Meningitis. Causes, symptoms, diagnosis and treatment. Acute meningitis - symptoms, prognosis, prevention

A serious and quite severe neuroinfectious disease is meningitis - an inflammatory process in the soft and arachnoid membranes of the brain, leading to swelling of the brain structures and threatening for the patient's life.

The cause of such damage to the central nervous system can be bacterial agents, viruses, and less commonly protozoa. Sometimes meningitis in adult patients is provoked by autoimmune diseases, intracranial tumor processes or traumatic hemorrhage.

Meningitis is a dangerous and fleeting disease

Classification of meningitis

In accordance with the root cause of inflammation of the meninges, secondary and primary meningitis are distinguished. Secondary is often provoked by a head injury or occurs as a complication after neurosurgical manipulations; purulent ENT diseases (otitis media, sinusitis) can also be the cause. Primary meningitis is caused by the influence of a pathogenic pathogen directly on the structures of the nervous system (for example, meningococcal infection).

By preferential localization inflammatory process meningitis can be:

• Convexital.
• Basal.
• Cerebrospinal.

According to the nature of the pathological process, it can be classified:

• Fulminant meningitis.
• Spicy.
• Subacute.
• Chronic.

Meningitis can also vary in severity: mild, moderate, severe.

Main causes of the disease

There are two main types of meningitis causative agents: viruses and bacteria. Other etiological factors (mycoses, protozoa, rickettsia) are relatively rare.

Meningitis can be caused by a variety of pathogens

Among the viral pathogens of the disease, the Coxsackie and ECHO viruses play the most important role. It is the viral etiology of the disease that is diagnosed in 60% of patients. A smaller part, about 30%, is due to inflammation of the meninges of a bacterial nature.

The main bacteria that cause meningitis in adults are pneumococcus, meningococcus, and Haemophilus influenzae. In children during the neonatal period, E. coli, enterococci, and Klebsiella can also become pathogens.

How does the inflammatory process develop?

The most common route of infection spread is hematogenous. Less commonly noted contact path, for example, in the presence of purulent inflammation in the bones of the skull, paranasal sinuses, and middle ear.

The incubation period for inflammation of the meninges depends on etiological factor. So, with viral meningitis it can last from three to seven days, and with bacterial meningitis - from a day to a week. Tuberculous meningitis often has a longer duration incubation period, up to 10-14 days; sometimes this period is regarded as prodromal, when there is no specific symptoms lesions and swelling of the membranes of the brain, and there is general weakness, malaise, and sleep disturbances.

After penetration of a pathogenic agent into the subarachnoid space, inflammatory changes and swelling occur in the meninges, which are incapable of stretching. As a consequence, a displacement of the structures of the cerebellum and medulla oblongata occurs, which leads to cerebral edema and poses a threat to the patient’s life. This development of the disease is typical for severe meningitis with a fulminant onset. In the chronic course of the disease, cerebral edema is less pronounced, and accordingly, the symptoms of the disease may not be so bright.

Signs of meningitis

Regardless of the etiology of the disease, its description clinical picture consists of three main syndromes:

• Intoxicating
• Meningeal
• Characteristic changes cerebrospinal fluid.

Intoxication syndrome

This symptom complex includes signs characteristic of any other infectious pathology. Hyperthermia is noted; in acute bacterial inflammation it can reach 39 degrees and above, chronic course(for example, exacerbation of the process of tuberculous etiology) is often accompanied by a slight rise in temperature to 37.5 degrees.

Other symptoms of meningitis are a feeling of chills, excessive sweating, weakness, loss of strength. IN laboratory indicators peripheral blood there is a leukocyte shift to the left, increased ESR, characteristic of an acute inflammatory process.

Meningeal syndrome

It includes cerebral manifestations and meningeal symptoms themselves. General cerebral - a consequence of swelling of the meninges and increased intracranial pressure. The main characteristics of the syndrome: severe diffuse headache, nausea, maybe repeated vomiting. In severe cases of the disease, consciousness is impaired, from mild stupor to coma. In some cases, the disease may manifest itself as psychomotor agitation, hallucinations, and intellectual-mnestic disorders.

Checking Kernig's sign

Actually meningeal signs are distinctive feature pathology and allow the doctor to establish a primary diagnosis based on examination of the patient. These include symptoms of hyperesthesia - increased sensitivity to light, sound, touch of skin. The second group is pain phenomena (Kerer, Mendel, Pulatov) and so-called muscle contractures. The latter are most often used in medical practice for diagnostics, their main characteristics:

• The inability to fully bend the patient’s head in a supine position is due to stiffness of the neck muscles.
• Kernig's sign - muscle tension back surface thighs, as a result of which it is impossible to straighten the leg bent at the knee of a person lying on his back.
• The so-called meningitis pose is when, due to excessive tension of the long back muscles, maximum extension of the back occurs with the head thrown back and the legs brought to the stomach and bent at the knees.

