Attacks of meningitis. Tuberculous meningitis is serous leptomeningitis. By the nature of inflammation

Meningitis is an inflammatory disease localized in the hard, soft or arachnoid membrane of the brain or spinal cord.

Meningitis can develop as a primary (independent) disease or as a consequence of an inflammatory process localized in other organs.

To diagnose the disease, a lumbar puncture of the cerebrospinal fluid is used, which makes it possible to determine the presence and cause of inflammation.

The most characteristic symptoms:

• photophobia (acute painful reaction to light);
• severe sensitivity to sounds;
• strong headache;
• rigidity (tension, stiffness) of the neck muscles;
• feverish condition;
• altered consciousness;
• drowsiness;
• irritability.

Classification of meningitis

There are several ways to classify meningitis. The main medical classification when making a diagnosis is the ICD-10 classification of meningitis.

Bacterial pathogens not covered elsewhere (G00):

• influenza (G00.0);
• pneumococcus (G00.1);
• streptococcus (G00.2);
• staphylococcus (G00.3);
• other microorganisms (G00.8);
• unspecified bacteria (G00.9).

Other bacterial pathogens(G01):

• typhoid fever (A01.0);
• salmonellosis (A02.2);
• tuberculosis (A17.0);
• anthrax (A22.8);
• leptospirosis (A27);
• listeriosis (A32.1);
• meningococcus (A39.0);
• syphilis:
  • primary (A50.4);
  • secondary (A51.4);
• neurosyphilitic (A52.1);
• gonococcus (A54.8);
• Lyme disease (A69.2).

• For viral lesions (G02.0):
  • enterovirus (A87.0);
  • rubella (B06.0);
  • adenovirus (A87.1);
  • chicken pox (B01.0);
  • herpes simplex (B00.3);
  • herpes zoster (B02.1);
  • measles (B05.1);
  • mononucleosis (B27);
  • mumps (B26.1).
• For fungal infections (G02.1):
  • candidiasis (B37.5);
  • coccidioidomycosis (B38.4);
  • cryptococcus (B45.1).
• For other established etiologies (G02.8):
  • trypanosomiasis (B56);
  • Chagas disease (B57.4).

Caused by unspecified etiology (G03):

• chronic (G03.1);
• recurrent benign (G03.2);
• non-pyogenic (G03.0);
• caused by other pathogens (G03.8);
• unspecified (G03.9).

As can be seen from the lists presented, there are a lot of causes of the disease - from specific pathogens (G00) to complications of viral diseases and other invasions (G02).

Simplified classification of meningitis by etiopathology:

1. Bacterial.
2. Fungal.
3. Mixed.
4. Viral.
5. Protozoan.
6. Other (unspecified) etiology.

In addition to the main medical classification, there is a clinical and anatomical classification, based on the localization of the inflamed meninges:

• pachymeningitis - inflammation in the dura mater of the brain;
• arachnoiditis - inflammation of the arachnoid membrane;
• leptomeningitis - inflammation is localized in the pia mater.

Also, depending on the lesion:

1. Basal - in the area of ​​the base of the brain, symptoms of damage to the cranial nerves.
2. Convexital - localized on the convex surface of the cerebral hemispheres, symptoms of cortical irritation with predominant psychomotor agitation, severely confused consciousness.
3. Total - with damage to the entire area of ​​the meninges and spinal cord.
4. Spinal - affecting only the spinal cord.

Based on changes in the cerebrospinal fluid, meningitis (more precisely, leptomeningitis) and the nature of the inflammatory process can be divided into:

• purulent;
• serous.

According to the nature of occurrence, meningitis can be divided into primary and secondary.

According to the clinical picture, it can have a fulminant (fulminant), acute, subacute and chronic course.

There are three degrees of severity of meningitis: mild, moderate, severe. Depending on the presence of complications, meningitis can be complicated or uncomplicated.

Determining the etiology of meningitis plays a decisive role in choosing therapy. Some forms of meningitis can be prevented with vaccinations: hemophilus influenzae, meningococcal, mumps, pneumococcal.

Treatment of meningitis

The main principle of treating meningitis is the use of special drugs.

The main treatment method successfully used to treat meningitis of various etiologies is etiotropic therapy.

Its main goal is to destroy the pathogen using medications(antibiotics, etc.) of targeted action.

Before determining the type and type of pathogen, broad-spectrum antibiotics are prescribed.

After determining the type of pathogen and determining its sensitivity to antibiotics different groups, treatment is adjusted: antibacterial therapy with a more precise spectrum of action is prescribed.

