What is meningitis and its symptoms. Symptoms and first signs of meningitis: how does this disease manifest itself? The pathogenesis of the development of inflammation of the meninges

Meningitis is an inflammatory process that affects the meninges. Meningitis is represented by several forms, each of which is life-threatening for the patient and requires immediate medical attention. In most cases, inflammation of the meninges develops against the background of ingestion of infectious pathogens. This pathological process, regardless of etiology, is characterized by the presence of general meningeal symptoms, general inflammatory signs, as well as inflammatory elements in the cerebrospinal fluid. When diagnosing meningitis, an analysis of the clinical picture is carried out, and a number of additional studies are carried out, the key among which is lumbar puncture, according to its results, it is possible to clarify the form of meningitis and determine the optimal treatment tactics.

Classification of meningitis

To date, there is no single classification of meningitis; in clinical practice, inflammation of the meninges is divided simultaneously according to several criteria.

By etiology:

• bacterial (staphylococci, mycobacterium tuberculosis, streptococci);
• fungal (cryptococci, fungi of the genus Candida);
• protozoal (with toxoplasmosis, malaria);
• viral (for herpes, measles, rubella, HIV, ECHO).

By the nature of the inflammatory process:

• serous (develops with infectious diseases);
• purulent (in the presence of a high level of leukocytes in the cerebrospinal fluid).

By pathogenesis:

• primary (the development of the inflammatory process in the meninges occurs independently, in the absence of a general infectious lesion of the body or local infection of any organ);
• secondary (developing against the background of a local or general infectious disease).

According to the prevalence of the process:

• limited;
• generalized.

By localization of the process:

• convexital;
• diffuse;
• local;
• basal.

According to the course of the disease:

• acute (these include lightning);
• subacute;
• chronic;
• recurrent.

According to the severity, the forms are distinguished:

• light;
• average;
• heavy;
• extremely heavy.

Etiology and pathogenesis of meningitis

Etiological factors that trigger the mechanism of development of meningitis can be:

• bacterial pathogens (pneumococcus, staphylococcus, meningococcus, E. coli, streptococcus, mycobacterium tuberculosis);
• mushrooms (cryptococci, candida);
• viruses (rubella, measles, Coxsackie, HIV, ECHO, herpes).

In some cases, inflammation of the meninges develops as a result of complications of helminthiases and the introduction of protozoa into the body.

Ways of entry of infection into the body

• Infectious agents can penetrate the meninges in various ways, but most often the primary focus of inflammation, and as a result, the entrance gate for infection, is localized in the nasopharynx. Further, the infection, along with the bloodstream, moves to the membranes of the brain. As a rule, the spread of infection throughout the body through the bloodstream is characteristic in the presence of chronic foci of infection (sinusitis, otitis media, cholecystitis, furunculosis, pneumonia, etc.).
• There is also a contact route for the introduction of an infectious pathogen into the meninges. This variant of the development of meningitis can occur when the integrity of the skull bones is broken and pus penetrates into the cranial cavity as a result of osteomyelitis against the background of purulent sinusitis, inflammation of the eyeball and orbit, as well as with congenital malformations of the central nervous system, after lumbar punctures, with defects in the soft tissues of the head and with skin fistulas.
• In rare cases, the infection can spread to the meninges through the lymphatic vessels of the nasal cavity.

Patients of any age can suffer from this disease, but most often meningitis develops in children, the reason for this is the imperfection of the blood-brain barrier (a function of the body whose task is to protect the human nervous system from foreign substances) and insufficient development of immunity.

An important role in the development of meningitis is played by predisposing factors, which include: infectious diseases, traumatic brain injury, intrauterine fetal pathologies, vaccination, etc.

With the penetration of pathogenic microorganisms into the central nervous system, the soft membranes of the brain and spinal cord are damaged. In most cases, the pathological process extends to the soft and arachnoid membranes, but it is also possible to damage the dura mater, the roots of the cranial and spinal nerves, and the upper brain.

The impact of the inflammatory process on the meninges can provoke many complications from most organs and systems, in particular adrenal, renal, respiratory and heart failure, and in some cases leads to death.

Clinical picture of meningitis

Regardless of the etiological factors and mechanisms of development of this pathology, the clinical picture of meningitis is characterized by standard manifestations: meningeal syndrome in combination with characteristic changes in the cerebrospinal fluid, as well as general infectious symptoms.

Meningeal syndrome develops as a result of irritation and inflammatory reactions in the meninges and is clinically manifested by a general cerebral symptom complex and proper meningeal symptoms. General cerebral symptoms include dizziness, headache, light and sound phobia. The first manifestations of meningeal symptoms, as a rule, occur 2-3 days after the onset of the disease and are expressed as follows: stiff neck muscles, symptoms of Brudzinsky, Kernig, Lesage, etc. The impossibility of passive head flexion (stiff neck) is the first and constant sign of inflammation meninges.

In addition, there is a separate group of symptoms, which consists of characteristic pain sensations diagnosed during palpation and percussion of certain target points. With meningitis, patients feel pain if they press on the eyeballs through closed eyelids, on the front wall of the external auditory canal, when the skull is tapped, etc.

