Causes of meningitis in newborns. Bacterial meningitis in newborns: causes, symptoms, treatment

Infections of the central nervous system in newborns and children of the first year of life are considered one of the most severe and unfavorable diseases. Among all infections of the central nervous system of young children, meningitis takes first place.

SYNONYMS

Acute bacterial meningitis.

CLASSIFICATION

Meningitis is called serous in cases where the inflammatory process manifests itself in the form of lymphocytic pleocytosis and lymphocytic infiltration membranes of the brain.

The serous nature of inflammation of the meninges occurs most often with viral meningitis.

In cases where modern available clinical and laboratory diagnostic methods fail to identify the causative agent of the disease, the term “aseptic meningitis” is used.

EPIDEMIOLOGY

The incidence of purulent meningitis in newborns, according to various sources, is 0.1-0.5 per 1000 children. Moreover, up to 80% of all cases of the disease occur in premature infants.

The mortality rate of newborns from purulent meningitis ranges from 6.5 to 37.5%.

Severe consequences of purulent meningitis are noted in 21-50% of patients. These include hydrocephalus, blindness, deafness, spastic paresis and paralysis, epilepsy, and delayed psychomotor development.

ETIOLOGY

The etiology of purulent meningitis in newborns differs significantly from the etiology of this infection in children of older age groups and adults.

Infection of a child leading to the development of meningitis can occur in utero, intrapartum or postnatally.

Intrauterine meningitis, as a rule, clinically manifests itself in the first 48-72 hours after birth (early); Postnatal meningitis can appear at any age, but more often after 3-4 days of life (late).

Pathogens early meningitis may contain maternal microflora. In contrast, most late meningitis is essentially a hospital-acquired infection (Table 27-9).

Table 27-9. Risk factors for the development of meningitis and probable sources of infection

In addition to the time of development of meningitis, an important guide to its etiology may be the presence or absence of other foci of infection. Meningitis that develops in the absence of obvious foci of infection is considered primary (isolated), and meningitis that develops against the background of infectious processes of a different localization is considered secondary (one of the septic foci).

LEADING ETIOLOGICAL AGENTS OF EARLY MENINGITIS

Streptococcus agalactiae

Streptococcus agalactiae ((3-hemolytic streptococcus group B). Str. agalactiae is divided into five serotypes: la, lb, Ic, II and III. Early bacterial meningitis is caused by all serotypes with almost the same frequency.

Antibiotic sensitivity Str. agalactiae

Str. agalactiae is characterized by high natural sensitivity to most antibiotics. Benzylpenicillin, ampicillin, cephalosporins, and carbapenems are active. Acquired resistance to penicillins is quite rare (there are no data for the Russian Federation). Their level of natural resistance to aminoglycosides is low, and therefore antibiotics of this group can be used in combination to increase the effectiveness of betalactams.

Escherichia coli

The role of E. coli in the etiology of early meningitis is comparable to the value of Str. agalactiae. Virulence of E. coli

E. coli strains that cause early meningitis more often have a capsular polysaccharide - Ag K-1, which, in its chemical structure and immunochemical characteristics, is quite invasive and dangerous for a child. Bacterial meningitis caused by E. coli, which has Ag K-1, is much more severe and has more serious consequences than meningitis caused coli, not possessing this Ag.

Antibiotic sensitivity of E. coli

E. coli has a high natural sensitivity to semisynthetic penicillins (amoxicillin, piperacillin, etc.), cephalosporins, aminoglycosides, and less sensitivity to ampicillin.

Listeria monocytogenes

The significance of L. monocytogenes in the etiology of meningitis in the Russian Federation has not been definitively established, but in other geographical regions, for example, in North America, this microorganism ranks third in frequency in the etiology of neonatal meningitis.

Virulence of L.monocytogenes

L. monocytogenes (Gram-positive coccobacilli) is a widespread microorganism in nature that causes infectious diseases in humans and animals. Due to the relatively low virulence in immunocompetent individuals, the infection is most often asymptomatic.

However, L. monocytogenes can be transmitted from mother to fetus, often resulting in either miscarriage or neonatal sepsis. In addition, there are known cases of listeria endometritis during pregnancy, which can also serve as a source of infection for the fetus. The number of women infected with this microorganism in the Russian Federation is insignificant.

Antibiotic sensitivity of L. monocytogenes

Listeria is characterized by a high level of sensitivity to natural and semi-synthetic penicillins (primarily ampicillin) and carbapenems (imipenem is not recommended for the treatment of meningitis, meropenem is not allowed in children under 3 months). Important Feature This microorganism is resistant to all existing generations of cephalosporins. Listeria is moderately sensitive to aminoglycosides.

ETIOLOGY OF LATE MENINGITIS

Late meningitis in most cases is a manifestation hospital infection. Their etiology is diverse and depends on the epidemiological situation in specific institutions.

Most often, late neonatal meningitis develops in children in the NICU. And also in departments for nursing premature babies.

The main pathogens are representatives of the family Enterobacteriaceae (E. coli, Klebsiellaspp., Serratia marcescens, Proteusspp., Citrobacter diversus, etc.), less often Pseudomonas aeruginosa, Flavobacterium meningosepticum and other “non-fermenting” microorganisms, III serotype Str. agalactiae.

Almost all causative agents of late meningitis are opportunistic microorganisms. Therefore, the development of meningitis during this period is facilitated not only by severe immunosuppression in a particular newborn, but also by iatrogenic factors (invasive interventions, violations of the sanitary and epidemiological regime, etc.).

PATHOGENESIS AND PATHOLOGICAL ANATOMY

Possible routes of infection:

Hematogenous (the most common route of infection), as a consequence of bacteremia. Approximately 3/4 of cases of neonatal purulent menicitis are associated with the presence of bacteremia. The most common entry point for microorganisms can be the mucous membranes of the respiratory tract. In these cases, bronchitis, tracheitis, and pneumonia develop primarily. In some cases, the primary focus of inflammation does not manifest itself clinically; in such situations they speak of primary or isolated meningitis. In cases of a verified general septic process and confirmed bacteremia, secondary purulent meningitis is spoken of as one of the septic foci;

Infection by contact along the length: with infectious processes in the area of ​​the scalp (for example, with suppurating cephalohematoma), inflammation of the paranasal sinuses, inflammation of the middle ear. osteomyelitis of the skull bones, with inflammation of the orbit and eyeball, skin and soft tissue defects, after spinal punctures, with congenital defects development of the central nervous system and skeleton (cerebral and spinal hernias), dermal fistulas and sinuses. However, this path is quite rare; the rarest route of spread bacterial infection on the membranes of the brain in newborns - penetration of microorganisms from the perineural spaces and lymphatic vessels draining the nasal cavity.

In most cases, bacterial meningitis goes through several main stages of development.

1st stage. During the birth process, the initial meeting of the fetus with microorganisms occurs, the process of colonization in the upper respiratory tract and gastrointestinal tract. Colonization is the presence of bacteria in the body in the absence of a clear immune response and clinical manifestations.

2. stage. The pathogen enters the blood, usually through the respiratory tract. Bacteremia occurs. Moreover, conditions are created under which microorganisms, bypassing the liver, enter the central nervous system via the shortest route.

3. stage. Hematogenous seeding of the soft meninges of the brain and spinal cord.

4. stage. Inflammation of the meninges with the development (or without) inflammatory changes in the brain parenchyma.

Despite the diversity of pathogens of purulent neonatal meningitis, their morphological changes are similar. The inflammatory process is localized mainly in the soft and arachnoid membranes (leptomeningitis). Involvement of the dura mater in the process occurs only sometimes in the form of small purulent deposits and hemorrhages (pachymeningitis). To one degree or another, the inflammatory process also extends to the roots of the spinal and cranial nerves, to the superficial parts of the brain along the perivascular spaces, and sometimes to the ependyma and choroid plexuses of the ventricles.

In some cases, the cerebral vessels of the perivascular brain parenchyma may be involved in the inflammatory process, which can be regarded as meningoencephalitis.

