Meningitis: etiology, symptomatic complex, types of diagnostic research methods. Meningitis in adults and children. Early symptoms of meningitis All symptoms of meningitis

“Don’t go without a hat - you’ll get meningitis!” Who among us did not have to listen to this kind of “horror stories” as a child? In fact, the mechanism of infection with this disease is much more complex and just wearing a warm hat cannot protect you from it. Let's say more: you can get meningitis even in the summer at sea, and massive outbreaks of this disease occur more often in tropical countries than in regions with a harsh climate.

Meningitis is an inflammation of the meninges, which is fatal in 10% of cases. The human brain and spinal cord consists of three membranes: soft, arachnoid and hard. If an inflammatory process begins in any of them (or all at once), they speak of meningitis. Inflammation of the dura mater of the brain is called pachymeningitis. With leptomeningitis, the soft and arachnoid membranes are affected, and panmeningitis is an inflammatory process in all three layers. But most often, doctors diagnose inflammation in the soft membranes of the brain.

Thus, everyone should know how and why meningitis occurs, whether it is contagious, whether it is possible to get it again, and who is most susceptible to inflammation of the meninges.

Types of meningitis

It is generally accepted that Hippocrates was the first to describe the symptoms of meningitis, and then medieval healers. So humanity has known about this disease for a very long time. But for many years, tuberculosis and consumption were mistakenly believed to be the cause of inflammation of the meninges, and before the discovery of antibiotics, 95 out of 100 patients died from meningitis. Nowadays, treating meningitis is also not easy, but thanks to modern knowledge, the survival rate is much higher than several centuries ago.

However, for therapy to be effective, you first need to understand what type of meningitis you will have to fight. And this disease is very “many-sided” in origin and nature, therefore, in the international classification of diseases (ICD 10), each type is assigned its own code and definition, and specialists use different methods to systematize the disease.

According to the nature of inflammation, meningitis occurs:

purulent;
serous.

In the first case, the disease is caused by meningococcal bacteria, is very severe, and is caused by a primary septic process. The second type is of viral origin. This variety is considered not as dangerous as purulent and is less likely to cause complications.

By origin, meningitis is divided into:

primary (independent disease);
secondary (appears as a complication of sinusitis, otitis, respiratory infections, osteomyelitis of the skull bones, caries, boils on the face or neck, tonsillitis, sometimes occurs against the background of diseases such as tuberculosis, mumps, syphilis).

Classification by pathogen:

bacterial;
fungal;
viral;
protozoan;
mixed.

According to the nature of the flow:

lightning (fulminant);
spicy;
subacute;
chronic;
recurrent.

By localization of inflammation:

total;
basal (affects the deep parts of the brain);
spinal (affects the spinal cord);
convexital (affects the superficial brain).

According to severity:

mild;
moderately heavy;
heavy.

In addition, there is also non-infectious meningitis. This is a type of aseptic meningitis, that is, a disease caused by anything other than bacteria that usually causes acute meningitis - non-infectious diseases, drugs or vaccines. Overall, these causes of meningitis are uncommon. Most often, doctors diagnose cases of viral, bacterial, secondary purulent and fungal meningitis. Moreover, the bacterial (meningococcal) variety of the disease is more common among children under 5 years of age, and the fungal type is more common among pregnant women, patients after chemotherapy, and patients with acquired immunodeficiency. Bacterial, also known as purulent, meningitis can affect even babies under one year old, and viral (serous) meningitis usually appears in children after mumps or due to ECHO. The viral form is not as dangerous for children as the purulent form, since it is easier to treat and less likely to cause complications.

Causes of infection

In many clinical cases, meningitis manifests itself as a seasonal disease. But contrary to popular belief, hypothermia cannot be considered its main cause. Statistics indicate that more cases of infection occur in the warm season, as well as in countries with temperate climates. However, experts also record surges in the spread of the disease in the off-season. This is facilitated by several factors: increased humidity and decreased air temperature outside, seasonal hypovitaminosis, as well as longer stays in poorly ventilated areas. Not long ago, scientists noticed another cyclical pattern: every 10-15 years, an epidemic of meningitis occurs in the world. For example, in 2017, an epidemic of serous meningitis was recorded in Russia, the cause of which was the enterovirus ECHO30, which came from China.

People with weakened immune systems and children under 5 years of age are most susceptible to the disease (their immune system is still developing, and the blood-brain barrier is characterized by increased permeability). If we analyze the prevalence of the disease between the sexes, then more cases of inflammation in the brain are diagnosed among men (usually at the age of 20-30 years). Also at risk are pregnant women, people with diabetes, gastrointestinal ulcers, AIDS, those suffering from chronic fatigue or people suffering from malnutrition. In the so-called “Third World” countries, the prevalence of meningitis is almost 40 times higher than the European average. It is also interesting that in Europe and Russia, diseases of bacterial etiology are approximately 3 times less common than viral ones. Doctors say the main reason for this is vaccination, which can help prevent the bacterial form of the disease. After vaccination, the body, when faced with a pathogen, will independently protect itself from it.

To protect yourself, first of all, you need to understand that meningitis is a contagious disease. Depending on the species, it can be transmitted in different ways:

airborne (through saliva particles during coughing and sneezing);
fecal-oral (through unwashed hands, fruits and vegetables, contaminated water);
hemocontact (through blood);
lymphogenous (through lymphatic fluid);
placental (from pregnant women to the fetus);
water (when swimming in open reservoirs or pools);
contact and household (through household items, dishes, toys);
through insect bites (mainly in African countries).

In children under 1 year of age, meningitis can be caused by the same reasons as in adults or have other causes. For example, be a consequence of birth trauma, prematurity, damage to the brain or spinal cord, sepsis, disease of the middle ear or nasopharynx. If a woman has meningitis during pregnancy, the risk of transmitting the infection to the fetus is very high, and this can lead to developmental disorders of the child. In most cases, meningitis during pregnancy ends in spontaneous abortion or intrauterine fetal death. But even if the fetus survives, doctors usually advise women to terminate their current pregnancy.

Variants of the course of meningitis

Meningitis is most dangerous for children under 5 years of age. Sadly, every 20 baby diagnosed with inflammation of the meninges dies. The most dangerous form of infant meningitis is considered to be a disease caused by streptococcal infection. Infection usually occurs during the baby's passage through the mother's birth canal. In this case, the disease develops at lightning speed and the child either dies within the first month of life or suffers serious developmental disorders. A complicated form of meningitis is no less dangerous for children. And already at the age of 1 to 5 years, children more often suffer from viral meningitis, which usually goes away more easily than bacterial meningitis.