The presence of meningeal signs means an inflammatory process and swelling of the meninges; if such symptoms are present, you should seek medical help as soon as possible.

Changes in cerebrospinal fluid

Carrying out a lumbar puncture, followed by laboratory diagnostics cerebrospinal fluid(cerebrospinal fluid), allows not only to confirm the diagnosis of meningitis, but also to find out its etiology. Inflammatory processes and swelling of the meninges are manifested by a significant increase in cerebrospinal fluid pressure, with external inspection it can change transparency or color. This is especially characteristic of a bacterial process - the cerebrospinal fluid becomes cloudy and light yellow in color.

Spinal tap

Laboratory analysis shows a change in cellular composition towards its increase (pleocytosis). When the process is caused by bacteria, an increase in neutrophils is detected, with viral infection– lymphocytes. Further microbiological examination helps to identify the type of pathogen, and therefore its sensitivity to a particular antibiotic. When analyzing cerebrospinal fluid, they also give a description of the amount of sugar and protein it contains. Some clinics additionally perform serological reactions.

Other symptoms of meningitis include: skin manifestations. For example, with meningococcal infection, a stellate (hemorrhagic) rash appears on the extremities, abdomen, and less often on the head.

It should be remembered that the presence of high body temperature, which is combined with severe headache, nausea, vomiting, and the appearance of rashes on the body, may indicate a severe form of meningitis.

In this case, it is necessary to immediately seek medical help, since the fulminant course of such a disease can cause cerebral edema and threaten the patient’s life.

Complications of meningitis

IN acute period The most dangerous disease is cerebral edema and complications in the form of secondary encephalitis (damage directly to the brain tissue). Meningoencephalitis can manifest itself as focal and diffuse neurological symptoms, which sometimes persist long time after the patient has recovered, and in severe cases causes disability.

A particularly dangerous complication can be the formation of a brain abscess, which more often occurs with secondary bacterial meningitis against the background of existing ENT pathology (sinusitis, otitis). It causes rapid perifocal swelling of brain tissue and displacement midline structures, which means it poses a threat to the patient’s life. In this case, along with conservative therapy, surgical treatment is carried out.

Treatment

The sooner treatment for meningitis is started, the greater the patient’s chances for a full recovery.

Treatment of meningitis of any etiology is carried out only in a hospital setting. As a rule, primary forms of the disease (bacterial or viral) are treated in infectious diseases department, secondary - in a specialized department, depending on the main diagnosis (neurosurgery, ENT). In severe cases with rapidly progressive cerebral edema, the patient is in the intensive care unit.

Therapeutic regimen meningitis includes three main components: antibiotic therapy, symptomatic treatment and measures aimed at eliminating pathogenetic mechanisms(detoxification, fight against cerebral edema, neuroprotection, correction of acidosis).

Since bacterial meningitis is inflammation and swelling of the meninges caused by a certain type of pathogen, antibacterial treatment is carried out with appropriate antibiotics or wide range actions. In addition, the antibacterial drug must penetrate well through the blood-brain barrier. The most commonly used are Cefotaxime, Ceftriaxone in combination with Ampicillin, and Benzylpenicillin.

Treatment for viral meningitis includes antiviral drugs– Tiloron, recombinant interferons, immunoglobulins. Anti-tuberculosis drugs are prescribed when it is confirmed tuberculous etiology diseases.

Rehabilitation

After discharge from the hospital, the patient is given recommendations for the period of treatment at home. Also, for two years, a person who has had meningitis has been registered with a neurologist at the dispensary.

Nootropic drug

For moderate and severe forms of meningitis, as well as after meningoencephalitis, tablet forms of drugs are prescribed: neuroprotectors (piracetam, encephabol), multivitamin complexes(vitrum, duovit), adaptogens. When there are residual neurological effects (paresis, paralysis), exercise therapy, massage, and physiotherapy are recommended. Treatment by an ophthalmologist or ENT doctor is indicated for existing visual or hearing impairments, respectively.

Full rehabilitation after meningitis also includes nutritional correction. The diet must be complete, which means it must include a sufficient amount of easily digestible protein (chicken, rabbit, lean fish, cottage cheese, fermented milk drinks), fresh vegetables and fruits, vegetable oils rich in polyunsaturated fatty acids(olive, flaxseed).

For a period of about six months, heavy physical activity, work in night shift, on high.

Prevention

The main prevention of meningitis is strengthening immune system, which is ensured good nutrition, quality rest and regular physical activity. It is also necessary to promptly and under medical supervision treat purulent foci in the skull area, for example, otitis media or sinusitis, and undergo regular medical examination to identify foci of tuberculosis.

