Meningitis in children: consequences and treatment of the disease. Meningitis: prevention is better than cure

Inflammation of the membranes of the brain and spinal cord. Pachymeningitis - inflammation of the dura mater, leptomeningitis - inflammation of the pia and arachnoid meninges. Inflammation of the soft membranes is more common, in such cases the term "meningitis" is used. Its causative agents may be one or another pathogenic microorganisms: bacteria, viruses, fungi; less common protozoal meningitis. Meningitis is manifested by severe headache, hyperesthesia, vomiting, stiff neck, typical position of the patient in bed, hemorrhagic skin rashes. To confirm the diagnosis of meningitis and establish its etiology, a lumbar puncture and a subsequent examination of the cerebrospinal fluid are performed.

The causative agents of infection, entering the body through the entrance gate (bronchi, gastrointestinal tract, nasopharynx), cause inflammation (serous or purulent type) of the meninges and adjacent brain tissues. Their subsequent edema leads to disruption of microcirculation in the vessels of the brain and its membranes, slowing down the resorption of cerebrospinal fluid and its hypersecretion. At the same time, intracranial pressure rises, dropsy of the brain develops. Possible further distribution inflammatory process on the substance of the brain, roots of cranial and spinal nerves.

Classification of meningitis

Meningitis is classified according to several criteria.

By etiology:

bacterial (pneumococcal, tuberculosis, meningococcal, etc.)
viral (caused by Coxsackie and ECHO enteroviruses, acute lymphocytic choriomeningitis, etc.)
fungal (cryptococcal, candidal, etc.)
protozoan (with malaria, with toxoplasmosis, etc.)

By the nature of the inflammatory process:

purulent (neutrophils predominate in the cerebrospinal fluid)
serous (lymphocytes predominate in the cerebrospinal fluid)

By pathogenesis:

primary (no history common infection or infectious disease of any organ)
secondary (as a complication of an infectious disease)

According to the prevalence of the process:

generalized
limited

According to the course of the disease:

lightning fast
sharp
subacute
chronic

By severity:

mild form
moderate
severe form
extremely severe form

Clinical picture of meningitis

The symptom complex of any form of meningitis includes general infectious symptoms (fever, chills, fever), increased respiration and disturbance of its rhythm, changes in heart rate (tachycardia at the onset of the disease, bradycardia as the disease progresses).

Meningitis is characterized by hyperesthesia of the skin and soreness of the skull during percussion. At the onset of the disease, there is an increase in tendon reflexes, but with the development of the disease they decrease and often disappear. In the case of involvement in the inflammatory process of the substance of the brain, paralysis, pathological reflexes and paresis develop. Severe meningitis is usually accompanied by dilated pupils, diplopia, strabismus, impaired control of pelvic organs(in case of development of mental disorders).

Symptoms of meningitis in old age atypical: weak manifestation of headaches or their complete absence, tremor of the head and limbs, drowsiness, mental disorders(apathy or, conversely, psychomotor agitation).

Diagnosis and differential diagnosis

The main method for diagnosing (or excluding) meningitis is a lumbar puncture followed by examination of the cerebrospinal fluid. In favor this method say its safety and simplicity, so holding lumbar puncture indicated in all cases of suspected meningitis. All forms of meningitis are characterized by leakage of fluid under high pressure(sometimes in a jet). With serous meningitis, the cerebrospinal fluid is transparent (sometimes slightly opalescent), with purulent meningitis, it is cloudy, yellow-green in color. By using laboratory research cerebrospinal fluid determine pleocytosis (neutrophils in purulent meningitis, lymphocytes in serous meningitis), a change in the ratio of the number of cells and increased content squirrel.

In order to clarify etiological factors diseases, it is recommended to determine the level of glucose in the cerebrospinal fluid. In the case of tuberculous meningitis, as well as meningitis caused by fungi, glucose levels are reduced. For purulent meningitis, a significant (to zero) decrease in glucose levels is typical.

The main landmarks of a neurologist in the differentiation of meningitis are the study of cerebrospinal fluid, namely the determination of the ratio of cells, the level of sugar and protein.

Treatment of meningitis

In case of suspected meningitis, hospitalization of the patient is mandatory. In severe prehospital stage (depression of consciousness, fever), the patient is administered prednisolone and benzylpenicillin. Performing a lumbar puncture on prehospital stage contraindicated!

