Treatment of neuroinfection. Neuroinfectious diseases in children. The results of the disease

Etiology

In most cases, bacterial meningitis is caused by one of the following three organisms:

• Neisseria meningitidis(meningococcus)
• haemophilus influenzae(type B) (rarely observed with vaccination initiation)
• Streptococcus pneumoniae(Pneumococcus).

Other organisms, especially Mycobacterium tuberculosis, can be found in patients at risk, i.e. with immune deficiency (Table 1).

Table 1. Rare causes of bacterial meningitis in risk groups

Epidemiology

In developed countries, meningitis occurs in 5-10 out of 100,000 people a year.

The above three microorganisms have characteristics clinical manifestations:

• meningitis caused by meningococcus may be epidemic
• H. influenzae more common in children under 5 years of age
• pneumococcal infection is more common among older patients and is associated with alcoholism and splenectomy. It can cause meningitis by spreading through the bloodstream from neighboring organs (ears, nasopharynx) or from the lungs.

Clinical manifestations

Headache may be associated with neck and back muscle stiffness, vomiting, and photophobia. Headache increases rapidly (from minutes to hours), although not as quickly as with subarachnoid hemorrhage. Oppression of consciousness and epileptic seizures are possible.

Clinical examination reveals signs of infection, including fever, tachycardia, and shock. In a number of patients, the primary source of infection is detected (pneumonia, endocarditis, sinusitis, otitis media). Many patients with meningococcal meningitis have petechial lesions.

Neurological symptoms include:

• meningeal syndrome - a manifestation of irritation of the membranes, rigidity of the neck muscles when trying to passively flex it, high "meningeal" cry in children, Kernig's symptom
• oppression of consciousness
• increased intracranial pressure - disc edema optic nerve, tense fontanel in children
• defeat cranial nerves and other focal symptoms.

Examinations and diagnostics

• Lumbar puncture for untreated acute bacterial meningitis reveals:
• clouding of the CSF
• high blood pressure
• polymorphonuclear leukocytosis (hundreds or thousands of cells per microliter)
• increased protein content (more than 1 g/l)
• decrease in glucose concentration (less than half of the content in the blood, not always recognized).

The causative agent of meningitis is identified by Gram staining, when cultivated in a special medium, using a polymerase chain reaction.

• Contraindications to lumbar puncture in patients with suspected meningitis: papilledema, depression of consciousness and focal neurological deficit. In such patients, a CT scan is required before puncture to rule out a neoplasm, for example in the posterior cranial fossa, which can give a picture similar to meningitis.

• Other examinations:
• deployed clinical analysis blood (neutrophilia is detected)
• stages of coagulation (presence of disseminated intravascular coagulation syndrome)
• electrolyte levels (possible hyponatremia)
• blood cultures to detect microflora (results may be positive even with sterile CSF)
• x-ray of the chest and skull (paranasal sinuses) to identify the primary source of infection.

Complications

Acute complications of meningitis: epileptic seizures, abscess formation, hydrocephalus, excess secretion antidiuretic hormone and septic shock.

Severe manifestation of septic shock with the development of disseminated intravascular coagulation syndrome and hemorrhage in the adrenal glands may be a complication of meningococcal meningitis (Waterhouse-Friderichsen syndrome). Meningococcal meningitis can also be complicated by the development of septic arthritis or immune-mediated arthropathy.

Treatment

• Bacterial meningitis can lead to lethal outcome within a few hours, so early diagnosis and intravenous administration high doses of antibiotics.
• Benzylpenicillin- the drug of choice in the treatment of infectious diseases caused by meningococcus or pneumococcus (although a significant number of strains that are insensitive to penicillin appear). The first dose is 2.4 g, subsequent doses (1.2 g) are administered every 2 hours. If clinical improvement occurs within 48-72 hours, the frequency of administration can be reduced to once every 4-6 hours, but with that the same daily dose (14.4 g). Treatment should be carried out for 7 days after normalization of temperature (14 days for pneumococcal infection).
• For meningitis caused by H. influenzae, intravenous administration of high doses of chloramphenicol, cefotaxime or ceftriaxone is effective.
• When the nature of the pathogen is unknown, a combination of benzylpenicillin with cefotaxime or ceftriaxone should be used.
• If meningococcal meningitis is suspected, the doctor general practice must intravenously or intramuscularly inject the first dose of benzylpenicillin and hospitalize the patient.
• If lumbar puncture is delayed until CT scan, antibiotic treatment should be started prior to neuroimaging, immediately after blood cultures are taken.
• Other General requirements to treatment: bed rest, analgesics, antipyretics, anticonvulsants for seizures and supportive measures for coma, shock, increased intracranial pressure, electrolyte imbalance and circulatory disorders. It's believed that early application corticosteroids along with antibiotics reduces mortality in bacterial meningitis.

