Purulent meningitis in children, consequences, symptoms, causes. Purulent meningitis: how not to miss the onset of infection What are the consequences after purulent meningitis

Purulent meningitis is a purulent inflammation of the membranes of the brain caused by streptococci, pneumococci, staphylococci, Pseudomonas aeruginosa, intestinal microbes, etc. Purulent meningitis occurs in people of all ages.

Risk factors include: smoking, insolation, frequent stress, hypothermia, excessive alcohol consumption, pharyngitis, tonsillitis, acute respiratory infections.

The reasons

Most often, the causative agents of purulent meningitis are representatives of the bacterial microflora - meningococci, pneumococci, Haemophilus influenzae (influenza bacillus), Pseudomonas aeruginosa, various types of staphylococci and streptococci, gonococci, salmonella, E. coli, causative agents of typhoid fever and listeriosis.

But sometimes purulent meningitis also develops with a fungal infection (more often it still has a non-purulent, serous character) - cryptococcosis, coccidioidosis and candidiasis. The cause of purulent meningitis can also be protozoa, for example, some types of amoebas.

1. Primary purulent meningitis, caused by meningococcus, is transmitted mainly by airborne droplets: infection with meningitis occurs when sneezing, coughing, kissing, through objects contaminated with saliva, and so on.
2. Secondary meningitis, which is a complication of some other inflammatory processes (rhinogenic, otogenic, odontogenic, and so on), as a rule, is not contagious.

Secondary purulent meningitis

Secondary purulent meningitis occurs when there is a purulent focus in the body. They can develop either as a result of a direct transfer of infection from purulent foci to the membranes of the brain, for example, with or, thrombosis of the sinuses of the dura mater, brain abscess, or by metastasis from purulent foci located at a distance, for example, with abscesses or bronchiectasis of the lungs, ulcerative endocarditis, etc. Purulent meningitis sometimes complicates penetrating wounds of the skull.

The causative agents of secondary purulent meningitis can be various bacteria: pneumococci, staphylococci, Haemophilus influenzae Afanasiev-Pfeiffer, Salmonella, Pseudomonas aeruginosa, Listerella.

Symptoms of purulent meningitis

At the very beginning, meningitis in adults is manifested by symptoms similar to many other diseases. Noticing them, you need to see a doctor as soon as possible to prevent formidable complications. Later, actually purulent meningitis develops, the symptoms of which are quite specific.

The incubation period is 1-5 days. The disease develops acutely: severe chills, body temperature rises to 39-40°C.

An intense pain in the head occurs and rapidly increases with nausea or repeated vomiting. Possible delirium, psychomotor agitation, convulsions, impaired consciousness. In the first hours, shell symptoms (stiff neck muscles, Kernig's symptom) are detected, increasing by the 2-3rd day of illness.

1. Kerning's symptom - the sick person is not able to fully straighten his legs.
2. Brudzinski's symptom is an uncontrolled flexion of the hip and knee joints.

Deep reflexes are animated, abdominal ones are reduced. In severe cases, lesions of the cranial nerves are possible, especially III and VI pairs (ptosis, anisocoria, strabismus, diplopia), less often - VII and VIII pairs. On the 2-5th day of illness, herpetic eruptions often appear on the lips.

Sometimes there are also various skin rashes (more often in children) of a hemorrhagic nature, which indicates meningococcemia. Cerebrospinal fluid is turbid, purulent, flows out under high pressure.

Neutrophilic pleocytosis (up to several tens of thousands of cells in 1 µl), high protein content (up to 1-16 g/l), low sugar and chloride levels are detected. Meningococcus is found in smears of CSF sediment after Gram stain. It can also be isolated from mucus taken from the throat. In the blood - leukocytosis (up to 30-109 / l) and.

In preschool children, the disease often takes the form of meningoencephalitis, in which the leading symptoms are motor activity, confusion, signs of damage to the cranial nerves - strabismus, paralysis of the face and larynx. With such a course, the stage of paralysis sets in rather quickly, and when the cerebrospinal fluid ducts are blocked with pus, hydrocephalus develops.

In the case of the development of meningococcal septicemia, syndromes of increased vascular permeability and intravascular coagulation are pronounced. At the same time, foci of hemorrhages of irregular shape are formed on the skin, protruding above the surface of the skin, and necrosis - areas of necrosis.

Complications

Complications and consequences of meningitis in adults are very dangerous for human health and life, they can be avoided if treatment of the disease is started in a timely manner.

The consequences of purulent meningitis include:

• cerebrosthenic syndrome;
• increased fatigue;
• instability of attention;
• inability to long-term stress;
• irritability;
• capriciousness;
• tearfulness;
• fussiness;
• excessive physical activity;
• general lethargy;
• slow thinking.

An early and formidable complication that can be accompanied by purulent meningitis is cerebral edema, leading to compression of the brain stem with vital centers located in it. Acute cerebral edema, as a rule, occurs on the 2-3rd day of the disease, with a lightning-fast form - in the first hours.

Forecast

According to some reports, purulent meningitis is fatal in 14% of cases. However, with timely started and correctly carried out treatment, purulent meningitis has a generally favorable prognosis.

After suffering meningitis, asthenia, liquor-dynamic disorders, sensorineural hearing loss, and some mild focal symptoms can be observed. Severe consequences of purulent meningitis (hydrocephalus, amaurosis, deafness, dementia,) are rare in our time.

Treatment of purulent meningitis

Purulent meningitis with proper and timely treatment recedes completely after two weeks. At the first signs of the disease, the patient must be hospitalized and placed in the intensive care unit.

First of all, the doctor prescribes the intake of antibacterial drugs that have an effect directly on the brain. If after three days of taking the drugs of this group there is no improvement, a second puncture of the cerebrospinal fluid is prescribed. And then the drugs change.

To relieve symptoms of intoxication in purulent meningitis in adults, intravenous infusions of solutions are prescribed. Diuretic drugs are also applicable to remove toxins from the blood. Sedatives are prescribed in cases of severe and frequent convulsions. And to restore cerebral circulation, special drugs are prescribed.

Acute infectious disease with a tendency to epidemic spread. Meningitis affects the soft membranes of the brain and is almost always caused by a bacterial infection that begins in the upper respiratory tract, including the sinuses, ears, and throat. People of any age can get sick, but most often the target for meningitis is children under 5 years of age. Fortunately, thanks to antibiotics, purulent meningitis in developed countries is now very rare, whereas in the past entire epidemics of the disease broke out.

