Meningitis in children: consequences and treatment of the disease. Purulent meningitis in children, consequences, symptoms, causes

Purulent meningitis- an inflammatory disease of the pia mater that appears under the influence of bacterial flora.

The incidence rate is 3.3 per 100 thousand people. The disease can develop at any time age group, but children from newborns to 5 years are most susceptible to infection. The highest incidence rate is recorded in winter and spring.

Everyone is susceptible to the disease age categories, but most often purulent meningitis develops in children under 5 years of age

Etiology of the disease

Call this pathology pneumo-, meningo-, streptococci, hemophilus influenzae, coli. In newborns, the etiology of the disease is often E. coli, streptococci, and salmonella.

Classification

Considering the way the microbe enters the pia mater, consider:

• primary;
• secondary purulent meningitis.

The primary one is formed when bacteria enter through the bloodstream from the nasopharynx, where they penetrate from the outside. The source of infection is a sick adult or newborn, as well as a bacteria carrier, the route of infection is airborne and contact. Bacterial contamination of the pia mater occurs with open fractures of the skull bones and injuries of the nasal sinuses.

Secondary purulent meningitis is formed when there is a primary focus of inflammation, from where bacteria move into the membranes of the brain. Influx of bacteria by contact occurs with limited abscess of the brain, suppuration of the skull bones, sepsis. The entry of bacteria through the blood and lymph is possible from any purulent focus, but most often occurs with recurrent inflammatory diseases of the nasopharynx.

The development of purulent meningitis can be caused not only by meningococcal infection, but also by pneumococci, Haemophilus influenzae and other bacteria

By severity:

• light;
• medium-heavy;
• heavy.

With significant immunity impairment, a severe form often develops.

According to flow options, they are distinguished:

• fulminant;
• abortive;
• spicy;
• recurrent purulent meningitis.

An acute course with classic cerebral symptoms and signs of inflammation of the membranes occurs especially often. The fulminant course is characterized by the rapid progression of cerebral edema, which leads to damage to consciousness and the development of sepsis. With the abortive option, the clinical picture is erased, and signs of intoxication come first. A recurrent course is formed when untimely therapy acute variant illness, as well as in the presence of a chronic source of inflammation.

Clinic

Incubation period primary purulent meningitis 2-5 days. Characterized by rapid development with an increase in temperature to 39-40°, severe chills, increasing headache, nausea and frequently recurring vomiting. Motor and speech agitation, delusions, hallucinations, disturbances of consciousness, and convulsions develop. Signs of damage to the membranes characteristic of the pathology (Kernig’s, Brudzinsky’s symptoms, tension in the neck muscles) are positive from the very beginning of the disease and increase over the 2-3rd day. Hemorrhagic rashes appear on the body.

When inflammation spreads to brain cells, focal symptoms characteristic of encephalitis appear.

This is expressed in a disorder of the activity of the cranial nerves. Nuclear involvement oculomotor nerves can be determined due to the appearance of diplopia, strabismus, ptosis upper eyelid, differences in the size of the left and right pupils. Inflammation of the facial, trigeminal, and optic nerves develops. In adults, this is manifested by loss of fields and decreased visual acuity. Damage to the vestibulocochlear nerve is clinically manifested by decreased hearing. This is easily determined in adults; in newborns, diagnosing minor hearing loss is difficult.

Focal symptoms are diagnosed when complete and incomplete paralysis appears, speech disorders, changes in sensitivity, development pathological reflexes, increasing muscle tone. Hyperkinesis, hallucinations, sleep disorders, behavior and memory may appear. The transition of infection to the ventricles of the brain - ventriculitis, is expressed by the appearance of spastic attacks, flexion contractures upper limbs and extensor lower ones.

Consequences of purulent meningitis

Swelling of the brain due to purulent meningitis can cause compression of the brain stem. Cerebral edema develops on days 2-3 of illness, with lightning-fast form- in the first hours, expressed by speech excitation, disturbance of consciousness, appearance pathological types breathing, reflexes, increased or slowed heart rate, decreased or increased blood pressure.

Other consequences of the disease may also occur: sepsis, adrenal insufficiency, pneumonia, Bladder, kidneys, joints, infective endocarditis. When the disease develops in newborns, differential diagnosis is carried out to determine the degree of lag in mental development.