If there is an outbreak of meningitis in a kindergarten, the institution is closed for two weeks quarantine

If the sick child visited kindergarten, then a quarantine is declared in the group. In terms of timing, it corresponds to the incubation period of the disease. For viral meningitis, it is up to 7 days; for meningococcal infection, quarantine lasts up to 10 days. It should be taken into account that if the child visited preschool, then he can continue to go to the group during the entire quarantine period. At school, when meningitis is detected, quarantine is usually not declared. Parents of children should be informed about what meningitis is, what its symptoms are, the first signs and possible complications. If there is the slightest suspicion of meningitis ( heat, headache, vomiting, rash on the body), you need to urgently contact a medical facility.

Good day, dear readers!

In today's article we will look at a disease of the meninges, such as meningitis, as well as its first signs, symptoms, causes, types, diagnosis, prevention and treatment with traditional and folk remedies. So…

What is meningitis?

Meningitis– infectious inflammatory disease membranes of the spinal cord and/or brain.

The main symptoms of meningitis are headache, high body temperature, disturbances of consciousness, increased sensitivity to light and sound, and numbness of the neck.

The main causes of meningitis are fungi. Often, this disease becomes a complication of others, and often ends in death, especially if its cause is bacteria and fungi.

The basis of treatment for meningitis is antibacterial, antiviral or antifungal therapy, depending on the causative agent of the disease, and only in a hospital setting.

Meningitis in children and men is most common, especially the number of cases increases in the autumn-winter-spring period, from November to April. This is facilitated by factors such as temperature fluctuations, hypothermia, a limited amount of fresh fruits and vegetables, and insufficient ventilation in rooms with a large number of people.

Scientists also noticed a 10-15 year cyclical pattern of this disease, when the number of patients especially increases. Moreover, in countries with bad sanitary conditions residence (Africa, Southeast Asia, Central and South America), the number of patients with meningitis is usually 40 times higher than in Europeans.

How is meningitis transmitted?

Like many other infectious diseases, meningitis can be transmitted in a fairly large number of ways, but the most common of them are:

• airborne droplets (through, sneezing);
• contact and household (non-compliance), through kisses;
• oral-fecal (eating unwashed foods, as well as eating with unwashed hands);
• hematogenous (through blood);
• lymphogenous (through lymph);
• placental route (infection occurs during childbirth);
• through ingestion of contaminated water (by swimming in polluted waters or drinking dirty water).

Incubation period of meningitis

The incubation period of meningitis, i.e. from the moment of infection to the first signs of the disease depends on the type of specific pathogen, but generally it ranges from 2 to 4 days. However, the incubation period can range from several hours to 18 days.

Meningitis - ICD

ICD-10: G0-G3;
ICD-9: 320-322.

How does meningitis manifest? All signs of this disease spinal cord or brain correspond infectious manifestations. It is very important to pay attention to the first signs of meningitis so as not to miss precious time to stop the infection and prevent complications of this disease.

The first signs of meningitis

• A sharp rise in body temperature;
• Rigid neck (numbness of the neck muscles, difficulty turning and tilting the head);
• Lack of appetite;
• and frequent without relief;
• Sometimes a rash appears, pink or red, disappearing with pressure, which after a few hours appears in the form of bruises;
• (mainly in children);
• , malaise;
• Hallucinations, agitation, or lethargy may occur.

The main symptoms of meningitis are:

• Headache;
• – up to 40°С, ;
• Hyperesthesia (increased sensitivity to light, sound, touch);
• , disturbances of consciousness (even to the point of coma);
• Lack of appetite, nausea, vomiting;
• Diarrhea;
• Pressure in the eye area;
• Inflammation of the lymph glands;
• Pain when pressing on the trigeminal nerve area, the middle of the eyebrows or under the eye;
• Kernig's sign (due to tension in the posterior thigh muscles, the leg does not straighten at the knee joint);
• Brudzinski's sign (legs and other parts of the body move reflexively when pressing on various parts of the body or when tilting the head);
• Bekhterev's symptom (tapping on the zygomatic arch causes contractions of the facial muscles);
• Pulatov's symptom (tapping the skull causes pain);
• Mendel's sign (pressure on the area of ​​the external ear canal causes pain);
• Lesage's symptoms (the large fontanel in small children is tense, bulges and pulsates, and if you take it under the armpits, the baby throws his head back, while his legs reflexively tuck into his tummy).

Nonspecific symptoms include:

• Decreased visual function, double vision, strabismus, nystagmus, ptosis;
• Hearing loss;
• Paresis of facial muscles;
• Abdominal pain, ;
• Body cramps;
• Epileptic seizures;
• , bradycardia;
• Uveitis;
• Drowsiness;
• Increased irritability.

