Subacute meningitis. Meningitis in adults: symptoms, causes, diagnosis and treatment. What is meningitis

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

Definition of disease. Causes of the disease

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

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

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

Depending on the type of meningitis, the ways of infection and the mechanisms of the onset of the disease differ. With regard to infectious meningitis, one can point to an extremely wide geographical distribution, with a tendency to increase the foci of the disease on the African continent (meningococcal meningitis), more frequent development diseases in children and an increase in morbidity in the cold season (viral meningitis as a complication of SARS). Infection is more likely to be transmitted by airborne droplets.

Symptoms of meningitis

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

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

The pathogenesis of meningitis

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

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

The place of introduction (gate) is the mucous membrane of the nasopharynx. In the vast majority of cases, the infectious process does not develop or local forms of the disease develop. When meningococcus overcomes local anti-infectious barriers, hematogenous spread of infection occurs and a generalized meningococcal infection occurs, including the development of meningococcal meningitis, in the absence of adequate treatment, ending in more than 50% of cases with a fatal outcome. In the pathogenesis of the disease, toxins are released after the death of bacteria in the bloodstream, damage to the walls of blood vessels, which leads to impaired hemodynamics, hemorrhages in organs and profound metabolic disorders. There is hyperirritation of the membranes of the brain, the development of purulent inflammation of the tissue and a rapid increase in intracranial pressure. Often, due to edema and swelling of the brain tissue, the brain is wedged into the foramen magnum and the patient dies from respiratory paralysis.

The latent period of the disease is from 2 to 10 days. The beginning is acute (even more correctly - the most acute). In the first hours of the disease, there is a sharp increasing increase in body temperature up to 38.5 degrees and above, severe lethargy, weakness, pain in the periorbital region, loss of appetite, sharp headache. A characteristic sign of a headache is a constant increase in its intensity, diffuse pain without a clear localization, bursting or pressing in nature, causing true torment for the patient. At the height of the headache, vomiting gushes without previous nausea, bringing no relief. Sometimes in patients with a severe uncontrolled course, mainly in children in an unconscious state, an uncontrollable cry is observed, accompanied by clasping the head with hands - the so-called. "hydrocephalic cry" caused by a sharp increase in intracranial pressure. Crashes into memory appearance patients - sharpening of facial features (Lafort's symptom), meningeal posture on the 2nd-3rd day of the disease (so far "pointing dog"). Some patients develop hemorrhagic rashes on the body, resembling a stellate rash (which is an unfavorable sign). In the course of 2-3 days, the severity of symptoms increases, hallucinations and delusions may appear. The degree of impaired consciousness can vary from somnolence to coma, in the absence of treatment, death can occur at any time.

Tuberculous meningitis- slowly developing pathology. It is mainly secondary, developing with the already existing tuberculous process of other organs. It has several periods of development, consistently developing over a long period of time:

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

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

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

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

Herpetic meningitis most commonly caused by viruses herpes simplex 1 and 2 types, virus chickenpox and develops against the background of a weakening of the body with ARVI or serious immunosuppression, incl. AIDS. It is divided into primary (when the process develops during primary infection with the virus) and secondary (reactivation of the infection against the background of a decrease in immunity). Always an acute illness primary manifestations depend on the previous premorbid background. More often against the existing background of ARVI phenomena, herpetic eruptions severe headache occurs in the perioral region and genitals diffuse character, aggravated over time, vomiting that does not bring relief. All this can occur against a background of moderate or high rise body temperature, mild meningeal symptoms. Often, brain damage joins, in such cases mental disorders (often aggression), hallucinations, disorientation, generalized convulsions occur on the 3-4th day. With proper treatment, the prognosis is usually quite favorable; in the absence of adequate treatment in conditions of impaired immunological resistance, it is possible fatal outcome or persistent residual phenomena.

Classification and stages of development of meningitis

There are the following types of infectious meningitis:

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

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

3. Downstream:

• sharp (as an option - lightning fast)
• subacute
• chronic

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

Complications of meningitis

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

Diagnosis of meningitis

Primary diagnostic search includes an examination by an infectious disease specialist and a neurologist and, if possible meningitis is suspected, a leading diagnostic study - lumbar puncture.

It involves the insertion of a hollow needle into the subarachnoid space of the spinal cord at the level lumbar spine. The purpose of this study is to clarify the type, properties and nature of the change cerebrospinal fluid, identification of possible pathogens and ways of treating this type of meningitis.

