Contact meningitis. Meningitis: negative consequences and methods to minimize them. According to the rate of development of pathology

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.

Reasons

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.

Reasons

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

• High temperature
• Severe 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

Reasons

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 testing. 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

Reasons

Possible causes 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 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 cerebral 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 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 substance of the brain itself, 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”

Among the many human diseases, meningitis is one of the most dangerous. You can suffer from pneumonia on your feet, you can walk with tuberculosis for years, you can, with the help of “healers,” try to recover from sexually transmitted diseases for a long time. With meningitis, such “numbers” do not go through - either to the hospital, or...

What kind of disease is meningitis?

Meningitis is a well-known disease. At least the average person, without any special medical education, knows the word “meningitis” and, although the features of the disease itself are not very clear, everyone is afraid of meningitis. An emergency doctor may say: “You have a sore throat (flu, pneumonia, enterocolitis, sinusitis, etc.). Get ready to the hospital quickly.” In response, he will definitely hear: “Doctor, is there no way to get treatment at home?” But if the word “meningitis” is uttered, even if not categorically: “You have meningitis!”, but with doubt: “It looks like meningitis,” you can say with confidence: a normal person will not even mention any treatment at home.

This attitude towards meningitis is generally understandable - not even 50 years have passed since it became possible to treat it (meningitis). But if the mortality rate from most childhood diseases decreased during this time by 10-20 times or more, then for meningitis - only 2 times.

So what kind of disease is this, meningitis? First of all, it should be noted that meningitis is an infectious disease. That is, the direct cause of the disease is certain microbes. Most human infections allow us to establish a clear relationship between the name of the disease and the name of its specific pathogen. Syphilis is a pale spirochete, scarlet fever is streptococcus, salmonellosis is salmonella, tuberculosis is Koch's bacillus, AIDS is the immunodeficiency virus, etc. At the same time, there is no specific connection between meningitis and the causative agent of meningitis.

The word “meningitis” itself means inflammation of the membranes of the brain, and the cause of this inflammation can be a huge number of microorganisms - bacteria, viruses, fungi. Infectious disease experts say, not without confidence, that under certain conditions any microorganism can cause meningitis in a person of any age. From this it is clear that meningitis can be different - different in the speed of development, in the severity of the condition, in the frequency of occurrence, and, most importantly, in the methods of treatment. All meningitis has one thing in common - a real threat to life and a high probability of complications.

For meningitis to occur, a specific pathogen must enter the cranial cavity and cause inflammation of the membranes of the brain. Sometimes this happens when foci of infection occur in the immediate vicinity of the membranes of the brain - with purulent otitis media, for example, or with sinusitis. Often the cause of meningitis is traumatic brain injury. But most often, microbes enter the cranial cavity through the bloodstream. It is obvious that the very fact of a microbe entering the blood, the very possibility of its “introduction” and subsequent reproduction on the meninges is determined by the state of immunity.

It should be noted that there are a number of, usually congenital defects that predispose to the occurrence of meningitis. It is not surprising that in some families all children suffer from meningitis - although this disease is not so common, in comparison, for example, with sore throat, whooping cough, or rubella. But if the role of immunity is generally clear, then so far it has not been possible to find a convincing explanation for the fact that boys suffer from meningitis 2-4 times more often than girls.

Causative agents of meningitis

Depending on the type of pathogen, meningitis can be viral, bacterial, or fungal. Some protozoa (such as amoeba and toxoplasma) can also cause meningitis.

Development viral meningitis can accompany the course of well-known infections - chickenpox, measles, rubella, mumps; damage to the meninges occurs with influenza, with infections caused by herpes viruses. In weakened patients, in the elderly, and in infants, meningitis caused by fungi occurs (it is clear that in these situations it is the lack of immunity that plays the leading role in the occurrence of the disease).

Of particular importance are bacterial meningitis. Any purulent focus in the body - pneumonia, an infected burn, tonsillitis, various abscesses, etc. - can cause meningitis, provided that the pathogen enters the blood and reaches the meninges with the blood flow. It is clear that the well-known causative agents of purulent processes (staphylococci, streptococci, Pseudomonas aeruginosa, etc.) will be the causative agent of meningitis in this case. One of the most terrible is tuberculous meningitis - almost forgotten, it is now occurring more and more often.

