Meningitis - Causes, symptoms and treatment. MF.
Meningitis is an inflammatory disease of the membranes of the brain.
Causes of meningitis
For the etiology( cause of occurrence), meningitis is infectious, infectious-allergic - neuroviral and microbial( serous meningitis, influenza meningitis, tuberculosis, herpetic), fungal and traumatic meningitis.
Localization of the lesions secrete panmenigites - all brain membranes are affected, pachymeningitis - mainly affects the dura mater, leptomeningitis - the arachnoid and mild membranes are affected. The primary lesion of the arachnoid casing - arachnoiditis - is due to clinical features and is isolated into a separate group.
Meningitis is divided into serous and purulent.
By origin distinguish primary - they include most of the neuroviral meningitis, purulent meningitis and secondary - influenza, tuberculosis, syphilitic.
By the nature of the cerebrospinal fluid - serous, purulent, hemorrhagic, mixed.
Downstream - fulminant, acute, subacute, chronic.
Localization - convective( superficial) and basal( deep - on the basis of the brain).
On the pathways of infection of the meninges - hematogenous, lymphogenous, perineural, contact( for example, with diseases of the paranasal sinuses, ear inflammation, teeth), with craniocerebral trauma.
For any meningitis, there is meningeal syndrome - increased intracranial pressure - a bursting headache with a feeling of pressure on the eyes and ears, vomiting, light and sounds irritate( photophobia and hyperacus), high fever, possible epicas, rash. Symptoms and treatment of meningitis is different.
Meningococcus under the microscope
Purulent meningitis
Purulent meningitis is a severe microbial inflammation of the meninges. This is leptomeningitis caused by meningococcal infection, streptococci, staphylococci, pneumococci and other microbes - intestinal microbes, Pseudomonas aeruginosa. ..
Risk factors for purulent meningitis: intoxication - smoking, alcohol, infections, stress, hypothermia, insolation - everything that weakens the body's defense capabilities.
Source of the disease - carriers of the first order( not sick, but carry a microbe), second order( ailing ARD, sore throats, pharyngitis).
Have meningitis at any age.
Meningococcus enters the meninges from the nasopharynx by the hematogenous way. This convectional meningitis is a serious inflammatory process, the purulent contents spread, forming a "purulent cloak".
Symptoms of purulent meningitis
Purulent meningitis has a rapid onset - the temperature rises rapidly, headache, nausea, repeated vomiting, possible development of an epiprema, symptoms of cranial nerve damage appear, all internal organs are affected - meningococcemia - pericarditis, ulcer, pyelitis, cystitis, amazedjoints. The patient takes a characteristic posture with bent legs and a head thrown back. Possible herpetic eruptions and hemorrhagic rash, rose-olyphic rash on the skin and mucous membranes. On day 2-3, a coma may develop.
Rash with meningitis
The patient is examined by an oculist - stagnant phenomena develop on the fundus. The leading meaning is lumbar puncture - the increase in CSF pressure is determined, the content of neutrophils increases.
The neurologist sees meningeal signs - stiff neck( impossibility to bend his head and touch the sternum), Kernig's symptom( impossibility to unbend the leg bent at the hip and knee joints), soreness with pressure on the eyeballs, Brudzinsky's symptom( when trying to tilt the head forward in positionlying legs bend at the knees, with pressure on the pubis legs bend at the knee joints).
A blood test is needed - high leukocytosis and COE are detected, shifting the leukocyte formula to the left. In severe cases, with a decrease in the defenses of the body - leukopenia.
Lightning fastness occurs more often in newborns - the child screams, shaking chills, fever and dies( from hours to 3 days).In adults, the course is acute, subacute. It takes 4-5 weeks with good output. Subacute flow is more common in the elderly - slow development with a long period of precursors. In elderly people, atypical course is possible, there are only symptoms of nasopharyngitis or epiprip. Perhaps a mild, moderate and severe course of meningitis.
A typical posture of a patient with advanced meningitis.