Depending on the etiological agent, causing meningitis, the properties of liquor differ, we present their main types and characteristics:

1. Bacterial meningitis (including meningococcal meningitis):

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

2. Serous meningitis (including viral):

• cerebrospinal fluid pressure is normal or slightly increased
• transparent liquor, flowing at a puncture 60-90 drops per minute
• amount cellular elements in cerebrospinal fluid (cytosis) less than 800 per µl
• protein concentration up to 1 g/l and below
• glucose within normal limits

3. Tuberculous meningitis:

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

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

MRI of the brain for meningitis

brain CT

Treatment of meningitis

The main and main condition effective assistance patients with meningitis is early hospitalization and the beginning of specific etiotropic and pathogenetic therapy! Therefore, at the slightest suspicion of a doctor or paramedic on meningitis, all possible steps should be taken to deliver the suspicious patient to an infectious hospital as soon as possible and start treatment, doubts of medical specialists or the patient himself in terms of diagnosis and hospitalization should be regarded as unreasonable (dangerous) and immediately stopped.

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

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

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

Forecast. Prevention

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

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

Prevention of meningitis includes specific and non-specific activities.

Non-specific - healthy lifestyle life, strengthening the immune system, observing the rules of hygiene, the use of repellents, etc.

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

Bibliography

• 1. Alekseeva, L. A. Diagnostic value of the spectrum of cerebrospinal fluid in bacterial and viral meningitis in children / L. A. Alekseeva, M. N. Sorokina // Clinical laboratory diagnostics. 2001. No. 2. S. 215-219
• 2. Bogomolov B.P. Diagnosis of secondary and primary meningitis. // Epidemiol. and infectious diseases, 2007. No. 6. pp.44-48.
• 3. Kazantsev A.P., Zubik T.M., Ivanov K.S., Kazantsev V.A. Differential Diagnosis infectious diseases. Guide for doctors. M.: Med. inform. agency, 1999. - 481s. / Ch. 13. Meningitis and meningoencephalitis. pp.342-379
• 4. infectious diseases: national leadership. / Ed. N.D. Yushchuk, Yu.Ya. Vengerov. M.: GEOTAR-Media, 2009. 1056s. (p.725-735)
• 5. Meningococcal meningitis. Newsletter N°141. WHO. November 2015
• 6. Meningococcal Disease (Neisseria meningitidis)/Centers for Disease Control&Prevention/July 24, 2015
• 7. Meningococcal Disease: Technical and Clinical Information/Centers for Disease Control&Prevention/July 24, 2015
• 9. Meningococcal Disease/Centers for Disease Control&Prevention/July 24, 2015
• 10. Sejvar JJ, Johnson D, Popovic T, et al. Assessing the risk of laboratory-acquired meningococcal disease. J Clin Microbiolol 2005; 43:4811–4

Meningitis is a collective concept. It includes all diseases of an inflammatory nature that affect the membranes of the brain. The classification of meningitis is quite extensive.

Clinicians divide this disease into groups depending on the severity of the disease, the nature of the process, the course, etiology and other signs.

Define correct form sometimes it is possible only with the help of additional diagnostic methods, or by assessing the patient's condition in dynamics.

Origin of the disease

Depending on the origin, meningitis can be primary or secondary. The primary process is that which develops among full health without any previous infection. It is caused by meningococcus, tick-borne encephalitis virus, influenza. The secondary form occurs as a complication of the previous disease. The etiological factor in this case is a large number of viruses and bacteria - pale treponema, Koch's stick, streptococci, staphylococci, enterobacteria.

The most common causes of meningitis are bacteria or viruses that affect the meninges and cerebrospinal fluid.

Listeria meningitis also belongs to this group. In very rare cases, an association of two or more types of bacteria becomes the cause of the disease. The prerequisites for such a development of events are:

• congenital and acquired immunodeficiency states;
• alcoholism;
• traumatic brain injury, in particular, a fracture of the base of the skull, penetrating damage to the cranial cavity;
• neurosurgical operations;
• surgical treatment abdominal diseases.

Of the viral processes, enteroviral meningitis, provoked by the ECHO and Coxsackie viruses, is most often diagnosed. It accounts for about 70% of all viral meningitis. In addition, the mumps virus, Epstein-Barr virus, herpes simplex type 2, cytomegaloviruses, adenoviruses, togaviruses become a common cause of the disease. Also, meningitis is caused by the causative agent of chickenpox, which belongs to the herpes virus type 3.

The nature of the inflammatory process

On this basis, meningitis is divided into two forms - serous and purulent. The first is observed in the case viral nature diseases. If the cause of the pathology is a bacterium, the process acquires purulent character. It is possible to suspect this or that form of inflammation already at the stage of collecting complaints and studying the medical history, but the final diagnosis cannot be made without the use of additional research methods.

