Among the dangerous childhood diseases that entail serious complications, one of the leading places is meningitis. Symptoms in children do not always manifest themselves clearly, disguised as signs of other, more harmless diseases, which greatly complicates the diagnosis.
How to recognize pathology in the early stages in children of different ages, what specific reactions of the body appear - we will talk about all this today.
What is meningitis
Most likely, in childhood you often had to hear from your parents the phrase that if you walk without a hat in the winter, you can get meningitis. But the development of meningitis has nothing to do with the presence of a cap on the head or its absence.
Hypothermia can serve as a trigger, but the root cause of the disease is not.
Most often, children under the age of 5 suffer from meningitis. The incidence rate of children is about 80%. Older children (up to 14 years old) are not so susceptible to the disease - only in 10 cases out of 100,000 people are diagnosed with this disease in adolescents.
Meningitis is an inflammatory process in the meninges of the spinal cord or brain. Transmitted by airborne droplets from an infected person or carrier of infection. The most dangerous contacts with seriously ill people in the early days of the disease.
Less commonly, pathogens are domestic and wild animals.
Types of pathology
- Viral meningitis - develops against the background of rubella, smallpox, measles, flu,
- bacterial - occurs when infected with staphylococci, meningococci, hemophilic bacillus, salmonella,
- fungal - a rare form of the disease, occurs with the active growth of fungi of the genus Candida against the background of weakened immunity, autoimmune, endocrine diseases,
- parasitic - an infectious disease occurs when infected with amoeba, toxoplasma.
By the nature of the inflammation, meningitis is purulent and serous, can occur in acute or chronic form.
Most often, the disease is diagnosed in children under 4 years of age, the peak of the disease occurs in 3-8 months of the baby's life. Even with timely medical care, the number of deaths is 5-30%, more than 30% of children after recovery have severe neurological disorders.
The first signs of meningitis in children
The incubation period is 2-10 days, the first signs of meningitis in children appear within 4-6 days after infection.
How does meningitis begin:
- a sharp increase in temperature, severe vomiting, signs of severe dehydration appear - the symptoms are characteristic of serous meningitis,
- the child throws back his head strongly, arches his back:
- photophobia, intolerance to harsh sounds,
- the skin becomes pale, the nasolabial triangle turns blue,
- shortness of breath, increased heart rate,
- severe headache, discomfort intensifies with pressure on the upper lip, the central part of the forehead, eyelids,
- intense thirst, refusal to eat,
- diarrhea, abdominal pain, bloating - similar symptoms appear if pathogenic viruses enter the body with food, water,
- rash in the form of large spots.
If at least one of these signs appears, immediately call an ambulance, even if it is not meningitis, similar symptoms occur with other serious and dangerous diseases.
How is the disease manifested in children up to a year
One of the main signs of meningitis in babies up to a year is bulging of a large fontanel.
How to recognize meningitis in children up to a year:
- symptom of Lessage - if you raise the child’s armpits, he will reflexively throw his head back, pull his legs to his stomach,
- severe diarrhea, regurgitation,
- the child is agitated, constantly crying, due to increased sensitivity of the skin, any touch causes pain,
- high temperature, which does not decrease after taking antipyretic drugs,
- decreased muscle tone
- a rash appears on the mucous membranes,
- possible loss of consciousness.
Meningitis is very dangerous for young children - the disease develops rapidly, the condition of the child worsens with each passing minute, and severe dehydration aggravates the situation.
Signs of the disease in children older than a year
To independently recognize a dangerous disease, you can conduct a simple preliminary diagnosis.
One of the main symptoms of the pathology - the child cannot raise his head, reach his chest with his chin due to hypertonicity of the cervical muscles.
If you try to tilt your head to the chest, the baby will involuntarily bend his knees, with inflammation of the meninges, the child cannot completely straighten the previously bent leg in the knee and hip joint.
Signs of brain inflammation:
- when you press the cheek under the cheekbones, the shoulders involuntarily rise,
- in the supine position, pull one leg up, the second limb will also rise involuntarily,
- when you press the pubic region, both legs are impulsively bent,
- the child complains of a severe headache, tinnitus, hides under a blanket, he dislikes bright light, loud sounds,
- fever lasts for several days, falls and rises again,
- a rash appears on the body in the form of bright red, burgundy single or group spots, the skin becomes very sensitive,
- the baby raves in a dream, chills, a convulsive symptom.