Complications of meningitis

Complications of meningitis may include:

• Hearing loss;
• Epilepsy;
• Hydrocephalus;
• Disruption of normal mental development children;
• Purulent arthritis;
• Blood clotting disorder;
• Death.

The first factor and main cause of meningitis is the entry into the body, into the blood, cerebrospinal fluid and brain of various infections.

The most common causative agents of meningitis are:

Viruses– enteroviruses, echoviruses (ECHO - Enteric Cytopathic Human Orphan), Coxsackie virus;

Basically, to relieve viral meningitis, a combination of the following drugs: “Interferon” + “Glucocorticosteroids”.

Additionally, barbiturates may be prescribed, nootropic drugs, high protein diet, especially various antiviral drugs(depending on the type of virus).

3.3. Antifungal therapy

Treatment for fungal meningitis usually involves taking the following medications:

For cryptococcal and candidal meningitis (Cryptococcus neoformans and Candida spp): “Amphotericin B” + “5-Flucytosine”.

• The dose of Amphotericin B is 0.3 mg per 1 kg per day.
• The dose of Flucytosine is 150 mg per 1 kg per day.

Additionally, Fluconazole may be prescribed.

3.4. Detoxification therapy

To remove waste products of infection (toxins) from the body, which poison the body and further weaken the immune system and the normal functioning of other organs and systems, detoxification therapy is used.

To remove toxins from the body, use: “Atoxil”, “Enterosgel”.

For the same purposes, drinking plenty of fluids is prescribed, especially with vitamin C - rosehip decoction, tea with raspberries and fruit juice.

3.5. Symptomatic treatment

For allergic reactions, prescribed antihistamines: « », « ».

At high temperature, above 39°C anti-inflammatory drugs: “Diclofenac”, “Nurofen”, “”.

For increased irritability and anxiety, prescribed sedatives: "Valerian", "Tenoten".

To reduce edema, including edema of the brain, diuretics (diuretics) are prescribed: Diacarb, Furosemide, Uroglyuk.

To improve the quality and functionality of cerebrospinal fluid, the following is prescribed: Cytoflavin.

Forecast

Timely consultation with a doctor, accurate diagnosis and correct treatment regimen increases the chances of complete cure from meningitis. It depends on the patient how quickly he will go to a medical facility and adhere to the treatment regimen.

However, even if the situation is extremely difficult, pray, the Lord is able to deliver and heal a person even in cases where other people cannot help him.

Important! Before using folk remedies, be sure to consult your doctor!

When using folk remedies, keep the patient calm, dim the light, and protect him from loud sounds.

Poppy. Grind the poppy seed as thoroughly as possible, pour it into a thermos and fill it with hot milk, in the proportion of 1 teaspoon of poppy seed per 100 ml of milk (for children) or 1 tbsp. spoon of poppy seeds per 200 ml of milk. Leave the solution to infuse overnight. You need to take 1 tbsp of poppy infusion. spoon (children) or 70 g (adults) 3 times a day, 1 hour before meals.

Chamomile and mint. To drink, use tea from or, for example, one remedy in the morning, another in the evening. To prepare such a medicinal drink you need 1 tbsp. Pour a spoonful of mint or chamomile into a glass of boiling water, cover the lid and let the product brew, then strain and drink a portion at a time.

Lavender. 2 teaspoons of medicinal lavender in dry, ground form, pour 400 ml of boiling water. Leave the product overnight to infuse and drink 1 glass, morning and evening. This product has analgesic, sedative, anticonvulsant and diuretic properties.

Herbal collection. Mix 20 g of the following ingredients - lavender flowers, peppermint leaves, rosemary leaves, primrose root and. Next, pour 20 g of the resulting mixture from plants with 1 glass of boiling water, cover with a lid and let the product brew. After the collection has cooled, strain it and you can start drinking the whole glass at a time, twice a day, morning and evening.

Needles. If the patient does not have an acute phase of meningitis, you can prepare a bath from fir needles; it is also useful to drink an infusion of pine needles, which help cleanse the blood.

Linden. 2 tbsp. spoons linden color pour 1 liter of boiling water, cover the product with a lid, let it brew for about 30 minutes and you can drink it instead of tea.

— During periods of seasonal outbreaks, avoid staying in places with large numbers of people, especially indoors;

— Do wet cleaning at least 2-3 times a week;

— Temper yourself (if there are no contraindications);

— Avoid stress and hypothermia;

- Move more, go in for sports;

— Do not let various diseases, especially infectious ones, take their course, so that they do not become chronic;

What is meningitis? We will discuss the causes, diagnosis and treatment methods in the article by Dr. P. A. Aleksandrov, an infectious disease specialist with 11 years of experience.

