Meningitis: symptoms in children and adults, signs, treatment
Meningitis is the development of the inflammatory process in the membranes covering the brain and spinal cord.
Any of the three shells can be affected in any of its lengths, and the substance of the spinal cord or brain itself can be involved in the process.
In children and adults, meningitis can cause a large number of viruses and bacteria, as well as fungi and protozoa, depending on the type of pathogen, the pathways of infection also change.
In an acute period, the disease can be detected only with the help of a lumbar puncture. Treatment will depend on the type of microorganism that caused the process, the extent of its prevalence, the initial state of the organism. The disease is life-threatening.
There are several classifications of this pathological process according to different criteria. By type of pathogen, meningitis is:
Serous meningitis most often causes viruses, less often some bacteria and fungi. Purulent meningitis is caused by a bacterial flora.
On the way of infection in the brain membrane, meningitis is primary and secondary. The first type develops as an independent disease, when the microbe enters the body and immediately with the current of blood or lymph is deposited on the shell of the brain, where it causes a pathological process. Secondary meningitis - when the microbe enters the envelope from another focus of inflammation.
Localization of meningitis can be convective( superficial) and basal( the process develops in deep structures).
By involvement in the pathological process of the membranes of the brain: if the soft and arachnoid sheath has inflamed - leptomeningitis, only the arachnoidal cobweb itself, the hard shell - pachymeningitis. On the path of penetration of the microbe, the infectious process can be: lymphogenic( the microbe penetrated with lymphal flow), hematogenous( with blood flow), perineural( along the path of nerve fibers) and contact( when the microbe got through the wound of the cranial cavity).
Microbes that can overcome a specific cell barrier, by which immunity has shielded the brain from external influences, can penetrate into it in various ways:
Any of the three shells can be affected in any of its lengths, and the substance of the spinal cord or brain itself can be involved in the process.
In children and adults, meningitis can cause a large number of viruses and bacteria, as well as fungi and protozoa, depending on the type of pathogen, the pathways of infection also change.
In an acute period, the disease can be detected only with the help of a lumbar puncture. Treatment will depend on the type of microorganism that caused the process, the extent of its prevalence, the initial state of the organism. The disease is life-threatening.
Classification of
There are several classifications of this pathological process according to different criteria. By type of pathogen, meningitis is:
- 1) Bacterial, which can be nonspecific( caused by meningococcus, pneumococcus, staphylococcus, streptococcus, hemophilic rod, enterococcus and even Escherichia coli) and specific( tuberculosis caused by the causative agent of syphilis, leptospirosis and others);
- 2) Viral;
- 3) Fungal;
- 4) Protozoal( that is, caused by protozoa).
Serous meningitis most often causes viruses, less often some bacteria and fungi. Purulent meningitis is caused by a bacterial flora.
On the way of infection in the brain membrane, meningitis is primary and secondary. The first type develops as an independent disease, when the microbe enters the body and immediately with the current of blood or lymph is deposited on the shell of the brain, where it causes a pathological process. Secondary meningitis - when the microbe enters the envelope from another focus of inflammation.
Localization of meningitis can be convective( superficial) and basal( the process develops in deep structures).
By involvement in the pathological process of the membranes of the brain: if the soft and arachnoid sheath has inflamed - leptomeningitis, only the arachnoidal cobweb itself, the hard shell - pachymeningitis. On the path of penetration of the microbe, the infectious process can be: lymphogenic( the microbe penetrated with lymphal flow), hematogenous( with blood flow), perineural( along the path of nerve fibers) and contact( when the microbe got through the wound of the cranial cavity).
How is meningitis transmitted?
Microbes that can overcome a specific cell barrier, by which immunity has shielded the brain from external influences, can penetrate into it in various ways:
- 1) Airborne: this is transmitted from a sick person by meningococcus, less often - pneumococcus and hemophilic rod, Koch's stick and many speciesviruses. Of this total abundance of germs, the chance that a second person will develop meningitis, is only with meningococcal infection, which has not been treated yet and enteroviral meningitis( at the second - very minimal).All other microorganisms can get from a sick person to a healthy one, but, most likely, they will cause only a general infection process, not complicated by meningitis.
- 2) Food and water. Thus, some microbes penetrate the body, which usually trigger a common disease, which can be complicated by meningitis if immunity decreases. Some of the exceptions are enteroviruses, which, when absorbed into the digestive tract, can, even without causing an intestinal infection or an ORL-like disease, enter the brain's membranes.
- 3) The hematogenous pathway. Thus, microbes come from any source of infection in the body. If this focus( for example, with pneumonia or osteomyelitis) is located far from the head, the path is called generalized. The most common is the regional-vascular pathway, when microorganisms( this is almost always bacteria) first caused inflammation in the cranial cavity( usually purulent rhinitis, purulent otitis, sinusitis, brain abscess or bacterial process in the mouth), and then hit the brain. Such meningitis is called secondary and is not transmitted from person to person.
- 4) By contact: when the integrity of the bones of the skull was damaged( gunshot, knife wound, fracture, operation), and the bacteria got into the wound. This meningitis is also not contagious to others. Symptoms of meningitis in children and adults
At the present time, meningitis in adults and children is more common and has atypical symptoms, which greatly complicates the diagnosis. But some common, "classic" features still persist. They are the following( for all meningitis, except tuberculosis):
Meningitis usually begins with the appearance of ARD-like phenomena: rhinitis, coughing, conjunctivitis, accompanied by changes in general health( lethargy, body aches, loss of appetite).This increase in body temperature is not an obligatory sign.