After 5 years, the first signs of meningitis may be respiratory symptoms - redness of the throat, pain when swallowing.
In addition, confusion is observed, the child cannot answer simple questions, raves, the whites of the eyes acquire a yellowish tint, the face swells, turns red, muscle hypertonicity is observed.
Meningitis in adolescence
In adolescents, meningitis often begins with meningococcal nasopharyngitis - the back of the pharynx becomes grainy, acquires a bluish-purple hue, which distinguishes a dangerous pathology from the usual viral form of the disease.
Other characteristic signs:
- unbearable headache
- nose is stuffed,
- the voice becomes hoarse.
In many ways, meningitis is similar to a common cold, an analysis of the cerebrospinal fluid will help to make an accurate diagnosis.
The most effective method of prevention is a vaccine against meningitis in children. Unfortunately, it is not included in the list of mandatory activities, so you have to buy the vaccine yourself. Some routine vaccinations also help reduce the risk of infection.
What vaccines and vaccines can protect against meningitis:
- MeningoACWmeningococcalA,A+C,A+C+Y+W135 immunity is developed within 14 days, lasts for 3-4 years. Many children do not tolerate these vaccines, but vaccine complications are not comparable to the effects of meningitis. Vaccination is carried out at the age of 9 months to 2 years, depending on the type of vaccine, the epidemiological situation in the region.
- Haemophilus influenzae vaccine, immunization is carried out simultaneously with DTP vaccination, the most commonly used drug is Pentaxim.
- Pneumococcal meningitis vaccine - In a planned manner, they are done to children who often suffer from bronchitis for a long time. Immunization can be carried out from 2 months to 5 years with Prevenar 13, you need to enter it 4 times. If your baby is not at risk, you will have to pay for the vaccine.
- Rubella, measles and mumps vaccine, pneumococcal vaccine, chickenpox - These vaccines do not directly protect the child from meningitis, but significantly reduce the risk of contracting a dangerous disease.
I do chemoprophylaxis for all children who have had contact with sick meningitis in the infectious ward - they undergo a short course of antibacterial therapy with broad-spectrum drugs. Children are under medical supervision for 10 days, daily blood is taken from them for general and biochemical analysis.
To avoid infection, regularly strengthen the immunity of the child, walk more, ventilate the room, often do wet cleaning.
Since many dangerous bacteria enter the body with dirty hands, from an early age teach your baby to wash his hands often and wash well, use antibacterial sprays and wipes for a walk.
Meningitis is a dangerous disease for a child that can cause mental retardation and physical development, the development of other serious complications.
Tell us in the comments what you think about the vaccine against meningitis, whether you have encountered this disease.
And do not forget to share the article with your friends on social networks - knowing how dangerous pathology manifests itself in the initial stages of development can save many babies' lives and health.
Types of Meningitis in Children
The following types of meningitis are distinguished depending on the anatomy of the inflammatory process:
- pachymeningitis - is an inflammation of the tissues of the dura mater,
- Leptomeningitis - characterized by damage to the subarachnoid space and choroid.
According to the pathogenesis of meningitis is classified into two types:
- primary - develops against the background of general well-being in the absence of local foci of the inflammatory process and previous infectious diseases,
- secondary - develops as complications of another pathological process in the body of the child.
Causes of Meningitis in Children
Experts call the following etiological factors in the development of meningitis:
- exposure to infectious pathogens, such as pneumococcus, meningococcus, staphylococcus, hemophilus bacillus, enteroviruses, mumps virus, candida fungi, treponema, toxoplasma, etc.,
- oncological diseases,
- pathological conditions of the immune system of the child’s body,
- adverse reactions in response to the introduction of drugs,
- history of traumatic brain injury,
- conducting neurosurgical surgical interventions.