What is purulent meningitis

Purulent meningitis is a bacterial infection that causes inflammation of the soft membranes of the brain and spinal cord with the release of purulent exudate. It can develop as an independent disease or be a complication of an existing infection in any part of the body. Bacterial meningitis poses the greatest threat to life in comparison with other varieties of this disease (viral, fungal or protozoal). The leaders among the causative agents of bacterial meningitis are called meningococcus and Haemophilus influenzae.

Being a contagious disease, meningitis is spread between people by airborne droplets or by contact. However, most people infected with meningococcus do not develop any clinical signs of the disease. Approximately one in ten people have symptoms of a rhinovirus infection. Only in some cases, the pathogen spreads throughout the body through the bloodstream and a generalized form of infection develops. According to medical statistics, in developed countries, one out of several tens of thousands of carriers of the infection falls ill with a generalized form.

Reasons for the development of the disease

Bacterial infections of the meninges are caused by:

• meningococci;
• hemophilic bacillus;
• streptococci of groups B and D;
• pneumococci;
• staphylococci;
• salmonella;
• Pseudomonas aeruginosa;
• Klebsiella.

Infection more often occurs from a bacillicarrier or a patient with meningitis, but the pathogen can also invade directly into the wound during trauma or head surgery, including interventions in the paranasal sinuses. The penetration of a pathogenic microorganism into the blood and nervous tissues is facilitated by factors such as:

• recent viral infections;
• sudden change in natural conditions;
• previous traumatic brain injury or surgery;
• immunodeficiency states.

The disease begins with the spread of infection through the bloodstream. The bacteria then die and release toxins. After a short time, not only pathogenic microorganisms, but also many toxic substances are found in the patient's blood, which plays an important role in the development of the disease.

Meningococcal meningitis is a combination of generalized septic and toxic processes, as well as a subsequent allergic reaction.

As the disease progresses, accumulated toxins affect small vessels: capillaries, arterioles, venules. The general vascular tone is disturbed. As a result of damage to the microvasculature, disturbances occur in the functioning of vital organs, such as the brain, liver, kidneys and adrenal glands.

Disease classification

Depending on how exactly the pathogen penetrated the membranes of the brain, neurologists distinguish bacterial meningitis: primary and secondary. The mechanism of development of the primary pathological process is triggered when the pathogen enters the blood from the nasopharyngeal cavity, where it was transmitted from the bacillicarrier, into the blood.

The reason for the development of the secondary form is a pre-existing focus of infection in the patient's body. The pathogen can enter the meninges through the bloodstream or lymphatics from any site of chronic inflammation in the body, but most often long-term infectious inflammation of the middle ear or paranasal sinuses becomes such a focus.

The severity of the course of the pathological process determines one of the three forms of the disease: mild, moderate or severe. The latter develops with severe immunodeficiency or in patients with an absent spleen.

The typical course of bacterial meningitis is acute.

Depending on the characteristics of the course of the disease, meningitis is:

• acute - rapidly increasing inflammation;
• fulminant - characterized by an ultra-rapid progression of symptoms within a few hours;
• abortive - characterized by an erased clinical picture with a predominance of symptoms of intoxication;
• chronically relapsing - develops again after treatment.

Symptoms of bacterial meningitis

The average duration of the incubation period of the disease does not exceed 5 days. Bacterial meningitis is characterized by an acute onset with an intense, aggravated in an upright position and does not go away after sleep. The condition is accompanied by fever (the patient's body temperature reaches 40 ° C) and symptoms of intoxication in the form of nausea and recurrent vomiting. Disorders of consciousness are observed (an adequate perception of reality suffers), mental overexcitation, signs of delirium. Convulsions are not excluded. Specific symptoms include stiffness of the muscles of the back of the head and neck. The intensity of symptoms increases from the first hours and worsens by the 2nd or 3rd day. Typical for patients is hypersensitivity to external stimuli: light, noise, wind. Perhaps the appearance of hemorrhages on the body in the form of a rash or spots.

In most meningococcal bacteria carriers, the disease never develops. But such people are able to infect others with the infection.

Purulent meningitis is accompanied by focal symptoms due to impaired transmission of nerve impulses in different areas of the skull. Pathology can affect the oculomotor nerves, which leads to limited mobility of the eyeball, visual bifurcation, ptosis of the upper eyelid. Less commonly, nerve damage develops:

• visual (the patient sees worse, suffers from loss of visual fields);
• vestibulocochlear (deafness develops);
• facial and trigeminal nerve (part of the face is immobilized).

When the inflammatory process covers the cerebral substance of the brain, this indicates the onset of meningoencephalitis. Focal symptoms characteristic of encephalitis are added to the manifestations of meningitis. This is partial or complete paralysis, speech disorders, loss of sensitivity, the occurrence of abnormal reflexes, excessive muscle tone. The patient has involuntary movements, hallucinations, impaired gait and coordination, memory disorders, sleep and wakefulness. Involvement in the purulent process of the ventricles of the brain is accompanied by attacks of excessive muscle tone in the limbs, limitation of flexion-extension movements of the legs and arms.

Manifestations of the disease in children

In young children, the disease has a clinical picture similar to adults, but in some cases it is expressed mainly by symptoms of intoxication, such as lethargy, loss of appetite, decreased overall activity, and repeated vomiting. Increased sensitivity threshold when normal touch causes pain. In infants, symptoms may be subtle and are often confused at first with signs of teething or other benign conditions. The child becomes drowsy and lethargic, cries non-stop. Looking closely, you can notice other growing symptoms of a serious condition - trembling in the hands, pulsation of the fontanel, the manifestation of a venous network on the head and eyelids of the baby. Often the skin becomes covered with red spots, formed from hemorrhages as a result of multiple ruptures of capillaries. Subsequently, the child may fall into a subcoma - a condition preceding a coma.

Diagnostics

The diagnosis and treatment of the disease is carried out by a neurologist. A specific clinic, positive meningeal symptoms and signs of cranial nerve damage - all this allows the doctor to make a preliminary diagnosis. Diagnosis of the abortive form and secondary purulent meningitis can be difficult. In this case, a lumbar puncture will help to finally establish the causative agent of the disease - a lumbar puncture with a special long needle in order to collect cerebrospinal fluid for further analysis. In the pathologically clouded cerebrospinal fluid, a high content of neutrophils and protein is found. Bacterial inoculation of the material and its microscopic analysis make it possible to determine the pathogen.

Other necessary tests include a clinical analysis of blood and exudate released by elements of a hemorrhagic rash. Consultation of a narrow specialist (ENT, pulmonologist) may be required in connection with suspicions of the secondary nature of the infectious process.