Definition of disease. Causes of the disease

Infectious meningitis- a group of acute, subacute and chronic infectious diseases caused by various types pathogenic microorganisms (viruses, bacteria, fungi, protozoa), which, under conditions of specific resistance of the body, cause damage to the membranes of the brain and spinal cord, manifested in a pronounced meningeal irritation syndrome, severe intoxication syndrome and always occurs with a potential threat to the patient’s life.

Infectious meningitis can be a primary pathology (developing as an independent nosological form), and secondary (developing as a complication of another disease).

Looking ahead, I would like to answer a popular question from readers and netizens: what is the risk of infection from a patient, and is it possible to be near a patient without a particular risk of developing meningitis? The answer is quite simple: in view of the fact that meningitis is a combined group of diseases caused by various infectious agents, the risk of infection will depend on the etiological cause of meningitis, but the likelihood of developing meningitis will depend on the capabilities of the human immune system. In other words, to know whether there is a risk, you need to know which microorganism caused meningitis in the patient and what the protective immune abilities of those around him are.

Depending on the type of meningitis, the routes of infection and the mechanisms of disease occurrence differ. In relation to infectious meningitis, one can point to an extremely wide geographical distribution, with a tendency to increase foci of the disease on the African continent (meningococcal meningitis), more frequent development illnesses in children and increased morbidity during the cold season (viral meningitis as a complication of ARVI). Transmission of infection occurs more frequently by airborne droplets.

Symptoms of meningitis

Quite characteristic of meningitis (and in particular with the meningococcal process) are signs of involvement in pathological process meninges (meningeal syndromes), which are divided into groups:

Separately worthy of mention is a specific manifestation that is similar to the symptoms of meningitis (meningeal syndrome), but is not such and has nothing to do with the pathogenesis of true meningitis - meningism. Most often it develops as a result of mechanical or intoxicating effects on the meninges in the absence of an inflammatory process. It stops when the provoking effect is removed; in some cases, differential diagnosis is possible only through special studies.

Pathogenesis of meningitis

Variety of pathogens and individual characteristics Individuals in the human population are also determined by a fairly pronounced variability in the forms and manifestations of meningitis, and the risk of infection for other people, so in this article we will focus on the most significant forms of diseases and their causative agents in social terms.

Meningococcal meningitis- always an acute (acute) disease. Caused by Wekselbaum's meningococcus (a gram-negative bacterium, unstable in the environment, at a temperature of 50 degrees Celsius it dies after 5 minutes, UV irradiation and 70% alcohol kill almost instantly). The source of the spread of infection is a sick person (including meningococcal nasopharyngitis) and a bacteria carrier; transmission occurs by airborne droplets.

The site of introduction (gate) is the mucous membrane of the nasopharynx. In the overwhelming majority of cases, the infectious process does not develop or develops local forms diseases. When meningococcus overcomes local anti-infective barriers, hematogenous spread of infection occurs and a generalized meningococcal infection occurs, including the development of meningococcal meningitis, which in the absence of adequate treatment ends in death in more than 50% of cases. In the pathogenesis of the disease, a role is played by toxins released after the death of bacteria in the bloodstream, damage to the walls of blood vessels, which leads to hemodynamic disturbances, hemorrhages in organs and deep metabolic disorders. There is hyperirritation of the meninges, the development of purulent inflammation of the tissue and a rapid increase in intracranial pressure. Often, due to edema and swelling of the brain tissue, the brain becomes wedged into the large foramen magnum and the death of the patient from respiratory paralysis.

The latent period of illness is from 2 to 10 days. The onset is acute (even more correctly, acute). In the first hours of the disease, there is a sharp increasing increase in body temperature to 38.5 degrees and above, severe lethargy, fatigue, pain in the periorbital region, loss of appetite, and a sharp headache. A characteristic sign of a headache is a constant increase in its intensity, diffuse pain without clear localization, bursting or pressing in nature, causing true agony for the patient. At the height of the headache, vomiting occurs without preceding nausea, which does not bring any relief. Sometimes in patients with severe uncontrolled course, mainly in children in unconscious, there is an uncontrollable scream, accompanied by clasping the head with one’s hands - the so-called. "hydrocephalic cry" caused by sharp growth intracranial pressure. Etched in memory appearance patients - sharpening of facial features (Lafore's symptom), meningeal posture on the 2-3rd day of the disease (still a “cop dog”). Some patients develop hemorrhagic rashes on the body, resembling a star-shaped rash (an unfavorable sign). Over the course of 2-3 days, the severity of symptoms increases, hallucinations and delusions may appear. The degree of impairment of consciousness can vary from somnolence to coma; if untreated, death can occur at any time.

