Meningitis. Causes, symptoms, diagnosis and treatment

Pneumococcus
Pneumococci can be on the mucous membrane of the oral cavity and upper respiratory tract for a long time and do not cause any symptoms. However, with a decrease in the body's defenses, the infection is activated and spread by blood. The difference between pneumococcus is its high tropism ( preference) to brain tissue. Therefore, already on the second or third day after the disease, symptoms of damage to the central nervous system develop.

Pneumococcal meningitis can also develop as a complication of pneumococcal pneumonia. In this case, pneumococcus from the lungs with a lymph flow reaches the meninges. Meningitis is highly lethal.

Haemophilus influenzae
Haemophilus influenzae has a special capsule that protects it from the immune forces of the body. A healthy body is infected by airborne droplets ( when sneezing or coughing), and sometimes contact ( in case of non-observance of hygiene rules). Getting on the mucous membrane of the upper respiratory tract, Haemophilus influenzae with a blood or lymph flow reaches the meningeal membranes. Further, it is fixed in the soft and arachnoid membrane and begins to multiply intensively. Haemophilus influenzae blocks the villi of the arachnoid, thereby preventing the outflow of cerebral fluid. In this case, the fluid is produced, but does not depart and the syndrome of increased intracranial pressure develops.

In terms of frequency of occurrence, meningitis caused by Haemophilus influenzae is in third place after meningococcal and pneumococcal meningitis.

This route of infection is characteristic of all primary meningitis. For secondary meningitis, dissemination of the pathogen from the primary chronic focus of infection is characteristic.

The primary site of infection may be:

• inner ear with otitis;
• paranasal sinuses with sinusitis;
• lungs in tuberculosis;
• bones in osteomyelitis;
• injuries and wounds in fractures;
• jaw and teeth in inflammatory processes in the jaw apparatus.

Otitis media
Otitis media is an inflammation of the middle ear, that is, the cavity located between the eardrum and the inner ear. Most often, the causative agent of otitis media is staphylococcus aureus or streptococcus. Therefore, otogenic meningitis is most often staphylococcal or streptococcal. Infection from the middle ear can reach the meningeal membranes both in the acute period of the disease and in the chronic.

Routes of infection from the middle ear to the brain :

• with blood flow;
• through the inner ear, namely through its labyrinth;
• by contact with destruction in the bone.

sinusitis
Inflammation of one or more paranasal sinuses is called sinusitis. The sinuses are a kind of air corridor that communicates the cranial cavity with the nasal cavity.

Types of paranasal sinuses and their inflammatory processes :

• maxillary sinus- its inflammation is called sinusitis;
• frontal sinus- its inflammation is called frontal sinusitis;
• lattice labyrinth- its inflammation is called ethmoiditis;
• sphenoid sinus- its inflammation is called sphenoiditis.

Due to the proximity of the paranasal sinuses and the cranial cavity, the infection spreads very quickly to the meningeal membranes.

Ways of spread of infection from the sinuses to the meningeal membranes :

• with blood flow;
• with lymph flow;
• by contact ( in the destruction of the bone).

In 90 to 95 percent of cases, sinusitis is caused by a virus. However, viral sinusitis can rarely cause meningitis. As a rule, it is complicated by the addition of a bacterial infection ( with the development of bacterial sinusitis), which can subsequently spread and reach the brain.

The most common causative agents of bacterial sinusitis are:

• Pneumococcus;
• hemophilic bacillus;
• moraxella catharalis;
• golden staphylococcus aureus;
• pyogenic streptococcus.

Pulmonary tuberculosis
Pulmonary tuberculosis is the main cause of secondary tuberculous meningitis. Tuberculosis is caused by Mycobacterium tuberculosis. Pulmonary tuberculosis is characterized by a primary tuberculosis complex, in which not only lung tissue is affected, but also nearby vessels.

Components of the primary tuberculosis complex:

• lung tissue ( as tuberculosis pneumonia develops);
• lymphatic vessel ( tuberculous lymphangitis develops);
• lymph node ( tuberculous lymphadenitis develops).

Therefore, most often, mycobacteria reach the meninges with lymph flow, but they can also be hematogenous ( with blood flow). Having reached the meninges, mycobacteria affect not only them, but also the blood vessels of the brain, and often the cranial nerves.

Osteomyelitis
Osteomyelitis is a purulent disease in which the bone and surrounding soft tissues are affected. The main causative agents of osteomyelitis are staphylococci and streptococci, which enter the bone due to trauma or through the bloodstream from other foci ( teeth, boils, middle ear).

Most often, the source of infection reaches the meninges with blood flow, but with osteomyelitis of the jaw or temporal bone, it enters the brain by contact, due to bone destruction.

Inflammatory processes in the jaw apparatus
Inflammatory processes in the jaw apparatus affect both bone structures ( bone, periosteum) and soft tissues ( The lymph nodes). Due to the proximity of the bone structures of the jaw apparatus to the brain, the infection spreads with lightning speed to the meninges.

Inflammatory processes of the jaw apparatus include:

• osteitis- damage to the bone base of the jaw;
• periostitis- damage to the periosteum;
• osteomyelitis- damage to both bone and bone marrow;
• abscesses and phlegmon in the jaw apparatus- limited accumulation of pus in the soft tissues of the jaw apparatus ( e.g. at the bottom of the mouth);
• purulent odontogenic lymphadenitis- damage to the lymph node of the jaw apparatus.

Inflammatory processes in the jaw apparatus are characterized by contact dissemination of the pathogen. In this case, the pathogen reaches the meningeal membranes due to bone destruction or abscess rupture. But the lymphogenous spread of the infection is also characteristic.

The causative agents of infection of the jaw apparatus are:

• green streptococcus;
• white and golden staphylococcus aureus;
• peptococcus;
• peptostreptococcus;
• actinomycetes.

A special form of meningitis is rheumatic meningoencephalitis, which is characterized by damage to both the meninges and the brain itself. This form of meningitis is the result of a rheumatic attack ( attack) and is mainly characteristic of childhood and adolescence. Sometimes it can be accompanied by a large hemorrhagic rash and is therefore also called rheumatic hemorrhagic meningoencephalitis. Unlike other forms of meningitis, where the patient's movements are limited, rheumatic meningitis is accompanied by strong psychomotor agitation.

Some forms of meningitis are the result of generalization of the initial infection. So, borreliosis meningitis is a manifestation of the second stage of tick-borne borreliosis ( or Lyme disease). It is characterized by the development of meningoencephalitis ( when both the membranes of the brain and the brain itself are damaged) in combination with neuritis and radiculitis. Syphilitic meningitis develops in the second or third stage of syphilis when a pale treponema of the nervous system is reached.

Meningitis can also be the result of various surgical procedures. For example, postoperative wounds, venous catheters and other invasive medical equipment can be the gateway of infection.
Candidal meningitis develops against the background of a sharply reduced immunity or against the background of prolonged antibacterial treatment. Most often, people with HIV infection are susceptible to the development of candidal meningitis.

Signs of meningitis

The main signs of meningitis are:

• chills and temperature;
• headache;
• neck stiffness;
• photophobia and hyperacusis;
• drowsiness, lethargy, sometimes loss of consciousness;

Some forms of meningitis may cause:

• rash on the skin, mucous membranes;
• anxiety and psychomotor agitation;
• mental disorders.

Chills and temperature

Fever is the dominant symptom in meningitis. It occurs in 96 - 98 percent of cases and is one of the very first symptoms of meningitis. The rise in temperature is due to the release of pyrogenic ( fever-inducing) substances by bacteria and viruses when they enter the blood. In addition, the body itself produces pyrogenic substances. Leukocyte pyrogen, which is produced by leukocytes in the focus of inflammation, has the greatest activity. Thus, the increase in temperature occurs due to increased production of heat both by the body itself and by pyrogenic substances of the pathogenic microorganism. In this case, a reflex spasm of the vessels of the skin occurs. Vasospasm entails a decrease in blood flow in the skin and, as a result, a drop in skin temperature. The patient feels the difference between internal heat and cold skin as chills. Violent chilliness accompanied by trembling all over. Muscle tremors are nothing more than an attempt by the body to warm up. Terrific chills and a rise in temperature to 39 - 40 degrees are often the first sign of the disease.

Headache

Severe diffuse increasing headache, often accompanied by vomiting, is also an early sign of the disease. Initially, the headache is diffuse and is caused by the phenomenon of general intoxication and fever. In the stage of damage to the meninges, the headache grows and is caused by swelling of the brain.

The cause of cerebral edema is:

• increased secretion of cerebrospinal fluid due to irritation of the meninges;
• violation of the outflow of cerebrospinal fluid up to the blockade;
• direct cytotoxic effect of toxins on brain cells, with their further swelling and destruction;
• increased vascular permeability and, as a result, the penetration of fluid into the brain tissue.

As intracranial pressure increases, the headache becomes bursting. At the same time, the sensitivity of the scalp is sharply increased and the slightest touch to the head causes severe pain. At the peak of the headache, vomiting occurs, which does not bring relief. Vomiting may be repeated and does not respond to antiemetic medications. Headache is provoked by light, sounds, head turns and pressure on the eyeballs.

In infants, there is bulging and tension of the large fontanel, a pronounced venous network on the head, and in severe cases, the divergence of the sutures of the skull. This symptomatology, on the one hand, is due to the syndrome of increased intracranial pressure ( due to cerebral edema and increased secretion of cerebrospinal fluid), and on the other hand, the elasticity of the bones of the skull in children. At the same time, monotonous "brain" crying is observed in young children.

Stiff neck

Neck stiffness occurs in more than 80 percent of meningitis cases. The absence of this symptom may be observed in children. The patient's posture, characteristic of meningitis, is associated with muscle rigidity: the patient lies on his side with his head thrown back and his knees brought to his stomach. At the same time, it is difficult for him to bend or turn his head. Stiff neck is one of the early symptoms of meningitis and, along with headache and fever, forms the basis of the meningeal syndrome, which is caused by irritation of the meninges.

Photophobia and hyperacusis

Painful sensitivity to light ( photophobia) and to the sound ( hyperacusis) are also common symptoms in meningitis. Like hypersensitivity, these symptoms are due to irritation of receptors and nerve endings in the meninges. They are most pronounced in children and adolescents.

However, the opposite symptoms can sometimes be observed. So, with damage to the auditory nerve, with the development of neuritis, hearing loss can be observed. In addition to the auditory nerve, the optic nerve can also be affected, which, however, is extremely rare.

Drowsiness, lethargy, sometimes loss of consciousness

Drowsiness, lethargy and loss of consciousness are observed in 70 percent of cases and are later symptoms of meningitis. However, with fulminant forms, they develop on the 2nd - 3rd day. Lethargy and apathy are due to both general intoxication of the body and the development of cerebral edema. For bacterial meningitis ( pneumococcal, meningococcal) there is a sharp depression of consciousness up to coma. Newborn children at the same time refuse to eat or often spit up.