At the same time, there is a microorganism that causes meningitis most often (60-70% of all bacterial meningitis). It is not surprising that it is called meningococcus. Infection occurs by airborne droplets, meningococcus settles on the mucous membranes of the nasopharynx and can cause a condition very similar to a common respiratory viral infection: a slight runny nose, redness of the throat - meningococcal nasopharyngitis. It was not for nothing that I used the phrase “can cause” - the fact is that the entry of meningococcus into the body quite rarely leads to the onset of disease; the leading role here belongs to very special individual changes in immunity. Two facts are easily explained in this regard: the first is the risk of developing meningitis during contact, for example, in children's institutions is 1/1000, and the second is the frequent detection of meningococcus in the nasopharynx in completely healthy individuals (from 2 to 5% of children are healthy carriers). The body's inability to localize the microbe in the nasopharynx is accompanied by the penetration of meningococcus through the mucous membrane into the blood. With the bloodstream, it enters the meninges, eyes, ears, joints, lungs, adrenal glands, and in each of these organs a very dangerous inflammatory process can occur. It is obvious that damage to the meninges is accompanied by the development of meningococcal meningitis.

Sometimes meningococcus enters the blood quickly and in huge quantities. Meningococcal sepsis occurs, or meningococcemia - perhaps the most terrible of all childhood infectious diseases. The microbe secretes poisons (toxins), under their influence multiple blockages of small vessels occur, blood clotting is impaired, and multiple hemorrhages appear on the body. Sometimes, within a few hours after the onset of the disease, hemorrhage occurs in the adrenal glands, blood pressure drops sharply and the person dies.

There is an amazingly dramatic pattern in the occurrence of meningococcemia, which is as follows. The fact is that when a microbe penetrates the blood, it begins to react with certain antibodies that try to destroy meningococcus. It has been proven that there is cross-activity of a number of antibodies - that is, if there are large quantities of antibodies, for example, to streptococcus, pneumococcus, staphylococcus - then these antibodies can have an inhibitory effect on meningococcus. So it turns out that children who are sick, have chronic foci of infections, have had pneumonia and many other illnesses, almost never get meningococcemia. The scary thing about meningococcemia is that within 10-12 hours an absolutely healthy child who has never been sick before can die!

Symptoms and suspicion of meningitis

All the above information is not intended to intimidate readers. Meningitis is treatable. But the results (duration and severity of the disease, the likelihood of complications) are closely related to the time that will be lost before the start of adequate therapy.

Obviously, the above-mentioned “timing of initiation of adequate therapy” depends on when human subjects seek medical attention. Hence the urgent need for specific knowledge, so that later there will be no excruciating pain...

The essence of specific knowledge regarding meningitis is that the appearance of certain signs indicating the possibility of this disease requires immediate medical attention.

Inflammation of the meninges is characterized by a number of symptoms, but many of them are not specific - that is, their (symptoms) may also occur in other diseases that are much less dangerous. Most often this is what happens, but the slightest suspicion of the development of meningitis does not allow you to take risks and requires immediate hospitalization and careful medical supervision.

Let us now consider the most typical situations, each of which does not allow us to exclude the development of meningitis.

1. If against the background of any infectious disease - acute respiratory infections, chickenpox, measles, mumps, rubella, "fever" on the lips, etc. - perhaps not at the beginning of the disease (even more often not at the beginning) an intense pain appears, so strong that it worries more than all other symptoms if the headache is accompanied by nausea and vomiting.
2. In all cases, when, against the background of increased body temperature, there is pain in the back and neck, aggravated by moving the head.
3. , confusion, nausea, vomiting.
4. Convulsions of any intensity and any duration.
5. In children of the first year of life - fever + monotonous crying + bulging fontanel.
6. Any (!!!) rash against a background of elevated temperature.

In addition to the symptoms described above, some reflexes change in a very definite way, and only a doctor can detect this.

It is important to remember and understand that such frequent symptoms as vomiting, nausea and headache necessarily require a medical examination - God protects the best. Any rash accompanied by an elevated temperature may be meningococcemia. You (or your smart neighbors) may be confident that it is rubella, measles or “diathesis”. But the doctor must see the rash, and the sooner the better. If the elements of the rash look like hemorrhages, if new rashes appear quickly, if this is accompanied by vomiting and high fever, every chance should be taken to ensure that the patient immediately ends up in the hospital, preferably immediately in the infectious diseases department. Remember: with meningococcemia, the count is not in hours, but in minutes.