Diagnostic criteria for purulent meningitis

A typical clinical picture, the presence of meningeal signs and manifestations of focal neurological symptoms help the specialist to suspect the presence of purulent meningitis in the patient. Differential diagnosis is mandatory in situations where the disease has a hidden course or is formed secondary to the presence of a focus of inflammation. To complete the diagnosis, you should perform spinal tap, which determines increased cerebrospinal fluid pressure and its turbidity. Further Analysis cerebrospinal fluid reveals an increased presence of protein and pus. Diagnosis of the pathogen is possible using microscopy of cerebrospinal fluid smears and its inoculation on culture media.

Purulent meningitis is extremely important in the practice of any doctor, since it can be not only independent disease caused by the penetration of harmful agents, but also a consequence of many other pathologies

If the disease is secondary, they look for primary focus infections.

Differential diagnosis must be carried out with serous meningitis, manifestations of meningism with other infectious pathologies (typhoid fever, severe form of ARVI, especially in newborns).

Treatment of forms of purulent meningitis

Purulent meningitis direct reading to inpatient treatment.

In newborns and adult patients, a spinal tap and cerebrospinal fluid analysis are performed. After determining the etiology of meningitis, the patient is given antibiotic therapy taking into account the causative agent of the disease.

To combat cerebral edema during purulent meningitis, diuretics (Lasix, mannitol) are administered. Pathogenetic therapy purulent meningitis involves the use hormonal drugs(dexazone, prednisolone), doses are selected depending on the severity of the disease. Held symptomatic treatment. For sleep disorders it is recommended sedatives; to relieve motor agitation and seizures - Relanium, magnesia; in case of manifestations of infectious-toxic shock, infusion solutions are administered intravenously.

On recovery stage after completion of the acute phase of purulent meningitis, nootropic and neuroprotective drugs (Cerebrolysin, phenotropil, Cereton, piracetam, nootropil), vitamin therapy and restoratives.

Treatment of meningitis is carried out with antibiotics, antiviral or antifungal agents.

Secondary purulent meningitis is treated by eliminating the primary purulent focus, including surgical sanitation (opening, draining the abscess, puncture).

Forecast

According to the literature, up to 14% of cases of the disease in newborns and adults end fatal, especially when sepsis is associated. With timely complex therapy Purulent meningitis has a favorable prognosis. Eventually past illness There may be consequences in the form of asthenia, decreased hearing, vision, drooping eyelids, strabismus, and memory impairment. Irreversible consequences of this pathology (sepsis, blindness, deafness, dementia, epileptic seizures) are now rare.

Prevention

Effective modern method Vaccinations serve to prevent the disease. Vaccines are made according to epidemiological indications against known microorganisms that cause purulent meningitis. It is advisable to carry out vaccination in organized groups when cases of the disease are detected in them.

Purulent meningitis is an acute inflammatory disease that affects the soft membrane of the brain. Such dangerous disease can affect a person at almost any age. But the most susceptible to purulent meningitis are people with a weakened immune system, who have previously suffered severe infectious or inflammatory diseases, or with head injuries. Premature babies are also at risk.

With timely treatment, secondary infection occurs extremely rarely. If treatment is not started at the right time, not only serious complications are possible, but also death. The peak of the disease is observed in the winter-spring period.

Etiology

Development pathological process in the human body they are provoked by specific microorganisms – meningococci. Infection of an adult occurs only through airborne droplets and under the condition of close contact with an already infected person.

Risk factors include the following:

• alcohol abuse and drugs;
• infectious diseases;
• hypothermia of the body;
• frequent stressful situations, nervous tension.

The secondary causes of the development of purulent meningitis in adults are the following:

• entry into the body of Haemophilus influenzae;
• pneumococcal infection;
• spicy ;
• too weakened immune system;
• infectious and viral diseases.

It should be noted that infection can occur during surgery if the instrument is not completely sterile. Infection is also possible with open TBI.

As for newborns and children under 5 years of age, the etiological factors are the following:

• infection;
• salmonella;
• streptococcal infection.

It is worth noting that if the mother is infected with one of the above infections or is already suffering from purulent meningitis, it is not excluded intrauterine infection fetus

General symptoms

The incubation period of purulent meningitis lasts from 2 to 5 days. On initial stage the following symptoms appear:

• elevated temperature, up to 40 degrees;
• chills;
• nausea and vomiting;
• headache, which is growing.

