- What is meningitis?
- The prevalence of the disease, seasonality of the disease, risk groups
- Ways of contracting meningitis
- Meningitis in adults
- Meningitis in children
- Meningitis symptoms
- Main symptoms of meningitis
- Complications of Meningitis
- Causes of Meningitis
- Viral Meningitis
- Bacterial forms
- Tuberculous Meningitis
- Other causes of meningitis
- Meningitis Classification
- Types of disease, depending on the nature of the inflammatory process
- Classification by the nature of the disease
- Types of disease depending on the prevalence of the inflammatory process
- Diagnosis of Meningitis
- Treatment of meningitis
- Etiotropic therapy for meningitis
- Additional Therapies
Meningitis is a disease characterized by inflammation of the membranes of the brain or spinal cord of infectious etiology. Severe clinical signs of meningitis are neck stiffness (significant tension of the neck muscles, in which the patient’s head is thrown back, returning to the normal position is difficult), severe headache, hyperthermia of the body, impaired consciousness, hypersensitivity to sound and light stimuli. Meningitis manifests itself as a primary form of response to infection of the membranes or a secondary inflammatory process that occurs with the complications of other diseases. Meningitis is a disease with a high percentage of deaths, disability of patients, incurable disorders and body dysfunctions.
What is meningitis?
Meningitis is a serious illness that causes inflammation of the membranes of the brain and / or spinal cord. Shells cover the brain and spinal canal tissue. There are two types of shells: soft and hard. Depending on which species is affected by the infection, there are types of the disease according to the localization of the inflammatory process:
- leptomeningitis, the most common form in which soft shells are affected;
- pachymenigitis – inflammation of the dura mater, occurs in about 2 out of 100 cases of the disease;
- Panmeningitis is diagnosed if all the membranes of the brain are affected.
As a rule, in the medical sense, in the diagnosis of meningitis implies inflammation of the extremely soft shells of the brain. Meningitis is among the most dangerous diseases of the brain, causing complications, provoking serious health problems, permanent disability, developmental disorders. A high percentage of deaths.
The description of the symptoms of meningitis was Hippocrates, the doctors wrote in the Middle Ages. For a long time, the cause of the development of the inflammatory process was considered tuberculosis or consumption, the epidemic of which caused the death of millions of people.
Before the discovery of antibiotics, the death rate from meningitis was 95%. Opening penicillin allowed to significantly reduce the statistics of fatal outcomes of the disease.
Today, modern synthetic drugs exist for the treatment of meningitis; for the prevention of most forms of the disease, vaccination against the most common pathogens is used – pneumococcal bacteria, meningococcus and hemophilus bacilli.
The prevalence of the disease, seasonality of the disease, risk groups
The disease occurs throughout the world, but there is a pronounced correlation between the level of welfare of the state and the frequency of meningitis in the population. For example, in Africa, Southeast Asia, Central and South America, meningitis is diagnosed 40 times more often than among residents of European countries.
The statistical incidence of meningitis in Russia and European countries today is 3 cases per 100 thousand population for meningitis of bacterial etiology and 10 cases per 100 thousand population with the viral meningitis pathogen. The tuberculous form of meningitis depends on the number of patients and the quality of medical services for the treatment of the main disease in the country, with the second factor prevailing over the first one.
Seasonality and annual cycle of outbreaks of the disease. The most characteristic period for meningitis is the half year from November to April, which is caused by fluctuations in air temperature, dietary restriction and vitamin deficiencies, crowds in poorly ventilated rooms, and bad weather, etc. Scientists argue that meningitis has a yearliness : there is an increase in the incidence of 1 every 10-15 years. At risk because of the characteristics of the organism and social causes are children aged from birth to 5 years and men 25-30 years.