Diagnosis of meningitis

It should be noted that even a doctor of the highest qualifications can diagnose meningitis with absolute certainty only in one case - when the symptoms of irritation of the meninges are combined with the typical rash described above. In all other cases, the diagnosis can only be suspected with varying degrees of probability.

The only way to confirm or exclude meningitis is a spinal (lumbar) puncture. The fact is that a special cerebrospinal fluid circulates in the brain and spinal cord - cerebrospinal fluid. With any inflammation of the brain and (or) its membranes, inflammatory cells accumulate in the cerebrospinal fluid; the appearance of the cerebrospinal fluid (normally colorless and transparent) often changes - it becomes cloudy. A study of cerebrospinal fluid allows not only to establish a diagnosis of meningitis, but also to answer the question of what kind of meningitis it is - bacterial (purulent) or viral, which is crucial in choosing a treatment option.

Unfortunately, at a purely philistine level, there is a very widespread opinion about the enormous dangers that a spinal puncture poses. In fact, these fears are absolutely unfounded - the puncture of the spinal canal is carried out between the lumbar vertebrae at the level where no nerve trunks extend from the spinal cord, so there are no mythical paralysis after this manipulation. From a legal point of view, the doctor is obliged to perform a spinal tap if there is a real suspicion of meningitis. It should be noted that puncture has not only diagnostic, but also therapeutic usefulness. With any meningitis, as a rule, there is an increase in intracranial pressure, the consequence of which is a severe headache. Taking a small amount of cerebrospinal fluid can reduce blood pressure and significantly alleviate the patient’s condition. During a puncture, antibiotics are often administered into the spinal canal. For example, with tuberculous meningitis, the only chance to save the patient is frequent (often daily) punctures, during which a special version of streptomycin is injected into the spinal canal.

Treatment of meningitis

Taking into account the above information, it becomes clear that meningitis treatment depends on the type of pathogen. The main thing in the treatment of bacterial meningitis is the use of antibiotics. The choice of specific drug depends on the sensitivity of the particular bacterium and whether the antibiotic is able to penetrate the cerebrospinal fluid. With timely use of antibacterial drugs, the chances of success are very high.

With viral meningitis, the situation is fundamentally different - there are practically no antiviral drugs, the exception is acyclovir, but it is used only for herpes infection (let me remind you that chicken pox is one of the variants of herpes). Fortunately, viral meningitis has a more favorable course compared to bacterial meningitis.

But helping a patient is not limited to just influencing the pathogen. The doctor has the opportunity to normalize intracranial pressure, eliminate toxicosis, improve the functioning of nerve cells and blood vessels in the brain, and use powerful anti-inflammatory drugs.

Timely treatment of meningitis within two to three days leads to a significant improvement in the condition, and in the future almost always to a complete cure without any consequences. I emphasize once again: timely treatment started...

Meningitis is usually understood as an inflammatory process in the membranes of the spinal cord and brain, accompanied by an acute course. The provoking factors of the disease are fungi, pathogenic bacterial, viral microflora (tuberculosis bacillus, enterovirus, meningococcal infections). Diagnosis of meningitis allows us to understand the etiology of the disease and develop adequate drug treatment tactics. Symptoms may present differently in children and adults, but they are generally grouped into a single spectrum of clinical presentation.

Meningitis is a dangerous disease that affects the membranes of the brain.

Timely, correct treatment makes it possible to make favorable prognoses for patients. Meningitis is especially dangerous for children, but modern medicine makes it possible to preserve the integrity and functionality of vital organs and systems of a growing body. Very rarely, meningeal infection is recurrent in nature (about 0.2% of all cases of disease). If the course of meningitis is prolonged and the patient does not see a doctor, the disease can lead to irreversible consequences, for example, deafness, decreased vision (even blindness). The disease can lead to coma and even death. The treatment tactics for meningitis are determined based on the results of diagnostic measures after identifying the type and nature of the infection.

1. Classification and causes of occurrence.
2. Signs of the development of meningitis.
3. Diagnostic methods.
4. Indicators of pathology in laboratory studies.
5. CSF analysis.

Classification and causes

The criteria for determining meningeal infection come down to several large groups:

By type of origin:

• Bacterial nature. Varieties include tuberculous, meningococcal, and pneumococcal meningitis.
• Viral origin. Pathogens: enteroviruses, ECHO, arenoviruses (pathogens of acute lymphocytic choriomeningitis). Reproduction of fungal microflora. Pathogens: cryptococcal, candidal and similar fungi.
• Protozoal meningitis. The formation is caused by malaria and toxoplasmosis.

