Symptoms of meningitis in an adult, the first signs, diagnosis and treatment. Modern methods of treatment of meningitis of various etiologies

"Don't go without a hat - you'll get meningitis!" Who among us did not have to listen to this kind of “horror stories” in childhood. In fact, the mechanism of infection with this disease is much more complicated and only a warm hat cannot protect against it. Let's say more: you can get sick with meningitis even in the summer at sea, and massive outbreaks of this disease occur more often in tropical countries than in regions with a harsh climate.

Meningitis is an inflammation of the meninges, which is fatal in 10% of cases. The human brain and spinal cord consists of three membranes: soft, arachnoid and hard. If in any of them (or immediately in all) an inflammatory process begins, they speak of meningitis. Inflammation in the dura mater is called pachymeningitis. With leptomeningitis, the soft and arachnoid membranes are affected, and panmeningitis is an inflammatory process in all three layers. But most often, doctors diagnose inflammation in the soft membranes of the brain.

Thus, everyone should know how and why meningitis appears, whether it is contagious, whether it is possible to get sick with it again and who is most susceptible to inflammation of the meninges.

Types of meningitis

It is generally accepted that the first symptoms of meningitis were described by Hippocrates, and then by medieval healers. So this disease has been known to mankind for a very long time. But for many years, tuberculosis and consumption were mistakenly considered the cause of inflammation of the meninges, and before the discovery of antibiotics, 95 out of 100 patients died from meningitis. Treatment of meningitis is also difficult these days, but thanks to modern knowledge, the survival rate is much higher than it was several centuries ago.

However, for the therapy to be effective, you first need to understand what type of meningitis you have to fight. And this disease is very “many-sided” in origin and character, therefore, in international classification diseases (ICD 10), each variety has its own code and definition, and specialists use different methods to systematize the disease.

By the nature of inflammation, meningitis is:

• purulent;
• serous.

In the first case, the disease is caused by meningococcal bacteria, is very difficult, and is caused by a primary septic process. The second type is of viral origin. This variety is considered not as dangerous as purulent and rarely causes complications.

By origin, meningitis is divided into:

• primary (independent disease);
• secondary (appears as a complication of sinusitis, otitis, respiratory infections, osteomyelitis of the bones of the skull, carious processes, boils on the face or neck, tonsillitis, sometimes occurs against the background of diseases such as tuberculosis, mumps, syphilis).

Classification by pathogen:

• bacterial;
• fungal;
• viral;
• protozoan;
• mixed.

By the nature of the flow:

• lightning fast (fulminant);
• spicy;
• subacute;
• chronic;
• recurrent.

According to the localization of inflammation:

• total;
• basal (affects the deep parts of the brain);
• spinal (affects the spinal cord);
• convexital (affects the surface of the brain).

According to the severity of the flow:

• mild degree;
• medium heavy;
• heavy.

In addition, there is non-infectious meningitis. This is a type of aseptic meningitis, that is, a disease caused by any other causes than the bacteria that usually cause acute meningitis - non-communicable diseases, drugs or vaccines. In general, these causes of meningitis are rare. Most often, doctors diagnose cases of viral, bacterial, secondary purulent and fungal meningitis. Moreover, the bacterial (meningococcal) variety of the disease is more common among children under 5 years of age, and fungal - among pregnant women, patients after chemotherapy, as well as patients with acquired immunodeficiency. Bacterial, also purulent, meningitis can affect even babies up to a year old, and viral (serous) in children usually appears after mumps or due to ECHO. The viral form is not as scary for children as the purulent one, since it is easier to treat and less likely to cause complications.

Causes of infection

In many clinical cases, meningitis manifests itself as a seasonal disease. But contrary to popular belief, it main reason hypothermia cannot be considered. Statistics indicate that more cases of infection occur in warm time year, as well as in countries with a temperate climate. However, experts also record spikes in the spread of the disease in the off-season. Several factors contribute to this at once: an increase in humidity and a decrease in air temperature outside, seasonal hypovitaminosis, as well as a longer stay in poorly ventilated rooms. Not so long ago, scientists noticed another cyclical pattern: every 10-15 years, an epidemic of meningitis occurs in the world. For example, in 2017, an epidemic of serous meningitis was recorded in Russia, the cause of which was the enterovirus ECHO30, which came from China.

