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Meningitis is an inflammatory disease of the lining of the brain.

Causes of meningitis

According to the etiology (cause of occurrence), meningitis can be infectious, infectious-allergic - neuroviral and microbial (serous meningitis, influenza meningitis, tuberculosis, herpetic), fungal and traumatic meningitis.

According to the localization of the lesion, panmeningitis is distinguished - all meninges are affected, pachymeningitis - the dura mater is mainly affected, leptomeningitis - the arachnoid and pia mater are affected. The predominant lesion of the arachnoid membrane - arachnoiditis - due to clinical features is allocated to a separate group.

Meningitis is divided into serous and purulent.

Based on their origin, they are divided into primary ones - these include most neuroviral meningitis, purulent meningitis and secondary ones - influenza, tuberculosis, syphilitic.

The nature of the cerebrospinal fluid is serous, purulent, hemorrhagic, mixed.

According to the course – fulminant, acute, subacute, chronic.

By localization - convexital (superficial) and basal (deep - at the base of the brain).

By the routes of infection of the meninges - hematogenous, lymphogenous, perineural, contact (for example, with diseases of the paranasal sinuses, inflammation of the ear, teeth), with traumatic brain injuries.

Any meningitis occurs meningeal syndrome- increased intracranial pressure - bursting headache with a feeling of pressure on the eyes and ears, vomiting, irritating light and sounds (photophobia and hyperacusis), high temperature, possible epileptic seizures, rash. The symptoms and treatment of meningitis vary.

Purulent meningitis

Purulent meningitis– severe microbial inflammation of the meninges. This is leptomeningitis caused by meningococcal infection, streptococci, staphylococci, pneumococci and other microbes - intestinal microbes, Pseudomonas aeruginosa...

Risk factors for purulent meningitis: intoxication - smoking, alcohol, infections, stress, hypothermia, insolation - everything that weakens the body's defenses.

The source of the disease is first-order carriers (those who are not sick, but carry the microbe), second-order carriers (those with acute respiratory infections, tonsillitis, pharyngitis).

People suffer from meningitis at any age.

Meningococcus enters the meninges from the nasopharynx by hematogenous route. This is convexital meningitis - a severe inflammatory process, the purulent contents spread, forming a “purulent cloak”.

Symptoms of purulent meningitis

Purulent meningitis has a violent onset - the temperature rises quickly, headache, nausea, repeated vomiting increases, an epileptic attack may develop, symptoms of damage to the cranial nerves appear, all internal organs are affected - meningococcemia - pericarditis, ulcers, pyelitis, cystitis, joints are affected. The patient assumes a characteristic position with legs bent and head thrown back. Possible herpetic rashes and hemorrhagic rash, roseola rash on the skin and mucous membranes. Coma may develop on days 2-3.

The patient is examined by an ophthalmologist - congestion develops in the fundus. Lumbar puncture is of leading importance - an increase in cerebrospinal fluid pressure is determined, and the content of neutrophils increases.

The neurologist sees meningeal signs - stiff neck (inability to bend the head and touch the sternum), Kernig's symptom (inability to straighten a leg bent at the hip and knee joints), pain when pressing on the eyeballs, Brudzinski's sign (when trying to tilt the head forward in a lying position the legs bend at the knees; when pressing on the pubis, the legs bend at the knee joints).

A blood test is necessary - high leukocytosis and ESR will be detected, a shift in the leukocyte formula to the left. In severe cases, with a decrease in the body's defenses - leukopenia.

A fulminant course occurs more often in newborns - the child screams, has tremendous chills, has a high temperature and dies (from hours to 3 days). In adults, the course is acute, subacute. Lasts 4-5 weeks with good yield. The subacute course is more common in older people - slow development with a long period of precursors. In older people, an atypical course is possible, with only symptoms of nasopharyngitis or an epileptic seizure. Mild, moderate and severe meningitis is possible.

Head thrown back

Acute lymphatic meningitis

Acute lymphatic meningitis is a serous meningitis that occurs in epidemic outbreaks and sporadic cases. The carriers of the virus are mice (field and domestic), which secrete the virus in nasal secretions, urine, feces and contaminate objects around humans. When infected, the onset is acute with gastrointestinal disorders (nausea, vomiting, diarrhea, abdominal pain), normal or high temperature and the development of meningeal syndrome. Possible damage to 3 and 6 pairs of cranial nerves (oculomotor and abducens).