In adults

In addition to etiotropic therapy, symptomatic therapy is carried out, aimed at alleviating the patient’s condition and eliminating the concomitant manifestations of meningitis. The disease is characterized by a significant increase in intracranial pressure, so diuretics are often prescribed - diuretics that help reduce pressure.

Meningitis is often accompanied by vomiting and fever, so anti-intoxication therapy is carried out by drip intravenous infusion of solutions of sodium chloride and glucose with the addition of potassium and magnesium.

Infusion therapy allows you to normalize the water-salt balance during the use of diuretics, avoid dehydration during vomiting, and alleviate the condition during fever.

Anticonvulsants, painkillers, and antipyretics (antipyretics) are prescribed as needed. IN in rare cases, especially with fulminant development of meningitis, a lumbar puncture can be performed to reduce intracranial pressure. Many people are interested in the timing of treatment for meningitis. medications. When treated with antibiotics, the course continues for at least 7 days after the condition has normalized.

Hormonal therapy with corticosteroids can significantly reduce the risk of developing cerebral edema. Therefore, in the absence of significant contraindications, a short course of corticosteroid therapy is prescribed.

Types of vaccination against potential meningitis pathogens:

• From hemophilus influenzae infection at 3, 4.5, 6 months, followed by vaccinations at 1.5 years.
• Pneumococcal and meningococcal vaccination carried out according to indications, is not included in the list of mandatory vaccinations.
• The triple vaccine against measles, rubella, mumps is carried out three times and then every 5-10 years.
• From chickenpox. But most experts believe that it is easier for children to get chickenpox than to be vaccinated against it. A potential danger arises if a person did not have chickenpox in childhood.

Vaccination is the main means of preventing meningitis in children (since it is children who most often get meningitis). Therefore, doctors strongly recommend not to ignore national calendar vaccinations.

Video on the topic

is an inflammatory process that occurs in the membranes of the brain and spinal cord. In this case, there is a distinction pachymeningitis (inflammation of the dura mater of the brain) and meningitis (inflammation of the soft and arachnoid membranes of the brain).

According to experts, cases of inflammation of the soft tissues are more often diagnosed meninges, which are usually referred to as “meningitis”. Pathogens of this disease are a variety of pathogenic microorganisms: viruses, protozoa, bacteria. Meningitis most often affects children and adolescents, as well as older people. Serous meningitis most often affects children of preschool age. Viral meningitis has milder symptoms and course than bacterial meningitis.

Types of meningitis

According to the nature of inflammation in the membranes, as well as changes in the cerebrospinal fluid, meningitis is divided into two types: serous meningitis And purulent meningitis . In this case, the predominance in the cerebrospinal fluid is characteristic of serous meningitis, and the presence of more neutrophils – for purulent meningitis.

Meningitis is also divided into primary And secondary . Primary meningitis occurs without the presence of infectious diseases in the patient’s body, and secondary meningitis manifests itself as a complication, such as general infection, and an infectious disease of a specific organ.

If you monitor the prevalence of the inflammatory process in the meninges, then meningitis is divided into a disease of a generalized and limited nature. So, basal meningitis arises from the base of the brain, convexital meningitis - on the surface of the cerebral hemispheres.

Depending on the speed of onset and further progression of the disease, meningitis is divided into fulminant , spicy (sluggish ), subacute , chronic .

According to etiology there are viral meningitis , bacterial , fungal , protozoal meningitis .

Clinical picture of meningitis

Diseases that have become chronic form (sarcomatosis , , toxoplasmosis , leptospirosis , , brucellosis etc.), can serve as a kind of impetus for the development of meningitis.

Infection of the meninges can occur by hematogenous, perineural, lymphogenous, or transplacental routes. But basically, the transmission of meningitis is carried out by airborne droplets or contact. At contact method infection, pathogens can get on the membranes of the brain due to the presence of a purulent infection of the middle ear, paranasal sinuses, the presence of dental pathologies, etc. The mucous membrane of the nasopharynx, bronchi, and gastrointestinal tract acts as an entry point for infection during meningitis. Entering the body in this way, the pathogen spreads through the lymphogenous or hematogenous route to the membranes of the brain. Clinical manifestations of meningitis are accompanied by the presence of an inflammatory process in the meninges and adjacent brain tissue, microcirculation disorders in cerebral vessels. Due to too strong secretion of cerebrospinal fluid and its slow resorption, the normal level may be disrupted and dropsy of the brain appears.