Ways of contracting meningitis
Primary meningitis as a disease of infectious etiology is caused by pathogenic microorganisms. Viruses and bacteria that trigger the development of meningitis are transmitted in various ways, the most common of which are:
- airborne: discharge of the pathogen with saliva, mucus during coughing and sneezing into the airspace;
- contact and household; by direct contact with the patient or carrier of infection, the use of certain household items (dishes, towels, hygiene items);
- oral and fecal if non-compliance with the rules of hygiene: eating with unwashed hands, eating unprocessed foods, dirty vegetables, fruits, greens, etc.;
- hematogenous, transportation of the causative agent of meningitis of various etiologies (most often bacterial, but viral, protozoal and other forms are possible) through the blood, the spread of infection inside the patient’s body from the existing inflammatory focus to the brain membranes;
- lymphogenous, with the spread of the infectious agent present in the body with the flow of lymphatic fluid;
- placental route during prenatal development and passage of the pathogen through the placenta, as well as infection in the birth canal or when an infectious agent enters the amniotic fluid from the fetus;
- oral: when ingesting contaminated water (when bathing in reservoirs, public pools without a disinfection system, drinking dirty water), and so on.
Meningitis in adults
The group at high risk of the disease consists of young men from 20 to 30 years. The most frequent pathogens are meningococci, pneumococci, hemophilus bacillus, and tuberculous form of meningitis is also encountered in the background of inappropriate therapy for tuberculosis.
A common cause of inflammation of the meninges at this age is considered to be a lack of medical culture: treating various inflammatory diseases (carious processes, sinusitis, otitis, bronchitis, respiratory infections) as not deserving of proper attention and complete therapy. Women are less susceptible to meningitis, but the risk of the disease increases during the childbearing period due to a natural decrease in immunity during pregnancy. Prevention is pre-vaccination, timely rehabilitation, treatment of inflammatory diseases, limiting contacts.
Meningitis in children
In the age period from birth to 5 years, meningitis is a particularly serious danger to the child, the percentage of deaths is extremely high: every 20 children die during illness. Complications of the disease at this age also have a serious impact on the health of the child.
The most severe form of childhood meningitis develops during infection with streptococcal agalactia (Streptococcus agalactiae) in the process of passing through the birth canal. The disease proceeds with lightning speed, causing severe consequences or death of the infant.
For children 1-5 years of age, the most common are viral forms of meningitis with a less pronounced clinical picture and the consequences of the disease. The bacterial forms provoked by meningococcus, pneumococcus, and hemophilus bacilli are much more difficult to bear, so vaccination is recommended to protect against the disease.
Meningitis is an infectious disease, and its first signs indicate the presence of infection and damage to the nervous system. These signs of the disease include:
- sudden increase in body temperature, sometimes to critical indicators;
- severe headaches;
- stiff neck muscles (occipital muscles), numbness, difficulty in head movements, tilting, turning;
- loss of appetite, nausea, frequent bouts of vomiting, not bringing relief, possible diarrhea (mainly in childhood);
- A pinkish, red rash may appear. The rash disappears when pressed, after a few hours it changes color to bluish;
- weakness, malaise;
- even in the early stages, especially with the rapid development of meningitis, manifestations of confusion, excessive lethargy or agitation, hallucinatory phenomena are possible.
Main symptoms of meningitis
Meningitis is manifested by the following symptoms:
- severe headache;
- hyperemia up to 40 ° C, fever, chills;
- hyperesthesia, hypersensitivity to various stimuli (light, sound, tactile);
- dizziness, confusion, hallucinations, disturbances of consciousness, even coma;
- lack of appetite, nausea, repeated vomiting;
- feeling of pressure on the eyeballs, possibly tearing, manifestations of conjunctivitis;
- soreness, swollen lymph glands due to inflammation;
- pain on palpation of the trigeminal nerve, interbubular region, under the eyes;
- Kernig’s symptom (inability to straighten the legs at the knee joints due to increased tension of the hip muscles);
- positive response to Brudzinsky’s symptom (reflex movements of the limbs when the head is tilted, pressing);
- Bekhterev symptom manifestations (facial muscle contractions in response to tapping on the facial arc);
- Pulatov’s symptom (pain when tapping on the scalp);
- Mendel’s symptom (pressure on the area of the ear canal causes pain);
- Lesage symptoms in infants: pulsation, bulging of the membrane over a large spring, when lifting a child with a grip under the armpits, the head is thrown back, legs are pressed against the stomach.
Among the non-specific symptoms of meningitis, the following can be noted:
- decrease in visual function, dystonia of the visual muscles, causing strabismus, nystagmus, ptosis, visual disturbances in the form of doubling of objects, etc.
