Purulent meningitis is an inflammatory process of the soft membrane of the brain due to the penetration of various microorganisms into it (streptococci, pneumococci or meningococci). Purulent meningitis is manifested by the following symptoms:
high temperature;
severe headache;
vomiting;
nausea;
malfunctions in the functioning of cranial nerves;
manifestation of meningeal symptoms;
disorder of consciousness;
hyperesthesia;
uncontrolled psychomotor agitation.
The content of the article:
Causes of purulent meningitis
Classification of purulent meningitis
Symptoms of purulent meningitis
Diagnosis of purulent meningitis
Complications of purulent meningitis
Treatment of purulent meningitis
Prognosis of purulent meningitis
Prevention of purulent meningitis
Purulent meningitis
The diagnosis of purulent meningitis takes place on the basis of the collected clinical picture and the results of the analysis of cerebrospinal fluid. The main treatment of purulent meningitis will be antibiotic therapy, as well as the use of glucocorticosteroids, anticonvulsants, tranquilizers and decongestants. Symptomatic therapy may also be performed.
Purulent meningitis is a disease characterized by its bacterial etiology. This disease is rare: no more than 3 cases per 100 thousand people. The risk of contracting purulent meningitis is high among all categories of the population and age groups, but most often it affects children under the age of five. Most often, children with weakened immunity become infected with it. The peak falls in winter-spring.
An interesting fact is that in the first half of the 90s of the 20th century, fewer people became infected with purulent meningitis. In addition, the number of deaths and cases that were accompanied by severe consequences after purulent meningitis significantly decreased.
Causes of purulent meningitis
The main causative agent leading to infection with purulent meningitis is considered to be meningococcal infection. However, in recent years, scientists have proven that not only it leads to the disease, but also hemophilic bacillus and pneumococci. In half of all cases, the causative agent of purulent meningitis will be hemophilic bacillus, whereas meningococcus accounts for no more than 20%, and pneumococci — only 12-13%.
Purulent meningitis also occurs in newborns. The cause of what will be a streptococcal infection or salmonellosis. In addition, infected E. coli can also be the main causative agent.
Regarding the ways of penetration of the pathogen into the human body , purulent meningitis is classified into:
primary: the development is facilitated by the hematogenic spread of the causative agent bacillus from the nasal cavity, where it enters when a person breathes; it is easy to get infected by contacting patients (airborne droplet pathway or contact); direct infection of the meninges occurs in the case of open-type craniocerebral trauma, skull fracture or any other open damage to the paranasal sinuses (or mastoid process); non—compliance with hygiene rules during neurosurgical operations is another possible cause of infection;
secondary: occurs on the basis of an already existing primary focus, from which the infection spreads to the brain area; the nature of the spread of infection can be both contact (with a brain abscess or osteomyelitis of the cranial bones) and hematogenous, characterized by the spread from any focus of infection, but most often with sinusitis or otitis media.
If the causative agent of purulent meningitis enters the body through the blood-brain barrier, then immunity is weakened. The latter can also be caused by acute respiratory viral infections or frequent stressful situations, as well as physical fatigue, change of climatic zones.
Classification of purulent meningitis
Regarding the severity of symptomatic manifestations , the following forms of purulent meningitis are distinguished:
easy;
medium heavy;
severe (inherent in people with severely reduced immunity or those who have previously had their spleen removed).
Regarding the features of the course of the disease, they talk about purulent meningitis:
lightning-fast (characterized by a very rapid deployment of symptoms in the form of increased cerebral edema, which contributes to confusion and the onset of vital functions);
abortive (has erased symptoms, where the first place is given to intoxication);
acute (occurs more often than others; it is characterized by traditional cerebral and shell symptoms);
recurrent (characteristic in the case of a neglected form, with untimely treatment or in the case when a chronic type of purulent infection is observed in the body).
Symptoms of purulent meningitis
The onset of purulent meningitis is usually acute and is characterized by a sharp increase in body temperature to 39-40 ° C. Along with the temperature, there is a characteristic chill, a severe headache of an increasing nature, nausea and vomiting. The patient’s condition may be characterized by psychomotor agitation, confusion, manifestations of delirium.
About 40-45% of patients are characterized by convulsive syndrome. The so-called shell symptoms: rigidity of the occipital muscles, Kernig’s symptom, Guillain’s symptom, are usually expressed in the first hours of the disease, intensifying more and more on 3-4 days.
Additional symptoms of purulent meningitis will be hyperesthesia, a decrease in abdominal reflexes, which is observed against the background of already increased activity of deep reflexes. The occurrence of a diffuse rash having a hemorrhagic character is not excluded.
The focal symptoms that accompany purulent meningitis are understood, first of all, to be a violation of the functioning of the cranial nerves. Most often, the oculomotor nerves are affected, which leads to double vision, further development of strabismus, the upper eyelid may drop or anisocoria may appear (a noticeable difference in the size of the pupils). Neuritis of the facial nerve is much less common, there may be a lesion of the trigeminal nerve or a disorder of the function of the optic nerves, which is expressed in a partial loss of the field of vision and a decrease in its acuity. There is also a violation of the functioning of the vestibular cochlear nerve, which in medicine has been called progressive hearing loss.
Severe focal symptoms indicate the continued spread of inflammatory processes occurring in the brain, as well as the development of vascular abnormalities similar to the manifestations of ischemic stroke, which is explained by the presence of vasculitis, thrombosis of cerebral vessels or reflex spasm.
If the inflammatory process entirely extends to the substance of the brain, then we are already talking about meningoencephalitis. In this case, purulent meningitis unfolds with the addition of special focal symptoms inherent in encephalitis (paresis or paralysis, impaired sensitivity, slurred speech, the occurrence of pathological reflexes, muscle excitability).
