Meningitis is a disease characterized by the inflammatory process of the membranes of the head of the spinal cord of infectious etiology. The pronounced clinical signs of meningitis are neck stiffness (significant neck tension, when the head of the patient throws back, return to normal position is difficult), severe headache, hyperthermia of the body, impaired consciousness, hypersensitivity to sound and light stimuli. Meningitis is manifested as a primary form of reaction to infection of the membranes or a secondary inflammatory process that occurs in the complications of other diseases. Meningitis is a disease with a high percentage of deaths, disability of patients, incurable disorders and body dysfunctions.
What is meningitis?
Meningitis is a serious disease accompanied by inflammation of the membranes of the head and / or spinal cord the brain. Shells cover the tissues of the brain and spinal canal. There are two types of shells: soft and hard. Depending on which variety is affected by the infection, the types of the disease are differentiated according to the localization of the inflammatory process:
- leptomeningitis, the most common form in which soft membranes are affected
- pachymenitis – inflammation of the dura is found in approximately 2 out of 100 cases of the development of the disease.
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As a rule, in the medical sense, in the diagnosis of meningitis, inflammation is implied exceptionally soft shells of the brain. Meningitis is one of the most dangerous brain diseases, causing complications, provoking serious health problems, persistent disability, developmental disorders. A high percentage of deaths.
The description of the symptoms of meningitis was Hippocrates, and the doctor wrote in the Middle Ages. For a long time, tuberculosis or consumption was considered the cause of the inflammatory process, the epidemics of which caused the death of millions of people. Prior to the discovery of antibiotics, mortality from meningitis was 95%. The discovery of penicillin significantly reduced the statistics of fatal outcomes of the disease. Today, for the treatment of meningitis, there are modern synthetic drugs, for the prevention of most forms of the disease, vaccination is used against the most common pathogens – pneumococcus bacteria, meningococcus and hemophilic rods.
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The prevalence of meningitis, the seasonality of the disease, the risk group
The disease is found all over the world, but there is a pronounced correlation between the level of state welfare and the frequency of meningitis in the population. Thus, in Africa, South-East Asia, Central and South America, meningitis is diagnosed 40 times more often than in European countries. The statistical frequency of the incidence of meningitis in Russia and European countries today is 3 cases per 100 thousand of population for meningitis of bacterial etiology and 10 cases per 100 thousand of population with a virus pathogen of meningitis. The tuberculosis form of meningitis depends on the number of patients and the quality of the provision of medical services for the treatment of the underlying disease in the country, the second factor prevalent in importance over the former. Seasonality and annual cyclicity of outbreaks are noted. The most characteristic period for meningitis is the half-year from November to April, which is caused by fluctuations in air temperature, restriction of diet and lack of vitamins, clumps of people in rooms with insufficient ventilation due to bad weather, etc. Scientists claim that meningitis has an annual cyclicity : there is an increase in the incidence of 1 time every 10-15 years. In the risk group due to the characteristics of the organism and social causes are children aged from birth to 5 years and men 25-30 years.
Paths of infection with meningitis
Primary meningitis as a disease of infectious etiology is caused by pathogenic microorganisms. Viruses and bacteria that cause the development of meningitis are transmitted in various ways, the most common of which are:
- airborne: excretion of the pathogen with saliva, mucus during coughing and sneezing into the airspace.
- contact-household. with direct contact with the patient or the carrier of infection, use of household items (dishes, towels, hygiene items).
- oral fecal if hygiene is not respected: eating with unwashed hands, eating raw foods, dirty vegetables, fruits , greens, etc. ..
- hematogenous, transportation of the causative agent of meningitis differentiated etiology (most often bacterial, but viral, protozoal and other forms are possible) through the blood, the spread of infection within the patient’s body from the existing inflammatory focus to the brain envelopes.
- lymphogenous, with the spread of the infectious agent present in the body current of the lymphatic fluid.
- placental pathway during fetal development and passage of the pathogen through the placenta, as well as infection in the birth canal or when an infectious agent enters from the amniotic fluid to
- oral: when swallowed by water contaminated by the pathogen (when swimming in water bodies, public pools without a disinfection system, drinking dirty water), etc.