The course is characterized by reverse development without residual effects.

The group of serous meningitis includes meningitis caused by polio-like Coxsackie viruses, ECHO. They differ in summer-autumn seasonality and more often affect children. Acute development - fever, meningeal syndrome, gastrointestinal disorders. A two-wave current is possible.

The development of serous meningitis is possible with mumps, influenza, herpes infection, fungal diseases, protozoans (malaria, toxoplasmosis).

During lumbar puncture, the cerebrospinal fluid is clear, the pressure is increased, and lymphocytic pleocytosis occurs. Serous meningitis virus can be isolated from cerebrospinal fluid and nasopharyngeal swabs. Coxsackievirus can be isolated from stool. With mumps meningitis, they look for the pathogen in saliva. Cryptococcus causes severe meningitis in patients with AIDS. With syphilis, late syphilitic meningitis develops.

Tuberculous meningitis is serous leptomeningitis.

Massive prevention of the incidence of tuberculosis is being carried out - primary BCG vaccination of newborns in maternity hospitals (the vaccine was first administered to a newborn in 1921), monitoring the presence of immunity - the Mantoux reaction to select patients for re-vaccination, fluorographic examination of the entire population. Full treatment of all patients and follow-up monitoring of all those who have had tuberculosis are necessary to prevent a tuberculosis epidemic.

In 1993, WHO declared tuberculosis a national disaster and March 24 as World Tuberculosis Day. The seriousness of the tuberculosis problem can be judged by the existence of a special WHO program to identify and treat patients, which operates in 180 countries around the world.
Massive vaccination (according to the vaccination calendar) prevents many diseases that can cause meningitis. Vaccines are used against Haemophilus influenzae, meningococcal infection, pneumococcal infection, measles, mumps, measles rubella, chickenpox, and influenza.

Doctor's consultation on meningitis:

Question: when is lumbar puncture performed for tuberculous meningitis?
Answer: in the presence of minimal symptoms of meningism, immediate lumbar puncture is indicated. There will be high cerebrospinal fluid pressure, increased protein content, sugar levels decrease, and chlorides decrease. To inoculate the tuberculosis bacillus, three test tubes are analyzed, in which, upon settling, a film is formed and the pathogen can be found in it. Liquor is taken twice every other day for diagnosis, 2-3 weeks after the prescribed specific treatment to monitor the prescribed doses, then three times before discharge to monitor recovery.

Question: how can you protect yourself when in contact with someone with meningitis?
Answer: when in contact with a patient, it is necessary to use gauze bandages, wash your hands with soap, disinfect utensils, persons in close contact are given chemoprophylaxis - rifampicin, ceftriaxone, immunoglobulin.

Question: Is a CT scan done to diagnose meningitis?
Answer: yes, they do, differential diagnosis requires excluding serious brain diseases - subarachnoid hemorrhage, brain abscess, brain tumor.

Question: What is meningism?
Answer: Meningism is a mild manifestation of meningeal symptoms against the background of infection, influenza, or intoxication. Lasts 2 – 3 days and passes. Meningism occurs more often in children.

Neurologist Kobzeva S.V.

Meningitis is a disease characterized by inflammation of the lining of the brain, most often caused by infection of the cerebrospinal fluid.

Meningitis can develop for various reasons: bacterial or viral infection, traumatic brain injury, cancer, and certain medications.

The severity of the disease depends on the cause, and the treatment regimen is selected individually in each case. That's why it's so important to know everything about meningitis.

Bacterial meningitis

Bacterial meningitis is severe. Although most patients recover, many experience complications such as brain damage, hearing loss or loss, and learning disabilities.

There are several germs that cause meningitis: meningococcus, group B streptococcus, pneumococcus, listeria, Haemophilus influenzae.

Causes

The main causes of the disease (more precisely, the types of microbes that cause it):

Risk factors

Factors that increase the risk of developing bacterial meningitis:

• Age
  • Young children are more likely to get meningitis than people of all other ages. However, this does not mean that adults are not at risk.
• Staying in a team
  • Any infectious disease spreads quickly in large groups of people. Meningitis is no exception. Recruits are at greatest risk.
• Certain Conditions
  • There are some diseases, medications, and surgeries that can weaken your immune system or otherwise increase your risk of contracting meningitis.
• Working in the laboratory with pathogens that cause meningitis.
• Trips
  • A number of African countries located near the Sahara are considered to be unfavorable areas for meningitis.