Tuberculous meningitis- slowly developing pathology. It is mainly secondary, developing in the context of existing tuberculosis in other organs. It has several periods of development, consistently developing over a long time:

1. prodromal (up to 10 days, characterized by mild symptoms of general malaise)

2. sensorimotor irritation (from 8 to 15 days, the appearance of initial cerebral and weak meningeal manifestations)

3. paresis and paralysis (attracts attention from the 3rd week from debut infectious process in the form of changes and loss of consciousness, swallowing disorders, speech).

Initially, a moderate increase in body temperature appears without pronounced jumps and rises, quite tolerable headaches of low intensity, well relieved by taking analgesics. In the future, headaches intensify, nausea and vomiting become involved. An invariable sign of tuberculous meningitis is a rise in temperature, fever, and the numbers and duration can vary from subfebrile to hectic values. Gradually, from the end of the second week, symptoms of disorientation and stupor appear and slowly increase, ending in deep “congestion” of the patient, stupor and coma. Dysfunction of the pelvic organs and abdominal pain develop. Meningeal symptoms also gradually develop, and truly classic symptoms (the “pointing dog” position) develop only in advanced cases.

Herpetic meningitis most often caused by viruses herpes simplex types 1 and 2, the varicella zoster virus and develops against a background of weakening of the body due to acute respiratory viral infections or serious immunosuppression, incl. AIDS. It is divided into primary (when the process develops during initial infection with the virus) and secondary (reactivation of the infection against the background of decreased immunity). Always acute illness, primary manifestations depend on the previous premorbid background. More often against the existing background of ARVI phenomena, herpetic rashes in the perioral area and genitals there is a severe headache of a diffuse nature, intensifying over time, vomiting that does not bring relief. All this can occur against the background of moderate or high promotion body temperature, mild meningeal symptoms. Brain damage is often associated; in such cases, mental disorders (often aggression), hallucinations, disorientation, and generalized convulsions occur within 3-4 days. With proper treatment, the prognosis is usually quite favorable; in the absence of adequate treatment in conditions of impaired immunological resistance, death or persistent residual effects are possible.

Classification and stages of development of meningitis

The following types of infectious meningitis are distinguished:

2. According to the predominant course of the inflammatory process:

• purulent (meningococcal, pneumococcal, caused by Haemophilus influenzae)
• serous (viral)

3. Downstream:

• sharp (optionally - lightning fast)
• subacute
• chronic

4) By localization, severity, clinical forms and etc.

Complications of meningitis

Complications observed with meningitis of meningococcal nature (less often with other forms of meningitis) can be early and late, associated both with a catastrophe of the nervous system and other parts of the body. The main ones:

Diagnosis of meningitis

The primary diagnostic search includes an examination by an infectious disease specialist and a neurologist and, if possible meningitis is suspected, conducting the leading diagnostic test - a lumbar puncture.

It involves inserting a hollow needle into the subarachnoid space of the spinal cord at the level of the lumbar spine. The purpose of this study is to clarify the type, properties and nature of changes in cerebrospinal fluid, to determine possible pathogens and treatment options for this type of meningitis.

Depending on the etiological agent causing meningitis, the properties of the cerebrospinal fluid differ; here are their main types and characteristics:

1. Bacterial meningitis (including meningococcal meningitis):

• liquor high pressure(over 200 mm water column)
• the leaking liquid is yellow-green, viscous, with significant cell-protein dissociation, flows out slowly
• high cell content (neutrophilic pleocytosis 1000 per µl and above)
• increase in protein level 2-6 g/l and above
• drop in chloride and sugar levels

2. Serous meningitis(including viral ones):

• CSF pressure is normal or slightly increased
• The cerebrospinal fluid is clear, flowing out when punctured is 60-90 drops per minute
• the number of cellular elements in the cerebrospinal fluid (cytosis) is less than 800 per µl
• protein concentration up to 1 g/l and below
• glucose is within normal limits

3. Tuberculous meningitis:

• moderate increase in liquor pressure
• transparent in appearance, sometimes opalescent film
• moderate number of cells (up to 200 per µl, predominantly lymphocytes)
• protein increased to 8 g/l
• glucose and chlorides are reduced

Besides defining physical and chemical properties cerebrospinal fluid, today methods are widely used to isolate and identify the causative agent of the disease, which can play a decisive role in therapy and prognosis. The most significant are the cultivation of native cerebrospinal fluid on nutrient media (search for bacterial, fungal pathogens), PCR of cerebrospinal fluid (polymerase chain reaction) to identify the nucleic acids of the pathogen, and ELISA ( enzyme immunoassay) cerebrospinal fluid, blood, urine, etc. in order to determine antigens and antibodies of possible pathogens of meningitis, microscopy of cerebrospinal fluid and nasopharyngeal mucus, clinical and biochemical tests blood. An MRI of the brain is quite informative.