Bacterial meningitis must be differentiated from intracranial hemorrhage, viral meningitis, manifestations of meningism in infectious lesions of the chest organs or inflammation of the upper respiratory tract.

The most specific meningeal symptoms are:

• the patient is not able to straighten the leg at the knee if it is bent at the hip joint;
• when the doctor tries to tilt the patient's head to the chest in a horizontal position on the back, his legs reflexively bend at the knees and hip joints;
• when trying to passively bend the patient's leg at the knee and hip, the other leg involuntarily assumes a similar position.

Treatment

Bacterial meningitis of any etiology requires immediate hospitalization. Early diagnosis and treatment will prevent brain damage and death. Purulent meningitis is treated with intravenous antibiotics.

Medical therapy

The antibacterial drug is selected, starting from the origin of meningitis and its causative agent in each case. A combination of Penicillin or another antibiotic of the penicillin series, for example, Ampicillin, with drugs from the cephalosporin group (Ceftriaxone, Ceftazidime, Cefotaxime) is often used. Penicillins, like cephalosporins, are beta-lactam antibiotics with bactericidal (destroying microbes) action. These drugs tend to disrupt the synthesis of the bacterial cell wall. The penicillin group includes natural antibiotics and some semi-synthetic ones. But the main advantage of penicillins is low toxicity. They can be used in children and pregnant women.

With an unknown origin of purulent meningitis, empirical antibiotic therapy is possible. While the test results are expected, drugs of the aminoglycoside group (Gentamicin, Kanamycin) are used, sometimes combining these drugs with penicillins.

To reduce swelling and dropsy of the brain due to excessive accumulation of fluid in the ventricles of the brain, diuretics are used (Mannitol, Furosemide). Glucocorticoids (Prednisolone, Dexamethasone) are prescribed to relieve inflammatory reactions. Symptoms are relieved with appropriate medications, which include:

• tranquilizers - drugs that have a sedative, hypnotic and anticonvulsant effect;
• lytic mixtures (for example: Diphenhydramine + Trimeperidine + Chlorpromazine) - potent mixtures of three medicinal components for the rapid removal of convulsions and psychomotor overexcitation, fever reduction and pain relief.

With a decrease in the volume of circulating blood and signs of septic shock, a blood transfusion is performed. Treatment of secondary purulent meningitis includes sanitation of the primary infectious focus.

After the completion of the acute stage of inflammation, the intake of neuroprotectors is indicated, which prevent the development of destructive processes (death of nerve cells) in the brain, the treatment ends with a course of general strengthening agents and vitamins.

Surgery

Secondary purulent meningitis caused by an ear infection is an indication for surgery to drain pus from the mastoid process (the raised part of the skull behind the ear). Modern powerful antibiotics in the vast majority of cases avoid surgery. But in case of ineffectiveness of drug treatment or when the inflammatory process passes into the chronic stage, mastoidectomy is indicated. The intervention is performed under general anesthesia through an arcuate incision behind the auricle. Next, the skin and periosteum are gently shifted, then the underlying bone is trepanned (drilled) with a special medical chisel. Then the cells of the mastoid process are opened and pus is drained, the affected tissues are removed. The wound is sutured, after placing a drainage tube in it to drain the pus. Apply an antiseptic bandage. After the operation, the patient takes a course of antibiotic therapy.

Forecast and consequences of purulent meningitis

Untreated bacterial meningitis is almost always fatal. With treatment, the risk of death is drastically reduced. Thus, the probability of death in newborns, subject to adequate treatment, is from 20 to 30%, in older children - about 2%. The likelihood of death is higher in adults, even with treatment, it ranges from 19 to 37%. Many adults who recover from purulent meningitis may develop complications such as deafness (14%) or memory loss (10%).

The negative consequences of bacterial meningitis are quite common. They can be temporary or permanent, occur immediately after the disease or in the long term. Adults who have had bacterial meningitis are susceptible to complications such as:

• septicemia, or blood poisoning - develops in 25% of those who have recovered from meningococcal meningitis;
• hearing loss - may be partial or complete, so recovering patients need a hearing test;
• problems with memory and concentration;
• problems with coordination and balance;
• speech and vision disorders (loss of vision may be partial or complete);
• mental illnesses and disorders such as depression, anxiety, increased fatigue.

Septicemia can cause gangrene. The abundance of toxins in the blood leads to the death of healthy tissues, especially fingers and toes, or the entire limb. As a result, the limb may be amputated.

Newborns who have had meningitis are at risk of developing cerebral palsy. This leads to a number of symptoms affecting movement and coordination. Many children are at increased risk of developing epilepsy after meningitis.

Recovered children may change in behavior, for example, become capricious, irritable or even aggressive. Other complications of purulent meningitis in childhood include:

• sleep disturbances, nightmares;
• bed-wetting;
• psychological depression and fear of doctors and hospitals.

In general, children may have behavioral and learning problems after an episode of meningitis.

Prevention of purulent meningitis

Prevention consists in observing the elementary rules of a healthy lifestyle:

• reasonable alternation of work / rest, sufficient night sleep (at least 7–8 hours);
• to give up smoking;
• preventing contact with sick people.

If contact with a person with bacterial meningitis cannot be avoided, you should notify your doctor as soon as possible. He will prescribe a course of antibiotics for preventive purposes, which will significantly reduce the chances of developing the disease.

Vaccination is an important tool for prevention. Vaccines such as the following can prevent bacterial meningitis:

Some types of meningitis are spread through close contact with an infected person's body fluid, such as saliva or nasal mucus. Avoid sharing drinks, utensils, and personal items that may contain the patient's saliva or other fluids. The steps described will help prevent infection in most cases.

Purulent meningitis: video

Bacterial purulent meningitis poses a threat to the life of the patient and requires emergency treatment. Timely adequate treatment increases the patient's chances of recovery and reduces the risk of severe consequences in the future.

A group of infectious diseases of the nervous system, characterized by the development of general infectious, cerebral, meningeal syndromes and inflammatory changes in the cerebrospinal fluid of a purulent nature - purulent meningitis. From this article you will learn its causes and symptoms, as well as how it is treated in a child.

Causes of purulent meningitis

In the structure of neuroinfection is 20 - 30%. In 90% of cases, the causative agents are meningococcus, Haemophilus influenzae, pneumococcus. Less common are staphylococci, Escherichia, Salmonella, Pseudomonas aeruginosa, Klebsiella, Listeria, fungi of the genus Candida, etc.

