Symptoms of meningitis in an adult, first signs, diagnosis and treatment. Description of the disease

What is meningitis? We will discuss the causes, diagnosis and treatment methods in the article by Dr. P. A. Aleksandrov, an infectious disease specialist with 11 years of experience.

Definition of disease. Causes of the disease

Infectious meningitis- a group of acute, subacute and chronic infectious diseases caused by various types pathogenic microorganisms(viruses, bacteria, fungi, protozoa), which, under conditions of specific resistance of the body, cause damage to the membranes of the brain and spinal cord, manifested in a pronounced syndrome of irritation of the meninges, severe intoxication syndrome and always occurring with a potential threat to the life of the patient.

Infectious meningitis can be either a primary pathology (developing as an independent nosological form) or secondary (developing as a complication of another disease).

Looking ahead, I would like to answer a popular question from readers and netizens: what is the risk of infection from a patient, and is it possible to be near a patient without a particular risk of developing meningitis? The answer is quite simple: due to the fact that meningitis is a group of diseases caused by various infectious agents, then the risk of infection will depend on etiological cause meningitis, but the likelihood of developing meningitis depends on the abilities immune system person. In other words, to know whether there is a risk, you need to know which microorganism caused meningitis in the patient and what the protective immune abilities of those around him are.

Depending on the type of meningitis, the routes of infection and the mechanisms of disease occurrence differ. In relation to infectious meningitis, one can point to an extremely wide geographical distribution, with a tendency to increase foci of the disease on the African continent (meningococcal meningitis), more frequent development illnesses in children and increased morbidity during the cold season (viral meningitis as a complication of ARVI). Transmission of infection occurs more frequently by airborne droplets.

Symptoms of meningitis

Quite characteristic of meningitis (and in particular with the meningococcal process) are signs of involvement in pathological process meninges (meningeal syndromes), which are divided into groups:

Separately worthy of mention is a specific manifestation that is similar to the symptoms of meningitis (meningeal syndrome), but is not such and has nothing to do with the pathogenesis of true meningitis - meningism. Most often it develops as a result of mechanical or intoxicating effects on the meninges in the absence of an inflammatory process. It is relieved when the provoking effect is removed; in some cases, differential diagnosis is possible only when special research.

Pathogenesis of meningitis

Variety of pathogens and individual characteristics individuals in the human population are also determined by the fairly pronounced variability in the forms and manifestations of meningitis and the risk of infection for other people, so in this article we will focus on the most meaningful forms diseases and their causative agents in social terms.

Meningococcal meningitis- always an acute (acute) disease. Caused by Wekselbaum's meningococcus (a gram-negative bacterium, unstable in the environment, at a temperature of 50 degrees Celsius it dies after 5 minutes, UV irradiation and 70% alcohol kill almost instantly). The source of the spread of infection is a sick person (including meningococcal nasopharyngitis) and a bacteria carrier; transmission occurs by airborne droplets.

The site of introduction (gate) is the mucous membrane of the nasopharynx. In the vast majority of cases, the infectious process does not develop or local forms of the disease develop. When meningococcus overcomes local anti-infective barriers, hematogenous spread of infection occurs and a generalized meningococcal infection occurs, including the development of meningococcal meningitis, which, in the absence of adequate treatment, ends in death in more than 50% of cases. In the pathogenesis of the disease, toxins that are released after the death of bacteria in the bloodstream and damage to the walls of blood vessels play a role, which leads to hemodynamic disturbances, hemorrhages in organs and profound metabolic disorders. Hyperirritation of the membranes of the brain occurs, development purulent inflammation tissue and rapid increase in intracranial pressure. Often, due to edema and swelling of the brain tissue, the brain becomes wedged into the foramen magnum and the patient dies from respiratory paralysis.

The latent period of illness is from 2 to 10 days. The onset is acute (even more correctly, acute). In the first hours of the disease, there is a sharp increasing increase in body temperature to 38.5 degrees and above, severe lethargy, fatigue, pain in the periorbital region, loss of appetite, and a sharp headache. A characteristic feature headache is a constant increase in its intensity, diffuse pain without clear localization, bursting or pressing in nature, causing true torment for the patient. At the height of the headache, vomiting occurs without preceding nausea, which does not bring any relief. Sometimes in patients with a severe uncontrolled course, mainly in children in an unconscious state, an uncontrollable cry is observed, accompanied by clasping the head with the hands - the so-called. "hydrocephalic cry" caused by sharp growth intracranial pressure. The appearance of the patients is etched in the memory - sharpening of facial features (Lafora’s symptom), meningeal posture on the 2-3rd day of the disease (still “coping dog”). Some patients develop hemorrhagic rashes on the body, resembling a star-shaped rash (an unfavorable sign). Over the course of 2-3 days, the severity of symptoms increases, hallucinations and delusions may appear. The degree of impairment of consciousness can vary from somnolence to coma; if untreated, death can occur at any time.

Tuberculous meningitis- slowly developing pathology. It is mainly secondary, developing in the context of existing tuberculosis in other organs. It has several periods of development, consistently developing over a long time:

1. prodromal (up to 10 days, characterized by mild symptoms of general malaise)

2. sensorimotor irritation (from 8 to 15 days, the appearance of initial cerebral and weak meningeal manifestations)

3. paresis and paralysis (attracts attention from the 3rd week from the onset of the infectious process in the form of changes and loss of consciousness, difficulty swallowing, speech).

Initially, a moderate increase in body temperature appears without pronounced jumps and rises, quite tolerable headaches of low intensity, well relieved by taking analgesics. In the future, headaches intensify, nausea and vomiting become involved. An invariable sign of tuberculous meningitis is a rise in temperature, fever, and the numbers and duration can vary from subfebrile to hectic values. Gradually, from the end of the second week, symptoms of disorientation and stupor appear and slowly increase, ending in deep “congestion” of the patient, stupor and coma. Dysfunction of the pelvic organs and abdominal pain develop. They are also gradually developing meningeal symptoms, and truly classic symptoms (the “pointing dog” pose) develop only in advanced cases.