Most susceptible to the disease are people with weakened immune systems, children under 5 years of age (their immune system is still developing, and the blood-brain barrier is characterized by increased permeability). If we analyze the prevalence of the disease between the sexes, then more cases of inflammation in the brain are diagnosed among men (more often at the age of 20-30 years). Also at risk are pregnant women, patients with diabetes, ulcers digestive organs, AIDS sufferers chronic fatigue or people suffering from malnutrition. In the countries of the so-called "Third World", the prevalence of meningitis is almost 40 times higher than the European average. It is also interesting that in Europe and Russia the disease bacterial etiology occurs about 3 times less frequently than viral. Doctors say the main reason for this is vaccination, with which you can prevent the bacterial form of the disease. The body after vaccination, faced with the causative agent of the disease, will independently protect itself from it.

To protect yourself, first of all, you need to understand that meningitis is a contagious disease. Depending on the species, it can be transmitted in different ways:

• airborne (through particles of saliva during coughing and sneezing);
• fecal-oral (through unwashed hands, fruits and vegetables, contaminated water);
• blood contact (through the blood);
• lymphogenous (through lymphatic fluid);
• placental (from pregnant women to the fetus);
• water (when swimming in open water or pools);
• contact-household (through household items, dishes, toys);
• through insect bites (mainly in Africa).

In babies under 1 year old, meningitis can be caused by the same reasons as in adults or have other reasons. For example, be the result of a birth injury, prematurity, damage to the brain or spinal cord, sepsis, disease of the middle ear or nasopharynx. If a woman has had meningitis during pregnancy, the risk of transmission of the infection to the fetus is very high, and this can lead to impaired development of the child. In most cases, meningitis during pregnancy ends spontaneous abortion or intrauterine fetal death. But even if the fetus survived, doctors usually advise women to terminate their current pregnancy.

Options for the course of meningitis

The most dangerous meningitis is for children under 5 years of age. Regrettably, every 20th baby diagnosed with "inflammation of the meninges" dies. The most dangerous form of infantile meningitis is considered to be a disease caused by streptococcal infection. Infection usually occurs during the passage of the baby through birth canal mother. In this case, the disease develops at lightning speed and the child either dies during the first month of life, or suffers from serious developmental disorders. A complicated form of meningitis is no less dangerous for babies. And already at the age of 1 to 5 years, children are more likely to get viral meningitis, which is usually easier than bacterial.

The course of the disease consists of three periods: incubation, prodrome and the disease itself. The incubation period is the time from the moment the virus enters the body until the first symptoms of the disease appear. At this time, viruses or bacteria are contained in the body in small quantities, and therefore cause almost imperceptible harm. Depending on the type of disease, the incubation period can last from a few minutes (rapid development) to several years (chronic inflammation). The duration of the incubation period also depends on the condition immune system patient: the weaker it is, the faster the disease manifests itself. Most often, the incubation period lasts from 1 to 10 days. If the disease was diagnosed in the first two days after infection, then the chances of a cure reach 95%.

The fulminant or fulminant form of meningitis is the most dangerous. With this form, all stages of the disease pass almost instantly, and death is possible already on the first day. Acute meningitis also proceeds according to the "accelerated" program: as a rule, the infection is enough for 3 days to reach its peak or even cause the death of the patient.

Purulent meningitis in the prodromal stage (the time when the classic symptoms of the disease appear) can pass within a few hours after the bacteria enter the body. Acute bacterial inflammation progresses very quickly. If the disease was caused by Neisseria meningitidis, then the patient may die within a few hours after infection. Against the background of this type of disease, bilateral hemorrhagic infarction of the adrenal glands (Waterhouse-Friderichsen syndrome) is possible. A disease caused by the bacterium Haemophilus influenzae, or hemophilic meningitis, in more common in countries that do not vaccinate against hemophilia.