Due to the increased permeability of the blood-brain barrier and immaturity of the immune response, the child's body is easily exposed to infectious agents. Sick people, as well as animals, can act as sources of infection. The causative agent can spread by airborne droplets, alimentary, contact-household and other ways. The infection enters the child's body through the mucous membrane of the upper respiratory tract, gastrointestinal tract, and skin. After the development of local inflammation, an infection with a blood stream or by contact, for example, with the destruction of the paranasal sinuses, penetrates the meninges. After this, the development of purulent, serous or serous-purulent inflammation. The accumulating exudate along with the toxins of microorganisms, antigens, and immune complexes stimulates the production of cerebrospinal fluid, which causes an increase in intracranial pressure. Squeezing tissue with impaired cerebrospinal fluid and blood circulation causes the development of cerebral edema.
Symptoms of Meningitis in Children
The classic triad of symptoms of meningitis, including headache, fever and meningeal symptoms, is not always found in children. The clinical picture of the disease largely depends on the age of the child. So in infants up to a year, the following symptoms most often appear:
- decreased appetite
- increased irritability or drowsiness of the child,
- the characteristic “brain” cry of a child, characterized by monotony,
- decrease or increase in body temperature,
- the occurrence of seizures,
- fontanel swelling and divergence of skull sutures.
In children older than a year, the clinical picture of meningitis is characterized by the following symptoms:
- vomiting that is not associated with eating and does not bring relief,
- fever with chills
- sound sensitivity
- convulsive syndrome
- meningeal signs, for example, stiff neck,
- the forced position of the child in bed with his head thrown back and arms and legs brought to the body.
Certain features in the clinic of the disease are determined with various infectious pathogens of meningitis:
- Bacterial meningitis - characterized by lightning-fast onset of the disease with a rapid increase in clinical symptoms. In some cases, bacterial meningitis begins with a common upper respiratory tract infection and has a smoother development. A rapid increase in the clinic of the disease is characteristic mainly for meningococcal inflammation. A distinctive feature of bacterial meningitis is the paradoxical excitability of the child. This pathological condition is characterized by the calmness of the child during sleep and the appearance of strong crying and screaming during any calming movements. Infants are characterized by a fontanel bulging, which may be absent with severe dehydration as a result of repeated vomiting. Older children complain of severe headache, aggravated by bright lighting, under the influence of loud sounds.
- Viral meningitis - symptoms of inflammation of the meninges caused by viral pathogens appear gradually. Within a few days, there is an increase in fever, general weakness, and a decrease in appetite. In some cases, viral meningitis still begins suddenly with nausea, vomiting, a sharp increase in body temperature. Often in patients with this diagnosis, concomitant inflammation of the conjunctiva of the eye, nasopharynx, and muscles is detected. The progression of the disease leads to the development of encephalitis with convulsive syndrome, local neurological disorders, loss of consciousness.
Meningitis in children can take a severe course and lead to the development of the following complications:
- Cerebral edema is one of the most common complications of the acute course of meningitis in children. In the case of the development of such a pathological condition, a change in consciousness can occur with the appearance of stupor, stunning, and with further compression of the brain stem - coma. Convulsions and focal neurological symptoms such as ataxia and hemiparesis often appear. An even more dangerous condition is the dislocation of the brain stem with the development of a wedging syndrome, characterized by cardiac arrest and respiratory arrest.
- Hydrocephalus is an acute condition characterized by a significant increase in intracranial pressure due to excessive accumulation of cerebrospinal fluid. The child has an increase in head circumference, divergence of cranial sutures, tension and bulging of a large fontanel. When conducting ultrasound, it is possible to determine the expansion of the ventricles and cerebrospinal fluid spaces of the brain.
- Subdural effusion - the accumulation of inflammatory fluid in the subdural space is most characteristic of purulent meningitis. The effusion is often localized in the frontal parts of the brain and is diagnosed against the background of a deterioration in the general condition of the child, preservation of fever during antibiotic therapy, and depression of consciousness with the development of convulsive syndrome.
- Ventriculitis syndrome - this pathological condition develops with the spread of the inflammatory process from the meninges to the ependyma of the ventricles of the brain.