In children, this disease is especially severe. It causes complications, which may include mental retardation, toxic shock, bleeding disorder

Purulent meningitis is different severe course. A detailed clinical picture develops within a day after the onset of the disease, in children even earlier. Along with typical complaints of headache, nausea, vomiting, there is a pronounced intoxication syndrome. The patient complains of intense general weakness. Intoxication and dehydration syndromes are very pronounced, toxic shock often develops.

In the blood test - an increase in the level of leukocytes, a shift of the leukocyte formula to the left, an increase in ESR. The cerebrospinal fluid is cloudy, flows out in a trickle or frequent drops. At microscopic examination- cytosis due to neutrophils.

Serous form has more easy current and favorable prognosis. Most often, this type of enteroviral meningitis occurs. With timely and proper treatment, recovery occurs within 1-2 weeks. In the general blood test - an increase in the level of lymphocytes, a shift of the leukocyte formula to the right, in the cerebrospinal fluid - cytosis due to lymphocytes. Such changes are typical for viral infections.

Stages, nature of the course and severity

During meningitis, there are incubation period, the period of the prodrome, the stage of the detailed clinical picture and recovery.

Depending on how quickly the clinical picture develops, these types of meningitis are distinguished:

• fulminant, or lightning fast;
• spicy;
• subacute;
• chronic.

According to the severity of meningitis are:

• heavy;
• moderate severity;
• lungs.

fulminant, or fulminant meningitis is characterized by a rapid transition from one stage of the disease to another, which is why its second name is malignant. From the onset of the disease to the serious condition of an adult patient, a day passes, in children - even less. In such conditions, doctors simply do not have time for a full diagnosis, so treatment is prescribed according to preliminary diagnosis. Most often, this course is characterized by primary bacterial meningitis - staphylococcal, streptococcal, meningococcal.

The disease of meningitis begins suddenly in a healthy child the day before, when his temperature rises to 39-400 C within an hour

Acute the form is also characterized by a rapid course, but the patient's condition is not as severe as in malignant. Body temperature reaches 40°C, all cerebral symptoms are present and meningeal signs. Intoxication syndrome is pronounced, but toxic shock develops relatively rarely.

Subacute or sluggish meningitis, observed in tuberculosis, syphilis, leptospirosis, acquired immunodeficiency states. Meningeal symptoms are not as pronounced as in acute course.

At chronic the process of changes in the blood and cerebrospinal fluid observed for a month or longer. Against the background of persistent persistence of symptoms appear mental disorders, convulsive syndrome. growing intracranial pressure. Focal symptoms appear, indicating damage to the cranial nerves. The etiological factors of chronic meningitis are the same as those of subacute meningitis.

Sometimes doctors diagnose another subtype of meningitis called chronic relapsing meningitis. This form of flow is typical for aseptic processes, as well as for infection with the herpes simplex virus type 2.

Localization

According to the predominant localization of the process, the following types of meningitis are distinguished:

• basal;
• convexital;
• total;
• spinal.

The diagnosis is confirmed by specific signs of the disease, determined using motor tests, the clinical picture, complaints of the patient or his relatives.

The basal process is localized at the base of the brain. As a rule, it is caused by specific etiological factors - Mycobacterium tuberculosis, spirochete. Since cranial nerves are located in this part, the symptoms of the disease include cerebral manifestations and focal signs cranial nerve lesions. The last group includes:

• tinnitus, hearing loss;
• double vision due to disruption of the abducens nerve;
• omission of both eyelids;
• asymmetry of the face - drooping of the corner of the mouth, smoothing of the nasolabial fold;
• if you ask the patient to stick out his tongue, he will deviate to the side.

Meningeal symptoms are absent or mild. There is an intoxication syndrome.

Convexital meningitis affects the sections of the meninges that are located under the cranial vault. With this localization, symptoms of irritation of the meninges come to the fore. With total localization, signs characterizing the basal and convexital process are observed.

Spinal meningitis affects the lining of the spinal cord. In addition to cerebral, meningeal and intoxication symptoms, the disease is characterized by an intense radicular syndrome. Pain is localized in the zone of innervation of the spinal nerves involved in the process. Light palpation or percussion dramatically increases pain. As the disease progresses, symptoms of spinal cord compression increase - a violation motor activity and sensitivity below the level of compression, dysfunction of the pelvic organs.

Etiological factor

Depending on which pathogen caused the disease, meningitis can be:

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

The most typical representative of viral meningitis is enteroviral meningitis.

As a rule, it is characterized by an acute course, a serous nature of the process and a favorable outcome. Meningitis after chickenpox is caused by the causative agent of chickenpox, which belongs to the herpes simplex virus.

