Viral meningitismay follow other viral infections such as mumps, herpes
simplex or zoster, enterovirus, or measles. Viral meningitis is often a self-limiting
illness.
Patients with immunocompromise have an increased risk for contracting a
fungal meningitis. This may travel from the bloodstream to the CNS or by
direct contamination. Cryptococcus neoformans may be the causative organ-
ism in these patients.
Bacterial meningitis still has a significant mortality rate, and these patients
need to be managed in the hospital. Some patients will have permanent neuro-
logic effects following the acute episode. Viral meningitis is typically self-limited.
Fungal meningitis often occurs in patients who are immunocompromised.Nursing alert Always isolate a patient who is suspected of having bacterial
meningitis until bacterial meningitis is ruled out.Signs and Symptoms
Stiff neck due to meningeal irritation and irritation of the spinal nerves.
Nuchal rigidity (pain when flexing chin toward chest) due to meningeal
irritation and irritation of the spinal nerves.
Headache due to increased intracranial pressure.
Nausea and vomiting due to increased intracranial pressure.
Photophobia (sensitivity to light) due to irritation of the cranial nerves.
Fever due to infection.
Malaise and fatigue due to infection.
Myalgia (muscle aches) due to viral infection.
Petechial rash on skin and mucous membranes with meningococcal
infection.
Seizures due to irritation of brain from increased intracranial pressure.
Bulging anterior fontanel in infants.
Kerning sign where the child lies flat with legs flexed at hips and knees.
The child resists positioning and experiences pain indicating a positive
Kerning sign.
Brudzinski sign where the head is flexed while in the supine position. A
positive sign is if the child experiences pain or if the child’s hips and
knees are flexed.Test Results
Lumbar puncture for CSF analysis, glucose (bacterial low), protein (bac-
terial elevated), cell counts (bacterial elevated neutrophils), and culture.
Increased CSF pressure noted.
Polymerase chain reaction (PCR) test of CSF to test for organisms:
Results within a few hours (not all labs).2(^206) Pediatric Nursing Demystified