Meningitis syndromes and symptoms. Meningitis - symptoms in adults and children, treatment. Laboratory signs of meningitis in children

Almost all forms of meningitis develop extremely quickly. The infection affects the soft and arachnoid membranes, the substance of the brain is not directly affected by the disease. The main provocateurs of meningitis can be: mumps, and other infectious diseases.

The most common is meningococcal meningitis. The source of infection are sick people and bacteria carriers. In winter and spring, the number of cases of the disease increases significantly. The spread of the pathogen is affected by a decrease in air temperature, an increase in humidity and crowding of people. Every 10-15 years there are outbreaks of the disease.

Meningitis is ubiquitous, but the number of cases in Africa is more than 40 times higher than the European average. Until the 20th century, mortality from meningitis was about 90%, but thanks to the invention of antibiotics and other effective drugs it has been significantly reduced.

People of any age can get sick with meningitis, but children under the age of five, premature babies people with weakened immune systems are at risk for this disease.

The reasons

Any infectious agents, when penetrating the pia mater, can cause meningitis. The main causative agents of meningitis, as a rule, are bacteria and viruses, less often they encounter infection with protozoa and yeast fungi. More often a person becomes infected with meningococcus, tubercle bacillus and Afanasiev-Pfeiffer bacillus. Less common: pneumococci, staphylococci, and Haemophilus influenzae streptococcus.

Causes childhood meningitis usually become enteroviruses that enter the body with food, water and contaminated objects, they can also spread against the background of chickenpox and rubella.

Adult patients are characterized bacterial form diseases caused by Neisseria meningitidis and Streptococcus pneumoniae. Microorganisms can inhabit the mucous membranes of the respiratory tract and do not manifest themselves in any way, but with a decrease defensive forces organism, they penetrate into the membranes of the brain, where they cause severe symptoms of the disease.

Group B streptococci often cause disease in newborns, infection can occur during childbirth or in the postpartum period. Listeria can cause disease in infants, debilitated people and the elderly. AT rare cases The causative agent of meningitis is Klebsiella, or coli. This pathogen provokes a disease with brain injuries and blood poisoning.

The main routes of transmission of meningitis are:

• airborne;
• fecal-oral;
• bites of insects and rodents;
• transplacental.

Meningitis may occur as a complication of other infectious processes flowing in the body. Infectious agents penetrate the brain membrane in different ways. The most common is hematogenous. It is also possible to spread the infection through the lymphogenous route. If the focus of inflammation is in contact with the meninges, it is likely contact way transmission. It is promoted by purulent otitis media, frontal sinusitis, brain abscess, and sinus thrombosis of the brain. open injuries the spine and head with the expiration of CSF create a gateway for infection.

Classification

Classification of meningitis is carried out according to many criteria.

Depending on the cause of its occurrence (etiology), there are:

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

By origin, meningitis is divided into:

• primary (most neuroviral infections and purulent meningitis);
• secondary (, syphilitic, tuberculous).

Depending on the characteristics of the infectious process:

• serous (more often caused by viruses);
• purulent (caused by bacteria).

According to the nature of the course, meningitis is divided into:

• spicy;
• subacute;
• chronic;
• fulminant.

The localization of the lesion can be different, on this basis the disease is classified into types:

• spinal (defeat spinal cord);
• cerebral (brain damage);
• convexial (surface);
• basal (damage to the base of the brain).

Primary meningitis is considered as a separate pathology in which the pathogen enters the body from environment and then develops into the tissue of the meninges. In the case of secondary infection, meningitis is a serious complication of another disease in the patient's body, from the focus of which the infection has spread.

Symptoms

Meningitis is characterized by a predominantly acute course. The disease is diagnosed according to three syndromes:

• General infectious.
• Shell (meningeal).
• Analysis of cerebral fluid.

The first symptoms of the disease may resemble a cold (general infectious):

• an increase in temperature to 38 ° C and above;
• muscle pain;
• chills;
• rapid breathing;
• , an increase in ESR.

There are also specific signs meningitis (meningeal):

• Headache. Localization pain syndrome often absent, usually diffuse. Over time, the pain becomes unbearable, bursting, any movements and irritations intensify it even more. Confusion may occur.
• Nausea and vomiting, after which relief does not come.
• Skin rashes. Primary meningococcal meningitis in mild form may present as a small, dark red rash that resolves after a few days. Long-term bruising and large red spots indicate a severe form of the disease.
• Neck stiffness. When trying to bring the chin to chest, patients experience severe pain. The typical posture for these patients is on the side with the head thrown back and the limbs bent, pressed against the chest and abdomen.
• Brudzinski's symptom. When pressed on eyeballs or while moving eye muscles the patient feels pain. There is also irritability from bright light, strong odors and loud sounds.
• Kernig's sign. The patient takes a supine position, then in the knee and hip joint, his leg is bent at a right angle. Trying to straighten the knee causes the patient pain in the lower back and hip.
• Bakhterev's symptom. With light tapping on the zygomatic bone, pain occurs.
• Lessage's symptom is characteristic of infants. When lifting the child by the armpits, he involuntarily bends his legs in hip joints and knees.

