Meningitis at children – the infectious and inflammatory process affecting brain covers. The course of meningitis at children is followed all-infectious (hyperthermia), all-brain (a headache, vomiting, spasms, consciousness violation) and a meningealny syndrome (a rigidnost of occipital muscles, the general giperesteziya, a meningealny pose, positive symptoms of Kerniga, Le Sage, Brudzinsky, a vybukhaniye of a big fontanel). Diagnosis of meningitis demands carrying out a lyumbalny puncture, a research of a likvor and blood from children. The basic principles of treatment of meningitis at children are: hospitalization of the child, bed rest, performing antibacterial/antiviral, dezintoksikatsionny, dehydrational therapy.
Meningitis at children
Meningitis at children – the neuroinfection causing primary damage to a soft brain cover of a head and spinal cord; proceeding with development of all-infectious, all-brain, meningealny symptoms and inflammatory changes in tserebrospinalny liquid. In structure of pediatrics and children's infectious pathology special attention is paid to meningitis that is explained by frequent organic defeat of TsNS, a high lethality from this pathology, serious medico-social consequences. The incidence of meningitis among children up to 14 years makes 10 cases on 100 thousand of the population; at the same time about 80% of the diseased are made by children up to 5 years. The risk of a lethality at meningitis depends on age of children: the child is younger, the probability of a tragic outcome is higher.
The meningitis reasons at children
Meningitis at children can be caused by the most various activators: bacteria, viruses, mushrooms, the elementary. The most numerous group of causative agents of meningitis at children is presented by bacteria: meningokokky, pneumococcus, hemophilic stick of a serogruppa of b, staphylococcus, enterobakteriya, tuberculosis mikobakteriya. Viral meningitis at children is most often associated with the ECHO viruses, Koksaki, epidemic parotitis, chicken pox, measles, a rubella, poliomyelitis, tick-borne encephalitis, Ebshteyna-Barre, herpes, enteroviruses, adenoviruses, etc. The meningitis at children caused by mushrooms, rikketsiya, spirokheta, toxoplasma, a malarial plasmodium, helminths and other pathogens is among seldom met forms.
The sick person or the bacillicarrier is a potential source of an infection; infection can happen airborne, contact and household, alimentary, water, inoculable, vertical, hematogenic, limfogenny, perinevralny in the ways.
Development of meningitis in newborn children is promoted by the adverse course of pregnancy and childbirth, a fruit hypoxia, prematurity, pre-natal infections. At children of early age as risk factors of development of meningitis serve purulent diseases of various localization (otitises, mastoidita, sinusitis, pharyngitises, tonsillitis, gastroenterokolita, furuncles of the person and neck, osteomyelitis, an endocarditis), a SARS, infectious diseases of children's age, intestinal infections, craniocereberal injuries. Predisposition to meningitis of children of the first years of life is explained by immaturity of immune system and the increased permeability of a hematoencephalic barrier. As a background for development of pathological process the hypotrophy, defects of care of the child, overcooling, change of climatic conditions, a stress, excessive physical activities can serve in covers of a brain.
Seasonality (the peak of incidence falls on the winter and spring period) and recurrence is characteristic of the outbreaks of meningitis at children (rise in incidence is noted each 10-15 years).
Pathogenesis of meningitis at children
At primary meningitis at children as entrance gate for an infection most often serve mucous membranes respiratory or digestive tract. Penetration of the activator into a cavity of a skull and brain covers happens hematogenic, segmentary and vascular or contact in the ways. The expressed toksemiya and increase of level of biologically active agents create conditions for increase in permeability of vascular membranes, a hematoencephalic barrier, penetration of microorganisms and their toxins in TsNS with development of a serous, serous and purulent or purulent inflammation of brain covers.
