Meningitis is an inflammation of the membranes of the brain of a bacterial or viral nature. This disease is quite dangerous due to the localization of the inflammatory process - the spread of the process to the brain tissue entails many serious consequences.

The outcome of the disease directly depends on the adequacy and timeliness of treatment, which is almost impossible to provide at home, so meningitis is treated in a hospital setting. How long will the treatment take and how long will the hospitalization last?

Treatment of meningitis is carried out in a hospital setting

A little about the disease

It is impossible to establish the exact duration of treatment for meningitis - it consists of many individual characteristics of the body and the clinical course of the disease. The form of the disease, depending on the etiological factor and the severity of the patient’s condition, are of decisive importance.

Meningitis can be caused by a large number of microorganisms and viruses, among which are often:

• Meningococcus.
• Haemophilus influenzae.
• Pneumococcus.
• Tuberculosis bacillus.
• Viruses.
• Mushrooms.
• Chlamydia.
• Protozoa.

In addition, meningitis is divided into primary, which arose independently, without previous infections, and secondary, which is a consequence of some infectious process in another part of the body. The pathogen can penetrate into the brain in several ways - hematogenous (through the circulatory system), lymphogenous (through the lymphatic vessels) and contact (in the presence of a purulent-inflammatory focus in communicating areas).

The disease is accompanied by multiple pathological changes:

• The production of cerebrospinal fluid increases.
• The permeability of the blood-brain barrier increases.
• The blood supply to the brain, especially the microvasculature, is disrupted.
• Toxins negatively affect brain tissue.
• The outflow of cerebrospinal fluid is obstructed, which leads to hydrocephalus (dropsy of the brain).
• Signs of hypoxia are increasing.
• Brain swelling occurs.
• The process gradually spreads to the substance and ventricles of the brain.

Symptoms of meningitis vary depending on the etiological factor, but we can identify the main ones that are common to all forms of the disease. In most cases, the disease begins with an intense headache, spreading over the entire surface of the head and growing to unbearable. After some time, nausea appears and vomiting is possible. Patients take a characteristic position on their side, with their head thrown back and legs tucked to their stomach. Meningococcal infection is accompanied by a characteristic rash on the body, pneumococcal infection is accompanied by rhinitis, and enterovirus additionally causes digestive disorders.

Factors influencing the duration of treatment

If you suspect meningitis, you should call an ambulance

There is no clear answer to the question of how long it will take to treat the disease.

The duration of drug therapy depends on many factors that are taken into account when drawing up an individual treatment plan.

Meaning:

• The form of the disease - bacterial meningitis is more severe than viral meningitis.
• General condition of the body and age of the patient - preschool children and older people get sick longer, the clinical picture is more severe; concomitant chronic diseases can complicate treatment and prolong hospitalization.
• Time to start treatment - timely diagnosis and the start of treatment measures help to bring recovery closer; If the disease is detected late, the prognosis is less favorable and treatment will take longer.
• Individual sensitivity of the body to incoming medications.

Duration of treatment depending on the form of the disease

The duration of treatment in a hospital depends on the form of meningitis - the more severe the clinical picture, the more time it takes for a complete recovery.

Meningococcal meningitis

This is what meningococcus looks like

This form of meningitis is often accompanied by cerebral edema, hyperemia and the appearance of infiltrates on the surface of the medulla. In case of timely (within the first day from the onset of clinical manifestations) detection of the disease, it is possible to prevent further spread of the process and reduce the treatment time. Advanced meningococcal meningitis or irrational drug therapy can lead to severe pathological processes, as a result of which treatment measures are delayed and do not always give the desired result. On average, treatment for this form of the disease lasts from two to five to six weeks, with a prolonged course – up to 8 weeks.

Purulent and tuberculous meningitis

Purulent inflammation of the meninges is severe - pus fills the subarachnoid space, meningeal symptoms are pronounced, the patient's condition is serious. On average, the clinical course of this form of the disease lasts about 4-5 weeks; the prognosis is favorable if adequate treatment is started in a timely manner.

Symptoms of tuberculous meningitis increase slowly over several weeks. Treatment is also quite long - specific medications are taken for 12-18 months.