The clinic of meningitis in young children is characterized by mildness, therefore, when examining a child with a suspected inflammatory process in the brain and in particular meningitis, attention is paid to tension, bulging and pulsation of the large fontanelle and a number of other symptoms.

An important element of the clinical picture of meningitis is the presence of characteristic changes in the cerebrospinal fluid. Inflammation of the meninges is evidenced by cell-protein dissociation in the cerebrospinal fluid. During the study of purulent meningitis, the cerebrospinal fluid has a cloudy color, there is an increased pressure of the cerebrospinal fluid, and a large number of protein cells are determined in its content.

In elderly patients, the symptoms are atypical, which manifests itself in mild headaches or their complete absence, drowsiness, tremors of the limbs and head, as well as mental disorders.

Diagnosis and differential diagnosis of meningitis

Treatment of meningitis

Meningitis is a direct indication for hospitalization of the patient. Therapeutic tactics is etiotropic in nature and is aimed at eliminating the primary focus of infection. The effect of etiotropic treatment is to be assessed by analyzing clinical data and the results of microscopic examination of the cerebrospinal fluid.

In the treatment of bacterial meningitis, both in children and adults, the main emphasis in drug therapy is on the appointment of antibacterial drugs in large doses. The choice of antibiotic depends on the causative agent of the infection.

With a viral origin of the inflammatory process, the use of antiviral drugs, in particular viferon, is relevant. And with fungal etiology, meningitis is treated with antimycotic drugs.

Along with therapeutic measures aimed at eliminating the cause of the disease, the use of detoxification and restorative therapy is very important.

In order to prevent seizures, the use of lytic mixtures (pipolphen, chlorpromazine, novocaine) is recommended. If the course of meningitis is complicated by cerebral edema or Waterhouse-Friderichsen syndrome, it is advisable to use corticosteroids (dexamethasone). Also, if necessary, symptomatic treatment of pain and hyperthermia is carried out.

Prognosis for meningitis

The prognosis of this disease depends on the cause of its development and the timeliness of therapeutic measures. Sometimes, after treatment of inflammation of the meninges, patients may have a headache, impaired hearing, vision, cerebrospinal fluid hypertension, etc. If not diagnosed and treated in time, meningitis can be fatal.

Prevention of meningitis

To prevent this disease, it is necessary to lead a healthy lifestyle, harden, timely sanitize foci of acute and chronic infection, and at the slightest suspicion of a disease, immediately contact a specialist.

Meningitis is an acute infectious disease that causes inflammation of the lining of the spinal cord and brain. Infection can be provoked by fungi, viruses and various bacteria, for example: Haemophilus influenzae, enteroviruses, meningococcal infection, tuberculosis bacilli. Signs of meningitis can appear at any age, but tend to affect immunocompromised people, premature babies, and patients with head, back, and central nervous system injuries.

With adequate and, most importantly, timely treatment of meningitis, the vital organs and systems of a person usually do not suffer. The exception is the so-called reactive meningitis, the consequences of which are extremely severe. If meningitis treatment is not started on the first day after the onset of severe symptoms, the patient may become deaf or blind. Often the disease leads to coma and even death. As a rule, transferred meningitis in children and adults forms immunity to the action of pathogens, but there are exceptions. However, cases of recurrence are extremely rare. According to experts, the infection occurs again only in 0.1% of people who have been ill.

What can be meningitis?

The disease is primary and secondary. The first type of infection is diagnosed if the meninges are immediately affected during infection. Secondary meningitis in adults and children manifests itself against the background of the underlying disease (leptospirosis, otitis media, mumps, etc.), develops slowly, but eventually also leads to damage to the meninges.

A distinctive feature of both types of infection is the acute nature of the clinical course of the disease. The disease develops within a few days and requires immediate treatment to prevent serious complications. An exception to this rule is tuberculous meningitis, which may not manifest itself for several weeks or even months.

Causes of meningitis

The main causative agent of the disease is meningococcal infection. In most cases, it is transmitted by airborne droplets. The source of infection is a sick person, and you can catch the infection anywhere, anywhere, from public transport to clinics. In children's groups, the pathogen can cause real epidemics of the disease. We also note that when a meningococcal infection enters the human body, purulent meningitis usually develops. We will talk about it in more detail in one of the following sections.

The second most common cause of the disease are various viruses. Most often, an enterovirus infection leads to damage to the meninges, however, the disease can also develop in the presence of the herpes virus, measles, mumps or rubella.

Other factors that provoke meningitis in children and adults include:

• boils on the neck or face;
• frontitis;
• sinusitis;
• acute and chronic otitis;
• lung abscess;
• osteomyelitis of the bones of the skull.

Reactive meningitis

Reactive meningitis is one of the most dangerous forms of infection. Often it is called lightning because of the extremely fleeting clinical picture. If medical assistance was provided too late, the patient falls into a coma and dies from multiple purulent foci in the brain. If doctors began to treat reactive meningitis within the first day, the consequences will not be so serious, but they can also threaten a person's life. Of great importance in reactive meningitis is timely diagnosis, which is carried out by taking a lumbar puncture.