Head tilted back
The following photo is not recommended for children and persons with a weak nervous system.
Photo The brain of a deceased person from purulent meningitis - there are inflammatory changes and purulent raids - "purulent cloak" - on the convolutions of the brain.
Complications of purulent meningitis
Possible complications development: sepsis, hydrocephalus, hypothalamic syndrome, visual, hearing, astheno - neurotic syndrome, internal organs.
Treatment of purulent meningitis
The earlier the diagnosis is established and the treatment is started, the more favorable the outcome of the disease. Therefore, you should not delay the treatment of a doctor and engage in self-medication.
In the appointment of treatment, the precise definition of the pathogen plays a particularly important role. This determines the specific therapy and the outcome of the disease.
Patients with purulent meningitis in infectious hospitals are treated with massive doses of antibiotics( penicillins, aminoglycosides, cephalosporins), sulfanilamide preparations, perform powerful dehydration( hormones, diuretics), detoxification. Symptomatic treatment is prescribed by a therapist, oculist, pulmonologist, ENT.
Follow-up after recovery and discharge from an infectious disease hospital is performed by a neurologist.
Self-medication is unacceptable and will lead to death. Traditional medicine is not used.
Prevention of purulent meningitis
As prevention, attention is paid to the sanation of foci of chronic infection - diseases of the nasal cavity and paranasal sinuses, ear, teeth. All contact with the patient is observed, disinfection of the premises is carried out.
Secondary purulent meningitis
Secondary purulent meningitis has a softer flow, there is no violent onset, not so high temperature. Occurs in sepsis, postoperative period, osteomyelitis, severe pneumonia.
Acute lymphatic meningitis
Acute lymphatic meningitis - serous meningitis, occurs in the form of epidemic outbreaks and sporadic cases. The carriers of the virus are mice( field and domestic), which isolate the virus with nasal secretions, urine, feces and pollute surrounding objects. When infected, the onset is acute with gastrointestinal disorders( nausea, vomiting, diarrhea, abdominal pain), normal or high fever, and the development of meningeal syndrome. Possible lesions of 3 and 6 pairs of cranial nerves( oculomotor and discharge).
The current differs in reverse development without residual effects.
The group of serous meningitis includes meningitis caused by poliomyelitis-like Coxsackie viruses, ECHO.They differ in summer and autumn seasonality and more often affect children. Development of acute - temperature, meningeal syndrome, gastrointestinal disorders. A two-wave flow is possible.
The development of serous meningitis is possible with parotitis, influenza, herpetic infection, fungal diseases, protozoal( malaria, toxoplasmosis).
With lumbar puncture, the cerebrospinal fluid is transparent, the pressure is increased, lymphocytic pleocytosis takes place. From the cerebrospinal fluid and nasopharyngeal washings, the virus of serous meningitis can be isolated. The Coxsackie virus can be isolated from feces. In mumps, meningitis is sought in the saliva. Cryptococcus causes a severe form of meningitis in patients with AIDS.With syphilis, late syphilitic meningitis develops.
Tuberculous meningitis is serous leptomeningitis.
The causative agent is a tubercle bacillus( mycobacterium) of Koch. Almost all people are carriers. The transmission path is airborne.
All age categories are ill. Earlier, the spring-autumn seasonality was observed, the incidence of tuberculosis is growing and there is no seasonality, it occurs year-round. The increase in morbidity is affected by the social conditions of life - unsanitary living conditions, malnutrition, unemployment, and the growth of "untreated" TB patients. In contact are all. The cerebral membranes are affected by the presence in the body of a focus of tuberculosis in the lungs, osteoarticular system, kidneys, genital organs.
Distribution in the body: hematogenous-liquor way.
Tuberculous meningitis - the basic process - the 3rd ventricle of the brain, the variola oblongata.