Diagnostics

Any suspicion of meningitis should seek medical attention as soon as possible. If a child has vomiting against a background of high body temperature, this is also a reason to conduct a diagnosis to exclude meningitis.

To clarify the diagnosis and determine the type of pathogen in the conditions of medical institutions, the following measures are taken:

• Lumbar puncture allows you to explore cerebrospinal fluid for inflammatory processes. The study of cerebrospinal fluid provides answers to the question about the type of meningitis (purulent or serous) and the type of pathogen.
• Bacteriological examination of a smear from the mucous membrane of the nasopharynx.
• Blood, feces, urine tests to determine general indicators.
• X-ray examination of the lungs to check for.
• MRI and computed tomography in the first week of illness to exclude similar pathologies.

Meningitis is diagnosed by infectious disease specialists and neuropathologists.

Treatment

At the first symptoms of meningitis, the first priority is to urgent hospitalization to start treatment. Prior to the introduction of penicillin and sulfa drugs, mortality from meningococcal meningitis ranged from 30 to 70%. Modern drugs help to effectively fight the disease.

With symptoms of meningitis in a reactive form, the struggle to save a person is calculated in hours. The patient may need intensive therapy or resuscitation. The course of treatment consists of etiological, pathogenetic and symptomatic therapy. The purpose of treatment tactics and drugs depends on the type of pathogen that caused the disease.

At purulent meningitis antibiotics are shown that have the ability to penetrate in the required dosage through the barrier between the circulatory and central nervous systems. The choice of drug will depend on the parameters of the lumbar puncture, history and level of consciousness of the patient. After clarifying the pathogen and its sensitivity (which takes time) antibiotic therapy correct.

The tuberculous type of meningitis requires the use of anti-tuberculous antibiotics in the maximum allowable dosages. Treatment of viral meningitis requires the use of antiviral agents, interferon preparations, immunoglobulins, etc. Antibiotics in this case are used to treat complications.

All types of meningitis require the use of detoxification, dehydration, maintenance therapy and analgesics. Diuretics are given to prevent cerebral edema. In severe cases, the use of anticonvulsants and corticosteroids may be required.

People who have had meningitis long time are registered with a psychoneurologist, pediatrician, neuropathologist and therapist.

Complications

Effects past illness will depend on which microorganism caused it, and on general condition human health. The later treatment of meningitis is started, the higher the likelihood of severe complications.

One of the most dangerous states that are provoked by meningitis is cerebral edema. This complication most often develops in adolescents and children after the first day after the onset of the disease. Further, due to paralysis of the respiratory center, breathing stops and the patient dies.

Infectious-toxic shock occurs due to the ingress of meningococcal pathogens into bloodstream. This condition is called meningococcemia. Fatal outcome from such a complication can happen within three days. In young patients, simultaneous development of toxic shock and cerebral edema is possible.

Sometimes a consequence of meningitis transferred to long years become migraines, meteorological dependence and drowsiness, in other cases appear:

• memory impairment and distraction;
• hearing loss;
• loss of visual acuity;
• delay mental development in children;
• and psychopathy;
• strabismus.

After treatment of meningitis in childhood, severe complications can remain for life, so the disease requires long-term therapy and careful monitoring after recovery.

Prevention

United specific prevention meningitis does not exist. It is difficult to prevent the development of the disease, since there are quite a few pathogens, and the prevention system for each of them is different. The general rules are:

• timely isolation of patients;
• early diagnosis;
• compliance with hygiene rules;
• use of protective equipment when communicating with the patient;
• maintaining a normal immune status.

The only specific method that can protect against the most common and severe forms of the disease is vaccination. Most often used for this purpose meningococcal vaccine, MMR triple vaccine and Haemophilus influenzae type B vaccine.

Forecast

The prognosis of the disease is individual and depends on many factors:

• type of pathogen;
• the timing of the start of treatment;
• the general health of the patient;
• involvement of brain tissue.

The prognosis is ambiguous, sometimes the disease is reactive, and no emergency measures do not help to save the patient, in other cases there is a complete recovery without any consequences.

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Meningitis - inflammatory disease membranes of the brain.

Causes of meningitis

According to the etiology (cause of occurrence), meningitis is infectious, infectious-allergic - neuroviral and microbial (serous meningitis, influenza meningitis, tuberculous, herpetic), fungal and traumatic meningitis.

According to the localization of the lesion, panmeningitis is distinguished - all meninges are affected, pachymeningitis - the dura mater is mainly affected, leptomeningitis - the arachnoid and pia mater are affected. The predominant lesion of the arachnoid membrane - arachnoiditis - due to clinical features is allocated to a separate group.

Meningitis is divided into serous and purulent.

By origin, primary are distinguished - they include the majority of neuroviral meningitis, purulent meningitis and secondary - influenza, tuberculosis, syphilitic.

By the nature of the cerebrospinal fluid - serous, purulent, hemorrhagic, mixed.

Downstream - fulminant, acute, subacute, chronic.

By localization - convexital (superficial) and basal (deep - at the base of the brain).