The course of the disease consists of three periods: incubation, prodromal and the disease itself. The incubation period is the time from the moment the virus enters the body until the first symptoms of the disease appear. At this time, viruses or bacteria are contained in the body in small quantities, and therefore cause almost imperceptible harm. Depending on the type of disease, the incubation period can last from several minutes (rapid development) to several years (chronic inflammation). The duration of the incubation period also depends on the state of the patient’s immune system: the weaker it is, the faster the disease manifests itself. Most often, the incubation period lasts from 1 to 10 days. If the disease was diagnosed in the first two days after infection, then the chances of cure reach 95%.

The fulminant, or fulminant, form of meningitis is the most dangerous. With this form, all stages of the disease pass almost instantly, and death is possible within the first day. Acute meningitis also occurs according to an “accelerated” program: as a rule, 3 days are enough for the infection to reach its peak or even cause the death of the patient.

Purulent meningitis can enter the prodromal stage (the time when classic symptoms of the disease appear) within a few hours after bacteria enter the body. Acute bacterial inflammation progresses very quickly. If the disease was caused by Neisseria meningitidis, the patient may die within a few hours after infection. Against the background of this type of disease, bilateral hemorrhagic adrenal infarction (Waterhouse-Friderichsen syndrome) is possible. And the disease caused by the bacterium Haemophilus influenzae, or hemophilic meningitis, is more common in countries where vaccination against hemophilia is not carried out.

If we are talking about the acute period of the disease, then it usually develops from several days to several weeks, and chronic meningitis manifests itself no earlier than 4 weeks after infection. In addition, while most forms of inflammation in the brain occur rather quickly, chronic meningitis can drag on for even more than 25 years. In this case, the disease develops gradually, and it is almost impossible to determine when the infection entered the body.

Sometimes inflammation of the meninges returns even after successful treatment. Relapse can be caused by viruses, bacteria or non-infectious factors. The most common cause of recurrent disease is herpes simplex virus type 2 (Mollare meningitis). Bacterial meningitis can recur due to congenital or acquired defects of the base of the skull or spine.

Symptoms

The insidiousness of meningitis lies in its rapid development. Medicine knows of cases where death occurred just a few hours after the onset of the acute period of the disease. In the classic version, the incubation stage of meningitis in most cases lasts from 4 days to a week. If the disease is recognized in time, the patient has a chance of recovery. And for this you need to know the first symptoms of the disease. However, in most cases, the signs accompanying the onset of meningitis are not perceived by the patient as an alarming signal; the disease is manifested by general infectious symptoms: the patient experiences chills, fever, increased body temperature, and in some cases, skin rashes may appear.

The main symptom of meningitis is headache, which becomes more intense as the disease progresses. The nature of the pain is bursting, the pain can be very intense. In this case, the pain can be localized in the forehead and occipital region, radiating to the neck and spine. Bursting pain is associated with increased intracranial pressure as a result of the action of pathogen toxins. The pain syndrome intensifies when moving the head, as well as due to loud sounds and bright lights. Another sign important for differentiating the nature of a headache is rigidity (strong tension) of the neck muscles. Patients with meningitis (adults and children) do not lie in the usual position on their back. To ease the pain, they turn on their side, tuck their knees to their stomach and instinctively throw their head back.

Inflammation of the membranes of the brain is in many cases accompanied by nausea and severe vomiting. Moreover, the gag reflex does not stop even with a complete refusal of food. In addition, the patient’s body temperature rises (intermittently or remains consistently high at 39-40 degrees) and is not controlled by traditional antipyretics, severe weakness and sweating appear. The patient complains of intolerance to bright light, which worsens the headache. The presence of meningitis can also be suspected in cases where a bursting headache is accompanied by a disturbance of consciousness (a person answers questions slowly and with difficulty or does not respond to requests at all). Mental disorders indicating inflammation of the membranes of the brain can manifest as hallucinations, apathy or aggression. The patient may experience leg and/or arm cramps, muscle pain, and squint (if the inflammation has spread to the optic nerves).

In addition to the classic ones, specific signs will help to recognize meningitis in young children: Kernig's sign and the upper Brudzinski's sign. In the first case, a child lying on his back with his legs raised will not be able to straighten them at the knee joints. The second symptom is also determined in the supine position. If a baby, raising his head, involuntarily bends his knees, this may also indicate inflammation in the meninges. To identify the disease in infants, the fontanel is examined: its swelling and tension are an alarming signal. Another sign of inflammation of the meninges in children is a rash, which is then replaced by specific bright burgundy spots that appear all over the baby’s body.

Diagnostics

An experienced doctor can suspect a patient has meningitis based on external clinical signs. But it is too early to make an accurate diagnosis based only on symptoms. Moreover, it is important not only to confirm or deny the presence of the disease, but also to determine its type and stage of development. To do this, the patient will have to undergo a comprehensive examination. In such cases, patients donate blood for a general analysis (CBC), a general urinalysis and a smear from the pharynx mucosa. One of the main confirmatory tests is spinal cord puncture and laboratory diagnosis of cerebrospinal fluid (CSF). Since the brain and spinal cord are in constant contact, clouded cerebrospinal fluid is always considered as the main marker of meningitis.

If during a puncture there are signs of increased cerebrospinal fluid pressure (cerebrospinal fluid flows out in a trickle or in frequent drops), experts regard this as one of the laboratory signs of meningitis. In addition, the color of the cerebrospinal fluid in a sick person changes: it becomes cloudy white or yellowish-green. Not only a cerebrospinal fluid analysis, but also a blood test can also tell about the disease. In the presence of the disease, an increased number of lymphocytes or neutrophils is observed. The patient's sugar and chloride levels also typically increase.

Differential diagnosis of the disease is based on a biochemical analysis of the cellular composition of the cerebrospinal fluid. To establish the causative agent of the disease, they resort to bacteriological and bacterioscopic examination of the cerebrospinal fluid to determine the causative agent of the disease. Using serodiagnosis, the presence of antigens and antibodies to various pathogens in the patient’s body is determined.