Purulent meningitis in adults and children

Purulent meningitis is characterized by the development of cerebral, general infectious and meningeal syndromes, as well as CNS lesions and inflammatory processes in the cerebrospinal fluid. In 90% of reported cases, the causative agent of the disease was infection. If a child develops purulent meningitis, the symptoms initially resemble a common cold or flu, but after a few hours, patients experience the characteristic signs of a meningeal infection:

• very severe headache;
• repeated vomiting;
• confusion;
• the appearance of a rash;
• neck muscle tension
• strabismus;
• pain when trying to pull the head to the chest.

In addition to the above symptoms of meningitis, children also have some other signs: drowsiness, convulsions, diarrhea, pulsation of the large fontanel.

Treatment of meningitis

Patients with meningitis are subject to immediate hospitalization. Do not try to treat meningitis with folk remedies and do not put off calling an ambulance at all, because infection jokes can easily end in disability or death.

Antibiotics are the drugs of choice in the treatment of meningitis. Note that in about 20% of cases, it is not possible to identify the cause of the disease, therefore, broad-spectrum antibiotics are used in hospitals in order to act on all possible pathogens. The course of antibiotic therapy lasts at least 10 days. This period increases in the presence of purulent foci in the skull.

Currently, meningitis in adults and children is treated with penicillin, ceftriaxone, and cefotaxime. If they do not give the expected effect, then patients are prescribed vancomycin and carbapenems. They have serious side effects and are only used when there is a real risk of life-threatening complications.

If there is a severe course of meningitis, the patient is prescribed endolumbar administration of antibiotics, in which the drugs go directly into the spinal canal.

Video from YouTube on the topic of the article:

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

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

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

Bacterial meningitis

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

There are several microbes 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 getting bacterial meningitis:

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

Distribution routes

A patient with bacterial meningitis may be contagious. Some pathogens are transmitted with droplets of saliva when sneezing, coughing, kissing. But fortunately, all these bacteria are not as contagious as viruses, so the risk for 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 debuts with fever, headache, and neck stiffness. Other persistent symptoms include:

• Nausea
• Vomit
• Consciousness disorders

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

Newborns (under 1 month old) are at greater risk of getting bacterial meningitis than older babies. In toddlers, 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 babies, 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, can develop.

Diagnostics

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

Treatment

Bacterial meningitis is well treated with antibiotics in the vast majority of cases. It is very important to start treatment as early as possible. Properly selected antibiotics reduce the risk of death by up to 15%, although mortality can remain high among young children and the elderly.

Prevention

The best way to protect yourself and your children from bacterial meningitis is to keep all vaccinations up to date. 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 patients with meningitis, or relatives of the sick person, are sometimes given prophylactic antibiotics.

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

Viral meningitis

Viral meningitis is much easier than bacterial meningitis. Sometimes it goes away on its own without any treatment. However, viral meningitis can be extremely dangerous for the elderly and those 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 enterovirus meningitis.

Other viral infections that can be complicated by meningitis include:

• 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, then he can 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 drugs that can weaken the immune system. For example, chemotherapy or immunosuppressive therapy.

Spreading

Enterovirus spreads from person to person by the fecal-oral route, that is, it is a disease of dirty hands. Also, enterovirus can be transmitted by airborne droplets, through droplets of saliva that fly out when coughing and sneezing.

Signs and symptoms

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

• Nausea
• Vomit
• Photophobia (painful sensitivity to light)
• Consciousness disorders

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

Anyone can get viral meningitis. The symptoms of viral meningitis are practically the same as 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 specific to 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) they disappear. The viruses that cause meningitis can also affect not only the membranes, but also the tissues of the brain and spinal cord.

Diagnostics

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

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

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

Infectionists are trying to select the right antiviral agents for the treatment of patients, for example, Acyclovir to combat herpes meningitis. Since antibiotics do not act on viruses, they are not prescribed. Most patients recover in 7 to 10 days.

Prevention

A specific 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 people who are sick. However, this can be difficult because viral infections do not always produce symptoms: a person can be sick and contagious without knowing it.

Risk factors

Negleria Fowler is found in all corners of the world. It can be found in:

• rivers and lakes
• geothermal springs
• 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 join. 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, it has not yet been possible to find out 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 waters where it can live.

Fungal meningitis

Causes

Fungal meningitis is rare. Although theoretically no one is immune from this type of meningitis, people with immunodeficiencies have the highest risk of getting sick.

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

Spreading

Fungal meningitis is not contagious, it is not transmitted from a sick person to a healthy one. Fungal meningitis develops after the fungus enters the brain through the bloodstream from the primary focus.

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

Risk factors

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

Signs and symptoms

Symptoms of fungal meningitis include:

• Fever
• Headache
• Neck muscle stiffness
• Nausea and vomiting
• Photophobia
• Consciousness disorders

Diagnostics

At the diagnostic stage, the patient is given a blood test, a lumbar puncture, and the cerebrospinal fluid is sent to the laboratory for analysis. Without establishing 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 entire period of treatment, the patient must be in the infectious diseases department. 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 prophylaxis against fungal meningitis.