- Syndrome of violation of secretion of antidiuretic hormone - develops with damage to the structures of the hypothalamus and is characterized by a violation of the water-salt balance in the body.
Diagnosis of meningitis in children
The following diagnostic methods are used to examine children with suspected meningitis:
- Lumbar puncture - aimed at obtaining cerebrospinal fluid, the study of which allows to detect an increase in the number of cells, protein and a decrease in glucose concentration. In addition, spinal fluid bacterioscopy is performed to identify the causative agent of the disease. Microorganism antigens can be determined by PCR. Sowing cerebrospinal fluid for sterility allows not only to identify the pathogen, but also to determine its sensitivity to drugs.
- Blood tests are aimed not only at determining the basic vital signs, but also at identifying antigens of infectious pathogens. If you suspect a generalization of the inflammatory process, blood is sown for sterility.
- Radiography, CT - are performed if it is necessary to conduct differential diagnosis of meningitis with other pathological conditions, for example, injuries and brain tumors. Among the radiological manifestations of the disease, cerebral edema, the presence of intracerebral hemorrhages are distinguished.
Treatment of meningitis in children
Meningitis is treated in an inpatient setting. The treatment program includes etiotropic and pathogenetic therapy, rational nutrition, and observance of the protective regime.
- Regime - in the acute period of meningitis and within 3 days after lumbar puncture, it is recommended to observe bed rest.
- Diet - for children of the first year of life, feeding mothers with expressed breast milk is shown without violating the physiological principles of nutrition. For older children, a complete, but chemically and mechanically sparing diet is recommended.
- Etiotropic therapy - is the use of antibacterial, antiviral and antifungal drugs. The choice of a drug for the treatment of meningitis is determined by the etiology of the inflammatory process, the sensitivity of the pathogen, the presence of concomitant diseases in the patient.
- Pathogenetic therapy - to alleviate the patient’s condition and accelerate the elimination of the pathogen from the body, detoxification, dehydration, anti-inflammatory, desensitizing therapy is carried out. In severe patients, parenteral nutrition preparations are used. During the recovery period, drugs are prescribed to improve the metabolism of the tissues of the central nervous system, adaptogens and restorative drugs. If necessary, diuretic and anticonvulsant drugs are used.
In most cases, with treatment, the symptoms of meningitis completely disappear. Only with an unfavorable outcome of the disease can the following disorders persist:
- cerebral dysfunction
- asthenovegetative syndrome,
- paresis and paralysis,
- hypertensive hydrocephalic syndrome,
- hypothalamic syndrome,
Prevention of Meningitis in Children
There are several levels of prevention of meningitis in children:
1. Nonspecific - is to limit contact with patients with meningococcal infection. During the period of the epidemic, it is recommended to use respirators, gauze dressings and other available protective equipment.
2. Specific - the main measure of specific prophylaxis of meningitis is vaccination in early childhood. Several types of vaccines can protect against the development of this disease:
- rubella, measles and mumps vaccine,
- chickenpox vaccine,
- pneumococcal vaccine,
- meningococcal vaccine
- type B haemophilus influenzae vaccine
3. Chemoprophylaxis - recommended for those children who have had close contact with patients with meningitis. It consists in conducting a short course of antibacterial therapy with broad-spectrum drugs.
Timely seeking qualified medical care is the key to successful treatment and the minimum risk of developing complications of meningitis.
Causes and Risk Factors
Infectious agents for meningitis in children can be viruses, bacteria, microscopic fungi, protozoa.
The penetration of the pathogen into the cranial cavity and the lining of the brain occurs in the following ways:
- contact household (through contaminated items),
- fecal-oral (with food, water),
- airborne (from sick people and carriers of infection),
- transmissible (with bites of blood-sucking arthropods),
- hematogenous, lymphogenous (with blood flow and / or lymph from the affected organs),
- segmental-vascular (along regional vessels from the primary focus of infection, located near bypassing the common bloodstream),
- perineural (in the tissues surrounding the nerves),
- transplacental (from a pregnant woman to the fetus).
Meningitis in newborns can occur when passing through the birth canal, as well as against the background of an unfavorable course of pregnancy and childbirth, intrauterine infection, prematurity, and a lack of oxygen entering the placenta (fetal hypoxia).