According to the type of inflammation:

• purulent (pronounced predominance of neutrophils in the cerebrospinal fluid);
• serous (predominance of lymphocytes in the cerebrospinal fluid).

Pathogenesis:

• primary infection (provided there is no local infectious or general infectious disease of the system or organ in the patient’s clinical history);
• secondary infection (usually occurs as a complication of an infectious disease).

By localization:

• generalized meningitis (extensive forms);
• limited (local infection without spread with adequate treatment).

Intensity of meningitis:

• sudden flashes (lightning);
• sharp forms;
• chronic (recurrent) forms of meningitis.

According to the severity of the course, consequences:

• light form;
• moderate disease;
• aggravated course;
• extremely severe form.

People from young to old can suffer from meningitis

The disease can occur in patients of different ages. Among the causes of occurrence in children are the following:

• prematurity, deep prematurity;
• chickenpox, mumps (in circulation - mumps), measles rubella, measles.

Other reasons may well provoke meningitis in adults and pediatric patients with equal probability:

• enteroviral infections;
• cytomegalovirus, poliomyelitis;
• trauma to the head, cervical vertebrae, back;
• diseases of the nervous system;
• congenital pathologies of brain development;
• immunodeficiency states of various etiologies and genesis.

The main way of transmitting bacterial meningitis is failure to maintain personal hygiene (dirty hand disease), contaminated water, and food.

Signs of meningitis development

Clinical symptoms of meningitis

Symptoms of meningitis usually develop rapidly. Doctors observe a sharp increase in body temperature, damage to the central nervous system, and signs of extensive intoxication of the body. All signs are clearly expressed in a feverish state, general malaise, loss of appetite, abdominal pain of unclear localization, joint and muscle pain, digestive disorders (loose stools, regular vomiting, feeling of nausea). The patient experiences stupor, drowsiness, and confusion.

Already in the first days there is a headache, meningeal signs are the primary signs of meningeal syndrome. Blood tests show an excess of white blood cell counts. Pain in the head is of an increasing, unbearable nature, its localization is extensive, covering the entire head. The slightest sources of light and sound become unbearable. When you change your body position, the pain in your head only gets worse. Associated symptoms include convulsive syndrome, hallucinations, delusions, and signs of acute respiratory infections. When palpating the head in infants, pronounced bulging of the fontanelles is revealed.

Pronounced symptoms of meningitis during the initial examination of the patient are the following:

• Kernig's sign. The symptom is expressed by the following signs: the patient lies on his back, his legs passively bend at the knee and hip joints, forming an angle of approximately 90°. An attempt to straighten the leg at the knee becomes impossible as a result of a reflex increase in the tone of the muscles responsible for flexing the lower leg. With meningitis, this symptom is positive on both sides. The symptom may be negative if the patient has a history of hemiparesis on the side of the paresis.

Checking Kernig's sign

• Brudzinski's sign. The patient's position is on his back. If the patient tilts his head to his chest, a reflex flexion of the knee joints is observed.

With proper treatment, the prognosis for adult patients is much better than for young children. In children, due to untimely treatment of meningitis, persistent hearing and developmental impairments appear.

Diagnostic methods

Differential diagnosis of meningitis is a set of methods for identifying the nature of meningitis by their nature and characteristics (tests, instrumental, computer research). Diagnostic measures for meningitis have a strict algorithm, which all doctors adhere to without exception:

• Collection of biological materials (general urine test and sterility test, detailed blood test for urea, creatinine and electrolytes).
• Blood glucose test.
• Smears for pathogenic microflora from the nasal cavity and pharynx.
• Coagulogram (blood clotting indicators) and PTI (prothrombin index, which allows you to assess the likelihood of bleeding).
• Blood test for HIV.
• Liver tests (biochemistry of liver function or puncture, which is performed for special indications).
• Blood test for sterility and blood culture development.
• Blood test for serological parameters.
• Examination of the fundus by an ophthalmologist to check for vasoconstriction.
• Liquor (pressure indicators, biochemical analysis, bacteriological culture, bacterioscopy).

Lumbar puncture

• Carrying out CT (computed tomography), NMR (nuclear magnetic resonance at a certain frequency), EEG (electroencephalogram of the brain), EchoEG (echoencephalography of the brain), ECG.
• X-ray of the skull.
• Examination by specialized specialists (endocrinologist, ENT, neurologist).