Noninfectious meningitis

Causes

Possible causes of noninfectious meningitis include:

• Malignant neoplasms
• Systemic lupus erythematosus
• Some medicines
• Head injury
• Operations on the brain

Spreading

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

Signs and symptoms

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

• Nausea
• Vomit
• Photophobia
• Consciousness disorders

Diagnostics

• If a person experiences severe headaches and he has a fever and stiff neck, then all doctors first of all think about meningitis. Then a series of studies is carried out to determine the nature of the disease (bacterial, viral, fungal). If a patient has mild symptoms, they most likely have non-bacterial 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 are a large number of leukocytes in the cerebrospinal fluid, confirming inflammation, but there are no bacteria, no viruses, or other possible pathogens.
• If the infectious disease specialist suspects the presence of a cyst in the brain, then the patient will be assigned an MRI or CT scan.

Treatment

• If the patient's condition is very serious, then 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 excluded. Otherwise, if the patient still has bacterial meningitis, without prescribing 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.
• After the cause of meningitis is identified, the doctor prescribes the appropriate treatment. The patient must undergo symptomatic therapy.

Meningitis is an infectious disease, the course of which is characterized by extensive inflammation of the spinal cord and brain; various types of viruses and bacteria act as its causative agents. Meningitis, the symptoms of which appear depending on the specific type of pathogens, occurs either suddenly or within a few days from the moment of infection.

general description

As we have already noted, with meningitis, the brain is exposed to inflammation, in particular, its membranes. That is, it is not brain cells that are damaged during meningitis, but the outer region of the brain, within which the inflammatory process is concentrated.

Meningitis in adults and children can occur in a primary or secondary form. So, primary meningitis occurs with a one-time lesion of the brain, secondary meningitis is formed against the background of a concomitant underlying disease, in which infection spreads with a subsequent, relevant for meningitis, lesion of the meninges. As the main diseases in this case, one can single out, etc.

In almost all cases, meningitis proceeds quickly - as we have already noted, it develops over a period of several days. As an exception to the general variants of the course of the disease, only tuberculous meningitis, which develops gradually, can be distinguished.

The incidence of meningitis is noted in a variety of age categories, while age is not a determining criterion in susceptibility to this disease - here, as expected, the state of the body as a whole plays a leading role. For example, premature babies, due to the weakened state of the body, are most susceptible to meningitis.

In addition, the group of people who may develop meningitis can include patients with certain CNS defects, as well as with back or head injuries. Also, the transmission of the disease is possible during childbirth, through mucous membranes, contaminated food and water, through insect bites and airborne droplets. In any case, there are many factors that can also determine the predisposition to meningitis.

Types of meningitis

Depending on the etiology, that is, on the causes that provoked meningitis, this disease can be infectious, infectious-allergic, microbial, neuroviral, traumatic or fungal. Microbial meningitis, in turn, can manifest itself in the form of serous meningitis, tuberculous meningitis, influenza or herpetic meningitis.

Depending on the localization of the inflammatory process in meningitis, pachymeningitis is distinguished, in which, as a rule, the dura mater is affected, leptomeningitis, in which the soft and arachnoid membranes of the brain are affected, and panmeningitis, in which all membranes of the brain are affected by the inflammatory process. If the inflammatory lesion is predominantly localized in the area of ​​the arachnoid, then the disease is defined as arachnoiditis, which, due to its characteristic clinical features, is classified as a separate group.

Basically, meningitis is divided into purulent meningitis and serous meningitis, we will consider the features of both types of forms a little lower.

Depending on the origin, as we have already identified, meningitis can be primary (this includes most of the neuroviral forms of meningitis, as well as purulent meningitis) and secondary (syphilitic, tuberculous, serous meningitis).

Depending on the nature of the CSF, meningitis can be hemorrhagic, purulent, serous, or mixed. Based on the characteristics of the course, meningitis can be fulminant or acute, subacute or chronic.

The localization of the inflammatory process in meningitis determines such varieties of its forms as superficial meningitis (or convexital meningitis) and deep meningitis (or basal meningitis).

The ways of infection of the meninges determine the following possible forms for meningitis: lymphogenous, contact, hematogenous, perineural meningitis, as well as meningitis that occurs against the background of traumatic brain injuries.

Any type of meningitis is characterized by the occurrence of meningeal syndrome, which manifests itself in an increase in intracranial pressure. As a result of this manifestation, this syndrome is characterized by the appearance of a bursting headache with a simultaneous sensation of pressure on the ears and eyes, there is also an increased sensitivity to the effects of sounds and light (which is defined, in turn, as hyperacusis and photophobia). Vomiting and fever appear, rashes and epileptic seizures may also appear.

meningococcal meningitis

With this form of meningitis, pathological changes affect the basal and convex surfaces of the brain. Fibrinous-purulent or purulent fluid formed in the area of ​​inflammation (exudate) densely covers the brain (similar to a cap), while the infiltrates formed in the area along the vessels end up in the substance of the brain. As a result, edema begins to develop, the medulla begins to overflow with blood within its own vessels (i.e., hyperemia occurs).