MRI of the brain for meningitis

CT scan of the brain

Treatment of meningitis

The main and main condition effective assistance For patients with meningitis, early hospitalization in a hospital and the beginning of specific etiotropic and pathogenetic therapy are recommended! Therefore, at the slightest suspicion of meningitis by a doctor or paramedic, all possible steps should be taken to quickly transport the suspicious patient to an infectious disease hospital and begin treatment; doubts of medical specialists or the patient himself in terms of diagnosis and hospitalization should be regarded as unfounded (dangerous) and immediately suppressed.

Etiotropic therapy (aimed at getting rid of the pathogen) depends on specific situation(research conducted, doctor’s experience, algorithms) and may include prescriptions antibacterial drugs, including anti-tuberculosis (for meningitis of a bacterial, tuberculous nature, the situation is unclear), antiviral agents(for herpetic meningitis and other viral pathogens), antifungal agents(for fungal infections). Advantage is given intravenous administration medicines under the control of the patient’s condition and periodic monitoring of the cerebrospinal fluid (control lumbar puncture).

Pathogenetic and symptomatic therapy is aimed at interrupting the pathogenesis, improving the action of etiotropic drugs and improving the general condition of the patient. This may include the use of hormones, diuretics, antioxidants, vascular agents, glucose, etc.

Severe and life-threatening forms of meningitis should be treated in intensive care units and intensive care under constant supervision medical personnel.

Forecast. Prevention

The prognosis for the development of meningitis depends on its causative agent. With bacterial meningitis (taking into account the fact that in 60% of cases it is meningococcal meningitis), the prognosis is always (even in modern conditions hospitals) is very serious - mortality can reach 10-15%, and with the development of generalized forms of meningococcal infection - up to 27%. Even with a successful outcome, there is a high risk of residual effects, such as intellectual impairment, paresis and paralysis, ischemic stroke, etc.

It is impossible to predict the development of certain disorders; it is only possible to minimize their occurrence by timely contacting a doctor and starting treatment. With viral meningitis, the prognosis is more favorable; in general, mortality is no more than 1% of all cases of the disease.

Prevention of meningitis includes specific and non-specific activities.

Nonspecific- healthy lifestyle, strengthening the immune system, maintaining good hygiene, using repellents, etc.

Specific prevention is aimed at developing immunity against certain pathogens of infectious meningitis; this is vaccination, for example, against meningococcal infection, pneumococcus, and Haemophilus influenzae. Vaccinations are most effective in children's groups, since children are most susceptible to developing meningitis, and vaccination reliably reduces their incidence rate.

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Meningitis is an acute infectious disease that leads to inflammation of the membranes of the spinal cord and brain. The infection can be caused by fungi, viruses and various bacteria, for example: Haemophilus influenzae, enteroviruses, meningococcal infection, tuberculosis bacilli. Signs of meningitis can appear at any age, but, as a rule, people with weakened immune systems, premature babies, patients with head injuries, back injuries and central nervous system lesions become ill.

With adequate and, most importantly, timely treatment of meningitis, it is vital important organs and human systems are usually not affected. The exception is the so-called reactive meningitis, the consequences of which can be extremely severe. If treatment for meningitis is not started within the first day after the onset severe symptoms, the patient may become deaf or blind. The disease often leads to coma and even death. As a rule, meningitis in children and adults forms immunity to the action of pathogens, but there are exceptions. However, cases of recurrent disease are extremely rare. According to experts, the infection occurs again in only 0.1% of people who have recovered from the disease.

What can meningitis be?

The disease can be primary or 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, parotitis etc.), develops slowly, but ultimately also leads to damage to the meninges.

A distinctive feature of both types of infection is its acute nature. clinical course diseases. The disease develops over several 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, 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 is various viruses. Most often, damage to the membranes of the brain leads to enterovirus infection 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;
• frontal sinusitis;
• sinusitis;
• acute and chronic otitis media;
• lung abscess;
• osteomyelitis of the skull bones.

Reactive meningitis

Reactive meningitis is one of the most dangerous forms infections. It is often called fulminant due to its extremely transient clinical picture. If medical assistance was provided too late, the patient falls into a coma and dies from multiple purulent foci in the brain area. If doctors began to treat reactive meningitis within the first 24 hours, 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 lesions of the central nervous system 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 within a few hours patients experience 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 your head to your chest.

In addition to the above symptoms of meningitis, some other signs are also found in children: drowsiness, cramps, 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 delay calling an ambulance at all, since jokes with the infection can easily result in disability or death.