Herpetic meningitis most often caused by viruses herpes simplex types 1 and 2, by the varicella zoster virus and develops against a background of weakening of the body due to ARVI or serious immunosuppression, incl. AIDS. It is divided into primary (when the process develops during initial infection with the virus) and secondary (reactivation of the infection against the background of decreased immunity). Always acute illness, primary manifestations depend on the previous premorbid background. More often, against the existing background of acute respiratory viral infections, herpetic rashes of the perioral area and genital organs, a severe headache of a diffuse nature occurs, intensifying over time, and vomiting, which does not bring relief. All this can occur against the background of moderate or high promotion body temperature, mild meningeal symptoms. Brain damage is often associated; in such cases, mental disorders (often aggression), hallucinations, disorientation, and generalized convulsions occur within 3-4 days. With proper treatment, the prognosis is usually quite favorable; in the absence of adequate treatment in conditions of impaired immunological resistance, death or persistent residual effects are possible.

Classification and stages of development of meningitis

Highlight the following types infectious meningitis:

2. According to the predominant course of the inflammatory process:

• purulent (meningococcal, pneumococcal, caused by Haemophilus influenzae)
• serous (viral)

3. Downstream:

• sharp (optionally - lightning fast)
• subacute
• chronic

4) By localization, severity, clinical forms, etc.

Complications of meningitis

Complications observed with meningitis of meningococcal nature (less often with other forms of meningitis) can be early and late, associated both with a catastrophe of the nervous system and other parts of the body. The main ones:

Diagnosis of meningitis

The primary diagnostic search includes an examination by an infectious disease specialist and a neurologist and, if possible meningitis is suspected, a leading diagnostic study- lumbar puncture.

It involves inserting a hollow needle into the subarachnoid space of the spinal cord at the level lumbar region spine. Target said study- clarify the type, properties and nature of changes in the cerebrospinal fluid, identification of possible pathogens and treatment options for this type of meningitis.

Depending on the etiological agent, causing meningitis, the properties of cerebrospinal fluid differ; here are their main types and characteristics:

1. Bacterial meningitis (including meningococcal meningitis):

• liquor high pressure(over 200 mm water column)
• the leaking liquid is yellow-green, viscous, with significant cell-protein dissociation, flows out slowly
• high cell content (neutrophilic pleocytosis 1000 per µl and above)
• increase in protein level 2-6 g/l and above
• drop in chloride and sugar levels

2. Serous meningitis (including viral):

• CSF pressure is normal or slightly increased
• The cerebrospinal fluid is clear, flowing out when punctured is 60-90 drops per minute
• quantity cellular elements in the cerebrospinal fluid (cytosis) less than 800 per µl
• protein concentration up to 1 g/l and below
• glucose is within normal limits

3. Tuberculous meningitis:

• moderate increase in liquor pressure
• transparent in appearance, sometimes opalescent film
• moderate number of cells (up to 200 per µl, predominantly lymphocytes)
• protein increased to 8 g/l
• glucose and chlorides are reduced

In addition to determining the physicochemical properties of cerebrospinal fluid, methods are widely used today to isolate and identify the causative agent of the disease, which can play a decisive role in therapy and prognosis. The most significant are the cultivation of native cerebrospinal fluid on nutrient media (search for bacterial, fungal pathogens), carrying out PCR of cerebrospinal fluid ( polymerase chain reaction) in order to identify the nucleic acids of the pathogen, performing ELISA ( enzyme immunoassay) cerebrospinal fluid, blood, urine, etc. in order to determine antigens and antibodies of possible pathogens of meningitis, microscopy of cerebrospinal fluid and nasopharyngeal mucus, clinical and biochemical tests blood. An MRI of the brain is quite informative.

MRI of the brain for meningitis

CT scan of the brain

Treatment of meningitis

The main and main condition effective assistance For patients with meningitis, early hospitalization in a hospital and the beginning of specific etiotropic and pathogenetic therapy are recommended! Therefore, at the slightest suspicion of meningitis by a doctor or paramedic, all possible steps should be taken to quickly transport the suspicious patient to an infectious disease hospital and begin treatment; doubts of medical specialists or the patient himself in terms of diagnosis and hospitalization should be regarded as unfounded (dangerous) and immediately suppressed.

Etiotropic therapy (aimed at getting rid of the pathogen) depends on specific situation(conducted research, doctor’s experience, algorithms) and may include the prescription of antibacterial drugs, including anti-tuberculosis drugs (for meningitis of a bacterial, tuberculous nature, uncertainty of the situation), antiviral agents(for herpetic meningitis and other viral pathogens), antifungal agents(for fungal infections). Preference is given to intravenous administration medicines under the control of the patient’s condition and periodic monitoring of the cerebrospinal fluid (control lumbar puncture).

Pathogenetic and symptomatic therapy is aimed at interrupting the pathogenesis links, improving the action of etiotropic drugs and improving the general condition of the patient. This may include the use of hormones, diuretics, antioxidants, vascular agents, glucose, etc.

Severe and life-threatening forms of meningitis should be kept in intensive care units and intensive care units under constant supervision of medical personnel.

Forecast. Prevention

The prognosis for the development of meningitis depends on its causative agent. At bacterial meningitis(taking into account the fact that in 60% of cases it is meningococcal meningitis) the prognosis is always (even in modern conditions hospitals) is very serious - mortality can reach 10-15%, and with the development of generalized forms of meningococcal infection - up to 27%. Even with a successful outcome, there is a high risk of residual effects, such as intellectual impairment, paresis and paralysis, ischemic stroke, etc.

It is impossible to predict the development of certain disorders; it is only possible to minimize their occurrence timely appeal see a doctor and start treatment. With viral meningitis, the prognosis is more favorable; in general, mortality is no more than 1% of all cases of the disease.

Prevention of meningitis includes specific and non-specific activities.

Nonspecific- healthy lifestyle, strengthening the immune system, maintaining good hygiene, using repellents, etc.

