Meningitis: Symptoms and Treatment
Meningitis is an infectious disease, the course of which is characterized by extensive inflammation of the spinal cord and brain, various types of viruses and bacteria act as its pathogens. Meningitis, the symptoms of which are manifested depending on the specific type of pathogens, occurs either suddenly, or in the period of several days from the time of infection.
As we have already noted, with meningitis, the brain is exposed to inflammation, in particular, its membranes. That is, damage to meningitis is affected not by brain cells, but by the external area of the brain, within which the inflammatory process is concentrated.
Meningitis in adults and children can occur in primary or secondary form. Thus, primary meningitis occurs with a single lesion of the brain, secondary meningitis is formed against the background of a concomitant underlying disease, in which there is a spread of infection in the subsequent, actual for meningitis, affecting the meninges. As the main diseases in this case it is possible to isolate otitis, leptospirosis, epidemic parotitis, etc.
In almost all cases, meningitis proceeds rapidly — as we have already noted, it develops over a period of several days. As an exception to the general variants of the course of the disease, only tuberculous meningitis that develops gradually can be isolated.
The incidence of meningitis is noted in a variety of age categories, and age is not the determining criterion in the susceptibility to this disease — here, as assumed, the leading role is played by the state of the organism as a whole. For example, premature infants due to a weakened state of the body are most likely to have meningitis.
In addition, the group of people who can have meningitis, you can refer patients with those or other defects of the central nervous system, as well as with back or head injuries. Also, the transmission of the disease is possible during labor, through mucous, contaminated food and water, through insect bites and airborne droplets. In any case, factors that can also determine the predisposition to meningitis are many.
Types of meningitis
Depending on the etiology, that is, the causes that provoked meningitis, the disease can be infectious, infectious-allergic, microbial, neuroviral, traumatic or fungal. Microbial meningitis, in turn, can manifest itself in the form of serous meningitis, tuberculous meningitis, influenza or herpetic meningitis.
Depending on the localization of the inflammatory process with meningitis, pachymeningitis is isolated, which usually affects the hard shell of the brain, leptomeningitis, in which the soft and arachnoid membranes of the brain are affected, as well as panmenigitis, in which all the membranes of the brain are affected by the inflammatory process . If the inflammatory lesion is mainly localized in the area of the arachnoid membrane, then the disease is defined as arachnoiditis, which, due to its characteristic clinical features, is considered to be a separate group.
In general, meningitises are divided into meningitis purulent and meningitis serous, the features of both varieties of forms we will consider below.
Depending on the origin, as we have already identified, meningitis can be primary (this includes most of the neuroviral forms of meningitis, as well as purulent meningitis) and secondary (meningitis syphilitic, tuberculous, serous).
Depending on the nature of the cerebrospinal fluid, meningitis can be hemorrhagic, purulent, serous or mixed. Based on the characteristics of the course, meningitis can be fulminant or acute, subacute or chronic.
The localization of the inflammatory process with meningitis determines such varieties of its forms as superficial meningitis (or meningitis convexual) and deep-seated meningitis (or basal meningitis).
Pathways of infection of the brain membranes determine the following possible forms for meningitis: lymphogenous, contact, hematogenous, perineural meningitis, as well as meningitis arising on the background of craniocerebral trauma.
Any of the types of meningitis is characterized by the onset of meningeal syndrome, which manifests itself in an increase in intracranial pressure. As a result of this manifestation, this syndrome is characterized by the emergence of a bursting headache with simultaneous sensation of pressure on the ears and eyes, there is also a heightened sensitivity to the effects of sounds and light (which is determined, in turn, as hyperacusis and photophobia). There is vomiting and fever, and rashes and epileptic seizures may also appear.
With this form of meningitis, pathological changes affect the basal and convex surfaces of the brain. Fibrinous purulent or purulent fluid formed in the area of inflammation (exudate) densely covers the brain (similarly to the cap), while the infiltrates formed in the region along the vessels are in the brain substance. As a result, swelling begins to develop, the brain substance begins to be filled with blood within the framework of its own vessels (ie, hyperemia occurs).
Similar changes are also noted in the spinal cord.