The congestion of inflammatory exudate causes irritation of vascular textures of ventricles of a brain that is followed by increase in production of tserebrospinalny liquid and increase in intra cranial pressure. The main clinical displays of meningitis at children are connected with development of a gipertenzionno-gidrotsefalny syndrome. A consequence of expansion of likvorny spaces and the sdavleniya of tissues of brain serves deterioration in perfusion, development of a hypoxia, a liquid exit from the vascular course and developing of hypostasis of a brain.
At the correct treatment of meningitis children in a phase of the return development have a resorption of inflammatory exudate, normalization of a likvoroproduktion and intra cranial pressure. In case of irrational treatment of meningitis children can have an organization of purulent exudate and formation of fibrosis, violation of a likvorodinamika with development of hydrocephaly will be a consequence of what.
Classification of meningitis at children
Primary meningitis at children arises without the previous local inflammatory process or an infection; secondary meningitis at children develops against the background of the main disease and acts as its complication.
Taking into account depth of defeat in structure of meningitis at children distinguish: pan-meningitis – an inflammation of all brain covers; pakhimeningit – a primary inflammation of a firm brain cover; leptomeningit – the combined inflammation of web and soft brain covers. Separately allocate arakhnoidit - the isolated defeat of a web cover having the clinical features.
On expressiveness of an intoksikatsionny and all-brain syndrome, and also inflammatory changes in cerebrospinal fluid, distinguish an easy, average and severe form of meningitis at children. The course of a neuroinfection can be lightning, sharp, subsharp and chronic.
In the etiologichesky relation, according to accessory of activators, meningitis at children shares on virus, bacterial, fungal, rikketsiozny, spirokhetozny, gelmintny, protozoan and mixed. Depending on character of a likvor, children can have serous meningitis, hemorrhagic and purulent. In structure of pathology in pediatrics meningitis at children prevails serous virus and bacterial (meningococcal, hemophilic, pnevmokokkovy).
Meningitis symptoms at children
Irrespective of etiologichesky accessory, the course of meningitis at children is followed by all-infectious, obyoshchemozgovy, meningealny symptoms, and also typical vospalitelyyony changes of a likvor.
The all-infectious symptomatology at meningitis at children is characterized by sharp temperature increase, oznoba, and tachycardia, refusal of the child of food and drink. The pallor or hyperaemia of integuments, hemorrhagic rash on skin connected with a bacterial embolism or toxic paresis of small vessels can be noted. Separate nonspecific symptoms occur at certain forms of meningitis at children: sharp nadpochechnikovy insufficiency - at meningococcal, respiratory insufficiency - at pnevmokokkovy, heavy diarrhea - at an enteroviral infection.
The intensive headaches connected as with toxic, and mechanical irritation of brain covers are typical for the all-brain syndrome accompanying the course of meningitis at children. The headache can be diffusion, holding apart or localized in frontal and temporal or occipital area. Owing to reflex or direct irritation of receptors of the emetic center in a medulla there is repeated, not connected with meal and not giving relief vomiting. Violation of consciousness at meningitis at children can be expressed in a somnolentnost, psychomotor excitement, development of a soporozny state or coma. Quite often at meningitis children have spasms which expressiveness can vary from twitchings of separate muscles to a generalized epipristup. Development of focal symptomatology in the form of glazodvigatelny frustration, a hemiparesis, giperkinez is possible.
The most typical for meningitis at children is the meningealny syndrome. The child lies on one side, with the thrown-back head; the hands bent in elbows and the legs bent in coxofemoral joints ("a pose cocked"). Hypersensibility to various irritants is noted: giperesteziya, , giperakuziya. The rigidnost of zayotylochny muscles (impossibility to press the child's chin to a thorax because of tension of occipital muscles) is a characteristic sign. Owing to the increased intra cranial pressure at babies tension and a vybukhaniye of a big fontanel, the expressed venous network on the head and centuries is noted; at percussion of a skull there is a sound of "a ripe water-melon". Symptoms of Kerniga, Brudzinsky, Le Sage, Mondonezi, Bekhterev belong to obolochechny signs, characteristic of meningitis at children.