According to the ways of infection of the meninges - hematogenous, lymphogenous, perineural, contact (for example, in diseases paranasal sinuses nose, inflammation of the ear, teeth), with craniocerebral injuries.

Any meningitis occurs meningeal syndrome- promotion intracranial pressure- bursting headache with a feeling of pressure on the eyes and ears, vomiting, light and sounds are irritating (photophobia and hyperacusis), heat, possible epileptic seizures, rash. The symptoms and treatment of meningitis vary.

Purulent meningitis

Purulent meningitis- severe microbial inflammation of the meninges. This is leptomeningitis caused by meningococcal infection, streptococci, staphylococci, pneumococci and other microbes - microbes intestinal group, Pseudomonas aeruginosa ...

Risk factors for purulent meningitis: intoxication - smoking, alcohol, infections, stress, hypothermia, insolation - everything that weakens the body's defenses.

The source of the disease is carriers of the first order (not sick, but they carry a microbe), the second order (suffering with acute respiratory infections, tonsillitis, pharyngitis).

Get sick with meningitis at any age.

Meningococcus enters the meninges from the nasopharynx by the hematogenous route. This is convexital meningitis - a severe inflammatory process, purulent contents spread, forming a "purulent cloak".

Symptoms of purulent meningitis

Purulent meningitis has a rapid onset - the temperature rises rapidly, headache increases, nausea, repeated vomiting, epileptic seizures may develop, symptoms of damage appear cranial nerves, everyone is amazed internal organs- meningococcemia - pericarditis, ulcer, pyelitis, cystitis, joints are affected. The patient assumes a characteristic posture with bent legs and head thrown back. Possible herpetic eruptions and hemorrhagic rash, roseolous rash on the skin and mucous membranes. A coma may develop for 2-3 days.

The patient is examined by an ophthalmologist - congestion develops in the fundus. Lumbar puncture is of leading importance - an increase in cerebrospinal fluid pressure is determined, and the content of neutrophils increases.

The neurologist sees meningeal signs- neck stiffness (inability to bend the head and touch the sternum), Kernig's symptom (inability to straighten the leg bent at the hip and knee joints), pain when pressing on the eyeballs, Brudzinsky's symptom (when you try to tilt your head forward in a prone position, the legs bend at the knees , when pressing on the pubis, the legs bend in knee joints).

A blood test is necessary - a high leukocytosis and ESR will be detected, a shift leukocyte formula to the left. In severe cases, with a decrease in the body's defenses - leukopenia.

A fulminant course is more common in newborns - the child screams, a terrific chill, high fever and dies (from hours to 3 days). In adults, the course is acute, subacute. It takes 4-5 weeks to good way out. Subacute course more often in older people - slow development with a long period of precursors. In older people, an atypical course is possible, only symptoms of nasopharyngitis or an epileptic seizure are present. Possibly a light moderate and severe course meningitis.

Head tilted back

Acute lymphatic meningitis

Acute lymphatic meningitis - serous meningitis, occurs in the form of epidemic outbreaks and sporadic cases. Carriers of the virus are mice (field and domestic), which excrete the virus with nasal secretions, urine, feces and contaminate objects surrounding humans. When infected, the onset is acute with gastrointestinal disorders (nausea, vomiting, diarrhea, abdominal pain), normal or high fever and the development of meningeal syndrome. Damage to 3 and 6 pairs of cranial nerves (oculomotor and abducens) is possible.

The flow is characterized by a reverse development without residual phenomena.

The group of serous meningitis includes meningitis caused by poliomyelitis-like Coxsackieviruses, ECHO. They differ in summer-autumn seasonality and more often affect children. Acute development - fever, meningeal syndrome, gastrointestinal disorders. Perhaps a two-wave flow.

Development serous meningitis possibly with mumps, flu, herpetic infection, fungal diseases, protozoal (malaria, toxoplasmosis).

With lumbar puncture, the CSF is transparent, the pressure is increased, and lymphocytic pleocytosis occurs. Serous meningitis virus can be isolated from cerebrospinal fluid and nasopharyngeal washings. Coxsackievirus can be isolated from feces. With mumps meningitis, they look for the pathogen in saliva. Cryptococcus causes severe meningitis in AIDS patients. With syphilis, late syphilitic meningitis develops.

Tuberculous meningitis is a serous leptomeningitis.

Mass prevention of tuberculosis incidence is carried out - primary BCG vaccination of newborns in maternity hospitals (the vaccine was first introduced to a newborn back in 1921), control of the presence of immunity - the Mantoux reaction to select patients for re-vaccination, fluorographic examination of the entire population. Full treatment of all patients and control observations of all who have had tuberculosis are necessary to prevent an epidemic of tuberculosis.

In 1993, WHO declared tuberculosis a national disaster and March 24 as World Tuberculosis Day. The seriousness of the tuberculosis problem can be judged by the existence of a special WHO program that allows to identify and cure patients, which operates in 180 countries of the world.
Mass vaccination (according to the vaccination calendar) prevents many diseases that can cause meningitis. Vaccines are used against Haemophilus influenzae, meningococcal infection, pneumococcal infection, measles, mumps, rubella measles, chicken pox, influenza.