Specific prevention is aimed at developing immunity against certain pathogens of infectious meningitis; this is vaccination, for example, against meningococcal infection, pneumococcus, and Haemophilus influenzae. Vaccinations are most effective in children's groups, since children are most susceptible to developing meningitis, and vaccination reliably reduces their incidence rate.

Bibliography

• 1. Alekseeva, L. A. Diagnostic value of the spectrum of cerebrospinal fluid in bacterial and viral meningitis in children / L. A. Alekseeva, M. N. Sorokina // Clinical laboratory diagnostics. 2001.No. 2. P. 215-219
• 2. Bogomolov B.P. Diagnosis of secondary and primary meningitis. // Epidemiol. and infectious diseases, 2007. No. 6. P.44-48.
• 3. Kazantsev A.P., Zubik T.M., Ivanov K.S., Kazantsev V.A. Differential diagnosis infectious diseases. Guide for doctors. M.: Med. information agency, 1999. - 481 p. / Ch. 13. Meningitis and meningoencephalitis. P.342-379
• 4. Infectious diseases: national leadership. / Ed. N.D. Yushchuka, Yu.Ya. Vengerova. M.: GEOTAR-Media, 2009. 1056 p. (P.725-735)
• 5. Meningococcal meningitis. Newsletter N°141. WHO. November 2015
• 6. Meningococcal Disease (Neisseria meningitidis)/Centers for Disease Control&Prevention/July 24, 2015
• 7. Meningococcal Disease: Technical and Clinical Information/Centers for Disease Control&Prevention/July 24, 2015
• 9. Meningococcal Disease/Centers for Disease Control&Prevention/July 24, 2015
• 10. Sejvar JJ, Johnson D, Popovic T, et al. Assessing the risk of laboratory-acquired meningococcal disease. J Clin Microbiolol 2005; 43:4811–4

Meningitis is an inflammatory process in the membranes of the brain and spinal cord. The disease is very dangerous and if meningitis is suspected, the patient should be hospitalized as soon as possible, since it can only be treated in a hospital, regardless of the patient’s age.

Meningitis is believed to be more common in children. The failure or high permeability of the blood-brain barrier in children determines not so much the incidence of morbidity in children, but the severity of the disease and the frequency of deaths (substances that should not penetrate there penetrate into the brain, causing seizures and other cortical or pyramidal disorders).

Meningitis is dangerous because even with timely, proper therapy he can call serious complications And long-term consequences, such as recurrent headaches, decreased hearing, vision, dizziness, epileptic seizures, which can last several years or remain for life.

Regardless of the causes of occurrence, the causative agent of infection, the localization of the process, clinical manifestations the diseases have several common first signs of meningitis.

The first symptoms of meningitis

Meningitis is so serious dangerous disease, complications of which can lead to disability and even death, so every person should know how to identify meningitis, what its characteristic symptoms are, how meningitis manifests itself, in order to seek medical help as early as possible and begin adequate treatment on time.

General infectious symptoms

One of the symptoms of meningitis: if you lay the patient on his back and tilt his head to his chest, his legs will involuntarily bend.

This is primarily intoxication:

• high body temperature
• pale skin
• pain in muscles and joints
• shortness of breath, rapid pulse, cyanosis of the nasolabial triangle
• at severe course may have low blood pressure
• loss of appetite, complete failure from food
• patients feel thirsty and therefore drink a lot; refusal to drink is regarded as an unfavorable sign.

Meningeal syndrome

These are the first cerebral symptoms of meningitis, such as:

Headache

occurs due to the toxic effect of infection on the meninges, due to increased intracranial pressure, it is observed in all patients with any meningitis. Headache, bursting, very intense, worsens with movement, sharp sounds and light irritations, is not localized in individual parts, but is felt throughout the head. Moreover, taking analgesics has no effect and does not relieve pain.

Dizziness, photophobia, sound sensitivity, vomiting

They appear on the 2-3rd day of illness. Vomiting may occur at the peak of the headache; it does not bring relief. Usually this vomiting is a fountain and is not associated with food intake. Increased visual, tactile and sound sensitivity develops due to irritation of the cells of the brain ganglia, dorsal roots and receptors of the meninges; this significantly reduces the threshold of sensitivity to any irritants. Even a slight touch of the patient can cause increased pain in the patient.

Features of symptoms in infants

Infants are very excited, restless, often cry out, become very excited when touched, they also often have diarrhea, drowsiness, and repeated regurgitation. In young children, one of the first signs of meningitis is often convulsions, often repeated. Adult patients usually cover their heads with a blanket and lie facing the wall. If at the onset of the disease in adults and adolescents it is accompanied by convulsive twitching, this is an unfavorable sign.

From the first days of the disease, the first symptoms of meningitis are observed:

• • stiff neck– difficult or impossible bending of the head. This is the earliest sign of meningitis and is permanent.
  • Kernig's symptoms- a state when the knees are bent and hip joints legs cannot straighten.
  • Brudzinski's symptoms – upper symptom characterized by involuntary bending of the legs when the head is tilted to the chest. If you lay the patient on his back and tilt his head to his chest, the legs at the knee and hip joints will involuntarily bend. The average symptom is involuntary bending of the patient’s legs if pressure is applied to the area of ​​the symphysis pubis. Lower symptom– when checking the Kernig sign, the other leg involuntarily bends.

• Lesage's symptoms– in young children, some characteristic meningeal symptoms are not clearly expressed, so the large fontanel is examined. It bulges, throbs and is tense. They also check for the posture of a pointing dog - when the child is held under the armpits, he throws his head back, pulls his legs towards his stomach - this is Lesage's symptom.
• The man takes a forced kicking dog (trigger) pose. This is when the patient covers his face with a blanket and turns to the wall, brings his bent legs to his stomach in a position on his side and throws back his head, as this relieves the tension of the membranes and reduces headaches.
• Patients with meningitis may also have the following characteristic pain:
  • Bekhterev's symptom - contraction of facial muscles when tapping on the zygomatic arch
  • Pulatov's symptom - pain when tapping the skull
  • Mendel's sign - pain when pressing on the area of ​​the external auditory canal
  • Pain when pressing on the exit points of the cranial nerves ( for example, trigeminal, under the eye, in the middle of the eyebrow).
• In addition, damage to the cranial nerves can clinically manifest itself as the following symptoms:
  • decreased vision
  • double vision
  • nystagmus
  • ptosis
  • squint
  • paresis of facial muscles
  • hearing loss
  • in most cases, patients experience changes and confusion.