If there is little exudate, it forms thin strips in the grooves of the brain along the veins. When there is a large amount of exudate, it permeates the membranes completely, accumulating mainly at the base of the brain (in the tanks). The volume and weight of the brain increase due to swelling of its parenchyma. In some cases, the brain may become wedged into natural fissures and foramina, especially the greater occipital opening. In the first 2 days of the disease, serous or serous-purulent inflammation predominates, in the next days - purulent.

Removal of exudate occurs by phagocytosis of fibrin and necrotic cells by macrophages. Sometimes it undergoes organization, which is accompanied by the development adhesive process in the cerebrospinal subarachnoid spaces. Impaired patency of the cerebrospinal fluid pathways often leads to the development of occlusive hydrocephalus. Reparation may take 2-4 weeks or more.

CLINICAL MANIFESTATIONS

The clinical picture of purulent meningitis consists of general infectious symptoms and neurological disorders. Features of clinical manifestations in each specific case of the disease are determined by factors such as gestational age (degree of maturity), the presence of concomitant pathological or borderline conditions, various diseases, as well as the time and routes of penetration of the pathogen into the meninges.

Among general somatic disorders, the syndrome of “infectious toxicosis” often comes first, manifested by a grayish tint against the background of pallor or “marbling” of the skin, jaundice, impaired thermoregulation (usually hyperthermia), tachycardia, respiratory rhythm disturbances, intestinal paresis, regurgitation or vomiting. , hepato- and splenomegaly.

There may be a large variability of signs in the neurological status. Some newborns in the early stages of the disease show signs of central nervous system depression: lethargy, drowsiness, disturbances in the level of wakefulness, adynamia, hyporeflexia, muscle hypotonia. In another part of children, neurological disorders prevail in the form of agitation, motor restlessness, painful or high-pitched cry, hyperesthesia, tremor of the chin and limbs.

Disorders affecting the cranial nerves may manifest as large-amplitude nystagmus, floating movements eyeballs, convergent or divergent strabismus, a symptom of the “setting sun”.

Bulging and tension of the large fontanel, muscle rigidity back surface neck - signs of meningitis, which are not always detected early and clearly in newborns, especially premature ones. In some cases, a rapidly progressive increase in head circumference and divergence of cranial sutures can be observed.

Distinct disturbances in the level of wakefulness, up to the development of coma, full-blown convulsions, as a rule, appear against the background of current general infectious manifestations, but in some cases they can be one of the earliest neurological symptoms.

EARLY COMPLICATIONS OF NEONATAL PURULENT MENINGITIS

Like any infectious disease, meningitis has a certain phase of progression. The initial phase is distinguished: disturbance of cerebral circulation and facial fluid dynamics. Most frequent complications During this period, there may be cerebral edema and convulsions.

Clinically, cerebral edema is manifested by increasing intracranial hypertension with progression of impaired consciousness.

In the early stages of cerebral edema, a sharply animated (spontaneous) Babinski reflex is recorded on both sides, which is of a long-term tonic nature. Due to severe muscle extensor hypertension, examination is often impossible tendon reflexes and passive flexion lower limbs. Systemic blood pressure increases (especially its systolic component and mean blood pressure) as cerebral edema progresses, shortness of breath and tachycardia increase.

Newborns assume a posture with the head thrown back, legs extended, semiflexion, or pronounced flexion of the arms. The cry is monotonous with episodes of piercing, sometimes turning into a groan. In most cases, bulging of the large fontanel, its pulsation, and sometimes rapid separation of the cranial sutures are observed.

With severe edema of the brain, dislocation of its brainstem parts is possible, followed by their wedging into the foramen magnum, the development of secondary brainstem symptoms: coma, disturbance of the rhythm and depth of breathing, attacks of apnea, a drop in systemic blood pressure, cardiac arrhythmia (usually bradycardia or bradyarrhythmia).

Coma is clinically manifested by increasing depression of all types of cerebral activity: adynamia, areflexia and diffuse muscle hypotonia. However, due to severe disorders of peripheral hemodynamics in the child’s muscles, sclerema often develops, and identifying motor, reflex, and tone disorders can be difficult. As the coma deepens, convulsive paroxysms disappear, if they existed before. The reaction of the pupils to light disappears, there is no pain and tactile sensitivity, attacks of apnea become more frequent and deepen, a drop in systemic blood pressure is possible, and bradyarrhythmia develops.

Often the development of cerebral edema is accompanied or preceded by a convulsive syndrome.

Depending on the location of the foci of cerebral circulatory disorders and the increase in cerebral edema, convulsions can be of a different nature: tonic (primary - characteristic of very premature infants); clonic (focal, multifocal, generalized - more often in full-term infants); fragmentary (motor, ophthalmic, absence, apneic); myoclonic (axial, limb myoclonus, mixed).

As a rule, in full-term infants the convulsions are initially clonic in nature, and as the phenomena of cerebral edema progress, they transform into tonic ones.

The appearance of isolated tonic convulsions against the background of an intractable convulsive syndrome indicates decortication - a poor prognostic sign.

Brain edema can involve the nuclei and the cranial nerves themselves, which can be clinically manifested by dysfunction of the oculomotor nerves, facial nerve, trigeminal, hypoglossal nerves. In rare cases, the development of boulevard and pseudobulbar disorders is possible.

A very dangerous complication of meningitis caused by gram-negative flora is bacterial (septic) shock. Its development is associated with penetration into the bloodstream large quantity bacterial endotoxins (often at the time of prescribing antibiotics or changing the antibiotic regimen).

Clinically, septic shock is manifested by sudden cyanosis of the extremities, patchy pallor of the skin of the chest and abdomen, a catastrophic decrease in systemic blood pressure, tachycardia, severe shortness of breath, diffuse hypotension with attacks of short-term motor restlessness and a weak moaning cry, loss of consciousness, often in combination with DIC syndrome.

Late complications of neonatal purulent meningitis

Late complications of purulent meningitis include ventriculitis or ependymatitis, abscesses of the brain and spinal cord, and various forms of hydrocephalus. Late complications develop, as a rule, due to late diagnosis or inadequate treatment.

DIAGNOSTICS

The study of the clinical picture and course of bacterial meningitis in newborns indicates that they do not have unambiguous clinical criteria for early diagnosis, therefore additional laboratory methods research.

In all situations, the decisive role in diagnosis belongs to the study of CSF, therefore a spinal puncture should be performed in all doubtful and unclear cases, at the slightest suspicion of meningitis.

Indications for spinal puncture

Convulsive syndrome of unknown etiology.

Hyperthermia of unknown etiology.

Rigid neck, hyperesthesia.

Coma of unknown etiology.

Progressive depression or agitation, the cause of which is not clear.

Rapidly increasing intracranial hypertension (bulging and tension of the large fontanelle, divergence of cranial sutures, extensor hypertension in the legs).

A combination of any of the above syndromes with signs of “infectious toxicosis” without obvious clinical foci.

Contraindications to urgent spinal puncture

DIC syndrome.

Cerebrospinal fluid examination for bacterial meningitis

Laboratory analysis of CSF includes the following studies (Table 27-10).

Counting the number and determining the morphology of cells (determining their ratio as a percentage).

Determination of glucose and protein levels.

Bacterioscopy of a fixed drop of CSF, Gram-stained.

Culture of CSF to determine the sensitivity of the pathogen to antibiotics.

Detection of bacterial Ags in the CSF using standard antiserum kits (if possible).

Table 27-10. Summary data of laboratory parameters in the study of CSF in healthy newborns and in patients with purulent meningitis (McCracken G., 1992)

With purulent meningitis the level total protein in the CSF begins to increase much later than the increase in neutrophilic pleocytosis (on the 2-3rd day of the disease), this is an indicator of fibrinous exudation.

The higher the protein level in the CSF, the later the diagnosis of meningitis is made.

With concomitant hemorrhages, an increase in the concentration of total protein in the CSF is usually determined from the first days due to the penetration of plasma proteins into the CSF and lysis of red blood cells.

In premature newborns, mainly in children with ELBW, water balance disturbances are much more common, which indirectly affects the concentration of total CSF protein (on average, this indicator is higher compared to full-term ones).

When examining the CSF, it is advisable to determine the sugar level in it. With purulent meningitis, as a rule, it is reduced in relation to blood sugar levels.

In all cases, comparison of the dynamics of the clinical picture and changes in liquorological data allows us to make the correct diagnosis.

