Causes
Meningitis: bacterial (S. pneumoniae, N. meningitidis, H. influenzae), viral, fungal. Encephalitis: viral (HSV, West Nile, enterovirus). Bacterial meningitis: 10-15% mortality even with treatment.
Clinical Presentation
Classic triad: fever, nuchal rigidity, altered mental status. Kernig/Brudzinski signs. Meningococcal: petechial rash. Encephalitis: focal deficits, seizures, behavioral changes.
Nursing Management
Isolate immediately (droplet precautions). Antibiotics ASAP (delay >2h increases mortality). LP for CSF analysis. Monitor for increased ICP, seizures, DIC. Neuro checks hourly.
Important Notes
- Droplet precautions required immediately for suspected bacterial meningitis — do not wait for confirmation.
- Antibiotics should not be delayed for LP — start empiric therapy while awaiting results.
Clinical Tips
- Assess for petechial rash — purpura fulminans (DIC) is life-threatening in meningococcal meningitis.
- CSF opening pressure >200 mmH2O suggests increased ICP — notify provider.
Summary
Meningitis and encephalitis require prompt isolation, immediate antibiotics, CSF analysis, and hourly neuro monitoring.