The basis of the treatment of purulent meningitis is the early appointment of sulfonamides (etazol, norsulfazol) or antibiotics (penicillin). Allows the introduction of benzylpenicillin intralumbally (in an extremely severe case). If a similar treatment meningitis during the first 3 days is ineffective, you should continue therapy with semi-synthetic antibiotics (ampicillin + oxacillin, carbenicillin) in combination with monomycin, gentamicin, nitrofurans. The effectiveness of such a combination of antibiotics has been proven before the isolation of a pathogenic organism and the detection of its sensitivity to antibiotics. Maximum term such combination therapy - 2 weeks, after which it is necessary to switch to monotherapy. The criteria for cancellation are also a decrease in body temperature, normalization of cytosis (up to 100 cells), regression of cerebral and meningeal symptoms.

The basis of the complex treatment of tuberculous meningitis is the continuous administration of bacteriostatic doses of two or three antibiotics (for example, isoniazid + streptomycin). When possible side effects(vestibular disorders, hearing impairment, nausea) cancellation given treatment is not required, a reduction in the dose of antibiotics and a temporary addition to the treatment of desensitizing drugs (diphenhydramine, promethazine), as well as other anti-tuberculosis drugs (rifampicin, PAS, ftivazide) are shown. Indications for discharge of the patient: no symptoms of tuberculous meningitis, sanitation of cerebrospinal fluid (after 6 months from the onset of the disease) and improvement in the general condition of the patient.

Treatment of viral meningitis may be limited to the use of symptomatic and restorative agents (glucose, metamizole sodium, vitamins, methyluracil). AT severe cases(pronounced cerebral symptoms) prescribe corticosteroids and diuretics, less often - repeated spinal puncture. In case of layering bacterial infection antibiotics may be prescribed.

Forecast and prevention of meningitis

In the further prognosis, an important role is played by the form of meningitis, the timeliness and adequacy of therapeutic measures. Headaches, intracranial hypertension, epileptic seizures, visual and hearing impairments often remain as residual symptoms after tuberculous and purulent meningitis. Due to the late diagnosis and resistance of the pathogen to antibiotics, the mortality rate from purulent meningitis (meningococcal infection) is high.

As preventive measures to prevent meningitis, regular hardening (water procedures, sports), timely treatment of chronic and acute infectious diseases, as well as short courses of immunostimulating drugs (eleutherococcus, ginseng) in the foci are provided meningococcal meningitis (Kindergarten, school, etc.)

Meningitis is inflammatory lesion membranes of the spinal cord and brain. Meningitis refers to serious illnesses, which represent serious danger for human life.

Depending on the etiology, that is, on the cause of the onset of the disease, meningitis is divided into:
infectious,
infectious-allergic - neuroviral and microbial (influenza, herpetic, tuberculous and serous meningitis),
traumatic,
fungal.

By location, there are:
panmeningitis, in which all meninges are affected,
pachymeningitis, mostly the dura mater is affected,
leptomeningitis, the meninges are affected - arachnoid and soft.

Due to her inherent clinical features damage to the arachnoid, the so-called arachnoiditis, stands out in an independent group. Besides, meningitis is divided into serous and purulent.

There are meningitis primary and secondary. Primary meningitis develops when, when the body is infected, the meninges are simultaneously damaged (in this case, the disease immediately affects the brain directly). Secondary meningitis is characterized by the fact that against the background of the underlying disease, such as leptospirosis, mumps, otitis media, and others, the infection spreads and subsequently the meninges are damaged.

The course of meningitis in absolutely all cases characterized as acute (the disease progresses over several days). Makes an exception only tuberculous meningitis, it can develop over several weeks or even months.

According to the ways of infection of the meninges, there are:
hematogenous,
perineural,
lymphogenous,
contact (for example, with painful paranasal sinuses, inflammatory processes in the ear, painful teeth), with craniocerebral injuries.

meningeal syndrome, such as promotion intracranial pressure, is present with any meningitis and is characterized by bursting pains in the head, while pressure is felt on the ears, eyes, vomiting appears, photophobia (irritation to light), hyperacusis (reaction to sound), fever epileptic attacks, rashes can be observed. The symptoms and treatment of meningitis vary.

