Inflammation of the meninges is provoked by various infectious agents. Headache, vomiting and fever are the main symptoms of the disease. Diagnosis is based on clinical signs and laboratory findings. Treatment includes exposure to the pathogen and fluid therapy
Meningitis is called inflammatory changes that develop in the soft and arachnoid membranes of the brain only as a result of the aggressive action of a microbial agent. Headache with meningitis is an obligatory component of clinical symptoms, regardless of the type of infectious agent.
For a complete diagnosis, it is necessary to identify other symptoms, since there are signs typical for certain types of meningitis, as well as a full range of laboratory diagnostics. Treatment involves exposure to the pathogen (antiviral agents or antibiotics), as well as massive infusion therapy to compensate for the resulting metabolic disorders.
Inflammatory changes in the meninges are the main triggering factors for subsequent systemic disorders. Classic signs of inflammation are observed: inflammatory edema, hyperemia and other changes in the characteristic color of brain tissue, pain, and subsequent dysfunction.
Another important point, as a result of which the headache arises and increases with meningitis, are changes in the circulation of cerebrospinal fluid. With meningitis of any etiology, there is an increased production of cerebrospinal fluid, which increases the edema of the brain tissue. On the other hand, there is a violation of its circulation, which leads to compression of the surrounding tissues and an increase in headache.
It is the tissues of the brain that are most sensitive to the slightest metabolic disturbances, since they do not have a depot of nutrients. The lining of the brain changed as a result of inflammation does not provide the required level of metabolism. Developing hypoxia and nutritional deficiencies provoke an increase in headache.
The development of inflammatory changes in the meninges can occur at any age: both in an infant and in an elderly person. Meningitis in children is characterized by a more violent picture of the disease and the dynamism of its development.
Classification of meningitis
There are various options for the classification of this disease: in accordance with the pathogen, depending on the nature of the inflammatory process (purulent and serous meningitis), in the presence or absence of a primary focus (after the formation of which a secondary process develops in another organ, in its absence, a primary one occurs).
In clinical practice, the most important changes in the cerebrospinal fluid, that is, typical signs of inflammatory changes. In accordance with this, a conclusion is made: serous meningitis or purulent has developed, appropriate treatment is prescribed. Once a specific microbial agent is identified in the cerebrospinal fluid, treatment can be adjusted.
One of the most severe variants of the disease. Its causative agent is meningococcus, today about 13 of its types are known. If meningococcal meningitis develops, the incubation period (that is, hidden, without clinical symptoms, only the accumulation of the microbial agent in the human body occurs) is quite short, it is only a few days.
Headache with meningococcal meningitis is intense, diffuse, pulsating or bursting. As the disease progresses, the intensity of the pain increases, up to unbearable. This headache is not relieved by any analgesics. Usually it is combined with repeated vomiting, which does not bring the desired relief to the patient.
Meningococcal meningitis in children is often combined with other forms of this disease, for example, meningococcemia. As with meningitis itself, the symptoms of brain damage and general intoxication dominate, and a typical irregular hemorrhagic rash appears on the skin.
Treatment for this variant of the disease includes the use of:
- powerful, broad-spectrum antibiotics (cephalosporins, protected penicillins, carbapenems);
- saline and colloidal solutions to reduce intoxication and headache;
- nootropics (Piracetam, Cerebrolysin) to improve the metabolism of the brain.
After properly treated meningococcal meningitis, residual effects are rare.
The causes of secondary meningitis are improperly treated or not diagnosed various foci of purulent infection. Most often it occurs as a complication of sinusitis, widespread dental caries, otitis media. It develops in people with immunodeficiency or severe chronic diseases.
For secondary purulent meningitis, the symptoms are the same: headache, severe intoxication. In some cases, the headache is not diffuse, but concentrated over the primary focus. For example, in the frontal zone with inflammation of the frontal sinus, in the upper jaw – with damage to the maxillary sinus. Perhaps a severe course of this type of disease, the development of residual effects (paresis and paralysis of the limbs, hearing and vision loss) after the disease.
Treatment of a secondary purulent process consists not only in antibacterial and powerful infusion therapy, but also in the elimination of the primary focus. Otherwise, the prescribed treatment will be ineffective and the disease will recur.
