  • Severe neck pain and stiffness
  • Headache
  • Back pain
  • Vomiting
  • Photophobia
  • Fever and chills
  • Muscle ache
  • Tarchy cardia
  • Twitching
  • seizures
  • Altered level of consciousness such as confusion
  • Abdominal and chest pain in viral meningitis
  • Red, macular rash with meningococcal meningitis (Petechae or purpuric rash)
  • Poor sucking or feeding in children
  • Bulging fountanels in children
  • Brudzinki's sign(severe neck stiffness)


  1. Diagnostic measures include history taking, Lab test. It is important to ascertain the recent trauma and infection and possible contacts with affected persons.
  2. Positive kerning sign and Brudizinskis' signs are important diagnostic sign (meningitis symptoms)
  3. Lumber puncture should be preferred immediately meningitis is suspected to confirm the diagnosis the cerebrospinal fluid will be crowdy or milky white blood cells up to 50,000 per cubic millimeter. C.S.F pressure and protein levels are elevated glucose concentration is decreased
  • chloride level may be normal or slightly reduced
  • culture and sensitivity will help to determine the presence of organisms and te appropriate antibiotics. Blood cultures may also be used in isolating the causative organism
  1. Chest and skull x-ray maay be taken to detect areas of inflammation or abscess
  2. Blood-for culture and sensitivity


Tetanus, whooping cough, poliomyelitis etc


The management of meningitis is aimed at combating the invading organism, focal of infection and irritation, this is a preamble of management

Preventive measure can reduce the incidence of all forms of meningitis.

Education of public on the mode of transmission is very important emphasis should be placed on respiratory care. instructions should be given to people on the use of handkerchief and disposable tissues to minimize droplet spread. Nutrition education is also important since well nourished person are least likely to be affected. To prevent secondary meningitis infection attention should be paid to the upper respiratory tract signs, dental or ear infection, as well as neurosurgical procedures or head trauma.

Prophylactic antibiotic are recommended in such situations. Adolescents should be advised against picking acne on the face especially on the nose, lip and fore-head blood vessels from this area lead to the brain. Those at risk in cases of epidemics should be given the appropriate vaccine for their protection.


The immediate objective of treatment is to observe and treat shock with appropriate fluid replacement as well as cardio respiratory support.

In meningitis treatment the following Medical (Drug therapy) is employed:

  • This is usually according to cause high doses of sulphanamide group such as sulphadiazine and sulphatriad are useful against meningococcal infection
  • High doses of chloromphenicol and penicillin are given Intramuscularly(im), intrathetically and intravenously(iv). The dose is regulated according to the age of the patient
  • A chloromphenicol and penicillin may be combined. (Chloromphenicol may be useful for influenzal meningitis)
  • Osmotic diuretic is necessary if cerebral oedema occurs for example: IV Manitol
  • For convulsive seizures: diazepan and phenyton sodium (dilatin or epanutin) may be useful
  • Analgesic for pain (Isomozide for tuberculosis meningitis)


The nurse or medical personnel should administer the following meningitis treatment to the patient:

  1. Observe isolation technique in all suspected cases preferably in a private room or cubicle(dark room or baseless padded cot (bed) is used)
  2. Provision for adequate rest
  3. Stimuli should be decreased from environment by controlling light and noise
  4. The patients temperature, pulse, respiration and blood pressure should be monitored at intervals according in consonance with patient's condition. The monitoring frequency depends of the condition of the patient, if hot expose to ventilation/air (fan)
  5. The fever should be controlled
  6. The patient should be positioned on the side slightly supported on extension
  7. Fluid intake should be decreased if there is evidence of cerebral oedema, levels of consciousness should be checked and fluid intake and output monitored
  8. Intracranial pressure should be monitored and controlled
  9. Provide emotional support for patient and family
  10. Drugs should be administered as prescribed and the effect of such drugs should also be checkmated
  11. Adequate nutrition, light nourishing diet, vitamin supplements should be provided for the patient and is usually preferred.
  12. Nasogastric intubation may be necessary if the patient can't feed well
  13. Adequate attention should be given to personal hygiene of the patient with adequate care of the skin and pressure areas.
  14. If seizures (spasm) occur (meningitis symptoms), seizure chart should be maintained.
  15. Rehabilitation: The rehabilitation of the patient should be a joint effort between the hospital, the patient's family, the employer and the community as a whole.

COMPLICATIONS (The resulting effects if Meningitis is not managed/treated properly)

  • Hydrocephalus
  • Increase in cranial pressure
  • otitis media
  • Arthritis
  • Endocarditis
  • Seizures (convulsion)
  • Demensia
  • Deafness
  • blindness and various forms of paralysis


With the advent of antibiotics, the prognosis has changed for better. Prognosis however depends upon duration of illness before treatment is started and the sensitivity of the infective organism to the available antibiotics




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