If it's about acute period disease, it usually develops from several days to several weeks, and chronic meningitis manifests itself no earlier than 4 weeks after infection. In addition, if most forms of inflammation in the brain proceed quite quickly, then chronic meningitis can drag on for even more than 25 years. In this case, the disease develops gradually, and it is almost impossible to determine when the infection entered the body.

Sometimes inflammation of the meninges even after successful treatment returns. Relapse can be caused by viruses, bacteria, or non-infectious factors. The most common cause of recurrent disease is called a virus herpes simplex Type 2 (Mollare meningitis). Bacterial meningitis can recur due to congenital or acquired defects in the base of the skull or spine.

Symptoms

The insidiousness of meningitis is in its rapid development. Medicine knows cases when death occurred just a few hours after the onset of the acute period of the disease. In the classical version, the incubation stage of meningitis in most cases lasts from 4 days to a week. If the disease is recognized in time, the patient will have a chance for a cure. And for this you need to know the first symptoms of the disease. However, in most cases, the signs accompanying the onset of meningitis are not perceived by the patient as an alarm signal, the disease manifests itself with general infectious signs: the patient has a feeling of chills, fever, fever body, in some cases, skin rashes may appear.

The main symptom of meningitis is a headache, which becomes more intense as the disease progresses. The nature of the pain is bursting, the pain can be very intense. In this case, pain can be localized in the forehead and in the occipital region, giving to the neck and spine. Bursting pain is associated with an increase in intracranial pressure as a result of the action of pathogen toxins. Pain syndrome aggravated by head movement and loud sounds And bright light. Another sign that is important for differentiating the nature of a headache is stiffness (strong tension) of the occipital muscles. Patients with meningitis (adults and children) do not lie in their usual position on their backs. To ease the pain, they turn on their side, pull their knees up to their stomachs, and instinctively tilt their heads back.

Inflammation of the meninges in many cases is accompanied by nausea and severe vomiting. And vomiting reflex does not stop even complete failure from food. In addition, the patient's body temperature rises (jumps or remains stably high at 39-40 degrees) and does not go astray with traditional antipyretics, severe weakness and sweating appear. The patient complains of intolerance to bright light, which exacerbates the headache. It is also possible to suspect the presence of meningitis in cases where a bursting headache is accompanied by a violation of consciousness (a person slowly and with difficulty answers questions or does not respond to requests at all). Mental disorders indicating inflammation of the membranes of the brain can be manifested by hallucinations, apathy or aggression. The patient may have cramps in the legs and / or hands, muscle pain, strabismus (if the inflammation has spread to the optic nerves).

To recognize meningitis in young children, in addition to the classic ones, specific signs will help: Kernig's symptom and upper symptom Brudzinsky. In the first case, the child in the supine position with legs raised will not be able to straighten them in the knee joints. The second symptom is also determined in the supine position. If the baby, raising his head, involuntarily bends his legs at the knees, this may also indicate inflammation in the meninges. To identify the disease in infants, the fontanel is examined: an alarm is its swelling and tension. Another sign of inflammation of the meninges in children is a rash, which is then replaced by specific bright burgundy spots that appear on the entire body of the baby.

Diagnostics

An experienced doctor can already suspect meningitis in a patient by external clinical signs. But it is too early to make an accurate diagnosis based on symptoms alone. Moreover, it is important not only to confirm or refute the presence of the disease, but also to determine its type, stage of development. For this, the patient will have to undergo a comprehensive examination. Patients in such cases donate blood for a general analysis (KLA), a general urinalysis and a smear from the pharyngeal mucosa. One of the main confirmatory tests is a spinal cord puncture and laboratory diagnosis of CSF (cerebrospinal fluid). Since the brain and spinal cord are in constant contact, cloudy cerebrospinal fluid is always considered as the main marker of meningitis.

If symptoms are observed during the puncture high blood pressure cerebrospinal fluid (cerebrospinal fluid flows out in a trickle or frequent drops), experts regard this as one of the laboratory signs meningitis. In addition, in a sick person, the color of the cerebrospinal fluid changes: it becomes cloudy white or yellowish green. Not only a CSF analysis, but also a blood test can also tell about the disease. In the presence of the disease, there is increased amount, lymphocytes or neutrophils. Also, the patient usually has elevated levels of sugar and chlorides.