• In the first days of illness, the patient generally experiences the following first signs of meningitis:
  • excitement, which may increase in the future
  • accompanied by hallucinations, motor restlessness
  • or, on the contrary, be replaced by stupor, lethargy
  • up to entering a comatose state.

From the first to second day, against the background of a rise in temperature and headache, a pink or red rash appears that disappears with pressure. Within a few hours it becomes hemorrhagic, that is, a rash in the form of bruises (cherry pits) with a darker middle of varying sizes. It starts from the feet, legs, creeping onto the hips and buttocks and spreading higher and higher (up to the face).

This is a dangerous signal, and an ambulance must be called immediately, otherwise the matter could quickly end in death. The rash is the necrosis of soft tissues against the background of incipient sepsis caused by meningococcus. Septicemia can occur without pronounced cerebral symptoms. A rash combined with fever is enough to urgently call an ambulance.

The first symptoms of meningitis are most often:

• high temperature (39-40 degrees);
• severe chills;
• headache;
• weakness;
• loss of appetite;
• excitement or, conversely, lethargy.

On the first or second day (against the background of a headache and high temperature), a pink or red rash may appear, which begins from the feet and legs, gradually spreading higher and higher - up to the face. The rash resembles small bruises that disappear with pressure.

If you notice in yourself or a patient this symptom, urgently call an ambulance, as this is a signal that sepsis is developing and if delayed (without qualified medical care), the matter can end in death.

Also, attention should be paid to a number of early symptoms meningitis:

1. Rigidity of the neck (immobility) - the head is difficult or impossible to bend, the patient cannot reach his chin to his chest. This is one of the earliest signs.
2. Brudzinski's symptoms - involuntary flexion of the legs occurs (in the knee and hip joints) when the head is tilted towards the chest area.
3. Kernig's symptoms - legs bent at the knees do not straighten.
4. a large fontanel may swell.
5. Another characteristic symptom is that the patient turns his face to the wall and covers his head with a blanket, while curling up in a ball position and throwing his head back.
6. In addition, you can note: blurred vision, double vision, confusion, hearing loss.

Signs of meningitis by type

Primary

With primary meningitis, an acute infectious process occurs, which is caused by. The trigger for the development of the disease is weakened immunity caused by hypothermia and viral infections. IN in this case, the disease develops independently, without progression infectious processes in any organ. For example, bacteria can enter the body through the respiratory system.

How does primary meningitis begin?:

• Strong headache;
• fever, chills;
• high body temperature;
• intolerance to light and harsh sounds;
• the appearance of a rash on the body;
• motor activity, which is often replaced by lethargy;
• loss of consciousness may occur;
• stiff neck;
• Sometimes convulsions occur.

Secondary

The disease occurs against the background of any infectious disease(after measles, mumps, syphilis, tuberculosis, pneumonia, sinusitis, tonsillitis, otitis, with skull injuries), and is often caused by pneumococci, less often staphylococci, streptococci, but also meningococci (as in the case of primary meningitis).

• general weakness;
• malaise;
• dizziness;
• chills with fever;
• temperature rise up to 40 degrees;
• a sharp headache that gradually gets worse;
• nausea and profuse vomiting;
• mental changes occur;
• the patient refuses to eat and drink;
• children may experience an increase in head size;
• insomnia;
• hallucinations;
• in rare severe cases- coma.

Symptoms of primary and secondary diseases may be similar. Only a doctor can determine the truth and prescribe appropriate treatment.

General symptoms

In addition to the above symptoms (headache, fever, etc.), which can occur with both primary and secondary meningitis, there are a number of symptoms characteristic of this disease.

General infectious signs of meningitis:

• pale skin;
• pain in joints and muscles;
• nasolabial triangle bluish in color;
• a constant feeling of thirst;
• decreased blood pressure;
• dyspnea;
• rapid pulse;
• Lesage's symptom in children - when a child is held in the armpits (suspended), he bends his legs to his stomach;
• increased tactile sensitivity.

Meningeal syndrome

This the first cerebral symptoms of the disease, which can be characterized by signs:

1. Severe bursting headache - occurs in all patients and occurs due to increased intracranial pressure. The pain spreads throughout the head and is not localized in one place. This may cause pressure on the eyes and ears. Analgesics are not given desired effect- the pain does not go away.
2. Dizziness, “fountain” vomiting, fear of light and sound - these symptoms appear on the second or third day of the disease. Vomiting usually occurs with increased headache and does not bring relief. Due to increased tactile sensitivity (due to irritation of the receptors of the meninges), the patient may experience pain even with a light touch to any area of ​​the skin.
3. there is severe agitation and anxiety, diarrhea, frequent regurgitation, drowsiness and convulsions.

What to do in such a situation?

If you notice symptoms of meningitis in yourself or your relative/friend, you should immediately call an ambulance to prescribe appropriate therapy. In severe forms of the disease, patients are hospitalized in infectious diseases department hospitals.

This is necessary for two reasons:

1. without inpatient treatment, the patient’s condition may deteriorate significantly and lead to irreversible consequences (disability, death);
2. Close relatives can also catch the infection.

An infectious disease specialist treats this disease. If the disease proceeds without bright severe symptoms(chills, high temperature), accompanied only by a headache, and the patient doubts that these are signs of meningitis - you can contact a neurologist.

However, if confidence in correct diagnosis is absent, it is better to consult an infectious disease specialist or a general practitioner, who will decide on subsequent tactics. There is no point in taking any painkillers - it will not help.

In neurologist's offices and clinics, you rarely hear about such a diagnosis. It seems that the destiny of neurology is osteochondrosis, radicular syndromes or hypertensive encephalopathy.