Primary serous meningitis results from exposure to certain microorganisms. Only damage to the meninges (primary process) or the development of systemic damage to the whole body, including meningitis (secondary), can develop.
Tuberculous serous meningitis is the most common form. The current unfavorable situation for tuberculosis is characterized by an increase in the incidence in general and an increase in the number of extrapulmonary forms in particular.
The symptoms of tubercle bacillus meningitis are slightly different from those described above. The headache is diffuse, but of moderate intensity, may be somewhat reduced with the use of traditional analgesics. Typically, a long and gradual onset of the disease, a person notes fatigue, constant weakness, the presence of a low (subfebrile) temperature.
Lack of the necessary therapy leads to the development of disorders in the substance of the brain, often to irreversible changes in a person’s personality, severe disorders of motor and sensory functions.
Treatment of the tuberculosis process is long-term (for six months or more) using special anti-tuberculosis drugs (Streptomycin, Rifampicin, Tubazid and others), massive infusion therapy, restoration of the body’s immune defense.
Secondary serous meningitis develops as a complication of the underlying infectious disease. Most common in the following cases:
- flu and other acute respiratory viral infections;
- childhood droplet infections (measles, rubella, chickenpox);
- group of TORCH infections (toxoplasmosis, herpes);
- syphilis, HIV infection.
Signs of secondary serous lesions of the meninges are nonspecific, the symptoms of the underlying disease come to the fore. After the transferred disease, residual effects, as a rule, are not observed. Treatment also depends on the underlying disorder. Treatment of the actual inflammation of the meninges includes detoxification and decongestant therapy.
Secondary meningitis in children is more often observed in the case of acute respiratory viral infections and childhood infections, in adults – in the terminal stage of HIV infection.
Among the many human diseases, meningitis is one of the most dangerous. You can endure pneumonia “on your feet”, you can walk with tuberculosis for years, you can try to cure sexually transmitted diseases with the help of “healers” for a long time. With meningitis, such “numbers” do not work – either to the hospital, or …
Meningitis is a well-known disease. At least the average person, without any special medical education, knows the word “meningitis” and, although the features of the disease itself are not very clear, everyone is afraid of meningitis.
An ambulance doctor may say: “You have a sore throat (flu, pneumonia, enterocolitis, sinusitis, etc.). Get to the hospital quickly.” In response, he will surely hear: “Doctor, can you get medical treatment at home?” But if the word “meningitis” is pronounced, even if not categorically: “You have meningitis!”, But with doubt: “It looks like meningitis,” we can say with confidence: a normal person will not even give a hint about any treatment at home.
This attitude towards meningitis is generally understandable – not even 50 years have passed since the time when it became possible to treat it (meningitis). But if mortality from most childhood diseases has decreased during this time by 10-20 or more times, then with meningitis – only 2 times.
So what is this disease, meningitis?
First of all, it should be noted that meningitis is an infectious disease. That is, certain microbes are the direct cause of the disease.
Most human infections make it possible to establish a clear relationship between the name of the disease and the name of its specific pathogen.
Syphilis – spirochete pallidum, scarlet fever – streptococcus, salmonellosis – salmonella, tuberculosis – Koch’s bacillus, AIDS – immunodeficiency virus, etc. At the same time, there is no specific relationship “meningitis – the causative agent of meningitis”.
The very word “meningitis” means inflammation of the membranes of the brain, and the cause of this inflammation can be a huge number of microorganisms – bacteria, viruses, fungi.
Infectious disease specialists claim with certainty that under certain conditions any microorganism can cause meningitis in a person of any age. Hence, it is clear that meningitis is different – different in the rate of development, and in the severity of the condition, and in the frequency of occurrence, and, which is especially important, in the methods of treatment. All meningitis has one thing in common – a real threat to life and a high likelihood of complications.
For meningitis to occur, a specific pathogen must enter the cranial cavity and cause inflammation of the lining of the brain. Sometimes this happens when foci of infection appear in the immediate vicinity of the meninges of the brain – with purulent otitis media, for example, or with sinusitis. Traumatic brain injury is often the cause of meningitis. But most often microbes enter the cranial cavity with the blood stream.
It is obvious that the very fact that a microbe enters the bloodstream, the very possibility of its “drift” and subsequent reproduction on the meninges are due to the state of immunity.