Approximate test results for meningitis

Indicators	Liquor is normal	Viral meningitis	Bacterial	Purulent
Color/transparency	No color/transparent		Colorless/transparent or opalescent	Whitish or greenish-brown/cloudy
Pressure	130-180 mm water. Art.	200-300 mm water. Art.	250-500 mm water. Art.	Increased
Rate of cerebrospinal fluid flow during puncture (drops/min.)	40-60	60-90	Trickle	Rare viscous drops
Cytosis (cells/µl)	2-8	20-800	200-700 (sometimes 800-1000)	More than 1000
Lymphocytes	90-95%	80-100%	40-60%	0-60%
Neutrophils	3-5%	0-20%	20-40%	40-100%
Sedimentary reactions	–	+ (++)	+++ (++++)	+++ (++++)
Dissociation	No	Low cell-protein (protein-cell after 8-10 days)	Moderately high cytosis and protein (then protein-cell dissociation)	High cellular protein
	1,83-3,89	More than 3.89	Significantly reduced	Moderately reduced
Chlorides (mmol/l)	120-130	More than 130	Significantly reduced	Moderately reduced
Fibrin film	Not formed	In 3-5%	In 30-40%	Coarse, often in the form of sediment
Reaction to puncture	Causes headache and vomiting	Causes relief, turning point of the disease	Causes significant but short-term relief	Moderate short-term relief

The results of a blood test will reveal neutrophilia or lymphocytosis, indicating the nature of the disease, as well as the ESR indicator - erythrocyte sedimentation rate, which in high values indicates the presence of an inflammatory process. In addition to laboratory examination of the cerebrospinal fluid and blood, the doctor will definitely need the patient’s medical history, he will conduct a thorough neurological examination, and suggest a computer or magnetic resonance imaging scan. Using an MRI or CT scan, a specialist will be able to examine the condition of the meninges and find the source of inflammation. During a conversation with the patient, the doctor will ask how long ago the headaches began, and whether the patient has been bitten by ticks or mosquitoes (carriers of the pathogen, particularly in Africa and Central Asia).

If suspicions of meningitis were detected in a child, then before sending the baby for a puncture, he should be examined by an ENT specialist, a neurologist, a neurosurgeon and a hematologist in order to exclude other possible causes of the malaise.

Treatment

Any inflammatory processes in the body are very serious. And if the inflammation occurs in the brain, then there can be no talk of any self-medication at home. Neither traditional methods nor alternative medicine can replace the necessary drug therapy. Meningitis should only be treated by a doctor and only in a hospital. The sooner a patient seeks help from a specialist, the higher his chances of survival.

The doctor can draw up a comprehensive treatment program only after receiving the results of the patient’s examinations. Meanwhile, in the case of meningitis, when the clock is ticking, not a minute can be lost. As an emergency treatment, all patients with suspected meningitis are prescribed broad-spectrum antibiotics. At the beginning of treatment, the doctor may prescribe drugs from the group of penicillins, cephalosporins, and macrolides. This will neutralize the bacteria that cause purulent meningitis. For antibiotics to start working immediately, the medicine is usually administered intravenously (drip), and in very severe cases, directly into the cerebrospinal fluid. Treatment of serous meningitis is carried out with the additional use of antiviral drugs. In addition to specific antibacterial or antiviral therapy selected for sensitivity, patients are prescribed nootropic and vascular drugs - Nootropil, Piracetam or their analogues are taken to restore nerve cells and the condition of blood vessels. As anti-inflammatory drugs, doctors provide hormonal therapy to patients with drugs such as Prednisolone, Dexamethasone, Methylprednisolone or Hydrocortisone.

Diuretic therapy is also used in the treatment regimen for meningitis. Diuretic medications are needed to relieve brain swelling.

Regardless of the form and stage of meningitis, children and adults are always prescribed vitamins and minerals. These substances are necessary to maintain immunity, which is always reduced during brain inflammation, as well as to restore the supply of nutrients necessary for the proper functioning of the patient’s systems and organs.

Prevention

The question of whether it is possible to become infected with meningitis interests many. But other problems are no less pressing: how to protect yourself from the disease and are there any vaccinations against brain inflammation? Meningitis is a contagious disease. But even if a child or adult is surrounded by a patient with inflammation of the meninges, one should not take this fact as a sentence of imminent infection. Meanwhile, protection should be taken care of in advance.

One of the most effective measures to prevent bacterial meningitis is vaccination against pathogens. Nowadays, vaccines against meningitis come in three types: protein, polysaccharide and conjugate. In each group of vaccines, there are drugs that are most suitable for different age categories. Which vaccine to choose for an adult or a child, and how often to vaccinate, should be determined by the attending physician.

Vaccination is, although not 100 percent, still a good guarantee that a healthy person will not become infected.

To protect yourself or your child from infection with viral meningitis, it is also important to follow the rules of hygiene and Sanitary Regulations, eat only clean fruits and vegetables, and wash your hands thoroughly with soap before each meal. The most common source of meningitis infection in the summer is polluted water bodies. To protect yourself from problems, it is important to avoid swimming and especially not to drink water from them.

An excellent way to prevent meningitis is to avoid contact with an infected person. But if this has already happened, you should undergo a course of chemoprophylaxis. It is also mandatory to disinfect the room where the patient was, and monitor contact persons. If contact with a carrier of infection is inevitable (for example, someone in the household is sick), respirators or gauze dressings must be used to prevent infection by airborne droplets. Remember: the infection first enters the upper respiratory tract of a person, settling on the mucous membranes, and then spreads throughout the body. But infection by airborne droplets does not always occur, but only in cases of reduced immunity and impaired functionality of the blood-brain barrier, which protects the brain from harmful substances. To prevent infection, family members are prescribed a course of rifampicin and vaccination using a conjugate vaccine. By the way, many people are interested in whether it is possible to get meningitis again. As a rule, this does not happen, but the possibility cannot be completely ruled out.

If meningitis was diagnosed on time and treatment was successful, a person has a chance to live a long, fulfilling life. But for everything to be exactly like this, after completing treatment in a hospital, you will have to follow the doctor’s recommendations.

After suffering from meningitis, it is important to continue monitoring with a doctor: it is important to be examined by a neurologist every three months. And so on for at least 2 years. In addition, some restrictions are temporarily imposed on the regime and way of life. It is forbidden to fly on airplanes for at least 6 months after illness. Flight during this period is dangerous because intracranial pressure changes sharply during the flight, which can negatively affect the restoration of liquor dynamics after inflammation of the meninges. Also, doctors do not advise going to the seaside immediately after an illness, especially for children. The temporary ban also applies to sports: after illness, heavy physical activity should be avoided for about 2 years.