According to tests in children, doctors first rule out meningitis of viral origin or meningococcal infection. In adult patients, it becomes possible to check and exclude tick-borne meningoencephalitis, fungal or meningococcal infection. A doctor’s examination, laboratory and instrumental research methods usually accurately recognize meningeal syndrome at the very beginning of its development, so additional research methods are a rare measure.

Pathology indicators in laboratory tests

• Blood test. Typically, blood is collected for culture and biochemical parameters. Blood cultures in patients with meningitis are always positive and can identify pneumococci and meningococci. It is also natural to see an increase in the level of leukocytes in the blood. Leukocytes are the main indicator of the course of any infection in the human body. According to the study, a shift in the leukocyte formula to the left is determined. Indicators of urea, creatinine and electrolytes in the blood serum determine the inadequate (impaired) production of the hormone ADH (antidiuretic hormone), which leads to a state of hyponatremia.

Blood test

• Cultures from the nose, throat, ear. Such crops often yield controversial results. The results can be erroneous, but, meanwhile, they carry a lot of information due to the inclusion of meningococci in the microflora of the ENT organs. If a patient has discharge of pus from the middle ear, then it is advisable to take the discharge for a thorough examination.
• Laboratory urine analysis often reliably determines high protein content and blood impurities.
• Biochemical liver test. The analysis determines the function of the liver and helps to carry out a differential diagnosis of its pathological changes, including inflammatory processes. Meningitis disrupts carbohydrate metabolism in the body, so the liver suffers.

The totality of all laboratory indicators serves as a direct basis for making an accurate diagnosis. Additional methods include X-ray studies, which allow a more comprehensive picture of the development and course of meningeal infection.

CSF analysis

The main diagnostic method for meningeal syndrome is the study of cerebrospinal fluid, carried out by lumbar puncture. The procedure is performed by piercing the meninges of the spinal cord between those lumbar vertebrae where there are already only spinal roots. The procedure is safe, does not cause any harm, and leaves no consequences for pediatric and adult patients. Taking cerebrospinal fluid not only allows you to accurately diagnose the nature of meningitis, but also significantly alleviate the patient’s condition. The cause of severe headaches is precisely the increase in intracranial pressure.

With meningitis, pathological changes are detected in the cerebrospinal fluid

Liquor (otherwise, cerebrospinal fluid - in the abbreviation CSF) is a biological fluid that determines the adequate functioning of the entire central nervous system. The main stages of the study of cerebrospinal fluid are identified:

• preanalytical (preparing the patient, collecting information from the clinical history, collecting material);
• analytical (CSF examination);
• post-analytical (decoding of research data).

Stages of cerebrospinal fluid analysis:

• determination of physical/chemical properties (classification by volume, color, characteristic features);
• obtaining data on the total number of cells;
• microscopic examination of the native specimen, cytology of the stained specimen;
• detailed analysis of biochemical components;
• microbiological examination (if there are special instructions).

Cerebrospinal fluid normally has high transparency without pronounced color. With pathological changes, the fluid and its composition change:

Normally, the cerebrospinal fluid should be clear

• Density change. The density norm is 1.006 - 1.007. If an acute inflammatory process occurs in the body, the density of the cerebrospinal fluid naturally increases to 1.015. The indicators become lower if the density is formed against the background of hydrocephalus.
• Fibrinogen content (colorless protein in plasma blood). The indicator is characteristic for the diagnosis of tuberculous meningitis and manifests itself in the form of a thick lump or fibrinous film. To confirm the formation of a film on the surface of the liquid, the test tube with the material is kept at room temperature for 24 hours.
• Indicators of protein, glucose, chlorides and other biochemical data to present a more accurate picture of the disease.

When excess contents are removed, intracranial pressure returns to normal, and pain subsides over time.

In cases where the diagnosis is in doubt, it is further confirmed or refuted using computed tomography or magnetic resonance imaging examination.

Prevention of meningitis is divided into specific and nonspecific

Meningitis is a rare but serious complication of viral and bacterial diseases. Preventive measures include basic rules for protecting one’s own health from colds, flu outbreaks and epidemics. Don't underestimate the seriousness of meningitis. In addition to severe complications, the disease can also take the patient’s life. Timely treatment of many diseases and subsequent protective regime will allow you to maintain both health and prevent relapses of associated complications in the form of meningitis.