Causes of meningitis

Meningitis can develop as a result of damage to the meninges by a pathogen of a viral or bacterial nature.
The main causative agents of primary meningitis are:
1. bacteria. The main cause of meningitis is meningococcal infection (Neisseria meningitidis). Carriers of meningococcal infection (patients with intestinal infections, nasopharyngitis,) act as a source of infection. Usually this kind of infection distributed by by airborne droplets. In a large percentage of cases, meningococcal infection affects the population of cities (affects the crush in transport, observed in autumn and winter). In children's groups, meningococcal infection can provoke outbreaks of meningitis. Meningococcal meningitis results in purulent meningitis. In addition to meningococcus, there are such causative agents of meningitis as tubercle bacillus, pneumococcus, Haemophilus influenzae, spirochetes.
2. Viruses. Another cause of meningitis can be a viral infection (viral meningitis). In most cases, meningitis manifests itself against the background enterovirus infection, however, it can develop against the background of rubella, herpes ( chicken pox), mumps, measles. Viral meningitis is called serous.

Secondary meningitis can provoke the following factors:
acute or chronic form otitis,
furuncle of the face or neck ( greatest danger represent boils that are located above the level of the lips),
sinusitis,
frontitis,
lung abscess,
osteomyelitis of the bones of the skull.

If poor-quality treatment of these diseases has been carried out, the infection may spread to the meninges, which leads to the appearance of meningitis.

Typical symptoms and signs of meningitis in adults and children

Meningitis in most cases characterized by an acute and sudden onset. Initial symptoms meningitis are very similar to the symptoms bad cold or flu:
feeling of weakness
fever (temperature rises to 39 degrees or more)
soreness in the joints and muscles,
decreased appetite.

For a period from a couple of hours to several days on the background high temperature appear characteristic (specific) symptoms of meningitis. These include:
1. Severe pain in the head. During meningitis, the nature of the headache is diffuse, that is, the pain is distributed throughout the head. Over time pain increase and acquire the character of bursting pain. After a certain period of time the pain progresses to unbearable (from such pain an adult groans, and children can scream). Then the pain in most cases is accompanied by a feeling of nausea, vomiting. Usually, with meningitis, pain in the head increases if you change the position of the body, as well as under the influence of stimuli from the outside ( loud noise, noise).
2. Meningococcal meningitis is characterized by the appearance of a rash. If meningitis manifests itself in mild form, the rash can be expressed as small punctate dark cherry-colored rashes. On the third or fourth day from the moment of formation, the rash with meningococcal meningitis disappears. In more severe meningitis, the rash appears as big size spots and bruises. Rashes in severe meningitis disappear within ten days.
3. Confusion of consciousness.
4. Multiple vomit, after which there is no sense of relief.
5. meningeal symptoms: the muscles of the back of the head are very tense; patients with meningitis, as a rule, prefer to lie on their side, while their knees are pulled up to their stomach, their head is thrown back, while if you change the position of the patient's head, tilting it to the chest, or try to straighten the legs at the knees, appear severe pain.
6. In some cases, meningitis occurs defeat cranial nerves which leads to strabismus.

In children under the age of one year, in addition to the already listed symptoms, there are also signs of meningitis, such as:
diarrhea (diarrhea),
apathy, drowsiness, constant strong crying, refusal to eat, anxiety,
convulsions,
swelling and pulsation in the region of the large fontanel,
vomiting and repetitive regurgitation.

Symptoms of chronic tuberculous meningitis

We have already said that the development of tuberculous meningitis occurs in a few weeks. The primary symptom of tuberculous meningitis is increasing pain in the head, the intensification of which occurs from day to day, in the end, it becomes simply unbearable. Headache may be accompanied by repeated vomiting, the patient may experience confusion, and the general condition worsens.

Diagnosis of meningitis

Diagnosis of meningitis is carried out using the following characteristic methods:
1. Study of cerebrospinal fluid. Cerebrospinal fluid can be obtained with a lumbar puncture. Diagnosis of meningitis involves determining various characteristics fluids (number and composition of cells, transparency and color of the fluid, amount of glucose, protein, as well as the presence of microflora). These data are needed to identify changes characteristic of meningitis.
2. Examination of the fundus.
3. X-ray of the skull.
4. Electroencephalography.
5. Nuclear magnetic resonance and computed tomography.

The diagnosis of "meningitis" becomes based on their combination of three signs:
signs of infection
symptoms of meningitis
available characteristic changes in the cerebrospinal fluid.