As the cerebral edema increases, the degree of confusion worsens. The patient is confused, disoriented in time and space. Massive cerebral edema can lead to compression of the brain stem and inhibition of vital centers, such as respiratory, vascular. At the same time, against the background of lethargy and confusion, pressure drops, shortness of breath appears, which is replaced by noisy shallow breathing. Children are often drowsy and lethargic.

Vomit

With meningitis, a single vomiting is rarely observed. As a rule, vomiting is often repeated, repeated and is not accompanied by a feeling of nausea. The difference between vomiting in meningitis is that it is not associated with eating. Therefore, vomiting does not bring relief. Vomiting can be at the height of a headache, or it can be provoked by exposure to irritating factors - light, sound, touch.

This symptomatology is due to the syndrome of increased intracranial pressure, which is the main one in meningitis. However, sometimes the disease can be accompanied by a syndrome of low intracranial pressure ( cerebral hypotension). This is especially common in young children. Their intracranial pressure is sharply reduced, up to collapse. The disease proceeds with symptoms of dehydration: facial features are sharpened, muscle tone is reduced, reflexes fade. Symptoms of muscle stiffness may disappear.

Rash on skin, mucous membranes

Hemorrhagic rash on the skin and mucous membranes is not an obligatory symptom of meningitis. According to various data, it is observed in a quarter of all cases of bacterial meningitis. Most often, it is observed with meningococcal meningitis, since meningococcus damages the inner wall of blood vessels. Skin rashes occur after 15 - 20 hours from the onset of the disease. At the same time, the rash is polymorphic - roseolous, papular, rash in the form of petechiae or nodules are observed. The rash is always irregular in shape, sometimes protruding above the level of the skin. The rash tends to merge and form massive hemorrhages that look like purplish-blue spots.

Hemorrhages are observed on the conjunctiva, oral mucosa and internal organs. Hemorrhage with further necrosis in the kidney leads to the development of acute renal failure.

convulsions

Seizures occur in one fifth of meningitis cases in adults. In children, convulsions of a tonic-clonic nature are often the onset of the disease. The younger the child, the more likely it is to develop seizures.

They can proceed according to the type of epileptic convulsions, or a tremor of individual parts of the body or individual muscles may be observed. Most often in young children there is a tremor of the hands, which later turns into a generalized seizure.

These convulsions both generalized and local) are the result of irritation of the cortex and subcortical structures of the brain.

Anxiety and psychomotor agitation

As a rule, the excitation of the patient is observed in a later stage of meningitis. But in some forms, for example, in rheumatic meningoencephalitis, this is a sign of the onset of the disease. Patients are restless, excited, disoriented.
With bacterial forms of meningitis, excitation appears on the 4th - 5th day. Often, psychomotor agitation is replaced by loss of consciousness or transition to a coma.
Anxiety and unmotivated crying begins meningitis in infants. At the same time, the child does not fall asleep, cries, is excited by the slightest touch.

Mental disorders

Mental disorders in meningitis are so-called symptomatic psychoses. They can be observed both at the beginning of the disease, and in a later period.

Mental disorders are characterized by:

• excitement or vice versa inhibition;
• rave;
• hallucinations ( visual and sound);

Most often, mental disorders in the form of delusions and hallucinations are observed with lymphocytic choriomeningitis and meningitis caused by tick-borne encephalitis virus. Encephalitis Economo ( or lethargic encephalitis) are characterized by visual colorful hallucinations. Hallucinations can be observed at high temperatures.
In children, mental disorders are more often observed with tuberculous meningitis. They have an anxious mood, fears, vivid hallucinations. Tuberculous meningitis is also characterized by auditory hallucinations, impaired consciousness of the oneiroid type ( the patient experiences fantastic episodes), as well as a disorder of self-perception.

Features of the onset of the disease in children

In children in the clinical picture of meningitis in the first place are:

• fever;
• convulsions;
• vomiting fountain;
• frequent vomiting.

Infants are characterized by a sharp increase in intracranial pressure with bulging of a large fontanel. A hydrocephalic cry is characteristic - a child suddenly cries out against the background of confused consciousness or even unconsciousness. The function of the oculomotor nerve is disturbed, which is expressed in strabismus or drooping of the upper eyelid ( ptosis). Frequent damage to the cranial nerves in children is explained by damage to both the brain and the meninges ( that is, the development of meningoencephalitis). Children are much more likely than adults to develop meningoencephalitis because the blood-brain barrier is more permeable to toxins and bacteria.

In infants, attention should be paid to the skin. They may be pale, cyanotic ( blue) or pale grayish. A clear venous network is visible on the head, the fontanel pulsates. The child can constantly cry, scream and tremble at the same time. However, with meningitis with hypotensive syndrome, the child is lethargic, apathetic, constantly sleeping.

Symptoms of meningitis

Symptoms that appear with meningitis can be grouped into three main syndromes:

• intoxication syndrome;
• craniocerebral syndrome;
• meningeal syndrome.

Syndrome of intoxication

Intoxication syndrome is caused by a septic lesion of the body, due to the spread and multiplication of infection in the blood. Patients complain of general weakness, fatigue, weakness. The body temperature rises to 37 - 38 degrees Celsius. Periodically there is a headache, aching character. Sometimes signs of SARS come to the fore ( acute respiratory viral infection): nasal congestion, cough, sore throat, aching joints. The skin becomes pale and cold. Appetite decreases. Due to the presence of foreign particles in the body, the immune system is activated, which tries to destroy the infection. In the early days, a rash may appear on the skin in the form of small red dots, which are sometimes accompanied by itching. The rash disappears on its own within a couple of hours.

In severe cases, when the body is unable to fight the infection, it attacks the skin vessels. The walls of blood vessels become inflamed and clogged. This leads to ischemia of skin tissues, small hemorrhages and skin necrosis. Constricted areas of the skin are especially vulnerable ( back and buttocks in a patient lying on his back).

craniocerebral syndrome

Craniocerebral syndrome develops as a result of intoxication of the body with endotoxins. infectious agents ( most often meningococcus) are distributed throughout the body and enter the bloodstream. Here they are subject to attack by blood cells. With increased destruction of infectious agents, their toxins enter the bloodstream, which adversely affect its circulation through the vessels. The toxins cause intravascular coagulation and the formation of blood clots. The medulla is especially affected. Blockage of cerebral vessels leads to metabolic disorders and accumulation of fluid in the intercellular space in the brain tissues. The result is hydrocephalus cerebral edema) with increased intracranial pressure. This causes sharp headaches in the temporal and frontal region, intense, excruciating. The pain is so unbearable that the patients groan or cry out. In medicine, this is called a hydrocephalic cry. The headache is aggravated by any external stimulus: sound, noise, bright light, touch.

Due to edema and increased pressure, various parts of the brain that are responsible for the functioning of organs and systems suffer. The center of thermoregulation is affected, which leads to a sharp increase in body temperature to 38 - 40 degrees Celsius. This temperature cannot be lowered by any antipyretics. The same explains the profuse vomiting ( vomiting fountain) that does not stop for a long time. It appears with increased headache. Unlike vomiting in case of poisoning, it is not associated with food intake, and does not bring relief, but only worsens the patient's condition. In severe cases, the respiratory center is affected, resulting in respiratory failure and death.
Hydrocephalus and impaired circulation of cerebral fluid causes convulsive attacks in various parts of the body. Most often they are of a generalized nature - the muscles of the limbs and torso are reduced.

Progressive cerebral edema and increasing intracranial pressure can lead to damage to the cerebral cortex with impaired consciousness. The patient cannot concentrate, is unable to perform the tasks given to him. Sometimes hallucinations and delusions appear. Psychomotor agitation is often observed. The patient randomly moves his arms and legs, the whole body twitches. Periods of excitement are replaced by periods of calm with lethargy and drowsiness.

Sometimes cranial nerves are affected due to cerebral edema. More vulnerable are the oculomotor nerves that innervate the muscles of the eye. With prolonged squeezing, strabismus, ptosis appears. When the facial nerve is damaged, the innervation of the facial muscles is disturbed. The patient cannot close his eyes and mouth tightly. Sometimes you can see the sagging of the cheek on the side of the affected nerve. However, these disturbances are temporary and disappear after recovery.

meningeal syndrome

The main characteristic syndrome in meningitis is the meningeal syndrome. It is caused by a violation of the circulation of cerebrospinal fluid against the background of increased intracranial pressure and cerebral edema. The accumulated fluid and edematous tissue of the brain irritates the sensitive receptors of the vessels of the meninges and spinal nerve roots. There are various pathological muscle contractions, abnormal movements and the inability to bend the limbs.

Symptoms of meningeal syndrome are:

• characteristic pose of "cocked the trigger";
• neck stiffness;
• Kernig's symptom;
• Brudzinski's symptoms;
• Gillen's symptom;
• reactive pain symptoms ankylosing spondylitis, palpation of nerve points, pressure on the ear canal);
• Lessage's symptom ( for kids).

characteristic posture
Irritation of sensitive receptors of the membranes of the brain causes involuntary muscle contraction. When exposed to external stimuli ( noise, light), the patient assumes a characteristic posture similar to a cocked trigger. The occipital muscles contract and the head leans back. The stomach is drawn in and the back is arched. The legs are bent at the knees to the stomach, and the arms to the chest.

Stiff neck
Due to the increased tone of the extensors of the neck, stiff neck appears. When trying to turn the head, bend to the chest, pain appears, which forces the patient to throw his head back.
Any movement of the limbs that causes tension and irritation of the spinal membrane causes pain. All meningeal symptoms are considered positive if the patient cannot perform a certain movement, as it causes acute pain.

Kernig's symptom
With Kernig's symptom, in a supine position, it is necessary to bend the leg at the hip and knee joint. Then try to straighten your knee. Due to the sharp resistance of the flexor muscles of the lower leg and severe pain, this is almost impossible.

Brudzinsky's symptoms
Brudzinski's symptoms are aimed at trying to provoke the characteristic meningeal posture. If you ask the patient to bring his head to his chest, it will cause pain. He will reflexively bend his knees, thereby loosening the tension of the spinal membrane and the pain will subside. If you press on the pubic region, the patient will involuntarily bend the legs at the hip and knee joints. When examining Kernig's symptom on one leg, during an attempt to straighten the leg at the knee, the other leg involuntarily bends at the hip and knee joint.

Gillen's symptom
If you squeeze the quadriceps femoris muscle on one leg, you can see an involuntary contraction of the same muscle on the other leg and flexion of the leg.

Reactive pain symptoms
If you tap with a finger or a neurological hammer on the zygomatic arch, there is a contraction of the zygomatic muscles, an increase in headache and an involuntary pain grimace. Thus, a positive symptom of Bechterew is determined.
When pressing on the external auditory meatus and on the exit points of the facial nerves ( brow ridges, chin, zygomatic arches) also appear pain and a characteristic pain grimace.