You will also have to reconsider your usual diet: give up fatty and fried foods in favor of boiled, stewed, baked or steamed. For meat, give preference to dietary varieties: poultry, and fish. It is useful to eat boiled porridge as a side dish, and heat-treat fruits and vegetables before eating. It is useful to eat low-fat dairy foods; the best drinks are, if not strong. The diet after meningitis completely excludes alcohol.

Physiotherapy during the rehabilitation period should consist of a course of massage, electrophoresis with the use of medications. To restore cognitive functions and coordination, they resort to magnetic and magnetic laser therapy, and use electrosleep. A course of physical therapy will help restore motor function. But for this you need to exercise under the supervision of a physical therapy specialist. To restore range of motion, strength and coordination, occupational therapy is used, and a cognitive program is necessary to restore memory, attention and logical thinking.

Possible complications

Inflammation of the meninges itself is a serious problem. But against the background of this disease, other, no less complex complications are possible.

One of the most common is cerebral edema. As a rule, a critical excess of cerebrospinal fluid accumulates already on the second day of the disease. A complication can be suspected based on several external signs. The patient suddenly loses consciousness, develops shortness of breath, and blood pressure readings either sharply decrease or increase. There are also jumps in heart rate: from severe bradycardia (slow) to tachycardia (rapid). If cerebral edema is not removed in time, death is possible, which usually occurs due to paralysis of the respiratory center.

The second common danger is infectious-toxic shock. It occurs as a result of poisoning of the body by decay products of pathogenic microorganisms. Against the background of this process, the patient’s body temperature usually drops, but intolerance to light and loud sounds increases, and shortness of breath appears. In many cases, infectious-toxic shock occurs along with cerebral edema. The result is coma and death within a few hours.

After suffering from meningitis, the body will need time to recover. Sometimes quite long. If the inflammatory process was caused by meningococcal infection, then there remains a high risk of damage to other organs or entire body systems. Only timely seeking medical help can prevent serious consequences.

Meningitis can cause deafness, paralysis, epilepsy, and hormonal disorders. In children, hydrocephalus, complete deafness or blindness, acute renal failure, developmental delays, and cerebroasthenia are possible. Often, inflammation of the membranes of the brain in children ends in death.

We answer your questions

Do they take you into the army after meningitis?

The question of whether people with meningitis are accepted into the army is of interest to many. Let us say right away that no one with an illness will be taken to the barracks directly, since any inflammation (especially the meninges) should be hospitalized. Workers diagnosed with meningitis are unconditionally given sick leave. If cases of the disease are recorded in a school or kindergarten, the educational institution is closed for quarantine. But what awaits the young man who suffered from meningitis several years ago? If there is documentary evidence of illness, the conscript automatically enters the reserve.

Meanwhile, the issue of compatibility between the army and meningitis is of interest not only to those who have had the disease, but also to healthy conscripts. Can you get meningitis in the army? Theoretically, such a risk exists, as, indeed, in boarding schools, schools, kindergartens, sanatoriums or children's camps. Therefore, to avoid an epidemic, vaccination is carried out. Conscripts should be vaccinated against meningitis approximately 75-80 days before conscription.

Can you die from meningitis?

Any inflammatory process in the body is already a potential danger of death. What then can we say about inflammation of the meninges? But if earlier the survival rate after meningitis was no more than 5-10%, then in our time this figure has increased to around 90. Of course, the risk of death always remains, but in most cases, patients who have suffered meningitis live a long, fulfilling life.

Take care of your health and be attentive to your body's signals. If you experience any unusual changes in your health, do not delay visiting your doctor. Be aware of the consequences of delaying treatment for meningitis.

2014 – “Nephrology” full-time advanced training courses at the State Budgetary Educational Institution of Higher Professional Education “Stavropol State Medical University”.

Meningitis, sometimes called spinal meningitis, is an inflammation of the membranes surrounding the brain and spinal cord. Meningitis is usually caused by a viral infection, but can also be caused by bacterial or fungal infections. Depending on the type of infection, meningitis can be easily cured or it can be potentially life-threatening.

Steps

Part 1

Identifying symptoms in adults and children

Watch for severe headaches. Headaches caused by inflammation of the meninges surrounding the brain and spinal cord feel different from other types of pain. It is much stronger than a headache resulting from dehydration or even a migraine. People with meningitis usually experience persistent, severe headaches.

Monitor for nausea and vomiting associated with headache. Migraines are often accompanied by nausea and vomiting, so these symptoms may not automatically indicate meningitis. However, it's important to pay close attention to other symptoms if you or someone you care about feels nauseous to the point of vomiting.

Check the temperature. A high temperature, along with other symptoms, may indicate that its cause is meningitis, and not a cold or sore throat. To determine if a fever is a symptom, measure it in someone who is sick.

Determine if you feel pain and stiffness in your neck. This is a very common symptom in people with meningitis. The tension and soreness is caused by pressure from the inflamed meninges. If you or someone you know has neck pain and it doesn't seem to be related to other common causes of soreness and stiffness, such as a muscle strain or injury from sudden head movement, then meningitis may be the cause of the problem.

Difficulty concentrating. Because meningitis causes inflammation of the lining of the brain, patients often have difficulty understanding. The inability to finish reading an article, concentrate on a conversation, or complete a task combined with a severe headache can be a warning sign.

Pay attention to photophobia. Photophobia manifests itself as severe pain caused by light. Eye pain and tenderness in adults is associated with meningitis. If you or someone you know has difficulty going outside or being in a room with bright lighting, consult a doctor.

Pay attention to cramps. Cramps are uncontrollable muscle contractions, often voluntary, that typically cause uncontrolled urination and general confusion. A person who has had a seizure may certainly not understand what year it is, where he is, or how old he is, immediately after the attack ends.

Note the characteristic rash. Certain types of meningitis, such as meningococcal meningitis, cause a rash. The rash appears as reddish or purple spots and may be a sign of blood poisoning. If you notice a rash, you can determine whether it is caused by meningitis using a glass test:

Press the glass onto the rash. Use a clear glass so you can see the skin through it.
If the skin under the glass does not turn white, this indicates that blood poisoning may have occurred. Go to the hospital immediately.
Not all types of meningitis cause a rash. The absence of a rash should not be taken as a sign that a person does not have meningitis.