For tuberculous meningitis, the patient is prescribed anti-tuberculosis drugs

Average length of disability after meningitis

The duration of disability depends on the form of the disease: after mild serous meningitis, the duration of disability is at least two to three weeks. More severe forms of the disease are accompanied by loss of working capacity for five to six months or more. It is possible to return to work only after complete elimination of all symptoms, while the patient is provided with special working conditions with a reduced workload ahead of schedule. For six months after discharge, the worker is exempt from night shifts and overtime assignments. If symptoms persist, sick leave is extended for one to two months. If 4-6 months after discharge from the hospital the symptoms do not disappear, the patient is sent for a medical and social examination to be assigned a disability group.

Inflammation of the meninges (meminx) is a serious disease that requires close attention and mandatory prevention. The consequences of the illness may be irreversible and even lead to death. Meningitis is especially dangerous in children - a child can lose sight, hearing and remain disabled for life.

Effective treatment depends on several factors:

1. timely detection of signs of illness and consultation with a doctor;
2. accurate diagnosis and identification of causes;
3. the right strategy for therapy, recovery and prevention.

The above aspects present considerable complexity. A primary symptom, such as a severe headache, may be mistakenly associated with other conditions. And to determine the causative agent of meningitis, for example, the fungus with which the virus is transmitted, is often only possible through very complex tests.

Anyone can get a disease called meningitis. There are cases when the meninges become inflamed without an external pathogen. For example, as a consequence of advanced sinusitis. Less commonly observed are phenomena where the disease appears due to a genetic predisposition.

Most often, such a virus is transmitted to a healthy person from a sick person. But it is necessary to note the facts, confirmed by statistics: bacteria, when they enter the body, do not always become active. If a person has good immunity, the virus is blocked.

The following groups of people are most susceptible to infection:

• children under five years of age;
• teenagers during puberty;
• aged people.

An increased danger comes from being in a crowd for a long time or constantly interacting with a large group of people:

• accommodation in dormitories;
• daily work in a crowded, cramped room;
• frequent trips in crowded transport.

Those who are faced with the above circumstances need to be especially attentive to issues of personal hygiene.

Classification of the disease

The treatment selected by a qualified doctor depends entirely on the type of inflammation. The disease is classified according to three criteria:

1. cause of occurrence;
2. speed of development;
3. flow form.

Inflammation of the meninges can be acute or chronic. In the first case, the disease progresses rapidly and is accompanied by vivid symptoms. In the second case, there are no obvious signs or they look like a cold or poisoning.

In terms of origin, the disease is divided into primary and secondary. And according to etiology - fungal, bacterial or viral.

Based on the form in which the inflammatory process takes place, it is determined whether a person suffers from serous or purulent meningitis. The second type is considered the most dangerous.

Causes of meningitis

The disease meningitis, as already noted, can be infected, or you can get sick as a result of complications from other ailments, for example, influenza or chronic sinusitis.

But the most common causes of meningitis are viruses. For example, enterovirus: it is usually the causative agent of gastroenteritis, but at the same time it can infect the meninges. Viral inflammation, oddly enough, has the best prognosis. With timely medical care, the patient feels better within 13-14 days.

One of the subtypes of viral meningitis is herpes. If a person’s immune system is weakened, this virus can trigger the onset of a chronic illness.

It is easy to get viral meningitis in a crowded place if you do not follow personal hygiene rules (for example, do not wash your hands). There have been cases of illness in children and adolescents who spent time in summer camps.

Most often, meningitis appears in children if:

• the child was premature;
• there were injuries during childbirth;
• there were disturbances in the functioning of the nervous system.

The causes of meningitis in adults have a wider range. There are even such rare cases as disease of the meninges after radiotherapy or chemical intoxication.

A common cause of meningitis is alcoholism. Regular poisoning of the body with alcohol causes damage to the nerves of the brain, after which inflammation of the membranes begins. Treatment of pneumococcal meningitis in such situations is extremely difficult: cirrhosis of the liver prevents antibiotic therapy, and without this there is practically no chance of a complete recovery.

Signs of meningitis in adults and children

The most common symptoms of meningitis include:

• heat;
• photophobia;
• weakness and;
• painful sensations in the back of the head;
• spontaneous vomiting;
• rash.

