Meningitis is a disease during which the membranes of the brain (meninges and subarachnoid space) become inflamed. It is caused by viruses and bacteria, depending on this the course of the disease occurs. In any case, this is a dangerous disease that requires medical treatment. It can lead to infection of the bloodstream or brain, as well as sepsis, which can be fatal.
Bacterial meningitis is believed to be more severe. If this form is diagnosed, the patient requires emergency medical care. In patients with viral meningitis, the symptoms and course of the disease are milder, but treatment is also in a hospital.
Meningitis in adults and children can have different symptoms, so next we will look at these two groups separately.
According to statistics, 90% of meningitis cases are children. In adults, those bacteria and viruses that can cause meningitis provoke the appearance of sore throat or tonsillitis. In some cases, the infection reaches the brain, affecting it and causing inflammation. Meningitis can also be a complication after sinusitis, tuberculosis and other similar diseases.
Meningitis in children: symptoms, signs and causes
The cause of meningitis in children can be viruses of different natures - polio, Coxsackie, enteroviruses, etc. The disease is also caused by bacteria: staphylococci, meningococci, Haemophilus influenzae, etc. A newborn can become infected during childbirth.
The risk of meningitis is very high in the following categories of children:
- premature babies with weak immune systems;
- newborns who were born with hypoxia, infections and severe pregnancy in the mother;
- young children (most often under three years of age) who have other foci of infection (ARVI, tonsillitis, otitis, etc.);
- children with brain and spinal cord injuries;
- children diagnosed with disorders of the nervous system.
2. Reasons
It is now generally accepted that herpetic meningitis is caused by the first three subtypes: herpes simplex viruses 1 (usually manifested by recurrent rashes on the lips) and 2 (genital herpes), as well as the aforementioned herpes virus 3, which causes chickenpox and herpes zoster. .
Most often, the causative agent is the second subtype - the genital herpes virus, in relation to which herpetic meningitis in this case acts as one of the possible severe complications.
Risk factors include traumatic brain injuries and cancer, infectious and inflammatory processes already present in the body, psycho-emotional shocks, as well as immunodeficiency states of any origin.
Entering the body (usually by airborne droplets), the virus penetrates the cells of the neural nodes of the spinal cord, where it can be present as a latent threat for an indefinitely long time - until the onset of conditions favorable to activation and rapid reproduction.
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Symptoms of meningitis
Children who develop the disease have the following symptoms:
- high temperature: from 39 degrees and above, it is difficult to get rid of or impossible to do at all;
- severe headache, which intensifies with sudden body movements or bright light;
- tension in the neck, which makes it impossible to tilt your head to your chest;
- severe vomiting, prolonged action, which does not bring relief!;
- there are convulsions.
In principle, the symptoms are the same as in adults. Only for newborns the signs of the disease may not be so bright. Frequent regurgitation, lack of appetite, upset stomach, lethargy, abnormal sleep, and changes in crying are noted. Any such symptoms are a reason to consult a pediatrician. A clear, recognizable sign of meningitis is a star-shaped rash, which indicates meningococcal infection.
Causes
More than 60% of cases of serous meningitis are caused by enteroviruses, which are the main causative agents of viral meningitis. Infectious agents that cause inflammation of the meninges include:
- enteroviruses (70-80% of cases);
- arboviruses;
- Coxsackie viruses type A and B;
- parotitis;
- togaviruses;
- HSV type 2;
- cytomegalovirus;
- adenoviruses
The incidence of viral meningitis increases sharply in the summer. Rotavirus meningitis develops extremely rarely.
What are the types of meningitis?
The etiology of meningitis varies. Let's consider the main causes of the disease.
- Viral . Most often they are caused by enteroviruses, mumps virus, flaviviruses, varicela zoster virus, and herpes simplex virus. Less commonly, the cause of the disease can be cytomegalovirus, adenoviruses, lymphocytic choriomeningitis virus, HIV, Epstein-Barr virus. Symptoms are similar to the flu; signs of meningitis in the form of a headache appear after a few days. The course of the disease is not very severe.
- Bacterial . This type of meningitis occurs when various bacteria enter the body: meningococci, Haemophilus influenzae, streptococci, and in rare cases, Escherichia coli, Klebsiella. The course of the disease is rapid and acute, all symptoms appear within one day.
- Purulent . Any bacterial infection of the body can develop into purulent meningitis. Most often, the development of the disease was preceded by infection with Haemophilus influenzae, meningococci and pneumococci. The appearance of purulent meningitis in newborns is often provoked by streptococcal infections, E. coli and salmonellosis.