In addition to the above symptoms, the patient may experience confusion, delirium and other mental disorders.

On the 3rd day of development inflammatory process general symptoms supplemented by the following features:

• double vision;
• development of strabismus;
• disruption optic nerve;
• partial hearing loss, and vision may also sharply decrease.

If the inflammatory process spreads to the brain substance, the above symptoms may be supplemented by the following signs:

• partial paralysis;
• speech disorder;
• hyperkinesis;
• hallucination;
• partial memory loss.

Such symptoms indicate severe form purulent meningitis in adults. If at this stage the patient is not provided with adequate medical care, then death is no exception.

In rarer clinical cases, the incubation period can last from 4 to 6 days. TO general list Symptoms may include a rash. The length of the incubation period depends on etiological factor And general condition health of the patient.

Pathogenesis

Depending on the mechanism of penetration of meningococci into the human body, two forms of development of the disease are distinguished - primary and secondary purulent meningitis.

In the first case, the infection enters from external environment and passes through the nose and throat to the brain. Infection is possible by airborne droplets or as a result of:

• skull fracture;
• non-compliance elementary rules asepsis during surgery.

Secondary purulent meningitis occurs only if the human body already has viral organism. From a septic focus, meningococci easily penetrate the cerebral cortex, which is the cause of the development of a purulent process in the dura mater of the brain. It should be noted that an adult who has already suffered from the primary form of purulent meningitis very rarely becomes ill with the secondary form of the disease.

In the secondary form of meningitis, the period of development of the disease is much shorter - from one day to two days. Wherein initial symptoms may be completely absent. The clinical picture manifests itself in the form of the following signs:

• temperature up to 40 degrees;
• nausea and severe vomiting;
• loss of consciousness, delirium;
• partial paralysis, hyperkinesis.

If these symptoms occur, seek emergency medical help immediately.

Classification

IN official medicine It is customary to classify purulent meningitis in two directions - according to the nature of the course and the severity of the clinical picture of the disease.

According to the nature of the clinical picture, meningitis is divided into the following forms:

• light;
• medium-heavy;
• heavy.

It should be noted that the severe form is diagnosed only in people with severely weakened immune systems.

Based on the nature of the course, the following forms of the disease are distinguished:

• fulminant;
• abortive;
• spicy;
• recurrent.

Most often the acute form of the disease is diagnosed. The period of development of the disease ranges from 2 to 5 days. Usually, serious complications, with timely and adequate treatment, does not occur. The symptoms are fully consistent with the clinical picture described above.

The most difficult to diagnose is the abortive form of the disease. Symptoms of meningitis are almost completely absent. The clinical picture resembles food poisoning. The period of development of this form of the disease can last from several hours to a couple of days.

As for the recurrent form of the disease in adults, it is more likely a complication from acute form diseases. The inflammatory process in this form develops if the acute subtype of meningitis was not completely cured or treatment was not started at all. The incubation period lasts from 2 to 4 days, with pronounced clinical picture.

Diagnostics

Since the clinical picture of the disease is well expressed (with the exception of abortive form), diagnosing the disease is not difficult. In addition to personal examination, instrumental and laboratory tests are required.

Laboratory diagnostics consists only of general and biochemical analysis blood. To the program instrumental methods research includes the following:

• lumbar puncture;
• collection of cerebrospinal fluid;
• X-ray of the lungs;

Treatment

Treatment is prescribed only after an accurate diagnosis and under the strict supervision of a doctor. Self-medication or ignoring medical care, in this case, can have dire consequences. According to official statistics in 15% of cases, purulent meningitis leads to death.

Treatment of purulent meningitis takes place only in a hospital. Drug therapy includes taking the following medications:

• glucocorticosteroids;
• decongestants;
• anticonvulsants;
• anti-inflammatory drugs.

If the patient is diagnosed with secondary purulent meningitis, then surgical intervention is possible.

At the end of treatment, the patient should undergo a course of rehabilitation and restorative treatment.

Forecast

If treatment is started in a timely manner, then serious consequences can be avoided.