The causative agent of the disease

The causative agent is Neisseria meningitidis, a gram-negative diplococcus. The source of infection is a patient with any form of meningococcal infection or a carrier of meningococcus. The incubation period of primary purulent meningitis lasts on average from 2 to 5 days.

Ways of transmission - airborne, contact-household. Mostly the symptoms of the disease appear in children under 5 years of age. Typical winter-spring seasonality.

Symptoms of purulent meningitis

The disease begins acutely with a rise in body temperature to 39-40 ° C and above, chills, pronounced symptoms of intoxication (lethargy, weakness, refusal to eat and drink, headache). In the future, the kids become restless, the headache increases, intensifies with sound and light stimuli, head turns; the phenomena of a hyperesthesia are sharply expressed. There is repeated vomiting that is not associated with eating and does not bring relief. The patient is pale, the sclera are injected; tachycardia, muffled heart sounds. From 2 to 3 days from the onset of the disease, meningeal symptoms (stiff neck muscles, symptoms of Kernig and Brudzinsky) are detected.

The main signs of purulent meningitis

Newborns have such a symptom as a monotonous cry; a large fontanel bulges, tense; venous network on the head and eyelids; positive symptom of "suspension" (Lessage). In severe cases, drowsiness appears, turning into stupor, convulsions and unstable focal symptoms of purulent meningitis are possible.

In 30 - 40% of cases, purulent meningitis is combined with meningococcemia (hemorrhagic rash on the skin of a petechial and / or "star" nature, etc.)

Diagnosis of the disease

Supporting and diagnostic signs of purulent meningitis:

• characteristic epidemiological anamnesis;
• an increase in body temperature to 39-40 ° C and above;
• severe intoxication;
• Strong headache;
• repeated vomiting;
• meningeal symptoms;
• possible oppression of consciousness (up to coma);
• convulsions are possible;
• the presence of other foci.

Laboratory diagnostics

Primary purulent meningitis is diagnosed by several methods:

Specific diagnostic methods:

• Bacteriological - sowing the pathogen from pharyngeal mucus, blood, cerebrospinal fluid and determining its sensitivity to antibiotics; bacterioscopic - detection of a pathogen in a smear of pharyngeal mucus, blood, cerebrospinal fluid.
• Express methods - detection of the pathogen antigen in the material with subsequent serotyping (RNGA, RLA, RCA).
• Serological - an increase in the titer of specific antibodies by 4 times or more in paired blood and cerebrospinal fluid samples taken in the first days of the disease and after 2 weeks.

Nonspecific diagnostic methods: lumbar puncture - cerebrospinal fluid is cloudy, neutrophilic pleocytosis is noted up to 1000-5000 cells in 1 μl or more; the protein level is increased; the content of sugar and chlorides is not changed (in severe cases it decreases); in the clinical analysis of blood - leukocytosis with a neutrophilic shift to immature forms, increased ESR.

Differential diagnosis is carried out with serous meningitis and meningism syndrome.

If purulent meningitis of the brain is suspected, the child must be hospitalized in a specialized hospital, with impaired consciousness and breathing - in the intensive care unit.

At the prehospital stage, to reduce intracranial pressure, it is necessary to carry out:

• dehydration - lasix 1-2 mg/kg;
• with symptoms of cerebral edema - dexazone 0.5-1 mg / kg or prednisone 2 mg / kg;
• with convulsions - seduxen in the age dosage.

If breathing is disturbed, it is necessary to supply humidified oxygen through a mask, intubation, and mechanical ventilation. With hyperthermia, a lytic mixture is administered (analgin with pipolfen and papaverine). In the hospital, complex treatment is carried out, including etiotropic, pathogenetic and symptomatic therapy.

Medication treatment

The choice of etiotropic antibacterial agents is determined by the proposed etiology and the ability of the drug to penetrate the blood-brain barrier. Given the etiological structure of the disease in children under 5 years of age (meningococci, pneumococci, Haemophilus influenzae, rarely staphylococci, salmonella, Escherichia), chloramphenicol succinate (80-100 mg / kg / day) is used for starting therapy in children at this age.

Treatment of children over 5 years of age is carried out with benzylpenicillin sodium salt (300 thousand units / kg / day), since most diseases are caused by meningococcus. After bacteriological isolation, biotyping and serotyping of the pathogen, antibiotic therapy is adjusted in accordance with the sensitivity of the isolated strain. Reserve drugs are III-IV generation cephalosporins (cefotaxime, ceftriaxone, ceftazidime, cefoperazone, cefpirome, cefepime), carbapenems (meropenem), monobactams (aztreonam). The duration of antibacterial treatment is at least 10-14 days.

Indications for the abolition of antibiotics are: the disappearance of symptoms of intoxication, persistent normalization of body temperature, normalization of the hemogram, sanitation of cerebrospinal fluid (the number of cells is not more than 30 in 1 μl, 70% of them are lymphocytes). In order to prevent candidiasis with massive and prolonged antibiotic therapy, the appointment of nystatin, diflucan is indicated.

How to cure purulent meningitis?

Pathogenetic treatment is aimed at reducing intoxication, intracranial hypertension and normalizing cerebral hemodynamics. For the purpose of dehydration, furosemide, diacarb are used; detoxification therapy includes intravenous infusion of rheopolyglucin, glucose-salt solutions; to improve cerebral circulation, trental, cavinton, instenon are prescribed.

With the development of edema-swelling of the brain, therapeutic measures begin after providing adequate respiratory support (humidified oxygen, intubation, mechanical ventilation). The volume of infusion therapy is reduced to 2/3 of the physiological need; mannitol, reogluman are used as starting solutions. Anticonvulsant therapy for this type of meningitis in a child includes the introduction of Relanium, GHB, sodium thiopental, 2% chloral hydrate solution in an enema.

In severe cases, weakened babies are given immunostimulating therapy:

• immunoglobulin for intravenous administration (pentaglobin, endoglobulin, sandoglobulin),
• leuco suspension,
• fresh frozen plasma
• UV blood.

In the period of convalescence, the treatment of meningitis is continued with drugs that improve microcirculation, immunomodulators (Dibazole, herbal adaptogens), according to indications - dehydration (diacarb, diuretic) and anticonvulsant (luminal).

Dispensary observation

After the illness, children are observed by a pediatrician, an infectious disease specialist and a neuropathologist with instrumental research methods (EEG, ECHO-EG, neurosonography). During the first year after discharge from the hospital, examinations by specialists are carried out 1 time in 3 months, in the second year - 1 time in 6 months. Deregistration is carried out in the absence of symptoms, residual effects not earlier than 2 years after the disease.