It develops a week after the appearance of rashes typical of chickenpox and is often accompanied by encephalitis - inflammation of the brain substance. Come to the fore neurological symptoms- hyperkinesis, transient paralysis, tremor, ataxia, nystagmus. At the same time, the general condition of the patient can be classified as moderate. salient feature meningoencephalitis after chickenpox. By the end of the second week from the onset of the disease, the patient's condition stabilizes. Influenza meningitis is much more severe than enteroviral meningitis and meningoencephalitis after chickenpox. In the cerebrospinal fluid, a large number of erythrocytes is observed, which is characteristic of the disease of influenza etiology.

All patients diagnosed with enteroviral meningitis are indicated for bed rest and hospitalization.

Bacterial meningitis characterized by an acute or fulminant course, serious condition patient and a high percentage lethality. At the same time, the processes of syphilitic and tuberculous etiology differ in subacute and chronic course.

Fungus and protozoan microorganisms cause inflammation of the meninges in individuals suffering from congenital or acquired immunodeficiency. The same applies to processes of mixed etiology.

Finally

Meningitis is a disease that poses a real threat to the life and health of the patient. His treatment is carried out by an infectious disease specialist and a neurologist. If necessary, the patient is consulted by other specialists. All medical measures are carried out under the conditions specialized hospital. It must be remembered that the disease tends to progress rapidly, and the success of treatment largely depends on timely treatment to the doctors.

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

Forms of meningitis

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

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

Serous meningitis

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

Ways of transmission of the virus:

1. Fecal-oral. Through contaminated food and water. The virus replicates in the intestines and long time is released into the external environment, where it is stored for a long time on household items, in food products, sewer waters.
2. Airborne.
3. Transplacental transmission of the virus is possible. In the early stages of pregnancy, this causes abnormalities in the development of the fetus, on later dates- his death or intrauterine infection.

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

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

How to suspect meningitis

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

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

From the first days of meningitis, meningeal symptoms appear:

1. Stiff neck - when you try to bend your head, there is resistance.
2. Positive Kernig's sign - when the leg is bent in hip joint, it is impossible to straighten it in the knee joint due to the tension of the posterior thigh muscle group.
3. Brudzinsky's symptom - with passive flexion of the patient's leg in the hip and knee joints, the other leg also automatically bends.

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

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

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

Children with serous meningitis are subject to hospitalization.

How to prevent meningitis?
Single specific prevention enterovirus infection, and meningitis in particular, yet. Timely isolation of patients and early diagnosis are of great anti-epidemic importance. Do not take your child to kindergarten the slightest sign any disease endanger the health of other children. It is necessary to teach the child to hygiene, to strengthen the immune system.

Meningitis caused by meningococcus

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

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

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

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

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

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

The fulminant form of meningococcemia (hyperacute meningococcal sepsis) is especially dangerous. Elements of the rash literally before our eyes form cyanotic spots resembling cadaveric ones. The child tosses about in bed, blood pressure drops, shortness of breath appears, meningeal symptoms are not constant, often not detected, muscle hypotension is noted. No online consultations on the Internet, you urgently need to call an ambulance!

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

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

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

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

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

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

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

From non-specific prevention, in addition to the above methods, it is recommended not to swim in open water, especially for young children, and not to travel to countries where meningitis is common.

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

Meningitis is a group of acute neuroinfections affecting the meninges and manifesting symptoms increased ICP(intracranial pressure) and irritation MO (meninges), as well as general intoxication. The inflammatory process in meningitis can affect both the membranes of the brain and spinal cord.

In the International Classification of Diseases (ICD), meningitis is classified under different headings.

Meningitis - ICD code 10:

1. A39.0 for meningococcal meningitis;
2. G00 - for bacterial meningitis, and, depending on the pathogen, the code is supplemented with a number:

• 1 for pneumococcal meningitis (G00.1);
• 2 - streptococcal;
• 3- staphylococcal;
• 8 - for meningitis caused by other bacterial pathogens;
• 9 for unspecified meningitis.

Code G01 is used for meningitis associated with various bacterial infections classified elsewhere;

Viral meningitis is classified under A87

• 2- for lymphocytic choriomeningitis;
• 9 - unspecified viral meningitis.

Is meningitis contagious?

Meningitis is a contagious disease. Meningococcal meningitis is the most highly contagious. Severely ill patients pose the greatest danger to others in the first days of illness. Patients with meningococcal infection presenting with nasopharyngitis may present with serious danger for others for a few weeks.

Healthy carriers can shed meningococci in environment when coughing and sneezing 2-3 weeks. In some cases, a healthy carrier state can last more than six weeks.

Children and immunocompromised patients are most susceptible to infection.

Is meningitis transmitted by airborne droplets?