Differential diagnosis of the disease is based on biochemical analysis cellular composition of the liquor. To establish the causative agent of the disease, bacteriological and bacterioscopic examination of the cerebrospinal fluid is used to determine the causative agent of the disease. With the help of serodiagnosis, the presence in the patient's body of antigens and antibodies to various pathogens is determined.

In the results of a blood test, neutrophilia or lymphocytosis will be detected, indicating the nature of the disease, as well as an ESR indicator - the erythrocyte sedimentation rate, which in high values indicates the presence of an inflammatory process. In addition to the laboratory study of cerebrospinal fluid and blood, the doctor will definitely need the patient's medical history, he will conduct a thorough neurological examination, and offer to undergo computed or magnetic resonance imaging. With the help of MRI or CT, a specialist will be able to examine the condition of the meninges and find the focus of inflammation. During a conversation with the patient, the doctor will ask how long the headaches began, whether the patient was bitten by ticks or mosquitoes (carriers of the pathogen, in particular in Africa and Central Asia).

If suspicions of meningitis were found in a child, then before sending the baby for a puncture, he should be examined by an ENT, neurologist, neurosurgeon and hematologist in order to exclude other possible causes of malaise.

Treatment

Any inflammatory processes in the body are very serious. And if inflammation occurs in the brain, then there can be no talk of any self-treatment at home. Neither folk ways, no alternative medicine can replace the necessary drug therapy. Meningitis should only be treated by a doctor and only in a hospital. The sooner the patient seeks help from a specialist, the higher his chances of survival.

A doctor can draw up a comprehensive treatment program only after receiving the results of the patient's examinations. Meanwhile, in the case of meningitis, when the clock counts, there is not a minute to lose. As an emergency, all patients with suspected meningitis are given broad-spectrum antibiotics. At the beginning of treatment, the doctor may prescribe drugs from the group of penicillins, cephalosporins, macrolides. This will neutralize the bacteria that cause purulent meningitis. In order for antibiotics to take effect immediately, the drug is usually administered intravenously (dropper), and in very severe cases- directly into the liquor. Treatment of serous meningitis is carried out with the additional use of antiviral drugs. In addition to the specific sensitivity-matched antibacterial or antiviral therapy, patients are prescribed nootropic and vascular preparations– Nootropil, Piracetam or their analogues are taken to restore nerve cells and condition of the vessels. As anti-inflammatory drugs, doctors give hormone therapy to patients with drugs such as Prednisolone, Dexamethasone, Methylprednisolone, or Hydrocortisone.

Diuretic therapy is also used in the treatment regimen for meningitis. Diuretic drugs are needed to relieve cerebral edema.

Regardless of the form and stage of meningitis, vitamins and minerals are always prescribed for children and adults. These substances are necessary to maintain immunity, which is always reduced during inflammation of the brain, as well as to restore the supply of nutrients necessary for the proper functioning of the patient's systems and organs.

Prevention

The question of whether it is possible to catch meningitis is of interest to many. But other problems are no less relevant: how to protect yourself from the disease and are there vaccinations against inflammation of the brain? Meningitis is a contagious disease. But even if there is a patient with inflammation of the meninges in the environment of a child or an adult, this fact should not be taken as a sentence of imminent infection. Meanwhile, protection should be taken care of in advance.

One of the most effective measures to prevent bacterial meningitis is vaccination against pathogens. There are three types of meningitis vaccines: protein-based, polysaccharide, and conjugated. In each group of vaccines, there are drugs that are most suitable for different age categories. Which vaccine to choose for an adult or a child, how often to vaccinate - this should be determined by the attending physician.

Vaccination is, if not 100%, but still a good guarantee that healthy man won't get infected.

To protect yourself or your child from contracting viral meningitis, it is also important to follow the rules of hygiene and SanPiN, eat only clean fruits and vegetables, and wash your hands thoroughly with soap and water before each meal. The most common source of meningitis infection during the summer is polluted water bodies. To protect yourself from problems, it is important to avoid bathing, and even more so not to drink water from them.