In primary meningitis in children, the mucous membranes of the respiratory and digestive tract usually serve as the entry gates of infection. The source of infection is a sick person or carrier.
In addition, meningitis in children can occur against the background of purulent diseases, childhood infections, acute respiratory viral infections, infectious diseases of the gastrointestinal tract, open craniocerebral and spinal cord injuries, cracks and fractures of the base of the skull, and surgical operations.
To protect the child from the most dangerous types of meningitis, vaccination with meningococcal, pneumococcal and hemophilic vaccines is necessary.
Factors contributing to the development of the disease are chronic malnutrition, hypothermia, changing climatic conditions, stressful situations. At risk are children with disorders of the functioning of the nervous system.
In the winter-spring period, the maximum number of cases of meningitis in children is recorded.
Forms of the disease
Depending on the etiological factor, meningitis is distinguished:
By the nature of the inflammatory process, meningitis in children happens:
- serous (lymphocytes predominate in the cerebrospinal fluid, the cerebrospinal fluid is transparent),
- purulent (neutrophils prevail in the cerebrospinal fluid, the cerebrospinal fluid is cloudy).
According to the pathogenesis, meningitis is distinguished:
- primary (develop as an independent disease),
- secondary (occur against the background of other diseases).
Depending on the prevalence of the pathological process, meningitis:
Children who have undergone meningitis are subject to medical observation with periodic detailed examination (ultrasonography, electroencephalography, echoencephalography).
The pace of the course distinguishes such forms of meningitis in children:
Depending on the severity, the following forms of the disease are distinguished:
- moderate severity
- extremely heavy.
Depending on the localization of the pathological process:
Possible complications and consequences
With meningitis, mild, moderate, and severe neurological complications may develop. Complications of serous meningitis develop less frequently and are easier than purulent.
Meningitis in children is complicated by the following pathological conditions:
- encephalitis, myelitis,
- cerebral edema,
- disseminated intravascular coagulation syndrome,
- epileptic seizures
- hydrocephalus (at the same time there are disturbances in the psyche, movements, coordination, developmental lag is observed),
- general or partial violation of the normal rate of mental development (lethargy or increased irritability, aggressiveness, indifference, etc.),
- delayed development of speech in children who underwent meningitis before the formation of speech function,
- cerebrosthenic syndrome (manifested by fatigue, increased irritability, sleep disturbance, headaches, as well as neurotic syndromes),
- minimal cerebral dysfunction (impaired attention, impaired behavioral reactions, which are most noticeable during physical, intellectual and emotional stress).
The prognosis of meningitis in children depends on the form and severity of the course of the disease, as well as the timeliness of diagnosis and the adequacy of the treatment regimen. With a timely diagnosis and correctly selected treatment, the prognosis is favorable.
Fatal outcome is recorded in 1–5% of cases of the disease.
In the winter-spring period, the maximum number of cases of meningitis in children is recorded.
With the untimely diagnosis of purulent meningitis and the pathogen's resistance to antibacterial drugs, the mortality rate increases tens of times (up to 50%).
Children who have undergone meningitis are subject to medical observation with periodic detailed examination (ultrasonography, electroencephalography, echoencephalography).
Signs of Meningitis in Children
In most cases, signs of meningitis in children manifest themselves almost identically in small patients and adults. An unfavorable prognosis appears when parents ignore the manifestations of the disease and therapy is not started on time. Judging by medical observations, the common clinical signs of meningitis in a child are as follows:
- severe weakness, general malaise,
- a significant increase in temperature
- loss of consciousness,
- another sign of meningitis in children is intense pain in the head, joints, muscles,
- fever, chills,
- decreased appetite
- the appearance of a runny nose, redness of the throat,
- rigidity (a sharp increase in muscle tone, their resistance to deformation),
- a sick child almost always lies on its side, with legs crossed and its head thrown back.
There are still common specific factors that signal the presence of neuroinfection. Often, the doctor makes a final, accurate diagnosis. Here's how children develop meningitis:
- Stiff neck. Constant tilting of the child’s head due to strong muscle tone.