The most common route of transmission of meningitis is droplet. However, in rare cases, infection with causative agents of meningitis can occur by blood-borne and vertical routes.

The pathogens of meningitis are transmitted from person to person. The source of infection in meningococcal meningitis are seriously ill patients, persons suffering from meningococcal nasopharyngitis and healthy carriers of meningococcal infection.

Types of meningitis

Depending on the etiology of the pathogen, meningitis can be bacterial (this includes classic meningococcal meningitis), viral, fungal, protozoal, etc.

The most common are meningitis. bacterial nature caused by staphylo-, streptomeningococci, Proteus, Escherichia, Haemophilus influenzae, etc.

Depending on the nature inflammatory processes, meningitis can be purulent or serous.

Also, it is necessary to divide the inflammation of the meninges into:

• primary, arising as an independent disease;
• secondary, which is a complication of another infection (meningitis can be a complication of purulent otitis media, sinusitis, mastoiditis, etc.).

By duration, the inflammatory process can be fulminant, acute, sluggish or chronic.

Severity is divided into mild, moderate, severe and extremely severe.

The pathogenesis of the development of inflammation of the meninges

The incubation period for meningitis in adults is 1 to 5 days. In some cases, up to 10 days.

The entrance gate for pathogens of meningitis, in most cases, are the mucous membranes lining the nasopharynx and bronchi. After pathogenic microorganisms enter the mucous membrane, their active reproduction begins. This process may be manifested by a local inflammatory reaction.

Meningitis of meningococcal etiology is characterized by the development of meningococcal nasopharyngitis, occurring as acute respiratory infections (catarrhal phenomena, fever, chills, sore throat, hoarseness, etc.). It should be noted that in patients with good immunity, as a rule, meningococcal infection can occur only in the form of nasopharyngitis, without leading to the development of meningitis or meningococcemia. Generalization of the infection will interfere with the patient's local humoral immunity. In some cases, there may be a rapid and complete destruction of meningococcus, without pronounced clinical manifestations. Also, the transition of the disease to a healthy (asymptomatic) carriage of meningococcal infection is possible.

In the presence of favorable factors (decreased immunity, exhaustion of the body by a long illness, etc.), meningococci can enter the subarachnoid space, causing inflammation of the meninges. It is also possible for bacteria to enter the membranes of the brain by the lymphogenous or hematogenous route (most often with severe complicated otitis media, sinusitis, etc.).

After the pathogen enters the cerebrospinal fluid, inflammation develops instantly. This is due to the fact that there are no anti-inflammatory defense mechanisms in the cerebrospinal fluid - immunoglobulins, complement, antibodies.

Once in the cerebrospinal fluid, bacteria and their toxins affect the epithelial cells of the microvasculature of the brain, stimulating the production of PVC (anti-inflammatory cytokines) and chemokines. The development of intracranial hypertensive syndrome occurs in response to inflammatory reactions in the meninges. In the future, the hypertensive syndrome exacerbates the severity of impaired blood flow and metabolic processes in the brain, as well as the severity of neurological disorders.

Continued response hyperproduction of cerebrospinal fluid causes cerebral edema and ischemic-hypoxic damage to the nervous system. It leads to parenchymal damage of the brain, accompanied by the death of neurons and the appearance of severe motor, sensory, mental and intellectual disorders.

Can you die from meningitis?

With the spread of infection (generalization of meningococcal infection) with the development of meningococcemia, in addition to severe bacteremia itself, significant endotoxemia occurs. These processes result in severe hemodynamic disturbances, septic shock, DIC, and metabolic disorders accompanied by irreversible damage to internal organs.

Severe meningitis, especially forms with fulminant development, often lead to death.

The first signs of meningitis in adults

The first manifestations of meningococcal infection are usually non-specific and are in the nature of a common ARVI. There are catarrhal phenomena in the nasopharynx, fever, a feeling of sore throat, slight nasal congestion, general intoxication symptoms.

In the future, with the development of inflammation of the meninges, meningeal symptoms join.

Meningitis does not occur without fever. The disease is always accompanied by high fever and severe intoxication. The temperature in meningitis, as a rule, rises to 40 degrees.

The first symptoms that allow you to suspect that the meninges are involved in the inflammatory process will be:

• severe, intense headaches;
• severe photophobia and intolerance to loud sounds;
• repeated vomiting. At the same time, vomiting itself is not accompanied by nausea and does not bring relief;
• decline muscle tone and tendon reflexes, severe weakness;
• impaired consciousness, the appearance of lethargy, stupor, or vice versa, pronounced arousal, delirium, anxiety;
• increased skin sensitivity.

