Meningitis — an inflammation of covers of a head and spinal cord. Pakhimeningit — an inflammation of a firm brain cover, leptomeningit — an inflammation of soft and web brain covers. The inflammation of soft covers meets more often, in such cases use the term "meningitis". These or those pathogenic microorganisms can be its activators: bacteria, viruses, fungi; less often protozoan meningitis meets. Meningitis is shown by a severe headache, a giperesteziya, vomiting, a rigidnost of occipital muscles, typical position of the patient in a bed, hemorrhagic rashes on skin. For confirmation of the diagnosis of meningitis and establishment of its etiology is conducted a lyumbalny puncture and the subsequent research of a likvor.
Meningitis — an inflammation of covers of a head and spinal cord. Pakhimeningit — an inflammation of a firm brain cover, leptomeningit — an inflammation of soft and web brain covers. The inflammation of soft covers meets more often, in such cases use the term "meningitis". These or those pathogenic microorganisms can be its activators: bacteria, viruses, fungi; less often protozoan meningitis meets.
Etiology and pathogenesis of meningitis
Meningitis can arise in several ways of infection. The contact way — developing of meningitis occurs in the conditions of already existing purulent infection. Development of sinusogenny meningitis is promoted by a purulent infection of okolonosovy bosoms (antritis), otogenny — a mastoidal shoot or a middle ear (otitis), odontogenny — pathology of teeth. The drift of infectious agents in brain covers is possible limfogenny, hematogenic, chrezplatsentarny, perinevralny in the ways, and also in the conditions of a likvorea at an open craniocereberal trauma or a vertebral and spinal trauma, a crack or a change of the basis of a skull.
Causative agents of an infection, getting to an organism through entrance gate (bronchial tubes, a GIT, a nasopharynx), cause an inflammation (serous or purulent type) of brain covers and adjacent tissues of a brain. The subsequent their hypostasis leads to violation of microcirculation in vessels of a brain and its covers, to delay of a resorption of tserebrospinalny liquid and its hyper secretion. At the same time intra cranial pressure increases, brain dropsy develops. Perhaps further distribution of inflammatory process on brain substance, backs of cranial and spinal nerves.
Classification of meningitis
Meningitis is classified by several criteria.
On an etiology:
- bacterial (pnevmokokkovy, tubercular, meningococcal, etc.)
- virus (Koksaki called by enteroviruses and ESNO, sharp limfotsitary horiomeningit, etc.)
- fungal (kriptokokkozny, kandidozny, etc.)
- protozoan (at malaria, at toxoplasmosis, etc.)
On the nature of inflammatory process:
- purulent (in a likvor neutrophils prevail)
- serous (in a likvor lymphocytes prevail)
- primary (in the anamnesis there is no general infection or an infectious disease of any body)
- secondary (as complication of an infectious disease)
On prevalence of process:
On rate of a course of a disease:
- easy form
- average weight
- severe form
- extremely severe form
Clinical picture of meningitis
The Simptomokompleks of any form of meningitis includes all-infectious symptoms (heat, a fever, temperature increase of a body), increase of breath and violation of its rhythm, change of ChSS (at the beginning of a disease tachycardia, in process of progressing of a disease — bradycardia).
The all-brain symptoms which are shown the tonic tension of muscles of a trunk and extremities are a part of a meningealny syndrome. Quite often there are prodormalny symptoms (cold, belly-aches, etc.). Vomiting at meningitis is not connected with meal, and develops right after change of situation or when strengthening a headache. Headaches, as a rule, of the holding apart character are very painful for the patient, can be localized in occipital area and give to cervical department of a backbone. Besides, patients painfully react to the slightest noise, touches, light therefore try to avoid a talk and lie blindly. At children's age emergence of spasms is possible.
The giperesteziya of skin and morbidity of a skull at percussion is characteristic of meningitis. At the beginning of a disease increase in tendinous reflexes is noted, but with development of a disease they decrease and quite often disappear. In case of involvement in inflammatory process of substance of a brain paralyzes, pathological reflexes and paresis develop. The heavy course of meningitis usually is followed by expansion of pupils, a diplopiya, squint, violation of control over pelvic bodies (in case of development of mental disorders).