But there are heavy, and sometimes even fatal diseases central nervous system – meningitis and encephalitis.

Previously, it was believed that a person who had suffered this disease either died or remained insane. In fact, this judgment is fundamentally incorrect. What is this, meningitis? Let's try to understand the main issues of this vast and very interesting topic.

What is meningitis and its causes?

Meningitis is inflammatory disease the central nervous system, namely its meninges. Since there are both hard and soft membranes, there can be pachymeningitis and leptomeningitis, respectively. Severe diseases are among the most painful in all of neurology and, perhaps, in the entire clinic of internal diseases.

The severity of the condition is due to the excellent sensory innervation of the meninges. They perceive pain well, which is the main symptom of any meningitis.

The causes of the disease, of course, are microorganisms and viruses. The most famous are the following:

• Meningococcal purulent meningitis caused by diplococci of the genus Neisseria. Is a "classic" with full development symptoms, the appearance of a hemorrhagic rash and all sorts of complications, including gangrene of the extremities. Currently, it is rare, occurring mainly in the form of outbreaks in organized institutions, especially children's;
• . A significant proportion of cases occur in the meningeal form, without damage to the medulla and focal neurological symptoms;
• Tuberculosis bacillus. Causes severe, sluggish tuberculous meningitis, which develops in weakened people who have been suffering from tuberculosis for a long time. To do this, you definitely need a primary focus of the tuberculosis process in the body.

In addition to these reasons, inflammation of the meninges can be caused by conditionally pathogenic flora or even fungi. The lower a person’s immunity, the higher this risk. In patients with HIV infection in the AIDS stage, meningitis can be caused by the most harmless bacteria, and the course of this disease will be severe.

Types of meningitis and features

As with any inflammation, meningitis can cause pus to form; such inflammation is called purulent. Moreover, during autopsies of patients who died from meningitis, the cerebral hemispheres are covered with a “purulent cap.” This is most noticeable in the meningococcal process.

Serous meningitis occurs much more easily, in which no pronounced protein production occurs in the cerebrospinal fluid, and the cerebrospinal fluid retains its transparency. An example is the meningeal form tick-borne encephalitis. As a rule and clinical course Such serous forms are easier than purulent ones.

But against the background of a serous process that proceeds unfavorably, secondary suppuration may develop. This process is called “secondary purulent meningitis.” It can appear, for example, as a complication of an open head injury.

In this case, a post-traumatic inflammatory process develops. If inflammation of the membranes complicates the course of purulent otitis media, then such meningitis is called otogenic, etc.

The disease can be classified according to the area affected. Inflammation at the base of the brain is called basal; with inflammation of the membranes covering the cerebral hemispheres, convexital meningitis develops. There is meningitis that affects the lining of the spinal cord (spinal meningitis).

The course of the disease can range from fulminant (meningococcal sepsis) to chronic (tuberculosis process).

The disease can also be classified by sensitivity to antibiotics, changes in the cerebrospinal fluid and many other signs.

Why is meningitis dangerous? - Consequences of the disease

Of course, a purulent process is more dangerous than a serous one. Therefore, most often complications can be analyzed using the example of epidemic cerebrospinal meningitis caused by meningococcal infection. The most common conditions that develop are:

• septic shock;
• edema - swelling of the brain with subsequent dislocation of its substance, the development of various variants of herniation, is the most common cause death on the first day of disease development;
• transfer of infection from the membranes to the substance of the cerebral cortex, with the addition of focal symptoms - the development of meningoencephalitis;
• A serious complication is occlusive hydrocephalus. At the same time, adhesions, which are located in abundance in the cerebrospinal fluid pathways after a purulent process, are capable of blocking these pathways to a greater or lesser extent. As a result, a rapidly progressive syndrome of intracranial hypertension develops.

Any purulent meningitis, the consequences of which cannot be predicted in advance, must be treated in the neuroinfection department of an infectious diseases hospital or in the intensive care unit.

Signs of meningitis in adults during the first hours and days may not be specific enough: when there is no headache yet, the following symptoms may bother you:

• increase in temperature, with chills, to high numbers;
• the appearance of skin hyperesthesia - the patient finds it unpleasant to touch the skin (senestophobia);
• Photophobia and phonophobia also arise - a person wants to retire to a dark, quiet room and, if possible, go to bed.

Of course, many diseases can have such signs, such as influenza, or even migraines (except fever). But the next day, meningitis develops in all its characteristic clinical picture.

The leading symptom of inflammation of the membranes is general cerebral symptoms. And the main symptom is a diffuse, diffuse, constant headache of high intensity. Many patients even noted the hour of onset of the illness, and not just the day. And this hour was marked by the appearance of such a headache, which turned out to be the strongest in my life.

Combined with fever, such pain exhausts a person. It cannot be relieved by any analgesics, since its mechanism is completely different - the membranes are irritated by local inflammation, and overproduction of cerebrospinal fluid occurs.

This aggravates the situation: increased pressure of cerebrospinal fluid on the inflamed membranes leads to an even greater increase in headaches, as well as to the appearance of cerebral or central vomiting. This vomiting occurs without any connection with the stomach, food intake, and has nothing to do with gastrointestinal tract: its cause lies in irritation of brain structures high blood pressure cerebrospinal fluid.

The sign of this vomiting is complete suddenness. Suddenly, without any previous nausea, the patient vomits in a “fountain”, a powerful stream, wherever necessary.

After a few seconds, a person may realize that next time he needs to remove all the surrounding things away, otherwise they will be spoiled. Vomiting does not bring relief. In addition, with meningitis, an extremely painful symptom of shaking of the membranes occurs.

Its weak copy is the famous or lumbar lumbago - lumbago. Each time a nerve root is shaken, a sharp pain occurs in the lower back, from which the person groans and freezes. So, the same pain, only it constantly “explodes” in the head of a patient with meningitis. He loses sleep and appetite.

Every rise of the head, attempt to change position, get up, sit up in bed, brings severe torment. Any deep breath and straining intensify the headaches so much that they force you to give up the idea of ​​emptying your bowels, and at this stage infectious intoxication is aggravated by constipation.