I> Symptom Lessage
In infants and young children, all these meningeal symptoms are mild. Increased intracranial pressure and cerebral edema can be detected by feeling a large fontanel. If it is enlarged, bulges and pulsates, then the baby has significantly increased intracranial pressure. Infants are characterized by Lessage's symptom.
If the baby is taken under the armpits and lifted, then he involuntarily assumes the characteristic “cocked trigger” pose. He instantly throws his head back and bends his legs at the knees, pulling them to his stomach.

In severe cases, when the pressure in the spinal canal increases and the membranes of the spinal cord become inflamed, the spinal nerves are affected. At the same time, motor disorders appear - paralysis and paresis on one or both sides. The patient cannot move his limbs, move, do any work.

Diagnosis of meningitis

With pronounced symptoms, the patient should contact the ambulance service with further urgent hospitalization in the infectious diseases hospital.

Meningitis is an infectious pathology and therefore it is necessary to contact an infectious disease specialist. If the course of the disease is sluggish, with an erased picture, then the patient, due to the headaches that disturb him, may initially turn to a neurologist.
However, the treatment of meningitis is carried out by the joint efforts of an infectious disease specialist and a neuropathologist.


Diagnosis of meningitis includes:

• questioning and neurological examination at the doctor's appointment;
• laboratory and instrumental examinations ( blood test, spinal puncture, computed tomography).

Poll

To diagnose meningitis, your doctor needs the following information:

• What diseases does the patient suffer from? Does he have syphilis, rheumatism or tuberculosis?
• If this is an adult, has there been contact with children?
• Was the disease preceded by trauma, surgery or other surgical procedures?
• Does the patient suffer from chronic pathologies such as otitis media, sinusitis, sinusitis?
• Has he recently had pneumonia, pharyngitis?
• What countries or regions has he visited recently?
• Was there a temperature, and if so, for how long?
• Has he taken any treatment? ( antibiotics or antivirals taken can erase the clinical picture)
• Does it irritate the light, sounds?
• If there is a headache, where is it located? Namely, is it localized or spilled over the entire skull?
• If there is vomiting, is it food related?

Neurological examination

A neurological examination is aimed at identifying the characteristic symptoms of meningitis, namely:

• stiff neck and symptom and Brudzinsky;
• Kernig's symptom;
• Lessage's symptom in infants;
• symptoms of Mondonesi and Bechterew;
• study of the cranial nerves.

Neck stiffness and Brudzinski's sign
The patient is in a supine position on the couch. When the doctor tries to bring the patient's head to the back of the head, a headache occurs and the patient throws his head back. At the same time, the patient's legs reflexively bend ( Brudzinski's symptom 1).

Kernig's symptom
The patient lying on his back is bent at the hip and knee joint at a right angle. Further extension of the leg at the knee with a bent hip is difficult due to the tension of the thigh muscles.

Symptom Lessage
If you take the child by the armpits and lift it, then there is an involuntary pulling of the legs to the stomach.

Symptom of Mondonesi and Bechterew
Symptom Mondonesi is a slight pressure on the eyeballs ( eyelids are closed). Manipulation causes a headache. Bekhterev's symptom is to identify painful points when tapping with a hammer on the zygomatic arch.

Sensitivity is also examined during a neurological examination. With meningitis, hyperesthesia is observed - increased and painful sensitivity.
With complicated meningitis, symptoms of damage to the spinal cord and its roots are revealed in the form of motor disorders.

Examination of the cranial nerves
The neurological examination also includes examination of the cranial nerves, which are also often affected in meningitis. Most often, the oculomotor, facial and vestibular nerves are affected. To examine the group of oculomotor nerves, the doctor examines the reaction of the pupil to light, the movement and position of the eyeballs. Normally, the pupil constricts in response to light. With paralysis of the oculomotor nerve, this is not observed.

To study the facial nerve, the doctor checks the sensitivity of the face, corneal and pupillary reflex. Sensitivity in this case can be lowered, increased, asymmetric. Unilateral or bilateral hearing loss, staggering and nausea indicate damage to the auditory nerve.

The attention of the doctor is also attracted by the patient's skin, namely the presence of a hemorrhagic rash.

Laboratory studies include:

• latex tests, PCR method.

General blood analysis
In a general blood test, signs of inflammation are revealed, namely:

• Leukocytosis. The increase in the number of leukocytes is more than 9 x10 9 . With bacterial meningitis, 20 - 40 x 10 9 is observed, due to neutrophils.
• Leukopenia. Reducing the number of leukocytes less than 4 x 10 9 . It is observed in some viral meningitis.
• Shift of the leukocyte formula to the left- an increase in the number of immature leukocytes, the appearance of myelocytes and metamyelocytes. This shift is especially pronounced in bacterial meningitis.
• Increased erythrocyte sedimentation rate- more than 10 mm per hour.

Sometimes anemia may be present:

• decrease in hemoglobin concentration less than 120 grams per liter of blood;
• decrease in the total number of erythrocytes less than 4 x 10 12 .

In severe cases:

• thrombocytopenia. Decreased platelet count less than 150 x 10 9 . Seen in meningococcal meningitis.

Blood chemistry
Changes in the biochemical analysis of blood reflect violations of the acid-base balance. As a rule, this manifests itself in a shift in the balance towards an increase in acidity, that is, towards acidosis. As a result, creatinine levels rise above 100 - 115 µmol/liter), urea ( above 7.2 - 7.5 mmol / liter), the balance of potassium, sodium and chlorine is disturbed.

Latex tests, PCR method
To determine the exact causative agent of meningitis, latex agglutination or polymerase chain reaction methods are used ( PCR). Their essence is to identify the antigens of the pathogen, which is contained in the cerebrospinal fluid. In this case, not only the type of pathogen is determined, but also its type.
The latex agglutination method takes 10 to 20 minutes, and the agglutination reaction ( gluing) is carried out before the eyes. The disadvantage of this method is the low sensitivity.
The PCR method has the highest sensitivity ( 98 - 99 percent), and its specificity reaches 100 percent.

Cerebrospinal puncture

Cerebrospinal puncture is essential in making a diagnosis of meningitis. It consists in introducing a special needle into the space between the pia mater and the arachnoid membrane of the spinal cord at the level of the lumbar region. In this case, spinal fluid is taken for the purpose of its further study.

Technique of cerebrospinal puncture
The patient is in the supine position with legs bent and brought to the stomach. Piercing the skin in the interval between the fifth and fourth lumbar vertebrae, a needle with a mandrel is inserted into the subarachnoid space. After a feeling of “falling through”, the mandrin is removed, and a glass tube is brought to the pavilion of the needle to collect spinal fluid. As it flows out of the needle, pay attention to the pressure under which it flows. After the puncture, the patient needs rest.
The diagnosis of meningitis is based on inflammatory changes in the cerebrospinal fluid.

Instrumental examination includes

• an electroencephalogram ( EEG);
• computed tomography ( CT).

Electroencephalography
EEG- This is one of the methods for studying the work of the brain by recording its electrical activity. This method is non-invasive, painless and easy to use. It is very sensitive to any slightest changes in the work of all brain structures. All types of brain activity are recorded using a special device ( electroencephalograph) to which the electrodes are connected.

EEG technique
The ends of the electrodes are attached to the scalp. All bioelectrical signals received from the cerebral cortex and other brain structures are recorded as a curve on a computer monitor or printed on paper. In this case, samples with hyperventilation are often used ( the patient is asked to breathe deeply) and photostimulation ( in a dark room where the study is carried out, the patient is exposed to bright light).

Indications for the use of EEG are:

• epileptic seizures;
• seizures of unknown etiology;
• attacks of headaches, dizziness and neurological disorders of unknown etiology;
• sleep and wake disturbances, nightmares, sleepwalking;
• trauma, tumors, inflammatory processes and circulatory disorders in the medulla.

With meningitis, the EEG indicates a diffuse decrease in the bioelectrical activity of the brain. This study is used in cases of residual effects and complications after meningitis, namely with the appearance of epileptic seizures and frequent convulsions. An EEG helps to determine which brain structures have been damaged and what type of seizures. In other cases of meningitis, this type of study is not informative. It only confirms the presence of damage to brain structures.

CT scan

CT is a layer-by-layer study of the structure of organs, in this case the brain. The method is based on circular transillumination of the organ by an X-ray beam with further computer processing. The information captured by X-rays is translated into graphical form in the form of black and white images.

CT technique
The patient lies on the table of the tomograph, which moves towards the frame of the tomograph. For a certain time, the X-ray tube moves in a circle, taking a series of pictures.

Detectable symptoms on CT
A CT scan shows the structures of the brain, namely the gray and white matter of the brain, the meninges, the ventricles of the brain, the cranial nerves and blood vessels. Thus, the main syndrome in meningitis is visualized - the syndrome of increased intracranial pressure and, as a result, cerebral edema. On CT, edematous tissue is characterized by reduced density, which can be local, diffuse, or periventricular ( around the ventricles). With severe edema, expansion of the ventricles and displacement of brain structures are observed. With meningoencephalitis, heterogeneous areas of low density are found, often bordered by a zone of increased density. If meningoencephalitis occurs with damage to the cranial nerves, then signs of neuritis are visualized on CT.

Indications for the use of CT
The CT method is necessary in the differential diagnosis of meningitis and volumetric brain processes. In this case, spinal puncture is initially contraindicated and is done only after computed tomography. However, CT is less informative than MRI ( magnetic resonance imaging). MRI is able to detect inflammatory processes both in the brain tissues and in the meninges.

Treatment of meningitis

The treatment of meningitis is complex, it includes etiotropic therapy ( aimed at eradicating the infection), pathogenetic ( used to eliminate the development of cerebral edema, increased intracranial pressure syndrome) and symptomatic ( aimed at the destruction of individual symptoms of the disease).

Eliminate the cause of meningitis

Elimination of the causes of bacterial ( meningococcal, staphylococcal, streptococcal) meningitis

A drug	Mechanism of action	How it is applied
benzylpenicillin	has a bactericidal effect against streptococci, pneumococci and meningococci	for 4.000.000 units. intramuscularly every 6 hours. For children, the dose is calculated based on 200.000 - 300.000 IU. per 1 kg of weight per day. The dose is divided into 4 doses
ceftriaxone	has a bactericidal effect against streptococci, pneumococci and Escherichia coli	adults, 2 grams intravenously every 12 hours. Children 50 mg per 1 kg of body weight per day in 2 divided doses
ceftazidime	effective against group B hemolytic streptococci, listeria and shigella	2 grams every 8 hours
meropenem	effective against hemolytic streptococci and Haemophilus influenzae	2 grams every 8 hours. Children: 40 mg per kg body weight three times a day
chloramphenicol	effective against Escherichia coli, Shigella and Treponema pallidum	50 - 100 mg per kg of body weight per day, the dose is divided into 3 doses ( interval every 8 hours)

With meningococcal meningitis, penicillin therapy is advisable; with streptococcal and staphylococcal meningitis - a combination of penicillins and sulfa drugs ( ceftriaxone, ceftazidime); with meningitis caused by Haemophilus influenzae ( H.influenzae) - a combination of chloramphenicol and sulfonamides.