Manifestation of pathological changes during purulent meningitis, which is acute, does not depend on the pathogen. After the pathogen penetrates the membranes of the brain through lymph or blood, the inflammatory process affects the entire subarachnoid space of the brain and spinal cord. If the area of ​​infection has a clear localization, then the purulent inflammatory process may be limited.

When infected, swelling of the membranes and substance of the brain occurs. Sometimes flattening of the cerebral convolutions occurs due to the presence of internal . In patients with serous viral meningitis, swelling of the membranes and substance of the brain is observed, while the cerebrospinal fluid spaces expand.

Symptoms of meningitis

Regardless of the etiology of the disease, the symptoms of meningitis are usually similar in different forms of the disease.

Thus, the symptoms of meningitis are accompanied by general infectious signs: the patient has a feeling of chills, fever, elevated temperature body, the presence of signs of inflammation in peripheral blood(increase, presence leukocytosis ). In some cases, skin rashes may appear. On early stage meningitis, the patient may experience a slow heart rate. This symptom does not change during the development of meningitis. A person's breathing rhythm becomes disturbed and becomes more frequent.

Meningeal syndrome manifests itself as nausea and vomiting, fear of light, skin hyperesthesia, stiffness of the neck muscles and other signs. In this case, the symptoms of meningitis first manifest themselves as a headache, which becomes more intense as the disease progresses. The manifestation of a headache provokes irritation pain receptors in the membranes of the brain and in the vessels due to the development of inflammation, exposure to the toxin and increased intracranial pressure. Character pain– bursting, the pain can be very intense. In this case, the pain can be localized in the forehead and occipital region, spreading to the neck and spine, even sometimes affecting the limbs. Even at the very beginning of the disease, the patient may experience vomiting and nausea, although these phenomena are not related to food. Meningitis in children, and in more rare cases in adult patients, can manifest itself as convulsions, delirium, and psychomotor agitation. But in the process of further development of the disease, these phenomena are replaced by a general stupor and. For more late stages diseases, these phenomena sometimes turn into coma.

Due to irritation of the membranes of the brain, reflex muscle tension is observed. Most often the patient has Kernig's sign and neck stiffness. If the patient's illness is severe, then other signs of meningitis appear. So, the patient throws his head back, draws in his stomach, straining the front abdominal wall. In this case, in a lying position, the legs will be pulled towards the stomach (the so-called meningeal position). IN in some cases the patient exhibits zygomatic Bekhterev's symptom , severe pain in the eyeballs, which manifests itself after pressure or when moving the eyes. The patient reacts poorly to loud noise, loud sounds, strong odors. Best in similar condition a person feels lying in dark room motionless and with eyes closed.

Meningitis in infants is manifested by tension and protrusion of the fontanelle, as well as the presence of Lesage’s “suspension” symptom.

With meningitis, manifestations of venous hyperemia and disc edema are possible optic nerve. If the disease is severe, then signs of meningitis may include dilated pupils, diplopia, . It is difficult for a person to swallow, and possible paralysis of the limbs, poor coordination of movements, and the presence of tremors. These symptoms of meningitis indicate damage to both the membranes and substance of the brain. This is possible on last stage diseases.

Bacterial meningitis, as a rule, begins acutely, with pronounced meningeal symptoms. Slower development is typical only for tuberculous meningitis . In most cases of bacterial meningitis, sugar levels are low and protein levels are high.

In older people, the course of meningitis may be atypical. Thus, headaches may be absent or appear slightly, but trembling of the arms, legs, and head is observed. There is drowsiness.

Diagnosis of meningitis

As a rule, the diagnosis of meningitis is made based on the presence of three signs of meningitis:

— presence of a general infectious syndrome;
— presence of meningeal (meningeal) syndrome;
- inflammatory changes in the cerebrospinal fluid.

However, meningitis cannot be diagnosed based on the presence of only one of these syndromes. To make a correct diagnosis, the results of a number of virological and bacteriological research methods are important. Diagnosis of meningitis is also carried out by visual examination of cerebrospinal fluid. In this case, the specialist must take into account the general epidemiological situation and features clinical picture.

Patients who have signs of meningeal irritation should undergo a lumbar puncture. During this procedure, cerebrospinal fluid is collected for later testing using a thin needle inserted into the lower back. The current state is also determined , the presence of a large number of cells is determined ( pleocytosis ), as well as how much their composition has changed. Special tests are also used to determine the difference between bacterial and viral meningitis.