Doctor's advice on meningitis:

Question: when is a lumbar puncture performed for tuberculous meningitis?
Answer: in the presence of minimal manifestations of meningism, an immediate lumbar puncture is indicated. High cerebrospinal fluid pressure, increased protein content, sugar levels decrease, chlorides decrease. To sow a tubercle bacillus, three test tubes are analyzed, in which, when settling, a film is formed and the pathogen can be found in it. Liquor is taken twice a day for diagnosis, 2-3 weeks after the appointment specific treatment to monitor prescribed doses, then three times before discharge to monitor recovery.

Question: how can you protect yourself when in contact with a patient with meningitis?
Answer: when in contact with the patient, it is necessary to use gauze bandages, wash hands with soap, disinfect dishes, persons in close contact are given chemoprophylaxis - rifampicin, ceftriaxone, immunoglobulin.

Question: do computed tomography to diagnose meningitis?
Answer: yes, they do, holding differential diagnosis requires an exception serious illnesses brain - subarachnoid hemorrhage, brain abscess, brain tumor.

Q: What is meningism?
Answer: Meningism is a mild manifestation of meningeal symptoms against the background of infection, influenza, intoxication. Lasts 2 - 3 days and passes. More often the phenomena of meningism occur in children.

Neurologist Kobzeva S.V.

Meningitis is an infectious disease, the course of which is characterized by extensive inflammation of the spinal cord and brain, its causative agents are various types viruses and bacteria. Meningitis, the symptoms of which appear depending on the specific type of pathogens, occurs either suddenly or within a few days from the moment of infection.

general description

As we have already noted, with meningitis, the brain is exposed to inflammation, in particular, its membranes. That is, it is not brain cells that are damaged during meningitis, but the outer region of the brain, within which the inflammatory process is concentrated.

Meningitis in adults and children can occur in the primary or during secondary form. So, primary meningitis occurs with a one-time lesion of the brain, secondary meningitis is formed against the background of a concomitant underlying disease, in which infection spreads with a subsequent, relevant for meningitis, lesion of the meninges. As the main diseases in this case, one can single out, etc.

In almost all cases, meningitis proceeds quickly - as we have already noted, it develops over a period of several days. As an exception to the general variants of the course of the disease, only tuberculous meningitis developing gradually.

The incidence of meningitis is noted in a variety of age categories, while age is not a determining criterion in susceptibility to this disease - here, as expected, the state of the body as a whole plays a leading role. For example, premature babies, due to the weakened state of the body, are most susceptible to meningitis.

In addition, the group of people who may develop meningitis can include patients with certain CNS defects, as well as with back or head injuries. Also, the transmission of the disease is possible during childbirth, through mucous membranes, contaminated food and water, through insect bites and airborne droplets. In any case, there are many factors that can also determine the predisposition to meningitis.

Types of meningitis

Depending on the etiology, that is, on the causes that provoked meningitis, this disease can be infectious, infectious-allergic, microbial, neuroviral, traumatic or fungal. Microbial meningitis, in turn, can manifest itself in the form of serous meningitis, tuberculous meningitis, influenza or herpetic meningitis.

Depending on the localization of the inflammatory process in meningitis, pachymeningitis is isolated, in which, as a rule, it is affected hard shell brain, leptomeningitis, in which the soft and arachnoid membranes of the brain are affected, as well as panmeningitis, in which inflammatory process all membranes of the brain are affected. If the inflammatory lesion is predominantly localized in the area of ​​the arachnoid, then the disease is defined as arachnoiditis, which, due to its characteristic clinical features, is classified as a separate group.

Basically, meningitis is divided into purulent meningitis and serous meningitis, we will consider the features of both types of forms a little lower.

Depending on the origin, as we have already identified, meningitis can be primary (this includes most of the neuroviral forms of meningitis, as well as purulent meningitis) and secondary (syphilitic, tuberculous, serous meningitis).

Depending on the nature of the CSF, meningitis can be hemorrhagic, purulent, serous, or mixed. Based on the characteristics of the course, meningitis can be fulminant or acute, subacute or chronic.

The localization of the inflammatory process in meningitis determines such varieties of its forms as superficial meningitis (or convexital meningitis) and deep meningitis (or basal meningitis).

The routes of infection of the meninges are determined for meningitis by the following possible forms: lymphogenous, contact, hematogenous, perineural meningitis, as well as meningitis that occurs against the background of craniocerebral injuries.

Any type of meningitis is characterized by the occurrence of meningeal syndrome, which manifests itself in an increase in intracranial pressure. As a result of this manifestation, this syndrome is characterized by the appearance of a bursting headache with a simultaneous feeling of pressure on the ears and eyes, it is also noted hypersensitivity in relation to exposure to sounds and light (which is defined, in turn, as hyperacusis and photophobia). Vomiting and fever appear, rashes and epileptic seizures may also appear.

meningococcal meningitis

With this form of meningitis, pathological changes affect the basal and convex surfaces of the brain. Fibrinous-purulent or purulent fluid formed in the area of ​​inflammation (exudate) densely covers the brain (similar to a cap), while the infiltrates formed in the area along the vessels end up in the substance of the brain. As a result, edema begins to develop, the medulla begins to overflow with blood within its own vessels (i.e., hyperemia occurs).

