Meningitis
Assessing for Meningitis
Kernig Sign = Knee Extension is painful
BrudziNsKi Sign = Neck Flexion leads to Knee Flexion
Meningitis is a serious and potentially life-threatening infection of the protective membranes that cover the brain and spinal cord. The signs and symptoms of meningitis include fever, headache, nausea or vomiting, stiff neck, sensitivity to light, confusion, and seizures.
Other signs that may indicate meningitis include a rash of tiny, red or purple spots that appear anywhere on the body, irritability, drowsiness, and difficulty waking up. In infants, meningitis may present with a bulge in the soft spot on the top of the head, a high-pitched cry or moaning, and poor feeding.
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- High fever
- Â Severe headache
- Stiff neck
- Â Nausea and vomiting
- Photophobia (sensitivity to light)
- Confusion or difficulty concentrating
- Seizures
- Skin rash
- Muscle pain and weakness
- Cold hands and feet
Case Study: Meningitis
A 6-month-old male infant presented to the emergency department with a fever of 101.5°F, irritability, and poor feeding. The infant’s mother reported that he had been fussy for the past 2 days and had not been eating well. The infant’s vital signs were within normal limits, and a physical examination was significant for a bulging fontanelle and nuchal rigidity. A lumbar puncture was performed, which revealed an increased cerebrospinal fluid (CSF) protein level and decreased glucose level. The CSF Gram stain was positive for Gram-negative cocci.
- The infant’s presentation with fever, irritability, poor feeding, a bulging fontanelle, and nuchal rigidity is consistent with bacterial meningitis. The findings of an elevated CSF protein level, decreased glucose level, and Gram-negative cocci on CSF Gram stain support the diagnosis.
- Streptococcus pneumoniae and Haemophilus influenzae type b are common causes of bacterial meningitis in infants, the presence of Gram-negative cocci on CSF Gram stain suggests that Haemophilus influenzae tybe b is the most likely cause of this infant’s meningitis. Neisseria meningitidis typically causes meningitis in older children and adults.
- Ceftriaxone is the appropriate initial treatment for bacterial meningitis in infants. Vancomycin should be added if there is suspicion of methicillin-resistant Staphylococcus aureus (MRSA) or if there is a high prevalence of community-acquired MRSA in the area. Ampicillin should be added if Listeria monocytogenes is suspected. Acyclovir is used to treat viral encephalitis.
- Infants with meningitis are often irritable and may require a quiet, low-stimulus environment to reduce agitation and allow adequate rest. Providing analgesics may be necessary to alleviate pain, but they should be used judiciously due to the potential for masking signs of worsening neurological status. Providing a soft, flat pillow may be contraindicated due to the risk of increasing intracranial pressure, and feeding small amounts frequently may not be appropriate in the acute phase of illness.