Treatment of meningitis in children and adults

Meningitis refers to emergency conditions. Patients with meningitis urgent hospitalization is required. Forbidden self-treatment a patient with meningitis at home, as this can be fatal. The sooner organized adequate treatment the patient, the greater the likelihood of his full recovery.

Treatment of patients with meningitis includes several areas.
1. Taking antibiotics. The main treatment for meningitis in adults and children is antibiotic therapy. It must be said that it is not possible to determine the nature of the pathogen from the blood for more than 20 % cases. Usually, medications for meningitis are prescribed empirically (that is, with an unidentified exact cause of the onset of the disease). The drug is selected in such a way that it is possible to cover the entire spectrum of the most possible pathogens. The duration of antibiotics should be at least 10 days, in without fail antibiotics should be taken for at least a week from the moment a normal temperature is established.

If there are purulent foci in the cranial cavity, antibiotic therapy should take longer. Used for meningitis the following antibiotics: Cephalosporins (Cefotaxime, Ceftriaxone), Penicillin. Used as reserve antibiotics Vancomycin, Carbapenems(these drugs are used only in cases where the effect of the previously mentioned drugs is absent). If the course of meningitis is severe, antibiotics are injected into the spinal canal (the so-called endolumbar administration of antibiotics).
2. Prevention and treatment of cerebral edema. Diuretics are used to treat and prevent cerebral edema ( Uregid, Lasix, Diacarb). Diuretics must be combined with the introduction of liquid inside.
3. Infusion therapy(detoxification). In meningitis, crystalloid and colloidal solutions. Intravenous infusions liquids must be carried out with extreme caution, since there is a risk that cerebral edema will develop.
4. Individual therapy. After outpatient treatment the patient continues the course of treatment already at home. Question about visiting a children's preschool or closing the sheet of temporary disability is decided individually for each patient. Usually had meningitis a person is released from work for a period of about a year.

Preventive measures (vaccination) of meningitis in children and adults

The greatest effect in the prevention of meningitis is given by vaccination of children and adults, directed against the causative agents of this disease. A vaccine against the bacteria Haemophilus influenzae is used. In childhood, three doses are administered - at three, four and a half and six months, at the age of one year, revaccination is carried out. When a child reaches two years of age, he is given a meningococcal vaccination. For an adult who has reached 65 years of age pneumococcal vaccine is indicated.

For the prevention of secondary meningitis, such a measure as a competent and timely treatment diseases that give complications in the form of meningitis. So, for example, it is strictly forbidden to squeeze out or rub boils, as well as acne in the face or neck of large sizes. If sinusitis or otitis has developed, necessary to as soon as possible apply for medical assistance and carry out treatment under medical supervision.

Meningitis is a disease caused by microbes: viruses, bacteria, rarely fungi. No one is immune from its appearance, but children and adolescents are most susceptible to the disease, especially those who have congenital or acquired brain pathologies. Elderly people with a weakened immune system and a chronic violation of the blood supply to the brain also quite often suffer from meningitis. The first signs of this disease should be known to everyone.

How does meningitis get transmitted?

The virus can get to a person by airborne droplets, through water and food that have not undergone sufficient heat treatment, through insect bites, or by contact. Also, being in the body for a long time, it can be activated and penetrate the brain membrane from lymphocytes or nerve cells with suppressed immunity (these are herpes viruses, Epstein-Barr, cytomegalovirus). If the virus is given a sufficient rebuff by the body's defense systems, meningitis will not develop.

Bacterial meningitis most often occurs when the pathogen spreads to the membranes of the brain from the ear cavity during purulent otitis media, from the nose - with purulent rhinitis, from the sinuses. It can be brought from the blood during sepsis, and also get directly onto the shell with a penetrating wound of the cranial cavity or spine.

If you catch them from the patient is almost impossible. The maximum that you get is a viral uncomplicated disease that will take the form of SARS, intestinal infections, herpetic rashes, as well as measles, chicken pox, mumps and others. viral infections. You can get sick if the immune system is very weakened or if the pathogen is very aggressive. Therefore, if your child had contact in the children's team with another baby, in whom it was later discovered, it was you who should know, but you should not panic because of this. You can limit yourself only to the prophylactic use of Arbidol, Anaferon or Groprinosin. You can drip drops of interferon into your nose.