With a bacterial or purulent form of the disease, the first signs of meningitis appear unexpectedly, and the disease develops very quickly. If treatment is not started immediately, the consequences will be disastrous for the patient.

With viral meningitis, symptoms are first observed that resemble a common respiratory disease: a “dull” headache, weakness, high fever, runny nose and possible cough. Next, meningococcal sepsis or nasopharyngitis develops, which causes intoxication of the body and inflammation of the meninges.

In order not to miss the onset of the disease, you should pay special attention to two important symptoms that help distinguish a cold from meningitis:

1. Headache extends to the back of the head. It is difficult for a person to tilt his head forward. The neck often becomes numb and has difficulty turning to the side. During acute attacks of headache, the eyeballs are so tense that it is almost impossible to move the eyes up, down or sideways.
2. A characteristic rash appears on the body - red-violet spots. Usually in the armpits or legs, gradually spreading throughout the body. Meningitis rashes may look like large or small stars. In children it is found even on the palms and shoulder blades.

Signs of meningitis in children may vary depending on the individual characteristics of the child: some become lethargic and sleepy, others become too restless. But common symptoms remain a rash, headache and frequent regurgitation. In infants, a tense fontanel is noted.

Signs of meningitis in adults can occur in several “waves”. For example, with viral inflammation, a person may feel a sharp deterioration in health, with nausea and pain in the back of the head. After taking a painkiller and lying in bed for a couple of days, the adult experiences temporary relief and goes back to work.

After a while, the attack resumes, the body becomes covered in a rash, and the temperature rises to 40 degrees. In these cases, you should not hesitate to consult a doctor. At the first signs, it is better to immediately undergo an examination and avoid consequences or complications.

What is the danger

Unfortunately, the mortality statistics from meningitis are quite sad. Treatment started untimely is not always able to prevent death or consequences in the form of mental retardation, loss of vision, hearing or full motor activity.

The symptoms of meningitis are sometimes difficult to recognize in time. Sometimes there is no characteristic rash, which makes the diagnosis of meningitis faster. In addition, people who tend to self-medicate misdiagnose themselves: they think that they have caught a regular flu, take painkillers uncontrollably and only temporarily postpone a serious problem.

The danger of the virus is that it can be very contagious. Meningococcus is quickly transmitted through unwashed hands or utensils. A sick person risks not only his own health, but also the well-being of the people around him.

Diagnosis of meningitis

A meningitis rash makes diagnosing the disease much easier. However, there are cases when this characteristic symptom is not present. Then additional methods of examining the patient are used:

1. Nasal discharge is analyzed. Testing the fluid may reveal the presence of bacteria such as pneumococcus in the body.
2. Accurate diagnosis of meningitis is possible by taking a puncture. This is a rather unpleasant procedure. However, analysis of cerebrospinal fluid from the lumbar spine allows you to quickly determine the type of meningitis and prescribe adequate treatment.
3. Testing the patient for the presence of Kernig, Hermann, Brudzinski, etc. symptoms. For example, according to the Kerning system, a patient with meningitis has difficulty straightening the knee while the person is sitting, and the Brudzinski test tests the ability to pull the knees towards the abdomen while trying to pull the chin towards the chest.

Disturbances in the functioning of joints are common consequences of the development of meningitis. But it can be difficult to determine them on your own, without the help of a doctor.

Drug treatment

Treatment methods are selected according to whether meningitis is to be treated in children or adults, at what stage of development the disease is, and whether the process is acute or chronic. And also whether it was possible to detect meningitis in its incubation period.

Treatment also depends on the type of meningitis. For example:

1. Therapy for meningococcal disease includes taking penicillin, meglumine, mulfanomethoxine and other drugs.
2. The pneumococcal species is usually treated with ampicillin, kanamycin sulfate and benzylpenicillin sodium salt.
3. The tuberculous type of meningitis usually requires the use of isoniazid, ethambutol, streptomycin, pyrazinamide and other drugs.

Treatment with antibacterial drugs is selected individually, since the doctor must take into account the patient’s age and individual contraindications. For example, with a weak liver and problem kidneys, strong antibiotics can cause even greater negative consequences.