- hearing loss;
- paresis of the facial muscles of the face;
- catarrhal symptoms (sore throat, cough, runny nose);
- pain in the peritoneum, impaired bowel movements in the form of constipation;
- convulsions of limbs, body;
- epileptic seizures;
- cardiac arrhythmias, tachycardia, bradycardia;
- increase in blood pressure values;
- lethargy, pathological drowsiness;
- aggressive, irritable.
Complications of Meningitis
Meningitis is a disease that is dangerous both in the process of damage to the brain membranes by exposure to the body, and possible concomitant complications of the disease.
Complications of meningitis include:
- hearing loss;
- development of epilepsy;
- purulent arthritis;
- bleeding disorders;
- lag, violations of the child’s mental development;
- emotional instability, hyper excitability, rapid exhaustion of the nervous system;
- If the disease develops at an early age, complications such as hydrocephalus are likely to occur.
Causes of Meningitis
Inflammation of the meninges can begin under the influence of various infectious agents. Depending on the type and type of meningitis pathogen, the diagnosis is classified according to the pathogenesis, which determines the methods of therapy and allows you to choose the desired treatment tactics.
Viral meningitis is considered to be the most favorable in the prognosis of the course of the disease and recovery form. When viral etiology of meningitis, as a rule, the degree of damage to the lining of the brain is minimal, serious complications and death of the disease with timely diagnosis and therapy are extremely rare.
In the overwhelming majority of cases, viral meningitis occurs as a complication of infectious diseases with pathogens-viruses (parotitis, measles, syphilis, acquired human immunodeficiency syndrome, etc.). The most common causes and infectious agents that can trigger the development of viral meningitis are the following:
- enterovirus infection (Coxsackie virus, ECHO virus);
- infectious mononucleosis (Epstein-Barr virus);
- herpes infections (human herpes virus);
- acute respiratory viral infections (influenza virus, adenovirus and others).
The paths of penetration of the pathogen into the membranes of the brain are different. Possible hemolytic path (through the blood), with a current of lymph, and can also spread with cerebrospinal fluid. In contrast to the bacterial form, viral pathogens cause an inflammatory process of a serous nature without the release of purulent exudate.
The viral form proceeds fairly quickly: the acute stage takes on average 2-3 days, followed by significant relief and the stage of reverse development on day 5 of the onset of the disease.
Bacterial meningitis has a more pronounced clinical picture, is characterized by the severity of the disease, the addition of additional foci of inflammation, serious complications. The highest percentage of deaths is observed precisely in the bacterial form of meningitis.
In the inflammatory process of bacterial origin on the surface of the membranes of the brain marked excretion of purulent exudate, hindering the outflow of CSF, which leads to an increase in intracranial pressure. A pronounced inflammatory process provokes feverish states, severe intoxication of the body.
This form is often accompanied by impaired consciousness, mental confusion, hyperesthesia, hallucinations, high psychomotor activity. With the active reproduction of bacteria, the patient may fall into a coma.
The most common pathogens of bacterial meningitis:
- haemophilus wand;
- Staphylococcus aureus.
Bacterial meningitis may occur as a disease of primary or secondary etiology against the background of the current inflammatory process, unhealed inflammation. Most often, the secondary form occurs as a complication of bacterial pneumonia, chronic tonsillitis, sinusitis, pyelonephritis, bone osteomyelitis, abscesses of various localization.
Furuncles, carbuncles as sources of pathogens capable of spreading with blood flow and causing meningitis are dangerous; we should pay special attention to various inflammatory phenomena on the face, in the nasolabial triangle, in and around the auricles.
Therapy of bacterial meningitis is based on the isolation of the pathogen and exposure to antibiotics (antibiotics) in large doses. Without the use of antibiotics in 95% of cases, the disease ends fatally.
If there are foci of tuberculosis, mycobacterium can spread through the body in a hematogenous or lymphogenous manner and penetrate into the lining of the brain. Most often, this complication is observed with an active tuberculous process with foci in the respiratory organs, bones, kidneys, and reproductive system.
Despite the serous form of tuberculous meningitis, in which purulent exudate is not formed, as well as in the viral etiology of the disease, meningitis that develops when the brain membranes are affected with a tuberculosis bacillus is worse than the viral form.
The basis of the therapy of this form is a complex treatment with specific antibiotics active against Mycobacterium tuberculosis.
Other causes of meningitis
Viral, bacterial and tuberculous meningitis are the most common etiological types of the disease. In addition to viruses and bacteria, other pathogens and their combinations can become the causative agent.