Treatment of meningitis

When treating meningitis, it is very important, first of all, to determine which pathogen provoked the development of the disease. However, this disease should be treated exclusively in a hospital setting. Viral meningitis, as a rule, is relatively mild, so the patient is strongly recommended to drink plenty of fluids in order to prevent dehydration of the body. Analgesics and antipyretic drugs are used to treat meningitis. Typically, a person recovers in about two weeks.

For bacterial meningitis, especially if it is provoked, treatment should be prescribed and carried out very urgently. If a patient is diagnosed with bacterial meningitis, then antibiotics are mainly used for treatment. generalist. The most commonly used drug for this form of the disease is . According to researchers, this remedy can destroy about 90% of meningitis pathogens. Also, immediate treatment with penicillin is prescribed to patients diagnosed with purulent meningitis.

Also, for the treatment of meningitis in children and adults, medications are used that can reduce intracranial pressure and drugs with antipyretic effects. Often in complex therapy nootropic drugs are also prescribed, , drugs that stimulate the activity of cerebral blood flow.

It is important to consider that if adults who have recovered from meningitis do not always need constant further monitoring by doctors, then meningitis in children is a reason to regularly visit a doctor even after complete recovery.

For patients who are in the recovery stage, it is important to avoid heavy stress of both a physical and emotional nature, not to be in direct sunlight for too long, not to drink a lot of fluids and try to consume as little salt as possible. Alcohol should be avoided altogether.

The doctors

Medicines

Prevention of meningitis

To date, vaccination against certain pathogens of meningitis (vaccine against pneumococcus, Haemophilus influenzae) has been successfully used. It is important to consider that vaccination gives quite tangible effect in matters of protection against meningitis, however, does not guarantee one hundred percent prevention of infection. However, even after contracting the disease, a person who has been vaccinated will get meningitis in a much shorter time. mild form. After vaccination valid for three years.

It is important to adhere to the basic rules of everyday hygiene as a method of preventing meningitis. Important Special attention Pay attention to regular hand washing; do not give personal items (lipstick, dishes, toothbrush, etc.) to strangers for use. If you have close contact with someone who has meningitis, it is important to contact your doctor immediately. A specialist may prescribe certain medications for preventive purposes.

Complications of meningitis

Bacterial meningitis can cause brain damage in humans. Thus, the most severe complications of this disease are, deafness, mental retardation due to meningitis in children. If you don't start right and timely treatment meningitis, the disease can cause death. In particular severe cases fatal outcome comes in a matter of hours.

List of sources

• E. I. Gusev, G. S. Burd, A. N. Konovalov. Neurology and neurosurgery. - 2000.
• Lobzin Yu.V., Pilipenko V.V., Gromyko Yu.N. Menigitis and encephalitis. St. Petersburg: Foliot, 2001.
• Khaitov R.M., Ignatieva G.A., Sidorovich I.G. Immunology. - M.: Medicine, 2001.
• Lobzina Yu.V., Kazantseva A.P. Guide infectious diseases. - St. Petersburg: Comet, 1996.

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

general description

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

Meningitis in adults and children can occur in primary or secondary form. Thus, primary meningitis occurs with one-time defeat brain, secondary meningitis is formed against the background of a concomitant underlying disease, in which there is a spread of infection with subsequent, relevant for meningitis, damage to the meninges. The main diseases in this case can be identified, etc.

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

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

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

Types of meningitis

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

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

Basically, meningitis is divided into purulent meningitis and serous meningitis; we will consider the features of both types of forms below.

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

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

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

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

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

Meningococcal meningitis

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

Similar changes are also observed in the spinal cord.

Timely initiation of treatment can ensure the subsidence of the inflammatory process, after which the exudate is completely destroyed. If we talk about advanced cases of this disease, as well as cases with the prescription of irrational therapy when it is relevant, then the possibility of the development of a number of specific processes cannot be excluded, as a result of which, in turn, the processes of cerebrospinal fluid dynamics may be disrupted, against the background of which it is already developing.

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

Most often it develops suddenly, which is accompanied by sharp increase fever and vomiting (it is repeated and does not bring adequate relief to the patient). Due to increased intracranial pressure, severe headache occurs. Against the background of the general condition, the patient develops a characteristic posture in which tension is noted in the area of ​​the occipital muscles with a simultaneous arching of the back and bent legs brought to the stomach.

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

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

If the course of meningitis in the form under consideration is determined to be favorable, then this, in turn, is accompanied by a decrease in temperature, and the patient develops previously lost appetite. Ultimately, a person with meningitis gradually moves into the recovery phase.