Excellent prevention of meningitis - avoidance of contact with infected person. But if this has already happened, you should undergo a course of chemoprophylaxis. It is also mandatory to disinfect the premises where the patient was, and monitor contact persons. In the event that contact with the carrier of the infection is inevitable (for example, one of the household members falls ill), respirators or gauze bandages should be used to prevent infection by airborne droplets. Remember: first, the infection enters the upper respiratory tract of a person, settling on the mucous membranes, and then spreads throughout the body. But infection by airborne droplets does not always occur, but only in cases of reduced immunity and impaired functionality of the blood-brain barrier, which protects the brain from harmful substances. To prevent infection, family members are prescribed a course of rifampicin and vaccination using a conjugate vaccine. By the way, many are interested in whether it is possible to get meningitis again. As a rule, this does not happen, but the possibility cannot be completely ruled out either.

If meningitis was diagnosed on time, and the treatment was successful, a person has a chance to live a long, full life. But for everything to be exactly like this, after completing treatment in a hospital, you will have to follow the recommendations of the doctor.

After suffering meningitis, it is important to continue monitoring with a doctor: it is important to undergo an examination by a neurologist every three months. And so for at least 2 years. In addition, some restrictions are temporarily imposed on the mode and way of life. At least 6 months after the illness, it is forbidden to fly on airplanes. The flight during this period is dangerous because intracranial pressure changes dramatically during the flight, which can adversely affect the recovery of liquorodynamics after inflammation of the meninges. Also, doctors do not advise immediately after the illness to go to the sea, especially for children. The temporary ban also applies to sports: after an illness for about 2 years, heavy physical exertion should be avoided.

You will also have to reconsider your usual diet: give up fatty and fried foods in favor of boiled, stewed, baked or steamed. From meat to give preference diet varieties: , bird, as well as fish. As a side dish, it is useful to eat boiled cereals, and heat-treat fruits and vegetables before eating. It is useful to eat low-fat dairy foods, drinks are best suited and, if - then weak. The diet after meningitis completely excludes alcohol.

Physiotherapy during the rehabilitation period should consist of a course of massage, electrophoresis using medicines. To restore cognitive functions and coordination, they resort to magnetic and magnetic laser therapy, use electrosleep. Well physiotherapy exercises help restore motor function. But for this you need to exercise under the supervision of a specialist in exercise therapy. Ergotherapy is used to restore range of motion, strength and coordination, and a cognitive program is necessary to restore memory, attention and logical thinking.

Possible Complications

Inflammation of the meninges is already a serious problem in itself. But against the background of this disease, other, no less complex complications are possible.

One of the most common is cerebral edema. As a rule, a critical excess of cerebrospinal fluid accumulates already on the second day of the development of the disease. A complication can be suspected by several outward signs. The patient suddenly loses consciousness, he has shortness of breath, indicators blood pressure then sharply decrease, then rise. There are also jumps in the heart rate: from severe bradycardia (slow) to tachycardia (rapid). If cerebral edema is not removed in time, then death is possible, which usually occurs due to paralysis of the respiratory center.

The second common danger is infectious-toxic shock. It occurs as a result of poisoning the body with decay products of pathogens. Against the background of this process, the patient's body temperature usually drops, but intolerance to light and loud sounds increases, shortness of breath appears. In many cases, infectious-toxic shock occurs along with cerebral edema. The result is coma and death within a few hours.

After suffering from meningitis, the body will need time to recover. Sometimes quite long. If the inflammatory process was caused by meningococcal infection, then there is a high risk of damage to other organs or entire body systems. prevent severe consequences will only allow timely appeal for medical care.

Meningitis can cause deafness, paralysis, epilepsy, and hormonal disorders. In children, hydrocephalus, complete deafness or blindness, acute renal failure, developmental delays, cerebroasthenia are possible. Often, inflammation of the membranes of the brain in babies ends in death.

We answer your questions

Do they take the army after meningitis

The question of whether they take meningitis into the army is of interest to many. Let's say right away that no one will be taken to the barracks directly with the disease, since with any inflammation (especially the meninges) one should lie in the hospital. Those working with a diagnosis of meningitis unconditionally open a sick leave. If cases of the disease are recorded at a school or kindergarten, then the educational institution is closed for quarantine. But what awaits a young man who had meningitis a few years ago? If there is documentary evidence of the fact of the disease, then the conscript automatically falls into the reserve.