Similar changes are also noted in the region of the spinal cord.

Timely initiation of treatment can ensure the subsidence of the inflammatory process, after which the exudate is completely destroyed. If we talk about advanced cases the course of this disease, as well as cases with the appointment of irrational therapy, if it is relevant, then the possibility of developing a number of specific processes is not excluded, as a result of which, in turn, the processes of liquorodynamics may be disrupted, against which it is already developing.

Now let's move on to the symptoms that characterize this form of meningitis.

Most often, it develops suddenly, which accompanies sharp rise temperature and the appearance of vomiting (it is repeated and does not bring proper relief to the patient). Due to increased intracranial pressure, a severe headache occurs. Against the background of the general condition, the patient develops a characteristic posture, in which there is tension in the region of the occipital muscles with simultaneous arching of the back and bent legs brought to the stomach.

Many patients during the first days of the disease notice the appearance of a rash, which, meanwhile, disappears within one to two hours. In some cases back wall The pharynx is also prone to hyperemia with simultaneous hyperplasia in its follicular area. Also, a number of patients are faced with the appearance, noted just a few days before the onset of meningitis. Meningitis in infants in this form develops mainly gradually; in older children, a similar variant of the course is noted in rare cases.

Based on the severity of the course of the disease, the patient may experience symptoms in the form of muscle cramps, darkening of consciousness or a state of unconsciousness. In the case of an unfavorable course of meningitis, by the end of the first week, patients have a coma, in which symptoms in the form of paralysis are the foreground. facial nerve and eye muscles. Convulsions, which appeared earlier periodically, gradually become more frequent and it is during one of the next manifestations that the patient dies.

If the course of meningitis in the form under consideration is defined as favorable, then this, in turn, is accompanied by a decrease in temperature, the patient has a previously lost appetite. Ultimately, the meningitis patient gradually moves into the recovery phase.

The total duration of the course of meningitis in the meningococcal form is about two to six weeks. Meanwhile, in practice, cases are not excluded in which the course of the disease occurs at lightning speed. In such a situation, the death of the patient occurs within just a few hours from the onset of the disease.

At protracted course after a short period of improvement, the patient's temperature rises again, and it is established for a long time. This type of protracted form is either a hydrocephalic stage or a stage in which the patient develops meningococcal sepsis, during which the meningococcus enters the bloodstream (which is defined as meningococcemia).

The main feature of this course is the appearance of a hemorrhagic rash. In addition, there is an increase in temperature and a decrease blood pressure, shortness of breath appears, and tachycardia is also noted in patients.

The most severe manifestation of meningitis in this form is bacterial shock. In this case, the disease develops acutely, with a sudden increase in temperature and the appearance of a rash. The patient's pulse also quickens, breathing is characterized by unevenness, convulsions are often noted. Further, the state becomes coma. Often, the death of a patient with such a course occurs without returning to consciousness.

There are also a number of the following symptoms With characteristic features, inherent to them:

• Skin necrosis. The severe course of the disease against the background of exposure to meningococcal infection leads to the development of inflammation in the vessels and. As a result of this, it develops, an extensive type of hemorrhage occurs and, in fact, necrosis, which is especially pronounced in those areas in which compression is noted. Subsequently, rejection of the subcutaneous tissue and necrotic skin occurs, resulting in ulcers. They heal, as a rule, quite slowly, the depth and vastness of the skin lesion often require its transplantation. Keloid scars in this case are also a frequent result of the course of the disease.
• . Acute stage The course of the considered form of meningitis in some cases is accompanied by damage to the cranial nerves, of which the greatest vulnerability is determined by the abducens nerve due to the passage of a significant part of it along the base of the brain. In case of damage to this nerve, paralysis occurs in the region of the lateral rectus muscles of the eyes. As a rule, strabismus disappears after a few weeks. But due to the spread of infection to the inner ear, partial deafness or complete hearing loss is often noted.
• . A frequent manifestation of meningitis of the form in question is, which disappears quite quickly during treatment. As for uveitis, it is much more serious complication which can result in panophthalmitis and subsequent blindness. Meanwhile, used today antimicrobial therapy minimizes such severe consequences.

Purulent meningitis

Purulent (secondary) meningitis is accompanied by turbidity, swelling and hyperemia of the meninges of the cerebral hemispheres (their convex surface). Purulent exudate fills the subarachnoid space.

The onset of the disease is accompanied by a sharp deterioration in the general condition of the patient, in which he experiences chills, his temperature also rises. Severe forms of the course may be accompanied by loss of consciousness, convulsions, delirium. There is also a symptom traditional for the disease as a whole in the form of repeated vomiting. With purulent meningitis, internal organs are affected, and joints are also affected.

A sharp severity is noted in the manifestation of symptoms such as stiff neck muscles and symptoms of Kernig, Brudzinsky. Kernig's symptom determines the impossibility of extension of the leg bent at the knee and hip joint. As for the Brudzinsky symptom, its manifestations are reduced to bending the legs at the knees when trying to tilt the head forward in lying position, to bending the legs in the knee joints also leads to pressure on the pubis.