Symptoms of meningitis in adults

In addition to the obligatory triad of symptoms: vomiting, fever and intense headache, the most specific and indicative of meningitis will be the appearance of the so-called meningeal signs:

• neck stiffness;

• symptoms of Kerning and Brudzinski.

Rashes with meningitis appear with the development of meningococcemia. The first elements of the rash most often appear on the buttocks, then they spread to the legs, torso, arms, face (rarely). The elements of the rash are star-shaped with necrotic foci in the center.

As well as children, adults have severe headaches, the intensity of which increases significantly in bright light or loud sounds.

The specific meningeal posture of a pointing dog is also characteristic.

Meningeal symptoms, as a rule, develop within 12-15 hours from the onset of the disease.

With damage to the cranial nerves, the appearance of mental disorders, the occurrence of a hallucinatory-delusional syndrome, and feelings of euphoria are characteristic. Convulsions, paresis, paralysis, and significant coordination disorders also develop.

In some cases, after the appearance of rashes, a clinic of an acute abdomen (severe abdominal pain) and diarrhea may develop.

In severe meningococcemia, a significant increase in heart rate, the appearance of shortness of breath, symptoms of renal failure (anuria), and increased bleeding are also characteristic.

Diagnosis of meningitis

It is possible to suspect meningococcal meningitis when a patient develops fever, vomiting, headache, meningeal signs, hemorrhagic rash.

To clarify the diagnosis, perform:

• UAC ( general analysis blood), OAM (general urinalysis);
• biochemical blood test;
• blood clotting tests (coagulogram);
• research and bacterial culture of cerebrospinal fluid (with meningitis this study is one of the most important) with further determination of the sensitivity of the pathogen to antibacterial agents;
• tank. sowing nasopharyngeal mucus for meningococcal flora;
• bacteriological diagnosis of blood culture.

They also carry out electrocardiography, radiography of the OGK (organs chest) and paranasal sinuses, MRI and CT of the brain.

Treatment of meningitis in adults

Treatment of meningitis with antibiotics in adults and children is mandatory.

All antimicrobial therapy is selected initially empirically (starting therapy based on clinical picture, anamnestic data and epidemiological history of the patient). Further, after receiving crops for the pathogen and its sensitivity to antibacterial drugs, the prescribed antimicrobial therapy can be adjusted (if necessary).

For pneumococcal meningitis, the first-line antibiotics are vancomycin with cefotaxime or ceftriaxone. If it is confirmed that meningitis is caused by penicillin-susceptible strains of pneumococcus, ampicillin or benzylpenicillin preparations may be prescribed. Reserve antibiotics in the treatment of pneumococcal meningitis will be drugs:

• cefotaxime;
• ceftriaxone;
• cefepime;
• meropenem;
• linezolid.

With meningitis caused by Haemophilus influenzae, the appointment of ceftriaxone or cefotaxime is recommended. Of the reserve drugs, cefepime, meropenem, and ampicillin are prescribed.

Benzylpenicillin, cefotaxime, or ceftriaxone are used to treat meningococcal meningitis. Of the reserve drugs, ampicillin or chloramphenicol can be used.

In enterococcal meningitis, the appointment of ampicillin with gentamicin or amikacin is indicated. A combination of vancomycin with gentamicin may also be used.

For the treatment of staphylococcal meningitis, oxacillin, vancomycin, rifampicin, and linezolid may be prescribed.

The rest of the therapy is symptomatic and is aimed at stabilizing the patient's condition:

• maintaining pressure and BCC;
• elimination of hemodynamic disorders and electrolyte imbalance;
• conducting infusion and detoxification therapy;
• relief of seizures;
• first aid for the development of symptoms of cerebral edema, etc.

Consequences of meningitis in adults

With a moderate course of the disease and the timely provision of specialized honey. assistance - the prognosis is favorable. However, it should be understood that meningococcal meningitis is one of the most unpredictable diseases in its course.

In some cases, fulminant development of meningococcal meningitis with severe meningococcemia, multiple organ failure, DIC, septic shock, and death is possible.

The consequences of the transferred inflammation of the meninges can be mental and intellectual deviations, the development of paresis and paralysis, convulsive seizures, etc.

But also, the disease can proceed without further consequences.

Article prepared
infectious disease doctor Chernenko A.L.

In the material, we will consider what constitutes such a dangerous disease as meningitis, types of meningitis and its causes. We will also talk about the first signs of the development of the disease, diagnostic methods, features of prevention and treatment.

General information

Before considering the types of meningitis, symptoms, causes, treatment, we learn what the disease is in general. The disease is characterized by the development of inflammatory processes on the membranes of the brain. In this case, not deep cellular structures suffer. The upper layers of tissue, which are located under the bone structure of the skull, are exposed to pathological effects. There is also a type of meningitis that affects the spinal cord.