Elimination of the causes of tuberculous meningitis

A drug	Mechanism of action	How it is applied
isoniazid	has a bactericidal effect against the causative agent of tuberculosis	15 to 20 mg per kg of body weight per day. The dose is divided into three divided doses and taken half an hour before meals.
ftivazid	anti-tuberculosis drug	40 mg per kg of patient weight per day
streptomycin	active against Mycobacterium tuberculosis, gonococci, Klebsiella, Brucella	1 gram per day intramuscularly. When combined with other drugs ( for example, with ftivazid) streptomycin is administered every other day

The average duration of treatment for tuberculous meningitis is 12 to 18 months.

Elimination of the causes of meningitis caused by malarial plasmodium or toxoplasma

Elimination of the causes of herpetic meningitis, as well as meningitis caused by the Epstein-Barr virus

There is no specific treatment for other types of viral meningitis. Basically, treatment for viral meningitis is pathogenetic and is aimed at reducing intracranial pressure. Corticosteroids are used by some clinicians for viral meningitis, but evidence of their effectiveness is mixed.

Elimination of the causes of candidal meningitis

Symptomatic treatment

Symptomatic treatment consists in the use of diuretics, drugs that replenish fluid deficiency, vitamins, painkillers and antipyretics.

A drug	Mechanism of action	How it is applied
20% mannitol solution	increases the pressure in the plasma, and thereby promotes the transfer of fluid from the tissue ( in this case from the brain) into the bloodstream. Reduces intracranial pressure	at the rate of 1.5 g per kg of body weight, injected intravenously
furosemide	inhibits Na reabsorption in the tubules, thereby increasing diuresis	in case of cerebral edema, the drug is administered by jet, in a single dose of 80-120 mg, most often combined with colloidal solutions; with moderate edematous syndrome in the morning on an empty stomach one or two tablets ( 40 - 80 mg)
dexamethasone	used to prevent complications, prevent hearing loss	initially 10 mg intravenously four times a day, then switched to intramuscular injections
hemodez	has a detoxifying effect	300 - 500 ml of a solution heated to 30 degrees is injected intravenously at a rate of 40 drops per minute
vitamin B1 and B6	improve tissue metabolism	administered intramuscularly at 1 ml daily
cytoflavin	has a cytoprotective protects cells) action	10 ml of the solution is diluted in 200 ml of 5% glucose solution and administered intravenously, drip for 10 days
acetaminophen	has analgesic and antipyretic	one to two tablets 500 mg - 1g) every 6 hours. The maximum daily dose is 4 grams, which equals 8 tablets.
calcium carbonate	Corrects acid-base balance in conditions of acidosis	5% solution 500 ml administered intravenously
cordiamine	stimulates metabolism in brain tissue	intramuscularly or intravenously, 2 ml from one to three times a day

Anticonvulsant therapy

If meningitis is accompanied by convulsions, psychomotor agitation, anxiety, then anticonvulsant therapy is prescribed.

Anticonvulsant therapy for meningitis

A drug	Mechanism of action	How it is applied
diazepam	has a calming, anti-anxiety and anticonvulsant effect	with psychomotor agitation, 2 ml ( 10 mg) intramuscularly; with generalized seizures, 6 ml ( 30 mg) intravenously, then repeat an hour later. The maximum daily dose is 100 mg.
chlorpromazine	has an inhibitory effect on the central nervous system	2 ml intramuscularly
a mixture of chlorpromazine + diphenhydramine	has a calming effect, relieves stress	with pronounced psychomotor agitation, chlorpromazine is combined with diphenhydramine - 2 ml of chlorpromazine + 1 ml of diphenhydramine. To prevent hypotension, the mixture is combined with cordiamine.
phenobarbital	has an anticonvulsant and sedative effect	50 - 100 mg 2 times a day, orally. Maximum daily dose 500mg

From the very first minutes of the patient's admission to the hospital, it is necessary to carry out oxygen therapy. This method is based on the inhalation of a gas mixture with an increased concentration of oxygen ( since pure oxygen is toxic). The method is indispensable, since cerebral edema in meningitis is accompanied by oxygen starvation ( cerebral hypoxia). With prolonged hypoxia, brain cells die. Therefore, as soon as the first signs of hypoxia appear ( cyanosis of tissues is observed, breathing becomes superficial) requires oxygen therapy. Depending on the severity of the patient's condition, it can be performed using an oxygen mask or by intubation.

In traumatic meningitis with the presence of purulent foci in the bones, in addition to intensive antibiotic therapy, surgical intervention is indicated with the removal of a purulent focus. Surgical treatment is also indicated in the presence of purulent foci in the lungs.

Patient care

People who have had meningitis need special care, which is based on diet, proper daily routine and a balanced distribution of physical activity.

Diet
When recovering from meningitis, food should be taken in small portions, at least five to six times a day. The patient's diet should ensure a decrease in the level of intoxication of the body and the normalization of metabolism, water-salt, protein and vitamin balance.

The menu should be balanced and include products containing easily digestible animal proteins, fats and carbohydrates.

These products include:

• lean meat - beef or pork tongue, veal, rabbit meat, chicken, turkey;
• lean fish - herring, salmon, tuna;
• eggs - boiled or soft-boiled, as well as steamed omelettes, soufflé;
• dairy and sour-milk products - kefir, curdled milk, cottage cheese, mild cheese, koumiss;
• milk fats - cream, butter, sour cream;
• low-fat broths and soups prepared on their basis;
• vegetables and fruits with a low content of coarse fiber - zucchini, tomatoes, cauliflower, cherries, cherries, plums;
• dried wheat bread, crackers, rye flour products, bran.

When cooking meat, fish and vegetables, preference should be given to such types of heat treatment as boiling, stewing, steaming.

When caring for a patient after meningitis, animal fats should be minimized, as they can provoke metabolic acidosis. It is also worth minimizing the consumption of easily digestible carbohydrates, which can cause intestinal fermentation processes, cause allergies and inflammation.

The diet of a person who has had meningitis should not contain the following foods:

• fatty meats - lamb, pork, goose, duck;
• cooked pork and fish products by smoking or salting;
• sweet drinks, desserts, creams, mousses, ice cream;
• fresh wheat bread, puff pastries, muffins;
• whole milk;
• buckwheat, pearl barley, legumes;
• vegetables and fruits with coarse vegetable fiber - carrots, potatoes, cabbage, red and white currants, strawberries;
• dried fruits;
• spicy and fatty sauces and dressings for dishes based on mustard, horseradish.

Water regime
In order to improve metabolism and accelerate the removal of toxins from the body, the patient should consume about two and a half liters of fluid per day.

You can drink the following drinks:

• loosely brewed tea;
• tea with milk;
• rosehip decoction;
• table mineral water;
• jelly;
• fresh fruit compote;
• natural sweet and sour fruit juices.

Schedule
The main factors in recovery from meningitis are:

• bed rest;
• lack of stress;
• timely sound sleep;
• psychological comfort.

Going to bed should be done no later than 10 pm. In order for the healing effect of sleep to be most noticeable, the air in the room must be clean, with a sufficient level of humidity. Water procedures help to relax before going to bed - a bath with herbal infusions or sea salt.
Foot massage helps to improve well-being and relax. You can do this procedure yourself, or use the Kuznetsov applicator. You can buy this product in pharmacies or specialized stores.

Distribution of physical activity
Return to an active lifestyle should be gradual, in accordance with the doctor's recommendations. You need to start with daily walks in the fresh air, exercises in the morning. Complicated physical activity should be excluded. You also need to minimize sun exposure.

Rehabilitation of patients after meningitis

After discharge from the infectious diseases hospital, the patient is sent to specialized rehabilitation centers and for outpatient treatment at home. Rehabilitation therapy begins in the hospital with an early recovery of the patient. All activities must be in strict sequence at different stages of recovery. Rehabilitation should be comprehensive and include not only recovery procedures, but also visits to specialist doctors. All activities and loads should be adequate for the physical condition of the patient and gradually increase. It is also necessary to constantly monitor the effectiveness of these rehabilitation measures and correct methods if necessary. Recovery is carried out in three stages - in a hospital ( during treatment), in a sanatorium, in a clinic.

The complex of all rehabilitation measures includes:

• medical nutrition;
• physiotherapy exercises;
• physiotherapy ( myostimulation, electrophoresis, heating, massage, water procedures, etc.);
• medical correction;
• psychotherapy and psychorehabilitation;
• sanitary-resort rehabilitation;
• vocational rehabilitation
• social rehabilitation.

Rehabilitation programs are selected individually, depending on the age of the patient and the nature of the dysfunction.

With a mild form of meningitis, which was diagnosed in time and the correct course of treatment started, there are practically no residual effects. However, such cases are rare in medical practice, especially if children have meningitis.

Often, the primary symptoms of meningitis are overlooked or mistaken for symptoms of other illnesses ( colds, poisoning, intoxication). In this case, the disease progresses with damage to the nervous structures, which recover very slowly after treatment or do not recover at all.

Residual effects

Possible residual effects after suffering meningitis include:

• headaches depending on meteorological conditions;
• paresis and paralysis;
• hydrocephalus with increased intracranial pressure;
• epileptic seizures;
• mental disorders;
• hearing impairment;
• violation of the endocrine system and autonomic nervous system;
• cranial nerve injury.

Recovery of patients with such complications of meningitis is long and requires special attention and treatment.

Elimination of complications of meningitis

In the case of paresis and paralysis, which lead to movement disorders, it is necessary to undergo a rehabilitation course with various types of massage, water procedures, therapeutic exercises, acupuncture. Consultations and supervision of the neurologist are obligatory.

With lightning-fast forms of meningitis or undiagnosed forms, when the circulation of cerebrospinal fluid is disturbed and it accumulates in large quantities in the cavities of the brain, hydrocephalus develops with high intracranial pressure. This is especially common in children. Headaches persist, mental disorders, mental retardation are noted. Periodically there are convulsions and epileptic seizures. The introduction of such children into public life undergoes some difficulties, therefore, first of all, they must undergo courses of psychotherapy and psychorehabilitation. They are under dispensary observation and should regularly visit a neurologist, neuropathologist and psychiatrist.

Hearing loss most often occurs when the inner ear becomes infected and inflamed. For the recovery of patients resort to physiotherapy ( electrophoresis, heating). In cases of deafness, patients need special training ( the language of the deaf and dumb) and special hearing aids.