Prevention

• Persons who have been in contact with patients meningococcal meningitis, shown prophylactic rifampicin or ciprofloxacin
• Immunization against infection caused H. influenzae recommended for children aged 2, 3 and 4 months (vaccines H. influenzae type B); the use of the vaccine significantly reduces the risk of disease.

Forecast

Mortality from acute meningitis is about 10%, with most of- with infection with Streptococcus pneumoniae.

Pneumococcal infection causes a large number of complications (up to 30% of patients), including hydrocephalus, cranial nerve damage, visual and motor disorders, and epilepsy. Children with acute bacterial meningitis may develop behavioral problems, learning difficulties, hearing loss, and epilepsy.

Other bacterial infections

brain abscess

Etiology

Brain abscess is less common compared to bacterial meningitis, may be a complication of otitis media (in particular, abscess temporal lobe and cerebellum) and other local infectious processes(for example, with paranasal sinusitis). It is also possible to develop it with distant foci of inflammation localized in the lungs (bronchiectasis), renal pelvis or heart (bacterial endocarditis and congenital diseases hearts).

Clinical manifestations

A local accumulation of pus is accompanied by quite expected symptoms of a volume effect on the brain:

• promotion intracranial pressure
• focal neurological deficit (dysphasia, hemiparesis, ataxia)
• epileptic seizures.

A high temperature is possible, but its appearance is not an obligate sign. The development of symptoms occurs over several days and sometimes weeks, which may resemble a brain tumor.

Diagnostics

• If an abscess is suspected, CT or MRI is mandatory (Fig. 1).
• Lumbar puncture is contraindicated (risk of herniation).
• Complete blood count (neutrophilic leukocytosis) and culture to detect microflora.

Rice. one. MPT, sagittal section. Multichamber brain abscess. There is a characteristic decrease in the intensity of the signal in the center and its increase along the periphery of the foci after intravenous administration. contrast medium(Gadolinium preparation). The surrounding area of ​​edema is revealed (hypointense shadow)

Treatment

• Neurosurgical intervention is carried out in order to reduce compression of the brain and empty the abscess, as well as to establish a bacteriological diagnosis.
• Broad Spectrum Antibiotics(cefotaxime with metronidazole) are prescribed in early dates and are introduced until the nature of the microflora is established.
• Corticosteroids(used along with antibiotics) may be needed to control cerebral edema.

Parameningeal infections

Pus may accumulate in the epidural space, especially in the spinal canal. The main stimulus Staphylococcus aureus from infected wounds. Possible osteomyelitis of the vertebrae and infection of the intervertebral discs in combination with an epidural abscess. Patients experience strong pain in the back, fever (but may be very mild) and rapidly increasing paraparesis. The examination includes an MRI of the corresponding part of the spine and blood cultures. Treatment is with antistaphylococcal antibiotics; if there are signs of compression of the neural structures, early surgical intervention is indicated.

Localized infections in the face and scalp may spread to the subdural space ( subdural empyema) and into the intracranial venous sinuses, causing purulent sinusitis and cortical vein thrombosis.

Tuberculosis

Tuberculous meningitis is usually not as acute as bacterial meningitis, so clinical diagnosis quite difficult to install. Patients with impaired immune systems, ethnic minorities and immigrants are at risk. Main clinical symptoms: persistent headache, fever, epileptic seizures and focal neurological deficits that develop over several weeks. CSF flows under high blood pressure and contains several hundred leukocytes per microliter (lymphocytes predominate), the protein content is increased, and glucose is reduced. Organisms can be detected by auramine or Ziehl-Neelsen staining, but most often they are not detected and numerous repeated CSF samples and cultures are required. A valuable diagnostic test is the detection of mycobacterial nucleic acid by polymerase chain reaction. Treatment should not be delayed even if the tuberculous nature of the process is suspected; prescribe isoniazid (with concomitant use of pyridoxine), rifampicin, pyrazinamide, and a fourth drug, usually ethambutol or streptomycin. Anti-tuberculosis treatment should be continued for up to 12 months or more under specialist supervision. Corticosteroids are usually used in combination with anti-tuberculosis drugs to suppress inflammation and possible cerebral edema.

Mycobacterium tuberculosis can also cause chronic caseous granulomas ( tuberculomas) which, like intracranial neoplasms, have a volumetric effect on the brain. Tuberculomas may develop as a consequence of chronic tuberculous meningitis or as an isolated disease. Spinal tuberculosis can lead to compression spinal cord(Pott's disease).

Syphilis

Currently, neurosyphilis is relatively rare, mainly in homosexuals. There are several well-defined clinical forms.

• Moderately severe, self-limiting meningitis resulting from secondary syphilis.
• Meningovascular syphilis: inflammation of the meninges and cerebrospinal arteries in tertiary syphilis, manifested subacute meningitis with focal neurological deficit in the form of damage to the cranial nerves, hemiparesis or paraparesis, atrophy of the muscles of the hands ( syphilitic amyotrophy).
• Gumma- focal meningovascular lesion, occurring as an intracranial neoplasm and clinically manifested epileptic seizures, focal symptoms, increased intracranial pressure.
• Dorsal tabes (tabes dorsalis)- damage to the posterior roots of the spinal cord (Fig. 2).
• Progressive paralysis- parenchymal disease of the brain (Fig. 2).
• Congenital neurosyphilis.