Ultrasound scanning of the brain is of some importance in differential diagnosis, allowing, in the presence of spinal puncture data, to distinguish intracranial hemorrhage, as well as the development of late complications of purulent meningitis in the form of ventriculitis, various forms of hydrocephalus, and brain abscess.

Microbiological examination of cerebrospinal fluid

Microbiological examination of CSF consists of bacterioscopy of a smear, isolation of the pathogen, and serological detection of Ag in the CSF.

Instrumental diagnostic methods

Neurosonography (NSG) is an ineffective method for early diagnosis of meningitis itself, but it allows diagnosing associated complications: developing ventriculitis, dilatation of the ventricular system, development of a brain abscess localized in the deep parts of the brain tissue or in the area of ​​the basal subarachnoid spaces. In addition, this method allows you to confirm or exclude concomitant intracranial hemorrhages, ischemic infarctions, developmental defects, etc.

CT scan of the head is indicated to exclude brain abscess, subdural effusion, and to identify areas of thrombosis, infarction, or hemorrhage localized in the superficial (convexital) structures of the brain.

PRINCIPLES OF TREATMENT

Antibacterial therapy

The main place in the treatment of bacterial meningitis is occupied by antibacterial therapy, which must be carried out not only if the diagnosis is confirmed, but also in cases where meningitis cannot be completely excluded.

When choosing a treatment regimen for a child diagnosed with bacterial meningitis, it is necessary to focus on the following factors:

Time of onset of first symptoms;

The nature of previous antibiotic therapy;

Microbiological monitoring data (if any) in a specific neonatal unit.

The effectiveness of antibacterial therapy is assessed by clinical data and the results of CSF microscopy, repeated examination of which is carried out no later than 48-72 hours from the start of treatment. If, after 48-72 hours from the start of empirical antibacterial therapy for neonatal bacterial meningitis, there is no obvious clinical and laboratory improvement, then the antibacterial treatment regimen is changed.

When prescribing antibacterial therapy in connection with suspected purulent meningitis or when it is confirmed by laboratory data, the following general rules are followed:

In newborns, during the first 7 days of life, antibiotics are administered intravenously, if not possible, intramuscularly, and the frequency of their administration depends on the effectiveness of diuresis;

One antibiotic or a combination of them is prescribed when a diagnosis is made in the maximum allowable for a newborn (the so-called meningeal) doses. Insufficient concentration of antibiotics in the blood serum can lead to chronicity of the process and reduce the penetration of the antibiotic through the blood-brain barrier. The dosage of antibiotics is not reduced for 3-5 days even after obvious clinical and laboratory improvement;

The effectiveness of antibacterial therapy is assessed by clinical data, microscopy results and CSF cultures over time. Repeated CSF examinations are carried out no later than 48-72 hours from the start of treatment;

When treating ventriculitis or late diagnosed meningitis, it is advisable to administer one of the antibiotics intrathecally (intraventricularly or endolumbarally), preferably intraventricularly. Not all antibiotics can be administered intrathecally due to their ability to provoke seizures. Antibiotics that provoke the development of convulsive syndrome include all betalactams (penicillins, cephalosporins, carbapenems).

Treatment of early neonatal meningitis

The leading etiological agents of early meningitis and the means of choice for their treatment are given in Table. 27-11.

Table 27-11. Antibiotics of choice for the treatment of early neonatal meningitis

Treatment of late neonatal meningitis

Often late neonatal meningitis develops in children in the NICU.

The etiology of late neonatal meningitis in these conditions is characterized by significant variability, but their common feature may be multiple resistance to antibiotics of the main groups. Under these conditions, the importance of timely microbiological diagnosis sharply increases, allowing for targeted etiotropic treatment. A rapid clinical effect can only be achieved through targeted antibacterial therapy.

None of the existing modern antibiotics or their combinations covers the entire spectrum of potential etiological agents (taking into account the spread of acquired resistance among them) of late neonatal meningitis. For this reason, it is not possible to recommend a universal scheme for empirical treatment of late meningitis. Targeted etiotropic therapy of meningitis can actually be carried out only after isolating the infectious agent and assessing its sensitivity. However, consistent analysis of data from the intermediate stages of microbiological diagnosis (smear microscopy, CSF culture, and pathogen isolation) makes it possible to justify treatment with increasing reliability.

A relatively informed choice can be made already at the level of obtaining the results of Gram staining of the CSF smear. This diagnostic appointment allows you to differentiate three groups of etiological agents.

Gram-positive microorganisms;

Gram-negative microorganisms;

If gram-positive and gram-negative bacteria are detected in the CSF smear, it is advisable to begin treatment with ceftriaxone or cefotaxime. However, it should be borne in mind that they cover a significant part of the spectrum of possible pathogens only in the absence of high level acquired resistance (multi-resistance). If fungi are detected in the CSF smear (or if they are suspected), antifungal drugs must be prescribed.

After receiving the results of the species identification of the pathogen, a more accurate adjustment of etiotropic therapy is possible. For example, when P. aeruginosa is detected, treatment benefit may be obtained by using a combination of ceftazidime and amikacin. However, the most effective treatment of meningitis can only be after obtaining the results of assessing the antibiotic sensitivity of the pathogen.

IN complex treatment neonatal purulent meningitis great value has infusion, immunocorrective and anticonvulsant therapy, described in the relevant sections of the manual.

Meningitis - severe pathological condition, characterized by cerebral edema and damage to the meninges. Meningitis most often occurs in children due to the anatomical and physiological characteristics of the body and immature immunity. The membranes of the brain and spinal cord become inflamed, but the brain cells themselves are not involved in the process. The disease is characterized severe symptoms, and if treatment is not started in a timely manner, the disease can cause severe complications, posing a threat to the child’s life.

Reasons

The reasons for its development have been studied quite well by doctors. It is known that meningitis in newborns and older children is caused by viruses:

• , or ;
• and some others.

No less often, the disease is provoked by bacterial agents, meningococci, protozoan microorganisms, and others. Somewhat less common are atypical forms of the disease caused by tuberculosis bacilli, fungi and even helminths.

Note that infection occurs when the carrier comes into contact with healthy person Therefore, outbreaks may occur in kindergartens and schools, since children there are actively in contact with each other. The disease has an incubation period when there are no symptoms, but the child has already become a source of infection for others, which contributes to the spread of inflammation.

The following categories of children are most susceptible to the disease:

• premature;
• born as a result of an abnormal pregnancy or pregnancy with complications;
• sick in infancy with purulent inflammatory diseases (and some others).

The disease can develop in a baby who received a birth injury or received open or closed traumatic injuries brain or spinal cord. Children suffering from disorders of the nervous system are also susceptible to meningitis.

Classification

Outbreaks of the disease usually occur in winter or spring. Infection occurs in the following ways:

• household (through contaminated toys, etc.);
• nutritional (when consuming contaminated products);
• airborne;
• vector-borne (mosquito bites).

Pathogens that cause meningitis in children can enter the child’s body vertically, through the placenta, or spread throughout the body through lymphatic system. Depending on which meninges are damaged, there are three forms of meningitis:

• most rare form- in which inflammation of the arachnoid membranes occurs;
• pachymeningitis, when hard membranes are involved in the inflammation process;
• one of the most common forms is leptomeningitis, when inflammation affects both the arachnoid and the main, soft membranes.

Classification, depending on the pathogen, divides meningitis into two main forms - bacterial and. Viral is more common. These two forms have subtypes, depending on the direct pathogen. So, they distinguish:

• pneumococcal meningitis - caused by streptococcus (a complication of severe);
• meningococcal - the causative agent is diplococcus;
• staphylococcal - in most cases, newborns or children who have undergone chemotherapy are susceptible;
• Haemophilus influenzae - caused by Haemophilus influenzae;
• Escherichiasis - excites the virus of the same name.

Rare varieties are salmonella and listeria meningitis.

If we talk about classification depending on the nature of the course, then purulent and serous meningitis are equally common. In newborns, it mainly occurs when the inflammatory process is serous in nature, and the disease occurs with less severe symptoms than in the purulent form.