Due to malfunctions in the nervous system, all organs and systems suffer, especially the endocrine and immune systems. Such people are more susceptible to environmental factors. Therefore, in the rehabilitation period, it is necessary to carry out measures to strengthen immunity. They include vitamin therapy, heliotherapy ( solar procedures), sanatorium rehabilitation.
Damage to the cranial nerves is more often accompanied by strabismus, facial asymmetry, ptosis ( omission of the eyelid). With adequate anti-infective and anti-inflammatory treatment, their risk is minimal, and they resolve on their own.

Terms of incapacity for work

Depending on the severity of meningitis and the presence of complications, the period of disability varies from 2 to 3 weeks ( in mild serous forms of meningitis) up to 5-6 months or more. In some cases, an early start to work is also possible, but with easier working conditions. In mild serous meningitis, residual effects are rare, and the period of disability is from three weeks to three months. With purulent meningitis with various residual effects ( hydrocephalus, epileptic seizures) period of disability is about 5 - 6 months. Only in the case of complete regression of symptoms can the convalescent return to work ahead of schedule, but with certain restrictions on work. It is necessary to alternate physical and mental loads and dose them correctly. The worker must be exempt from night shifts and overtime for at least six months. If the symptoms of complications return, then the sick leave is extended for another couple of months.

If, within 4 months after discharge from the hospital, the symptoms of complications do not disappear and the disease becomes chronic, the patient is sent for a medical and social examination to determine the disability group.

The main indications for referral to a medical and social examination are:

• persistent and severe complications that limit the life of the patient;
• slow recovery of functions, which leads to a long period of disability;
• chronic forms of meningitis or constant relapses with disease progression;
• the presence of the consequences of the disease, due to which the patient cannot perform his work.

To undergo a medical and social examination, you must first undergo an examination by specialists and provide their conclusions.

The main package of analyzes and consultations consists of:

• general and biochemical blood tests;
• all results of bacteriological, serological and immunological studies during acute meningitis;
• the results of the analysis of cerebrospinal fluid in dynamics;
• results of psychological and psychiatric research;
• results of consultations with an ophthalmologist, otorhinolaryngologist, neurologist and neuropathologist.

Children with severe motor, mental, speech, auditory disorders ( full recovery is not possible) are registered for disability for a period of one to two years. After this period, the children again undergo a medical and social examination. Children with persistent speech and mental disorders, with frequent epileptic seizures and hydrocephalus are assigned a disability group for two years. In case of severe complications ( deafness, dementia, deep paresis and paralysis) the child is assigned a disability group before reaching the age of 18.

Disability Determination System

Adults are awarded three different categories of disability, depending on the severity of complications and the degree of disability.

If, as a result of meningitis, the patient is limited in the ability to self-service due to blindness, decreased intelligence, paralysis of the legs and arms, and other disorders, he is given the first group of disability.

The second group of disability is given to patients who cannot perform work in their specialty under normal working conditions. In these patients, motor functions are significantly impaired, some changes in the psyche are observed, epileptic seizures, deafness appear. Also included in this group are patients with chronic and recurrent forms of meningitis.

The third group of disability includes persons with partial disability. These are patients with moderate impairments of motor functions, moderate hydrocephalus, with maladjustment syndrome. The third group includes all cases in which a person has difficulties in performing work in his specialty, and it is necessary to reduce qualifications or reduce the amount of work. This includes cases with epileptic seizures and intellectual impairment.

The third group of disability is determined at the time of retraining or training in a new profession and new employment.

Dispensary observation

After suffering meningitis, dispensary observation is mandatory for a period of at least 2 years, depending on the severity of the disease and complications. In mild forms of meningitis, the observation of doctors in the clinic is once a month for the first three months, then once every three months during the year. With purulent meningitis, severe forms with complications, visits to doctors should be at least twice a month for the first three months. The following year, an examination is required every three months and once every six months during the second year. Mandatory visits to such specialists as a neuropathologist, psychiatrist, therapist and infectious disease specialist. According to the testimony of specialists, dispensary observation can be extended.

Prevention of meningitis

Prevention is specific and non-specific. Vaccination refers to specific prevention.

Vaccination

The main vaccines to prevent bacterial and viral meningitis are:

• Meningococcal vaccine- provides protection against a number of bacteria that can cause meningitis. This vaccine is given to children 11-12 years old, and is also recommended for first-year students living in a hostel, recruit soldiers, tourists visiting places where there are epidemics of this disease;
• Haemophilus influenzae type B vaccine- Designed for children aged two months to five years;
• pneumococcal vaccine- can be of two types: conjugative and polysaccharide. The first category of vaccine is intended for children under two years of age, as well as for children at risk, whose age does not exceed five years. The type 2 vaccine is recommended for the elderly, as well as for middle-aged people whose immunity is weakened or there are certain diseases of the chronic type;
• Measles, rubella and mumps vaccines- are introduced to children in order to prevent meningitis, which can develop against the background of these diseases;
• Chickenpox vaccine.

Vaccinated children and adults may experience various side effects in the form of weakness, flushing or swelling at the injection sites. In most cases, these symptoms disappear after one to two days. In a small percentage of patients, vaccines can provoke severe allergic reactions that manifest as edema, shortness of breath, high fever, and tachycardia. In such cases, you should contact your doctor, giving the date of vaccination and the time of occurrence of side effects.

Non-specific prophylaxis

Nonspecific prophylaxis of meningitis is a series of measures aimed at increasing the body's immunity and preventing contact with possible pathogens.

What should be done?

To prevent meningitis, you need to:

• strengthen immunity;
• follow a balanced diet;
• observe the rules of personal hygiene and precautions;
• to vaccinate.

Strengthening immunity
Hardening strengthens the body's immune system, increasing its resistance to the effects of negative environmental factors. Hardening activities should begin with air baths, for example, with exercises in a room with an open window. Subsequently, classes should be moved to the open air.
Water procedures are an effective method of hardening, which should be resorted to if the body is healthy. It is worth starting with dousing with water, the temperature of which is not lower than +30 degrees. Further, the temperature must be gradually reduced to +10 degrees. When drawing up a schedule and choosing the type of hardening manipulations, one should take into account the individual characteristics of the body and consult a doctor.
Helps to increase the body's resistance to walking and doing various outdoor sports. If possible, you should choose places away from highways and roads, closer to green spaces. Sun exposure is beneficial for the production of vitamin D.

Diet
A balanced healthy diet is an important factor in the prevention of meningitis. In order to provide effective resistance to bacteria and viruses, the body should receive a sufficient amount of protein, fats, carbohydrates, vitamins and minerals.

The diet should include the following elements:

• Plant and animal proteins Immunoglobulins synthesized from amino acids help the body resist infections. Contains protein in meat, poultry, eggs, sea fish, legumes;
• Polyunsaturated fats- increase the endurance of the body. Included in nuts, fatty fish, linseed, olive and corn oils;
• Fiber and complex carbohydrates are required to strengthen the immune system. They are part of cabbage, pumpkin, dried fruits, wheat and oat bran, products made from wholemeal flour. Also with these products the body receives B vitamins;
• Vitamins of groups A, E, C- are natural antioxidants, increase the barrier resistance of the body. Contained in citrus fruits, sweet peppers, carrots, fresh herbs, apples;
• P vitamins- Immunity stimulants. Included in blackcurrant, eggplant, blueberries, dark grapes, red wine;
• Zinc- increases the number of T-lymphocytes. Found in quail eggs, apples, citrus fruits, figs;
• Selenium- activates the formation of antibodies. This element is rich in garlic, corn, pork liver, chicken and beef;
• copper and iron- provide good functioning of the blood supply system and are found in spinach, buckwheat, turkey meat, soybeans;
• calcium, magnesium, potassium- elements necessary to strengthen the immune system. The source of these substances are dairy products, olives, egg yolk, nuts, dried fruits.

Problems of the gastrointestinal tract have a negative impact on the immune background. To maintain the intestinal microflora, low-fat dairy products should be consumed. These products include: kefir, fermented baked milk, yogurt. Also, beneficial bacteria that synthesize amino acids and promote digestion are found in sauerkraut, pickled apples, and kvass.

Getting the necessary complex of vitamins from the diet is quite difficult. Therefore, the body should be supported with vitamins of synthetic origin. Before using these drugs, you need to consult a doctor.

Hygiene rules and precautions
In order to prevent the likelihood of bacterial meningitis, the following rules should be observed:

• for drinking and cooking use bottled water, filtered or boiled;
• vegetables and fruits before use should be poured over with boiling water;
• before eating, wash your hands with soap;
• to exclude the use of other people's handkerchiefs, toothbrushes, towels and other things of a personal nature.

You should be careful in crowded places. A person who is coughing or sneezing should turn away or leave the room. Those whose profession involves constant contact with a large number of people ( salesman, hairdresser, usher) you must have a gauze bandage with you. In transport and other public places, when grasping door handles or handrails, gloves should not be removed.

Some forms of meningitis are carried by insects.

Therefore, going to the forest or park, you need:

• use insect and tick repellents;
• dress in tight, closed clothing;
• wear a headdress.

If a tick is found on the skin, the insect should be removed with tweezers, after watering it with alcohol or vodka. Do not crush or tear off the tick, as the virus is in its salivary glands. After completing all the manipulations, the wound should be treated with an antiseptic.

In order to prevent meningitis, swimming in lakes, ponds and other bodies of water with stagnant water should be avoided. If you are going to travel to countries where epidemics of a viral or other type of meningitis are not uncommon, you should make the necessary vaccines. Also visiting exotic places, doctors recommend taking antifungal drugs. It is mandatory to refrain from contact with animals and insects during tourist trips.

In residential and office premises, the necessary level of cleanliness should be maintained and the extermination and prevention of rodents and insects should be systematically carried out.
If one of your family members has meningitis, you need to isolate the patient, reducing contact of any kind with him as much as possible. If communication with a person infected with meningitis is unavoidable, you should consult a doctor. The doctor will prescribe an antibiotic depending on the nature of the disease and the type of contact.

What should not be done?

To prevent meningitis, you should not:

• trigger otolaryngological diseases ( otitis, sinusitis, sinusitis);
• neglect preventive treatment in the presence of chronic diseases;
• ignore the vaccination schedule;
• do not comply with sanitary and hygienic standards at work and at home;
• eat dirty fruits and vegetables;
• do not take precautions when interacting with the patient;
• ignore protection methods when visiting potentially dangerous places ( transport and other public places).

Meningitis - causes, symptoms, complications and what to do? - Video

Inflammation of the brain is a dangerous disease in which cells gradually begin to die. There is also developing damage to the central nervous system. Pathology is usually caused by infections. The development of the inflammatory process occurs as an independent pathology, but in some cases inflammation in the head becomes the result of another disease.

If correct and timely diagnosis is carried out, doctors prescribe adequate treatment, then the disease can be completely eliminated without serious consequences and complications for a person.

It is customary to distinguish between two main types of inflammatory processes in the brain. They are called meningitis and encephalitis. It all depends on the location of the inflammatory focus.