In secondary meningitis, symptoms of the underlying disease first appear: cough, shortness of breath - with pneumonia;temperature, separated from the ear - with otitis;congestion and purulent discharge from the nose - with sinusitis.
Then the symptoms of directly the meningitis develop:
1) The appearance of fever. Some characteristic figures for meningitis can not be called, but usually hyperthermia - above 38 ° C;
2) Headache, which is usually described as follows:
- very intense;
- is localized in the frontal, temporal regions;
- is accompanied by nausea, vomiting, which does not bring relief;
- with such pain can not sit or do something for a long time - it becomes easier only in a lying position;
- the pain can force to accept the compelled pose - lying on the side with the head thrown back, the legs can be attracted to the stomach( this creates less tension for the inflamed meninges);
4) Increased sensitivity of the skin to the slightest tactile or temperature irritants;
5) A person becomes sluggish, drowsy. In infants, this symptom in combination with the temperature and the large fontanel protruding above the bones are the main signs of this disease;
6) Possibility of oppression of consciousness up to a coma( absence of reaction even on strong tactile irritants, disturbance of own breath of the person) is possible;
7) There may be an aggressive state, delirium, hallucinations, which may resemble a "white fever" or similar condition;
8) In some cases( especially in young children), the disease can debut with the development of generalized seizures( with a violation of consciousness, while breathing may stop).
Tuberculous meningitis has significant differences. His development is slow, for a long time the person notes increased fatigue, fatigue, not a very intense headache, occasionally vomiting.
Then different types of strabismus develop, one can note the asymmetry of the eyelids or corners of the mouth, it becomes difficult for a man to bite his teeth or inflate his cheeks. All these symptoms develop gradually, accompanied by an increase in temperature to small digits.
Meningitis in children: symptoms worth paying attention to are Dr. Komarovsky.
Diagnosis of meningitis
The first stage of diagnosis is to perform lumbar puncture: between the lumbar vertebrae( there is no spinal cord) under local anesthesia a puncture is made with a special needle. For the study, a very small amount of cerebrospinal fluid is taken, which is investigated laboratory.
One part of the CSF can tell whether there is a meningitis, as far as it is expressed, a purulent or serous process. The other part( this is literally a few drops), germinated on different nutrient media, after 5 or more days will help doctors navigate with the type of pathogen and its sensitivity to antibiotics.
So, if meningitis is serous, then in the CSF there will be an increased number of cells( in adults - more than 10, in children the figure depends on age), most( more than 50%) of which are represented by lymphocytes.
With purulent meningitis, a greater percentage is due to neutrophils.
If suspected of tuberculous meningitis, an X-ray examination of the lungs is necessary: the inflammation of the membranes of the brain in this case will be secondary, and develop only if the lung has a tuberculous focus.
Magnetic resonance imaging or computed tomography is shown in the first 7 days only if it is necessary to differentiate meningitis from other similar diseases. Uncomplicated meningitis in such terms will not be visible.
Treatment of meningitis
First of all, the choice of tactics for the treatment of meningitis will depend on its type and pathogen:
- 1) When purulent meningitis is mandatory the appointment of those antibiotics that are able to penetrate the hemato-encephalic barrier in a certain dosage. They are "Ceftriaxone", "Amikacin", "Abaktal", "Meronem", "Vancomycin", "Cefepime", "Ceftazidim".The choice of starting therapy depends on the number of cells in the cerebrospinal fluid, the history of the disease, the level of consciousness of the patient.
- 2) For tuberculous meningitis, several anti-tuberculosis antibiotics are administered at the maximum dosage allowed.
- 3) Leptospirosis serous meningitis requires treatment with antibiotics in their increased dosage.
- 4) In case of viral meningitis, antiviral drugs are prescribed. Usually it is "Viferon" or "Laferon" in the dosage that can be used at this age of the patient. If there is a suspicion that the meningitis could have been caused by one of the following viruses, Acyclovir( Virolex, Zovirax) is prescribed at a dose of 30 mg / kg of body weight per day.
- Epstein-Barr virus;
- herpes simplex virus types I or II;
- varicella virus;
- cytomegalovirus.
- for meningitis caused by fungi, the introduction of large doses of "Fucis", "Diflucan".
- protozoal process requires treatment by specific means.
Prophylaxis and prognosis
The prognosis is spoken individually. Everything depends on what causes meningitis, how early it was diagnosed, how hard it is, whether or not the brain substance is involved in the pathological process. In some cases, the disease occurs lightning fast, leading to rapid death, even if there is treatment, in other cases, complete recovery is possible.
Prevention of meningitis in children and adults is mainly non-specific. This is compliance with hygienic measures, individual protection( gauze or disposable masks) in compulsory communication with a sick family member.
For the prevention of certain types of meningitis, vaccines are available:
- against meningococcus;
- against Haemophilus influenzae;
- against pneumococcal;
- against rubella, mumps, measles.
Consequences of the transferred meningitis
All depends on what microorganism was caused by meningitis, how it flowed, what immunity is in man. In some cases, only the headache and drowsiness that appears when changing weather conditions will remind of the meningitis that has been transferred.
Other cases develop:
- decrease in memory, concentration, attention;
- hearing loss;
- vision impairment;
- strabismus;
- psychopathy;
- epilepsy;
- delayed mental development.
- very intense;