Timely initiation of treatment can ensure the abatement of the inflammatory process, after which the exudate completely collapses. If we talk about neglected cases of the course of this disease, as well as cases with the appointment of non-rational therapy in its relevance, it is possible that a number of specific processes may develop, as a result of which, in turn, the processes of liquorodynamics may be disturbed, Of the brain.
Now let’s pass directly to the symptomatology characterizing this form of meningitis.
Most often it develops in a sudden way, which is accompanied by a sharp rise in temperature and the appearance of vomiting (it is multiple and does not bring the required relief to the patient). Due to increased intracranial pressure, there is a severe headache. Against the background of the general condition, the patient has a characteristic posture, in which there is a tension in the region of the occipital muscles with simultaneous curvature of the back and the bent legs brought to the stomach.
Many patients during the first days of the disease notice the appearance of a rash, which, meanwhile, disappears within one to two hours. In some cases, the posterior wall of the pharynx is also prone to hyperemia with simultaneous hyperplasia in its area of follicles. Also, a number of patients are faced with the emergence of acute respiratory viral infection, noted literally a few days before the onset of meningitis. Meningitis in infants in this form develops mainly gradually, in older children, a similar variant of the course is noted in rare cases.
Based on the severity of the course of the disease, the patient may experience symptoms in the form of muscle cramps, obscuring consciousness or a state of unconsciousness. In the case of an unfavorable course of meningitis, by the end of the first week, the patients have a coma, in which the foreground is a symptom in the form of paralysis of the facial nerve and eye muscles. Seizures that appear earlier periodically, gradually increase and it is during one of the next manifestations of the patient dies.
If the course of meningitis in the form in question is determined as favorable, then this, in turn, is accompanied by a decrease in temperature, the patient has a previously lost appetite. Eventually, the patient with meningitis gradually passes to the phase of recovery.
The total duration of the course of meningitis in the meningococcal form is on the order of two to six weeks. Meanwhile, cases in which the course of the disease occurs at lightning speed are not excluded in practice. In such a situation, the patient’s death occurs within a period of just a few hours from the moment of the onset of the disease.
With prolonged flow, after a short period of improvement, the patient again raises the temperature, and it is set for a long time. This form of lingering form is either a hydrocephalic stage or a stage in which a meningococcal sepsis develops in the patient, the course of which is accompanied by the ingress of meningococcus into the blood (as defined by meningococcemia).
The main feature of such a course is the appearance of hemorrhagic rash. In addition, there is an increase in temperature and a decrease in blood pressure, dyspnea appears, and patients have tachycardia.
The most severe manifestation of meningitis in this form is bacterial shock. In this case, the disease develops sharply, with a sudden rise in temperature and the appearance of a rash. The patient also has a faster pulse, breathing is characterized by unevenness, cramps are often observed. Further, the condition becomes comatose. Often, the death of a patient in such a flow occurs without returning to consciousness.
There are also a number of the following symptoms with the characteristics that are inherent in them:
- Necrosis of the skin. The severe course of the disease on the background of the action of meningococcal infection leads to the development of inflammation and thrombosis in the vessels. As a result, ischemia develops, a vast type of hemorrhage and, in fact, necrosis, which are particularly expressed in those areas in which there is compression. Subsequently, rejection of subcutaneous tissue and necrotic skin occurs, resulting in ulcers. They heal, as a rule, quite slowly, the depth and vastness of the skin lesion often require its transplantation. Keloid scars in this case are also a frequent result of the disease course.
- The acute stage of the flow of the examined form of meningitis in some cases is accompanied by the defeat of the cranial nerves, of which the greatest vulnerability is determined by the abducent nerve due to the passage of a large part of it along the base of the brain. In the event of a lesion of the nerve, the paralysis of the region of the lateral rectus muscles of the eyes occurs. As a rule, strabismus disappears after several weeks. But because of the spread of infection to the inner ear, partial deafness or total loss of hearing is often noted.
- Uveitis. A frequent manifestation of the meningitis of the form in question is conjunctivitis, which disappears fairly quickly during treatment. As for uveitis, it is a much more serious complication, which can result in panophthalmitis and subsequent blindness. Meanwhile, antimicrobial therapy, applied today, minimizes such serious consequences to a minimum.
Purulent (secondary) meningitis is accompanied by turbidity, swelling and hyperemia of the cerebral membranes of the large hemispheres (their convex surface). Purulent exudate fills the subarachnoid space.