The development of symptoms is gradual with a long period of precursors - asthenia, adynamia, sleep disorders, appetite, slight fever, prolonged night sweats, headache, which can last 2-3 weeks. Then the headache increases, vomiting occurs, meningeal syndrome develops. Further, the condition worsens, the cranial nerves are affected( usually the second, third, sixth, seventh pairs).In this case, ptosis appears( eyelid drooping), strabismus, restriction of movements of eyeballs, the eye can not completely close, the corner of the mouth hangs, the cheek does not hold air and "sails" when breathing. In the absence of specific treatment, paralysis, breathing disorders, swallowing, coma are possible.
The course of tuberculous meningitis is more abnormal than typical.
Distinguish tubercular meningitis with acute course, with epileptic attack, without meningeal signs, pseudotumor development, subarachnoid.
Diagnosis is extremely difficult. It does not depend on the form of tuberculosis. It may be the first manifestation of tuberculosis. Differential diagnosis is performed with other forms of meningitis, subarachnoid hemorrhage, tumor. Detection of mycobacterium is especially important for correct and timely treatment. Without specific treatment, the mortality rate is very high. Before the discovery of PASCA in 1952 from tuberculous meningitis, there was a 100% mortality rate 3 to 4 weeks after the onset of the disease.
Complications are the largest of all meningitis - paresis, paralysis, hydrocephalus, atrophy of the optic nerves, vestibulopathy, hypothalamic and cerebellar disorders, hyperkinesia, tuberculomas.
Treatment is long, in tuberculosis dispensaries. Specific treatment is prescribed by the phthisiatrist( PASK, ftivazid, tubazid, rifadin, isoniazid).Nonspecific - a neurologist. They use hormone therapy, dehydration, detoxification, symptomatic treatment, anticholinesterase drugs, vitamin therapy and neuroprotectors. Treatment is long, up to a year and a half years. After in-patient treatment, sanatorium-and-spa treatment is used on the South Coast.
More information about this disease you can read in the article "tuberculous meningitis".
Mass prophylaxis of tuberculosis incidence is carried out - primary vaccination of BCG of newborns is still in maternity hospitals( for the first time the vaccine was introduced to a newborn in 1921), control of the presence of immunity - Mantoux reaction for selection of patients for repeated vaccination, fluorographic examination of the whole population. It is necessary to fully treat all the diseased and control observations of all those who have had tuberculosis to prevent the epidemic of tuberculosis.
In 1993, WHO declared tuberculosis a national disaster, and on 24 March - World TB Day. The severity of the problem of tuberculosis can be judged by the existence of a special WHO program that allows to identify and treat patients who work in 180 countries around the world.
Vaccination, mass-produced( according to the vaccination calendar) prevents many diseases that can cause meningitis. Vaccines are used against hemophilic rod, meningococcal infection, pneumococcal infection, measles, mumps, rubella, chicken pox, influenza.
Consultation of a doctor on the topic of meningitis:
Question: when is a lumbar puncture performed for tuberculous meningitis?
Answer: In the presence of minimal phenomena of meningism, immediate lumbar puncture is indicated. There is a high pressure of CSF, an increased protein content, the level of sugar decreases, chlorides decrease. For sowing a tubercle bacillus, three tubes are analyzed, in which a film forms during settling and an exciter can be found in it. Liquor is taken twice a day for diagnosis, 2-3 weeks after a specific treatment is prescribed to control the prescribed doses, then three times before discharge for control of recovery.
Question: How can I protect myself in contact with a patient with meningitis?
Answer: In case of contact with the patient, gauze dressings should be used, hands washed with soap, disinfected dishes, and chemoprophylaxis - rifampicin, ceftriaxone, immunoglobulin - is administered to persons in close contact.
Question: do computer tomography for diagnosis of meningitis?
Answer: yes, they do, differential diagnosis requires the exclusion of serious brain diseases - subarachnoid hemorrhage, brain abscess, brain tumor.
Question: What is meningism?
Answer: Meningue is an indistinct manifestation of meningeal symptoms on the background of infection, influenza, intoxication. Lasts 2 - 3 days and pass. More often the phenomenon of meningism occurs in children.
Doctor neurologist Kobzeva S.V.