Distribution routes

A patient with bacterial meningitis may be contagious. Some pathogens are transmitted through droplets of saliva when sneezing, coughing, or kissing. But fortunately, all these bacteria are not as contagious as viruses, so the risk to people visiting the sick person is not as great.

In healthy people, the microbe can be sown from the nasopharynx, but many carriers of meningococcus never get sick.

Signs and symptoms

Meningeal infection presents with fever, headache, and neck stiffness. Other persistent symptoms include:

• Nausea
• Vomit
• Impaired consciousness

Symptoms of bacterial meningitis may develop immediately or may take several days to appear. Symptoms usually appear 3 to 7 days after infection.

Newborns (up to 1 month of age) are at greater risk of developing bacterial meningitis than older children. In children, the classic symptoms of meningitis such as fever, pain, and stiff neck may be absent or unrecognized. Young children may experience loss of appetite, poor response to stimuli, vomiting, and poor appetite. In children, the doctor always checks the condition of the large fontanelle (bulging and tension is a sign of illness) and reflexes.

Later, dangerous symptoms of meningitis such as seizures and coma may develop.

Diagnostics

If meningitis is suspected, a blood test is always taken and a spinal tap is performed. The resulting samples are sent to a laboratory, where specialists do a culture to identify the bacteria and determine its sensitivity to antibiotics. It is necessary to know exactly the causative agent of the disease in order to select the right antibiotic from the very beginning and anticipate the course of the disease.

Treatment

Bacterial meningitis is highly treatable with antibiotics in the vast majority of cases. It is very important to start treatment as early as possible. The right antibiotics reduce the risk of death by up to 15%, although mortality may remain high among young children and the elderly.

Prevention

The best way to protect yourself and your children from bacterial meningitis is to stay up to date on all vaccinations. There are vaccines against pathogens that can cause meningitis:

• Meningococcal vaccine
• Pneumococcal vaccine
• Hib vaccine against Haemophilus influenzae.

Also, people who have been in contact with people with meningitis, or relatives of the sick person, are sometimes prescribed prophylactic antibiotics.

It is very important to lead a healthy lifestyle, not smoke, exercise and try not to come into contact with sick people. The latter is especially important for children, the elderly and people with weakened immune systems.

Viral meningitis

Viral meningitis is much milder than bacterial meningitis. Sometimes it goes away on its own, without any treatment. However, viral meningitis can be extremely dangerous for older people and people with weak immune systems.

Causes

Most cases of viral meningitis are complications. But it is worth noting that only a small number of people with enterovirus infection develop enteroviral meningitis.

Other viral infections that can be complicated by meningitis:

• Herpes virus, .
• Flu
• Viruses that are spread by insects (arboviruses)

Risk factors

Anyone can get viral meningitis, but newborns and people with weak immune systems are most at risk. If a person comes into contact with a patient with viral meningitis, he may catch a viral infection and get sick, for example, with the flu, but this does not mean that meningitis will necessarily develop as a complication.

Risk factors for getting viral meningitis include:

• Age
  • Most often, viral meningitis develops in children under 5 years of age.
• Weakened immune system
  • There are diseases and medications that can weaken the immune system. For example, chemotherapy or immunosuppressive therapy.

Spreading

Enterovirus spreads from person to person through the fecal-oral route, i.e. it is a disease of dirty hands. Enterovirus can also be transmitted by airborne droplets, through droplets of saliva released when coughing and sneezing.

Signs and symptoms

Meningeal infection causes sudden fever, headache, and neck stiffness. Other symptoms include:

• Nausea
• Vomit
• Photophobia (painful sensitivity to light)
• Impaired consciousness

Enterovirus is the most common cause of viral meningitis. Outbreaks of morbidity are typical in spring and autumn.

Anyone can get viral meningitis. The symptoms of viral meningitis are practically no different from those of bacterial meningitis.

Symptoms of viral meningitis may vary among patients of different age groups.

Symptoms characteristic of childhood

• Fever
• Irritability
• Poor appetite
• Drowsiness

Symptoms characteristic of adults

• Heat
• Strong headache
• Neck stiffness
• Photophobia
• Drowsiness
• Nausea and vomiting
• Poor appetite

Symptoms of viral meningitis persist for 7–10 days, and then (in people with healthy immunity) disappear. Viruses that cause meningitis can also infect not only the meninges, but also the tissues of the brain and spinal cord.