• Meningitis. With the development of this pathology, inflammation is observed in the meninges. The disease can be provoked by bacterial, viral, fungal pathogens.
• Encephalitis. With the development of this disease, inflammation of the white matter occurs. The course of the disease can be mild or severe (in the latter case, the likelihood of death increases significantly if medical or surgical treatment is not prescribed in time).

According to statistics, encephalitic inflammation of the brain is usually diagnosed in patients under the age of 14 years (more than 60% of cases). It is customary to distinguish between two types of encephalitis: primary and secondary.

• Primary encephalitis develops as a consequence of a bite of an encephalitis tick, or against the background of a severe form of influenza or herpes.
• Secondary encephalitis is always a complication of various pathologies (for example, measles, malaria, chicken pox, rubella). In recent years, secondary encephalitis has been repeatedly recorded after vaccination of children with low-quality vaccines.

Pathology can develop in three forms: acute, chronic, subacute.

Reasons for the development of the disease

Regardless of the statistics, a person at any age can develop inflammation of the cerebral cortex, white matter, or meninges. But in more than 70% of cases, this type of pathology occurs in children (under the age of 14) and in men aged 20 to 45 years. The disease can begin to develop as a result of various factors. By and large, the trigger of the disease can be not only infectious lesions of the brain, but also, for example, back injuries, diseases of other organs, a stroke, etc.

The main reasons for the development of inflammation in the head include:

• Hypothermia (of the whole body and head in particular).
• Infectious pathologies (in 90% of cases it is encephalitis due to a tick bite).
• Chronic colds and diseases of the ear-nose-throat zone (for example, rhinitis, sinusitis, sinusitis), which are not properly treated.
• Past severe inflammation of the lungs (pneumonia).
• Chickenpox (in children, due to chickenpox, inflammation of the brain cannot develop - only in adults).
• Conjunctivitis (under certain circumstances).
• Undertreated encephalitis or meningitis.

Inflammation begins due to the penetration of various pathogenic microorganisms (usually in large quantities) through the brain. They enter the human body by airborne droplets, through the digestive system, with direct contact with a sick person. Of particular danger are the bites of various insects that carry tick-borne encephalitis (this can be not only ticks).

Inflammation of the brain is a very common disease in cats and dogs, which is a common practice in veterinary medicine.

Symptoms

Signs of inflammation of the brain are very diverse - specific symptoms will depend on the type and form of the disease, on the stage of development of the pathology and the place in which the main inflammatory focus is localized.

It facilitates the diagnosis of the disease by the fact that the symptoms of encephalitis (caused by a virus) and meningitis are approximately the same.

The most frequent and pronounced symptoms of brain inflammation, with which you can immediately suspect the disease, are:

• A state of constant weakness, a significant decrease in performance, unreasonable malaise (for example, after sleep or a long rest).
• Systematic prolonged attacks of pain in the head, which are not stopped with the help of common drugs for headaches (a common characteristic of the inflammatory process in the meninges).
• Constant vomiting, severe nausea, a significant increase in body temperature.
• Drawing and prolonged pain in the muscles and joints, in the later stages of the disease, manifestations in the form of convulsions may be noted.
• There is also a possibility of developing visual or auditory hallucinations (also in the later stages).

It is necessary to highlight the neurological symptoms of inflammation of the cerebral cortex, which will clearly indicate the presence of an inflammatory process:

• Problems with coordination of movements, stiffness in the joints.
• The patient loses the ability to swallow.
• Patients experience various changes in consciousness.
• There are certain violations in articulation (of varying severity).
• Eye movements are almost always disturbed.

With inflammation in the cerebral cortex, psycho-emotional symptoms are necessarily manifested: sleep problems, constant anxiety, mood swings, visual and auditory hallucinations. The main problem of psycho-emotional symptoms in the development of an inflammatory process in the brain is the suddenness of their onset and equally rapid extinction. Disorders of this type can manifest as psychosis or delusional states. Patients often experience psychomotor agitation, which is characterized by inappropriate behavior, increased irritability, inability to control their own actions, and a lack of understanding of the current situation.

With the development of secondary inflammation of the brain, there is a rapid progression of the pathology, so the symptoms are usually more pronounced and brighter. In patients in this situation, the following symptoms of inflammation of the head are noted:

• Severe headache, pain in the joints, muscles, in different parts of the body, which is difficult to remove even with the help of potent drugs. Patients describe such pain as unbearable.
• There is a significant increase in intracranial pressure.
• The skin of the face noticeably darkens, acquires an unhealthy shade.
• Reddish spots in the form of a small rash appear on the entire surface of the body on the skin.
• Chills (patients feel cold even in hot weather).
• The level of sweating increases significantly, which can lead to even mild forms of dehydration.

Symptoms of this type develop in about 1-2 days. The patient may also experience convulsions and delusions during this time period.

Diagnosis of the disease

Due to the fact that the inflammatory process in the brain (in the shell, in the cortex, in the trunk) can develop rapidly, timely diagnosis of the pathology is extremely important. Therefore, at the first symptoms, it is recommended to contact the doctor directly at the clinic or call an ambulance that will take the patient to the hospital.

A high accuracy of establishing the correct diagnosis is likely already at the first symptoms of the disease. In the process of carrying out diagnostic manipulations, doctors examine the patient, study his anamnesis, clarify the signs of pathology.

It is difficult to diagnose the disease in young children. In a newborn child, it is not easy to differentiate the symptoms, therefore, in such cases, adequate treatment begins only after a specific diagnosis (CT, etc.).

Without fail, the patient is sent for additional examinations. According to the decision of the doctor, they can be as follows:

• Delivery of blood and urine tests. First you need to establish that it is inflammation that develops in the body, and nothing else. The results of a standard blood test can indicate an excess of leukocytes and lymphocytes, an increase in the erythrocyte sedimentation rate, and also provide other important indicators indicating the presence of an inflammatory process (the place of its localization is not specified).
• Analysis of fluid from the spinal cord. If an inflammatory process in the brain is suspected, the patient must take a puncture of fluid from the spinal cord (the spinal canal is pierced in the lumbar region). If there is inflammation of the head, then in the results of the analysis, doctors will see a significant increase in the volume of immune cells and an excess of standard protein indicators, a low glucose content. Also, when infected, the cerebrospinal fluid will have a yellowish tint and noticeable turbidity (the same is recorded with inflammation of the spine).
• Magnetic resonance imaging. With the help of MRI, the exact location of the inflammatory focus in the human brain is quickly established.

Treatment

Different parts of the brain in women, men and children can become inflamed due to various injuries and infections. It is possible to start treating such diseases only after the root cause of the development of the pathology has been clarified and the factor that caused the inflammation has been eliminated.

First of all, the patient after an ambulance or a visit to the clinic is immediately hospitalized, after which special drugs are administered, the action of which is aimed at reducing swelling and reducing the manifestation of symptoms of the disease.

The principles of therapy will depend on the results of the diagnosis and the type of pathology. The symptoms of the disease are somewhat similar to many other diseases of the brain and spinal cord, with mental disorders, so it is extremely important to make a correct diagnosis and conduct all necessary additional examinations.

After the diagnosis is made, the treatment course begins, which includes various therapeutic methods, the choice of which depends on a number of factors (age of the patient, type of disease, stage of its development, etc.):

• Etiotropic treatment (such therapy is required to eliminate the factors that caused the development of inflammation).
• Pathogenetic treatment (various drugs are used, the action of which is aimed at stopping processes that can damage nerve endings in the brain and brain tissue).
• Symptomatic treatment (signs of pathology are eliminated or weakened).

It is mandatory to carry out drug therapy, which is necessary in any case, regardless of the characteristics of the development of the disease, its type and stage.

• To eliminate focal infectious phenomena in the patient's body, antibacterial treatment is carried out (the duration of the course of taking antibiotics is about 10-14 days). Injection of the drug is recommended.
• If the disease is caused by the negative impact of the virus on the human body, then the patient is prescribed antiviral drugs.
• If the disease appeared due to a fungal infection, then antibiotics in this case will be useless, therefore, antimycotic drugs are prescribed.
• To eliminate swelling in the brain (frontal, occipital and other lobes), the use of diuretics is recommended (but only as prescribed by a doctor).
• If convulsions appear as symptoms of inflammation, anticonvulsant drugs must be prescribed.
• It is allowed to use potent antipyretics and painkillers if the patient has a fever and a condition close to feverish.

In the absence of positive dynamics after drug therapy, an appropriate operation is performed.

It is forbidden to treat inflammation of the brain with the help of folk remedies (they can be additional therapy, but by no means the only one). Self-medication with such a serious pathology can turn into the most dangerous consequences.

Treatment can only be carried out in a medical institution in a stationary mode. The patient requires constant monitoring - you need to systematically check the work of his respiratory and cardiovascular systems.

In patients under the age of 14 with inflammation of the brain, a severe course is almost always observed (much more severe than in adults). The child's body is not yet strong enough to fight such a complex disease.

The therapeutic tactics chosen by the doctor in each case is unique, so the use of universal solutions in the treatment of brain inflammation is a categorically wrong and ineffective approach. Therapy should also be comprehensive and carried out in a hospital, not at home.

After a stay in the hospital, the patient needs a long rehabilitation (especially if the course of the disease was severe and the treatment was long). Carrying out various rehabilitation measures will reduce the risk of consequences of damage to nerves and tissue in the brain. Most often, patients in this case are prescribed: exercise therapy, massage procedures, physiotherapy and other procedures according to indications.

Possible complications

The presence of an inflammatory process in the brain (regardless of the type of disease and the stage of its development) is an extremely dangerous condition for human health. Even after a completely cured pathology, the patient may face various unpleasant consequences and complications:

• Hearing problems.
• Problems with remembering new information and reproducing old.
• Strabismus (in various forms), progressive deterioration of vision (usually myopia).
• Decreased intellectual abilities.
• The development of various forms of epilepsy.
• Failure of the thyroid gland and other internal organs.
• Problems with coordination of movements.
• Violations in the functioning of the cardiovascular system.

With inflammation in the brain, there is almost always a chance of death. If adequate treatment is not carried out, the patient may well die within 4-7 days after the onset of the first symptoms of the disease.

Meningitis- an acute infection with an aerogenic transmission, which is an inflammation of the membranes of the brain and spinal cord due to the penetration of microorganisms into them.
The pathogenesis of the disease is determined by toxemia (poisoning of the body with toxins) caused by bacterial endotoxins. In severe meningitis, the development of an infectious-toxic shock state is possible, and if left untreated, a fatal outcome.
Meningitis is ubiquitous, but is more prevalent in African countries. In these regions, an average of 30,000 cases of meningitis are reported each year. Most often, the disease affects children and the male population, and the peak incidence is observed from late autumn (November) to December.