Rice. 2.

The diagnosis of neurosyphilis is established by positive serological samples in blood and cerebrospinal fluid. In the CSF, up to 100 lymphocytes / μl can be detected, an increased content of protein and oligoclonal proteins. Treatment includes intramuscular administration of procainpenicillin, 1 million units. per day for 14-21 days. Co-administration of corticosteroids at the start of penicillin treatment is recommended to prevent Jarisch-Herzheimer reactions- a severe toxic reaction to the massive death of spirochetes under the influence of an antibiotic.

Lyme disease

Spirochete infection Borrelia burgdorferi transmitted by a tick bite can cause neurological manifestations in conjunction with systemic manifestations diseases. In the acute phase, during the first month after the bite, meningismus may develop along with fever, rash, and joint pain. Chronic disease develops within weeks or months after the bite, characterized by meningitis, encephalitis, cranial nerve palsies (especially facial), spinal root involvement, and peripheral nerves. Serological tests confirm the clinical diagnosis. The organism is usually sensitive to cefotaxime or ceftriaxone.

Leprosy

Mycobacterium leprae- one of the few microorganisms that are introduced directly into the peripheral nerves. Patients with "tuberculoid leprosy", the milder and least contagious form of the disease, suffer from partial sensory neuropathy with palpable thickened nerves and depigmented, insensitive skin. In Europe and North America, this disease is very rare; worldwide, leprosy is one of the leading causes of multifocal neuropathy.

Bacterial toxins

Defeat nervous system can develop under the influence of toxins produced by certain microorganisms.

• Tetanus caused by toxins produced Clostridium tetani entering the wound. Signs: tonic spasms of the jaw muscles ( lockjaw) and torso ( opisthotonus), fever with painful paroxysmal spasms of the whole musculature and arching of the back and elongated limbs. Treatment in the intensive care unit includes the use of muscle relaxants, artificial ventilation lung, the introduction of human tetanus immunoglobulin, penicillin and wound toilet. This disease can* be eradicated by active immunization of the population.
• Botulism caused by a toxin produced Clostridium botulinum, - a poisonous substance that enters the body when eating poorly sterilized canned food and less commonly from infected wounds. Patients experience vomiting and diarrhea, followed by paralysis within two days of poisoning. Weakness usually "descends" in its development - first there are ptosis, diplopia and paralysis of accommodation, then weakness of the bulbar muscles and muscles of the limbs. Mechanical ventilation is usually required; Recovery can take months or even years.
• diphtheria the toxin can cause polyneuropathy; fortunately, with the advent of immunization (vaccination), in developed countries given state is very rare.

Viral infections

Viral meningitis

Caused by certain viruses (virus mumps, enterovirus, etc.) the disease has a benign, self-limiting course, not accompanied by serious complications inherent in acute bacterial meningitis. There may be an increase in CSF pressure and the presence of several hundred leukocytes per microliter, in most cases lymphocytes with single neutrophils are detected, except in the early stages of the disease. The protein content may be slightly increased, the glucose level is normal. Differential diagnosis with meningismus, also a common condition aseptic meningitis, in which shell symptoms and moderate lymphocytosis in the CSF are possible (Table 2).

Table 2. Differential diagnosis of aseptic meningitis

Viral encephalitis

Etiology and pathogenesis

A viral infection of the brain can cause lymphocytic inflammatory response with necrosis of neurons and glia.

Virus herpes simplex is the most common cause of sporadic encephalitis. Other viral pathogens: herpes zoster virus, cytomegalovirus and Epstein-Barr virus (herpesviruses are more likely to cause encephalitis in patients with impaired immune systems), adenoviruses and virus infectious parotitis. Encephalitis can be epidemic as a result of arbovirus infection in regions where mosquitoes can be carriers of the disease.

Clinical symptoms

Patients experience headache and depression of consciousness for hours and days, epileptic seizures and focal neurological deficit are possible, which indicates dysfunction of the cerebral hemispheres or the brain stem. Hemispheric symptoms (dysphasia, paraparesis) make it reasonable to assume that encephalitis is caused by the herpes simplex virus.

Diagnostics

• CT and MRI of the brain can exclude a neoplasm and establish the presence of cerebral edema. Characteristic manifestations encephalitis caused by the herpes simplex virus (Fig. 3) can develop within a few days.
• CSF pressure is usually increased, lymphocytosis, increased protein content with normal level glucose. In the diagnosis of encephalitis caused by the herpes simplex virus, the determination of viral antibody titer can only be of retrospective significance. Early diagnosis possible using immunoassay to detect antigen and using polymerase chain reaction to detect viral DNA.
• When registering the EEG, pronounced diffuse changes. Encephalitis caused by the herpes simplex virus hallmark are periodic complexes present in the temporal region.