Almost all patients are prescribed diuretics, as it is important to remove toxins from the body. General strengthening and immune supporting medications are prescribed. Symptomatic treatment is selected to provide relief.

Unfortunately, there is no universal treatment regimen. Too many different factors influence the correct choice of medications. Therefore, it is strictly not recommended to self-medicate or use folk remedies. Only professional help will help avoid the consequences of inflammation.

Prevention of meningitis

It is difficult to argue with the opinion that the most effective treatment is the one that could be minimized. Prevention of infection with meningitis includes simple safety measures that are easy to follow:

1. Always wash your hands before eating.
2. Have personal utensils. Do not drink from the same mug with other people.
3. When in nature, protect yourself from insect bites (which can spread infection).
4. Monitor the tone of your immune system: give up bad habits, take care of proper nutrition and rest, replenish vitamin reserves during the demi-season periods.
5. Do not self-medicate. At the slightest suspicion of inflammation of the meninges, you should call a doctor.

A good preventive measure can be vaccination against meningitis. It can be done even for a child from 2 months. Vaccination is usually carried out among children under 4-5 years of age.

Headache with sinusitis and after puncture: treatment methods

Meningitis is a very insidious inflammatory disease of the membranes of the spinal cord or brain, which sometimes develops at lightning speed and requires urgent medical intervention.

This disease always leaves a lot of consequences behind itself, ranging from migraine-like pain to serious disturbances in brain function.

Fortunately, if treatment is started early, meningitis can be defeated, and probably without consequences. Both children and adults suffer from this disease. Meningitis - symptoms in adults and consequences, read below.

This disease is common to a certain extent in all countries of the world, but is most often found in the countries of the African continent. In Russia, outbreaks of meningitis most often occur in winter or spring, from February to April. This seasonality is determined by sudden changes in weather conditions, as well as prolonged stay of people in closed and poorly ventilated areas.

Meningitis occurs due to the fact that harmful microorganisms penetrate the soft membranes of the brain in various ways. According to the etiology of the disease, that is, the reasons for its occurrence, several types of meningitis are distinguished:

• viral;
• bacterial;
• protozoan;
• fungal;
• mixed.

Based on the names of the species, the occurrence of meningitis can be caused by fungi, viruses and pathogenic bacteria, among which are:

• pneumococci;
• staphylococci;
• streptococci;
• hemophilus influenzae;
• Klebsiella;
• Pseudomonas aeruginosa, etc.

But the most common cause of this disease in adults is considered to be meningococcal infection, which is transmitted from an infected person by airborne droplets, although it can enter the body through head injuries or from developing infectious foci in the human body.

At the same time, you can catch meningitis anywhere – even on public transport, even in a clinic. This disease is characterized by a very severe course of the disease and often leads to the development of serious complications.

Other diseases can cause the development of meningitis:

• boils in the neck area;
• sinusitis;
• otitis;
• bone osteomyelitis;
• lung abscess, etc.

The risk group primarily includes people with weakened immune systems, head injuries, problems with the central nervous system, back diseases, premature babies, pregnant women, and people with chronic diseases. Meningitis most often affects men or young children. A healthy person can also be a carrier of meningococcal infection.

Meningitis is a dangerous disease, so at the first signs of its development it is important to immediately visit a doctor. The patient expects immediate hospitalization.

Symptoms

The very first signs of the disease appear within 24 hours after infection. Meningitis is quite easy to identify in the earliest stages, since it has very clear and characteristic symptoms that cannot be confused with signs of other diseases:

• body temperature quickly rises to 40 degrees;
• 3 hours after the temperature rises, a rash covers the whole body;
• persistent nausea and vomiting occur;
• soreness of the eyeballs when pressed;
• severe headaches;
• severe dizziness;
• the desire of the patient lying on his back to throw back his head;
• stiffness of the neck muscles (difficulty tilting the head to the chest);
• the patient draws in his stomach and draws in his legs, bending them at the joints;
• throat and tonsils are red.

Already at this stage, it is important to call a doctor as quickly as possible, who will prescribe the necessary treatment. If you delay even a little, the disease develops further and the following signs appear:

• loss of consciousness;
• inappropriate behavior;
• the person begins to delirium;
• convulsions.