It should be noted that there are a number of, usually congenital defects in the immune system that predispose to meningitis.
It is not surprising that in some families all children suffer from meningitis – although this disease is not so common, in comparison, for example, with sore throat, whooping cough, chickenpox or rubella. But if the role of immunity in general is clear, then until now it has not been possible to find a convincing explanation for the fact that boys suffer from meningitis 2-4 times more often than girls.
Depending on the type of pathogen, meningitis is viral, bacterial, fungal. Some protozoa (such as amoeba and toxoplasma) can also cause meningitis.
The development of viral meningitis can accompany the course of well-known infections – chickenpox, measles, rubella, mumps (mumps), lesions of the meninges occur in the flu, in infections caused by herpes viruses. Weakened patients, the elderly, and infants have meningitis caused by fungi (it is clear that in these situations it is the lack of immunity that plays the leading role in the onset of the disease).
Bacterial meningitis is of particular importance. Any purulent focus in the body – pneumonia, an infected burn, tonsillitis, various abscesses, etc. – can cause meningitis, provided that the pathogen enters the bloodstream and reaches the meninges with blood flow. It is clear that all known causative agents of purulent processes (staphylococci, streptococci, Pseudomonas aeruginosa, etc.) will in this case be the causative agent of meningitis. One of the worst are tuberculous meningitis – almost forgotten, it now occurs more and more often.
At the same time, there is a microorganism that causes meningitis most often (60-70% of all bacterial meningitis). It is not surprising that it is called that – meningococcus. Infection occurs by airborne droplets, meningococcus settles on the mucous membranes of the nasopharynx and can cause a condition very similar to the usual respiratory viral infection – a small runny nose, redness of the throat – meningococcal nasopharyngitis.
It is not for nothing that I used the phrase “can cause” – the fact is that the ingress of meningococcus into the body rarely leads to the onset of a disease – the leading role here belongs to very special individual shifts in immunity. It is easy to explain, in this regard, two facts: the first – the risk of developing meningitis upon contact, for example, in children’s institutions is 1/1000 and the second – the frequent detection of meningococcus in the nasopharynx in perfectly healthy individuals (from 2 to 5% of children are healthy carriers) …
The inability of the body to localize the microbe in the nasopharynx is accompanied by the penetration of meningococcus through the mucous membrane into the blood. With the blood flow, it enters the meninges, eyes, ears, joints, lungs, adrenal glands, and a very dangerous inflammatory process can occur in each of these organs. Obviously, the defeat of the meninges is accompanied by the development of meningococcal meningitis.
Sometimes meningococcus enters the bloodstream quickly and in large quantities. There is meningococcal sepsis, or meningococcemia – perhaps the most terrible of all childhood infectious diseases. The microbe releases poisons (toxins), under their influence there is multiple blockage of small vessels, blood clotting is impaired, and multiple hemorrhages appear on the body. Sometimes, within a few hours after the onset of the disease, hemorrhage occurs in the adrenal glands, blood pressure drops sharply and the person dies.
There is an amazingly dramatic pattern in the occurrence of meningococcemia, which is as follows. The fact is that when a microbe enters the bloodstream, it begins to react with certain antibodies that try to destroy the meningococcus.
It has been proven that there is a cross-activity of a number of antibodies – that is, if antibodies are present in large quantities, for example, to streptococcus, pneumococcus, staphylococcus – then these antibodies are capable of inhibiting meningococcus.
So it turns out that children are painful, with chronic foci of infections, have suffered pneumonia and many other ailments, meningococcemia almost never get sick. The horror of meningococcemia lies in the fact that within 10-12 hours an absolutely healthy and never before been ill child can die!
All of the above information is not intended to intimidate readers. Meningitis is treated. But the results (duration and severity of the disease, the likelihood of complications) are closely related to the time that will be lost before the start of adequate therapy.
Obviously, the aforementioned “timing of the initiation of adequate therapy” depends on when human humans seek medical attention. Hence the urgent need for specific knowledge, so that later it would not be excruciatingly painful …
The essence of specific knowledge regarding meningitis is that the appearance of certain signs indicating the possibility of this disease requires immediate medical attention.
A number of symptoms are inherent in inflammation of the meninges, but many of them are not specific – that is, their (symptoms) may occur in other diseases that are much less dangerous.