Serous meningitis

Serous meningitis is characterized by the appearance of inflammatory serous changes in the meninges. In particular, serous meningitis includes its viral forms. In about 80% of cases, enteroviruses, as well as a virus, are determined as the causative agent of serous meningitis. mumps. Influenza and adenovirus meningitis, herpetic and parainfluenza forms of this disease are also common, including a number of other variants of its manifestation.

The source of the virus is mainly house mice - the pathogen is found in their secretions (feces, urine, nasal mucus). Accordingly, human infection occurs as a result of the consumption of products that have undergone such contamination with secretions.

Mostly the disease occurs in children from 2 to 7 years.

The clinic of the disease can be characterized by meningeal symptoms in combination with fever, manifested to a greater or lesser extent, often combined with symptoms of lesions of a generalized scale in other organs.

Viral meningitis can be characterized by a two-phase course of the disease. Along with the main manifestations, there may be signs indicating damage to the peripheral and central nervous system.

Duration incubation period disease is about 6-13 days. Often noted prodrome, accompanied by manifestations in the form of weakness, weakness and catarrh of the upper respiratory tract simultaneously with a sudden increase in temperature up to 40 degrees,. Also, these symptoms can be supplemented by a pronounced shell syndrome, in which there is a severe headache and vomiting.

In some cases, the examination determines the presence of congestion in the fundus area. Patients complain of pain in the eyes. As for the vomiting noted above, it can be both repeated and multiple. As in the previous variants of the development of meningitis, there are symptoms of Kernig and Brudzinsky, a characteristic tension of the occipital region. Expressed cases of manifestation of the disease are accompanied by a typical posture of the patient, in which his head is thrown back, his stomach is pulled in, his legs are bent at the knee joints.

Tuberculous meningitis

This form of meningitis is also predominantly observed in children, and especially in infants. Tuberculous meningitis is much less common in adults. In about 80% of cases, the relevance of this disease in patients is detected either residual effects TB, previously transferred by them, or a form of the active course of this disease in a different area of ​​concentration at the time of detection of meningitis.

The causative agents of tuberculosis are a specific type of microbacteria, common in water and soil, as well as among animals and people. In humans, it mainly develops as a result of infection with the bovine species of the pathogen or the human species.

Tuberculous meningitis is characterized by three main stages of development:

• prodromal stage;
• irritation stage;
• the terminal stage (accompanied by paresis and paralysis).

prodromal stage the disease develops gradually. Initially, there are manifestations in the form of headache and nausea, dizziness and fever. Vomiting, as one of the main signs of meningitis, can appear only occasionally. In addition to these symptoms, there may be a delay in stool and urine. As for the temperature, it is mainly subfebrile, its high rates are noted on this stage disease is extremely rare.

After about 8-14 days from the beginning of the prodromal stage of the disease, the following stage develops - irritation stage. In particular, it is characterized by a sharp increase in symptoms and an increase in temperature (up to 39 degrees). There is a headache in the occipital and frontal regions.

In addition, there is an increase in drowsiness, patients become lethargic, consciousness is subject to oppression. Constipation is characterized by the absence of swelling. Patients cannot tolerate light and noise; vegetative-vascular disorders are also relevant for them, manifested in the form of sudden red spots in the chest and face, which also quickly disappear.

By the 5th-7th day of the disease, meningeal syndrome is also noted at this stage (symptoms of Kernig and Brudzinsky, tension in the occipital muscles).

Severe symptoms are noted within the second stage of the stage under consideration, its manifestations depend on the specific localization of the tuberculous inflammatory process.

Inflammation of the meningeal membranes is accompanied by the occurrence of typical symptoms of the disease: headaches, muscle stiffness of the neck and nausea. Accumulation at the base of the brain serous exudate can lead to irritation of the cranial nerves, which, in turn, manifests itself in visual impairment, strabismus, deafness, uneven pupil dilation and eyelid paralysis.

The development of hydrocephalus in varying degrees of severity leads to the blocking of certain cerebral cerebrospinal connections, and it is hydrocephalus that is the main cause that provokes a symptom in the form of loss of consciousness. In the case of blockade of the spinal cord, motor neurons experience weakness, paralysis may occur in the lower extremities.

The third stage of the course of the disease in this form is thermal stage characterized by the occurrence of paresis, paralysis. Manifestations of symptoms of this period are noted by 15-24 days of the disease.

The clinical picture in this case has symptoms characteristic of encephalitis: tachycardia, temperature, Cheyne-Stokes respiration (that is, periodic breathing, there is a gradual deepening and increase in rare and superficial respiratory movements upon reaching a maximum of 5-7 breaths and subsequent reduction / weakening, passing to a pause). The temperature also rises (up to 40 degrees), appear, as already noted, paralysis and paresis. The spinal form of the disease at stages 2-3 is often accompanied by extremely pronounced and severe girdle radicular pain, bedsores and flaccid paralysis.

Viral meningitis

The onset of the disease is acute, the main manifestations in it are general intoxication and fever. The first two days are characterized by the severity of the manifestations of the meningeal syndrome (headache, vomiting, drowsiness, lethargy, anxiety / agitation).