It is especially important to pay attention to the appearance of any of these symptoms if the person the day before suffered from sinusitis, pneumonia, or is suffering from tuberculosis.

The doctor will be able to make a final diagnosis and determine the type of meningitis only after conducting the necessary examination. Depending on the severity of the disease, a person may be placed either in a general ward or in intensive care.

Video on the topic

Meningitis is an infectious disease in which the meninges become inflamed. Therefore, it is important to understand how it can be transmitted from a sick person to a healthy person.

Transmission options

Meningitis, like most infectious diseases, is transmitted:

• by airborne droplets (when the patient coughs or sneezes);
• contact and household (if basic rules of personal hygiene are not observed);
• alimentary method (in the absence of proper food processing);
• through blood and lymph (during operations, intravenous injections, blood transfusions);
• during sexual intercourse;
• during childbirth from mother to child.

Classification and incubation period

The cause of inflammation of the meninges is an infection that has various origins. In this regard, they talk about the viral, bacterial, fungal, protozoal, mixed and other nature of meningitis. The rate of development of the disease also varies, which makes it possible to distinguish between acute and chronic variants.

The first is characterized by a rapid progression, when the disease makes itself felt on the first day. Often the patient dies before receiving proper medical care. The acute version of meningitis is characterized by the development of the disease within 2-3 days. The chronic form occurs with virtually no symptoms, so it is difficult to say when the disease began.

Once the infection has entered the body, the incubation period begins. It lasts from two to seven days, depending on the pathogen and the person’s immune strength. In some cases, 10-18 days pass before the first signs of the onset of the disease appear.

Characteristic symptoms

Almost all doctors talk about how important it is to see the first signs of meningitis in a timely manner. Inflammation is manifested by the fact that the temperature first rises sharply (the mercury reaches 40 degrees), and a headache appears. Loss of appetite, nausea and vomiting without subsequent relief are characteristic signs of the onset of the disease, which can easily be confused with manifestations of a common infection.

The list of main symptoms of meningitis infection in adults and children is also complemented by numbness of the neck muscles, which makes it difficult to turn and tilt the head. This phenomenon is called rigidity in medicine. Diarrhea is common in children, although diarrhea is sometimes considered a sign of meningitis infection in adults and adolescents.

Fungi – Candida yeast, Cryptococcus neoformans and the yeast that causes coccidioides, Coccidioides immitis. Protozoa are single-celled eukaryotes, for example, Naegleria fowlera, which causes primary amoebic meningoencephalitis.

An additional factor that increases the risk of developing meningitis is a weakened immune system. Chronic diseases (sinusitis, tuberculosis), infections suffered in the recent past, stress, lack of vitamins, and diet can lead to this condition. Hypothermia, improper medication use, alcohol and drug abuse, and injuries (primarily to the head and back) also increase the risk.

Diagnostics

Only a doctor can determine whether meningitis exists in adults or children by conducting the necessary examination. Diagnostics involves:

• taking blood tests (general and biochemical);
• performing a lumbar puncture (a puncture in the lower back to take cerebrospinal fluid);
• carrying out serodiagnosis.

The doctor may prescribe tomography, EEG and EMG.

The main research material is cerebrospinal fluid, which is taken with a syringe from the spine in the lumbar region. The quality of the material and its composition allow the doctor to judge the nature of the disease and the reasons that led to its occurrence.

Treatment of meningitis: general information

Once a diagnosis is made, a comprehensive treatment is prescribed, which involves a number of steps. Firstly, it is necessary to hospitalize a sick person in a hospital as quickly as possible.

After the examination, drug therapy is prescribed, which is carried out in accordance with the type of causative agent of meningitis infection. The patient also needs procedures and medications aimed at reducing intoxication, and symptomatic treatment.

Hospital and compliance

Since meningitis belongs to the class of deadly diseases, the patient must be treated only in a hospital under the close supervision of medical personnel. If we are talking about the mixed nature of the disease, then a different drug will be prescribed for each group of pathogens.

Only in a hospital setting is it possible to control therapy by doctors and prompt resuscitation in case of complications.

Prescribed medications

The bacterial form of meningitis is treated with antibiotics, primarily of the penicillin group. Semi-synthetic Ampicillin is given in a dosage of 200-300 mg per 1 kg of body weight. The daily dose is spread over 4-6 doses. Cefotaxime, Ceftriaxone, and Meropenem give effective results.