Similar changes are also noted in the region of the spinal cord.

Timely initiation of treatment can ensure the subsidence of the inflammatory process, after which the exudate is completely destroyed. If we talk about advanced cases of the course of this disease, as well as cases with the appointment of irrational therapy with its relevance, then the possibility of developing a number of specific processes is not excluded, as a result of which, in turn, the processes of liquorodynamics may be disrupted, against which it is already developing.

Now let's move on to the symptoms that characterize this form of meningitis.

Most often, it develops in a sudden way, which is accompanied by a sharp increase in temperature and the appearance of vomiting (it is repeated and does not bring proper relief to the patient). Due to increased intracranial pressure, a severe headache occurs. Against the background of the general condition, the patient develops a characteristic posture, in which there is tension in the region of the occipital muscles with simultaneous arching of the back and bent legs brought to the stomach.

Many patients during the first days of the disease notice the appearance of a rash, which, meanwhile, disappears within one to two hours. In some cases, the posterior pharyngeal wall is also prone to hyperemia with simultaneous hyperplasia in its follicular area. Also, a number of patients are faced with the appearance, noted just a few days before the onset of meningitis. Meningitis in infants in this form develops mainly gradually; in older children, a similar variant of the course is noted in rare cases.

Based on the severity of the course of the disease, the patient may experience symptoms in the form of muscle cramps, darkening of consciousness, or a state of unconsciousness. In the case of an unfavorable course of meningitis, by the end of the first week, patients have a coma, in which the foreground symptoms are paralysis of the facial nerve and eye muscles. Convulsions, which appeared earlier periodically, gradually become more frequent and it is during one of the next manifestations that the patient dies.

If the course of meningitis in the form under consideration is defined as favorable, then this, in turn, is accompanied by a decrease in temperature, the patient has a previously lost appetite. Ultimately, the meningitis patient gradually moves into the recovery phase.

The total duration of the course of meningitis in the meningococcal form is about two to six weeks. Meanwhile, in practice, cases are not excluded in which the course of the disease occurs at lightning speed. In such a situation, the death of the patient occurs within just a few hours from the onset of the disease.

With a prolonged course, after a short period of improvement, the patient's temperature rises again, and it is established for a long time. This type of protracted form is either a hydrocephalic stage or a stage in which the patient develops meningococcal sepsis, during which the meningococcus enters the bloodstream (which is defined as meningococcemia).

The main feature of this course is the appearance of a hemorrhagic rash. In addition, there is an increase in temperature and a decrease in blood pressure, shortness of breath appears, and tachycardia is also noted in patients.

The most severe manifestation of meningitis in this form is bacterial shock. In this case, the disease develops acutely, with a sudden increase in temperature and the appearance of a rash. The patient's pulse also quickens, breathing is characterized by unevenness, convulsions are often noted. Further, the state becomes coma. Often, the death of a patient with such a course occurs without returning to consciousness.

There are also a number of the following symptoms with characteristic features inherent in them:

• Skin necrosis. The severe course of the disease against the background of exposure to meningococcal infection leads to the development of inflammation in the vessels and. As a result of this, it develops, an extensive type of hemorrhage occurs and, in fact, necrosis, which is especially pronounced in those areas in which compression is noted. Subsequently, rejection of the subcutaneous tissue and necrotic skin occurs, resulting in ulcers. They heal, as a rule, quite slowly, the depth and vastness of the skin lesion often require its transplantation. Keloid scars in this case are also a frequent result of the course of the disease.
• . The acute stage of the course of the considered form of meningitis is in some cases accompanied by damage to the cranial nerves, of which the greatest vulnerability is determined by the abducens nerve due to the passage of a significant part of it along the base of the brain. In case of damage to this nerve, paralysis occurs in the region of the lateral rectus muscles of the eyes. As a rule, strabismus disappears after a few weeks. But due to the spread of infection to the inner ear, partial deafness or complete hearing loss is often noted.
• . A frequent manifestation of meningitis of the form in question is, which disappears quite quickly during treatment. With regard to uveitis, it is a much more serious complication, which can result in panophthalmitis and subsequent blindness. Meanwhile, the antimicrobial therapy used today minimizes such severe consequences.

Purulent meningitis

Purulent (secondary) meningitis is accompanied by turbidity, swelling and hyperemia of the meninges of the cerebral hemispheres (their convex surface). Purulent exudate fills the subarachnoid space.

The onset of the disease is accompanied by a sharp deterioration in the general condition of the patient, in which he experiences chills, his temperature also rises. Severe forms of the course may be accompanied by loss of consciousness, convulsions, delirium. There is also a symptom traditional for the disease as a whole in the form of repeated vomiting. With purulent meningitis, internal organs are affected, and joints are also affected.

A sharp severity is noted in the manifestation of symptoms such as stiff neck muscles and symptoms of Kernig, Brudzinsky. Kernig's symptom determines the impossibility of extension of the leg bent at the knee and hip joint. As for the symptom of Brudzinsky, its manifestations are reduced to bending the legs at the knees when trying to tilt the head forward in the supine position; pressure on the pubis also leads to bending the legs at the knee joints.