Other infectious and septic complications - pneumonia, arthritises, an endocarditis can join the course of purulent meningitis at children, perikardit, epiglottit, osteomyelitis, sepsis. Violations of intelligence, a gipertenzionno-gidrotsefalny syndrome, epilepsy, paralyzes and paresis, a hypothalamic syndrome, damage of cranial nerves (squint, an upper eyelid, relative deafness, asymmetry of the person, etc.) can become late complications from nervous system.
Diagnosis of meningitis at children
In the course of recognition of meningitis at children the accounting of an epidanamnez, clinical data, meningealny symptoms is important for the pediatrician and the children's infectiologist. Consultations of the children's neurologist, the children's ophthalmologist with survey of an eye bottom are necessary for the correct assessment of the objective status of the child (oftalmoskopiya); if necessary – the children's otolaryngologist and the neurosurgeon.
Suspicion of meningitis at children is the indication to carrying out a lyumbalny puncture and receiving a likvor for a biochemical, bacteriological/virologic and cytologic research. Results of a research of tserebrospinalny liquid allow to differentiate a meningizm and meningitis, to define an etiology of serous or purulent meningitis at children.
By means of serological methods (RNGA, RIF, RSK, IFA) existence and increase of specific antibodies in blood serum comes to light. The PTsR-research of cerebrospinal fluid and blood on activator DNA availability is perspective. Within diagnostic search bacteriological crops of blood and separated nasopharynxes on selective nutrient mediums are carried out.
Differential diagnosis of meningitis at children needs to be carried out with subarakhnoidalny hemorrhage, arteriovenozny malformation of a brain, ChMT, brain tumors, Ray's syndrome, a neuroleukosis, a diabetic coma, etc.
Treatment of meningitis at children
Suspicion of meningitis is the absolute indication to hospitalization of children in an infectious hospital. In the sharp period the bed rest is shown to children; maximum rest; full, mechanically and chemically shchayodyashchy diet; control of indicators haemo - and likvorodinamik, physiological departures.
Etiotropny therapy of meningitis at children assumes intramuscular or intravenous purpose of antibacterial medicines: penicillin, tsefalosporin, aminoglycosides, karbapenem. At the heavy course of meningitis at children antibiotics can is entered endolyumbalno. Before establishment of an etiology the antibiotic is appointed empirically; after obtaining results of laboratory diagnostics therapy correction is carried out. Antibiotic treatment duration at meningitis at children makes not less than 10-14 days.
After establishment of an etiology of meningitis at children introduction of antimeningococcal gamma globulin or plasma, anti-staphylococcal plasma or gamma globulin, etc. can be carried out. At viral meningitis at children antiviral therapy is carried out by an acyclovir, recombinant interferona, inductors of endogenous interferon, immunomodulators.
Pathogenetic approach to treatment of meningitis at children includes dezintoksikatsionny (introduction of glyukozo-salt and colloidal solutions, albumine, plasma), dehydrational (furosemide, ), anticonvulsive therapy (GOMK, tiopentat sodium, phenobarbital). For the purpose of prevention of brain ischemia nootropic medicines and neurometabolites are used.
The forecast and prevention of meningitis at children
The forecast of meningitis at children is defined by its etiology, a premorbidny background, weight of a course of a disease, timeliness and adequacy of therapy. Now in most cases it is possible to reach recovery of children; lethal outcomes are registered in 1-5% of cases. In the residual period of meningitis at children asthenic and gipertenzivny syndromes are most often noted.
Among the measures directed to decrease in incidence of meningitis, the leading role belongs to vaccinal prevention. At identification of the child sick with meningitis in child care facility, quarantine actions are carried out, the bakobsledovaniye of contact persons, introduction of specific gamma globulin or a vaccine by it is carried out. Nonspecific prevention of meningitis at children consists in timely and full treatment of infections, a hardening of children, to their schooling to respect for standards of personal hygiene and the drinking mode (washing of hands, the use of boiled water etc.).