Serous meningitis is confirmed by the presence of lumbar fluid lymphocytes. More often viral - bacteria lead to the development. This diagnosis is made when neutrophils predominate in the lumbar fluid. Both serous and purulent meningitis without timely treatment cause irreparable damage to the health of children and can lead to death.

First symptoms

The disease always develops suddenly against the background of good health. Symptoms are more pronounced in older children, and meningitis in newborns occurs almost unnoticed at the initial stage.

The incubation period is 2 – 10 days, depending on the condition immune system child. An incubation period of this length allows the pathogen to enter the meninges and cause inflammatory processes. After a specified period of time, the first symptoms of meningitis in children of an intoxication nature appear:

• sharp (up to 40 degrees);
• confusion, delirium;
• unbearable headache up to loss of consciousness;
• sharp pains in the stomach;
• nausea and vomiting;
• the appearance of muscle pain;
• photophobia.

Meningitis in newborns is manifested by anxiety and irritability of the child, thickening of the fontanel area, which even becomes slightly convex. Meningitis can be suspected in infants based on the following signs:

• a sharp rise in temperature to critical levels;
• stiff neck (when the child lies with his head thrown back);
• the appearance of vomiting;
• the occurrence of seizures.

When the first symptoms appear, the child requires urgent medical attention. In its absence, the clinical picture is complemented by symptoms of further brain damage. Signs of meningitis in children with progression of inflammation:

• spasm of the neck muscles, when the child cannot do this when asked to tilt his head forward;
• disturbance of consciousness up to the appearance comatose state;
• oculomotor disorders;
• convulsions, which can lead to muscle injury and respiratory or cardiac arrest.

The disease is characterized by a specific position of the child - lying on his side with his legs bent and his head thrown back. Photo and sound sensitivity, blepharospasm, and rash are noted.

Diagnostics

The first symptoms give an idea of ​​the general inflammatory process in the meninges, but specific signs characteristic of meningitis help doctors confirm the diagnosis:

1. Kernig's sign, when a child experiences tension in the back of the thigh when trying to bend the leg at the knee and hip joints.
2. Brudzinski's sign. The child is placed on his back and one leg is bent at the hip and knee joints. A positive symptom is indicated when the second leg begins to bend reflexively.

Blood and urine tests are performed, but the final diagnosis is made after evaluating the results of a lumbar puncture as the only reliable method of confirming meningitis.

Features of treatment

Treatment of meningitis depends on the form (serous or purulent), the causative agent and the stage of the disease. Not prescribed for serous viral meningitis antibacterial drugs, since antibiotics do not work on viruses. Medical measures for viral meningitis:

• dehydration therapy;
• prescription of anticonvulsants;
• desensitizing treatment.

To defeat viral serous meningitis, it is necessary to take interferon, DNase, RNase, lytic mixture and some other medications according to indications. Required and symptomatic treatment- taking antipyretic and painkillers.

To treat the purulent form of bacterial meningitis, antibiotics are prescribed taking into account the sensitivity of the pathogen. Usually a combination of several antibacterial drugs is used.

Along with antibiotic treatment, symptomatic therapy and pathogenetic treatment.

The consequences of meningitis in children can be very severe - from the development of paresis and paralysis, pneumonia and to severe with the onset of coma. However, complications can be avoided if drug treatment is started in a timely manner: with a correct diagnosis and a well-chosen therapeutic course, the symptoms of meningitis begin to subside already on the 3rd - 4th day, and the child’s condition stabilizes.

Prevention

The best way to protect your child from meningitis is prevention. Today, vaccination against meningitis is carried out by both public and private medical institutions.

In case of outbreaks of meningitis, vaccination will be the only reliable means of protecting a child from the disease. Statistics show that when children in groups where there is an outbreak of meningitis are vaccinated, the spread of the disease can be stopped.

Vaccination against meningitis involves the administration of a drug that protects against Haemophilus influenzae infection, the main cause of meningitis in children. Vaccination is indicated not only when there is an outbreak of infection in an educational institution, but also if there is a sick person in the house. In some countries, vaccination against meningitis is included in the vaccination calendar and is done regularly, in others it is carried out only for epidemiological indications.

It should be borne in mind that vaccination does not protect a child from meningitis if the disease is caused by viruses or nonspecific pathogens. In most cases, vaccination will be an effective means of prevention, but after the injection the child may experience complications, so not all doctors recommend such prophylaxis for children and not all parents agree to vaccinate their child. It is important to strengthen the immune system, observe personal hygiene rules, and isolate children with suspected meningitis from the group.

Is everything in the article correct from a medical point of view?

Answer only if you have proven medical knowledge

Meningitis is an extremely dangerous disease in which inflammation of the membrane (cortex) of the brain and spinal canal occurs. In case of untimely provision medical care such patients are likely to develop complications in the central nervous system.

Most often this leads to epilepsy, deafness, blurred vision, and mental retardation (depending on the part of the brain that has suffered the most due to inflammation).

What causes meningitis in children, how does the disease begin, can you determine it yourself? Is it possible to protect children from it, is vaccination carried out? What do the doctors themselves say about this?

General information

Meningitis is an inflammation of the soft, arachnoid or hard membrane of the brain and spinal cord. In 97% of cases, it is the lesion of the soft outer shell that is diagnosed.

The main reasons for the development of the disease are the penetration of infection into the brain and the channels through which cerebrospinal fluid enters. The pathogen itself can enter the area of ​​the brain membranes both from other organs (for example, with a complication of a sore throat) and as a result of external mechanical injuries.

The fungal form of the disease is very rare. It is diagnosed in children with very weakened immune systems: the body cannot even cope with the suppression of yeast fungi.

Who is most likely to get meningitis? According to official statistics published by the World Health Organization (WHO), boys are more prone to inflammation of the meninges.

Peak incidence occurs in the first 2 years of life. This is explained by the same weakened immune system. Although the body’s natural defenses work effectively, they cannot resist many infections and pathogenic bacteria. For the same reason most of Vaccinations are performed in the first year of a baby’s life - this is “training” of the immune system.

Classification of species: causes, how the disease manifests itself

Symptoms differ for each subtype of meningitis. In medical practice, the disease is classified into:

• meningococcal (most common);
• secondary purulent (inflammation develops against the background of complications of other infectious diseases);
• serous;
• protozoan (protozoal forms).

The symptoms and first signs of meningitis in children and infants in each of these forms should be considered in detail.

Meningococcal

The disease develops in an acute form, beginning with a sharp rise in body temperature to critical levels. The temperature with meningitis in children reaches 40 degrees.

Against this background, a very severe headache and bouts of vomiting occur, but even after them the patient’s general well-being does not improve.

May occur on the skin morbilliform rash with a bright purple color. It disappears quickly - a few hours after its appearance.

The muscles of the neck and back of the head are very tense. The patient himself the child, even lying on the bed, tries to throw his head back excessively- This is a sign of damage to the neural structure.

The “harbinger” of the meningococcal form is any respiratory disease that occurs a few days before the exacerbation. This is often followed by convulsions, a semi-conscious state, coma, signs of damage to the facial nerve (asymmetry of the lips, sagging cheeks).

In the future, paralysis may occur eye muscles, which is considered to be the extreme stage of exacerbation of the disease. If you do not seek help during this period, the likelihood of death is very high.

Possible complications of the meningococcal form:

There is also a derivative form of meningococcal meningitis, called in medicine as bacterial shock. In this situation, an exacerbation of the disease occurs literally within a few hours after the appearance of the first symptoms, and the patient dies. This form is quite common among children under 3-6 months..

Secondary purulent

Secondary purulent meningitis means exacerbation of other infectious diseases. Most often they belong to the respiratory group: , .

Untimely completion of therapy leads to the fact that the infection is not completely eradicated and can enter the spinal cord or brain through the bloodstream.

Doctors more often diagnose secondary purulent meningitis caused by streptococcus and respiratory infections.

Its main symptoms are difficult to distinguish from regular flu. The condition of the sick child worsens in a complex manner, the temperature rises to 39-40 degrees, and chills may also occur.

The main differences between meningitis are: signs of neck muscle rigidity, tachycardia, bradycardia(since the cardiovascular system is affected).