Concerning severe consequences, they are diagnosed extremely rarely. After a long course of treatment, the following physiological disorders are possible:

• hearing or vision impairment;
• asthenia;
• liquor-dynamic disorders.

Consequences such as complete deafness or disturbances in brain function are practically not observed if treatment is started in a timely manner.

To prevent the above complications from occurring, you should call an ambulance at the first symptoms in adults or children.

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Diseases with similar symptoms:

Migraine is a fairly common neurological disease accompanied by severe paroxysmal headache. Migraine, the symptoms of which are pain, concentrated on one side of the head mainly in the area of ​​the eyes, temples and forehead, nausea, and in some cases vomiting, occurs without reference to brain tumors, stroke and serious head injuries, although and may indicate the relevance of the development of certain pathologies.

An inflammatory process that occurs in soft shell brain when pyogenic microorganisms (pneumococci, meningococci, streptococci, etc.) penetrate into it. Purulent meningitis is characterized high temperature body, intense headache, nausea, vomiting, cranial nerve disorders, early appearance meningeal symptoms, hyperesthesia, disorder of consciousness, psychomotor agitation. Purulent meningitis can be diagnosed based on the typical clinical picture and cerebrospinal fluid analysis. Purulent meningitis is an indication for mandatory antibiotic therapy. Decongestants, glucocorticosteroids, tranquilizers, anticonvulsants, etc. are used. symptomatic therapy.

The penetration of pathogens of purulent meningitis through the blood-brain barrier is facilitated by a weakened state immune system body, which can be caused by frequent acute respiratory viral infections, hypovitaminosis, stress, physical overload, and sudden climate change.

Classification of purulent meningitis

Depending on severity clinical manifestations purulent meningitis is classified into mild, moderate and severe forms. Severe forms of the disease are observed mainly against the background sharp decline immunity and in patients with a removed spleen.

According to the characteristics of the course, fulminant, abortive, acute and recurrent purulent meningitis are distinguished. The most common is acute purulent meningitis with typical cerebral and meningeal symptoms. The fulminant course of purulent meningitis from the first hours of the disease is characterized by a rapid increase in cerebral edema, leading to impairment of consciousness and vital functions. The abortive variant is distinguished by a blurred clinical picture, in which the symptoms of intoxication come to the fore. Recurrent purulent meningitis can be observed with insufficient or delayed treatment of the acute form of the disease, as well as if there is chronic focus purulent infection.

Symptoms of purulent meningitis

The incubation period of primary purulent meningitis lasts on average from 2 to 5 days. Typically acute onset with sharp increase body temperature up to 39-40°C, severe chills, intense and increasing headache, nausea and repeated vomiting. Psychomotor agitation, delirium, and disturbances of consciousness may occur. In 40% of cases, purulent meningitis occurs with convulsive syndrome. Meningitis-specific meningeal symptoms (Kernig's, Brudzinski's, Guillain's symptoms, neck stiffness) are pronounced from the first hours of the disease and intensify on the 2-3rd day. Severe hyperesthesia and decreased abdominal reflexes are typical against the background general increase deep reflexes. A diffuse hemorrhagic rash may appear.

Focal symptoms accompanying purulent meningitis most often involve dysfunction of various cranial nerves. The most common lesion is damage to the oculomotor nerves, leading to double vision, the development of strabismus, drooping of the upper eyelid and the appearance of differences in the size of the pupils (anisocoria). Less commonly observed are neuritis of the facial nerve, damage to the trigeminal nerve, dysfunction of the optic nerve (loss of visual fields, decreased visual acuity) and vestibular-cochlear nerve (progressive hearing loss). More severe focal symptoms indicate the spread of inflammatory changes to the brain substance or the development vascular disorders type of ischemic stroke caused by vasculitis, reflex spasm or thrombosis of cerebral vessels.

When the inflammatory process spreads to the brain substance, they speak of the development of meningoencephalitis. In this case, purulent meningitis occurs with the addition of focal symptoms characteristic of encephalitis in the form of paresis and paralysis, speech impairment, changes in sensitivity, the appearance of pathological reflexes, and increased muscle tone. Hyperkinesis, hallucinatory syndrome, sleep disturbances, vestibular ataxia, behavioral and memory disorders are possible. The spread of the purulent process to the ventricles of the brain with the development of ventriculitis is manifested by spastic attacks of the hormetonia type, flexion contractures of the arms and extension of the legs.