Rice. 3. Encephalitis caused by the herpes simplex virus. Note the asymmetric decrease in density in the temporal lobes

Treatment

Application acyclovir(10 mg/kg IV every 8 hours for 14 days) has revolutionized the treatment of herpes simplex encephalitis by significantly reducing mortality. death and heavy residual effects(epilepsy, dysphasia and amnestic syndrome) still occur, especially when treatment is started late. Aciclovir for suspected herpes encephalitis should be started immediately, without waiting for the results of CSF analysis, sometimes a brain biopsy is required.

There is no specific treatment for other types of encephalitis; only for encephalitis caused by cyclomegalovirus is used ganciclovir. Patients are given supportive measures and symptomatic treatment, including anticonvulsants with epileptic seizures and the introduction of dexamethasone or mannitol with an increase in cerebral edema.

Shingles

The varicella-zoster virus, dormant in the dorsal horn of the spinal cord for many years after infection, can reactivate and present clinically as herpes zoster. In this case, the patient, as a rule, experiences local pain and burning, which precede the appearance of a characteristic unilateral rash that spreads in the area of ​​\u200b\u200bone individual dermatome or a number of adjacent dermatomes. In most patients, rashes are located on the trunk. After the rash disappears, pain that is difficult to treat may remain ( postherpetic neuralgia).

The virus can cause various diseases:

• Ophthalmic herpes zoster- the rash affects the ophthalmic branch of the trigeminal nerve, which is associated with a risk of damage to the cornea and the threat of postherpetic neuralgia.
• Ramsay-Hunt syndrome- with unilateral facial peripheral paralysis of mimic muscles and rashes in the external ear canal or in the oropharynx. There may also be severe pain in the ear canal, systemic dizziness and hearing loss ear herpes zoster).
• motor herpes zoster- muscle weakness, including damage to the myotomes at the same level as the dermatomes affected by the rash. So, for example, the development of unilateral paresis of the diaphragm with homolateral rashes on the neck and shoulder (dermatomes C3, C4, C5).

Although herpes zoster usually resolves without treatment, oral administration is required to speed recovery, reduce pain, and reduce the risk of complications. large doses acyclovir than is required in the treatment of herpes simplex infection.

Herpes infection can have various clinical manifestations, especially in patients with impaired immune systems, including generalized rashes and the development of encephalitis. Some patients have selective damage to the spinal cord (herpetic myelitis) or arteries of the brain, causing hemiplegia.

Retroviral infections

Infections in people with HIV can lead to neurological complications for two reasons. Firstly, this virus has an affinity for nervous tissue, i.e. it is neurotropic, as well as lymphotropic. Meningitis can occur in conditions of seroconversion. In the future, slowly progressive dementia and involvement of other parts of the nervous system, in particular the spinal cord and peripheral nerves, may develop. Secondly, the risk of accidental infection and unusual infectious lesions of the nervous system may be the result of a violation of the immune system with an expanded clinical picture AIDS.

• Cerebral toxoplasmosis in patients with AIDS, it is characterized by damage to the cerebral hemispheres (hemiparesis, dysphasia, extrapyramidal disorders), the cerebellum (ataxia), and cranial nerves. Often accompanied by headache, epileptic seizures, and on CT and MRI - signs of focal or multifocal encephalitis. Antitoxoplasmosis therapy is carried out with pyrimethamine, sulfadiazine or clindamycin. Brain biopsy is indicated in patients with no response to ongoing therapy.
• Cryptococcal meningitis- fungus Cryptococcus neoformans; most common cause of cryptococcal meningitis in AIDS patients. Clinically manifested by acute or subacute increasing headaches, fever, sometimes epileptic seizures, but focal neurological symptoms are rarely detected. CSF analysis (after CT, excluding intracranial neoplasm) reveals lymphocytosis, usually with high content protein and reduced - glucose. Cryptococci can be detected by specific staining or by the presence of antigen in CSF or blood. Combination treatment antifungal agents(amphotericin B or flucytosine) may not be effective. Cryptococcal meningitis may be a complication of other disorders of the immune system, such as a condition after organ transplant, requiring the use of immunosuppressants.
• Herpesviruses- cytomelagovirus infection; more common in patients with AIDS. Can cause encephalitis and damage to the spinal cord (myelitis). Other herpesviruses, such as herpes simplex and herpes zoster, can cause localized or diffuse encephalitis.
• Progressive multifocal leukoencephalopathy (PML) caused by opportunistic papovaviruses (JC and others) and is manifested by multiple lesions white matter hemispheres of the brain. The disease proceeds with progressive dementia and focal neurological deficits, such as hemiparesis and dysphasia. Death occurs within months. PML develops in conditions where the immune system is compromised, such as hematopoietic diseases, tuberculosis, and sarcoidosis.
• cerebral lymphoma- focal or multifocal lesion in the cerebral hemisphere or posterior cranial fossa; has a clear clinical picture, is detected by CT or MRI. In the absence of the effect of ongoing antitoxoplasma therapy, the diagnosis can be established by brain biopsy.