- Symptom Kernig. With meningitis, the ability to straighten the lower limb in the knee joint disappears if it is bent in the hip. This symptom is caused by a significant tone of the posterior femoral muscles.
- Buccal syndrome. When the doctor presses on the cheeks of the patient, the sick child raises his shoulders upward, there is a flexion of the elbow joints.
- Contraction of facial muscles in the process of tapping the zygomatic arch (ankylosing spondylitis).
- Symptom Lessage is inherent in infants up to a year. It consists in the fact that the baby involuntarily bends the legs when it is lifted up and held by the armpits.
- Mondonesi syndrome is a very strong pain that appears with slight pressure on the closed eyelids.
- Symptom of Brudzinsky. Upper type - if a small patient lies on his back, his legs will involuntarily bend at the knees when the doctor makes an attempt to tilt his head to the sternum. The average symptom is that the lower limbs of the child are bent when they click on the pubic joint. When one leg bends at the knee joint and hip, and the second assumes an identical pose - this is the bottom symptom of Brudzinsky.
In children up to a year
Standard common signs of meningitis in infants:
- partial or complete denial of food, liquids,
- the appearance of rashes, yellowing of the skin,
- severe vomiting (seizures will often recur)
- hypoglycemia may begin (lowering blood sugar),
- neck tension
- lethargy (hypotension), weakness,
- temperature rise,
- the baby is irritated, naughty,
- fontanel swelling also refers to signs of meningitis in children under one year old.
Meningococcal meningitis Edit
The only source of infection is human. Most people infected with meningococcus have practically no clinical manifestations, about 1 / 10–1 / 8 have a picture of acute nasopharyngitis, and only a few individuals have a generalized form of the disease. For one sick person with a generalized form, there are from 100 to 20,000 bacterial carriers.
In most cases, meningococcus, once on the mucous membrane of the nasopharynx, does not cause local inflammation or noticeable health problems. Only in 10-15% of cases, the ingestion of meningococcus on the mucous membrane of the nasopharynx, and possibly the bronchi, leads to the development of inflammation.
In the body, the pathogen spreads through the hematogenous route.
Bacteremia is accompanied by toxemia, which plays a large role in the pathogenesis of the disease. Prior viral diseases, a sharp change in climatic conditions, injuries and other factors are important.
In the pathogenesis of meningococcal infection, a combination of septic and toxic processes with allergic reactions plays a role. Most lesions that occur at the onset of the disease are due to the primary septic process. As a result of the death of meningococci, toxins are released that affect the vessels of the microvasculature.
The consequence of this is a severe damage to vital organs, especially the brain, kidneys, adrenal glands, and liver. In patients with meningococcemia, circulatory failure is also associated with a decrease in myocardial contractility and impaired vascular tone. Hemorrhagic rashes, hemorrhages and bleeding with meningococcal meningitis are caused by the development of thrombohemorrhagic syndrome and vascular damage.
Secondary purulent meningitis
Purulent meningitis - purulent inflammation of the meninges. The main pathogens in newborns and children are group B or D streptococci, E. coli, Listeria monocytogenes, hemophilic bacillus, and in adults, pneumococci, staphylococci and other pathogens. Risk factors are immunodeficiency, traumatic brain injury, surgical interventions on the head and neck. Microorganisms can penetrate directly into the nervous system through a wound or surgical opening (contact). For the occurrence of brain damage in most cases, it is necessary to have a focus of chronic infection, from which pathogen dissemination into the membrane of the brain occurs in various ways. In most cases, the entrance gate is the mucous membrane of the nasopharynx. Generalization of the infection occurs by hematogenous, lymphogenous, contact, perineural, as well as with injuries. In all cases suspicious of meningitis, for microbiological examination, in addition to cerebrospinal fluid, they are taken from the supposed primary focus of infection: smears from the nasopharynx, middle ear, wounds after neurosurgical and other surgical interventions, blood.
Serous Meningitis Edit
Serous meningitis of viral origin is caused by enteroviruses - Coxsackie and ECHO, polio viruses, mumps, and some other types of viruses.