Complications of purulent meningitis

An early and serious complication that can accompany purulent meningitis is cerebral edema, leading to compression of the brain stem with vital centers located in it. Acute cerebral edema, as a rule, occurs on the 2-3rd day of the disease, in the fulminant form - in the first hours. Clinically, it is manifested by motor restlessness, impaired consciousness, respiratory distress and disturbances in the of cardio-vascular system(tachycardia and arterial hypertension, in terminal stage alternating with bradycardia and arterial hypotension).

Among other complications of purulent meningitis, the following may be observed: septic shock, adrenal insufficiency, subdural empyema, pneumonia, infective endocarditis, pyelonephritis, cystitis, septic panophthalmitis, etc.

Diagnosis of purulent meningitis

Typical Clinical signs, the presence of meningeal symptoms and focal neurological symptoms in the form of damage to the cranial nerves, as a rule, allow the neurologist to assume that the patient has purulent meningitis. Diagnosis is more difficult in cases where purulent meningitis has an abortive course or occurs secondary to the symptoms of an existing septic focus of another location. To confirm purulent meningitis, it is necessary to perform a lumbar puncture, during which it is revealed high blood pressure cerebrospinal fluid, its turbidity or opalescent color. Subsequent examination of the cerebrospinal fluid reveals an increased content of protein and cellular elements (mainly due to neutrophils). The pathogen is identified by microscopy of cerebrospinal fluid smears and when it is inoculated on nutrient media.

WITH diagnostic purpose blood and secretions are also analyzed skin rash. If it is assumed that purulent meningitis is secondary, additional examinations aimed at searching for the primary source of infection: consultation with an otolaryngologist, pulmonologist, therapist; radiography of the paranasal sinuses, otoscopy, radiography of the lungs.

It is necessary to differentiate purulent meningitis from viral meningitis, subarachnoid hemorrhage, meningism phenomena in other infectious diseases (typhus, leptospirosis, severe forms flu, etc.).

Treatment of purulent meningitis

All patients with purulent meningitis must be treated in a hospital setting. Such patients should urgently undergo a lumbar puncture and bacterioscopic examination of the cerebrospinal fluid. Immediately after establishing the etiology of meningitis, the patient is prescribed antibiotic therapy. In most cases, it is a combination of ampicillin with cephalosporin drugs (ceftriaxone, cefotaxime, ceftazidime). For purulent meningitis of unknown etiology, initial therapy consists of intramuscular injection aminoglycosides (kanamycin, gentamicin) or their combination with ampicillin. Severe purulent meningitis may require intravenous or intrathecal antibiotics.

In order to reduce hydrocephalus and cerebral edema during purulent meningitis, dehydration therapy (furosemide, mannitol) is prescribed. Pathogenetic treatment purulent meningitis also includes the use of glucocorticosteroid drugs (dexamethasone, prednisolone), the doses of which depend on the severity of the disease. Along with this, the necessary symptomatic therapy is provided. For sleep disturbances, tranquilizers are prescribed; to relieve psychomotor agitation and seizures - lytic mixtures(chlorpromazine, diphenhydramine, trimeperidine), diazepam, valproic acid; in case of hypovolemia and the development of infectious-toxic shock, infusion therapy is carried out.

IN recovery period after suffering the acute phase of purulent meningitis, it is recommended to take nootropic and neuroprotective drugs, vitamin therapy and restorative treatment. Treatment of patients with secondary purulent meningitis should include elimination of the primary septic focus, including by surgical intervention(sanitizing operation

Prevention of purulent meningitis

Today, the most effective way to prevent purulent meningitis is vaccination. Vaccinations are carried out against the main pathogens of purulent meningitis: Haemophilus influenzae, meningo- and pneumococci. In Russia, these vaccines are not considered mandatory and are administered according to indications or at the request of patients.

