Meningitis
Meningitis is an inflammatory process in which the meninges are affected. Meningitis is represented by several forms, each of them is dangerous to the patient’s life and requires immediate medical intervention. In most cases, inflammation of the meninges develops against the background of infectious pathogens entering the body. This pathological process, regardless of etiology, is characterized by the presence of general meningial symptoms, general inflammatory signs, as well as inflammatory elements in the cerebrospinal fluid. In the diagnosis of meningitis, the clinical picture is analyzed, and a number of additional studies are carried out, the key among which is considered a lumbar puncture, according to its results, it is possible to clarify the form of meningitis and determine the optimal treatment tactics.
The content of the article:
Classification of meningitis
Etiology and pathogenesis of meningitis
Ways of infection penetration into the body
Clinical picture of meningitis
Diagnosis and differential diagnosis of meningitis
Treatment of meningitis
Prognosis for meningitis
Prevention of meningitis
Meningitis
Classification of meningitis
To date, there is no single classification of meningitis, in clinical practice, inflammation of the meninges are divided simultaneously according to several criteria.
By etiology:
bacterial (staphylococci, mycobacterium tuberculosis, streptococci);
fungal (cryptococci, fungi of the genus Candida);
protozoan (with toxoplasmosis, malaria);
viral (with herpes, measles, rubella, HIV, ESNO).
By the nature of the inflammatory process:
serous (develops in infectious diseases);
purulent (in the presence of a high level of leukocytes in the cerebrospinal fluid).
By pathogenesis:
primary (the development of the inflammatory process in the meninges occurs independently, in the absence of a general infectious lesion of the body or local infection of any organ);
secondary (develop against the background of a local or general infectious disease).
By the prevalence of the process:
limited;
generalized.
By localization of the process:
convexital;
diffuse;
local;
basal.
According to the rate of the course of the disease:
acute (these include lightning-fast);
subacute;
chronic;
recurrent.
According to the degree of severity, the following forms are distinguished:
light;
average;
heavy;
extremely heavy.
Etiology and pathogenesis of meningitis
Etiological factors triggering the mechanism of meningitis development can be:
bacterial pathogens (pneumococcus, staphylococcus, meningococcus, E. coli, streptococcus, mycobacterium tuberculosis);
fungi (cryptococci, candida);
viruses (rubella, measles, Coxsackie, HIV, ESNO, herpes).
In some cases, inflammation of the meninges develops as a result of complications of helminthiasis and the introduction of protozoa into the body of microorganisms.
Ways of infection penetration into the body
Infectious agents can enter the meninges in various ways, but most often the primary focus of inflammation, and as a consequence the entrance gate for infection, is localized in the nasopharynx. Further, the infection moves along with the blood flow into the membranes of the brain. As a rule, the spread of infection through the body through the bloodstream is characteristic in the presence of chronic foci of infection (sinusitis, otitis, cholecystitis, furunculosis, pneumonia, etc.).
There is also a contact pathway for the introduction of an infectious pathogen into the meninges. Such a variant of meningitis development can occur when the integrity of the skull bones is violated and pus penetrates into the cranial cavity as a result of osteomyelitis against the background of purulent sinusitis, inflammation of the eyeball and orbit, as well as with congenital malformations of the central nervous system, after lumbar punctures, with defects of the soft tissues of the head and with skin fistulas.
In rare cases, the infection can spread to the meninges through the lymphatic vessels of the nasal cavity.
Patients of any age can suffer from this disease, but most often meningitis develops in children, the reason for this is the imperfection of the blood-brain barrier (an organism function whose task is to protect the human nervous system from foreign substances) and insufficient development of immunity.
An important role in the development of meningitis is played by predisposing factors, which include: infectious diseases, traumatic brain injuries, fetal pathologies, vaccination, etc.
When pathogenic microorganisms enter the central nervous system, the soft membranes of the brain and spinal cord are affected. In most cases, the pathological process extends to the soft and spider membranes, but it is also possible to damage the dura mater, the roots of the cranial and spinal nerves and the upper parts of the brain.
The effect of the inflammatory process on the meninges can provoke many complications from most organs and systems, in particular adrenal, renal, respiratory and heart failure, and in some cases leads to death.