The onset of the disease is accompanied by a sharp deterioration in the general condition of the patient, in which he experiences chills, he also has a fever. Heavy forms of flow can be accompanied by loss of consciousness, convulsions, delirium. Appears and traditional for the disease as a whole symptom in the form of repeated vomiting. With purulent meningitis, internal organs are affected, joints and joints are affected.
Severe manifestations are noted in the manifestation of such symptoms as stiff neck muscles and symptoms of Kernig and Brudzinsky. The symptom of Kernig determines the impossibility of unbending the legs bent at the knee and hip joint. As for the symptom of Brudzinsky, his manifestations boil down to bending the legs in the knees when trying to tilt the head forward in the reclining position, and to flex the legs in the knee joints also presses the pubic region.
In addition to this, bradycardia and tachycardia develop. There is also a turbidity of the CSF and its leakage as a result of pressure.
Meningitis of this type can occur in both acute and lightning or chronic forms. Sometimes a typical pattern of symptoms can be masked by sufficiently pronounced manifestations characterizing the general septic state.
There may also be a hemorrhagic rash, a herpetic eruption. By the second or third day, a patient may develop coma.
The lightning-fast form of the disease course, as a rule, manifests itself more often in newborns. The child in this case screams, he has a fever at which he «shakes», the temperature rises. The lethal outcome occurs in the period from several hours to several days.
Adults face a subacute and acute course of the disease, it lasts about 4-5 weeks, is completed with adequate therapy well.
In the category of elderly patients, the disease most often occurs in a subacute form, that is, it develops slowly, the precursors of the disease manifest themselves for a long time. In the same case, meningitis often occurs in the atypical form of the flow, there is only symptomatology of nasopharyngitis or epileptic seizures. The course of meningitis can be mild, moderate and, consequently, severe.
As manifestations of complication of purulent meningitis, such manifestations as hydrocephalus, sepsis, lesions of internal organs, hearing and vision impairment, hypothalamic syndrome.
Serous meningitis is characterized by the appearance in the meninges of inflammatory serous changes. In particular, serous meningitis includes viral forms of it. In 80% of cases, enteroviruses and the mumps virus are detected as causative agents of serous meningitis. Influenza and adenoviral meningitis, herpetic and parainfluenza forms of this disease, including a number of other variants of its manifestation, are also common.
The source of the virus is mainly the brown mouse — the pathogen is in their secretions (feces, urine, nasal mucus). Accordingly, human infection occurs as a result of the use of products that have been contaminated by such emissions.
Predominantly the disease is noted in children 2 to 7 years old.
The clinic of the disease can be characterized by meningeal symptoms in combination with fever, manifested in a greater or lesser degree of severity, it is often possible to combine with the symptoms of lesions of generalized scale in other organs.
Viral meningitis can be characterized by a two-phase course of the disease. Along with the main manifestations, there may be signs indicating a lesion of the peripheral and central nervous system.
The duration of the incubation period of the disease is about 6-13 days. Often marked prodromal period, accompanied by manifestations in the form of weakness, weakness and catarrh of the upper respiratory tract, simultaneously with a sudden increase in temperature to 40 degrees, constipation. Also, this symptomatology can be supplemented by a pronounced shell syndrome, in which there is severe headache and vomiting.
In some cases, the examination determines the presence of stagnant phenomena in the eye fundus. Patients complain of pain in the eyes. As for the vomiting noted above, it can be either repeated or repeated. As in the previous variants of meningitis development, the symptoms of Kernig and Brudzinsky are noted, the characteristic tension of the occipital region. Expressed cases of manifestation of the disease are accompanied by a typical posture of the patient, at which his head is thrown back, the stomach is drawn in, legs in the knee joints are bent.
This form of meningitis is also predominantly noted in children, and especially in infants. Much less often, tuberculous meningitis occurs in adults. About 80% of the cases of this disease in patients, either residual events, previously transferred by them of tuberculosis, or a form of active course of this disease in another area of concentration at the time of detection of meningitis are detected.
As the causative agents of tuberculosis are a specific type of microbacterium, common in water and soil, as well as among animals and humans. In humans, tuberculosis predominantly develops as a result of infection by a bovine type of pathogen or a human species.