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

At protracted current after a short period of improvement, the patient’s temperature rises again, and it remains stable for a long time. This type of protracted form is either a hydrocephalic stage or a stage at which the patient develops meningococcal sepsis, the course of which is accompanied by the entry of meningococcus into the blood (which is defined as meningococcemia).

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

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

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

• Skin necrosis. The severe course of the disease against the background of meningococcal infection leads to the development of inflammation and inflammation in the vessels. As a result of this, extensive hemorrhage and, in fact, necrosis develop, which are especially pronounced in those areas in which there is compression. Subsequently, rejection occurs subcutaneous tissue and necrotic skin, resulting in ulcers. As a rule, they heal quite slowly; the depth and extent of skin damage often requires skin transplantation. Keloid scars in this case are also a common result of the disease.
• . The acute stage of this form of meningitis is in some cases accompanied by damage to the cranial nerves, of which the abducens nerve is the most vulnerable due to the passage of a significant part of it along the base of the brain. In case of defeat of this nerve paralysis occurs in the area of ​​the lateral rectus muscles of the eyes. As a rule, strabismus disappears after a few weeks. But due to the spread of infection to the inner ear, partial deafness or complete loss of hearing is often observed.
• . A common manifestation of meningitis of the form in question is, which disappears fairly quickly with treatment. As for uveitis, it is much more serious complication, which can result in panophthalmitis and subsequent blindness. Meanwhile, used today antimicrobial therapy minimizes such severe consequences.

Purulent meningitis

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

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

Sharp severity is noted in the manifestation of symptoms such as stiffness of the neck muscles and Kernig and Brudzinsky symptoms. Kernig's sign determines the inability to extend a leg bent at the knee and hip joint. As for Brudzinski's symptom, its manifestations are reduced to bending the legs at the knees when trying to tilt the head forward in a lying position, to bending the legs in knee joints also causes pressure on the pubis.

Serous meningitis

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

The source of the virus is predominantly house mice - the pathogen is found in their secretions (feces, urine, nasal mucus). Accordingly, human infection occurs as a result of consumption of products that have been subjected to similar contamination by secretions.

The disease is predominantly observed in children aged 2 to 7 years.

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

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

The duration of the incubation period of the disease is about 6-13 days. A prodromal period is often observed, accompanied by manifestations in the form of weakness, weakness and catarrhal inflammation of the upper respiratory tract simultaneously with a sudden increase in temperature to 40 degrees, . Also, these symptoms can be supplemented by severe meningeal syndrome, which causes severe headache and vomiting.

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

Tuberculous meningitis

This form of meningitis is also predominantly observed in children, and especially in infants. Tuberculous meningitis appears much less frequently in adults. In about 80% of cases of the relevance of this disease, patients reveal either residual effects of their previously suffered tuberculosis, or a form of active course of this disease in another area of ​​concentration at the time of detection of meningitis.

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

Tuberculous meningitis is characterized by three main stages of development:

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

Prodromal stage the disease develops gradually. Initially, symptoms include headache and nausea, dizziness and fever. Vomiting, as one of the main signs of meningitis, can appear only occasionally. Besides specified symptoms Retention of stool and urine may occur. As for the temperature, it is mostly low-grade; high levels are extremely rare at this stage of the disease.

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

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

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

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

Inflammation of the meningeal membranes is accompanied by the occurrence typical symptoms diseases: headaches, stiffness of the muscles of the neck and nausea. The accumulation of serous exudate at the base of the brain can lead to irritation of the cranial nerves, which, in turn, manifests itself in blurred vision, strabismus, deafness, uneven pupil dilation and eyelid paralysis.

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

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

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

Viral meningitis

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

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

Meningitis is a disease that is an inflammation of the membranes of both the brain and spinal cord. It develops as a result of pathological effects on the body of bacteria, viruses and other microorganisms. Doctors distinguish two main types of this disease, depending on the location of the inflammatory process. In leptomeningitis, the lesion affects the soft and arachnoid membranes of the brain, and in pachymeningitis it affects the dura mater. Next we will talk about the reasons for the development of meningitis and about it.

Causes

In most cases, meningitis develops due to the pathological effects of bacteria such as meningococcus, pneumococcus and Haemophilus influenzae. Such organisms can be present in the upper respiratory tract absolutely healthy people and not cause any negative consequences. But in some cases, they begin to attack the brain for no apparent reason.