Serous meningitis

Serous meningitis is characterized by the appearance of inflammatory serous changes in the meninges. In particular, serous meningitis includes its viral forms. In about 80% of cases, enteroviruses, as well as the mumps virus, are determined as the causative agent of serous meningitis. Influenza and adenovirus meningitis, herpetic and parainfluenza forms of this disease are also common, including a number of other variants of its manifestation.

The source of the virus is mainly house mice - the pathogen is found in their secretions (feces, urine, nasal mucus). Accordingly, human infection occurs as a result of the consumption of products that have undergone such contamination with secretions.

Mostly the disease occurs in children from 2 to 7 years.

The clinic of the disease can be characterized by meningeal symptoms in combination with fever, manifested to a greater or lesser extent, often combined with symptoms of lesions of a generalized scale in other organs.

Viral meningitis can be characterized by a two-phase course of the disease. Along with the main manifestations, there may be signs indicating damage to the peripheral and central nervous system.

The duration of the incubation period of the disease is about 6-13 days. Often there is a prodromal period, accompanied by manifestations in the form of weakness, weakness and catarrhal inflammation of the upper respiratory tract simultaneously with a sudden increase in temperature up to 40 degrees,. Also, these symptoms can be supplemented by a pronounced shell syndrome, in which there is a severe headache and vomiting.

In some cases, the examination determines the presence of congestion in the fundus area. Patients complain of pain in the eyes. As for the vomiting noted above, it can be both repeated and multiple. As in the previous variants of the development of meningitis, there are symptoms of Kernig and Brudzinsky, a characteristic tension of the occipital region. Expressed cases of manifestation of the disease are accompanied by a typical posture of the patient, in which his head is thrown back, his stomach is pulled in, his legs are bent at the knee joints.

Tuberculous meningitis

This form of meningitis is also predominantly observed in children, and especially in infants. Tuberculous meningitis is much less common in adults. In about 80% of cases of the relevance of this disease in patients, either residual effects of tuberculosis that they had previously suffered, or a form of the active course of this disease in a different area of ​​​​concentration at the time of detection of meningitis, are detected.

The causative agents of tuberculosis are a specific type of microbacteria, common in water and soil, as well as among animals and people. In humans, it mainly develops as a result of infection with the bovine species of the pathogen or the human species.

Tuberculous meningitis is characterized by three main stages of development:

• prodromal stage;
• irritation stage;
• the terminal stage (accompanied by paresis and paralysis).

prodromal stage the disease develops gradually. Initially, there are manifestations in the form of headache and nausea, dizziness and fever. Vomiting, as one of the main signs of meningitis, can appear only occasionally. In addition to these symptoms, there may be a delay in stool and urine. As for the temperature, it is mostly subfebrile, its high rates are extremely rare at this stage of the disease.

After about 8-14 days from the beginning of the prodromal stage of the disease, the following stage develops - irritation stage. In particular, it is characterized by a sharp increase in symptoms and an increase in temperature (up to 39 degrees). There is a headache in the occipital and frontal regions.

In addition, there is an increase in drowsiness, patients become lethargic, consciousness is subject to oppression. Constipation is characterized by the absence of swelling. Patients cannot tolerate light and noise; vegetative-vascular disorders are also relevant for them, manifested in the form of sudden red spots in the chest and face, which also quickly disappear.

By the 5th-7th day of the disease, meningeal syndrome is also noted at this stage (symptoms of Kernig and Brudzinsky, tension in the occipital muscles).

Severe symptoms are noted within the second stage of the stage under consideration, its manifestations depend on the specific localization of the tuberculous inflammatory process.

Inflammation of the meningeal membranes is accompanied by the occurrence of typical symptoms of the disease: headaches, muscle stiffness of the neck and nausea. The accumulation of serous exudate at the base of the brain can lead to irritation of the cranial nerves, which, in turn, manifests itself in visual impairment, strabismus, deafness, unequal pupillary dilation, and paralysis of the eyelid.

The development of hydrocephalus in varying degrees of severity leads to the blocking of certain cerebral cerebrospinal connections, and it is hydrocephalus that is the main cause that provokes a symptom in the form of loss of consciousness. In the case of blockade of the spinal cord, motor neurons experience weakness, paralysis may occur in the lower extremities.

The third stage of the course of the disease in this form is thermal stage characterized by the occurrence of paresis, paralysis. Manifestations of symptoms of this period are noted by 15-24 days of the disease.

The clinical picture in this case has the symptoms characteristic of encephalitis: tachycardia, temperature, Cheyne-Stokes respiration (that is, periodic breathing, there is a gradual deepening and increase in rare and superficial respiratory movements when reaching a maximum of 5-7 breaths and subsequent decrease / weakening , transitioning to a pause). The temperature also rises (up to 40 degrees), appear, as already noted, paralysis and paresis. The spinal form of the disease at stages 2-3 is often accompanied by extremely pronounced and severe girdle radicular pain, bedsores and flaccid paralysis.