Diagnostics

If an infectious disease specialist suspects meningitis, the patient will be prescribed:

• nasopharyngeal swab,
• blood, urine and stool tests,
• blood culture for sterility,
• spinal tap.

It is very important to identify the causative agent of meningitis, since the severity, possible complications and outcome of the disease depend on the type of virus.

Treatment

Infectious disease specialists try to select the right antiviral drugs for treating patients, for example, Acyclovir to combat herpes meningitis. Since antibiotics do not act on viruses, they are not prescribed. Most patients recover within 7–10 days.

Prevention

A special vaccine against viral meningitis has not yet been developed. Thus, the best way to protect yourself and your loved ones is to avoid contact with sick people. However, this can be difficult because viral infections do not always produce symptoms: a person may be sick and contagious and not know it.

Risk factors

Naegleria fowlera is found in all corners of the world. It can be found in:

• rivers and lakes
• geothermal springs
• swimming pools (which are poorly cleaned)
• water heaters, etc.

Spreading

Symptoms and signs

The first symptoms of PAM appear 1–7 days after infection. As with any other meningitis, headache, nausea, vomiting, fever, and stiff neck are noted. Later, disturbances of consciousness, hallucinations and convulsions appear. Once symptoms appear, the disease progresses rapidly and can be fatal within 1–12 days.

Diagnostics

Treatment

According to numerous studies, some drugs are quite effective against Naegleria fowleri. However, in practice this has not yet been clarified due to the high mortality rate.

Prevention

Since Naegleria Fowler enters the body through the nose while swimming, you should try not to swim in natural bodies of water where it can live.

Fungal meningitis

Causes

Fungal meningitis is quite rare. Although theoretically no one is immune from this type of meningitis, people with immunodeficiencies are at greatest risk of getting the disease.

The main causative agent of fungal meningitis is cryptococcus. Cryptococcal meningitis is most common in Africa.

Spreading

Fungal meningitis is not contagious and cannot be transmitted from a sick person to a healthy person. Fungal meningitis develops after the fungus travels through the bloodstream from the primary lesion to the brain.

Also, an increased risk of developing fungal meningitis is observed in people with weak immunity (it is caused by HIV, AIDS, chemotherapy, taking immunosuppressants, hormones).

Risk factors

Certain medical conditions, medical procedures, and medications may increase your risk of getting fungal meningitis. For example, premature babies are at risk for candidal meningitis.

Signs and symptoms

The following symptoms are typical for fungal meningitis:

• Fever
• Headache
• Neck muscle stiffness
• Nausea and vomiting
• Photophobia
• Impaired consciousness

Diagnostics

At the diagnostic stage, the patient undergoes a blood test, a lumbar puncture, and the cerebrospinal fluid is sent to the laboratory for analysis. Without identifying the causative agent of meningitis, proper treatment is impossible.

Treatment

Fungal meningitis is treated with long courses of antifungal drugs, which are usually given intravenously. Therefore, the patient must remain in the infectious diseases department for the entire period of treatment. The duration of treatment depends on the initial state of health, the reactivity of the immune system and the type of fungus.

Prevention

There is no specific prevention against fungal meningitis.

Non-infectious meningitis

Causes

Possible causes of the development of non-infectious meningitis:

• Malignant neoplasms
• Systemic lupus erythematosus
• Some medications
• Head injuries
• Brain surgery

Spreading

This type of meningitis is not spread from a sick person to a healthy person.

Signs and symptoms

Meningeal infection causes sudden fever, headache, and a stiff neck. Other common symptoms include:

• Nausea
• Vomit
• Photophobia
• Impaired consciousness

Diagnostics

• If a person experiences severe headaches and has a fever and a stiff neck, then all doctors first think about meningitis. Then a series of studies are carried out to determine the nature of the disease (bacterial, viral, fungal). If a patient has mild symptoms, they most likely have nonbacterial meningitis.
• But in any case, the patient undergoes a spinal tap, and the cerebrospinal fluid is sent to the laboratory for analysis. In the cerebrospinal fluid, the level of sugar, protein and the number of white blood cells are determined. A culture of the cerebrospinal fluid is also done to identify the pathogen and its sensitivity to drugs. The diagnosis of non-infectious meningitis is made when there is a large number of leukocytes in the cerebrospinal fluid, confirming inflammation, but there are no bacteria, viruses, or other possible pathogens.
• If an infectious disease specialist suspects the presence of a cyst in the brain, the patient will be prescribed an MRI or CT scan.