There may also be complaints of a runny nose, cough, sore throat and abdominal pain. Examination reveals all the same signs that characterize the disease as a whole (Kernig and Brudzinsky syndrome, tension in the occipital region). Normalization of temperature occurs within 3-5 days, in some cases a second wave of fever is possible. The duration of the incubation period is about 4 days.

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Meningitis in adults and children: causes, signs and symptoms, diagnosis, and effective methods therapy
Meningitis is an acute infectious pathology, accompanied by an inflammatory process of the membranes of the spinal cord and brain. This disease develops as a result of exposure to the human body of such viruses and bacteria as tuberculosis bacillus, meningococcal infection, enteroviruses, Haemophilus influenzae and some others. To clear signs this disease can be attributed as a high body temperature, and a severe headache, strong pain when trying to straighten the patient's legs at the knees, a dark rash on the body, inability to bend the head to the chest, as well as repeated vomiting.

In children under one year old, as well as in newborns, this pathology is accompanied by excessive anxiety, bulging of a large fontanel, constant crying, rashes, and refusal to eat. Both diagnosis and treatment of this pathology is the responsibility of neuropathologists and infectious disease specialists. In the event of the development of certain signs of this disease, the patient must be delivered as soon as possible to medical institution. Therapy of this disease is based on the use of antibiotic drugs, hormonal and diuretic drugs, as well as antipyretic drugs.

Meningitis - what is this pathology?

If we talk about European countries, then in most cases this disease affects the inhabitants of Ireland and Iceland. Recently, there has been a sharp jump in the number of people suffering from this pathology. Children are especially susceptible to meningitis. If we talk about children under the age of fourteen, then in their case this pathology is observed in ten children out of a hundred thousand. Most often, this disease is characterized by an extremely severe pathogenesis. The risk of death of a child is determined by his age. How younger child, topics more likely his death.

Meningitis in children and adults - what can it be?

Primary meningitis - what causes it?

Viruses. Viral meningitis is caused by a viral infection. As a rule, this enterovirus infection. In addition, measles, mumps, chickenpox, rubella can provoke the development of this pathology. This form meningitis is often referred to as serous.

bacteria. The most common cause of the development of this pathology is considered to be meningococcal infection. This infection occurs when direct contact with its bearers. It is transmitted by airborne droplets. As a rule, it is observed in urban residents, who especially often use public transport. The presence of this infection in preschool institutions provokes outbreaks of meningitis. In addition to this form of meningitis, it is quite possible to develop its purulent form. In addition to meningococcus cause this pathology can also Haemophilus influenzae, pneumococcus, spirochetes, tubercle bacillus.

Secondary meningitis - what are the causes of its occurrence?

• lung abscess
• Furuncle of the face or neck
• Acute or chronic otitis media
• Osteomyelitis of the bones of the skull

Signs and symptoms of meningitis in adults and children

• General weakness
• Pain in muscles and joints
• An increase in body temperature of more than thirty-nine degrees
• Lack of appetite

Literally in a few days, due to the very high body temperature, specific signs of this pathology also develop. Among them can be counted:

• Severe headache. AT this case pain sensations are diffuse character, that is, the pain is felt in the area of ​​\u200b\u200bthe entire head. Gradually, it becomes so strong that it begins, as if bursting. After a while, it becomes completely unbearable. Adults moan because of such pain, but children scream and cry. As a rule, such pain causes vomiting and nausea. In most cases, headache in the presence of this pathology tends to intensify at the moments when a person tries to change the position of his body, as well as when exposed to environmental stimuli.
• The rash is always noted in this case. If on the face mild form of this disease, then on the body of the patient appear small rashes dark cherry color. In the case of meningococcal meningitis, it disappears already on the third or fourth day. If the form is severe, then large spots and bruises appear on the patient's body. Such a rash disappears only after ten days.
• Confusion of consciousness.
• Frequent vomiting that does not bring relief to the patient.
• Meningeal signs: excessive stress occipital muscles, severe pain when trying to straighten the legs at the knees or bend the head to the chest.
• Strabismus occurs only if the nerves of the skull have been affected.

• Repetitive regurgitation and vomiting
• Apathy, restlessness, drowsiness, refusal to eat, constant strong crying
• Pulsation and bulging of the large fontanel

Symptoms associated with chronic tuberculous meningitis

Methods for diagnosing meningitis

An accurate diagnosis of meningitis is made if there are three signs of this pathology:
1. Signs of infection
2. The presence of symptoms of this disease
3. The presence of specific changes in the cerebrospinal fluid

Treatment of meningitis in adults and children

Prescribing antibiotic drugs

In the fight against meningitis, the following antibiotic agents are used:

• Penicillin - this drug is prescribed especially often and all because most often this disease occurs due to exposure to pathogens such as: staphylococcus, meningococcus, streptococcus, pneumococcus. This drug administered intramuscularly in the amount of three hundred thousand units per kilogram of body weight per day. For newborns, it is administered every three hours, but for adults, the intervals between injections should not exceed four hours.
• Cephalosporins such as Cefotaxime and Ceftriaxone. These antibiotics are used in the fight against pathogens of meningitis, which cannot be destroyed by penicillin. Ceftriaxone is prescribed for children at fifty to eighty milligrams per kilogram of body weight in two divided doses. For adults, it is prescribed in the amount of two grams.
• It is quite possible to use Vancomycin, as well as Carbapenems, but only if the above antibiotics did not have the proper therapeutic effect.