Meanwhile, the question of the compatibility of the army and meningitis is of interest not only to those who have had the disease, but also to healthy conscripts. Is it possible to get meningitis in the army? Theoretically, such a risk exists, as, indeed, in boarding schools, schools, kindergartens, sanatoriums or children's camps. Therefore, to avoid an epidemic, vaccination is carried out. Meningitis vaccinations for recruits should be done approximately 75-80 days prior to enlistment.

Can you die from meningitis?

Any inflammatory process in the body is already a potential danger of death. What then to say about inflammation of the meninges! But if earlier the survival rate after meningitis was no more than 5-10%, then in our time this figure has increased to around 90. Of course, the risk of death always remains, but in most cases, patients who have had meningitis live a long full life.

Take care of your health and be attentive to the signals of the body. In case of unusual changes in well-being, do not postpone a visit to the doctor. Be aware of the consequences of late treatment of meningitis.

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

Forms of meningitis

1. Leptomeningitis (inflamed soft and arachnoid membrane).
2. Pachymeningitis (inflammation of the hard lining of the brain).
3. Arachnoiditis (inflammation of the arachnoid membrane only, rare).

With meningitis, the membranes of the spinal cord and brain can be affected (spinal and cerebral meningitis). By the nature of inflammation, meningitis can be serous and purulent. Hyperproduction of cerebrospinal fluid is caused by inflammatory changes in the choroid plexuses of the ventricles. With involvement in the process of intrathecal structures of the brain, meningoencephalitis develops. All this causes certain symptoms of meningitis.

Serous meningitis

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

Ways of transmission of the virus:

1. Fecal-oral. Through infected products food and water. The virus multiplies in the intestine, and is released into the external environment for a long time, where it remains for a long time on household items, in food products, sewer waters.
2. Airborne.
3. Transplacental transmission of the virus is possible. On early dates pregnancy, this causes anomalies in the development of the fetus, in the later stages - its death or intrauterine infection.

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

The maximum incidence of meningitis is recorded in the spring-summer period. Enterovirus infection is very contagious, therefore, when it enters a children's group, epidemic outbreaks occur (up to 80% of the group get sick).

How to suspect meningitis

It all starts with damage to the mucous membrane of the nose and throat, then the virus with blood flow (hematogenous route) reaches different systems and organs, causing the development of acute serous meningitis or meningoencephalitis, myalgia or acute myositis, myocarditis, hepatitis and other diseases: enterovirus exanthema, gastroenteric form, myocarditis. Often there are combined forms, but the most typical of them is serous meningitis.

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

From the first days of meningitis, meningeal symptoms appear:

1. Stiff neck - when you try to bend your head, there is resistance.
2. A positive symptom of Kernig - when the leg is bent at the hip joint, it cannot be straightened at the knee joint due to the tension of the posterior thigh muscles.
3. Brudzinsky's symptom - with passive flexion of the patient's leg in the hip and knee joints, the other leg also automatically bends.

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

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

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

Children with serous meningitis are subject to hospitalization.

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

Meningitis caused by meningococcus

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

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

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

The prognosis for life and recovery depends on timely diagnosis, proper treatment, concomitant diseases, reactivity of the organism.

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

Menincococcemia often begins acutely, often suddenly, with a significant increase in temperature, chills, and vomiting. In young children, a headache is accompanied by a piercing cry, in especially severe cases, there may be loss of consciousness. A hemorrhagic stellate rash appears on the body with foci of necrosis in the center. Often its combination with a roseolous-papular rash. There is damage to the joints in the form of synovitis and arthritis. Uveitis develops in the choroid of the eye, it becomes brown (rusty) in color.