If meningitis has developed as a complication of other purulent diseases, it is not contagious. That is, if you talked with a relative who developed as a result of untreated or improperly treated otitis media, sinusitis (or other sinusitis), pneumonia, you can not worry about yourself. Only one bacterium, meningococcus, which causes infectious meningitis(it is also called epidemic), can be transmitted from one person to another. The source can be a sick meningococcal infection (it can manifest itself in the form of a runny nose and sore throat, maybe in the form of a rash or in the form of meningitis) or a carrier of this bacterium. He "hands out" germs with talking, coughing and sneezing. People who have had close contact with such a person become infected: relatives or children in a children's team. Among them are outbreaks of meningitis. If you or your child has had contact with a person who has been found to urgently consult with an infectious disease specialist about prophylactic antibiotics - is this indicated in this case and when you might get meningitis.

The first signs and symptoms of this disease

The initial symptoms of the disease can be a runny nose, malaise, weakness, cough. A rash may appear: one that will be characteristic of chickenpox, herpes, or shingles. If you develop a dark red, brown, or black rash that doesn't itch or hurt, or get paler when the skin underneath is stretched, call 911 immediately: it could be meningococcal meningitis, the first signs of which may appear much later.

Considered early:

The appearance of a severe headache, which is briefly relieved by painkillers, is aggravated by a sharp turn of the head, bright light, loud sounds;

Increased body temperature (mandatory sign of meningitis);

Nausea, vomiting, which occur against the background of a headache, are not accompanied by diarrhea.

Later they may appear: by the type of excitement and inadequacy, or, conversely, in the form of a state when it is difficult to wake a person; convulsions, delusions, hallucinations. A large fontanel bulges in babies, they become drowsy, refuse to eat and drink, do not want to go on their hands, but lie with their heads thrown back.

There are no diseases in life that could be pleasant.

Diseases are very dangerous and slightly less dangerous.

Acute meningitis is a very dangerous and serious disease that has four types of meningococci: A, B, C and D. The first two of them need constant attention during the epidemic.

Most common cause, because of which people get meningitis, is called walking on the street in cold weather without a hat, and even worse with a wet head.

There is some truth in this, but only a fraction. In most cases, meningitis is caused by bacteria and viruses that adversely affect soft shell brain and cerebrospinal fluid.

To catch a disease, you just need to contact a person who has a viral or infectious disease.

For children, the most common source of meningitis is the introduction of an enterovirus into the body through contaminated food or water. Also, the disease can be obtained during childbirth, when the virus can enter by airborne droplets, through dirty water or through the mucous membrane. In addition, meningitis is often a complication of various headaches and injuries.

It is very important for people of all ages to avoid at least the elementary causes due to which such a serious illness develops.

It is necessary to wash hands before eating, maintain hygiene and prevent freezing of the head in bad weather.

Symptoms of acute meningitis

With meningitis, the symptoms are obvious and very unpleasant.

Having received a disease, a person begins to feel a headache. The temperature rises, the neck muscles stop moving, the knee joint stops working.

Light and sound are perceived too sharply, which causes additional discomfort. Also, with meningitis, nausea and vomiting, a feeling of weakness and heart rhythm disturbances appear.

In the most unpleasant situations, a person can lose consciousness up to falling into a coma. A particularly acute reaction of the body to meningitis occurs if it is bacterial.

If a combination of these symptoms occurs, measures must be taken immediately to prevent the disease. Often a symptom of meningitis is a disease of the upper respiratory tract. In this case, timely antibiotic treatment can correct the disastrous state of affairs and normalize the situation with the disease.

Diagnostics

Nowadays, there are a number of ways to diagnose meningitis. The main ones include:

Blood chemistry. Such an analysis allows you to understand the state of the patient's immunity.
X-ray. The infection can occur in the respiratory tract and in the sinuses. Thanks to the X-ray, it will be possible to understand the cause of the disease.
Analysis of urine. Allows you to identify genitourinary system the presence of an infectious focus and helps to assess the functioning of the kidneys.
MRI. Allows you to explore the brain and nervous system for complications.
Puncture. As already mentioned, meningitis affects cerebrospinal fluid. The puncture allows you to determine the degree of infection of the body and how much the inflammatory process is running. The sensitivity of the organism to therapeutic agents is also determined.
Biopsy. It is not necessary to diagnose with a biopsy, but it often allows you to understand what condition the patient is in. skin covering and what is the cause of skin inflammation.

Despite all the variety of methods for diagnosing a disease, the key factor is the speed of the patient himself. It is he who must react in time to his illness and immediately turn to doctors.