Meningitis can also occur due to injury or a general weakening of the immune system under the influence of some disease. It quite often appears in those people who abuse alcohol, as well as in those who have suffered a pneumococcal infection or removal of the spleen. Various inflammatory diseases of the ear and nose are also a provoking factor.

Quite rarely, the causative agent of meningitis is Klebsiella or coli. This type of disease usually develops as a result of injuries to the brain and spinal cord, as well as against the background of blood poisoning.

Statistics show that in adults, meningitis usually has a bacterial form, and in children this disease is caused by enteroviruses. The latter penetrate into the body through water, food and contaminated objects.

In newborn babies, the disease often occurs due to infection with group B streptococcus, and infection usually occurs immediately during childbirth or some time after it. An organism such as Listeria also affects infants, and it also attacks older people.

Meningitis can be transmitted not only during childbirth, but also through airborne droplets. In addition, pathogens attack the body through mucous membranes, insect and rodent bites, as well as through food and dirty water.

Symptoms

The disease most often begins to develop acutely. Before meningeal manifestations there is fever, weakness and painful sensations in the muscles. In addition, there are different signs, characteristic of a particular pathogen. So, with pneumococcus, the patient develops pneumonia, a runny nose appears, and with meningococcus, a rash appears on the body. Enteroviruses cause disorders of the digestive tract, and mumps manifests itself as a violation functional activity salivary glands. It is imperative to pay attention to neck muscles person, if they are rigid (the patient cannot touch his chin to his neck), then it is best to immediately seek emergency medical help. In addition, often with meningitis a person cannot straighten his legs at the knee joints.

One of the most clear symptoms meningitis is a headache. Usually its manifestations grow strongly and quickly, and become so intense that small children cry or scream, and adults cannot stop themselves from groaning. After some time, the patient begins to experience intense nausea, which leads to vomiting. It can be repeated. There are also violations heart rate And muscle pain.

If a person changes body position, or is exposed to sound or visual stimuli, the pain increases significantly. Minor touching of the patient can also have an effect.

Literally a day after the very first symptoms of the disease appear, the condition begins to deteriorate sharply. The patient experiences confusion, becomes drowsy and irritable, and sometimes these symptoms develop into stupor and even coma. Meningitis causes swelling of the brain tissue, which interferes with normal blood flow and causes symptoms similar to those of a stroke. Death may occur.

Meningitis, as well as meningococcal septicemia, are not always amenable to accurate and quick recognition, since their symptoms may resemble those of the flu. The incubation period ranges from a couple of days to one and a half weeks. It is important to take into account that the disease does not always develop with all the prescribed manifestations, in addition, they do not necessarily make themselves felt consistently. Meningitis may be accompanied by other symptoms, and this is often misleading.

Quite often, before the development of meningitis, infection of the upper respiratory tract is observed; the consumption of antibiotics significantly smoothes out the overall picture of the disease. It is important to consider that when weak immunity the disease can progress as mild infection with a slight increase in body temperature, with the same degree of probability it can develop very quickly and develop into a coma.

To make an accurate diagnosis for all patients with the listed symptoms It is recommended to do a lumbar puncture to collect cerebrospinal fluid.

If you consult a doctor in a timely manner, carry out adequate diagnostics and correct selection pharmacological drugs, meningitis is quite treatable. Therefore, at the slightest suspicion of this disease, it is better to immediately consult a doctor.

A serious and quite severe neuroinfectious disease is meningitis - an inflammatory process in soft and arachnoid membranes brain, leading to swelling of brain structures and threatening for the patient's life.

The cause of such damage to the central nervous system can be bacterial agents, viruses, and less commonly protozoa. Sometimes meningitis in adult patients is provoked by autoimmune diseases, intracranial tumor processes or traumatic hemorrhage.

Meningitis is a dangerous and fleeting disease

Classification of meningitis

In accordance with the root cause of inflammation of the meninges, secondary and primary meningitis are distinguished. Secondary is often provoked by a head injury or occurs as a complication after neurosurgical manipulations; purulent ENT diseases (otitis media, sinusitis) can also be the cause. Primary meningitis is caused by the influence of a pathogenic pathogen directly on the structures of the nervous system (for example, meningococcal infection).

According to the predominant localization of the inflammatory process, meningitis can be:

• Convexital.
• Basal.
• Cerebrospinal.

According to the nature of the flow pathological process it can be classified:

• Fulminant meningitis.
• Spicy.
• Subacute.
• Chronic.

Meningitis can also vary in severity: mild, moderate, severe.