Vaccination against Haemophilus influenzae is carried out mainly for children aged 3 months to 5 years and people suffering from immunodeficiency states as a result of HIV infection, immunosuppressive therapy for cancer, removal of the thymus or spleen, etc. Vaccination against meningococcal infection Recommended for children over 18 months and adults. Children under 18 months of age are vaccinated according to epidemic indications(for example, if meningococcal purulent meningitis is diagnosed in one of the family members). In regions dangerous for meningococcal purulent meningitis, vaccination should be carried out for patients with immunodeficiency and people with anatomical defects of the skull. Vaccination against pneumococcal infection indicated for frequently ill children, patients with frequent pneumonia and otitis, in cases of reduced immunity.

Purulent meningitis is the most life-threatening inflammation of the mucous membranes of the brain and spinal cord, accompanied by their suppuration and swelling.

The disease occurs spontaneously, develops rapidly and is characterized by specific symptoms, not characteristic of other species. Most often diagnosed in children, young people, elderly people suffering from chronic infectious diseases with persistently decreased immunity.

Causes of purulent meningitis

Meningitis is always caused by an infection that can enter the brain different ways, first of all, with the blood flow from the primary site of localization. Most often, the source of infection in the human body is the organs of the respiratory system (throat, lungs), digestive system (stomach, various parts of the intestines), and affected teeth.
Purulent meningitis is caused by streptococci, meningococcus, E. coli, staphylococci and other microorganisms with which a person often comes into contact in everyday life.

Inflammation of the meninges can occur against the background of acute respiratory infections, etc. Meningitis usually develops without proper treatment listed diseases in persons with weakened immune systems.
People at risk of developing the disease are those most often subject to depression, stress, drug use or alcohol addiction. Outbreaks of meningitis occur during the cold season, when the human body is susceptible to various infections.

Symptoms of purulent meningitis

When the inflammatory process is localized in the brain, the following symptoms occur:

• headache, which intensifies with any stress on the body, rapid movement, or turning the head;
• general weakness, lack of appetite;
• pain in the eyes, blurred vision;
• vomit. This and the previous symptoms indicate the presence of increased intracranial pressure;
• high body temperature;
• pain in muscles, joints, decreased muscle tone;
• a skin rash that first affects the extremities and then spreads quickly. A rash due to meningitis is very dangerous; it can cause tissue death, blood poisoning, and the development of gangrene;
• loss of consciousness, convulsions, hallucinations, coma.

The signs of purulent meningitis listed at the end of the list develop on days 2-3 of the disease and can cause the death of the patient.

Purulent meningitis in children

Children under the age of one year who have had an infection or were born earlier are susceptible to developing the disease. deadline, with low weight, injured during childbirth. Purulent meningitis in a child is accompanied by characteristic symptoms of this disease symptoms, which may include shortness of breath, impairment heart rate, difficulty breathing, protrusion of the fontanel. The baby dies within a few hours from the moment the first signs of inflammation appear meninges if he is not given the right medical care.

Antibiotics from the penicillin group are used to treat purulent meningitis in children. Similar drugs are not recommended for treating a child, however in this case the risk of developing the disease exceeds the risk of developing unpleasant consequences from taking the drug. The course of treatment lasts from 5 to 10 days. Little patient After recovery, he is under the supervision of a specialist for several months.

Treatment of purulent meningitis

Meningitis can be diagnosed using laboratory research blood, urine and cerebrospinal fluid of the patient. If there is an infection in the blood, the level of leukocytes increases, taking cerebrospinal fluid makes it possible to identify the main causative agent of the disease and prescribe the correct treatment.

Therapy for purulent meningitis is based on intravenous administration the patient is given antibiotics, less often - corticoids (to reduce the inflammatory process), diuretics and agents whose action is aimed at reducing detoxification of the body (salt solution).

For meningitis, penicillin antibiotics, cephalosporins, and macrolides are effective. The latter are usually prescribed for patients intolerant to penicillin.

Inflammation of the meninges can lead to the development of complications in many body systems, and therefore requires outside supervision various specialists, including an ophthalmologist, pulmonologist, therapist, cardiologist.

Consequences of purulent meningitis

Complications and consequences of meningitis are very dangerous for human health and life; they can be avoided if treatment for the disease is started in a timely manner. Originating in the early childhood Inflammation of the membranes of the brain can cause hydrocephalus, a delay in the development of the child. To the most dangerous consequences Meningitis includes fatal pathologies: sepsis, gangrene, toxic coma.

The disease can also cause impairment various systems body, complete or partial blindness, hearing loss, lead to varying degrees of disability.