The disease can develop in primary and secondary forms. In the first case, pathological pathogens directly attack the membranes of the brain. In the second, the disease makes itself felt against the background of other pathological processes in the body. Gradually, the lesion reaches the brain. A prerequisite for the development of meningitis in a secondary form may be the presence of mumps, tuberculosis, leptospirosis, and others.

As a rule, meningitis comes on quickly. A significant deterioration in well-being occurs over several days. The only exception to the rule is tuberculous meningitis which develops slowly.

The mechanism of the development of the disease

The human brain is reliably protected from attacks by pathological pathogens by the immune system. Such a barrier protects the most important organ from the penetration of bacterial, viral and fungal infections. When the body is weakened, some of them are still able to find their way to the brain. Penetrating under its membranes, infections receive temporary isolation from the effects of immune cells, which are deprived of the opportunity to “devour” pathogenic structures.

Types of meningitis

Allocate also certain types meningitis, depending on the rate of development of inflammation. When pathological processes make themselves felt in the shortest possible time, such a course of the disease is called rapid. All stages of meningitis occur in this case literally within a day after infection of the meninges of the brain. In the acute course of the disease, death without proper treatment occurs within 3-4 days. Allocate also chronic view meningitis. In the latter case, the symptoms appear on the rise. Doctors find it difficult to determine real reason deterioration in the health of the patient.

What other types of meningitis are there? Based on the localization of the pathological process, classify:

• Basal - membranes in the lower part of the brain are inflamed.
• Convexital - tissue damage is localized in the frontal zone of the brain.
• Spinal - pathology affects the spinal cord.

Symptoms

It is important to identify both the types of meningitis and the symptoms. Among the main signs of the development of the disease can be identified:

1. Headache - constant, severe discomfort, a feeling of increasing pressure under cranium, gain discomfort when tilting the head.
2. Overstrain of muscle tissue in the back of the head - a person feels difficulty when trying to move to a supine position. A decrease in pain is observed during rest in case of tilting the head back.
3. Problems in the work of the digestive system - the development of attacks of nausea and vomiting. Stomach cramps can be repeated many times, even if a person completely refuses food and drink for a long time.
4. Hyperthermia - certain types of meningitis cause an increase in body temperature. The development of the process is accompanied general malaise, chills, significant sweating.
5. Acute reactions to external stimuli- inflammation of the brain leads to discomfort in bright light, loud sounds, and other influences.
6. Clouding of consciousness: a person has lethargy, an inability to respond to simple questions, delayed reactions to phrases addressed to him.
7. Mental disorder: all types of meningitis cause apathy or aggressive reactions. In some cases, hallucinations may occur.
8. Seizures: Meningitis often causes involuntary muscle contractions. Often this leads to twitching of the limbs. Gradually manifest muscle pain.
9. The development of strabismus - a sign manifests itself if the inflamed tissues of the meninges of the brain begin to put pressure on the optic nerves.

Diagnostics

For the purpose of setting correct diagnosis doctors resort, first of all, to questioning the patient. Specialists will find out how long ago the signs characteristic of the disease appeared, whether there were insect bites, for example, ticks, which act as carriers of a wide variety of infections.

Diagnosis also involves an assessment of the neurological condition. Doctors assess how adequately the patient responds to the speech addressed to him, whether there are signs of clouding of consciousness. The sensitivity of a person to sound and light stimuli is determined. Meningitis can also be identified by the presence of seizures, the appearance of the effect of facial asymmetry. All these signs tell doctors about malfunctions in the brain under the influence of inflammatory processes.

Among the laboratory tests that can be used to diagnose meningitis, the following should be highlighted:

1. A general blood test makes it possible to identify signs of inflammation of the meninges, in which there is an increase in the erythrocyte sedimentation rate.
2. Computed tomography allows you to assess the state of the brain based on the images obtained.
3. Lumbar puncture - in cartilage tissue a special needle is inserted into the spine, with the help of which a CSF sample is taken. The presence in its composition of an abundance of protein or purulent manifestations is a sign of the development of meningitis.

Therapy

We examined what meningitis is, types, causes, symptoms of the disease. Now let's find out what the treatment is. When diagnosing meningitis, resort to complex therapy, which consists of the following steps:

• Human hospitalization.
• The use of pharmacological preparations.
• Body detoxification.
• symptomatic treatment.

Hospitalization

Since all types of meningitis in adults and children are deadly, therapy should be performed exclusively in a hospital setting. This is required, first of all, to identify the nature of the causative agent of the disease. Depending on the type of infection, doctors determine the treatment strategy and prescribe appropriate medications. If necessary, in a hospital setting, actions can be taken to resuscitate the patient.