In developed countries, all of these complications have become less common due to the introduction of highly active antiretroviral therapy (HAART or English HAART).

Retroviruses other than HIV are also characterized by neurotropic properties. Thus, the HTLV-1 virus, which is common in certain regions, such as the Caribbean, is associated with tropical spastic paraparesis(HTLV-1-associated myelopathy, HAM).

Other viruses

• Polio rare in developed countries due to the introduction of the vaccine. During an epidemic, most patients experience mild malaise with headache, fever, and vomiting 7-14 days after the virus enters the body through the intestines or respiratory tract. Some patients are in a preparalytic state, which is manifested by meningitis, pain in the back and limbs, while the virus has gained access to the CSF. Due to tropism to the cells of the anterior horn of the spinal cord and homologous cells of the brain stem, a paralytic lesion develops within a few days with progressive muscle weakness. Clinical symptoms are the same as in damage to the peripheral motor neuron, with the difference that the muscle damage is partial and asymmetric, there are fascicular twitches in the early stages of the disease and subsequent atrophy and areflexia. Few patients develop bulbar abnormalities and respiratory failure. Although there is partial recovery after the paralytic stage, many patients remain with persistent paresis and paralysis and require prolonged mechanical ventilation. Post-poliomyelitis syndrome is a rather ambiguously characterized condition, since with a late deterioration in the condition of patients with poliomyelitis, the cause of the increase in neurological deficit is the influence of other diseases.
• Rabies eradicated in the UK and some other countries, but it is not uncommon in the world. The disease is usually transmitted by the bite of an infected dog, but can also be transmitted by the bite of other mammals. The virus spreads from the bite site to the CNS slowly (over several days or weeks) and causes an inflammatory reaction with diagnosable intracytoplasmic inclusions ( Negri bodies) found in neurons after death. If a inflammatory process the brainstem is predominantly affected, rabies has a "lightning" course, the disease develops after a period of precursors in the form of fever and mental disorders. Patients experience laryngospasm and fear when drinking water - rabies. If the inflammation affects mainly the spinal cord, there are flaccid paralysis. When the symptoms of rabies are established, the outcome of the disease is always fatal. Preventive immunization is possible for animals that are potential carriers of the infection, in addition, active and passive immunization should be undertaken immediately after being bitten by such an animal, along with cleansing and debridement of the wound.

Post-viral phenomena

• Subacute sclerosing panencephalitis is a late and almost always fatal complication of measles, fortunately rare nowadays due to the availability of immunizations.
• Spicy disseminated encephalomyelitis - a rare continuation of a viral infection.
• Guillain-Barré syndrome in most patients associated with a previous infection, usually.
• Other neurological and psychiatric symptoms, such as weakness, impaired attention and memory, can make recovery from viral infections difficult. In particular, infection caused by Epstein-Barr virus accompanied by post-viral weakness syndrome.

Other infectious and contagious diseases

Protozoa

• Malaria should be considered in patients with fever of unknown origin returning from endemic this disease districts. The disease is well diagnosed by the results of a blood test. Infection Plasmodium falciparum causes hemorrhagic encephalitis.
• Toxoplasmosis, mentioned as a cause of multifocal encephalitis in AIDS, can also develop in utero causing hydrocephalus, intracranial calcification and chorioretinitis.
• trypanosomiasis common in African tropical countries; runs relatively mild form encephalitis with excessive sleepiness and epileptic seizures (“sleeping sickness”).

Metazoa

Encapsulated larva tapeworm can cause cerebral damage:

• in the presence of echinococcal cyst the disease can proceed as an intracranial neoplasm, rupture of the cyst can lead to chemical meningitis;
• at cysticyrrhosis multiple cysts lead to epilepsy, increased intracranial pressure, focal or multifocal neurologic deficits, or hydrocephalus. Treatment is with praziquantel while administering steroids.

Neuroinfection of the brain is a complex of pathologies that includes diseases caused by various types microorganisms. Serious problem in neurology and neurosurgery, as it occurs in 40% of cases as a primary disease and as complications.

Frequent pathogens of pathologies of the central nervous system are viruses, especially tick-borne encephalitis. It develops rapidly, multiplies and gives severe consequences in one form or another.

Of the bacteria that cause primary inflammation of the membranes of the brain, meningococcus is in the first place. Mostly children or people with reduced immune status. Develops in autumn or winter time. Penetrates into the cranial cavity through the mucous membranes of the nasopharynx. Inside the cells contains endotoxin, with a large release in environment can cause toxic shock.

Secondary neuroinfection implies the penetration of specific microorganisms into soft tissues brain from other lesions of internal organs. It includes pathogens of tuberculosis, syphilis, brucellosis, toxoplasmosis and so on.

The development of the disease depends on internal and external factors. To external factors include temperature conditions, climate, region and its ecological situation. From internal greatest influence renders a person's age concomitant chronic diseases and performance of the immune system.