Main causes of the disease

There are two main types of meningitis causative agents: viruses and bacteria. Other etiological factors (mycoses, protozoa, rickettsia) are relatively rare.

Meningitis can be caused by a variety of pathogens

Among the viral pathogens of the disease, the Coxsackie and ECHO viruses play the most important role. Exactly viral etiology The disease is diagnosed in 60% of patients. A smaller part, about 30%, is due to inflammation of the meninges of a bacterial nature.

The main bacteria that cause meningitis in adults are pneumococcus, meningococcus, and Haemophilus influenzae. In children during the neonatal period, E. coli, enterococci, and Klebsiella can also become pathogens.

How does the inflammatory process develop?

The most common route of infection spread is hematogenous. Less commonly noted contact path, for example, if there is purulent inflammation in the bones of the skull, paranasal sinuses, middle ear.

The incubation period for inflammation of the meninges depends on etiological factor. Yes, when viral meningitis it can last from three to seven days, and with a bacterial infection - from a day to a week. Tuberculous meningitis often has a longer incubation period, up to 10-14 days; sometimes this period is regarded as prodromal, when there is no specific symptoms lesions and swelling of the membranes of the brain, and there is general weakness, malaise, and sleep disturbances.

After penetration of a pathogenic agent into the subarachnoid space, inflammatory changes and swelling occur in the meninges, which are incapable of stretching. As a consequence, a displacement of the structures of the cerebellum and medulla oblongata occurs, which leads to cerebral edema and poses a threat to the patient’s life. This development of the disease is typical for severe meningitis with a fulminant onset. In the chronic course of the disease, cerebral edema is less pronounced, and accordingly, the symptoms of the disease may not be so bright.

Signs of meningitis

Regardless of the etiology of the disease, a description of its clinical picture consists of three main syndromes:

• Intoxicating
• Meningeal
• Characteristic changes cerebrospinal fluid.

Intoxication syndrome

This symptom complex includes signs characteristic of any other infectious pathology. Hyperthermia is noted; in case of acute bacterial inflammation it can reach 39 degrees and above; a chronic course (for example, exacerbation of the process of tuberculous etiology) is often accompanied by a slight rise in temperature to 37.5 degrees.

Other symptoms of meningitis are a feeling of chills, increased sweating, weakness, loss of strength. IN laboratory indicators peripheral blood there is a leukocyte shift to the left, increased ESR, characteristic of an acute inflammatory process.

Meningeal syndrome

It includes cerebral manifestations and meningeal symptoms themselves. General cerebral - a consequence of swelling of the meninges and increased intracranial pressure. The main characteristics of the syndrome: severe diffuse headache, nausea, and possibly repeated vomiting. At severe course The disease affects consciousness, from mild stupor to coma. In some cases, the disease may manifest itself as psychomotor agitation, hallucinations, and intellectual-mnestic disorders.

Checking Kernig's sign

Meningeal signs themselves are a distinctive feature of the pathology and allow the doctor to establish a primary diagnosis based on examination of the patient. These include symptoms of hyperesthesia - increased sensitivity to light, sound, and touch of the skin. The second group is pain phenomena (Kerer, Mendel, Pulatov) and so-called muscle contractures. The latter are most often used in medical practice for diagnostics, their main characteristics:

• The inability to fully bend the patient’s head in a supine position is due to stiffness of the neck muscles.
• Kernig's sign is tension in the muscles of the back of the thigh, as a result of which it is impossible to straighten the leg bent at the knee in a person lying on his back.
• The so-called meningitis position - when due to excessive tension long muscles back, maximum extension of the back occurs with the head thrown back and the legs brought to the stomach and bent at the knees.

The presence of meningeal signs means an inflammatory process and swelling of the meninges; if such symptoms are present, you should seek medical help as soon as possible.

Changes in cerebrospinal fluid

Carrying out lumbar puncture, followed by laboratory diagnostics cerebrospinal fluid (CSF), allows not only to confirm the diagnosis of meningitis, but also to find out its etiology. Inflammatory processes and swelling of the meninges are manifested by a significant increase in cerebrospinal fluid pressure; upon external examination, it may change transparency or color. This is especially characteristic of a bacterial process - the cerebrospinal fluid becomes cloudy and light yellow in color.

Spinal tap

Laboratory analysis shows change cellular composition in the direction of its increase (pleocytosis). When the process is caused by bacteria, an increase in neutrophils is detected, with viral infection– lymphocytes. Further microbiological examination helps to identify the type of pathogen, and therefore its sensitivity to a particular antibiotic. When analyzing cerebrospinal fluid, they also give a description of the amount of sugar and protein it contains. Some clinics additionally carry out serological tests.