The only source of meningitis is sick people with severe and erased clinical forms, as well as healthy bacteria carriers.
The entry gate for infection is the skin, mucous membrane of the respiratory and digestive tract, but in most cases - the mucous membrane of the nasal cavity.
A focus of inflammation is formed at the entrance gate, in the future, the pathogen appears in the membranes of the brain and spinal cord, causing meningitis.

Those. a person can become infected with meningitis not only through direct contact with an infected person, but also through water, dirty hands, blood, during childbirth from mother to child.

The first signs of meningitis

The most common form of meningitis is meningococcal.
With meningococcal meningitis at the very beginning of the disease, the clinic may be absent. The first signs of meningitis appear either in the form of acute nasopharyngitis, or in the form of the development of generalized forms, which is much less common.
The first symptoms of meningitis are clinically manifested by hyperthermia, severe headache, and vomiting. The patient will be disturbed by perspiration and sore throat, nasal congestion, cough, pallor of the skin, muscle pain. Often, such a clinic is regarded as a manifestation of SARS. With a combined form of meningitis (a combination of meningococcemia and meningitis), a hemorrhagic rash may occur on the extremities. One of the main signs of meningitis is the inability or difficulty in bending the head.

Important information

If these symptoms appear, you should immediately consult a doctor, as meningitis is a very dangerous disease that can be fatal.

Symptoms of meningitis in adults

Signs of meningitis can be divided into non-specific and specific. The appearance of specific symptoms is characteristic of meningitis of a certain etiological nature.

Non-specific symptoms

• Decreased performance, weakness, increased fatigue;
• Heat;
• Adynamia (a state of impotence);
• blanching of the skin;
• An increase in intracranial pressure due to an increase in the volume of cerebrospinal fluid (hereinafter referred to as CSF).

Specific symptoms in meningococcal meningitis

Meningeal symptoms

Symptoms of meningitis in children

At the age of children under 1 year there is a non-specific clinic. The first signs of meningitis include: increased body temperature, frequent regurgitation of food, throwing back the head, and seizures may occur. Children of this age are also characterized by a "brain cry" - a monotonous prolonged crying of a child. Meningeal symptoms occur only by the third day.
In children aged 2 to 7 years, serous meningitis is most common. The clinic has a typical course. At the beginning, it is accompanied by weakness, a lethargic state of the child, loss of appetite, then symptoms of meningitis appear - cephalgia, febrile body temperature, and damage to some groups of cranial nerves is also characteristic.
Often occurs in newborns Lessage's sign of suspension- the child, who is held by the armpits, pulls the legs to the stomach. In a healthy child, the legs in this position unbend and bend freely.

Types of meningitis

Classification of meningitis by time of occurrence:

1. Primary - inflammation was not preceded by infection;
2. Secondary - meningitis, developing as a complication of the underlying disease;

According to the affected meninges:

1. Leptomeningitis is an inflammation of the pia and arachnoid meninges;
2. Pachymeningitis is an inflammation of the dura mater;

By etiology:

• Bacterial (meningococcal);
• Helminthic;
• Viral - characteristic of patients with compromised immunity;
• Fungal - fungi of the genus Candida;
• combined;

According to the nature of inflammation:

1. Serous - lymphocytes are found in the CSF;
2. Purulent - neutrophils are detected in the CSF;

With the flow:

1. Spicy;
2. Subacute;
3. Chronic;
4. Fulminant;

Diagnosis of the disease

Diagnosis of meningitis is based on data from the anamnesis of life and disease, laboratory diagnostic studies, the clinical picture and the detection of meningococcus in the discharge from the nasopharynx.

Helpful information

The most reliable method is a lumbar puncture. Lumbar puncture is a diagnostic procedure for the collection of cerebrospinal fluid and further microbiological examination to identify the pathogen.

The absence of signs of inflammation in the cerebrospinal fluid makes it possible to exclude the diagnosis of meningitis. Determining the nature of the disease allows you to start etiopathogenetic therapy.

Indicators indicating inflammatory changes in the CSF:

1. Hypertension syndrome;
2. Pleiocytosis with a predominance of neutrophilic granulocytes, lymphocytes;
3. Change in color and transparency of CSF;
4. Fluctuating protein levels;
5. Change in sugar level;

Indicators of liquor in the norm and with meningitis of various nature:

CSF indicators	Liquor is normal	Viral meningitis	Bacterial meningitis (serous)	Bacterial meningitis (purulent)
Colour	colorless	colorless	colorless	whitish, greenish
Transparency	transparent	transparent, opalescent	opalescent	turbid
CSF pressure (mmHg)	from 130 to 180	from 200 to 300	from 250 to 500	pressure is increased
Cytosis (cells in 1 microliter)	2 to 8	from 20 to 800	from 200 to 700	over 1000
Protein mg/l	from 160 to 330	from 160 and more	from 1000 to 3300	from 660 to 16000
Dissociation	No	cell-protein	protein-cellular	cell-protein

Liquor fluid can be examined as follows:

• Bacterioscopic;
• Carrying out PCR of CSF with the determination of DNA of meningococcus;
• Bacteriological;
• Serological - RPHA with erythrocyte diagnosticums for the detection of anti-meningococcal antibodies;

Additional research methods:

• Neurosonography - this study is performed in patients with signs of intracranial hypertension, the presence of neurological symptoms, convulsive syndrome;
• Computed tomography of the brain is performed to exclude organic lesions of the brain tissue;
• Magnetic resonance imaging;
• Electroencephalogram - in severe cases, a pronounced violation of electrical activity is detected;
• Electrocardiogram - in severe cases, signs of myocarditis may be detected;
• X-ray of the chest with the clinical picture of pneumonia (complication of meningitis);
• A coagulogram is performed in the presence of a hemorrhagic rash;
• Urinalysis - proteinuria, single leukocytes and erythrocytes;
• Clinical blood test - revealed an increase in ESR from 30 to 50 mm / h, neutrophilic leukocytosis with a shift of the formula to the left, lymphopenia, monocytosis, anemia.

Differential diagnosis of meningitis:

Etiological forms	Patient Complaints	Meningeal symptoms	General infectious symptoms
Purulent meningitis	Cephalgia, hyperthermia, vomiting	Acute onset, meningeal symptoms increase on the first day	Fever (hyperthermia to febrile numbers)
Serous meningitis	Cephalgia, nausea, chills	Moderately pronounced	moderate fever
Tuberculous meningitis	Weakness, nausea, asthenic syndrome	Not expressed, gradual onset of the disease	subfebrile temperature

Regardless of the form of meningitis, the treatment of patients should be carried out in specialized medical institutions in the conditions of the infectious diseases department.
Basic principles of meningitis treatment:

1. Elimination of symptoms that form the clinical picture of the disease;
2. Prevention of the development of complications;
3. Prevent further progression of the disease.

In the treatment of meningitis, 2 stages can be distinguished:

1. Until the etiology of meningitis is established (broad-spectrum antibiotics);
2. After establishing the etiological factor.

The basic principles of treatment consist of etiotropic and symptomatic therapy.

Etiotropic therapy. The main principle of this therapy is the impact on the cause of the disease, that is, on the pathogen. It is represented by antimicrobial therapy - broad-spectrum antibiotics are used. Antibiotic therapy is carried out for at least 10 days. In the presence of septic foci, antibiotic therapy is carried out for a longer time. If the patient underwent surgery, antibiotic therapy should be continued for at least three days after the operation. When prescribing antibiotics, the doctor should focus on the analysis of the cerebrospinal fluid.

Symptomatic therapy is based on the elimination of symptoms that threaten human health and life. As such therapy, the following means are used:

• Diuretics. They have the effect of increasing urination for the purpose of dehydration in cerebral edema;
• Carrying out infusion therapy in order to reduce the effects of intoxication and restore water-salt balance (using glucose, plasma transfusion, colloids, albumin);
• In the presence of convulsions, the use of anticonvulsants is indicated;
• hormone therapy;
• metabolic therapy;
• Immunotherapy.

Non-drug treatment includes adherence to a diet, aeration of living quarters, hygiene measures, sanitation of the upper respiratory tract.

With proper treatment, regression of symptoms occurs by the 10th day of the treatment started.

Complications after meningitis

Meningitis, if not properly treated, can cause hearing loss up to the development of deafness, epileptic seizures, and organic brain damage. Mortality in meningitis is 50%.

• Cerebral edema is one of the complications of meningitis, most often occurring in the phase of the height of the disease. It is characterized by a change in the patient's consciousness, convulsions, the appearance of a clinic of neurological pathology. Cerebral edema is most often observed in children, due to the high hydrophilicity of the brain tissue and greater mobility compared to adults. The aggravation of this condition leads to the phenomenon of wedging of the brain stem, in which the respiratory and vasomotor centers are located, which in turn leads to vital dysfunction (the patient is not able to breathe on his own). Quite rarely, paresis of the cranial nerves is formed, which regresses over the next 3 months.
• Brain infarction. This complication is characterized by the occurrence of severe neurological symptoms: spastic tetraparesis, delayed speech and psychomotor development, impaired higher nervous activity.

Disease prevention

Prevention of meningitis consists of two components: specific and nonspecific.

Prevention of meningitis also consists in isolating the active bacteriocarrier during treatment in a hospital in a box and observing personal hygiene. After hospitalization of the patient during the day, it is necessary to examine the doctor of all persons who had contact with him. When identifying individuals with acute nasopharyngitis, they need to conduct a more thorough examination, including bacteriological examination in order to identify meningococcus, make a diagnosis and start treatment as early as possible. All persons who have not been diagnosed with catarrhal phenomena from the nasopharynx are given chemoprophylaxis with antibacterial agents. Vaccination is also added to antibiotics.

Timely diagnosis of the patient can avoid serious complications. Since the disease can begin with nasopharyngitis - it is often similar in clinical picture to SARS, a specialist consultation is necessary to make the correct diagnosis and prescribe treatment.

Meningitis is an infectious disease in which the meninges become inflamed. Therefore, it is important to understand how it can be transmitted from a sick person to a healthy person.

Transmission options

Meningitis, like most infectious diseases, is transmitted:

• by airborne droplets (when the patient coughs, sneezes);
• contact-household (if elementary rules of personal hygiene are not observed);
• in an alimentary way (in the absence of proper processing of food);
• through the blood and lymph (during operations, intravenous injections, blood transfusions);
• during sexual contact;
• during childbirth from mother to child.

Classification and incubation period

The cause of inflammation of the meninges is an infection that has a different origin. In this regard, they talk about the viral, bacterial, fungal, protozoal, mixed and other nature of meningitis. The rate of development of the disease is also different, which makes it possible to distinguish between acute and chronic variants.

The first is characterized by a rapid course, when the disease makes itself felt on the first day. Often the patient dies without having time to receive proper medical care. The acute variant of meningitis is characterized by the development of the disease within 2-3 days. The chronic form proceeds with virtually no symptoms, so it is difficult to say when the disease began.