Clinical picture of meningitis
Regardless of the etiological factors and mechanisms of development of this pathology, the clinical picture of meningitis is characterized by standard manifestations: meningial syndrome in combination with characteristic changes in the cerebrospinal fluid, as well as general infectious symptoms.
Meningial syndrome develops as a result of irritation and inflammatory reactions in the meninges and is clinically manifested by a cerebral symptom complex and meningial symptoms proper. The general cerebral symptoms include dizziness, headache, light and sound phobia. The first manifestations of meningial signs, as a rule, occur 2-3 days after the onset of the disease and are expressed as follows: rigidity of the muscles of the occiput, symptoms of Brudzinsky, Kernig, Lesage, etc. The inability to passively bend the head (regidity of the occipital muscles) is the first and constant sign of inflammation of the meninges.
In addition, there is a separate group of symptoms, which consists of characteristic pain sensations diagnosed during palpation and percussion of certain target points. With meningitis, patients feel pain if they are pressed on the eyeballs through closed eyelids, on the front wall of the external auditory canal, when the skull is tapped, etc.
The clinic of meningitis in young children is characterized by low expression, therefore, when examining a child with a suspected inflammatory process in the brain and in particular meningitis, attention is paid to tension, swelling and pulsation of the large fontanel and a number of other symptoms.
An important element of the clinical picture of meningitis is the presence of characteristic changes in the cerebrospinal fluid. The inflammation of the meninges is indicated by cellular-protein dissociation in the cerebrospinal fluid. During the study of purulent meningitis, the cerebrospinal fluid has a cloudy color, there is an increased pressure of cerebrospinal fluid, and a large number of protein cells are determined in its content.
In elderly patients, symptoms are atypical, which manifests itself in mild headaches or their complete absence, drowsiness, tremor of the limbs and head, as well as mental disorders.
Diagnosis and differential diagnosis of meningitis
The main diagnostic method in the study of meningitis will be a lumbar puncture, since the study of cerebrospinal fluid allows you to identify meningitis even with minimal clinical manifestations. This study is performed only in a hospital setting and after a preliminary diagnosis, which includes anamnesis collection, palpation, percussion, detection of meningial and cerebral signs, as well as the exclusion of contraindications. In most cases, the study of the cerebrospinal fluid allows you to determine the etiology of the disease and prescribe appropriate treatment. The main task of differential diagnosis is to exclude other diseases with similar symptoms, in particular meningism. A distinctive feature of meningism is the absence of general infectious symptoms against the background of meningial syndrome.
Treatment of meningitis
Meningitis is a direct indication for hospitalization of the patient. Therapeutic tactics are etiotropic in nature and are aimed at eliminating the primary focus of infection. The effect of etiotropic treatment is subject to evaluation by analyzing clinical data and the results of microscopic examination of the cerebrospinal fluid.
During the treatment of bacterial meningitis, both in children and adults, the main emphasis in drug therapy is on the appointment of antibacterial drugs in large doses. The choice of an antibiotic depends on the causative agent of the infection.
With the viral origin of the inflammatory process, the use of antiviral drugs, in particular viferon, is relevant. And with fungal etiology, meningitis is treated with antimycotic drugs.
Along with therapeutic measures aimed at eliminating the cause of the disease, it is very important to use detoxification and restorative therapy.
In order to prevent seizures, the use of lytic mixtures (pipolfen, aminazine, novocaine) is recommended. If the course of meningitis is complicated by cerebral edema or Waterhouse-Friederiksen syndrome, it is advisable to use corticosteroids (dexamethasone). Also, if necessary, symptomatic treatment of pain and hyperthermia is carried out.
Prognosis for meningitis
The prognosis of this disease depends on the cause of its development and the timeliness of therapeutic measures. Sometimes, after treatment of inflammation of the meninges, patients may have a headache, hearing impairment, vision, cerebrospinal hypertension, etc. If it is not diagnosed in time and treatment is not started, meningitis can be fatal.
Prevention of meningitis
To prevent this disease, it is necessary to lead a healthy lifestyle, harden up, sanitize the foci of acute and chronic infection in a timely manner, as well as immediately contact a specialist at the slightest suspicion of the disease.