The source of infection is a sick person and a "healthy" virus carrier. The virus is transmitted through water, vegetables, fruits, food, and dirty hands. It can be transmitted by airborne droplets in large crowds. Infection often occurs when swimming in ponds and swimming pools.Most often, children from 3 to 6 years old suffer from serous meningitis, school-age children are sick a little less often, and adults are very rarely infected. The most pronounced summer-seasonal incidence. Various arthropods, such as ticks, for the tick-borne encephalitis pathogen can also serve as carriers of the virus.
Tuberculous Meningitis Edit
Tuberculous meningitis develops when there is a tuberculous focus in the body. The infection enters the brain membrane through the hematogenous route. In this type of meningitis, the membranes, mainly the base of the brain, are seeded with tuberculous nodules ranging in size from a pinhead to millet grain. In the subarachnoid space, a grayish-yellow gelatinous exudate accumulates. The number of cerebrospinal fluid increases. With lumbar puncture, it follows a stream, transparent. In a laboratory study, a large number of protein and uniform elements, mainly lymphocytes, are always found. An increase is often noted in the cerebrospinal fluid, but sometimes there may also be a decrease in the amount of glucose to 0.825-1.650 mmol / l. Leukopenia or mild leukocytosis with a slight left shift and lymphopenia are sometimes noted.
Viral Meningitis Edit
The causative agent - Coxsackie viruses and ECHO belong to the Picornavir family>.
The viruses are resistant to freezing, the action of ether, 70% alcohol, 5% lysol, remain active at room temperature for several days and are inactivated by formalin, chlorine-based agents, when heated, dried, and ultraviolet radiation.
Protozoal Meningitis Edit
One of the causative agents is Toxoplasma gondii, which is of the type Protozoa (intracellular parasite). Asymptomatic carriers may be cats.
Also, this microorganism can be found in meat and meat products, can remain viable at a temperature of from 2 to 5 ° C for up to a month. It dies at temperatures up to -20 ° C. The formation of immunity leads to the disappearance of the pathogen from the blood, its reproduction in the cells stops. True tissue cysts are formed that can persist for decades, in an intact state, in the body.
Protozoal Meningitis Edit
Pathomorphological changes have been studied in animal experiments. It was established that in the central nervous system the phenomena of necrotic periventriculitis, small foci of necrosis in the subcortical white matter develop. Signs of serous proliferative inflammation are noted in the vessels of the brain, pia mater, and choroid plexuses. Ocular pathological changes (such as retinitis, choroiditis, iridocyclitis) and changes in the internal organs (heart, lungs, liver, spleen) are also detected.
Tick-borne encephalitis Edit
Meningeal form of tick-borne encephalitis manifests itself in the form of acute serous meningitis with pronounced cerebral and meningeal symptoms. In the cerebrospinal fluid there is a characteristic increase in pressure (up to 500 mm Hg), mixed lymphocytic-neutrophilic pleocytosis (up to 300 cells in 1 μl). Patients complain of severe headache, aggravated by the slightest movement of the head, dizziness, nausea, single or multiple vomiting, eye pain, photophobia. Sick listless and inhibited. The stiff neck muscles, the symptoms of Kernig and Brudzinsky are determined. Meningeal symptoms persist throughout the febrile period. The duration of the fever is 7-14 days. The forecast is favorable.
Early Syndrome Diagnosis of Meningitis Edit
In infants, the main meningeal symptom is persistent bulging and tension of the large fontanel, but in weakened children suffering from dyspepsia, malnutrition, and in the presence of thick pus on the convexital surface of the brain, this symptom is not detected.
The primary or etiologically undifferentiated diagnosis of meningitis is established on the basis of a combination of a triad of syndromes:
- shell (meningeal) symptom complex,
- intoxication syndrome,
- inflammatory cerebrospinal fluid syndrome.
In the triad of syndromes that recognize meningitis, it is necessary to emphasize the crucial importance of inflammatory changes in cerebrospinal fluid. The absence of inflammatory changes in the cerebrospinal fluid always excludes the diagnosis of meningitis.