Viral meningitis

The onset of the disease is acute, the main manifestations in it are general intoxication and fever. The first two days are characterized by the severity of the manifestations of the meningeal syndrome (headache, vomiting, drowsiness, lethargy, anxiety / agitation).

There may also be complaints of a runny nose, cough, sore throat and abdominal pain. Examination reveals all the same signs that characterize the disease as a whole (Kernig and Brudzinsky syndrome, tension in the occipital region). Normalization of temperature occurs within 3-5 days, in some cases a second wave of fever is possible. The duration of the incubation period is about 4 days.

Meningitis in adults is a severe inflammatory process that affects the membranes of the brain and spinal cord. The danger of the disease lies in the long latent incubation period and the rapid development of acute pathological symptoms. If meningitis is suspected, emergency medical attention is important, otherwise the course of the disease can lead to delayed irreversible consequences, disability or death.

Pathology is rarely recognized during the incubation period of meningitis, which lasts up to 7 days. For a week, the patient may be disturbed by symptoms of mild malaise:

In the absence of treatment during this period, the symptoms begin to gain intensity and be supplemented by more severe symptoms:

• pain in the head grows and acquires;
• the muscles of the back of the head tense up, which makes the patient take a pose with the head thrown back and the legs pressed at the knees to the stomach;
• the temperature rises to 39-40 ° C, accompanied by chills, fever;
• there is severe nausea and repeated vomiting, not dependent on food intake;
• consciousness is disturbed, the patient does not respond to the appeal to him;
• mental disorders appear - hallucinations, attacks of aggression;
• the limbs convulse, and in rare cases, involuntary urination may occur at such moments;
• there is a pronounced strabismus in cases where the inflammatory process affects the optic nerve.

The described symptoms develop at different rates depending on the type of disease. At the first suspicion of meningitis, it is necessary to go to the hospital and start immediate treatment.

Causes of the disease

The main cause of meningitis in adults is infection in the membranes of the brain, the causative agents of which can be:

1. Viruses - herpetic, mumps.
2. Bacteria - staphylococci, meningococci, streptococci, Escherichia and tubercle bacillus.
3. Fungal infections - mycoses, candida.

The factors in which pathogens are activated are:

• immunity weakened by chronic diseases or long-term use of chemicals;
• chronic fatigue;
• poor diet;
• violation of metabolic processes, the presence of diabetes;
• diseases of the gastrointestinal tract;
• the presence of HIV infection;
• insect bites (such as ticks or mosquitoes);

Also, meningitis in adults can manifest itself as a complication after suffering, pneumonia, purulent otitis or TBI.

Types of meningitis in adults

The disease is classified according to many criteria - the origin, the rate of development, the nature and cause of inflammation.

By origin, meningitis is distinguished:

1. Primary - are the result of the pathological effect of the pathogen on the membranes of the brain.
2. Secondary - develop as a complication after suffering infectious diseases.

According to the rate of development, the disease is distinguished:

1. Reactive meningitis - develops rapidly under the influence of pneumococci, type B streptococci, meningococci, and also as a complication after otitis media, sinusitis, pneumonia and other pathologies. The death of an adult patient occurs within a day.
2. Acute meningitis - caused by a purulent infection, characterized by a rapid increase in temperature. In case of failure to provide assistance within a maximum of 3 days after the onset of acute symptoms, the patient may die.
3. Subacute meningitis - inflammation is sluggish in nature, manifests itself gradually over 3-4 weeks.
4. Chronic meningitis - can occur in a latent benign form lasting from a month to 25 years, after which it suddenly disappears.

By the nature of inflammation, meningitis is:

1. Purulent meningitis is a severe form of the disease caused by meningococcal bacteria. The accumulation of pus in the membranes of the brain provokes a sharp deterioration in well-being and the rapid spread of infection throughout the body. A subspecies of purulent infection is:

• Meningococcal meningitis - the infection affects the tissues of the basal and convex part of the brain. Due to purulent contents in the membranes of the brain, edema develops, which, if no assistance is provided, causes a violation of vital functions and can lead to death.

1. Serous meningitis is a non-purulent inflammation of the tissues of the spinal cord and brain, in which an increased content of lymphocytes is observed in the cerebrospinal fluid. Subspecies of the disease include:

• Tuberculous meningitis - occurs when the tuberculosis bacillus is activated. In most cases, the disease occurs in a subacute or chronic form. It is impossible to contract this type of infection.
• Viral meningitis - develops under the influence of herpes viruses or mumps. The course of the disease is acute with severe intoxication of the body, the peak of development in most cases occurs in the summer and early autumn.

Due to the development of the disease is:

1. Bacterial meningitis - occurs due to exposure to staphylococci, E. coli, meningococci and other pathogenic bacteria.
2. Fungal meningitis - causative agents are pathogenic fungi (candida, mycoses).
3. Mixed meningitis - the cause of the development of the disease is the activation of several types of bacteria and viruses at the same time.