- Tuberculous . The first symptoms are fever, after a few days vomiting and severe headache appear. The disease affects the brain only after two weeks.
- Meningococcal . It occurs due to the entry of the bacterium Neisseria meningitidis into the human body. Signs of this type of meningitis include hemorrhagic rash, fever and chills. Acute inflammatory changes occur in the blood.
Viral meningitis - symptoms and treatment
Although in the majority of cases of viral meningitis there is no clear clinical differentiation with a specific type of pathogen, some characteristic features can be traced.
Enteroviral meningitis
The incubation period lasts on average about a week, although cases of incubation up to 12 days have been described. Damage to the central nervous system (CNS) in typical cases is preceded by general (of varying severity and intensity) symptoms of enterovirus infection (skin rashes, abdominal discomfort, loose stools, aphthous stomatitis, rhinitis, pharyngitis, etc.) The virus invades the entire body through the gastrointestinal tract. intestinal tract (GIT) or nasopharynx and causes the initial manifestations of the disease (fever, symptoms of gastrointestinal damage, discomfort in the mouth). It then penetrates through the blood and is introduced hematogenously into the nervous system, most often affecting the meninges (up to 85% of all enteroviral lesions of the nervous system).
Initially, the body temperature rises lytically (gradually) to 40 °C, anxiety and sleep disturbance appear, and at the height of a headache of a diffuse bursting nature, repeated vomiting is noted, which does not bring relief, and photophobia. True meningeal symptoms (symptoms of irritation of the meninges) are absent or mildly expressed (mainly stiffness of the muscles of the back of the head is noted). It should be noted hyperemia (redness) of the patient's face, scleral injection, pale nasolabial triangle. Often these symptoms occur in parallel with rashes and muscle pain, which allows the doctor to suspect the etiological role of the enterovirus.
The peak of the disease lasts for 4-5 days, then with a favorable course (most often during treatment) there is a decrease in body temperature and regression of clinical symptoms. A feature of enteroviral meningitis is the possibility of relapse, which occurs in 10-40% of cases and is signaled by lytic hyperthermia (overheating) of the body and the return of cerebral and meningeal signals.
Deaths are rare and are recorded mainly in young children, but are most often associated not with disorders in the central nervous system, but with the development of enteroviral myocarditis and acute impairment of liver function [5]. After the illness, recovery occurs; some patients may subsequently experience residual effects in the form of asthenia (powerlessness) and headaches of moderate intensity for some time. Immunity is strictly type-specific, i.e. it does not protect against recurrent diseases caused by other types of enteroviruses.
Herpetic meningitis
There are some differences in the pathogenesis and clinical manifestations of meningitis caused by different types of herpesvirus infection. For example, with meningitis caused by herpes simplex virus types 1 or 2, as a rule, there is a subfebrile body temperature (37.1-38.0 ° C), a slow increase in cerebral and meningeal symptoms with obvious dissociation of the meningeal syndrome complex - significantly pronounced muscle tension occipital region with weakly expressed nominal syndromes. Photophobia is detected, the headache increases and is not relieved by taking analgesics, and is accompanied by repeated vomiting.
Signs of encephalitis often appear, patients become aggressive, confusion, hallucinations, coordination disorders, and focal symptoms appear. With adequate treatment, in typical cases, a slow regression of clinical symptoms with recovery is possible. In severe cases, especially in conditions of severe immunosuppression, death is possible [4].
With meningitis induced by the herpes zoster virus (VVZ), the course of the disease is more pronounced. Against the background of previous herpetic rashes, there is an increase in body temperature to 39 ° C, sharply defined headaches, and vomiting. Shell symptoms and focal symptoms are quite pronounced. There is a disturbance in consciousness, orientation, and hallucinations are rarely detected [6].
Lymphocytic choriomeningitis (LCM)
In acute LCM, the latent period can range from 6 to 14 days. After a short, mildly expressed prodromal period, body temperature rises sharply to 40 °C, severe headache, vomiting, and disturbances of consciousness. Bradycardia in the late period, nystagmus, and coordination problems are possible. On examination, rigidity (stiffness) of the neck muscles, Kernig's and Brudzinski's symptoms are evident. Ophthalmoscopy reveals congestive changes in the fundus. Symptoms typically last for 14 days, followed by a slow progression of the disease. Sometimes there are residual effects in the form of asthenia [7].