In addition, pain occurs in all tendons of the body, which, together with large muscles, contract due to painful impulses of the membranes.

Therefore, a characteristic posture of a patient with meningitis arises: it is aimed at “compensating” for the pain that arises: the patient lies on his side, his head is extended (thrown back), and his legs are pulled up to his stomach.

The classic symptom of meningitis, which distinguishes it from all other conditions, is zygomatic symptom Ankylosing spondylitis: when tapping the cheekbone with a neurological hammer, a pronounced outbreak of headache occurs in the entire head, and not at the site of tapping. This symptom is a clear example of the effect of a concussion of the inflamed meninges.

Besides, sharp pain causes pressure on the eyeballs. The above symptoms may be accompanied by a painful grimace from the patient, confirming the pain reaction.

The symptoms of meningitis in adults described by us characterize both purulent and serous form diseases. In the event that foci of a rash that tends to merge appear on a person’s skin, a case of meningococcal meningitis is likely.

Further leaving the patient without urgent help neurologist and infectious disease specialist causes progression of symptoms.

An increase in intracranial pressure and infectious-toxic symptoms lead to a gradual loss of consciousness, infectious-toxic shock and the development of cerebral edema. There is a slow development of coma and oculomotor disorders (for example, strabismus) against the background of severe stupor and depression of consciousness.

Brain damage due to meningitis, photo

Meningitis is an interesting disease: obligatory and completely required method diagnostics - lumbar puncture, almost always, in addition to the necessary and important information for the doctor (transparency and color of the cerebrospinal fluid, its flow out in drops or streams), brings the first and significant relief: the headache is sharply reduced. Therefore, treatment of meningitis in adults begins with a lumbar puncture.

It is carried out in a hospital, lying down; after the puncture, you are not allowed to get up for 24 hours. Further tactics depend on the composition of the cerebrospinal fluid. Yes, treatment purulent meningitis begins with the introduction of bacteriostatic antibiotics, and treatment of tuberculous meningitis begins with tuberculostatics and the use of reserve drugs.

At the same time, anti-inflammatory therapy is carried out: intravenous administration of dexamethasone solution or other corticosteroid hormones can stop pain syndrome for serous meningitis, reduce its intensity during a purulent process.

As a rule, with proper antibacterial and pathogenetic therapy, on the first or second day the intensity of the headache decreases, the temperature normalizes, vomiting stops, and appetite appears.

Forecast

With meningitis, the prognosis is quite difficult to determine. The later the time has passed since the development of the first symptoms, the easier it is to give some kind of prognosis. And on the first day it is completely unclear. For meningitis, the prognosis depends on:

1. Urgency of seeking medical help;
2. Level of development of fever and signs of intoxication;
3. The appearance of a hemorrhagic rash;
4. Severity of general cerebral symptoms (headache, vomiting);
5. The appearance of focal symptoms, signs of depression of consciousness;
6. Results of bacteriological and general research cerebrospinal fluid and the patient’s reaction to puncture;
7. First reaction to treatment;
8. Time frame for normalization of temperature and regression of symptoms.
9. Availability concomitant pathology, aggravating factors (age, cardiac, renal and liver failure, polyvalent drug allergy).

Long-term results for quality of life are favorable. Sometimes subsequent treatment with nootropic drugs, vitamins, and absorbent agents is required. To prevent the increase in intracranial pressure and treat adhesions, electrophoresis with lidase through the eyeballs and administration of diacarb may be required.

Headache and high temperature are not always a consequence of an acute respiratory disease, sometimes it is much worse. Inflammatory processes that occur in the membranes of the brain, and in some cases in the membranes of the spinal cord, are called meningitis - symptoms, causes, classification, diagnostic and treatment options for which will be discussed in this article.

So, what kind of disease is meningitis and what causes it? Meningitis is an acute inflammatory disease of the central nervous system (CNS). In modern neuroscience this disease is, if not the most common, then at least in leading positions.

Shell differences

As the disease progresses, the outer membranes of the brain or spinal cord are damaged. It is noteworthy that the inflammatory process does not penetrate into the brain and does not spread to its cells.

Where this disease comes from is a somewhat incorrect question, since there is no “meningitis virus” in nature. The disease can be caused by various viruses, bacteria or fungi. Moreover, there is such a thing as secondary meningitis, which develops against the background concomitant disease. Some doctors believe that the secondary form of the disease is the most dangerous, since it is difficult for the body, already weakened by the primary disease, to fight on two fronts.

The disease is dangerous as it can lead to death. The disease has no age preference, although young children, due to objective reasons suffer more often from this disease (weak immunity, fewer resources to fight infection, etc.).

Types of meningitis

Much to the regret of doctors, meningitis has several varieties. Thus, the classification of the disease consists of more than seven subparagraphs, which in turn significantly complicates the diagnosis and prescription of effective treatment.

So, what types of classification exist:

• by etiology;
• by origin;
• by the nature of the inflammatory process;
• with the flow;
• by the prevalence of the process;
• by localization;
• according to severity.

By etiology

Classification of a disease by etiology implies the causes of the disease. So, the disease can be:

• infectious;
• infectious-allergic;
• fungal;
• traumatic.

Infectious meningitis is a bacterial disease with a mortality rate of 10%. The main pathogens are meningococci, pneumococci and haemophilus influenzae.

Haemophilus influenzae and meningococcal infection in most cases affects young children who are in indoors in a micro group (kindergartens). Meningococcal meningitis has fulminant development and a transient course.

Pneumococcal infection is an infectious disease, but can begin as a result of the spread of infection from purulent foci (wounds or abscesses). It is the most dangerous of the two types.

The infectious-allergic type of the disease, as the cause of development, has strong allergic reactions to various things.
As the name implies, the fungal type of disease has a fungal structure. In particular, the disease is characterized by the least rapid progression compared to infectious species. The development of the disease is provoked by fungi such as Candida and some others. Fungi are carried with food digestive system birds, unwashed fruits, unpasteurized milk.