Notice the constant crying. It can be caused by many illnesses and other problems, but if your baby seems too upset and won't calm down after diaper changes, feedings, and other things you would normally do to calm him down, you should call a doctor. When combined with other symptoms, constant crying may be a sign of meningitis.

Pay attention to drowsiness and lethargy. If a normally active child becomes lethargic, sleepy, or irritable, he may have meningitis. Look for noticeable changes in your child's behavior that indicate lethargy and an inability to fully wake up.

Pay attention to weak sucking during feeding. Babies with meningitis have decreased ability to suck during feeding. If your baby has trouble sucking, consult your doctor immediately.

Pay attention to changes in your baby's neck and body. If your baby seems to have difficulty moving his or her head and his or her body seems unusually tense and stiff, this could be a sign of meningitis.

Part 3

Identify different types

Study of viral meningitis. Viral meningitis usually does not require treatment and goes away on its own. There are several specific viruses, such as herpes simplex virus (HSV) and HIV, that require specific targeted treatment with antiviral drugs. Viral meningitis is transmitted by contact. A group of viruses called enteroviruses are the main source and usually appear in mid-summer to early fall.

What you need to know about pneumococcus. There are three types of bacteria that cause bacterial meningitis, which are the most dangerous and deadly. Streptococcus pneumoniae is the most common form in the United States, affecting infants, young children and adults. However, there is a vaccine against this bacterium, so it is curable. It most often spreads from a sinus or ear infection and should be suspected if a person with a pre-existing sinus or ear infection develops symptoms of meningitis.

Meningococcus . Another bacterium that causes bacterial meningitis is Meningococcus. This is a highly contagious form that instead affects healthy teenagers and young adults. It is transmitted from person to person, and outbreaks occur in educational institutions and dormitories. It is particularly lethal and, if not caught early and given a course of intravenous antibiotics, leads to multiple organ failure, brain damage and death.

Meningitis is a dangerous infectious disease that affects the membranes of the brain, thereby causing inflammation in them. It can appear either independently or as an infection from another source.

The disease has 5 different forms, it can be bacterial, viral, fungal. The nature of the inflammatory process is purulent and serous.

At the slightest suspicion of the development of meningitis, an adult or child should be taken to the hospital as quickly as possible, since the disease can only be treated in a hospital under the supervision of experienced doctors.

Treatment of meningitis must begin from the moment the first signs of the disease are detected, since its consequences are very dangerous for a person, regardless of age. Children are more likely to get meningitis because their immunity is underdeveloped and the blood-brain barrier is imperfect, unlike adults.

Causes of meningitis

The causative agent of meningococcal infection is the bacterium meningococcus, which belongs to the genus Neisseria, which contains 2 types of bacteria - meningococci and gonococci. The source of infection is carriers of the infection, which is transmitted by airborne droplets.

The most pathogenic are group A meningococci; when infected, they lead to the development of severe meningococcal infection. In children, meningitis is caused mainly by enteroviruses that enter the body through food, water, and dirty objects. It can develop against the background, or.

The disease can be transmitted during childbirth, by airborne droplets, through mucous membranes, dirty water, food, bites of rodents and various insects. You can also become infected through a kiss.

Secondary meningitis occur when an infection enters the brain from other foci of inflammation - boils, osteomyelitis, etc. Men and children under 10 years of age are most susceptible to this infection.

Symptoms of meningitis

This is a very dangerous disease that is transmitted by airborne droplets, which increases the risk of contracting this disease. In this regard, it is important to know the first symptoms of meningitis, as well as how it manifests itself in children and adults. Timely detection of meningitis and its symptoms will help to promptly seek medical help, which will minimize possible complications.

The duration of the incubation period for meningitis depends on the main pathogen; in the case of meningococcal infection, it is 5-6 days, in some cases the period increases to 10 days.

Symptoms with the bacterial form usually occur suddenly. Symptoms of the viral type may appear suddenly or gradually over several days.

The most common first signs of meningitis in adults are:

severe and persistent headache;
high body temperature;
muscle and joint pain;
stiffness of the neck muscles - difficult or impossible flexion of the head;
shortness of breath, rapid pulse, cyanosis of the nasolabial triangle;
increased sensitivity to light and sound;
nausea and vomiting, general weakness, loss of appetite.

Meningeal syndrome is expressed Kernig's and Brudzinski's symptoms.

Kernig's sign (inability to straighten a leg bent at the hip and knee joints), pain when pressing on the eyeballs.
Brudzinski's sign(when you try to tilt your head forward in a lying position, your legs bend at the knees; when you press on the pubis, your legs bend at the knee joints).

Patients lie on their side, their head is thrown back strongly, their arms are pressed to their chest, and their legs are bent at the knees and brought to the stomach (“pointing dog pose”). Meningitis and meningococcal septicemia cannot always be identified immediately, since the symptoms are very similar to influenza. It is important to understand that the disease can be accompanied by other symptoms, which can complicate self-diagnosis.

Symptoms of meningitis in children

It is not easy to suspect meningitis in a child, since he cannot yet complain about the symptoms that bother him.

In a small child, signs of meningitis may include high fever, increased excitability, in which it is difficult to calm the baby, decreased appetite, rash, vomiting and high-pitched crying. There may be tension in the muscles of the back and limbs. In addition, children may cry when they are picked up.

Parents should definitely call a doctor if they notice the above signs.

Treatment of meningitis

For meningitis, treatment in children and adults should be comprehensive and carried out in a hospital. To clarify the diagnosis, as well as identify the causative agent of meningitis, a spinal puncture is performed.

Therapeutic measures for meningococcal infection include etiotropic, pathogenetic and symptomatic therapy.

The basis of treatment for meningitis is antibacterial therapy. The drug is prescribed taking into account the identified causative agent of the disease and is administered intravenously. The use of medications will be carried out for at least a week after the person’s temperature returns to normal. To destroy meningococcus, antibiotics of the penicillin group or their semisynthetic analogues (amoxicillin) are most often used.
Anti-inflammatory and are prescribed to alleviate the symptoms of the disease, reduce the risk of complications, including an allergic reaction to any antibiotic
In case of development of cerebral edema, dehydration with diuretics (diuretics). When using diuretics, it should be taken into account that they contribute to the leaching of calcium from the body.

Depending on the clinical form of meningitis, the severity of meningococcal infection, the combination of drugs and therapeutic approaches are different. After completion of inpatient treatment, it is necessary to continue treatment on an outpatient basis. In case of correct and timely treatment, the probability of death is no more than 2%.