Treatment

• If the patient's condition is very serious, the doctor prescribes standard treatment without waiting for the results of laboratory tests. The treatment regimen includes antibiotics, which the patient will receive until the bacterial nature of meningitis is ruled out. Otherwise, if the patient does have bacterial meningitis, without antibiotics, severe complications (psycho-neurological abnormalities) or even death may develop. Acyclovir is also included in the standard treatment regimen in case meningitis may be viral.
• Once the cause of meningitis is identified, the doctor prescribes appropriate treatment. The patient must undergo symptomatic therapy.

Meningitis is an inflammation of the membranes of the brain caused by bacteria, viruses, protozoa or fungi. Sometimes meningitis is of mixed etiology.

Forms of meningitis

1. Leptomeningitis (inflammation of the soft and arachnoid membranes).
2. Pachymeningitis (inflammation of the dura mater of the brain).
3. Arachnoiditis (inflammation of only the arachnoid membrane, rare).

Meningitis can affect the membranes of the spinal cord and brain (spinal and cerebral meningitis). According to the nature of inflammation, meningitis can be serous and purulent. Overproduction of cerebrospinal fluid is caused by inflammatory changes in the choroid plexuses of the ventricles. When intrathecal brain structures are involved in the process, meningoencephalitis develops. All this causes certain symptoms of meningitis.

Serous meningitis

Serous meningitis is caused by the Coxsackie and ECHO viruses. In addition to meningitis, these viruses can cause meningoencephalitis, myocarditis, and myalgia (muscle pain).

Routes of transmission of the virus:

1. Fecal-oral. Through contaminated food and water. The virus multiplies in the intestines and is released into the external environment for a long time, where it persists for a long time on household items, in food products, and sewage water.
2. Airborne droplet.
3. Transplacental transmission of the virus is possible. In the early stages of pregnancy, this causes abnormalities in the development of the fetus, in the later stages - its death or intrauterine infection.

The susceptibility of children to enteroviruses is very high, especially in children aged 3 to 10 years. Innate immunity persists until 3 months of age. In older children and adults, enterovirus infection is rare, which is explained by the presence of immunity as a result of an asymptomatic infection.

The maximum incidence of meningitis is recorded in the spring and summer. Enterovirus infection is very contagious, therefore, when introduced into a children's group, epidemic outbreaks occur (up to 80% of the group become ill).

How to suspect meningitis

It all starts with damage to the mucous membrane of the nose and throat, then the virus through the bloodstream (hematogenously) reaches different systems and organs, causing the development of acute serous meningitis or meningoencephalitis, myalgia or acute myositis, myocarditis, hepatitis and other diseases: enteroviral exanthema, gastroenteric form , myocarditis. Combined forms are often found, but the most typical of them is serous meningitis.

Meningitis begins acutely. The temperature rises to 40 degrees. Meningitis causes dizziness, severe headache, agitation, anxiety, and repeated vomiting. Sometimes there are abdominal pains, delirium, and convulsions. The face with meningitis is red (hyperemic), slightly pasty (edematous), the sclera of the eyes are injected, the throat is red, granularity is noted on the back wall of the pharynx and the soft palate.

From the first days of meningitis, meningeal symptoms appear:

1. Stiff neck - when you try to bend your head, resistance occurs.
2. A positive Kernig sign is when the leg is bent at the hip joint, but it is impossible to straighten it at the knee joint due to tension in the posterior thigh muscles.
3. Brudzinski's symptom - when the patient's leg is passively flexed at the hip and knee joints, the other leg also automatically bends.

The combination of these three symptoms is not necessary for meningitis; sometimes they are mild. More often they occur at the height of the temperature reaction during meningitis, and are short-lived.

The diagnosis is confirmed by lumbar puncture based on changes in the cerebrospinal fluid.

Meningitis lasts 3-5 days, relapses of serous meningitis are possible. After meningitis, asthenia persists for 2-3 months, residual effects of increased intracranial pressure (headache attacks, periodic vomiting).