Most often, this happens, but the slightest suspicion of the development of meningitis does not allow taking risks, requires immediate hospitalization and careful medical supervision. Let us now consider the most typical situations, each of which does not allow to exclude the development of meningitis.
- If, against the background of any infectious disease – acute respiratory infections, chickenpox, measles, mumps, rubella, “fever” on the lips, etc. – perhaps not at the beginning of the disease (even more often not at the beginning) an intense headache appears, so strong, that she worries more than all other symptoms if the headache is accompanied by nausea and vomiting.
- In all cases, when against a background of increased body temperature there are pains in the back and neck, aggravated by head movement.
- Drowsiness, confusion, nausea, vomiting.
- Convulsions of any intensity and duration.
- In children of the first year of life – fever + monotonous crying + bulging fontanelle.
- Any (!!!) rash against a background of fever.
In addition to the symptoms described above, some reflexes change in a very specific way, and only a doctor can detect this. It is important to remember and understand that such frequent symptoms as vomiting, nausea and headache without fail require a medical examination – God protects those who are careful.
Any rash associated with an elevated temperature may be meningococcemia. You (or your smart neighbors) can rest assured that it is rubella, measles, or diathesis. But the doctor should see the rash, and the sooner the better. If the elements of the rash look like hemorrhages, if new rashes appear quickly, if this is accompanied by vomiting and high fever, every chance should be used so that the patient immediately ends up in the hospital, preferably immediately in the infectious diseases room.
Remember: with meningococcemia, the count goes not in hours, but in minutes.
It should be noted that even the most highly qualified doctor can diagnose meningitis with absolute certainty in only one case – when the symptoms of irritation of the meninges are combined with the typical rash, which is described above. In all other cases, the diagnosis can only be suspected with varying degrees of probability.
The only way to confirm or rule out meningitis is with a lumbar puncture. The fact is that a special cerebrospinal fluid circulates in the brain and spinal cord – CSF.
With any inflammation of the brain and (or) its membranes, inflammatory cells accumulate in the cerebrospinal fluid, the type of cerebrospinal fluid (normally colorless and transparent) often changes – it becomes cloudy. The study of cerebrospinal fluid allows not only to establish the diagnosis of meningitis, but also to answer the question of whether it is bacterial (purulent) or viral meningitis, which is crucial in choosing a treatment option.
Unfortunately, at a purely philistine level, there is a very widespread opinion about the huge dangers that a spinal tap is fraught with. In fact, these fears are absolutely not justified – the puncture of the spinal canal is carried out between the lumbar vertebrae at the level where no nerve trunks leave the spinal cord, so there are no mythical paralysis after this manipulation.
From a legal point of view, the doctor is obliged to perform a lumbar puncture in case of real suspicion of meningitis.
It should be noted that the puncture is not only diagnostic, but also therapeutic. With any meningitis, as a rule, there is an increase in intracranial pressure, the consequence of the latter is a severe headache. Taking a small amount of cerebrospinal fluid allows you to reduce pressure and significantly alleviates the patient’s condition.
During a puncture, antibiotics are often injected into the spinal canal. So, for example, with tuberculous meningitis, the only chance to save a patient is frequent (often daily) punctures, during which a special version of streptomycin is injected into the spinal canal .
Given the above information, it becomes clear that the treatment of meningitis depends on the type of pathogen. The main thing in the treatment of bacterial meningitis is the use of antibiotics. The choice of a particular drug depends on the sensitivity of the particular bacterium and on whether the antibiotic is capable of penetrating the cerebrospinal fluid. With the timely use of antibacterial drugs, the chances of success are very high.
With viral meningitis, the situation is fundamentally different – there are practically no antiviral drugs, the exception is acyclovir , but it is used only for herpes infection (let me remind you that chickenpox is one of the variants of herpes). Fortunately, viral meningitis has a more favorable course than bacterial meningitis.
But helping the patient is not limited only to the effect on the pathogen. The doctor has the ability to normalize intracranial pressure, eliminate toxicosis, improve the functioning of nerve cells and blood vessels in the brain, and apply powerful anti-inflammatory drugs.
Timely treatment of meningitis within two to three days leads to a significant improvement in the condition, and in the future, almost always to a complete cure without any consequences.