• Describe the epidemiology of meningitis

  • 1.2 million cases worldwide per annum

  • Severe morbidity (disability) and mortality rate of over 20%

  • Approximately 135,000 fatalities per annum

  • Common in the "Meningitis Belt" in Africa from Senegal to Ethiopia.

  • UK and Ireland have the highest incidence in Europe

 

• Describe the pathophysiology of meningitis

  • Infection of the meninges, mainly the pia and arachnoid mater.

  • Streptococcus pneumoniae and Neisseria meningitidis are the most common and most aggressive pathogens of meningitis.

  • Inflammation also affects brain parenchyma, resulting in cerbral oedema and raised intracranial pressure

  • Damage to brain structures can occur, and if untreated or treated late, cellular destruction will take place resulting in brain damage, and damage to cranial nerves.

 

• Describe the assessment process for a patient with meningitis

  • Obtain an accurate history from the caregiver or parent.

  • Assess for any life-threatening conditions in primary survey.

  • Perform a detailed physical exam looking for signs of rash or meningeal irritation. Remember however that these may not be present in all patients.

  • Check temperature, many patients with bacterial meningitis will be pyrexial. Children with septicaemia often have rigors.

  • Perform point of care lactate, VBG and electrolyte testing if available to help guide fluid and shock therapy.

 

• Outline the signs and symptoms of meningitis

  • Symptoms and signs may vary from patient to patient

  • Only half of patients will develop the classic signs of bacterial meningitis - headache, fever, neck stiffness and altered mental status

  • Signs and symptoms in infants and younger children can be subtle, and can range from irritability, drowsiness, vomiting and diarrhoea to seizures, headache, difficulty breathing and unconsciousness.

  • Signs of septicaemia can occur independently of meningitis.

  • Signs of meningeal irritation are not always present.

 

• Describe the management of a patient with meningitis

  • Ensure appropriate infection control measures are taken

  • Manage any identified life threatening conditions

  • Provide supportive therapy as required, including fluid resuscitation

  • Administer antibiotic therapy

  • Consider administration of corticosteroids in conjunction with antibiotic therapy

  • Pre-alert ED and activate care pathway if available

 

• List the infection control precautions required when dealing with a patient with suspected meningitis

  • Perform adequate handwashing prior to, during and after patient contact

  • Wear gloves and standard precautions throughout the assessment and management of the patient

  • Wear faceshield and mask if performing invasive airway manouevres

  • If exposure to droplets occurs, seek occupational health advice or follow local exposure protocols

  • Ensure your vaccination status is current

 

Remember, many patients with meningitis will not present with classic signs and symptoms, and physical examination alone has been shown to be insufficient to diagnose meningitis. Paramedics should always maintain a high index of suspicion for meningitis in the unwell child.