Antibacterial treatment

The purulent type of meningitis in children and adults requires the use of antibacterial pharmacological agents. Among these should be noted:

• penicillins;
• ampicillins;
• cephalosporins;
• carbapenems.

In the case of the development of tuberculous meningitis, the following drugs are prescribed: Ethambutol, Isoniazid, Streptomycin. To enhance the bactericidal effect of these drugs, patients are prescribed "Rifampicin", "Pyrazinamide". In general, the course of admission antibacterial medicines with meningitis should be at least 10-15 days, depending on the characteristics of the course of the disease.

Antiviral therapy

Treatment of serous meningitis involves the use of a regimen similar to that for acute respiratory diseases. Doctors resort to prescribing painkillers, drugs that can lower body temperature, slow down the vital activity of viral pathogens. Often, patients are prescribed a combination of drugs containing glucocorticosteroids and interferon. As additional measures barbiturates may be used vitamin complexes, nootropics.

Treatment of fungal meningitis

Antifungal therapy is based on the use of such pharmacological agents:

• "Flucytosine".
• "Amphotericin".
• "Fluconazole".

The active ingredients in these preparations effectively fight the growth of fungal spores, their spread, and provide good support to the body when it is weakened.

Body detoxification

Why in the course of treatment of meningitis resort to detoxification of the body? Infectious pathogens secrete a whole mass of toxins into the tissues. The latter poison healthy cells and weaken the immune system. All this leads to disruption of the organs and systems. To reduce the negative health effects, in the fight against meningitis, Enterosgel and Atoxil are prescribed. These funds help to eliminate toxic substances from the body. Additionally, vitamin C intake, plentiful drinking in the form of decoctions of raspberries and rose hips can be prescribed.

Symptomatic treatment

With meningitis, the most numerous unpleasant symptoms can appear. In order to eliminate individual negative states prescribe the following medications:

• Allergic reactions - "Claritin", "Suprastin".
• An increase in body temperature - "Paracetamol", "Nurofen".
• Vomiting and nausea - Cerucal, Motilium.
• Emotional irritability - "Tenoten", valerian.
• Puffiness - "Furosemide", "Diakarb".
• Damage to the cerebrospinal fluid - "Cytoflavin".

Meningitis of the spinal cord

With this nature of the disease, they become inflamed. The disease is extremely difficult. There are numerous complications here. Types of meningitis of the spinal cord are the same. The causative agents of the disease can be viral, fungal or bacterial pathogens. Basically, the disease develops in people who suffer from a decrease protective functions organism, for example, due to the presence of HIV infection.

Spinal meningitis is treated with antibiotics. AT without fail doctors prescribe immunomodulatory drugs. Sometimes steroids and diuretics are used. Throughout the course of treatment, the patient should be at rest, adhering to strict bed rest.

Complications

The consequences of meningitis are the following manifestations:

1. Violation of the respiratory organs and the cardiovascular system. As a result of cerebral edema, bradycardia and tachycardia, increased blood pressure, shortness of breath, pneumonia can develop.
2. Toxic shock - a complication is a consequence of absorption by cells copious amounts waste products infectious agents meningitis. Against the background of the problem, partial loss of vision and hearing, hormonal dysfunction, paresis may occur.
3. Pressure sores - treatment of meningitis requires bed rest. Sometimes patients fall into someone or lose the ability to move. All this leads to the gradual formation of bedsores.

Prevention

We found out what types of meningitis can affect the body. Consider preventive actions which should be resorted to in order to prevent a terrible disease. Among preventive measures it is worth noting the following:

• Compliance with generally accepted rules of hygiene.
• Compilation of a daily diet based on foods rich in vitamins and minerals.
• Avoiding contact with people susceptible to viral, bacterial and fungal infections.
• Refusal to visit places large cluster people during epidemics of respiratory diseases.
• Performing regular wet cleaning in the apartment.
• Hardening of the body (in the absence of contraindications).
• Prevention of hypothermia of the body.
• Avoidance of factors that can lead to the development of stress.
• Active lifestyle, sports.
• Timely treatment of infectious diseases, until they have time to go into the chronic stage.
• Refusal of drugs, alcohol, smoking.
• Taking pharmacological preparations only after consultation with a qualified doctor.

Finally

As you can see, meningitis is extremely serious illness, the cure of which does not pose a danger to health and life only if it is diagnosed in the early stages. In the absence of adequate treatment, the consequences of the disease lead to the development of irreversible pathological processes. Sometimes the elimination of complications of meningitis occurs throughout life. Therefore, at the first signs of the disease, it is necessary to urgently seek medical advice.