The fulminant form of meningococcemia (hyperacute meningococcal sepsis) is especially dangerous. Elements of the rash literally before our eyes form cyanotic spots resembling cadaveric ones. Baby tossing about in bed arterial pressure falls, shortness of breath appears, meningeal symptoms are not constant, more often they are not determined, muscle hypotension is noted. No online consultations on the Internet, urgently required to call ambulance!

meningococcal meningitis begins with chills, fever, severe headache, aggravated by turning the head, strong light or sound stimuli. There may be pain along the spine. The phenomena of increased skin sensitivity (hyperesthesia) is one of the leading symptoms of purulent meningitis. From the first day of the onset of meningitis, vomiting appears, and it is not associated with food intake. Seizures are an important symptom. Meningeal symptoms can be distinct from the first day of illness, more often observed on the 2nd-3rd day of meningitis.

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

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

If a meningococcal infection is suspected, mandatory immediate hospitalization is required. In no case should you self-medicate. No traditional methods.

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

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

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

From nonspecific prophylaxis In addition to the above methods, it is recommended not to swim in open water, especially for young children, and not to travel to countries where meningitis is common.

Meningoencephalitis (two-wave viral meningoencephalitis) also occurs with tick-borne encephalitis. Meningitis and meningoencephalitis also occur with candidal (fungal) infections in young children. The phenomena of meningism occur in various diseases, even with influenza and SARS, and in each case, accurate diagnosis and treatment are required. competent treatment. The virus cannot be treated with antibiotics, and with a microbial infection, antiviral drugs will not help. Same with fungal infections. All appointments should be made only by a doctor. Parents are required to be attentive to their health and the health of the child. With physicians - a clear performance of their duties.

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

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

What can be meningitis?

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

The hallmark of both types of infection is the acute nature clinical course illness. 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, anywhere, from public transport to clinics. In children's groups, the pathogen can cause real epidemics of the disease. We also note that when a meningococcal infection enters the human body, purulent meningitis usually develops. We will talk about it in more detail in one of the following sections.

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

Other factors that provoke meningitis in children and adults include:

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

Reactive meningitis

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

Purulent meningitis in adults and children

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

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

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

Treatment of meningitis

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

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

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

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

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A serious and rather severe neuroinfectious disease is meningitis - an inflammatory process in the pia and arachnoid membranes of the brain, leading to swelling of the brain structures and menacing for the life of the patient.

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

Meningitis is a dangerous and transient 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 TBI or occurs as a complication after neurosurgical manipulations; purulent ENT diseases (otitis media, sinusitis) can also become a cause. Primary meningitis is caused by the action of a pathogenic agent directly on the structures of the nervous system (for example, meningococcal infection).

According to the predominant localization of the inflammatory process, meningitis can be:

• Convexital.
• Basal.
• Cerebrospinal.

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

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

Also, meningitis can vary in severity: mild, moderate, severe.

The main causes of the disease

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

Meningitis can be caused by a variety of pathogens.

Among the viral causative agents of the disease, Coxsackie and ECHO viruses play the greatest 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, Haemophilus influenzae. In children during the neonatal period, pathogens can also be coli, enterococci, klebsiella.

How does the inflammatory process develop?

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

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

After the penetration of a pathogenic agent into the subarachnoid space, inflammatory changes and edema occur in the meninges, which are incapable of stretching. As a result, the structures of the cerebellum and medulla oblongata are displaced, 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, respectively, and the symptoms of the disease may not be so bright.

Signs of meningitis

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

• intoxication
• Meningeal
• Characteristic changes liquor.

Intoxication syndrome

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

Other symptoms of meningitis include feeling chills, excessive sweating, weakness, loss of strength. In laboratory parameters of 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 proper meningeal symptoms. Cerebral - a consequence of edema of the meninges and increased intracranial pressure. The main characteristics of the syndrome are: severe headache of a diffuse nature, nausea, there may be repeated vomiting. At severe course illness, consciousness is disturbed, from mild deafness to coma. In some cases, the disease can be manifested by psychomotor agitation, hallucinations, intellectual-mnestic disorders.