How to treat purulent meningitis?

Treatment of patients in the acute period.

Therapy at the prehospital stage:

Dehydration - Lasix 1-2 mg/kg/day IM.

Treatment with antipyretics - paracetamol.

At a body temperature of 38.5 "C and above - lytic mixture (w / m):

• papaverine solution 2% - ml / year.

Therapy in the hospital:

Shown bed rest for the entire acute period. The diet is age-appropriate, complete, mechanical and chemical sparing, rich in vitamins and microelements.

Etiotropic therapy for this type of meningitis:

Drugs of choice:

• chloramphenicol succinate 80-100 mg/kg/day (no more than 2 g per day) after 6 hours IM or IV;
• benzylpenicillin sodium salt 300 thousand units / kg / day after 4 hours IM or IV.

Reserve drugs:

3rd generation ceflosporins:

• cefotaxime 150 mg/kg/day 8 hours IM or IV;
• ceftriaxone 150 mg/kg/day 12 hours IM or IV.

Carbapenems:

• meronem 40 mg/kg 8 h i.v. The duration of the course of treatment is at least 10-14 days.

Pathogenetic therapy of purulent meningitis:

Detox:

• oral rehydration (tea, fruit drink, juices, etc.);
• intravenous infusion of glucose-salt (10% glucose, 0.9% NaCl, Ringer) and colloidal (rheopolyglucin, rheomacrodex) solutions.

Ratio 1:3.

Dehydration:

• lasix 0.1-0.2 ml/kg/day IM for 1-2 days;
• diacarb 0.06-0.25 mg once on an empty stomach according to the scheme 3 - 2 - 3 (3 days are prescribed, 2 days are a break, 3 days are prescribed, etc.) for 3-4 weeks.

treatment with drugs that improve cerebral circulation:

• trental 5 - 10 mg / kg / day;
• Cavinton 0.5-1.0 mg / kg / day. The course of treatment is 3-4 weeks.

Symptomatic therapy for purulent meningitis:

Antipyretic - paracetamol 10-15 kg / kg 3 times a day.

At a body temperature of 38.5 ° C and above - a lytic mixture:

• analgin solution 50% - 0.1 ml / year;
• pipolfen solution 2.5% - 0.15 ml / year;
• papaverine solution 2% - 0.1 ml / year.

Multivitamins with trace elements.

In the treatment of meningitis occurring with cerebral edema, the therapy is added:

Glucocorticosteroids:

• dexamethasone 0.5-1 mg/kg/day IM, IV;
• prednisone 2 mg/kg/day IM, IV.

Anticonvulsants:

• seduxen up to 10-30 mg/kg/day;
• GHB 50-100 mg/kg;
• luminal 10 mg/kg.

Respiratory support - humidified O 2 , endotracheal intubation, mechanical ventilation.

Treatment of patients with purulent meningitis in the period of convalescence:

Drugs that improve metabolic processes in the brain:

• Cavinton 0.5-1.0 mg/kg + Pantogam 0.125-0.5 g orally 3 times a day;
• picamilon 1 mg/kg orally 3 times/day;
• piracetam: 3-7 years - 0.4-0.8 g; 7-12 years old - 0.4 (0.8) - 1.2 (2.0) g; 12 - 16 years - 0.8 - 2.4 g orally 2 times a day. Course 1 - 1.5 months.

Herbal adaptogens - preparations of echinacea, zamanihi, Chinese magnolia vine (1 drop per year of life 3 times a day).

Dehydration (according to indications) - diacarb, diuretic herbal teas.

Vitamin therapy - lifepack junior +, lifepack senior, antiox +, detox +, mega, beauty, brain-o-flex, bisque, active, chromvital +, nutrimax +, ursul, hyper, mystic, passilat, winex.

Purulent meningitis is treated with a course of 1 - 1.5 months.

Anticonvulsants (if indicated).

Clinical follow-up with a neurologist for at least 2 years with instrumental research methods (EEG, EchoEG, neurosonography). Examination frequency: in the first year - 1 time in 3 months, in the second year - 1 time in 6 months. For 3 months, a sparing regime - it is forbidden to run, jump, stay in the sun.

Consequences of purulent meningitis

Edema-swelling of the brain - the most common complication of the acute period of this type of meningitis - manifests itself:

• change of consciousness (stunning, stupor);
• convulsions;
• unstable focal symptoms (hemiparesis, ataxia).

Increasing cerebral edema leads to compression of the brain stem, which contributes to a further disorder of consciousness up to coma, an increase in epileptic seizures with a transition to epistatus, a violation of vital functions, bilateral motor disorders that first form a decortication posture, then decerebration. The decortication posture in purulent meningitis is characterized by the flexion position of the upper limbs (hands clenched into fists are given in the wrist and elbow joints of the hands) and the extensor position of the legs. Posture of decerebration - a sharp hypertonicity of the limbs in the extensor type.

With these syndromes, hyperreflexia, pathological foot signs are noted. The level of damage to the brain stem is determined by the violation of the functions of the cranial nerves: oculomotor (pupil size, reaction to light, position of the eyeballs), facial (weakness and / or asymmetry of the facial muscles) or bulbar (swallowing functions, sound pronunciation). Purulent meningitis of the brain with progressive edema leads to the dislocation of the trunk and the development of the herniation syndrome (respiratory and cardiac arrest).

Acute hydrocephalus is manifested by bulging and tension of the large fontanelle, divergence of the sutures of the skull, an increase in the circumference of the head, and expansion of the cerebrospinal fluid spaces (determined by ultrasound and computed tomography of the brain).

Cerebral infarction is noted on the 1st week. diseases of purulent meningitis and is manifested by focal symptoms of loss of functions.

Subdural effusion occurs more often in young children. The usual localization of the effusion is in the frontal regions of the brain, parasagitally. The leading diagnostic criteria are:

• persistent fever for more than 3 days. against the background of adequate antibiotic therapy or an inexplicable rise in body temperature after its decrease on the 3rd - 5th day of illness;
• deterioration, depression of consciousness, the appearance of local convulsions, hemiparesis;
• lack of pulsation of the fontanel with its compaction, sometimes local hyperemia;
• asymmetric luminescence focus during diaphanoscopy;
• the presence of effusion on ultrasound and computed tomography of the brain.

In the future, a child with purulent meningitis may develop drowsiness, vomiting, stiff neck muscles, congestion in the fundus, and a sharp increase in the protein content in the cerebrospinal fluid.