There are three ways of infection with meningitis, depending on the type of disease:

1. Airborne - the infection is transmitted from a sick person to a healthy person when sneezing, coughing and even talking. Cases of infection can be both single and massive, epidemic. In this way, viral and meningococcal meningitis is transmitted.
2. Fecal-oral - the causative agent of the disease enters the body of a healthy person through unwashed hands or food, household items. The nature of infection and types of infection are similar to the previous method.
3. Hematogenous - the infection penetrates into the blood during transfusion, through the placenta from the pregnant woman to the fetus, with an insect bite. This method is typical for meningitis of the secondary form, infection with it occurs much less frequently than the two previous methods.

The most dangerous carriers of the infection are patients whose meningitis occurs in the incubation period or the initial stage of the disease. In such cases, the risk of contracting meningitis increases by 5-6 times.

When diagnosing meningitis in adults, it is important to distinguish the disease by its characteristic signs and symptoms from other pathological conditions and disorders. During the initial examination, the doctor interviews the patient, clarifying the following information from him:

• the time of onset of symptoms characteristic of meningitis;
• the presence or absence of bites of ticks and other insects in recent times;
• whether the patient has visited countries with a tropical climate in the coming month, where the likelihood of being bitten by infectious insects is extremely high.

After that, the doctor assesses the patient's neurological condition by conducting tactile and auditory tests for reaction, and prescribes the following types of examination:

• a blood test for the presence of an inflammatory process in the body;
• tomography of magnetic resonance or computer type for layer-by-layer examination of the meninges;
• lumbar puncture to examine the cerebrospinal fluid and detect an increased amount of protein or lymphocytes in it.

After receiving all the results of the study, the doctor prescribes treatment, which must be started immediately.

Treatment of meningitis should be carried out in a hospital under the constant supervision of doctors. Depending on the type of infection, the patient is prescribed the following types of drugs:

1. Broad-spectrum antibiotics - prescribed in the form of intramuscular, as well as intravenous and lumbar injections:

• Penicillins (Amoxicillin, Ampicillin) - are indicated for infections caused by staphylococci, meningococci, pneumococci.
• Cephalosporins (Ceftriaxone, Cefatoxime) - are prescribed for infections when antibiotics of the penicillin group do not have the desired effect.
• Glycopeptides (Vancomycin) and Carbapenems (Bapenem) are prescribed for severe meningitis and the ineffectiveness of the above antibiotics.

1. Antifungal drugs (Fluconazole, Amphotericin) - are indicated for the treatment of meningitis caused by candida and mycoses.
2. Antiviral agents (Acyclovir) and immunomodulatory drugs - for the treatment of meningitis provoked by active viruses.
3. Diuretics (Diakarb, Uregid) - are indicated to relieve swelling of the brain tissue and reduce.
4. Infusion solutions (Colloids, Crystalloids) - are prescribed for the removal of toxins, which are the decomposition products of bacteria and viruses.
5. Antipyretics and painkillers (Paracetamol, Aspirin, Nurofen) - to relieve symptoms such as headache and high fever.

Timely treatment of meningitis in adults can alleviate the patient's condition after a few days, but a number of symptoms continue to appear over the next 2-3 months. For their complete disappearance, it is necessary to regularly visit the outpatient clinic and undergo dispensary treatment.

Self-medication with folk and improvised means is fraught with loss of time and the risk of developing complications of the disease in the future.

Consequences of meningitis in adults

Regardless of the type and degree of neglect, meningitis in adults almost always entails serious complications and consequences, since the infection affects the brain. Complications can appear both immediately at the time of the course of the disease, and in the delayed period. In the first case, the patient may develop:

• Cerebral edema - there is a disorder of consciousness, sharp fluctuations in blood pressure, tachycardia and shortness of breath with symptoms typical of pulmonary edema.
• Infectious-toxic shock - occurs against the background of poisoning of the body by the decay products of bacteria that provoke the development of meningitis.

In both cases, if emergency care is not provided by resuscitators, the patient may fall into a coma and die 2-3 hours after the onset of the active phase of complications.

The delayed effects of meningitis in adults, transferred in a mild form, may manifest themselves in the next six months in the form of symptoms:

• monotonous and frequent headaches;
• decrease in memory and mental functions;
• seizures that occur spontaneously for no specific reason.

The consequences after severe meningitis are more serious. Throughout the rest of a person's life, the following pathological conditions caused by a disorder of general brain activity may manifest themselves:

Timely access to doctors at the first signs of meningitis minimizes the likelihood of developing the described consequences.

Prevention. Vaccination against meningitis

The main preventive measure to prevent the development of meningitis is regular vaccination with a vaccine against meningococcal infection, as well as against viruses that can act as causative agents of the disease - measles, chicken pox, rubella, hemophilic and pneumococcal bacilli. Most of the vaccinations described are done in childhood. Vaccination against meningococcal infection is recommended every 3 years, starting from one and a half years, in cases of increased risk of getting meningitis.

In addition to vaccinations, people with weak immunity to prevent meningitis infection should take a number of the following measures:

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The described measures will help, if not eliminate, then significantly reduce the risk of meningitis and the development of serious consequences.