Tuberculous meningitis is characterized by three main stages of development:
- prodromal stage
- irritation stage
- terminal stage (accompanied by paresis and paralysis)
The prodromal stage of the disease develops gradually. Initially, there are manifestations in the form of headache and nausea, dizziness and fever. Vomiting, as one of the main signs of meningitis, can appear only occasionally. In addition to these symptoms, there may be a delay in stool and urine. As for the temperature, it is mainly subfebrile, its high levels are very rare at this stage of the disease.
After about 8-14 days from the onset of the prodromal stage of the disease, the following stage develops — irritation stage. In particular, it is characterized by a sharp increase in symptoms and an increase in temperature (up to 39 degrees). There is a headache in the occipital and frontal areas.
In addition, there is an increase in drowsiness, the patients become sluggish, the mind is prone to oppression. Constipation is characterized by a lack of swelling. Patients do not tolerate light and noise, they are also concerned with disorders of a vegetative-vascular nature, manifested in the form of sudden red spots in the chest and face, which also quickly disappear.
By the 5th-7th day of the disease, meningeal syndrome (symptoms of Kernig and Brudzinsky, tension in the occipital muscles) is noted at this stage.
Severe symptomatology is noted in the second stage of the stage under consideration, its manifestations depend on the specific localization of the tuberculous inflammatory process.
Inflammation of meningeal membranes is accompanied by the appearance of typical symptoms of the disease: headaches, stiff neck muscles and nausea. The accumulation of serous exudate at the base of the brain can lead to irritation of the cranial nerves, which, in turn, is manifested in impaired vision, strabismus, deafness, uneven enlargement of the pupils and in the paralysis of the eyelid.
The development of hydrocephalus in varying degrees of severity leads to the blocking of certain cerebrospinal cerebral connections, and it is hydrocephalus that is the main cause provoking a symptom in the form of loss of consciousness. In the case of blockade of the spinal cord, motor neurons experience weakness, paralysis in the lower extremities may occur.
The third stage of the disease progression in this form is the thermal stage , characterized by the appearance of paresis, paralysis. Manifestations of symptoms of this period are marked by 15-24 days of the disease.
The clinical picture has in this case the symptomatology peculiar to encephalitis: tachycardia, temperature, Cheyne-Stokes breathing (ie, periodic breathing, it gradually deepens and frequents rare and superficial respiratory movements when the maximum reaches 5-7 breaths and then Decreasing / decreasing, moving to a pause). Also, the temperature rises (to 40 degrees), there are, as already noted, paralysis and paresis. The spinal form of the disease in the 2-3 stages is often accompanied by extremely pronounced and strong gingival root pains, bedsores and flaccid paralysis.
The onset of the disease is acute, the main manifestations of it are general intoxication and fever. The first two days are characterized by the severity of manifestations of meningeal syndrome (headache, vomiting, drowsiness, lethargy, anxiety / arousal).
There may also be complaints of a runny nose, cough, sore throat and abdominal pain. Inspection reveals all the same signs that characterize the disease as a whole (Kernig and Brudzinsky syndrome, tension in the occipital region). Normalization of the temperature occurs in the period of 3-5 days, in some cases a repeated wave of fever is possible. The duration of the incubation period is on the order of up to 4 days.
Diagnosis of meningitis
Diagnosis of the disease under consideration consists in applying the following methods:
- spinal puncture — a lumbar puncture is made, in which the spinal fluid is withdrawn for further study under a microscope for the presence of appropriate microorganisms and cells
- blood cultures;
- CT and MRI of the brain.
Treatment of meningitis
Bacterial meningitis requires mandatory hospitalization. In this case, the treatment consists in the complex administration of significant doses of antibiotics, often intravenously by administration. Corticosteroids can also be used, aimed at reducing inflammation. To prevent seizures, tranquilizers can be used.
If the patient is diagnosed with viral meningitis, then the use of antibiotics in this case will not determine proper effectiveness. The disease in this variant often manifests itself in a moderate form, being cured as a result of the protection of the organism from the impact. Advantageously, the treatment focuses on reducing the concomitant symptomatology.
Prevention of meningitis in some of its forms is possible, for which a vaccine is given for about 4 years, but it is impossible to fully protect against the disease today.
A doctor who is needed for meningitis — a neurologist, may additionally need advice from a phthisiatrist and an ophthalmologist.