Antibiotics are the drugs of choice for treating meningitis. Let us note that in approximately 20% of cases it is not possible to identify the cause of the disease, so hospitals use broad-spectrum antibiotics in order to affect 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 area.

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 used only in cases where there is a real risk of developing fatal complications.

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

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Meningitis is an acute infectious disease that affects the soft membrane of the brain and spinal cord. Meningitis is accompanied by inflammatory changes in the cerebrospinal fluid and cerebrospinal fluid. Just a century ago, this diagnosis sounded like a death sentence. Today, although this is serious disease nervous system, it is almost always curable. Sometimes only minor changes in health status may indicate the presence of meningitis, but more often ominous symptoms force the patient to immediately seek medical help.

In adults, this disease is less common than in children, but the symptoms are somewhat different from the manifestations of meningitis in childhood. We will talk about symptoms in adults in this article.

Functions of the pia mater

The pia mater is a thin layer of connective tissue that covers the entire surface of the brain and spinal cord. It has several main functions:

• contains blood vessels, nourishing the brain;
• participates in the circulation of cerebrospinal fluid that washes the brain;
• protects brain tissue from infectious and toxic effects.

Causes and classification of meningitis

Because meningitis is infectious disease, pathogens can be:

• bacteria: a wide variety, most often pneumococci, meningococci, tuberculosis bacillus;
• viruses: enteroviruses, adenoviruses, influenza and parainfluenza viruses, measles, rubella, Epstein-Barr herpes, cytomegalovirus;
• mushrooms: candida, cryptococcus;
• protozoa: toxoplasma, malarial plasmodium, mycoplasma, chlamydia, helminths, etc.

Of course, the first two groups of pathogens cause the disease in 95% of cases. The entry points for infection are most often the nasopharynx, bronchi and intestines. From these organs, viruses and bacteria enter the pia mater through the bloodstream. Much less often, meningitis develops when infection occurs through a wound due to injuries to the brain or spinal cord.

Meningitis occurs:

• primary: when there is no mention of the disease in the history of the disease general infection or disease of any organ;
• secondary: if meningitis is a result (complication) of any disease.

Based on changes in the cerebrospinal fluid (CSF), meningitis is divided into:

• serous: if lymphocytes predominate in the cerebrospinal fluid;
• purulent: if neutrophils predominate in the cerebrospinal fluid.

Serous meningitis is usually caused by viruses, while purulent meningitis is caused by bacteria.

According to the speed of development of the inflammatory process, there can be:

• fulminant (especially typical for meningococcus);
• spicy;
• subacute;
• chronic;
• recurrent.

According to severity, meningitis is divided into:

• lungs;
• moderate severity;
• heavy;
• extremely heavy.

Symptoms

All symptoms of meningitis can be divided into three groups:

• general infectious diseases;
• general cerebral;
• meningeal.

General infectious symptoms non-specific, i.e. their presence does not at all indicate meningitis. These signs only indicate a possible infectious onset of the disease.

These include: general malaise, feeling hot or chills, muscle pain, joint pain, catarrhal phenomena in the form of a runny nose, redness of the throat, sneezing, etc., fever, rash, redness of the face, increased heart rate and breathing, increased lymph nodes, blood changes characteristic of infection (increased ESR, increased number of leukocytes).

General cerebral symptoms include headache, vomiting, disturbance of consciousness, generalized convulsive seizures, congestion in the fundus.

The headache with meningitis is bursting in nature, spreading to the entire head, the person experiences pressure on the eyes from the inside. The source of headaches is irritation of the meninges, increased intracranial pressure as a result of inflammation. A characteristic feature of headaches with meningitis is the occurrence of vomiting at the peak of pain without preceding nausea. Vomiting does not bring relief and may recur several times. This type of vomiting is called “brain vomiting.”

The presence of disturbances of consciousness depends on the severity of meningitis. Consciousness may not be impaired in mild forms. In severe meningitis, quantitative (stunning, stupor, coma) and qualitative (hallucinations, delirium, psychomotor agitation, oneiroid) disorders of consciousness.

Seizures occur due to irritation of the meninges and increased intracranial pressure. Sometimes an epileptic seizure develops suddenly, in the absence of other symptoms of meningitis.

General cerebral symptoms are also not specific to meningitis.

Meningeal symptoms– these are special Clinical signs lesions of the membranes of the brain. One or two symptoms detected separately do not confirm the diagnosis of meningitis, since they can also develop with other diseases of the nervous system (for example, with subarachnoid hemorrhage). However, the presence of a whole complex of such symptoms in one patient allows us to confidently assume the presence of meningitis. And if the patient simultaneously with meningeal symptoms has both general infectious and cerebral symptoms, then the preliminary diagnosis can be considered established.