Traumatic meningitis can develop in people who have suffered any kind of trauma to the skull, when there is a possibility of infection from the nasal, auditory or other sinuses spreading to the brain.

By origin

By origin, meningitis is:

Bacterial meningitis is a dangerous disease that, if not properly treated, is 100% likely to be fatal. The disease is caused by bacteria (meningococci, streptococcus aureus, enterobacteria, spirochetes, etc.), hence the name.

The viral nature of the disease is easier for humans to tolerate and has better survival rate among patients compared to the bacterial form. The disease is provoked by various viruses, but 80% of cases were caused by enterovirus infection(Coxsackie virus and ECHO).

The mixed form is also a dangerous type of disease because it can contain several types of illness, which complicates the treatment process.

According to the nature of the inflammatory process

There is a complete and incomplete classification based on the nature of inflammation. Full includes:

• purulent;
• hemorrhagic;
• mixed.

Purulent meningitis is an infectious disease. The cause of which is meningococcal or pneumococcal infection. The disease can be primary or secondary.

In the first case, the infection enters the body by airborne droplets or as a result of existing mechanical damage skulls In the second case, the development of the disease is due to the presence of a focus of purulent inflammation in the body, and the infection from there enters the brain.

What is the difference between ailments

The least dangerous type of disease known. The disease does not cause the death of brain cells and does not lead to irreversible consequences. This disease Children are more susceptible.

Hemorrhagic meningitis is characterized by multiple hemorrhages into the pia mater (source - slovariki.org)

With the flow

Based on the nature of the process, the following are distinguished:

• spicy;
• subacute;
• recurrent;
• chronic.

The acute type of the disease manifests itself with lightning-fast development and rapid progression. Symptoms appear almost all at once and may increase gradually.

The subacute type is characterized by a slower (up to 5-6 weeks) development of the disease

The chronic type of the disease develops even more slowly, until symptoms appear after several years (the so-called chronicity of symptoms).

The recurrent form of the disease is characterized by a wave-like course. They note either deterioration or improvement of the patient’s condition
According to the prevalence of the process:

According to the prevalence of the process, they distinguish

• generalized;
• limited.

The generalized form is characterized by the possibility of infection spreading through tissue or lymph, and accordingly, this infection can affect other organs.

Limited, in turn, on the contrary, is limited to one area.

By localization of the inflammatory process

According to localization, meningitis occurs:

• convexital;
• basal;
• diffuse;
• local.

Convexital means superficial. That is, the disease occurs on the outside of the lining of the brain.
In turn, the basal type of disease means in-depth inflammatory processes. This type of illness is the most dangerous and more difficult to tolerate.

The diffuse type is characterized by damage to the entire plane of the lining of the brain, while the local type, on the contrary, affects a specific area.

Causes of meningitis

In order to understand what meningitis is and what causes it, it is necessary to understand the classification of the disease, since when different types it is possible to highlight various reasons. However, regardless of the pathogen, there are general conditions that contribute to the development of the disease. So, the cause of the disease may be:

• striking cerebrospinal fluid viruses or bacteria;
• the presence in the body or the recent end of an infectious disease (flu, herpes, mumps, etc.);
• using unwashed items after potentially transmitting the virus;
• alcohol abuse;
• spinal or brain surgery;
• head injury;
• insect or rodent bites (the bite itself does not mean the transmission of infection, but the formation of a purulent wound at the site of the bite can cause the infection that has developed in it to migrate);
• hypothermia of the body;
• taking corticosteroid drugs;
• presence of renal failure.

The disease can be passed on to a child from the mother during childbirth.

In microgroups there is a greater likelihood of developing such an infection and transmitting it by airborne droplets

How is meningitis transmitted?

The causative agents of meningitis are different, and therefore their routes of transmission are different. Undoubtedly, this disease is contagious and can be transmitted from person to person by airborne droplets or through blood.

There are two options:

1. Transmission of infection from a sick person to a healthy person.
2. Transmission of infection from a carrier of the virus (in most cases, the carrier does not even suspect that he has a dangerous disease in his body).

But how exactly is the infection transmitted?

• airborne;
• fecal-oral;
• sexual;
• cutaneous.

In addition, you can become infected not only from humans. Some rare forms of the disease can be contracted while swimming in ponds. There is also a possibility of infection through the bite of an insect that can carry the disease.

It should be understood that many sources have poor survival rate in the external environment and die almost instantly when they get there. They are also not susceptible to boiling or exposure to sunlight.

Incubation period of meningitis

To understand how people get meningitis, it is necessary to take into account such a concept as the incubation period.

Incubation period is the period of time from the moment the infection enters the body until the first symptoms appear.

The period without fever and other unpleasant symptoms of the disease for this disease may vary. It is very difficult to track the pattern, since initial stage It is not clear what kind of infection has affected the body (an exception may be a secondary type of disease).

Infection under a microscope

On average, this period lasts from 2 to 10 days, but there are some peculiarities.

Dependence of the incubation period on the infectious agent

1. Entroviruses - 3-8 days (in especially serious cases, up to several hours).
2. Mumps - up to 3 weeks (on average 10-18 days).
3. Viral and have an incubation period of 2 to 4 days, but symptoms usually begin much earlier.

Symptoms of meningitis

The first signs of impending danger are high fever and headache, which is increasing in nature. Is there always a high temperature? Yes, this is the most main symptom. And usually, it rises without any visible reasons, and subsequently the rest of the symptoms come into play.

In addition to the above-mentioned manifestations, the following symptoms are characteristic of all types of meningitis:

meningeal symptoms - symptoms characteristic only of meningitis

• nausea;
• general weakness of the body;
• vomit;
• increased sensitivity to light and loud sounds;
• drowsiness;
• loss of consciousness;
• convulsive manifestations;
• nervous overexcitability;
• stiffness of the neck muscles (swelling of the fontanelle in infants);
• rash;
• delirium;
• inhibited reaction;
• hallucinations;
• chills.

As for children, the manifestation of the disease in them is somewhat different. If we're talking about o, many symptoms are similar to those of adults.