Symptoms such as hallucinations, vestibular ataxia, hyperkinesis, sleep disorders, memory and behavior disorders are not excluded.
If the purulent process spreads further to the ventricles of the brain, then a spastic attack may occur, unfolding according to the type of gormetonia with flexion contractures of the arms or extensor legs.
Diagnosis of purulent meningitis
Usually, the diagnosis of purulent meningitis is made on the basis of detailed symptoms in the form of meningeal and neurological manifestations, lesions of cranial nerves.
Lumbar puncture
It is more difficult to diagnose purulent meningitis in the case of abortive course or with its secondary occurrence against the background of already existing symptoms of a septic focus. To make a final diagnosis, a lumbar puncture is performed, which determines whether the pressure of the cerebrospinal fluid is increased, as well as whether its color has changed, whether turbidity has occurred.
Smear microscopy
With further examination of the cerebrospinal fluid, an increased content of protein substances and cellular elements can be detected. Usually, the pathogen is determined by microscopy of a smear taken from the cerebrospinal fluid, as well as when it spreads to the nutrient medium.
Additional diagnostic measures
During the diagnosis, a blood test and an analysis of the separated elements of the skin rash are also carried out. If a specialist has an assumption about the presence of purulent meningitis of a secondary nature, then an additional examination is prescribed, the purpose of which is to identify the primary infectious focus. To do this, the patient is sent for consultation to a pulmonologist, otolaryngologist or therapist. Effective diagnostic measures here will be otoscopy, X-ray of the paranasal sinuses, X-ray of the lungs.
Differential diagnosis is carried out with viral meningitis, subarachnoid hemorrhage, meningism, which is also observed in typhus, leptospirosis and severe cases of influenza.
Complications of purulent meningitis
The most serious complication of purulent meningitis is cerebral edema, which squeezes the brain stem, disrupting the functioning of vital centers located in it. Acute swelling occurs on the 3rd day from the onset of the disease. In the case of a lightning current, the acute form manifests itself already in the first hours.
According to its clinic, complications of purulent meningitis are most often expressed in motor restlessness, confusion, violation of normal breathing and functioning on the part of the cardiovascular system (in the form of tachycardia, bradycardia, arterial hypotension or hypertension).
Other complications of purulent meningitis may be:
septic shock;
subdural empyema;
adrenal insufficiency;
purulent arthritis;
pneumonia;
pyelonephritis;
infectious endocarditis;
cystitis;
septic panophthalmitis.
Treatment of purulent meningitis
With purulent meningitis, patients are treated only in a hospital. Patients should immediately undergo a lumbar puncture with further bacterioscopic examination of the cerebrospinal fluid. After the etiology of meningitis is established, the patient is prescribed a course of antibiotics. The latter often involves the use of ampicillin with drugs from a number of cephalosporins, including cefotaxime, ceftriaxone and ceftazidime. If the causative agent of purulent meningitis is not established, initial therapy consists of intramuscular administration of aminoglycosides or their combination with ampicillin. In severe forms of purulent meningitis, intravenous administration of antibiotics may be prescribed.
To reduce swelling of the brain, dehydration therapy with mannitol and furosemide can be prescribed. If we talk about the pathogenetic type of treatment, it implies the use of dexamethasone or prednisone, in a word, glucocorticosteroids. The prescribed doses will depend on the severity of the disease. In addition, doctors prescribe symptomatic therapy. If the patient also has a benson, then tranquilizers are prescribed. In order to stop psychomotor agitations and eliminate seizures, lytic mixtures are prescribed, as well as valproic acid or diazepam. Infusion therapy will be prescribed in the presence of infectious and toxic shock.
Treatment during the recovery period
If we talk about therapy in the recovery period after acute purulent meningitis, then the reception of neuroprotective or nootropic substances, as well as vitamin therapy and other restorative therapy is shown here.
Treatment of secondary purulent meningitis
In secondary purulent meningitis, the treatment of patients should involve the elimination, first of all, of the primary septic focus, including the possible use of surgery in the form of a sanitizing operation (in the case of otitis media), removal of an intracerebral abscess, frontotomy or sphenotomy.
Prognosis of purulent meningitis
According to statistics, about 15% of all cases of purulent meningitis end in death. If the diagnosis was made in a timely manner, and treatment was started urgently, then the prognosis of the disease will be favorable.
It should be said that after a person has had purulent meningitis, he may develop asthenia with characteristic liquor-dynamic disorders and inherent hearing loss of a sensorineural nature. Also, in some cases, there may be an implicitly expressed focal symptomatology.
Such severe complications after purulent meningitis as complete deafness, hydrocephalus, amaurosis, dementia or epilepsy are very rare today.
Prevention of purulent meningitis
The proven right way to prevent purulent meningitis will be vaccination. Usually, the goal will be to resist infection with such major pathogens as hemophilic bacillus, pneumococci or meningococci. Such vaccination is not mandatory, but it is very desirable.
Vaccination is usually carried out among young children (usually up to 5 years old), as well as among people who have an immunodeficiency condition due to the development of HIV infection in the body.
Interestingly, vaccination is also prescribed to people after removal of the spleen, thymus or after immunosuppressive therapy of cancer patients. If we talk about vaccination against meningococcal infection, it is indicated for children older than 18-20 months, and is mandatory if the disease has been diagnosed in at least one family member. In those regions that are considered the most susceptible to the spread of meningococcal purulent meningitis, vaccination should be carried out regularly, especially for people with immunodeficiency, as well as those with traumatic brain injuries. Vaccinations should be carried out among children who often suffer from otitis media, pneumonia or simply have low immunity.