The syndrome of inappropriate secretion of antidiuretic hormone (ADH) or the syndrome of water intoxication develops as a result of damage to the hypothalamic structures of the central nervous system and is characterized by an extremely serious condition; high intracranial pressure; reduced osmolarity of blood and cerebrospinal fluid; hyponatremia (

The syndrome of ventriculitis (ependymatitis) with purulent meningitis is characterized by the spread of a purulent process to the ependyma of the ventricles of the brain and manifests itself:

• bulging and tension of the large fontanel, headache, divergence of the sutures of the skull, dilation of the veins of the fundus, frequent vomiting, progressive disorder of consciousness, convulsions;
• the development of opisthotonus (legs stretched and crossed in the lower parts of the legs, fingers clenched into fists, flexed hands) and cachexia of central origin;
• slight lymphocytic pleocytosis with a high protein content in the cerebrospinal fluid.

Adverse Outcomes: asthenovegetative syndrome; minimal brain dysfunction syndrome; hypertensive-hydrocephalic syndrome; paresis and paralysis; hyperkinesis; ataxia; adhesive arachnoiditis; epilepsy; hypothalamic syndrome, etc.

Now you know why purulent meningitis occurs in children, what symptoms it manifests and how to treat it.

Purulent meningitis is an inflammatory disease of a bacterial nature that affects the membranes (mainly soft) of the brain and spinal cord, may be of an infectious primary or secondary nature.

It is registered in all countries of the world, the frequency of occurrence ranges from 3 (developed countries) to 200 cases per 10,000 population. Epidemic outbreaks of purulent meningitis periodically occur due to the emergence of new strains of the pathogen or the transfer of old ones to other regions of the planet. Children under five years of age are more susceptible to the disease; among adults, pathology is more often observed in men.

Types of purulent meningitis

According to the etiological basis, two large groups of forms of purulent meningitis are distinguished - primary and secondary. Such a division is rather arbitrary, since it is not always possible to reliably determine the source of the infection that caused the disease. Each of these groups is characterized by a certain set of features:

• Primary forms of purulent meningitis occur when a person is infected with pathogenic bacteria of a certain type - from the group of meningococcus, pneumococcus, Haemophilus influenzae.
• Secondary forms of purulent meningitis develop in the presence of a focus of bacterial infection in other organs or as a result of the introduction of bacteria to the meninges from the external environment (after medical manipulations, surgical operations, with traumatic brain injuries).

The course of purulent meningitis varies in speed and severity of symptoms. Such differences are due to the nature of the pathogen, the reactivity of the body, the state of the immune system and a number of other factors. According to these signs, the following clinical types of the disease are distinguished:

1. Lightning type. The most severe form - from the development of symptoms to the death of the patient from cerebral edema, takes only a few hours. Most often occurs with purulent meningitis in children and debilitated adults.
2. Sharp type. The most common variant of purulent inflammation of the meninges. It is characterized by a rapid increase in symptoms and a severe general condition.
3. abortive type. A rare form of purulent meningitis in adults, in which the symptoms of the underlying disease are quite blurred. At the forefront are manifestations of general intoxication.
4. recurrent type. The rarest form of purulent bacterial meningitis, in which periods of improvement alternate with exacerbations over many weeks or months.

The cause of the disease is the penetration of pathogenic bacteria into the membranes of the brain and spinal cord and their further reproduction with the development of purulent inflammation. The main route of entry of the pathogen into the membranes (both in primary and secondary purulent meningitis) is hematogenous, occasionally (only in secondary forms) - injection and contact. Most often, the disease is caused by infection with the following bacteria:

1. Haemophilus influenzae. According to medical statistics, the pathogen is determined in almost 50% of cases of purulent meningitis, which affects people at any age.
2. Meningococcus (Neisseria meningitidis). Causes about 20% of cases of the disease, and it is its strains that most often lead to epidemic outbreaks of meningitis.
3. Pneumococcus (Streptococcus pneumoniae). Causes purulent meningitis in 10-13% of all cases. The course of pathology is severe, mortality reaches 50%.

In some cases, infection with staphylococci, Escherichia coli, salmonella, Pseudomonas aeruginosa and some other bacteria leads to the development of the disease. A significant variety of causative agents of purulent meningitis complicates the treatment, since the effectiveness of therapeutic measures largely depends on properly selected antibacterial drugs.

The disease always begins acutely, the duration of the incubation period ranges from several hours to 5–7 days. The first symptoms of purulent meningitis are high fever (up to 40-41 ° C), severe headaches, nausea, vomiting, which is profuse and repeated. Many patients experience convulsions - the frequency of their development in pathology increases with a decrease in the age of the patient. Often, against the background of fever, hallucinations, delirium, psychomotor agitation develop. From the first day of the course of the disease, tension (rigidity) of the occipital muscles is determined, with movements of the neck, painful sensations are determined.

For the prevention of secondary purulent meningitis, it is necessary to promptly identify and eliminate potentially dangerous foci of infection in the body - otitis, sinusitis, chronic abscesses, dental pathologies.

With inflammation of the meninges caused by meningococcal infection, a hemorrhagic rash develops - spots of various localization and sizes that do not turn pale when pressed. Also, when infected with this pathogen, the development of skin necrosis is possible, especially in places subject to pressure. On the 2nd–4th day of the course of the pathology, signs of damage to the cranial nerves are often recorded - strabismus, ptosis of the eyelids, anisocoria, visual impairment and hearing loss. The occurrence of nystagmus, hyperkinesis, muscle tone disorders indicates involvement in the pathological process of the nervous tissue of the brain - the development of meningoencephalitis.

Diagnostics

For the diagnosis of purulent meningitis, instrumental and laboratory research methods are used. When examined by a neurologist, the rigidity of the occipital muscles and the presence of specific meningeal symptoms are determined:

1. Kernig's sign.
2. Brudzinski's symptoms.
3. Guillain's sign.

These manifestations, in combination with other symptoms of purulent meningitis, clearly indicate the presence of the disease. In addition, to confirm the diagnosis and determine the nature of the pathogen, a number of laboratory tests are carried out:

1. Collection of cerebrospinal fluid by spinal puncture. Liquor is cloudy, flows out under pressure. Subsequently, with the help of microscopy, neutrophils are determined in it, when sown on nutrient media, the pathogen is isolated.
2. General and biochemical analysis of blood. Bacteria of the pathogen (bacteremia) can be isolated in it, and strong leukocytosis is also determined due to an increase in the level of neutrophils, an increase in ESR.
3. Other studies to determine the state of other organs and systems, prevent complications and identify the primary focus of infection (if secondary purulent meningitis is suspected).