The International Classification of Diseases of the Tenth Revision (ICD-10) considers neuroinfection as inflammatory diseases central nervous system, code: G00-G09.

Includes the following diseases:

• Meningitis;
• Encephalitis;
• Myelitis;
• Phlebitis and thrombophlebitis;
• Arachnoiditis;

Some experts include here the combined form, when several membranes of the brain are affected, for example, soft and arachnoid.

Depending on the time of development, pathology can be acute, subacute and chronic.

Symptoms

The clinical picture of all neuroinfections is similar to each other. A person is primarily concerned about headaches. The patient describes them in different ways: pressing, squeezing, burning, knocking at the temples, stabbing. They are associated either with an increase in intracranial pressure, which indicates a violation of the outflow of cerebrospinal fluid, or are manifestations acute inflammation fabrics. Pain usually worsens in the morning. Characteristic signs general intoxication body: nausea, vomiting, weakness, fatigue, confusion, hallucinations, malaise and high fever. Moreover, the temperature can reach critical figures (up to 40 ° C). There is a lack of appetite and disorder of organs gastrointestinal tract. It is possible to increase the heart rate, breathing, regular changes in blood pressure.

As the condition worsens, logically incoherent speech, delusional statements, disruption of the work of visual, auditory, gustatory and olfactory analyzers can be observed. There are failures in the transmission of impulses nerve endings organs and systems. Suffering a lot musculoskeletal system, as indicated by spasm of fibers and muscle pain. Sometimes there is another situation - the muscular apparatus is in complete relaxation, a person is not able to perform elementary motor movements.

Neuroinfections in children, especially young children, are much longer and more severe. In addition to the above symptoms, the clinical picture is complemented by constant crying and its intensification when lifting the child in his arms, swelling of the quadrangular and triangular fontanelles, stiffness of movements, and a rash on the skin.

Rarely, with a sluggish course, symptoms are not observed at all for a long time.

Complications

In case of untimely diagnosis or incorrectly selected therapy Great chance the development of complications. ICD-10 considers the consequences of neuroinfection as "conditions specified as such or as late manifestations or consequences that exist for a year or more after the onset of the condition that caused them."

A frequent consequence of an unfavorable course of pathology is encephalopathy - damage to cells, neurons of the brain, code according to ICD-10: G93.4. Manifested by increased emotional excitability, anxiety, mood swings, decreased memory, attention, mental abilities. Sleep is disturbed, but is accompanied by chronic fatigue even with normal physical activity. On the late stages development of parkinsonism mental disorders, chronic disorder functioning of organs and systems.

Complications include multiple sclerosis autoimmune pathology in which nerve fibers are demyelinated. Loss of coordination of movements, increased muscle tone, tendon reflexes, the psycho-emotional sphere is disturbed.

The consequence may be a migraine - a sharp severe headache in various areas with nausea, vomiting, loss of consciousness. Such attacks are either not caused by anything, or are a sign of a change in the weather, atmospheric pressure, air temperature.

Diagnosis and treatment

The neurologist is obliged to listen to the patient's complaints, examine him, evaluate the coordination of movements, speech, sensitivity to external stimuli. AT laboratory research blood, all signs of inflammation will be present: an increased number of leukocytes, the presence of C-reactive protein, increased erythrocyte sedimentation rate (ESR). It is possible to conduct an analysis of blood serum for the presence of antibodies to a particular pathogen, which will make it possible to identify the type of microorganism.

From modern methods diagnostics, magnetic resonance is preferred and CT scan brain. They can be used to objectively differential diagnosis with other pathologies, malignant neoplasms. The picture clearly depicts the shells and the state of the tissues of the organ.

Sometimes, by puncture from the spine, cerebrospinal fluid is taken for analysis to confirm the presence of the disease, to identify the pathogen.

Treatment should be carried out only in a hospital under the supervision of a specialist. The patient should be provided with complete rest, optimal temperature and humidity of the room, bed rest is indicated.

First of all, in order to destroy the microorganism, antiviral and antibacterial drugs are prescribed, as well as drugs that stimulate the immune system. To restore the water-electrolyte balance, intravenous drip solutions of potassium, sodium, calcium, and glucose salts are prescribed.

In the initial stages, in order to avoid cerebral edema, it is recommended to prescribe diuretics in small doses, such as mannitol, furasemide.

As a symptomatic treatment, it is important to use painkillers and anti-inflammatory drugs, both steroidal (glucocorticoids) and non-steroidal nature.

It is important to monitor blood pressure, heart rate and respiration, diuresis volume. At the first violation it is obligatory complementary therapy providing correction of body functions.