Children with serous meningitis must be hospitalized.

How to prevent meningitis?
There is no single specific prevention of enterovirus infection, and meningitis in particular. Timely isolation of patients and early diagnosis are of great anti-epidemic importance. You cannot take your child to kindergarten at the slightest sign of any disease, endangering the health of other children. It is necessary to accustom the child to hygiene and strengthen the immune system.

Meningitis caused by meningococcus

Meningococcal infection is characterized by a variety of clinical manifestations: from simple carriage, nasopharyngitis, to generalized forms - meningoencephalitis, purulent meningitis, meningococcemia.

Meningococcus belongs to the genus Neisseria meningitidis. This bacterium dies after 30 minutes once outside the body.

From whom can you get meningitis?
Meningitis of meningococcal etiology affects only people, most often under the age of 14 years. Among them, the largest number of cases of meningitis occurs in children under 5 years of age. Children in the first three months of life rarely get meningitis. But cases of meningitis incidence have also been described in the neonatal period. Intrauterine infection is also possible. The source of the disease are carriers or sick people with catarrhal symptoms in the nasopharynx. The mechanism of transmission of infection is aerosol (by air). For infection, the crowding of children in the room and the duration of contact are important. Susceptibility to meningococcus is low: 10 - 15%. There is evidence of a family predisposition to meningococcus.

The prognosis for life and recovery depends on timely diagnosis, proper treatment, concomitant diseases, and the body’s reactivity.

Meningococcal nasopharyngitis is very difficult to distinguish from other types of runny nose and sore throat. And only during an outbreak of meningococcal infection in a children's group can it be suspected. It can go away on its own in 5-7 days, or develop into a life-threatening generalized form of the disease - meningococcemia.

Menincococcemia often begins acutely, often suddenly, with a significant increase in temperature, chills, and vomiting. In young children, headaches are accompanied by a high-pitched scream; in particularly severe cases, there may be loss of consciousness. A hemorrhagic star-shaped rash with foci of necrosis in the center appears on the body. Often it is combined with a roseolous-papular rash. There is damage to the joints in the form of synovitis and arthritis. Uveitis develops in the choroid of the eye and it becomes brown (rusty) in color.

The fulminant form of meningococcemia (hyperacute meningococcal sepsis) is especially dangerous. Elements of the rash literally form cyanotic spots, reminiscent of corpses, before our eyes. The child tosses about in bed, blood pressure drops, shortness of breath appears, meningeal symptoms are not constant, often undetectable, and muscle hypotension is noted. No online consultations on the Internet, urgently need to call an ambulance!

Meningococcal meningitis begins with chills, fever, severe headache, aggravated by turning the head, strong light or sound stimuli. There may be pain along the spine. The phenomenon of increased skin sensitivity (hyperesthesia) is one of the leading symptoms of purulent meningitis. From the first day of meningitis, vomiting appears, and it is not associated with food intake. An important symptom is seizures. Meningeal symptoms can be clear from the first day of illness, most often observed on days 2-3 of the development of meningitis.

Along with the severe course of meningococcal infection, leading to death, there are also mild abortive variants.

With timely and competent treatment of meningococcal infection, the prognosis is favorable, but it depends on the age of the child and the form of the disease. But the mortality rate remains quite high, averaging 5%.

If meningococcal infection is suspected, immediate hospitalization is required. Under no circumstances should you self-medicate. No traditional methods.

Persons who have been in contact with the generalized form of meningococcal infection or carriers are not allowed into children's institutions until the test results are negative. studies of mucus from the nasopharynx.

Hygienic measures are of important preventive importance: frequent ventilation of premises, disaggregation of children's groups, ultraviolet irradiation of premises, household items should be treated with chlorine-containing solutions, boiling of toys, dishes, preventive examinations of children by a health worker.

Are there preventive vaccinations against meningitis?
Yes, there is, but not against all groups of bacteria. Meningococcal vaccine protects against serogroups A+C or ACWY N. meningitidis. It is placed from the age of 2 years.

For non-specific prevention, in addition to the above methods, it is recommended not to swim in open water, especially for young children, and not to travel to countries where meningitis is common.