After the infection has entered the body, the incubation period begins. It lasts from two to seven days, depending on the pathogen and the immune forces of the person. In some cases, 10-18 days pass before the first signs of the onset of the disease appear.

Characteristic symptoms

Almost all doctors talk about how important it is to see the first signs of meningitis in a timely manner. Inflammation is manifested by the fact that at first the temperature rises sharply (the mercury column reaches 40 degrees), a headache appears. Loss of appetite, nausea and vomiting without subsequent relief are characteristic signs of the onset of the disease, which is easy to confuse with the manifestations of a common infection.

The list of main symptoms of meningitis infection in adults and children is also complemented by numbness of the neck muscles, which makes it difficult to turn and tilt the head. This phenomenon is called rigidity in medicine. Diarrhea is common in children, although diarrhea is sometimes considered a sign of meningitis in adults and adolescents.

Fungi - yeast of the genus Candida, cryptococcus neoformans and the yeast fungus Coccidioides immitis that causes coccidioidomycosis. Protozoa are single-celled eukaryotes, such as Naegleria Fowler, which causes primary amoebic meningoencephalitis.

An additional factor that increases the risk of developing meningitis is a weakened immune system. Chronic diseases (sinusitis, tuberculosis), recent infections, stress, lack of vitamins, and diet can lead to this condition. Also increase the risk of hypothermia, improper medication, alcohol and drug abuse, injuries (primarily head and back).

Diagnostics

To determine whether there is meningitis in adults or children, only a doctor can make the correct diagnosis by conducting the necessary examination. Diagnostics involves:

• taking blood tests (general and biochemical);
• carrying out a lumbar puncture (puncture of the lower back in order to take cerebrospinal fluid);
• serodiagnosis.

The doctor may prescribe a tomography, EEG and EMG.

The main research material is cerebrospinal fluid, which is taken with a syringe from the spine in the lumbar region. The quality of the material, its composition allow the doctor to judge the nature of the disease, the causes that led to its occurrence.

Treatment of meningitis: general information

When making a diagnosis, a complex treatment is prescribed, involving a number of steps. First, it is necessary to hospitalize a sick person in a hospital as soon as possible.

After the examination, drug therapy is prescribed, which is carried out in accordance with the type of causative agent of meningitis infection. Also, the patient needs procedures and drugs aimed at reducing intoxication, and symptomatic treatment.

Hospital and compliance

Since meningitis belongs to a class of deadly diseases, it is necessary to treat the patient only in a hospital under the close supervision of medical personnel. If we are talking about the mixed nature of the disease, then each group of pathogens will be assigned its own drug.

Only in a hospital setting is it possible to control therapy by doctors, quick resuscitation in case of complications.

Prescribed medications

The bacterial form of meningitis is treated with antibiotics, primarily of the penicillin group. Semi-synthetic Ampicillin is given at a dosage of 200-300 mg per 1 kg of body weight. The daily dose is stretched into 4-6 doses. Cefotaxime, Ceftriaxone, and also Meropenem give effective results.

If the infection is tuberculous, Streptomycin, Isoniazid, or Ethambutol may be prescribed. The bactericidal effect of the drugs is enhanced by the additional intake of Pyrazinamide or Rifampicin. The duration of the course of taking the drugs is from 10 to 17 days, depending on the severity of the disease.

Antibiotics are not treated, so all actions are aimed at reducing the negative manifestations of the disease. Pain is relieved, elevated body temperature is brought down by antipyretics, the body's water-salt balance is restored, and detoxification is carried out. The treatment regimen for meningitis almost repeats the tactics of getting rid of a cold.

The combination of an immune system modulating drug (Interferon) and glucocorticoids has a positive effect. Nootropics, barbiturates are used as additional drugs, vitamins of groups B and C are prescribed. Sometimes the doctor prescribes a protein diet and an antiviral agent (depending on the causative agent of meningitis).

Antifungal therapy is carried out taking into account the specific microbe that caused the development of the disease. Cryptococcal and candidal meningitis are treated with Amphotericin B in combination with Flucytosine. Sometimes the synthetic drug Fluconazole is additionally prescribed.

The waste products of the microorganisms that caused the infection must be removed from the body. Detoxification will not allow the body to weaken its immunity even more, it normalizes the functioning of organs. Usually used Enterosgel or Atoxil. Plentiful drink helps to cope with intoxication - decoctions with vitamin C (rosehip broth), tea with lemon or fruit drinks.

Inflammation of the membranes of the brain and spinal cord. Pachymeningitis - inflammation of the dura mater, leptomeningitis - inflammation of the pia and arachnoid meninges. Inflammation of the soft membranes is more common, in such cases the term "meningitis" is used. Its causative agents can be certain pathogenic microorganisms: bacteria, viruses, fungi; less common protozoal meningitis. Meningitis is manifested by severe headache, hyperesthesia, vomiting, stiff neck, typical position of the patient in bed, hemorrhagic skin rashes. To confirm the diagnosis of meningitis and establish its etiology, a lumbar puncture and a subsequent examination of the cerebrospinal fluid are performed.

General information

Inflammation of the membranes of the brain and spinal cord. Pachymeningitis - inflammation of the dura mater, leptomeningitis - inflammation of the pia and arachnoid meninges. Inflammation of the soft membranes is more common, in such cases the term "meningitis" is used. Its causative agents can be certain pathogenic microorganisms: bacteria, viruses, fungi; less common protozoal meningitis.

Etiology and pathogenesis of meningitis

Meningitis can occur through several routes of infection. Contact way - the occurrence of meningitis occurs in the conditions of an already existing purulent infection. The development of sinusogenic meningitis is facilitated by a purulent infection of the paranasal sinuses (sinusitis), otogenic - mastoid process or middle ear (otitis media), odontogenic - pathology of the teeth. open craniocerebral injury or spinal cord injury, crack or fracture of the base of the skull.

The causative agents of infection, entering the body through the entrance gate (bronchi, gastrointestinal tract, nasopharynx), cause inflammation (serous or purulent type) of the meninges and adjacent brain tissues. Their subsequent edema leads to disruption of microcirculation in the vessels of the brain and its membranes, slowing down the resorption of cerebrospinal fluid and its hypersecretion. At the same time, intracranial pressure rises, dropsy of the brain develops. It is possible to further spread the inflammatory process to the substance of the brain, the roots of the cranial and spinal nerves.

Classification of meningitis

Clinical picture of meningitis

The symptom complex of any form of meningitis includes general infectious symptoms (fever, chills, fever), increased respiration and disturbance of its rhythm, changes in heart rate (tachycardia at the onset of the disease, bradycardia as the disease progresses).

Meningitis is characterized by hyperesthesia of the skin and soreness of the skull during percussion. At the onset of the disease, there is an increase in tendon reflexes, but with the development of the disease they decrease and often disappear. If the substance of the brain is involved in the inflammatory process, paralysis, pathological reflexes and paresis develop. Severe meningitis is usually accompanied by dilated pupils, diplopia, strabismus, impaired control of the pelvic organs (in the case of the development of mental disorders).

Symptoms of meningitis in old age are atypical: a slight manifestation of headaches or their complete absence, tremor of the head and limbs, drowsiness, mental disorders (apathy or, conversely, psychomotor agitation).

Diagnosis and differential diagnosis

The main method for diagnosing (or excluding) meningitis is a lumbar puncture followed by examination of the cerebrospinal fluid. This method is favored by its safety and simplicity, so lumbar puncture is indicated in all cases of suspected meningitis. All forms of meningitis are characterized by fluid leakage under high pressure (sometimes a jet). With serous meningitis, the cerebrospinal fluid is transparent (sometimes slightly opalescent), with purulent meningitis, it is cloudy, yellow-green in color. With the help of laboratory studies of cerebrospinal fluid, pleocytosis is determined (neutrophils in purulent meningitis, lymphocytes in serous meningitis), a change in the ratio of the number of cells and an increased protein content.

In order to determine the etiological factors of the disease, it is recommended to determine the level of glucose in the cerebrospinal fluid. In the case of tuberculous meningitis, as well as meningitis caused by fungi, glucose levels are reduced. For purulent meningitis, a significant (to zero) decrease in glucose levels is typical.

The main landmarks of a neurologist in the differentiation of meningitis are the study of cerebrospinal fluid, namely the determination of the ratio of cells, the level of sugar and protein.

Treatment of meningitis

In case of suspected meningitis, hospitalization of the patient is mandatory. In severe prehospital stage (depression of consciousness, fever), the patient is administered prednisolone and benzylpenicillin. Lumbar puncture at the prehospital stage is contraindicated.

The basis of the treatment of purulent meningitis is the early appointment of sulfonamides (etazol, norsulfazol) or antibiotics (penicillin). Allows the introduction of benzylpenicillin intralumbally (in an extremely severe case). If such treatment of meningitis during the first 3 days is ineffective, therapy with semi-synthetic antibiotics (ampicillin + oxacillin, carbenicillin) in combination with monomycin, gentamicin, nitrofurans should be continued. The effectiveness of such a combination of antibiotics has been proven before the isolation of a pathogenic organism and the detection of its sensitivity to antibiotics. The maximum duration of such combination therapy is 2 weeks, after which it is necessary to switch to monotherapy. The criteria for cancellation are also a decrease in body temperature, normalization of cytosis (up to 100 cells), regression of cerebral and meningeal symptoms.

The basis of the complex treatment of tuberculous meningitis is the continuous administration of bacteriostatic doses of two or three antibiotics (for example, isoniazid + streptomycin). With the appearance of possible side effects (vestibular disorders, hearing impairment, nausea), the abolition of this treatment is not required, a decrease in the dose of antibiotics and a temporary addition to the treatment of desensitizing drugs (difenhydramine, promethazine), as well as other anti-tuberculosis drugs (rifampicin, PASK, ftivazide). Indications for discharge of the patient: no symptoms of tuberculous meningitis, sanitation of cerebrospinal fluid (after 6 months from the onset of the disease) and improvement in the general condition of the patient.

Treatment of viral meningitis may be limited to the use of symptomatic and restorative agents (glucose, metamizole sodium, vitamins, methyluracil). In severe cases (pronounced cerebral symptoms), corticosteroids and diuretics are prescribed, less often - repeated spinal puncture. In the case of a layering bacterial infection, antibiotics may be prescribed.

Forecast

In the further prognosis, an important role is played by the form of meningitis, the timeliness and adequacy of therapeutic measures. Headaches, intracranial hypertension, epileptic seizures, visual and hearing impairments often remain as residual symptoms after tuberculous and purulent meningitis. Due to the late diagnosis and resistance of the pathogen to antibiotics, the mortality rate from purulent meningitis (meningococcal infection) is high.

Prevention

As preventive measures to prevent meningitis, regular hardening (water procedures, sports), timely treatment of chronic and acute infectious diseases, as well as short courses of immunostimulating drugs (eleutherococcus, ginseng) in the foci of meningococcal meningitis (kindergarten, school, etc.) are provided.