Meningitis in adults
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The high-risk group consists of young men from 20 to 30 years old. The most frequent pathogens are meningococci, pneumococci, hemophilia, and a tuberculous form of meningitis, in addition to the wrong therapy for tuberculosis. The widespread cause of the development of inflammation of the meninges at this age is considered to be the insufficiency of medical culture: the relation to various kinds of inflammatory diseases (carious processes, sinusitis, otitis, bronchitis, respiratory infections) as not deserving of proper attention and full therapy. Women are less likely to have meningitis, however, during the period of gestation, the risk of the disease increases due to a natural decrease in immunity during pregnancy. Preventive measures include pre-vaccination, timely sanitation, treatment of inflammatory diseases, restriction of contacts.
Meningitis in children
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In the age of birth to 5 years, meningitis is a particularly serious danger for the child, the percentage of deaths is extremely high: every 20 kids die with the disease. Complications of the disease at this age also have a serious impact on the health of the child. The heaviest form of childhood meningitis develops when Streptococcus agalactiae is infected with Streptococcus agalactiae during passage through the birth canal. The disease proceeds with lightning speed, causing severe consequences or death of the baby.
For children 1-5 years old, viral forms of meningitis with a less pronounced clinical picture and the consequences of the disease are most typical. Bacterial forms, provoked by meningococcus, pneumococcus and hemophilic rod, are much heavier, so vaccination is recommended to protect against disease.
Symptoms of meningitis
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Meningitis is an infectious disease, and its first signs indicate the presence of infection and damage to the nervous system. Such symptoms include:
- sudden increase in body temperature, sometimes to critical values
- severe headaches
- stiff neck muscles (neck muscles), numbness , difficult head movements, slopes, turns.
- loss of appetite, nausea, frequent bouts of vomiting that do not bring relief, diarrhea is possible (mainly in childhood).
- rash, Red. The rash disappears with pressure, after a few hours it changes color to bluish.
- general weakness, malaise. Even at the first stages, especially with lightning-fast development of meningitis, manifestations of confusion, excessive lethargy or excitement, hallucinatory effects. / h
The main symptoms of meningitis
Meningitis is manifested by the following symptoms:
- severe headache
- hyperemia up to 40 ° C , fever, chills.
- hyperesthesia, hypersensitivity to various stimuli (light, sound, ta
- dizziness, confusion, hallucinations, consciousness up to coma
- lack of appetite, nausea, multiple vomiting
- sensation of pressure on the eyeballs, possibly lacrimation, manifestations of conjunctivitis
- soreness, enlarged lymph glands due to the inflammatory process
- pain sensation in the palpation of the trigeminal nerve region, under the eyes.
- presence of the Kernig symptom (the inability to unbend legs in the knee joints after )
- positive response to the Brudzinsky symptom (reflex movements of the limbs with head inclinations, pressure)
- manifestations of Bechterew’s symptom (facial contractions in response to tapping by facial
- Pulatov’s symptom (pain sensation when tapping on the scalp).
- Mendel’s symptom (pressing on the external auditory canal causes pain).
- symptoms of Lesage in infants: pulsation, protrusion of the membrane over the large fontanel, lifting the child with a grip under the arms, the head throws back, legs are pressed to the stomach.
- Among the non-specific symptoms of meningitis, the following can be noted:
- reduction of visual function, dystonia of visual muscles, causing strabismus, istagm, ptosis, visual impairment in the form of doubling of objects, etc.
- hearing loss
- paresis of facial musculature of the facial part
- catarrhal phenomena sore throat, cough, runny nose).
- abdominal pain, defecation in the form of constipation.
- convulsions of limbs, body.
- epileptic seizures. / li
- heart rhythm disturbances, tachycardia, bradycardia
- increase in blood pressure values
- lethargy, pathological drowsiness.
- aggression, increased irritability
- hearing loss
- development of epilepsy
- purulent arthritis
- blood clotting disorders
- lagging, mental development disorders of the child
- emotional instability, hyperexcitability, fast exhaustion of the nervous system
- the development of the disease at an early age is likely the occurrence of such a complication as hydrocephalus.