Meningoencephalitis (two-wave viral meningoencephalitis) also occurs with tick-borne encephalitis. Meningitis and meningoencephalitis also occur with candidiasis (fungal) infection in young children. The phenomena of meningism occur in various diseases, even with influenza and ARVI, and in each specific case accurate diagnosis and competent treatment are required. A virus cannot be treated with antibiotics, and antiviral drugs will not help with a microbial infection. The same goes for fungal infections. All prescriptions should be made only by a doctor. Parents are required to be attentive to their health and the health of their child. For doctors - strict fulfillment of their duties.

Meningitis is an inflammatory process in the soft and arachnoid membranes of the brain and spinal cord. This is a serious infectious disease caused by various pathogens.

Despite the large arsenal of antibacterial agents, meningitis remains one of the most terrible infections when such a diagnosis is made immediate hospitalization of the patient is necessary, since the consequences of untimely treatment of meningitis can be the most dire, the percentage of deaths is also high.

What types of meningitis are there?

Meningitis is classified:

1. According to the pathogen that caused them: bacterial, viral, fungal, rickettsial, protozoal.
2. According to the nature of inflammation: serous, purulent, mixed.
3. By severity: mild, moderate, severe.
4. According to the speed of development: fulminant, acute, subacute, chronic.
5. According to the prevalence of the process: diffuse, limited.
6. According to the source of infection: primary, when meningitis develops without an obvious primary source of infection; secondary, when the infection penetrates from another identified focus (mainly purulent).

How does meningitis develop?

For inflammation of the meninges to develop, the pathogen must somehow get inside the skull. Most often, it gets there through the bloodstream during infectious diseases (dysentery, typhoid fever), as well as in the presence of any purulent focus in the body (abscess, endocarditis, infected wound or burn). The infection can also penetrate to the meninges through the regional lymph flow, along the nerve sheaths, or by contact in the presence of a purulent focus in the head area (purulent, periostitis, peritonsillar abscess, osteomyelitis, purulent skin lesions, especially in the forehead, scalp and nasolabial triangle) , as well as in case of traumatic injuries of the skull.

The causative agent of meningitis can be almost any infectious agent. Most often this is a virus of influenza, measles, mumps, herpes,. Among the bacteria, these are pneumococci, meningococci, tuberculosis bacillus. Under certain conditions, meningitis can be caused by fungi and protozoa.

It is obvious that the penetration of infection into the membranes of the brain and the development of inflammation in them is possible under a certain state of the immune system. There are likely to be certain congenital immune defects that predispose one to the development of this disease.

When the pathogen enters the cranial cavity, it settles on the meninges, and an inflammatory reaction begins here - swelling, hypersecretion of cerebrospinal fluid, and disruption of its outflow. The membrane swells, intracranial pressure increases, irritation of the meninges and compression of the cranial and spinal nerves. Clinical symptoms arise: menningeal, cerebral, and general intoxication of the body also progresses.

During the purulent process, there is an accumulation of pus in the intrathecal space, foci of softening in the cerebral cortex, and microabscesses. Purulent exudate can cover the entire brain, or be located only in the grooves. It is obvious that with this course of meningitis, even if recovery occurs, its consequences are irreversible.

Meningitis clinic

Despite the variety of causes, the clinical picture of meningitis is usually typical for all forms. The acute form is especially similar in symptoms and usually does not cause difficulties in diagnosis. The main symptoms of meningitis, the combination of which makes it possible to make a diagnosis:

The severity of these signs of meningitis depends on the severity of the process; some of them may be weakly expressed or not detected at all in sluggish and erased forms of the disease.

In young children (up to one year) The first signs of meningitis may be nonspecific. Hyperthermia, anxiety, constant monotonous crying, regurgitation, and convulsions are noted. Only on the 2-3rd day do meningeal symptoms and impaired consciousness appear.

Let's look at the most common forms of meningitis.

Epidemic meningococcal meningitis

60-70% of all bacterial meningitis is caused by meningococcus. Its danger is that such meningitis The course is very difficult; often, especially in children, it occurs at lightning speed, leading to death within a few hours. Infection occurs from a sick or latent carrier. Infection occurs through airborne droplets, which is why it is also called epidemic meningitis.

When infected, meningococcal nasopharyngitis first develops, which differs little from the usual symptoms: redness and swelling of the mucous membrane of the pharynx, pharynx, runny nose.

Infection with meningococcus will not always cause the development of meningitis. It all depends on individual defenses. If the body is not able to create a barrier for it at the stage of nasopharyngitis, the pathogen enters the brain through the bloodstream and after a few days (from 1 to 5) a clinical picture of purulent meningitis develops (acute onset, severe course).