Treatment of meningitis
Treatment of meningitis must be carried out in a hospital setting and depends on its type. Until the results of the study are received, the patient is prescribed Cefotaxime and Ceftriaxox. This is the so-called starting antibiotic therapy. After receiving the tests, targeted antibiotic therapy is prescribed, depending on the bacteria detected and their sensitivity to the drug.
Symptomatic treatment may include infusion therapy, enteral or parenteral nutrition, rehabilitation exercises, which are recommended after relieving cerebral edema, treatment of complications and their prevention.
Prevention
To avoid getting viral meningitis, you should not swallow water while swimming in open water.
You should observe the rules of personal hygiene and thoroughly wash vegetables and fruits before eating. To prevent influenza, vaccination is carried out. If you have signs of viral meningitis, call the Yusupov Hospital. Doctors examine patients using equipment from leading European and American companies. To treat patients, neurologists use effective antiviral drugs that have a minimal range of side effects.
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Meningitis: which doctor treats it?
Since meningitis is most often an infectious disease, treatment is prescribed by infectious disease doctors . They also carry out diagnostics. Moreover, all this is done after the patient is hospitalized, i.e. in the infectious diseases department. Additionally, observation by a neurologist is necessary, since the infection affects the nervous system.
Even suspicion of meningitis requires immediate hospitalization until the causes are clarified . This disease has a very high mortality rate and an even higher rate of neurological complications. For prevention, you need to get vaccinated, maintain hygiene, and eat right. Be healthy!
Diagnostics
The diagnosis of viral meningitis can be reliably established or refuted by examining the cerebrospinal fluid.
A large number of lymphocytes and a slightly elevated protein level with normal glucose concentrations are detected in the cerebrospinal fluid. An indirect sign of the viral nature of meningitis is the absence of the pathogen in cerebrospinal fluid smears of any type of color. In the first 48 hours of illness, especially in some enterovirus infections and meningitis caused by eastern equine encephalomyelitis virus or ECHO virus 9, cytosis may be predominantly neutrophilic. In this case, the spin fluid analysis is repeated after 8-12 hours and it is monitored whether a lymphocytic shift has appeared. If neutrophils are present in the cerebrospinal fluid, an additional examination is performed to exclude bacterial meningitis or the presence of a focus of infection near the meninges.
Cytosis in viral meningitis does not exceed 1000 in one microliter of cerebrospinal fluid. Glucose levels are normal in most cases, but may be decreased in meningitis caused by the mumps virus, inflammation of the meninges caused by ECHO viruses and other enteroviruses, herpes simplex virus type 2, Varicella-zoster virus, or lymphocytic choriomeningitis. More often, lymphocytosis with low glucose levels is evidence of fungal, tuberculous or listeria meningitis or a non-infectious disease (sarcoid meningitis and diffuse tumor infiltration of the meninges).
Isolating the virus from cerebrospinal fluid is technically difficult. Adenoviruses and enteroviruses can be detected in feces, arboviruses in blood, mumps virus and cytomegalovirus in urine. Enteroviruses, mumps virus and adenoviruses are detected in nasopharyngeal swabs.
An important method for diagnosing viral meningitis is the detection of viral DNA or RNA using polymerase chain reaction (PCR). This method allows the detection of herpes simplex virus DNA in the cerebrospinal fluid of patients with Mollaret meningitis or herpetic encephalitis, even with negative culture results. PCR is widely used to detect Varicella Zoster virus, cytomegalovirus, and Epstein-Barr virus. This is the method of choice for detecting picornaviruses (poliomyelitis, Coxsackie, ECHO viruses) in the cerebrospinal fluid of patients suffering from meningitis.
Diagnosis of viral meningitis is carried out using electrophoresis of cerebrospinal fluid in agarose gel or isoelectric focusing of gamma globulins. These methods make it possible to identify oligoclonal immunoglobulins in meningitis caused by:
- human immunodeficiency virus;
- Human T-lymphotropic virus type 1;
- Varicella Zoster virus;
- mumps virus.
An increase in immunoglobulin titer is often accompanied by the appearance of antibodies to viral proteins.
Identification of oligoclonal immunoglobulins helps to carry out differential diagnosis, since they are absent in viral meningitis caused by enteroviruses, arboviruses and herpes simplex virus. Each patient with suspected viral meningitis at the Yusupov Hospital undergoes:
- general blood analysis;
- biochemical studies of liver function;
- determination of hematocrit, erythrocyte sedimentation rate, nitrogen and urea levels in the blood;
- determination of electrolytes and blood plasma glucose, creatinine, amylase and lipase.
Changes in certain indicators make it possible to clarify the nature of the disease.