Meningitis symptoms at senile age are atypical: weak display of headaches or their total absence, tremor of the head and extremities, drowsiness, mental disorders (apathy or, on the contrary, psychomotor excitement).
Diagnosis and differential diagnosis
The main method of diagnosing (or exceptions) meningitis is the lyumbalny puncture with the subsequent research of tserebrospinalny liquid. This method is spoken well by its safety and simplicity therefore carrying out a lyumbalny puncture is shown in all cases of suspicion of meningitis. The liquid effluence under high pressure is characteristic of all forms of meningitis (sometimes a stream). At serous meningitis tserebrospinalny liquid transparent (sometimes slightly opalestsiruyushchy), at purulent meningitis — muddy, flavovirent color. Define by laboratory researches of tserebrospinalny liquid (neutrophils at purulent meningitis, lymphocytes at serous meningitis), change of a ratio of quantity of cages and the increased protein content.
For clarification of etiologichesky factors of a disease determination of level of glucose in tserebrospinalny liquid is recommended. In case of tubercular meningitis, and also the meningitis caused by mushrooms, the level of glucose decreases. For purulent meningitis typically considerable (to zero) decrease to level glucose.
The main reference points of the neurologist in differentiation of meningitis — a research of tserebrospinalny liquid, namely definition of a ratio of cages, level of sugar and protein.
Treatment of meningitis
In case of suspicion of meningitis hospitalization of the patient is obligatory. At a heavy current of a pre-hospital stage (consciousness oppression, fever) to the patient enter Prednisolonum and benzylpenicillin. Carrying out a lyumbalny puncture at a pre-hospital stage is contraindicated!
Basis of treatment of purulent meningitis — early purpose of sulfanylamides (, ) or antibiotics (penicillin). Allows benzylpenicillin introduction intralyumbalno (in extremely hard case). If similar treatment of meningitis during the first 3 days is inefficient, it is necessary to continue therapy by semi-synthetic antibiotics (ampicillin + , ) in combination with monomitsiny, gentamycin, nitrofurans. Efficiency of such combination of antibiotics before allocation of a pathogenic organism and detection of its sensitivity to antibiotics is proved. The maximum term of such combinational therapy — 2 weeks then it is necessary to pass to monotherapy. As criteria for cancellation also serve decrease in body temperature, normalization of a tsitoz (to 100 cages), regress of all-brain and meningealny symptoms.
Basis of complex treatment of tubercular meningitis consists in continuous introduction of bakteriostatichesky doses of two-three antibiotics (for example, an isoniazid + streptomycin). At emergence of possible side effects (vestibular frustration, a hearing disorder, nausea) cancellation of this treatment is not required, reduction of a dose of antibiotics and temporary addition to treatment of the desensibilizing medicines (, ), and also other antitubercular medicines is shown (rifampicin, PASK, ). Indications to the patient's extract: lack of symptoms of tubercular meningitis, sanitation of tserebrospinalny liquid (6 months later from the beginning of a disease) and improvement of the general a condition of the patient.
Treatment of viral meningitis can be limited to application of the symptomatic and all-strengthening means (glucose, sodium metamizol, vitamins, methyluracil). In hard cases (the expressed all-brain symptoms) appoint corticosteroids and diuretics, is more rare — a repeated spinal puncture. In case of stratification of a bacterial infection prescription of antibiotics is possible.
Forecast and prevention of meningitis
In the further forecast an important role is played by a meningitis form, timeliness and adequacy of medical actions. As residual symptoms after tubercular and purulent meningitis often there are headaches, intra cranial hypertensia, epileptic seizures, violations of sight and hearing. Because of overdue diagnosing and resistance of the activator to antibiotics purulent meningitis mortality rate (a meningococcal infection) is high.
As preventive measures for the prevention of meningitis the regular hardening (water procedures, sport), timely therapy chronic and acute infectious diseases, and also the medicines immunostimulating short courses (, a ginseng) is provided in the centers of meningococcal meningitis (kindergarten, school, etc.)