It is meningococcal meningitis that causes the fulminant form in children: very acute course, with the development of meningococcal sepsis (high concentration of meningococcus in the blood - meningococcemia). Under the influence of toxins, microthrombi form, hemorrhages in all organs and the child dies. A terrible symptom of menigococcemia is a hemorrhagic rash on the skin.

With timely treatment there is a high probability of a complete recovery, since meningococcus is perfectly treated with regular old penicillin.

Other purulent meningitis

Staphylococcal, pneumococcal, caused by have a higher mortality rate and irreversible consequences, since these pathogens have mostly developed resistance to existing antibiotics.

Untreated purulent meningitis leads to death in 50% of cases. The most severe form of meningitis is named reactive meningitis. This is a bacterial meningitis with a fulminant course, caused mainly by meningococci, streptococci, and pneumococci. It can be either primary or secondary. This form leads to death in 90% of cases. In adults, death occurs within 1-2 days, children die within a few hours.

Serous meningitis

Serous meningitis is mainly seasonal and epidemic in nature. Children get sick more often. The most common causes of serous meningitis are enterovirus and mumps virus.

Such meningitis is characterized by less pronounced meningeal symptoms and a relatively benign course.

Tuberculous meningitis

Recently, this form of meningitis has become much more common. Such meningitis is always secondary, complicating the course of the tuberculosis process in another organ (mainly the lungs). Develops subacutely as the disease progresses. There is a gradually increasing headache, general weakness, nausea, and increased body temperature.

Meningeal symptoms also appear gradually, after 7-10 days from the onset of the disease. Damage to the cranial nerves is typical, which is manifested by double vision, ptosis and strabismus.

Changes in the cerebrospinal fluid are often serous in nature; in 2/3 of cases, Mycobacterium tuberculosis is detected by microscopy.

Treatment of meningitis

Any suspicion of meningitis requires immediate hospitalization and immediate lumbar puncture to clarify the diagnosis.

Antibiotic therapy is the main method of treating meningitis. The choice of antibiotic depends on the type of pathogen. For purulent meningitis, treatment begins with high doses of penicillin, which is administered intravenously. Combination with other antibiotics (gentamicin, cephalosporins, kanamycin) is possible. Upon receipt of the results of a bacteriological study of the cerebrospinal fluid, treatment is carried out with an antibiotic to which the isolated pathogen is sensitive.

For viral meningitis, treatment is mainly symptomatic, since there are no effective antiviral drugs.

Tuberculous meningitis is treated with specific anti-tuberculosis drugs.

Nonspecific treatment:

In addition to antibacterial therapy, the following are used to alleviate the condition:

• Diuretics for the treatment and prevention of cerebral edema.
• Glucocorticoid hormones.
• Plasma-substituting, saline solutions.
• Glucose solution intravenously.
• Cardiovascular drugs according to indications.

For secondary meningitis - treatment of the underlying disease. If meningitis is a complication of purulent inflammation of the ENT organs or the oral cavity, immediate surgical sanitation of the lesion (opening an abscess, draining the paranasal sinuses, middle ear cavity, etc.) is necessary.

Consequences of meningitis

There are many “horror stories” that after suffering from meningitis, consequences will inevitably remain for life. This is far from true.

If treatment is started on time, meningitis can go away without any unpleasant consequences, which is observed in most cases.

In a small percentage of cases, there may be increased fatigue, headaches that will intensify with changes in atmospheric pressure, difficulties in remembering information, absent-mindedness, and sleep disturbances. However, these symptoms usually gradually disappear over 5 years.

Even more rarely, when severe purulent forms of meningitis affect the very substance of the brain, visual impairment, hearing impairment, seizures, and significant mental retardation may remain.

Prevention of meningitis

No one is immune from meningitis. But meningitis has favorite ages:

• Children under 5 years old, and boys get sick 2-3 times more often than girls.
• Young people 16 – 25 years old.
• Elderly people over 60 years of age.

You need to know the basic rules that will help minimize the risk of infection, prevent the complicated course of other diseases, and also begin timely treatment of already developed meningitis. It must be remembered that meningitis is treatable and the earlier treatment is started, the more favorable the outcome.

Video: meningitis in children, “Dr. Komarovsky’s School”