- enterovirus infection (Coxsackie virus, ECHO virus)
- infectious mononucleosis (Epstein-Barr virus).
- herpetic infections (human herpesvirus)
- acute respiratory infections (influenza virus, adenovirus, etc.)
- haemophilus rod
- Staphylococcus aureus
- meningococcal meningitis
- pneumococcal form
- parotitis (against mumps or mumps), etc.
- general blood test
- biochemical blood test
- laboratory investigation of cerebrospinal fluid.
- PCR analysis.
- magnetic resonance imaging (MRI)
- computed tomography (CT)
- electroencephalography (EEG)
- electromyography (EMG).
- decongestants (Furosemide, Mannitol).
- anticonvulsants (Seduxen, Relanium, Phenobarbital).
- nootropic drugs
Complications of meningitis
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Meningitis is a dangerous disease, both in the process of affecting the membranes of the brain by exposure to the body, and possible concomitant complications of the disease. l /
Causes of meningitis
Inflammation of the meninges can begin under the influence of various infectious diseases agents. Depending on the type and type of the causative agent of meningitis, the diagnosis of pathogenesis is classified, which determines the methods of therapy and allows you to choose the appropriate treatment tactics.
Viral meningitis is considered the most favorable in predicting the course of the disease and the recovery of the form. With a virus etiology of meningitis, as a rule, the degree of damage to the membranes of the brain is minimal, serious complications and a lethal outcome of the disease with timely diagnosis and therapy are extremely rare. Viral meningitis in the vast majority of cases occurs as a complication of infectious diseases with pathogens-viruses (mumps, measles, syphilis, acquired human immunodeficiency syndrome, etc.). The most common causes and infectious agents capable of provoking the development of viral meningitis are the following:
The pathways of penetration of the pathogen into the membranes of the brain are different. Possible hemolytic pathway (through the blood), with a current of lymph, and can also spread with spinal cerebrospinal fluid. Unlike the bacterial form, viral pathogens cause an inflammatory serous process without the release of purulent exudate. The viral form proceeds rapidly enough: the acute stage takes an average of 2-3 days, followed by a significant relief and a stage of reverse development on day 5 from the onset of the disease.
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Bacterial meningitis has a more pronounced clinical picture, is characterized by the severity of the disease, the addition of additional inflammation foci, and serious complications. The highest percentage of deaths is recorded with the bacterial form of meningitis.
When inflammatory process of bacterial origin on the surface of the shells of the brain, there is a discharge of purulent exudate that hampers the outflow of the CSF, which leads to an increase in intracranial pressure. The pronounced inflammatory process provokes feverish conditions, strong intoxication of the body.
This form is often accompanied by impaired consciousness, confusion of thinking, hyperesthesia, hallucinations, high psychomotor activity. With active multiplication of bacteria, the patient may fall into a coma. The most common pathogens of bacterial meningitis:
Bacterial meningitis can occur as a disease of primary or secondary etiology against the background of the current inflammatory process, an untreated inflammatory focus. The most common secondary form occurs as a complication of bacterial pneumonia, chronic tonsillitis, sinusitis, pyelonephritis, osteomyelitis of bones, abscesses of various localization. Dangerous furuncles, carbuncles as sources of pathogenic microorganisms that can spread with blood flow and cause meningitis, we must pay special attention to various inflammatory phenomena on the face, in the area of the nasolabial triangle, inside and around the auricles.
Therapy of bacterial meningitis is based on the isolation of the pathogen and the exposure to it with antibacterial drugs (antibiotics) in significant doses. Without the use of antibiotics in 95% of cases, the disease ends fatal.
In the presence of foci of tuberculosis, mycobacterium can spread through the body by hematogenous or lymphogenous pathways and penetrate the membranes of the brain. This complication is most often observed with an active tuberculosis process with foci in the respiratory organs, bones, kidneys, reproductive system. Despite the serous form of tuberculous meningitis, in which purulent exudate does not form, just as in the case of a viral etiology of the disease, the meningitis that develops when the brain envelopes the tubercle bacillus is more severe than the viral form.