On an outpatient basis, secondary purulent meningitis is diagnosed either according to the results of laboratory tests or after examining the cerebrospinal fluid (the liquid will be cloudy, with signs of purulent inclusions).

Secondary purulent meningitis occurs in an acute form. A general deterioration in the patient’s well-being can be observed within 3-4 days.

Relief of the condition occurs only after the start of treatment. However, there remains a high probability of relapse of the disease in the first few weeks after discharge.

Serous - tuberculous and viral

According to statistics, occurs mainly in children aged 2-7 years. A common pathogen is the tuberculosis bacillus, but the disease itself develops in a chronic form.

It is preceded by a prodromal period of 2-6 weeks. At this time, the child experiences gradual deterioration of health, loss of appetite, Kernig and Brudzinski symptoms.

The viral form of serous meningitis is rare, diagnosed in 2-3% of all cases.

After the prodromal period comes sharp deterioration– headache, neck muscle tension, constant urge to vomit (even when the stomach is already empty).

In the severe stage, traditional acute symptoms are observed– head thrown back, legs bent at the knees, stomach pulled in strongly. The temperature after the prodromal period rises sharply to critical levels.

Meningeal syndrome is observed only when viral form diseases, but the final diagnosis is made only on the basis of tests.

Enteroviral meningitis. How to protect your child from a dangerous virus:

Protozoan forms

The spinal cord is affected, resulting in severe muscle and joint pain. It is rare in children. An increase in the concentration of leukocytes is detected in the cerebrospinal fluid.

The headache is minor, dull, accompanied by attacks of vomiting, but less pronounced than with other variations of meningitis. Fever also occurs, but is not constant. The temperature also fluctuates in waves.

Protozoan forms are quite rare. They affect children after 2-3 years of age. In rare cases, they are diagnosed before the age of 6 months.

Incubation period

Infectious bacterial meningitis in children predominantly develops in an acute form, with pronounced severe symptoms. The incubation period is 2-3 days, then a sharp deterioration in the health of the sick child is observed.

Serous meningitis is characterized by chronic form with a high risk of disease relapse. The spread of infection throughout the body takes from 2 to 6 weeks.

The duration of treatment depends on the stage at which the child began receiving medical care.

A bacterial infection can be gotten rid of quickly enough by using broad-spectrum antibiotics; a viral infection is more difficult. The entire treatment period takes from 1.5 to 9 weeks. Complications can last a lifetime.

How to recognize it yourself

How to recognize and distinguish meningitis from other diseases with a similar course? It is necessary to pay attention to possible damage to the central nervous system, muscle, joint pain(initially this is noticeable in the cervical area).

Symptoms and signs of meningitis in infants under one year of age, older children and adolescents:

Along with this Kernig's and Brudzinski's symptoms are observed when the child feels severe pain when pressing on the pubic bone. It is also difficult for a child to bend one leg while leaving the other straight.

The final diagnosis can only be made based on test results (bacterial culture), but treatment of meningitis begins before this due to its possible fulminant course. The main thing is to relieve inflammation and slow down the spread of infection.

The rash looks more like small subcutaneous bruises. Meningococcal infection affects the walls of small vessels located in the upper layers of the epithelium, which leads to their inflammation.

Over time, the rash can unite into entire papules, in the center of which whitish ligaments are visible.

This is what one of the main symptoms and signs looks like - a rash with meningitis in children, photo:

Meningitis: don't miss important symptoms! Classic meningeal symptoms are presented in the video:

Diagnostics

How to check for meningitis in a child, which doctor should you contact to identify the disease? Primary diagnosis meningitis is performed by a pediatrician. If there is suspicion, a sick child is sent to the infectious diseases department and blood and cerebrospinal fluid tests are taken.

Install accurate diagnosis can be determined by the presence of leukocytes in the cerebrospinal fluid, and then a culture for infection is done in order to accurately identify the causative agent of the disease.

At acute course illness and suspected meningitis, you should not wait to see your doctor. It's better to contact immediately Ambulance, pointing out any symptoms found.

Treatment

Is meningitis treated in children and how is it treated? The main treatment tactics are taking antibiotics (penicillin) and antiviral drugs(depending on the established form), suppressing the spread of infection.

At the same time, it is necessary to reduce intracranial pressure and eliminate toxicosis (droppers with glucose, Reosorbilact). To prevent complications in the central nervous system and restore normal blood flow in the brain area, Pirocetam and Nootropil are prescribed.

To quickly relieve inflammation, you need to take Hydrocortisone, Methylprednisolone. Timely prescribed and carried out therapy can radically improve the condition of a sick child within 2-3 days.

In infants up to one year old

For the youngest children, doctors prescribe sulfonamides (Etazol) and antibiotics from the penicillin group.

If this tactic does not lead to relief of the condition, then synthetic antibiotics are prescribed for meningitis in children such as Ampiox, but are taken only until the symptoms of the disease regress.

With tuberculosis form meningitis, it is recommended to use broad-spectrum antibiotics up to bacteriostatic doses, but for no more than 3 days. Then the patient is given only anti-tuberculosis drugs.

With a viral form Doctors give preference only to general restoratives and. Antibiotics will only do harm, since viruses are not susceptible to them.

Treatment of children under one year of age is possible only in a hospital setting. They are prescribed only after all the symptoms of meningitis in small infants have disappeared. This is monitored by the number of leukocytes and daily tests.

Symptomatic therapy

This treatment is used when third-party symptoms and signs appear childhood meningitis. For seizures and convulsions, anticonvulsants are prescribed: Diazepam (no more than 100 ml per day intramuscularly), Aminazine (2 ml intramuscularly directly to prevent an attack).

Oxygen therapy is widely used - inhalation of a special gas mixture, designed to prevent oxygen starvation of the brain. Depending on the condition of the sick child, the procedure is carried out with a special oxygen mask or intubation (forced supply of a gas mixture).

The need to reduce high fever after taking antibiotics disappears. But if therapy is ineffective, Paracetamol and Diphenhydramine are prescribed intramuscularly (as prescribed by a doctor).

Alternative medicine

Independently the immune system with infection behind such short period cannot cope, and alternative medicine is ineffective in this regard.

The only thing doctors advise in this regard is use an infusion of medicinal lavender, but only during the rehabilitation period.

To prepare it, take 3 tablespoons of dry lavender base (sold at the pharmacy) and pour 2 cups of boiling water. Infuse for 2-3 hours, filter through several layers of gauze.

You need to drink the resulting decoction 2 times a day 0.5 cups. This will speed up the restoration of immune function and prevent surges in blood pressure.

Doctor Komarovsky's opinion on video

Meningitis in a child - symptoms, first signs, treatment tactics in the “Doctor Komarovsky School” program:

The only one effective way prevention is vaccination up to 29 years of age(mandatory in the area of ​​the African “meningitis” belt established by the World Health Organization).

Currently, conjugate vaccinations are used, designed for 3 doses. At what age are children vaccinated against meningitis? In the early - from 3 to 12 months, followed by revaccination a year later.

We should not forget about others, which in the CIS countries are recognized as mandatory (but you can still refuse them).

For example, theoretically it can even worsen into an acute form of meningitis, not to mention measles and other similar diseases.

In detail about the symptoms, consequences and measures to prevent meningitis in children, about vaccinations against this disease:

Meningitis is a dangerous brain disease. Most often it affects boys under the age of 7 years. It often occurs in an acute form, and therefore requires mandatory hospitalization. The only possible prevention option is vaccination, since infections that lead to inflammation of the brain and spinal cord are even transmitted by airborne droplets.

Purulent meningitis in newborns - inflammation of the brain
membranes, a serious disease, occupying one of the first places among infectious
diseases of the central nervous system in young children. Incidence of purulent meningitis
is 1-5 per 10 thousand newborns.

It can be fatal or disabling
complications (hydrocephalus, blindness, deafness, spastic paresis and paralysis,
epilepsy, delayed psychomotor development up to mental retardation). Exodus
depends on timely initiation of intensive treatment. Etiology and pathogenesis.