Checking Kernig's sign

The actual meningeal symptoms are hallmark pathologies and allow the doctor to establish a primary diagnosis already on the basis of an examination of the patient. These include symptoms of hyperesthesia - increased sensitivity to light, sound, touching the skin. The second group is pain phenomena (Kerer, Mendel, Pulatov) and the so-called muscle contractures. The latter are most often used in medical practice for diagnosis, their main characteristics are:

• The inability to fully bend the patient's head in the supine position - stiff neck muscles.
• Kernig's symptom is a tension in the muscles of the back of the thigh, as a result of which it is impossible to unbend a leg bent at the knee in a person lying on his back.
• The so-called meningitis posture - when, due to excessive tension of the long muscles of the back, there is a maximum extension of the back 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, in the presence of such symptoms it is necessary to seek medical help as soon as possible.

Changes in the liquor

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

Spinal puncture

Laboratory analysis shows a change in the cellular composition in the direction of its increase (pleocytosis). When the process is caused by bacteria, an increase in neutrophils is detected, with a viral infection - lymphocytes. Further microbiological research helps to identify the type of pathogen, and hence its sensitivity to a particular antibiotic. When analyzing cerebrospinal fluid, they also give a description of the amount of sugar and protein contained in it. In some clinics, additional serological reactions.

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

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

In this case, you must immediately seek medical help, since the lightning-fast course of such a disease can cause cerebral edema and threaten the patient's life.

Complications of meningitis

In the acute period of the disease, the most dangerous is cerebral edema and a complication in the form of secondary encephalitis (damage directly to the brain tissue). Meningoencephalitis can be manifested by focal and diffuse neurological symptoms, which sometimes persist for a long time after the patient has recovered, and in severe cases becomes a cause of disability.

Especially dangerous complication may be the formation of an abscess of the brain, which often occurs with secondary bacterial meningitis against the background of the existing ENT pathology (sinusitis, otitis media). It causes rapid perifocal cerebral edema and displacement middle structures, which means that it poses a threat to the life of the patient. In this case, along with conservative therapy undergoing surgical treatment.

Treatment

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

Therapy of meningitis of any etiology is carried out only in a hospital setting. Usually, primary forms diseases (bacterial or viral) are treated in the infectious diseases department, secondary diseases are treated in the 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.

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

Because the bacterial meningitis- this is inflammation and swelling of the meninges caused by a certain type of pathogen, then antibacterial treatment is carried out with appropriate antibiotics or a broad spectrum of action. In addition, the antibacterial drug must penetrate the blood-brain barrier well. The most commonly used Cefotaxime, Ceftriaxone in combination with Ampicillin, Benzylpenicillin.

Therapy for viral meningitis includes antiviral drugs - Tiloron, recombinant interferons, immunoglobulins. Anti-tuberculosis drugs are prescribed when the tuberculosis etiology of the disease is confirmed.

Rehabilitation

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

Nootropic drug

In 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 phenomena (paresis, paralysis), exercise therapy, massage, and physiotherapy are recommended. Treatment by an ophthalmologist, ENT doctor is indicated for existing visual or hearing impairments, respectively.

Full rehabilitation after meningitis also includes nutrition correction. The diet should be complete, and therefore with the mandatory inclusion of a sufficient amount of easily digestible protein (chicken, rabbit, lean fish, cottage cheese, sour-milk drinks), fresh vegetables and fruits, vegetable oils rich in polyunsaturated fatty acids (olive, linseed).

For a period of about six months, severe physical exercise, work in the night shift, on top.

Prevention

The main prevention of meningitis is to strengthen the immune system, which is ensured by good nutrition, quality rest and regular physical activity. It is also necessary to treat purulent foci in the skull area, for example, otitis media or sinusitis, in a timely manner and under medical supervision, to undergo regular medical examinations to detect foci of tuberculosis.

In case of an outbreak of meningitis in the kindergarten, the institution is closed for a two-week quarantine

If the sick child visited kindergarten, the group is quarantined. In terms of time, it corresponds to the incubation period of the disease. With viral meningitis, it is up to 7 days, with meningococcal infection, quarantine lasts up to 10 days. It should be borne in mind that if a child attended a preschool institution on the day the infection was detected, then he can continue to go to the group during the entire quarantine period. At school, when meningitis is detected, quarantine is usually not announced. Parents of children should be informed about what meningitis is, what are its symptoms, first signs and possible complications. If there is the slightest suspicion of meningitis (fever, headache, vomiting, rash on the body), you should immediately contact a medical facility.