Clinical picture in adults and children

Concerning infants, then the symptoms of meningitis may be as follows:

• fever;
• convulsive syndromes;
• vomiting;
• profuse regurgitation;
• nervous excitability (the child constantly cries, does not want to sleep);
• apathetic state, lethargy;
• sudden screams.

In addition, it is possible to develop strabismus, drooping upper eyelid. A child's skin may have a bluish tint.

At the site of the fontanelle, a venous network is clearly visible

Diagnosis of meningitis

In order to diagnose meningitis, a comprehensive diagnosis of the patient is carried out, which includes a large number of tests and hardware studies.

So, the list of diagnostic procedures:

• blood and urine tests;
• smear to determine pathogenic flora in the nose and in the throat cavity;
• coagulogram;
• HIV test;
• liver puncture;
• test for syphilis;
• cerebrospinal fluid puncture;
• computed tomography (CT);
• head electroencephalogram (EEG);
• magnetic resonance imaging (MRI);
• nuclear magnetic resonance (NMR);
• electrocardiogram (ECG);
• X-ray of the skull;
• examination by an ENT specialist, ophthalmologist, endocrinologist and neurologist.

In addition, before conducting this study, the doctor must interview the patient to determine the presence of previous diseases, general state in order to draw a conclusion and make a correct diagnosis.

Treatment of meningitis

Is meningitis curable or not and can this disease be cured? Undoubtedly yes. This disease is classified as curable. Which doctor treats this disease? Infectious disease specialist, despite the fact that the disease affects nervous system. Since the disease is infectious in nature, it must be treated by a similar specialist.

So, meningitis can only be treated in a hospital setting, since the patient must be constantly under the supervision of a specialist.

Therapy is divided into:

• antibacterial;
• antiviral;
• antifungal;
• detoxification;
• symptomatic.

Such distinctions are important because a disease caused by a fungus cannot be treated with drugs for the virus and vice versa. The exception, of course, is interchangeable drugs.

Antibacterial therapy

When treating the bacterial form of meningitis, the patient is in any case recommended to use it. In addition, in the case of serious inflammatory processes, the use of corticosteroid drugs is indicated to reduce inflammation. And to reduce the convulsive effect, tranquilizers are indicated.

The duration of treatment is from 10 to 14 days. Cancel antibacterial therapy possible if body temperature normalizes and symptoms of intoxication disappear. In addition, to determine the patient's condition, he may be prescribed repeated blood and cerebrospinal fluid tests.

It is worth understanding that not every antibiotic is able to overcome the blood-brain barrier (BBB), and since the main inflammatory processes occur precisely behind the BBB, it is worth taking a very responsible approach to the choice of drugs so that treatment is not just for the sake of treatment.

Below is a table with the names of drugs that can and cannot overcome the BBB.

Comparative table of antibiotics that can and cannot cross the BBB

If antibiotics are used, the patient must be prescribed medications to normalize the intestinal microflora in order to avoid intestinal upset. Young children are especially susceptible to this.

Antiviral therapy

Usually, viral form Severe meningitis occurs in young children and pregnant women. Complications of the disease can even end in death for such patients. Therefore, hospitalization in this case is a mandatory measure.
Unlike the bacterial form of the disease, the viral form is not susceptible to antibiotics and its treatment is more related to the elimination of the symptoms accompanying the disease.

In particular:

1. To eliminate vomiting - cerucal.
2. To reduce general intoxication of the body - saline solution with prednesone and vitamin C intravenously.
3. To eliminate headaches - lumbar puncture or diuretics.
4. to reduce temperature - antipyretic drugs based on paracetamol.
5. to eliminate pain in the head - papaverine and similar medicine.

In addition, it is mandatory to carry out therapy to increase immunity (Interferon, etc.), antiviral therapy(Arbidol, etc.).

Antifungal therapy

One of the most dangerous species diseases - fungal meningitis. Previously, before the discovery of the drug Amphoterecin B, the disease showed almost 100% mortality. After starting to use the above-mentioned medicine this statistic has changed. Moreover, in the case of complex therapy Together with a drug such as fluconazole, survival rates have increased even more.

Treatment of this form of the disease is the most protracted and can last up to a year until the patient’s cerebrospinal fluid returns to normal.

The danger of the disease is that even after the end of therapy, a relapse is possible.

Detoxification therapy

Regardless of the type of meningitis, the patient will always experience intoxication of the body. Therefore, in any case, the doctor will prescribe detoxification therapy.

This type of treatment consists of administering an intravenous solution that reduces intoxication. In particular, this solution includes a saline solution with the mandatory addition of vitamin C and prednesalone.

Symptomatic treatment

This type of therapy is associated with the presence of a fairly wide range of symptoms in the patient, which cannot always be stopped standard set drugs. That is why it is appointed symptomatic treatment. In addition, the sudden development of some unpleasant complication is possible, in the form of severe vomiting or loss of consciousness. In such a situation, there is no time to wait for the doctor and listen to his recommendations. Medical staff in a hospital independently administer a medicine intended to eliminate a particular symptom.

Forecast

The consequences after suffering an illness can be very different, or there may be none at all. Since during the development of the disease the membranes of the brain and spinal cord are affected, the consequences are associated with neurological manifestations, in particular, the patient may retain:

1. Headache.
2. Hearing and vision impairment.
3. Epileptic seizures.

A fatal outcome cannot be ruled out in the absence of proper therapy or timely assistance for purulent and bacterial meningitis, and in children for its viral forms.

However, in general the prognosis is quite favorable, since modern level medicine allows you to qualitatively eliminate all possible consequences.

Prevention

1. Hardening the body.
2. Preventive use of immunostimulating drugs (especially in kindergartens).
3. Timely treatment of chronic diseases.
4. Maintaining hygiene.
5. Maintaining a healthy lifestyle.
6. Regular exercise.

So, meningitis is a serious disease and in the absence of proper and timely treatment able to even take the patient’s life. Treatment can only take place in a hospital setting and under the supervision of a doctor, so do not self-medicate under any circumstances, as this can be fatal. Take care of yourself and your loved ones, get treatment correctly!