According to etiology, meningitis is divided into viral, bacterial and
fungal. The route of infection is hematogenous. Child infection
can occur in utero, including during childbirth, or postnatally.
Sources of infection are the mother's genitourinary tract, infection also
may occur from a patient or from a carrier of pathogenic microflora. Development
meningitis is usually preceded by hematogenous spread of infection.
Microorganisms overcome the blood-brain barrier and penetrate the central nervous system.
Predisposing factors include infections genitourinary tract mothers,
chorioamnionitis, long anhydrous period (over 2 hours), intrauterine
infection, prematurity, intrauterine malnutrition of the fetus and its
morphofunctional immaturity, asphyxia of the fetus and newborn, intracranial
birth trauma and related therapeutic measures, developmental defects
CNS and other situations where there is a decrease in immunological factors
protection. The penetration of bacterial infection into the child’s bloodstream is facilitated by
inflammatory changes in the mucous membrane of the nose and pharynx during acute respiratory
viral infection, which, according to our observations, often accompanies the beginning
purulent meningitis.

The causative agents of meningitis are currently often
Streptococcus agalactiae (group B beta-hemolytic streptococcus) and
Escherichia coli. Meningococcal etiology of purulent meningitis in newborns in
nowadays it is rarely observed, which is apparently explained by the passage
through the mother's placenta to the fetus of immunoglobulin G containing antibodies to
meningococcus. Intrauterine meningitis, as a rule, clinically manifests itself in
the first 48-72 hours after birth, postnatal meningitis appears later.
According to our data, such children were admitted to the clinic on the 20-22nd day of life,
when there is a decrease in the level of immunoglobulin G obtained from the mother,
in the blood serum of a newborn. By this time, maternal immunoglobulin G
is catabolized and its level in the blood decreases by 2 times.

Postnatal meningitis can also develop in departments
resuscitation and intensive care and in departments for nursing premature babies.
Their main pathogens are Klebsiella spp., Staphylococcus aureus,
P. aeroginosae and fungi of the genus Candida. As our observations have shown, in the anamnesis
mothers noted such risk factors as threat of miscarriage,
urinary tract infection, presence of chronic foci of infection in pregnant women
(tonsillitis, sinusitis, adnexitis, vaginal thrush), as well as long-term
anhydrous interval during labor (from 7 to 28 hours).

Despite the diversity of pathogens of purulent meningitis in
newborns, the morphological changes in the central nervous system are similar. They are localized in
mainly in soft and arachnoid membranes. Exudate is removed by
phagocytosis of fibrin and necrotic cells by macrophages. Some people have it
undergoes organization, which is accompanied by the development of the adhesive process.
Impaired patency of the cerebrospinal fluid pathways can lead to the development of occlusive
hydrocephalus. Reparation may take 2-4 weeks or more.

Clinic and diagnostics

There are difficulties in diagnosing purulent meningitis at home,
and when the child is admitted to the hospital, since there are clear clinical manifestations
develop later, but are observed initially nonspecific symptoms, similar to
many infectious and inflammatory diseases (pallor, marbling,
skin cyanosis, conjugation jaundice, hyperesthesia, vomiting). Some children
There is an increase in temperature to subfebrile levels. Symptoms of the disease
develop gradually. The child's condition is progressively deteriorating. Temperature
rises to 38.5-39°C. On examination, the skin is pale, sometimes with a grayish
tint, acrocyanosis, marbling are often observed, sometimes pronounced in children
conjugation jaundice. Disorders of the respiratory system are noted -
decrease in respiratory rate, attacks of apnea, and from the cardiovascular
system is characterized by bradycardia. Patients also have hepato- and
splenomegaly.

In the neurological status of some newborns
signs of central nervous system depression are observed: lethargy, drowsiness, adynamia, decreased
physiological reflexes, muscle hypotonia. Others have symptoms
excitation of the central nervous system: motor restlessness, hyperesthesia, painful and
high-pitched scream, tremor of the chin and limbs, clonus of the feet. Violations with
sides of the cranial nerves may manifest as nystagmus, floating
movements of the eyeballs, strabismus, the “setting sun” symptom. Some
children experience regurgitation and repeated vomiting, sluggish sucking or breast refusal
and nipples. A sick child does not gain weight well. At a later date
head tilting back, meningeal symptoms (tension)
and bulging of the large fontanelle, stiffness of the muscles of the back of the neck).
A typical pose is for a child to lie on his side with his head thrown back, legs bent and
pressed to the stomach. Meningeal symptoms typical of older children (Kernig,
Brudzinsky), are not typical for newborns. Sometimes there is a positive
Lessage's symptom: the child is lifted up, grasped by the armpits, and in this
while his legs are in a flexed position. Polymorphic
convulsions, cranial nerve paresis, changes in muscle tone. The reason for the development
convulsions are caused by hypoxia, microcirculatory disorders, cerebral edema, and sometimes
hemorrhagic manifestations. In some cases there are
rapidly progressive increase in head circumference, separation of cranial sutures behind
account of intracranial hypertension.

Analysis of case histories of newborns with purulent meningitis,
who were in our clinic, revealed that all of them were admitted between the ages of 7 and
28 days of life ( middle age- 23 days). When referred to hospital, only 2
In children, purulent meningitis was suspected; in the rest, the guiding diagnosis was
ARVI, enterocolitis, conjugation jaundice, intrauterine infection, infection
urinary system, osteomyelitis. On admission, most newborns do not
There were clear and characteristic signs of meningitis. However, anamnestic
data and serious condition allowed us to believe that the disease began earlier,
which was confirmed by cerebrospinal fluid studies. Upon admission to
Most children had an increase in temperature to 38-39.6 ° C. Expressed
catarrhal phenomena, as a rule, there was no. In some children in clinical
in the picture there were manifestations of local purulent infection(purulent conjunctivitis,
omphalitis, urinary tract infection).

In the blood test, most children showed inflammatory
changes in the form of an increase in the number of leukocytes (13-34.5x109/l) with a significant
an increase in the number of band neutrophils until the appearance of juvenile forms,
as well as an increase in ESR to 50 mm/hour.

Changes in urine tests (leukocyturia) were noted in three
children with a combination of purulent meningitis and pyelonephritis.

To confirm the diagnosis, a lumbar puncture should be performed.
carried out at the slightest suspicion of meningitis, in early dates without waiting
development of his expanded clinic. In cases where for some reason it is not
it is possible to perform a lumbar puncture, one should focus on the clinical
picture of the disease. During lumbar puncture for purulent meningitis in
In newborns, cerebrospinal fluid often leaks under pressure, is cloudy,
sometimes, with large cytosis, the color is yellow and thick. Contraindication to
Lumbar puncture is indicated by shock and disseminated intravascular coagulation.

In our observations, almost all admitted children
The diagnosis was made on the first day of hospital stay. Indication for
urgent lumbar puncture was the presence of febrile temperature
(above 38oC), symptoms of infectious toxicosis without a visible focus of bacterial
infections, less often - hyperesthesia. In the liquor there was an increase in the content
leukocytes with a predominance of neutrophils (more than 60%).

With purulent meningitis, the content of total protein in the cerebrospinal fluid
increases later than neutrophilic pleocytosis increases. Protein content
increases from the onset of the disease and can serve as an indicator of the duration
pathological process. In our studies, protein concentration varied
from 0.33 0/00 to 9 0/00. Increased content protein in cerebrospinal fluid
obtained during the first puncture, it was found in 10 patients that
indicated a certain duration of the disease. For purulent
meningitis is characterized by low levels of glucose in the cerebrospinal fluid.

In order to identify the pathogen and determine its
antibiotic sensitivity is tested microbiologically
cerebrospinal fluid In our observations, clinical and laboratory data indicated
purulent nature of meningitis, while culture of cerebrospinal fluid and smear bacterioscopy in
In most cases, the pathogen was not identified. In two patients it was detected
beta-hemolytic streptococcus group B, one was cultured with Haemophilus influenzae
bacillus, and one more has pneumococcus.

Viral meningitis is characterized by serous inflammation
meninges with an increase in the content of lymphocytes in the cerebrospinal fluid. Serous
Meningitis has a milder course.

Instrumental methods include ultrasound
brain examination (neurosonography) and computed tomography,
which are carried out according to indications.

Neurosonography allows diagnosing ventriculitis,
expansion of the ventricular system, development of brain abscess, and also identify
severe concomitant intracranial hemorrhages, ischemic infarctions, defects
development.