The question of what a neuroinfection is begins to torment the patient after making such a diagnosis, and as a rule, such a diagnosis does not bode well. As a rule, neuroinfections of the brain are caused by all sorts of microorganisms that affect both the brain itself and other components of the central or peripheral nervous system, but, first things first…

Diseases that are included in the group of neuroinfectious diseases and their classification depends on several factors, in particular, depending on the affected area, neuroinfection of the brain affects:

In addition, the disease is divided according to the duration of the course into:

1. Acute.
2. Subacute.
3. Chronic (sometimes referred to as slow neuroinfections).

To acute types diseases include:

• encephalitis;
• meningitis;
• tetanus;
• rabies;
• myelitis;
• arachnoiditis.

To chronic types, in turn, include:

• neurosyphilis;
• neuroAIDS;
• leprosy;
• neurobrucellosis;
• brucellosis.

In addition, the disease is divided into:

1. Primary.
2. Secondary

Primary infection is characterized by the occurrence of a disease due to the defeat of a particular part of the brain by an infectious or viral pathogen from the outside. The occurrence of a secondary type of infection is provoked by a disease present in the patient's body (tuberculosis, syphilis, toxoplasmosis, etc.).

Watch video: Brain in neuroinfection

Symptoms

Viral neuroinfection is a generalized name for a number of diseases that affect the central nervous system (CNS) of a person and characteristic symptoms neuroinfections are similar to the symptoms of the diseases mentioned above.

The main symptoms of the disease:

• headache (especially morning time in the supine position);
• general weakness;
• temperature;
• disorder of consciousness;
• nausea;
• vomit;
• increased fatigue;
• hallucinations;
• lack of appetite;
• gastrointestinal disorder;
• incoherent speech;
• violation of the organs of vision, hearing and smell;
• increase in the number of vascular contractions;
• decrease in the lower mark of arterial pressure.

Among other things, the patient may be diagnosed with flaccid paresis lower extremities. When pressing on the affected limbs, the patient will feel a sharp pain.

Varieties of diseases

So, the most common neuroinfections are meningitis, arachnoiditis and encephalitis.

Meningitis

A disease that affects the spinal cord or brain. Infection occurs by airborne droplets and also with the help of blood. The main pathogens are viruses, bacteria and fungi.

There are several types of meningitis

• herpes meningitis (herpesvirus neuroinfection);
• purulent meningitis;

Each of the varieties of this disease has special symptoms, but there are also general symptoms, including:

• muscle rigidity;
• heat.

Arachnoiditis

This disease affects exclusively the arachnoid membrane of the brain and develops as a result of head injuries, the presence of advanced ENT infections.

For this disease the following symptoms are typical:

• nausea;
• heat;
• vomit;
• painful condition;
• headache;
• loss of consciousness;
• deterioration of vision.

This disease, like meningitis, is treatable, however, the later the diagnosis is made, the more severe the consequences can be.

Encephalitis

This disease is usually carried by ticks and is a rather serious illness. The disease affects the brain tissue and, if not properly treated, causes death.

The main symptom complex includes:

• heat;
• nausea;
• headache;
• visual disturbances.

Encephalitis has adverse consequences, even after the end of medical therapy.

At gunpoint a child

Neuroinfections in children should be singled out as a special category. Due to the fact that babies have less strong immunity, they are most often exposed to dangerous diseases. Most characteristic ailment is herpesvirus neuroinfection and varicella meningitis. Other forms of meningitis can also occur in a child, but not as often as those listed above.

In addition, neuroinfections in children are more difficult to diagnose. This is due to the fact that the child is simply not able to explain what is bothering him. As a result, the start of treatment is delayed and, possibly, the appearance of dangerous consequences.

Diagnosis and treatment

It is important to understand that in order to quality treatment need timely diagnosis disease and determine its true component.

What does an MRI machine look like?

Any neuroinfection is determined complex diagnostics, including:

• Magnetic resonance imaging (MRI);
• Computed tomography (CT);
• Encephalogram of the head (EEG).

Among other things, the doctor prescribes the patient to take tests:

• blood;
• urine;
• cerebrospinal fluid.

Important: often 40% of the information is provided by the analysis of cerebrospinal fluid

Treatment

Treatment is carried out strictly in stationary conditions and lasts at least one week, in most cases more.

What medications are prescribed to the patient?

First of all, antibiotic therapy is carried out. Moreover, the type of antibiotic and dosage is prescribed by the attending physician. As a rule, the drug is administered to the patient intravenously or directly into the spinal cord (with inflammation of the spinal cord).

In addition, the patient is prescribed a course of vitamins, immunosuppressive therapy, as well as a complex of hormonal agents.

In addition, in the event of complications (cerebral edema, etc.), the patient is given drugs that eliminate one or another complication.

This is how blood is tested

Residual effects after the illness can be treated at home, provided that the general condition of the patient is satisfactory.

What after

The consequences of neuroinfections are different. Depending on the time of initiation of treatment and type past illness. Basically, they belong to such a branch of medicine as neurology.

In particular:

• recurrent headaches;
• sensitivity of some organs to changes in the weather;
• hearing, smell or vision impairments;
• memory problems.

AT rare cases a person becomes disabled.

