When interviewing the parents of a 2-year-old child, a history of which of the following illnesses would lead the nurse to suspect pneumococcal meningitis?
A. Bladder infection
B. Middle ear infection
C. Fractured clavicle
D. Septic arthritis
Correct Answer: B. Middle ear infection
Organisms that cause bacterial meningitis, such as pneumococci or meningococci, are commonly spread in the body by vascular dissemination from a middle ear infection. Meningitis may also be a direct extension from the paranasal and mastoid sinuses. The causative organism is a pneumococcus. A chronically draining ear is frequently also found.
Option A: Bladder infection does not cause meningitis. The most common bacterial culprit varies by age. Group B Streptococcus is common in infants less than 2 months of age while Streptococcus pneumoniae is the most common in all other age groups, with the exception of 11 – 17 year olds, where Neisseria meningitidis is still the most common cause.
Option C: A fractured clavicle does not lead to meningitis. History should include questioning about any recent neurosurgical procedures, immunization status, and living arrangements. A physical exam may reveal nuchal rigidity or positive Kernig’s or Brudzinski’s signs.
Option D: Septic arthritis rarely leads to bacterial meningitis. Nosocomial infections are caused by S. pneumonia, Staphylococcus aureus, Staphylococcus albus, and gram-negative bacilli. As per Thigpen etal. out of the 1670 cases reported in the U.S. during 2003–2007, S. pneumoniae was the predominant infective species (58.0%), followed by GBS (18.1%), N. meningitidis (13.9%), H. influenzae (6.7%), and L. monocytogenes (3.4%).
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