Computed tomography is indicated to rule out an abscess.
brain, subdural effusion, as well as to identify areas of thrombosis, infarction
and hemorrhages in the structures of the brain.

Complications

The most common early complications are swelling and
brain swelling and seizures.

Clinically, cerebral edema is manifested by increasing intracranial
hypertension. During this period, the characteristic position of a newborn is with
with his head thrown back, a monotonous, at times shrill,
a cry, sometimes turning into a groan. Possible bulging of a large fontanel, its
pulsation, divergence of cranial sutures. Brain edema may be clinically manifested
dysfunction of the oculomotor, facial, trigeminal and sublingual
nerves. Coma is clinically manifested by depression of all types of cerebral
activity: adynamia, areflexia and diffuse muscle hypotonia. Next
there is a disappearance of the reaction of the pupils to light, attacks of apnea become more frequent,
bradycardia develops.

With purulent meningitis, convulsive syndrome often develops.
Initially, the convulsions are clonic in nature, and as the edema progresses
brain are transformed into tonic.

Very dangerous complication with meningitis is
bacterial (septic) shock. Its development is associated with penetration into
bloodstream of a large number of bacterial endotoxins. Clinically
septic shock is manifested by sudden cyanosis of the extremities, catastrophic
decreased blood pressure, tachycardia, shortness of breath, weak moaning cry,
loss of consciousness, often in combination with disseminated syndrome
intravascular coagulation. Among the newborns we observed, two children
died. One girl was admitted on the 11th day of life and died within the first 6 hours
hospital stay from infectious-toxic shock, complicated
disseminated intravascular coagulation. Second girl aged
17 days died on the 2nd day after admission. She had intrauterine
generalized cytomegalovirus infection and purulent meningitis developed.
Severe consequences of purulent meningitis can include hydrocephalus, blindness,
deafness, spastic paresis and paralysis, mental retardation, epilepsy.

Differential diagnosis

Neurological symptoms similar to purulent meningitis
may be observed in the presence of intracranial hemorrhage in a newborn. U
These children also experience motor restlessness, chin tremor, and
limbs, nystagmus, strabismus, “setting sun” symptom. To exclude
purulent meningitis requires a spinal puncture. For
intraventricular hemorrhage is characterized by the presence in the cerebrospinal fluid of a large
the number of changed red blood cells, as well as an increased concentration of total protein
in the cerebrospinal fluid from the first days of the disease due to the penetration of plasma proteins and
erythrocyte lysis.

Often purulent meningitis occurs with vomiting, so it is necessary
conduct differential diagnosis with pyloric stenosis, in which
there is vomiting "fountain" without fever and inflammatory
changes in blood tests. Often, when examining the abdomen, a positive
hourglass symptom. The main methods for diagnosing pyloric stenosis are
esophagogastroduodenoscopy and ultrasound examination.

Symptoms of central nervous system excitation
(restlessness, tremor of the limbs and chin, hyperesthesia), similar to purulent
meningitis, can be observed with influenza and ARVI. In this case there is
meningism is a condition characterized by the presence of clinical and cerebral
symptoms without inflammatory changes in the cerebrospinal fluid. Meningism is not caused by
inflammation of the meninges, and their toxic irritation and increased
intracranial pressure. During a spinal tap, the fluid is clear and
colorless, flows out under high pressure, often in a stream, but the contents
cells, protein, and glucose are normal. Meningismus usually manifests itself in acute
period of illness and often precedes inflammation of the meninges, which
may develop within a few hours after its detection. If
meningeal symptoms of influenza and ARVI do not disappear, or, moreover, increase,
repeated diagnostic spinal punctures are necessary.

Purulent meningitis can occur in a child with sepsis, which
significantly aggravates the clinical picture of the disease.

Treatment

Newborns with purulent meningitis need comprehensive
treatment, including antibacterial, infusion therapy, replacement
immunoglobulin therapy for intravenous administration. If necessary
hormonal, anticonvulsant, dehydration therapy is carried out. So
Children require the most gentle regimen possible. In the acute period they are not recommended
breastfeed. They get expressed mother's milk, or, in the absence
His mother has it, formula from a bottle. When the sucking reflex is suppressed
Feeding the child through a tube is used.

Causal antibacterial therapy is the main
method of treating newborns with purulent meningitis. It is carried out taking into account
pathogen isolated from the cerebrospinal fluid and its sensitivity to
antibiotics. If the pathogen was not found, the effectiveness of the antibacterial
therapy is assessed based on clinical data and the results of repeated studies
cerebrospinal fluid no later than 48-72 hours from the start of treatment. If during this time there is no
obvious clinical and laboratory improvement occurs, a change is made
antibacterial treatment. In newborns with purulent meningitis, antibiotics
must be administered intravenously three or four times in the maximum permissible doses
through a subclavian catheter.

Antibiotics are used that penetrate through
blood-brain barrier and have wide range antimicrobial action.
A combined course of antibacterial therapy usually includes
third generation cephalosporins (ceftazidime, ceftriaxone) and aminoglycoside
(amikacin, netilmicin, gentamicin). To all the children we treated
Antibacterial therapy was prescribed immediately upon admission to the hospital and
included a cephalosporin. After receiving the result of a lumbar puncture in the diagram
combination antibiotic therapy, a second antibiotic was added
aminoglycoside series. If a second course of antibiotics is necessary, when not
it was possible to achieve improvement in the patient’s condition and normalization of indicators
cytosis in the cerebrospinal fluid, the children received a second course of antibiotic therapy
meropenem, vancomycin.

The issue of hormone therapy was resolved
individually, taking into account the severity of the condition. In severe cases of purulent meningitis
hormone therapy in the acute period of the disease led to earlier
disappearance of fever and intoxication, improvement of the newborn’s condition.

For the treatment of hypertensive-hydrocephalic syndrome
dehydration was carried out using furosemide. Subsequently, after
elimination of symptoms of infectious toxicosis, in the presence of intracranial
for hypertension, acetazolamide was prescribed according to the regimen.

As our observations have shown, inclusion in
treatment regimen to increase the body's defenses of immunoglobulin for
intravenous administration, which is especially effective in the early stages of the disease.
Immediately after diagnosis, all patients began intravenous
administration of immunoglobulin. It was administered 2 to 5 times with mandatory laboratory tests.
control (determination of immunoglobulins G, M and A) before and after administration. More
frequent administration was required by children whose progress was slow positive dynamics
clinical and laboratory symptoms.

Viferon in suppositories containing recombinant human
leukocyte interferon alpha-2b, connected later, after improvement
clinical and laboratory parameters. It was administered at a dose of 150,000 IU 2 times a day,
The duration of the course was 10 days.

Simultaneously with the start of antibacterial therapy in children there was
intensive infusion therapy through a subclavian catheter, including
yourself transfusion of solutions of glucose, rheopolyglucin, vitamins (C, B6,
cocarboxylase), furosemide, antihistamines for the purpose of detoxification,
improving microcirculation, correcting metabolic disorders.

Diazepam was used to relieve convulsive syndrome. WITH
Phenobarbital was prescribed for maintenance anticonvulsant therapy.
Drugs that improve cerebral circulation (vinpocetine,
cinnarizine, pentoxifylline).

The average stay of patients in the clinic was 26 days (from 14
up to 48 days).

Prognosis and long-term consequences

Purulent meningitis in newborns is a serious disease,
the mortality rate from which remains high.

As our research has shown, comprehensive intensive
therapy for purulent meningitis in newborns, started at the earliest stage
diseases, gives good results. Observation of children for 1-3 years,
who suffered purulent meningitis in the neonatal period, showed that the majority
of which at early detection diseases and adequate therapy psychomotor
development corresponds to age. However, two children developed progressive
hydrocephalus, four had disturbances in muscle tone and
subcompensated hypertensive-hydrocephalic syndrome.

Inflammation of the meninges or meningitis in newborns and children infancy is not the most common disease. However, parents should not forget about this disease at all. Meningitis in a child under one year of age can occur with numerous severe complications. Only timely treatment will help the baby recover and even save his life.