The shell symptom complex (meningeal syndrome) consists of cerebral and actually shell (meningeal) symptoms. There is a sharp headache of a bursting nature, often so painful that patients, even those who are unconscious, hold their hands with their hands, moan or scream loudly ("hydrocephalic cry"). There is plentiful, fountain, vomiting ("cerebral vomiting"). In severe meningitis, convulsions or psychomotor agitation are observed, periodically replaced by lethargy, impaired consciousness. Mental disorders in the form of delirium and hallucinations are possible.
Actually shell (meningeal) symptoms can be divided into 2 groups, depending on their pathophysiological mechanisms and characteristics of the study.
The first group includes symptoms of general hyperesthesia or hyperesthesia of the sensory organs. If the patient is conscious, then he has intolerance to noise or increased sensitivity to him, loud conversation (hyperacusis). Headaches are aggravated by strong sounds and bright light. Patients prefer to lie with their eyes closed.
The second group includes reactive pain phenomena. If the patient is conscious, then pressing on the eyeballs through closed eyelids is painful. Patients note significant pain on palpation of the exit points on the face of the trigeminal nerve branches, and deep palpation of the exit points of the occipital nerves is painful (Kerer's symptom). Percussion with a finger or a hammer of the zygomatic arch causes an increase in headache and is accompanied by a painful grimace (ankylosing spondylitis). Percussion of the skull causes a painful grimace (craniofacial reflex Pulatov). Symptom of Flautau - dilated pupils with intense, fast passive flexion of the patient’s neck.
Differential Diagnostics Edit
|Clinical form||Typical complaints||Characteristic beginning||The severity of meningeal symptoms||Infectious symptoms||Consciousness changes|
|Purulent (meningococcal, pneumococcal, staphylococcal streptococcal, etc.) meningitis||Rapidly increasing headache, nausea, chills, vomiting||Spicy. Short prodrome is possible (several hours)||A sharp increase in the first hours and days||Significant increase in temperature (39-40’С) chills, flushing of the skin||Stunned, stupor, coma. Sometimes delirium, hallucinations|
|Serous viral meningitis (mumps, enterovirus, acute lymphocytic choriomeningitis, etc.)||Headache, chills, nausea, less often vomiting||Acute, sometimes after catarrh of the respiratory tract and gastrointestinal upset||moderate, intracranial hypertension predominates||Mild fever, sometimes biphasic, short-term (3-7 days.)||Usually somnolence, less often stunned, stupor, delirium|
|Tuberculous meningitis||Fatigue, anorexia, sweating, nausea, mild headache||Gradual with general symptoms of asthenia, sometimes acute in adults||Minor at the beginning with a gradual increase||Subfebrile condition with prevalence of intoxication signs||Consciousness preserved, impaired in adverse course|
|Meningism in common infections and somatic diseases||Mild headache||Various||Moderate||Depends on underlying disease||Not. The exception is extremely severe forms|
Symptom Kernig. It consists in the inability to straighten the patient’s leg in the knee joint when it is bent in the hip. It is not pain that disturbs extension, but tension of the posterior thigh muscle group (tonic sheath reflex). It is one of the most frequent and persistent symptoms of meningitis.
Upper symptom of Brudzinsky - with the passive reduction of the patient’s head to the sternum, while lying on his back, his legs are bent at the knee and hip joints.
The lower symptom of Brudzinsky - with passive bending of one leg of the patient in the knee and hip joints, the other leg is bent in the same way.
Sub-cheek (buccal) symptom of Brudzinsky - when pressing on the patient’s cheeks directly under the cheekbones, reflex raising of the shoulders and flexion of the forearms occur (due to the peculiar posture, this symptom is also called the “cross” symptom).
Symptom Guillain - squeezing the four muscles of the patient’s hip on one side causes involuntary flexion in the hip and knee joints of the opposite leg.
The symptom of "hanging" Lessage. A newborn child is taken by the axillary hollows with both hands, holding the head from the back with the index fingers, and lifted, which leads to involuntary pulling of the legs to the stomach due to their bending in the hip and knee joints and their long fixation in such a bent position. In a healthy child, during the Lessage test, the legs move freely (bend and unbend).
Symptom Mondonesi - pressure on the eyeballs through closed eyelids is painful.