Vaccination against meningitis

In most cases, the meningococcal vaccine, the Haemophilus influenzae type B vaccine, and the triple vaccination against measles, rubella and mumps are used. The meningitis vaccine is valid for 3 years and is up to 80% effective. The vaccine is not given to children under 18 months.

Doctor Komarovsky:

Prevention

The main preventive measure today is still vaccination. You can get vaccinated if you wish, it is not mandatory. Nonspecific prevention involves avoiding contact with adults or children who show signs of the disease.

Meningitis consequences

The consequences will depend on how the disease progressed in the person.

If it was complicated, the person may even lose hearing or vision. In addition, some forms of this disease can provoke disruption of the brain and difficulties with mental activity. If suffered in early childhood, it can cause mental retardation, disruption of primary brain functions, and hydrocephalus.

If treatment for meningitis is started in a timely manner and the patient is treated with antibiotics, then in 98% of cases the patients are completely cured and do not suffer from any consequences. The above complications can occur in 1-2% of people who have suffered from this disease.

Meningitis is a complex inflammatory lesion of the meninges, which most often occurs in children, although the disease can also develop in adults. Meningeal symptoms appear quite clearly and intensely. In addition, there are signs that are characteristic of this disease. In children and adults, the course of meningitis may differ slightly.

So, the presented pathology is a viral or bacterial inflammatory lesion of the membranes surrounding the brain, which can develop in people with weakened immune systems. All forms of the disease, except , are quite severe and can lead to serious consequences (impaired brain function, coma, loss of vision or hearing, death). Moreover, the highest risk of their occurrence is observed in older people.

As for the reasons for the development of the disease in a child or adult, they can be as follows:

Watch the video in which an infectious disease doctor talks in detail about the disease:

These reasons can be considered the most common. If a person has a strong immune barrier, then it will not allow inflammation to develop. However, it is necessary to know the reasons that provoke the disease. Only in this case can you provide effective preventive measures not only for yourself, but also for your loved ones.

Meningitis: common symptoms in adults and children

In order to recognize meningitis, it is necessary to consider its clinical manifestations. The following signs are common to children and adults:

Chills and fever, which is especially pronounced in children.
Changes in consciousness, disturbances in the human mental sphere, the appearance of hallucinations.
Nausea, which is often accompanied by uncontrollable vomiting.
Photophobia, excessive sensitivity to loud sounds. Usually the patient turns to the wall and completely covers himself with a blanket.
An adult or small child suffering from meningitis usually feels as if the skull is bursting. Moreover, the unpleasant sensations only intensify with any movement or exposure to various irritants.
Hardening of the neck muscles. In this case, the patient is unable to bend or turn his head.

Clinical forms of meningitis and their symptoms

Bluishness in the area of the nasolabial triangle.
Paleness of the skin.
Decreased attention.
Significant decrease in appetite.
Shortness of breath, rapid breathing and pulse.

Reduced blood pressure.
An unusual position when the patient's head is thrown back and his legs are pulled up to his stomach.
Among the meningeal signs one can also distinguish too high tactile sensitivity. When touching a sick adult or child, he feels severe discomfort.
Skin rash.

These symptoms are considered common to adults and children. If the causes and general signs of the disease are identified, then it is impossible to treat the disease on your own. You need to see a doctor immediately.

General infectious and cerebral signs of the disease

The above symptoms can be classified into several groups. The first of them is general infectious signs. The following symptoms of meningitis may include:

Feeling hot.
General weakness and malaise.
Pain in muscles and joints.
Runny nose, sneezing, red throat.
Increased body temperature.
Enlarged lymph nodes.

About the symptoms, causes, diagnosis, treatment and prevention of meningitis (detailed video in Russian, with comments from doctors):

In addition, we can also identify general cerebral symptoms of meningitis in adults and children:

, which cannot be appeased in any way.
Congestion at the bottom of the eyeball.
Headache that spreads throughout the head and into the eyes.
Disorders of consciousness.
Seizures caused by increased intracranial pressure.

These manifestations of meningitis are not considered specific, as they may indicate other pathologies.

Specific meningeal symptoms

There are special and adults who talk only about this disease. They make it possible to make a more accurate diagnosis. So, we can name the following signs of pathology:

Kernig's sign. It is the most well-known sign of meningitis in both children and adults. The disease can manifest itself as follows: when the leg is passively flexed at the hip and knee joints in a lying position, it is subsequently impossible to straighten it. The fact is that the leg muscles are straining too much. This symptom is specific.
Symptom of a “scaphoid” abdomen. In this case, the stomach pulls inward on its own; the patient cannot control this. Some doctors consider this symptom to be part of a special meningeal posture.
Bekhterev's sign. It lies in the fact that even with a light tap on the cheekbone, the facial muscle contracts and the patient develops a kind of grimace on his face. The fact is that at the slightest touch, a child or an adult feels wild pain.

Mendel's symptom, manifested in a sharp increase in headache when pressing with a finger on the front wall of the ear.
Kehrer's sign. When the doctor presses on the exit points of the trigeminal nerve, the patient also feels pain.
Hermann's sign. With meningitis, passive tilting of the head in a child or adult, if he is lying on his back with straightened limbs, causes spontaneous extension of the big toe.
Gordon's sign. If you squeeze the patient’s lower leg muscles with your hand, he will experience extension of the big toe.
Guillain's sign. It is characterized by involuntary flexion of one leg if the patient’s hand clamps the shin of the other limb.
Lafora's sign. It is characterized by the presence of pointed facial features in a child or adult.
Flatau's sign. If you carefully observe a patient with meningitis, then when you tilt your head, you can detect dilated pupils.

For a method for determining meningeal symptoms, watch the video:

Bogolepov's symptom. Regardless of whether the patient is conscious or impaired, a painful grimace will remain on his face when checking for Kernig and Guillain signs.
Mandanesi's sign. With meningitis it manifests itself very clearly. If you press on the patient's eyeballs, his face will be tense.
Bickel's sign. People who have meningitis cannot straighten their elbows even with the help of a doctor.
Levinson's sign. A child or an adult opens his mouth when he tilts his head forward. This movement is spontaneous and does not depend on the will of the patient.
Brudzinski's sign. If a cheek symptom is present, it manifests itself as follows: after pressing on the cheek under the cheekbone, the shoulder girdle on that same side rises in a child or adult. There is also an upper meningeal symptom in adults and children. In order to determine it, the patient will have to lie straight on his back and try to bend his head towards his chest. With meningitis, his legs will automatically bend at the knees, as well as the hip joint. In addition, the patient tries to pull the limbs towards the stomach. It produces the same actions when pressing on the pubis. This is the bottom symptom of meningitis.