Other symptoms of meningitis include: skin manifestations. For example, with meningococcal infection, a stellate (hemorrhagic) rash appears on the extremities, abdomen, and less often on the head.

It should be remembered that the presence of high body temperature, which is combined with severe headache, nausea, vomiting, and the appearance of rashes on the body, may indicate a severe form of meningitis.

In this case, it is necessary to immediately seek medical help, since the fulminant course of such a disease can cause cerebral edema and threaten the patient’s life.

Complications of meningitis

IN acute period The most dangerous disease is cerebral edema and complications in the form of secondary encephalitis (damage directly to the brain tissue). Meningoencephalitis can manifest itself as focal and diffuse neurological symptoms, which sometimes persist for a long time after the patient has recovered, and in severe cases becomes a cause of disability.

Especially dangerous complication may result in the formation of a brain abscess, which more often occurs with secondary bacterial meningitis against the background of existing ENT pathology (sinusitis, otitis). It causes rapid perifocal swelling of the brain tissue and displacement of the midline structures, and therefore poses a threat to the patient’s life. In this case, along with conservative therapy, surgical treatment is performed.

Treatment

The sooner treatment for meningitis is started, the greater the patient’s chances of full recovery

Treatment of meningitis of any etiology is carried out only in a hospital setting. As a rule, primary forms of the disease (bacterial or viral) are treated in the infectious diseases department, secondary forms - in a specialized department, depending on the main diagnosis (neurosurgery, ENT). In severe cases with rapidly progressive cerebral edema, the patient is in the intensive care unit.

The therapeutic regimen for meningitis includes three main components: antibiotic therapy, symptomatic treatment and measures aimed at eliminating pathogenetic mechanisms(detoxification, fight against cerebral edema, neuroprotection, correction of acidosis).

Since bacterial meningitis is inflammation and swelling of the meninges caused by a certain type of pathogen, then antibacterial treatment carried out with appropriate antibiotics or broad-spectrum antibiotics. In addition, the antibacterial drug must penetrate well through the blood-brain barrier. The most commonly used are Cefotaxime, Ceftriaxone in combination with Ampicillin, and Benzylpenicillin.

Treatment for viral meningitis includes antiviral drugs– Tiloron, recombinant interferons, immunoglobulins. Anti-tuberculosis drugs are prescribed when the tuberculosis etiology of the disease is confirmed.

Rehabilitation

After discharge from the hospital, the patient is given recommendations for the period of treatment at home. Also, for two years, a person who has had meningitis has been registered with a neurologist at the dispensary.

Nootropic drug

For moderate and severe forms meningitis, and also after meningoencephalitis, tablet forms of drugs are prescribed: neuroprotectors (piracetam, encephabol), multivitamin complexes(vitrum, duovit), adaptogens. When there are residual neurological effects (paresis, paralysis), exercise therapy, massage, and physiotherapy are recommended. Treatment by an ophthalmologist or ENT doctor is indicated for existing visual or hearing impairments, respectively.

Full rehabilitation after meningitis also includes nutritional correction. The diet must be complete, which means it must include a sufficient amount of easily digestible protein (chicken, rabbit, lean fish, cottage cheese, fermented milk drinks), fresh vegetables and fruits, vegetable oils rich in polyunsaturated fatty acids(olive, flaxseed).

For a period of about six months, heavy physical activity, night shift work, and work at height are contraindicated.

Prevention

The main prevention of meningitis is strengthening immune system, which is ensured by good nutrition, quality rest and regular physical activity. It is also necessary to promptly and under medical supervision treat purulent foci in the skull area, for example, otitis media or sinusitis, and undergo regular medical examination to identify foci of tuberculosis.

If there is an outbreak of meningitis in a kindergarten, the institution is closed for two weeks quarantine

If the sick child visited kindergarten, then a quarantine is declared in the group. In terms of timing it corresponds incubation period diseases. For viral meningitis, it is up to 7 days; for meningococcal infection, quarantine lasts up to 10 days. It should be taken into account that if the child visited preschool, then he can continue to go to the group during the entire quarantine period. At school, when meningitis is detected, quarantine is usually not declared. Parents of children should be informed about what meningitis is, what its symptoms are, the first signs and possible complications. If there is the slightest suspicion of meningitis (high fever, headache, vomiting, rash on the body), you should immediately contact a medical facility.