Differential diagnosis is made with viral, tuberculous and fungal forms of meningitis, as well as subarachnoid hemorrhage.

Treatment

Treatment of purulent meningitis includes taking antibacterial, diuretic and anti-inflammatory drugs and a number of other drugs, if indicated. In severe cases of the disease, treatment begins immediately with broad-spectrum antibiotics, in other cases, antibacterial agents are prescribed after receiving the results of a bacteriological study of the cerebrospinal fluid. Diuretics are needed to reduce cerebral edema and associated neurological disorders and complications.

The occurrence of nystagmus, hyperkinesis, muscle tone disorders indicates involvement in the pathological process of the nervous tissue of the brain - the development of meningoencephalitis.

As anti-inflammatory drugs, steroid drugs are most often prescribed, the dosage and the need to prescribe them depend on the severity of the manifestations and the severity of the patient's condition. Symptomatic treatment of purulent meningitis may include anticonvulsants (with convulsions), tranquilizers (with psychomotor agitation and sleep disturbances). During the recovery period, nootropic drugs, mineral-vitamin complexes, and a special diet are recommended.

Complications

The earliest and most formidable complication of purulent meningitis is acute cerebral edema, leading to compression of the vital nerve centers in the trunk and death due to respiratory and circulatory disorders. With a lightning-fast course of the disease, the development of edema can occur within a few hours after the onset of the disease, in the case of acute forms - for 2-3 days.

Other complications of the pathology during the peak period can be septic shock, uveitis, panophthalmitis, adrenal insufficiency. Late consequences of purulent meningitis include neurological disorders, impaired vision, hearing, memory, endocarditis and pyelonephritis.

Features of purulent meningitis in children

Purulent meningitis in infants often develops gradually, the causative agents are staphylococci, streptococci, Escherichia coli. The first manifestation of the disease in infants is the bulging and tension of the large fontanel.

When infected with meningococcus, the phenomena of meningococcemia in children under 3–4 years of age are much more severe than in older patients. Hemorrhagic rash and necrosis can occupy large areas of the skin, very often septic shock develops, damage to the heart, kidneys and other internal organs. In rare cases, meningitis at an early age leads to delayed psychomotor development and dementia.

Forecast

According to statistics, mortality in purulent inflammation of the meninges reaches 12–15%. The prognosis depends on the timeliness of hospitalization of the patient, the correct selection of drugs for antibiotic therapy. With early treatment to the doctor and the beginning of proper treatment, the prognosis is conditionally favorable.

The consequences of purulent meningitis may be hearing loss, some neurological disorders, memory loss. After a disease suffered at an early age, mental retardation may occur.

Preventive measures

The most effective measure to prevent the disease is vaccination - immunological preparations used to prevent infection by the most common pathogens (meningo- and pneumococci, Haemophilus influenzae).

For the prevention of secondary purulent meningitis, it is necessary to promptly identify and eliminate potentially dangerous foci of infection in the body - otitis, sinusitis, chronic abscesses, dental pathologies.

Video from YouTube on the topic of the article:

An inflammatory process that occurs in the pia mater of the brain when pyogenic microorganisms (pneumococci, meningococci, streptococci, etc.) penetrate into it. Purulent meningitis is characterized by high body temperature, intense headache, nausea, vomiting, disorders of the cranial nerves, early onset of meningeal symptoms, hyperesthesia, impaired consciousness, and psychomotor agitation. It is possible to diagnose purulent meningitis on the basis of a typical clinical picture and data from the analysis of cerebrospinal fluid. Purulent meningitis is an indication for mandatory antibiotic therapy. Decongestants, glucocorticosteroids, tranquilizers, anticonvulsants and other symptomatic therapy are used.

General information

Purulent meningitis is an inflammation of the meninges (meningitis) that has a bacterial etiology. Purulent meningitis occurs with a frequency of 3.3 cases per 100,000 population. All age categories are susceptible to the disease, but most often purulent meningitis develops in children under 5 years of age. It is noted that purulent meningitis often occurs against the background of a weakened state of the immune system. An increase in the incidence is observed in the winter-spring period. Since the beginning of the 90s of the last century, there has been a significant decrease in the incidence of purulent meningitis, a decrease in the number of deaths and cases of severe complications.

Causes of purulent meningitis

Not only meningococcal infection can lead to the development of purulent meningitis, but also pneumococci, Haemophilus influenzae and other bacteria. Almost half of the cases of purulent meningitis are due to Haemophilus influenzae. In 20% of cases, the cause of purulent meningitis is meningococcus, in 13% of cases - pneumococcus. In newborns, purulent meningitis often results from streptococcal infection, salmonellosis, or E. coli infection.

Depending on the mechanism of penetration of the pathogen into the membranes of the brain in neurology, primary and secondary purulent meningitis are distinguished. Primary purulent meningitis develops with hematogenous spread of the pathogen from the nasal cavity or pharynx, where it enters from the external environment. Infection occurs from sick persons and carriers by airborne droplets and contact. Direct infection of the meninges is possible with a fracture of the skull and open traumatic brain injury, open injuries of the mastoid process and paranasal sinuses, insufficiently careful observance of asepsis rules during neurosurgical interventions.

Secondary purulent meningitis occurs against the background of a primary septic focus in the body, the infection from which penetrates into the membranes of the brain. Contact spread of pyogenic microorganisms can be observed with brain abscess, osteomyelitis of the skull bones, septic sinus thrombosis. Hematogenous and lymphogenous spread of the pathogen is possible from an infectious focus of any localization, but most often occurs with long-term infections of the ENT organs (acute otitis media, chronic purulent otitis media, sinusitis).

The penetration of pathogens of purulent meningitis through the blood-brain barrier is facilitated by a weakened state of the body's immune system, which can be caused by frequent SARS, hypovitaminosis, stress, physical overload, and a sharp change in climate.

Classification of purulent meningitis

Depending on the severity of clinical manifestations, purulent meningitis is classified into mild, moderate and severe forms. Severe forms of the disease are observed mainly against the background of a sharp decrease in immunity and in patients with a removed spleen.

According to the characteristics of the course, fulminant, abortive, acute and recurrent purulent meningitis are distinguished. The most common acute purulent meningitis with typical cerebral and meningeal symptoms. The fulminant course of purulent meningitis from the first hours of the disease is characterized by a rapid increase in cerebral edema, leading to impaired consciousness and vital functions. The abortive variant is distinguished by an erased clinical picture, in which the symptoms of intoxication come to the fore. Recurrent purulent meningitis can occur with insufficient or belated treatment of the acute form of the disease, as well as in the presence of a chronic focus of purulent infection in the body.