The basis of this form of therapy is a complex treatment with specific antibiotics that are active against tuberculous mycobacteria.
Other causes of meningitis
Viral, bacterial forms and tuberculous meningitis are the most common etiologic types of the disease. In addition to viruses and bacteria, other pathogens and their combinations can become pathogens. Thus, the fungal form of meningitis (torulent, candida), protozoal (toxoplasma) is isolated. Meningitis can develop as a complication of processes and disorders of non-infectious etiology, for example, in metastasizing malignant tumors, systemic connective tissue diseases, etc.
Classification of meningitis
In addition to distinguishing various forms of the disease by etiology and pathogen, meningitis is classified according to the nature of the inflammatory process, the localization of the inflammation focus and its prevalence, the course of the disease.
Types of the disease depending on the nature of the inflammatory process
Purulent meningitis is characterized by a severe course with severe neurologic symptoms due to the formation of purulent exudate in the meninges. The most common form of bacterial infection. In the group of purulent meningitis, varieties are diagnosed depending on the pathogen:
Serous meningitis occurs most often in the viral etiology of the disease, characterized by the absence of purulent inflammation and a lighter course of the disease. The group of serous meningitis includes the following varieties:
Classification by the nature of the disease
Lightning fulminant meningitis develops in a few hours, especially typical of infants. The incubation period is practically absent, the lethal outcome can occur within 24 hours after infection.
The acute form of meningitis affects the body in a few days, characterized by acute clinical manifestations. Often ends with a fatal outcome or severe complications.
Chronic meningitis develops gradually, the symptoms grow, become more pronounced.
Types of the disease depending on the prevalence of the inflammatory process
Basal meningitis is characterized by the localization of inflammation in the base of the brain. The convexital form affects the convex parts of the brain. With total meningitis, the inflammatory process covers the entire surface of the membranes of the brain. If the inflammation is concentrated on the base of the spinal cord, the spinal form of the disease is diagnosed.
Diagnosis of meningitis
Diagnosis of meningitis begins with examination of the patient and collection of anamnesis and may include some or all of the following methods of examination:
Treatment of meningitis
Therapy for meningitis should begin immediately. Treatment in any case is carried out in the infectious department of the clinic, independent attempts or therapy in conditions of day hospital, especially sick children, are unacceptable.
The disease can develop rapidly, the symptomatology – suddenly increase. The condition of any patient can suddenly deteriorate, requiring urgent care (for example, with increasing intracranial pressure, edema of the brain, respiratory and adrenal insufficiency, oppression of consciousness, confusion in coma, etc.). The best conditions for therapy are a separate ward in the infectious department with 24-hour watch of specialists, the possibility of creating conditions for desensitization: to dim the light, eliminate sources of loud sounds, and worry the patient.
Etiotropic therapy for meningitis
Etiotropic therapy is a treatment aimed at eliminating the cause of infection. For meningitis of the viral form, therapy is based on antiviral drugs (recombinant interferons, inducers of endogenous interferon, immunomodulators, antiretroviral drugs, etc.), in the bacterial origin of the disease, antibiotics that are active against a particular pathogen (for example, , antimeningococcal or antistaphylococcal gamma globulin), with meningitis of fungal etiology treatment is carried out with antimycotic drugs, etc.
In combination with Drugs that are active against the pathogen are prescribed symptomatic remedies:
Depending on the course and probable or developed complications, therapy may include correction of the associated pathological conditions: respiratory, adrenal , cardiovascular failure statics. From the time of the beginning of therapy, both etiotropic and symptomatic, depends not only the recovery, but also the life of the patient. At the first signs (sudden rise in temperature, severe headache, especially against the background of acute respiratory-viral or other infectious diseases) it is necessary to immediately call a doctor or call home specialists from the ambulance. If the symptoms appear in the child, the examination and diagnosis should be carried out immediately, because with lightning-fast development of the disease in young children, the account goes literally for a minute.