Since it is quite difficult to determine meningitis on your own (precious time is lost), it is necessary to urgently consult a doctor, even if only one of these signs is observed. Meningeal signs will help to more accurately determine the disease.

Symptoms of meningitis depending on the age of the patient

Now you need to figure out what signs of meningitis are typical for patients of different ages. For example, the first signs of meningitis in children under 1 year of age are similar to the manifestations of colds, so they are sometimes confused. The baby's mucous membranes of the mouth and nose dry out, and signs of an inflammatory process appear. In most cases, the onset of meningitis in a child is not recognized in time until the pathology enters the acute phase of development.

In addition, the newborn himself cannot say what exactly hurts him, where the maximum discomfort is felt. That is why meningitis in a child may not be detected in time and in the first year of life he must be constantly under medical supervision. Also, in the first months of life, a brain ultrasound procedure is indicated, which will help identify many other pathologies, if they are present.

Signs of meningitis in children under one year of age are as follows: high temperature, chills, fever, protrusion and pulsation of the fontanelle, irritability of the baby, impaired sucking, sudden agitation from any touch.

Symptoms of meningitis in children 2-3 years old:

A sharp increase in temperature up to 40 degrees, and the fever is very persistent and difficult to bring down with standard medications.
Chills, drowsiness, lethargy.
Paleness of the skin.
Lack of response to an adult.
Constant vomiting, after which it does not get better.
Cramps and spasms.

Symptoms of meningitis in children 3-4 years old are easier to recognize than in infants, because you can already ask them about their sensations. Even if the baby cannot answer clearly, he will notice confusion, which already indicates health problems.

Traditional doctors from the program “Live Healthy!” will tell you how to protect your child from a dangerous virus. (start 32:55):

The first symptoms of meningitis in children who are 5-6 years old can be determined not only by the previously mentioned manifestations, but also by the condition of the internal and external mucous membranes, and by the ability to swallow food.

Signs of meningitis in children 7-10 years old are usually as follows:

Nausea, which is accompanied by uncontrollable vomiting.
Very rapid rise in temperature to extreme values.
Confusion, delirium.
Numbness of the limbs or the appearance of seizures.
Sharp.
Graininess of the palatal surfaces, redness of the throat, clouding of the whites of the eyes.

Signs of meningitis in children 11 years of age, as well as in adolescents, are practically no different from those described above.

Symptoms characteristic of different forms of the disease

We found out how meningitis manifests itself in children and adults. Let's consider the signs of pathology depending on its form:

Cryptococcal meningitis. The cause of the disease is a fungal infection that can be found anywhere. In this case, the patient has the following symptoms: headache, hallucinations, fever, mental disorders, nausea and vomiting, photophobia, neck curvature.
Aseptic meningitis. It develops as a result of poor treatment of syphilis. Aseptic meningitis is more common in adults. It is characterized by inflammation of the membranes of both the brain and spinal cord. Aseptic meningitis is characterized by the following symptoms: headache, fever, decreased vision and loss of visual acuity, neck pain, nausea and vomiting, confusion. In addition, this pathology is manifested by photophobia, an inadequate reaction to sounds.

Infectious meningitis. It is provoked by the influenza virus or lesions of the upper respiratory tract. The disease has the following symptoms: stiffening of the neck muscles, the patient exhibits fever, sensitivity to stimuli (light and sound), rapid breathing and heartbeat.
Meningococcal and enteroviral meningitis. It is characterized by a hemorrhagic rash, herpetic rashes in the area of the lips, mucous membranes of the mouth, and bruises. Enteroviral meningitis is not considered a fatal disease, but without treatment it can lead to the development of serious complications.

Bacterial meningitis. This form of the disease is the most dangerous. Bacterial meningitis can even lead to the death of the patient. It is provoked by any pathological bacterium that begins to multiply in conditions of decreased immunity. Bacterial meningitis is characterized by the following symptoms: a sharp increase in temperature, headache, dizziness, manifestations of mental disorders, and an unusual posture characteristic of the patient (legs bent to the stomach and head thrown back).

Tuberculous meningitis is considered quite common, the symptoms of which are: chills, slow increase in body temperature, tracheitis or catarrhal sore throat. In addition, the patient slowly develops asthenia, decreases appetite, and develops general malaise.
If a patient has suspicions of purulent meningitis, the symptoms of this pathology may be as follows: a sharp increase in body temperature, inadequate reaction to light and sounds, weakness and lethargy, the presence of all meningeal symptoms.

As you can see, the symptoms and treatment of meningitis depend on its type. Therefore, examination of the patient should begin as early as possible. Knowing how to recognize meningitis, you can, without exaggeration, save the life of yourself or another person.

Treatment of meningitis

Therapy is carried out mainly in a hospital setting. In this case, the patient is provided with complete rest, all possible irritants that contribute to increased pain are removed.

Various drugs are used for treatment: antibacterial, anti-inflammatory, immunomodulatory. Therapy generally helps, especially if you start it as early as possible. That is why diagnosis should not be delayed and attention should be paid to the symptoms of meningitis in adults and especially in children.

I remember from childhood how persistently my mother warned me not to run around in winter without a hat. It's so easy to catch meningitis. With such a serious illness it is unlikely that they will be saved. But if they pump you out, then there is a high risk of remaining mentally retarded for the rest of your life. Unfortunately it's true. People can even die from such a pathology. What kind of disease is this? And what are the signs of meningitis in adults?

Briefly about the disease

The disease meningitis is an inflammation of the membranes of the brain. It is provoked by bacteria and viruses that have penetrated the encephalitic barrier. This pathology often occurs with reduced immunity. This condition is dangerous for humans. Because in case of damage to large parts of the nerve fibers, it can be very sad. Sometimes there is cessation of breathing or cardiac activity.

Pathology can occur independently or is a complication of a previous illness. Depending on this, meningitis is distinguished:

Primary. Initially, damage to the meninges occurs.
Secondary. Against the background of illness (leptospirosis, mumps, otitis), the infection spreads to other tissues and affects the meninges.