So, the longer the delay in contacting a specialist, the worse consequences may eventually develop. Do not play with your health and the health of your children, take care of yourself.

Description:

Neuroinfections can be classified according to the place of their occurrence into (infectious inflammation of the brain), myelitis (infectious inflammation of the spinal cord), (infectious inflammation of the arachnoid meninges), (infectious inflammation of the meninges) and combined forms (encephalomyelitis, and so on).

Symptoms:

Any infectious lesion of the nervous system is accompanied by three clinical syndromes:

1. Intoxication (there is weakness, decreased ability to work, fever).
2. Liquor (there is a syndrome of cell-protein dissociation, i.e. the amount of protein and cells in the cerebrospinal fluid is increased, but the cells significantly prevail over the protein).
3. CSF hypertension syndrome (headache worsens when lying down, occurs in the morning, there may be fatigue, impaired consciousness, as well as Cushing's triad - and tachypnea against the background of reduced systolic blood pressure).

Causes of occurrence:

Infectious lesions of the nervous system may be associated with a viral, bacterial infection, may be caused by protozoa or fungi, and in some cases there is a development of specific inflammation of the nervous structures (tuberculous, syphilitic).

Treatment:

For treatment appoint:

Treatment depends on the pathogen. For treatment bacterial infections use broad-spectrum antibiotics until the pathogen is identified, then apply specific antibiotic therapy. At viral infections antiviral drugs, mainly interferon, are used. In addition to etiotropic therapy, pathogenetic and symptomatic treatment is also carried out - infusion therapy, diuretic, used vascular preparations, neuroprotectors, nephrotrophic drugs, nootropics, B and C vitamins.

What is a neuroinfection?

The concept of "neuroinfection" includes diseases of the central (brain or spinal cord) or peripheral (nerve trunks, plexuses, nerves) nervous system, mainly inflammatory nature that were caused by some kind of microbe or virus (sometimes fungi).

Examples of neuroinfections

It's pretty big list diseases. Some of them are acute, others proceed sluggishly, chronically. Acute diseases may occur once in a lifetime, or they may become prone to recurrence. Treatment of neuroinfection differs in each case.

Acute neuroinfections:

• meningitis (inflammation of the membrane common to the spinal cord and brain);
• encephalitis is an inflammation of the very substance of the brain, mainly caused by viruses, for example, tick-borne encephalitis virus, Japanese encephalitis virus;
• rabies;
• tetanus;
• myelitis (inflammation triggered by an infection in the spinal cord).

The list is very large. Main diseases:

• neurosyphilis;
• brucellosis;
• neuroAIDS;
• neurobrucellosis;
• leprosy (leprosy);
• tuberculous lesions of the nervous system.

Features of the course of neuroinfection

Neuroinfections in children are often acute course varying degrees of severity. There are some specifics associated with the greater immaturity of the immune system of babies. For example, meningococcal and Haemophilus influenzae damage to the nervous system is more common in children than in adults. In the latter, such microbes generally do not reach the brain, causing meningococcal nasopharyngitis (runny nose and sore throat) or hemophilic pneumonia. In practice, it has been observed that children who have congenital “malfunctions” in the functioning of the nervous system are more susceptible to neuroinfection: hypoxia during childbirth, cerebral palsy, cytomegalovirus brain damage during pregnancy.

It begins upon receipt of at least preliminary results of the survey. So, if there is a suspicion of meningitis or encephalitis, a lumbar puncture is mandatory. According to this analysis, the doctor looks, purulent inflammation or serous. Based on this, treatment begins: with purulent inflammation, antibiotics are required, with serous inflammation, antiviral agents. If neuroinfection arose as secondary lesion(that is, there was pneumonia at first, and then meningitis arose), then antibiotics are prescribed necessarily. In the clinical picture of diseases such as poliomyelitis, tetanus, brucellosis, blood, urine, feces are first taken for bacteriological and serological (for viruses) examination, and only then, after a short period of time, antibiotic treatment begins and antiviral agents, tetanus toxoid.

Except antimicrobial agents treatment of neuroinfection includes (according to indications):

• hormonal agents (for example, with meningococcal infection, the medicines "Prednisolone", "Dexamethasone" are life-saving);
• anti-inflammatory drugs: "Ibuprofen", "Diclofenac";
• sedative therapy;
• oxygen therapy;
• drugs that improve blood rheology;
• other medicines (depending on the situation).

Treatment of neuroinfection in its severe course

It includes the transfer of the patient to artificial ventilation of the lungs (if there is a disturbance of consciousness, prolonged convulsions), it is possible to maintain anesthesia for a long time, the administration of drugs that maintain blood pressure at a normal level, the administration of drugs that thin the blood.

Effects

The consequences of neuroinfection can be different. The most common phenomenon is a headache (or back pain - with inflammation of the spinal cord), which occurs "in the weather." Also often there is a violation of memory, impaired hearing or vision up to the complete loss of these feelings. Due to neuroinfection, a person can become disabled, so it is important timely appeal and adequate treatment.