Reasons

Among the various forms of meningitis, most are infectious forms. They are often caused by various viruses or bacteria. Meningococcal infection is the undoubted leader among the causative agents of the inflammatory process of the meninges. It occurs in 70-80% of cases in patients with meningitis.

Bacterial meningitis, which is quite severe and turns into purulent forms, is caused by various types of bacteria. The most common forms of meningitis in newborns and infants are meningococcal and streptococcal forms of meningitis. Such diseases are characterized by a severe course and frequent development of complications.

Serous meningitis is caused in 80-85% by viruses. Often the culprits of the disease are rubella, chickenpox, measles, herpes viruses and Epstein-Bar viruses. In weakened children, meningitis can also be caused by a common influenza infection. In such cases, the child usually has disturbances in the functioning of the immune system or even immunodeficiency.

For children with diabetes or taking glucocorticosteroids from birth, infection with candidal meningitis is possible. In this case, in a weakened children's body An opportunistic fungus, Candida, spreads rapidly. Getting into the meninges with the bloodstream, the microorganism quickly multiplies there and causes severe inflammation. Treatment for these forms of the disease usually takes longer than for bacterial forms.

The most rare forms of meningitis in children of the first year of life include the tuberculosis variant or a disease caused by protozoa. Such forms of the disease occur only in 2-3% of all cases.

The traumatic variant occurs after birth trauma. The disease usually develops within a few days or months after the baby is born. Traumatic meningitis is severe. Numerous complications may also occur. Treatment of a child with a traumatic form of meningitis requires a mandatory consultation with a neurosurgeon and observation by a neurologist.

At-risk groups

Children of any age are not immune from meningitis. The peculiarities of the structure and functioning of the nervous and immune systems of babies in the first months after birth make them quite vulnerable to various inflammatory diseases.

Not all babies are at the same risk of meningitis. To control and monitor children who are at high risk of the disease, doctors identify risk groups for the development of meningitis. These include:

Newborn babies with very low birth weight, as well as premature babies. These babies have not yet fully developed their nervous and immune systems. The blood-brain barrier in newborns functions very differently from that in adults. Microorganisms that have small size, easily penetrates this barrier and can cause inflammation.

Children with congenital or acquired immunodeficiency. The imperfection of the cells of the immune system does not allow them to respond in a timely manner to an external pathogenic factor. The leukocyte component of immunity is not yet capable of effectively eliminating any infectious agents from the body. In such children, the risk of a severe course of any, even the most harmless infection, increases many times over.

Birth injuries. Have adverse effects on the nervous system. Damage to the nerve trunks and membranes of the brain during traumatic external influences also contributes to the development of meningitis in children.

Chronic congenital diseases. Weakened kids with many accompanying pathologies are unable to fight infection adequately. Presence of congenital heart diseases, diabetes mellitus, Cerebral palsy affects possible prognosis with meningitis.

What are the main signs in newborns and infants?

Determining the first manifestations of meningitis in infants is a rather difficult task for any mother. The child’s behavior and well-being during the incubation period practically does not suffer. Typically this period ranges from 3-5 days to two weeks. Attentive mothers may notice that the child becomes more lethargic and tries to rest more often.

Signs characteristic of meningitis usually appear as:

Temperature rise. Usually fast. Within a few hours the temperature rises to 38-39 degrees. Babies may feel chills or have a fever. Taking paracetamol and other antipyretics does not bring relief. The temperature remains high for 4-5 days of illness. In severe cases - more than a week.

• Severe headache. Breasts can’t yet say what’s bothering them. If the child becomes more lethargic, cries, and tries to tilt his head below the level of the pillow, you should definitely be wary! Often this symptom is a manifestation of high blood pressure and requires immediate medical assistance.

• Changing the child's behavior. Babies refuse to breastfeed and become lethargic. When the head and neck are touched, the child may begin to cry or avoid contact. Any attempts to pull the legs towards the stomach or move them to the sides can cause problems for the baby. severe discomfort and even lead to increased pain.

• Frequent regurgitation. Despite the usual feeding, the baby may constantly regurgitate food. This is a manifestation of severe nausea. Some babies may even experience a single, but severe vomiting.

• IN severe cases- the appearance of seizures. This symptom usually occurs in children with congenital diseases nervous system or episyndrome. The appearance of this manifestation of the disease is an unfavorable prognostic sign of the disease and requires urgent hospitalization of the baby in the intensive care unit.

When worsening general condition and increasing signs of the inflammatory process - clouding of consciousness or even coma. Be sure to pay attention to the child's gaze. If it becomes “absent”, call your doctor immediately! This may be one of the manifestations of meningitis.

Diagnostics

To establish a diagnosis, the doctor conducts special tests. Typically, the doctor presses the baby's legs against the stomach or torso and assesses the reaction. Increased pain is a positive meningeal sign and requires additional diagnostics.

One of the most accessible tests is a general blood test. Its result provides information to doctors about the specific cause of the disease. Most often, a viral or bacterial etiology of the disease can be established. Leukocyte formula V general analysis blood shows how severe the inflammatory process is.

The causative agent of the disease can be more accurately determined using bacteriological tests. They allow you to identify various types of viruses, bacteria, fungi and even protozoa. The undoubted advantage of such a test is that it is possible to additionally determine the sensitivity of the microbe to various drugs. This allows doctors to prescribe the correct and effective treatment, eliminate the cause of the disease.

In difficult cases, doctors resort to puncture. The doctor makes a puncture in the spine with a special needle and takes some cerebrospinal fluid for examination. By using laboratory analysis It is possible to determine not only the pathogen, but also the nature of the inflammatory process and the form of the disease.

What are the consequences?

In many children who received adequate treatment for meningitis in a timely manner, the disease ends in complete recovery. However, such a result is not guaranteed in all cases. If the child had aggravating factors, the course of the disease becomes quite severe. In this case, the risk of developing adverse events increases significantly.

The most common complications encountered in infants in their first year of life are:

Nervous system disorders. These include: decreased concentration and attention, some lag in mental and even physical development. After rubella meningitis - hearing loss and poor speech perception.

The appearance of episyndrome. Some babies may experience seizures. This symptom is often temporary. To eliminate adverse events A mandatory consultation with a neurologist and additional diagnostic tests are required. Children undergo EEG, neurosonography, and other tests to assess the level of damage to the nervous system.

Heart rhythm disturbances. Transient arrhythmias are more common. They usually appear several months or even years after recovery from the infection. Babies with such complications require mandatory monitoring by a cardiologist or arrhythmologist.

How to treat?

All children with suspected meningitis must be hospitalized in a hospital. Newborn babies are delivered to hospitals equipped with all the necessary resuscitation equipment. The child must be monitored 24 hours a day by medical staff.

Treatment of the disease is carried out comprehensively. The leading role in therapy is played by eliminating the main cause that caused the disease. For infectious meningitis, large doses of antibiotics are prescribed. All antibacterial agents are administered parenterally. Intravenous administration of drugs allows you to quickly achieve the desired clinical effect and speed up recovery.

To restore the nervous system, the introduction of B vitamins is used. Such injection forms medicines allow to reduce toxic effect bacterial agents on nerve trunks. Vitamins are usually prescribed for a long time, in courses of 10 days.

To eliminate the symptoms of intoxication, various detoxification drugs are used. Children are often given large doses of a 5% glucose solution or isotonic sodium chloride solution. If seizures or movement disorders occur, electrolyte solutions are added to the treatment. With this administration of medications, the baby’s well-being returns to normal quite quickly.

After the condition has stabilized, children are prescribed immunostimulating drugs. They activate the immune system and help the immune system fight infection. Such medicines Quite effective for newborns and babies in the first year of life. They are generally well tolerated and do not cause adverse side effects.

Prevention

Compliance with the rules of personal hygiene for babies of the first year is also a necessary condition prevention of meningitis and other inflammatory diseases. In order to prevent infection through contact and household methods, it is imperative to ensure the cleanliness of all objects that touch the child’s skin and mucous membranes. Towels must be washed daily. Textiles should be ironed with a hot iron on both sides.

Treatment of meningitis in infants of the first year of life should be started, if possible, as soon as possible. short terms. This will not only prevent possible adverse complications of a dangerous disease, but also preserve life and health.

Watch all about meningitis in a child in the following video by Dr. Komarovsky.