Prognosis and treatment

Putting forward a prognosis for a cure for meningitis, doctors must correctly determine the type of disease.

Most dangerous view This is meningococcal meningitis and is the most common.

It is unpleasant to realize, but with this form of the disease there is a possibility of death.

Yes, today there are huge shifts in the field of medical progress, but this cannot completely eliminate the possibility of a patient dying.

It is worth noting that in general the situation is still improving. In former times, an average of 75% of patients died from meningococcal meningitis, and now this percentage has decreased by 4-5 times. In addition, the likelihood that after an illness a person will have complications such as paralysis, epilepsy and dementia is also reduced.

There are also such types as viral and tuberculous meningitis. They are not as dangerous, so the prognosis is much better. You can recover without consequences in a few weeks. For serous meningitis typical cure within a week.

Meningitis is treated with various kinds therapy. These include antibacterial, detoxifying, anti-inflammatory hormonal and symptomatic therapy. In addition, in the treatment of secondary meningitis, it is necessary to eliminate the purulent focus.

Prevention

Three categories of people are more likely to be affected by the disease:

children under five years of age;
teenagers from 16 to 25 years old;
elderly people over 60 years of age.

It is especially important for them to observe the elementary rules of hygiene and healthy lifestyle life.

In the event that it turned out that there was contact with a person suffering from meningitis, you must immediately go to the hospital.

You need to be under the supervision of a specialist for up to two weeks. In addition, if an infection is detected, it is necessary to immediately heal its focus.

One of the most important helpers for people in the fight against meningitis is vaccination. This disease is very dangerous and it is not a fact that vaccination will save you from problems, but if you carry out a whole range of vaccinations against viruses, this will greatly increase the chances of avoiding the disease.

Meningitis is a complex disease, the symptoms of which are unpleasant and visible immediately. It is impossible to insure yourself against meningitis, but you can make every effort to reduce the likelihood of the disease. If, nevertheless, the disease has overtaken, it is necessary to see a doctor in a timely manner, diagnose the problem and start treatment.

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, which develops gradually, can be distinguished.

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 distinguished, in which, as a rule, the dura mater is affected, leptomeningitis, in which the soft and arachnoid membranes of the brain are affected, and panmeningitis, in which all membranes of the brain are affected by the inflammatory process. If the inflammatory lesion is predominantly localized in the area of the arachnoid membrane, 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 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 of the course of this disease, as well as cases with the appointment of irrational therapy with its relevance, 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 symptomatology that characterizes this form meningitis.

Most often, it develops in a sudden way, which is accompanied by a sharp increase in temperature and the appearance of vomiting (it is repeated and does not bring proper relief to the patient). Due to the increase in intracranial pressure, there is a strong headache. On the background general condition the patient has 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 experience a coma, in which the foreground symptoms are paralysis of the 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.

With a prolonged 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.

Most severe manifestation meningitis in this form is a bacterial shock. In this case, the disease develops acutely, with sudden rise temperature and 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. Subsequent rejection occurs subcutaneous tissue and necrotic skin, 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 because of the spread of infection to 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.

Accompanying the onset of the disease sharp deterioration 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. At purulent meningitis are affected internal organs 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 bent at the knee and hip joint legs. As for the Brudzinsky symptom, its manifestations are reduced to bending the legs at the knees when trying to tilt the head forward in the supine position, to bending the legs in knee joints causes also pressure on the pubis.

Serous meningitis

Serous meningitis is characterized by meninges inflammatory serous changes. 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 there is a prodromal period, accompanied by manifestations in the form of weakness, weakness and catarrhal inflammation of the upper respiratory tract simultaneously with a sudden increase in temperature 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 of the relevance of this disease in patients, either residual effects of tuberculosis they had previously suffered, or a form of the active course of this disease in a different area of concentration at the time of detection of meningitis, are detected.

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 mostly subfebrile, its high rates are extremely rare at this stage of the disease.

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 typical symptoms diseases: headaches, stiffness of the muscles of the neck and nausea. The accumulation of serous exudate at the base of the brain can lead to irritation of the cranial nerves, which, in turn, manifests itself in visual impairment, strabismus, deafness, unequal pupillary dilation, and paralysis of the eyelid.

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 the 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 when reaching a maximum of 5-7 breaths and subsequent decrease / weakening , transitioning to a pause). The temperature also rises (up to 40 degrees), paralysis and paresis appear, as already noted. 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.