Therapy and prevention of cerebral edema

Infusion therapy

Individual Therapy

Vaccination of meningitis in children and adults

The first symptoms of meningitis are most often:

• high temperature (39-40 degrees);
• severe chills;
• headache;
• weakness;
• loss of appetite;
• excitement or, conversely, lethargy.

On the first or second day (against the background of headache and high temperature), a pink or red rash may appear, which begins with the feet and shins, gradually spreading higher and higher - to the very face. The rash resembles small bruises that disappear with pressure.

If you notice in yourself or a patient this symptom, urgently call an ambulance, as this is a signal that sepsis is developing and in case of delay (without a qualified medical care), the case can be fatal.

Also, attention should be paid to a number of early symptoms meningitis:

1. Stiffness of the neck (immobility) - the head is difficult or impossible to bend, the patient cannot reach his chest with his chin. This is one of the earliest signs.
2. Brudzinsky's symptoms - involuntary flexion of the legs (in the knee and hip joints) occurs when the head is tilted to the chest area.
3. Kernig's symptoms - legs bent at the knees do not straighten.
4. a large fontanel may swell.
5. Another characteristic symptom is that the patient turns to face the wall and covers his head with a blanket, while curling up in a ball position and throwing his head back.
6. In addition, it can be noted: blurred vision, double vision, confusion, hearing loss.

Signs of meningitis by type

Primary

With primary meningitis, an acute infectious process occurs, which is caused. The trigger for the development of the disease is a weakened immune system caused by hypothermia and viral infections. In this case, the disease develops independently, without the occurrence of infectious processes in any organ. For example, bacteria can enter the body through the respiratory system.

How does primary meningitis start?:

• Strong headache;
• fever, chills;
• high body temperature;
• intolerance to light and sharp sounds;
• the appearance of a rash on the body;
• motor activity, which is often replaced by lethargy;
• loss of consciousness may occur;
• neck stiffness;
• sometimes there are convulsions.

Secondary

The disease occurs against the background of any infectious disease (after measles, mumps, syphilis, tuberculosis, pneumonia, sinusitis, tonsillitis, otitis, with skull injuries), and is often caused by pneumococci, less often staphylococci, streptococci, but also meningococci (as in case of primary meningitis).

• general weakness;
• malaise;
• dizziness;
• chills with fever;
• temperature increase up to 40 degrees;
• a sharp headache that gradually increases;
• nausea and profuse vomiting;
• there are changes in the psyche;
• the patient refuses to eat and drink;
• children may experience an increase in head size;
• insomnia;
• hallucinations;
• in rare severe cases - coma.

Symptoms of primary and secondary disease may be of a similar nature. Only a doctor can establish the true and prescribe the appropriate treatment.

General symptoms

In addition to the above symptoms (headache, fever, etc.), which can occur both in primary and secondary meningitis, there are a number of symptoms characteristic of this disease.

General infectious signs of meningitis:

• pale skin;
• joint and muscle pain;
• nasolabial triangle cyanotic color;
• persistent feeling of thirst;
• lowering blood pressure;
• dyspnea;
• rapid pulse;
• Lesage symptom in children - when the child is held in the armpits (suspended), he bends his legs to his stomach;
• increased tactile sensitivity.

meningeal syndrome

it the first cerebral symptoms of the disease, which may be characterized by signs:

1. Severe bursting headache - occurs in all patients, and occurs due to increased intracranial pressure. The pain spreads throughout the head, and is not localized in any one place. In this case, patients may experience pressure on the eyes and ears. Do not give analgesics desired effect- the pain does not go away.
2. Dizziness, "fountain" vomiting, fear of light and sound - these symptoms appear on the second or third day of the course of the disease. Vomiting, as a rule, occurs with an increase in headache and does not bring relief. Due to increased tactile sensitivity (against the background of irritation of the receptors of the meninges), the patient may experience pain even with a light touch on any of the skin areas.
3. noted strong arousal and anxiety, diarrhea, frequent regurgitation, drowsiness and convulsions.

What to do in such a situation?

If you find symptoms of meningitis in yourself or your relative / friend, you should immediately call an ambulance and prescribe appropriate therapy. At severe forms illness, patients are hospitalized in the infectious diseases department of the hospital.

This is necessary for two reasons:

1. without inpatient treatment, the patient's condition may worsen significantly and lead to irreversible consequences(disability, death);
2. close relatives can also catch the infection.

This disease is treated by an infectious disease specialist. If the disease proceeds without bright severe symptoms(chills, high fever), accompanied only by a headache, and the patient doubts that these are signs of meningitis - you can contact a neurologist.

However, if confidence in correct diagnosis is absent, it is better to contact an infectious disease specialist or a therapist who will determine the subsequent tactics. It is pointless to take any painkillers - it will not help.