So, they distinguish the fungal form of meningitis (torulose, candida), and protozoal (Toxoplasma). Meningitis can develop as a complication of processes and disorders of non-infectious etiology, for example, in case of metastasis of malignant tumors, systemic diseases of the connective tissue, etc.
In addition to the allocation of various forms of the disease, according to etiology and causative agent, meningitis is classified depending on the nature of the inflammatory process, the localization of the center of inflammation and its prevalence, the course of the disease.
Types of disease, depending on the nature of the inflammatory process
Purulent meningitis is characterized by a severe course with severe neurological symptoms due to the formation of purulent exudate in the meninges. The most common form of bacterial infection. In the group of purulent meningitis, species are diagnosed depending on the causative agent of the disease:
- meningococcal meningitis;
- pneumococcal form;
Serous meningitis occurs most often in the viral etiology of the disease, characterized by the absence of purulent inflammation and an easier course of the disease. The following types of serous meningitis include:
- parotid (against parotid or mumps) and others.
Classification by the nature of the disease
Fulminant meningitis develops in a few hours, especially in infants. The incubation period is practically absent, death may occur within 24 hours after infection.
The acute form of meningitis affects the body for several days, characterized by acute clinical manifestations. Often ends in death or severe complications.
Chronic meningitis develops gradually, the symptoms are increasing, becoming more pronounced.
Types of disease depending on the prevalence of the inflammatory process
Basal meningitis is characterized by localization of inflammation at the base of the brain. The convexital form affects the bulging parts of the brain. With total meningitis, the inflammatory process covers the entire surface of the lining of the brain. If the inflammation is concentrated on the base of the spinal cord, the spinal form of the disease is diagnosed.
Diagnosis of Meningitis
Diagnosis of meningitis begins with examining the patient and taking history and may include some or all of the following methods of examination:
- complete blood count;
- biochemical blood test;
- laboratory study of cerebrospinal liquor;
- PCR analysis;
- magnetic resonance imaging (MRI);
- computed tomography (CT);
- electroencephalography (EEG);
- electromyography (EMG).
Treatment of meningitis
Therapy for meningitis should begin immediately. In any case, treatment is carried out in the infectious diseases department of the clinic, independent attempts or therapy in the day hospital, especially sick children, are unacceptable.
The disease can develop rapidly, symptoms – suddenly increase. The condition of any patient can suddenly deteriorate, requiring emergency care (for example, with an increase in intracranial pressure, cerebral edema, respiratory and adrenal insufficiency, depression of consciousness, falling into a coma, etc.).
Optimal conditions for therapy – a separate chamber in the infectious disease ward with round-the-clock duty of specialists, the ability to create conditions for desensitization: dim the lights, eliminate sources of loud noises, patient anxiety.
Etiotropic therapy for meningitis
Etiotropic therapy is a treatment aimed at eliminating the cause of infection.
For meningitis of the viral form, therapy is based on antiviral drugs (recombinant interferons, inducers of endogenous interferon, immunomodulators, antiretroviral drugs, etc.), when the bacterial origin of the disease is prescribed, antibiotics that are active against a specific pathogen (for example, antimeningococcal or antiphagous phytophagous bacteria, or anti-antiphiotics, are active against a specific pathogen (for example, antimenorrhagic drugs, etc.). , for meningitis of fungal etiology, treatment is carried out by antimycotic drugs, etc.
In combination with drugs that are active against the causative agent of the disease, prescribe symptomatic agents:
- decongestants (Furosemide, Mannitol);
- anticonvulsants (Seduxen, Relanium, Phenobarbital);
- detoxification therapy (infusion of colloids, crystalloids, electrolytes);
- Nootropic drugs.
Depending on the course and likely or developed complications, therapy may include correction of associated pathological conditions: respiratory, adrenal, cardiovascular deficiencies.
From the time of initiation of therapy, both etiotropic and symptomatic, depends not only recovery, but also the life of the patient. At the first signs (sudden fever, severe headache, especially against the background of acute respiratory viral or other infectious diseases), it is necessary to urgently consult a doctor or call the ambulance specialists to the house. If the symptoms appear in the child, the examination and diagnosis should be carried out immediately, since with lightning the development of the disease in young children the count goes on for literally minutes.