Symptoms of purulent meningitis

The incubation period of primary purulent meningitis lasts on average from 2 to 5 days. Typically acute onset with a sharp rise in body temperature to 39-40°C, severe chills, intense and growing headache, nausea and repeated vomiting. Psychomotor agitation, delirium, impaired consciousness may be observed. In 40% of cases, purulent meningitis occurs with a convulsive syndrome. Shell symptoms specific for meningitis (symptom of Kernig, Brudzinsky, Guillain, neck stiffness) are expressed from the first hours of the disease and intensify on the 2nd-3rd day. Severe hyperesthesia and a decrease in abdominal reflexes against the background of a general increase in deep reflexes are typical. Perhaps the appearance of a diffuse hemorrhagic rash.

Focal symptoms accompanying purulent meningitis most often consist in dysfunction of various cranial nerves. The most commonly observed damage to the oculomotor nerves, leading to double vision, the development of strabismus, drooping of the upper eyelid and the appearance of a difference in the size of the pupils (anisocoria). Less common is neuritis of the facial nerve, damage to the trigeminal nerve, dysfunction of the optic nerve (loss of visual fields, decreased visual acuity) and vestibulocochlear nerve (progressive hearing loss). More severe focal symptoms indicate the spread of inflammatory changes to the substance of the brain or the development of vascular disorders such as ischemic stroke due to vasculitis, reflex spasm, or thrombosis of cerebral vessels.

With the transition of the inflammatory process to the substance of the brain, they speak of the development of meningoencephalitis. At the same time, purulent meningitis proceeds with the addition of focal symptoms characteristic of encephalitis in the form of paresis and paralysis, speech disorders, changes in sensitivity, the appearance of pathological reflexes, and increased muscle tone. Hyperkinesis, hallucinatory syndrome, sleep disturbances, vestibular ataxia, behavioral and memory disorders are possible. The spread of the purulent process to the ventricles of the brain with the development of ventriculitis is manifested by spastic attacks of the type of hormetonia, flexion contractures of the arms and extensor legs.

Complications of purulent meningitis

An early and formidable complication that can be accompanied by purulent meningitis is cerebral edema, leading to compression of the brain stem with vital centers located in it. Acute cerebral edema, as a rule, occurs on the 2-3rd day of the disease, with a lightning-fast form - in the first hours. Clinically, it is manifested by motor anxiety, impaired consciousness, respiratory distress and disorders of the cardiovascular system (tachycardia and arterial hypertension, in the terminal stage giving way to bradycardia and arterial hypotension).

Among other complications of purulent meningitis, there may be: septic shock, adrenal insufficiency, subdural empyema, pneumonia, infective endocarditis, pyelonephritis, cystitis, septic panophthalmitis, etc.

Diagnosis of purulent meningitis

Typical clinical signs, the presence of meningeal symptoms and focal neurological symptoms in the form of damage to the cranial nerves, as a rule, allow the neurologist to assume that the patient has purulent meningitis. It is more difficult to diagnose in cases where purulent meningitis has an abortive course or occurs a second time against the background of symptoms of an existing septic focus of another localization. To confirm purulent meningitis, it is necessary to perform a lumbar puncture, during which an increased pressure of the cerebrospinal fluid, its turbidity or opalescent color is detected. Subsequent examination of the cerebrospinal fluid determines an increased content of protein and cellular elements (mainly due to neutrophils). Identification of the pathogen is carried out during microscopy of smears of cerebrospinal fluid and when it is sown on nutrient media.

For diagnostic purposes, they also perform a blood test and separated elements of a skin rash. With the assumption of the secondary nature of purulent meningitis, additional examinations are carried out aimed at finding the primary infectious focus: consultation of an otolaryngologist, pulmonologist, therapist; radiography of the paranasal sinuses, otoscopy, radiography of the lungs.

It is necessary to differentiate purulent meningitis from viral meningitis, subarachnoid hemorrhage, meningism phenomena in other infectious diseases (typhus, leptospirosis, severe forms of influenza, etc.).

Treatment of purulent meningitis

All patients with purulent meningitis are subject to treatment in a hospital setting. Such patients should immediately undergo a lumbar puncture and bacterioscopic examination of the cerebrospinal fluid. Immediately after the establishment of the etiology of meningitis, the patient is prescribed antibiotic therapy. In most cases, it is a combination of ampicillin with cephalosporin drugs (ceftriaxone, cefotaxime, ceftazidime). With purulent meningitis of unknown etiology, initial therapy consists of intramuscular administration of aminoglycosides (kanamycin, gentamicin) or their combination with ampicillin. Severe purulent meningitis may require intravenous or intrathecal antibiotics.

In order to reduce hydrocephalus and cerebral edema in purulent meningitis, dehydration therapy (furosemide, mannitol) is prescribed. Pathogenetic treatment of purulent meningitis also includes the use of glucocorticosteroid drugs (dexamethasone, prednisone), the doses of which depend on the severity of the disease. Along with this, the necessary symptomatic therapy is performed. In case of sleep disorders, tranquilizers are prescribed; for the relief of psychomotor agitation and convulsions - lytic mixtures (chlorpromazine, diphenhydramine, trimeperidine), diazepam, valproic acid; with hypovolemia and the development of infectious-toxic shock, infusion therapy is performed.

In the recovery period after the acute phase of purulent meningitis, nootropic and neuroprotective drugs, vitamin therapy and restorative treatment are recommended. Treatment of patients with secondary purulent meningitis should include the elimination of the primary septic focus, including through surgical intervention (sanitizing operation

Prevention of purulent meningitis

To date, the most effective way to prevent purulent meningitis is vaccination. Vaccinations are carried out against the main pathogens of purulent meningitis: Haemophilus influenzae, meningo- and pneumococci. In Russia, these vaccines are not considered mandatory and are administered according to indications or at the request of patients.

Vaccination against hemophilic infection is carried out mainly for children aged 3 months to 5 years and people suffering from immunodeficiency states as a result of HIV infection, immunosuppressive therapy for cancer, removal of the thymus or spleen, etc. Vaccination against meningococcal infection is recommended for children after 18 months and adults. Children under 18 months of age are vaccinated according to epidemic indications (for example, if meningococcal purulent meningitis is diagnosed in one of the family members). In regions dangerous for meningococcal purulent meningitis, vaccination should be carried out in immunocompromised patients and people with anatomical defects of the skull. Vaccination against pneumococcal infection is indicated for frequently ill children, patients with frequent pneumonia and otitis, in cases of reduced immunity.