Main reasons

Meningitis is an infectious disease. The causative agents of primary pathology can be:

Bacteria. The disease is caused by meningococcal infection. The source of infection is human carriers. As a rule, these are patients who are diagnosed with an intestinal infection, nasopharyngitis. Pathology is transmitted by airborne droplets. There is a high risk of becoming infected in crowded places. The pathology in medicine is called purulent meningitis. In addition to meningococcus, the disease can be provoked by: tuberculosis bacillus, pneumococcus, Haemophilus influenzae, spirochetes.
Viruses. They can also cause illness. Viral meningitis often occurs due to enterovirus infection. But sometimes the origins are: herpes, chickenpox, measles, mumps, rubella. This pathology is called serous meningitis.

Causes of secondary pathology

They may be the following diseases:

boils on the neck, face;
otitis - chronic, acute;
sinusitis;
frontitis;
lung abscess;
osteomyelitis of the skull bones.

If the above diseases are not treated correctly, the infection can quite easily spread to the membranes of the brain. Thereby provoking a dangerous pathology.

Symptoms of pathology

The following signs of meningitis in adults may occur:

Headache. The discomfort experienced by the patient is intense and bursting. The pain can wake you up even in the middle of the night. This symptom can be briefly eliminated with any painkiller: Ibuprofen, Ketanov, Diclofenac, Analgin. Discomfort is localized in the forehead and temples. Sometimes there is pain throughout the entire head. If we talk about the characteristic signs of meningitis in adults, then this is the main and obligatory symptom. There may be pain in the back area, especially in the lumbar region.
Heat. The above symptom necessarily occurs against the background of hyperthermia. The thermometer reading can reach 40 degrees. With tuberculous meningitis, the indicator, as a rule, does not exceed 38 degrees.
Vomiting, nausea. Such signs of meningitis in adults occur suddenly. They do not depend on food intake. The patient does not experience relief after vomiting.
Photophobia, dizziness. These are fairly common symptoms, but not necessary. The patient may experience discomfort if his skin is touched.
Rash. Viral meningitis can be characterized by red spots on the body of various sizes. When you press glass on them, they disappear. It is important to understand that not every rash is a sign of meningitis. Rubella, measles, and enterovirus infection can cause similar symptoms. Dark spots that do not disappear when pressed with glass may indicate the presence of meningococcal infection.
Drowsiness, lethargy. In some cases, such symptoms are so severe that the patient cannot be awakened.
Presence of seizures. They indicate severe brain damage.
Inappropriate behavior. Not all patients may experience drowsiness. Sometimes a person is in a cheerful state and complains of a headache. After which he exhibits inappropriate reactions: he does not recognize his relatives, is unable to navigate, sees hallucinations, shows aggression, and expresses delusional ideas.

How to suspect pathology based on the first symptoms?

There is a fairly easy way to test a conscious patient for possible cerebral meningitis. However, you should not make a diagnosis yourself. This is only a specific test that allows you to suspect pathology. The diagnosis can be made only on the basis of diagnostics.

Ask the patient to tilt their head forward and try to tuck their chin to their chest. With bacterial meningitis, a person will not be able to do this. His head hurts so much that he protects it like a crystal one, afraid to make an unnecessary movement. And if you bend over, the discomfort increases sharply.

Diagnosis of the disease

Confirming the presence of meningitis is possible only with a combination of three main signs:

the presence of characteristic symptoms;
identifying signs of infection;
certain changes in the cerebrospinal fluid.

Thus, the diagnosis of meningitis includes the following studies:

cerebrospinal fluid examination;
radiography of the skull;
fundus examination;
electroencephalography.

In this case, the most important study is a lumbar puncture - a study of cerebrospinal fluid. It checks the level of protein, glucose, and the number of leukocytes. This examination allows you to determine whether the patient has developed serous or purulent meningitis. This diagnosis is extremely important because the treatment the patient needs will be based on the findings.

MRI, ultrasound, CT can show the presence of pathology only after two weeks after its occurrence. However, such examinations are extremely necessary to be able to differentiate meningitis from other serious diseases: stroke, encephalitis, brain abscess, tumor.

The cerebrospinal fluid analysis is sent for a special microbiological study and PCR. After a few days, they will give results, answering the important question of what caused the meningitis. This will allow you to select adequate therapy.

Treatment of the disease

It is very important to understand how dangerous a disease such as meningitis is. Treatment of pathology should be carried out by a doctor in a hospital setting. It is completely unacceptable to fight this disease on your own.

For meningitis, antibiotic therapy is required. Such medications should be taken only as prescribed by a doctor. Don't forget that bacteria evolve very quickly. They are able to adapt to their environment.

A prerequisite for cure is a complete course of antibiotics. This will get rid of all germs. If the course is interrupted (when the patient experiences improvement), the bacteria survive and become immune to the prescribed remedy.

Fighting pathologies

In purulent meningitis, the causative agent of the disease is bacteria. Before receiving a cerebrospinal fluid analysis, the doctor prescribes broad-spectrum antibiotics in maximum doses.

Typically, the following medications are prescribed:

"Cefepime."
"Ceftriaxone".
"Ceftazidime."

If the pathology is caused by pneumococcus, then the antibiotic Vancomycin is prescribed. Additional drugs to it are Cefepime or Pefloxacin.

As a rule, serous meningitis is caused by viruses. Treatment can be quite specific if the pathology is provoked by the herpes virus, chickenpox virus, or cytomegalovirus.

In this case, one of the drugs is prescribed intravenously:

"Acyclovir".
"Virolex".
"Zovirax".

In addition, the patient is prescribed specific immunoglobulins according to the regimen.

For serous meningitis, interferons are also prescribed:

"Viferon".
"Laferon".

Be sure to treat any meningitis with diuretics to reduce swelling of the brain:

"Diakarb."
"Beckons."

The patient may be prescribed corticosteroid hormones and certain neuroprotectors. If necessary, anticonvulsant medications are included.

Consequences of pathology

In most cases, meningitis goes away in the patient like a bad dream, leaving behind:

headache - when the weather changes or overwork;
decreased memory, concentration, attention.

Sometimes more serious consequences of meningitis are observed:

blindness;
deafness;
stuttering;
decreased mental abilities;
disorders of internal organs;
neurological pathologies - nerve paresis, strabismus, mental changes.

To avoid such complications, and at the same time the pathology itself, fairly simple recommendations can be made: maintaining hygiene, timely vaccination and wearing a mask during epidemics.