If the infection is tuberculous in nature, then Streptomycin, Isoniazid or Ethambutol may be prescribed. The bactericidal effect of the drugs is enhanced by additional intake of Pyrazinamide or Rifampicin. The duration of the course of medication is from 10 to 17 days, depending on the severity of the disease.

There is no treatment with antibiotics, so all actions are aimed at reducing the negative manifestations of the disease. The pain is relieved, the elevated body temperature is brought down by antipyretic drugs, the water-salt balance of the body is restored, and detoxification is carried out. The treatment regimen for meningitis almost repeats the tactics for getting rid of a cold.

The combination of a drug that modulates the immune system (Interferon) and glucocorticoids gives a positive effect. Nootropics, barbiturates are used as additional medications, and vitamins B and C are prescribed. Sometimes the doctor prescribes a protein diet and an antiviral agent (depending on the causative agent of the meningitis infection).

Antifungal therapy is carried out taking into account the specific microbe that caused the development of the disease. Cryptococcal and candidal meningitis are treated with Amphotericin B in combination with Flucytosine. Sometimes the synthetic drug Fluconazole is additionally prescribed.

The waste products of microorganisms that cause the infection must be removed from the body. Detoxification will not allow the body to weaken its immunity even more and normalizes the functioning of organs. Enterosgel or Atoxil are usually used. Drinking plenty of fluids - decoctions with vitamin C (rosehip decoction), tea with lemon or fruit drinks - helps to cope with intoxication.

Meningitis - symptoms and treatment

What is meningitis? We will discuss the causes, diagnosis and treatment methods in the article by Dr. P.A. Aleksandrov, an infectious disease specialist with 12 years of experience.

Definition of disease. Causes of the disease

Infectious meningitis- a combined group of acute, subacute and chronic infectious diseases caused by various types of pathogenic microorganisms (viruses, bacteria, fungi, protozoa), which, under conditions of specific resistance of the body, cause damage to the membranes of the brain and spinal cord, manifested in a pronounced meningeal irritation syndrome, severe intoxication syndrome and always occurs with a potential threat to the patient’s life.

Infectious meningitis can be either a primary pathology (developing as an independent nosological form) or secondary (developing as a complication of another disease).

Looking ahead, I would like to answer a popular question from readers and netizens: what is the risk of infection from a patient, and is it possible to be near a patient without a particular risk of developing meningitis? The answer is quite simple: in view of the fact that meningitis is a combined group of diseases caused by various infectious agents, the risk of infection will depend on the etiological cause of meningitis, but the likelihood of developing meningitis will depend on the capabilities of the human immune system. In other words, to know whether there is a risk, you need to know which microorganism caused meningitis in the patient and what the protective immune abilities of those around him are.

Depending on the type of meningitis, the routes of infection and the mechanisms of disease occurrence differ. In relation to infectious meningitis, one can point to an extremely wide geographical distribution, with a tendency to increase foci of the disease on the African continent (meningococcal meningitis), more frequent development of the disease in children and an increase in incidence in the cold season (viral meningitis as a complication of ARVI). Transmission of infection most often occurs through airborne droplets.

If you notice similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of meningitis

Quite characteristic in meningitis (and in particular in the meningococcal process) are signs of involvement of the meninges in the pathological process (meningeal syndromes), which are divided into groups:

Separately worthy of mention is a specific manifestation that is similar to the symptoms of meningitis (meningeal syndrome), but is not such and has nothing to do with the pathogenesis of true meningitis - meningism. Most often it develops as a result of mechanical or intoxicating effects on the meninges in the absence of an inflammatory process. It stops when the provoking effect is removed; in some cases, differential diagnosis is possible only through special studies.

Pathogenesis of meningitis

The variety of pathogens and the individual characteristics of individuals in the human population also determine the fairly pronounced variability in the forms and manifestations of meningitis and the risk of infection for other people, so in this article we will focus on the most significant forms of diseases and their causative agents in social terms.

Meningococcal meningitis- always an acute (acute) disease. Caused by Wekselbaum's meningococcus (a gram-negative bacterium, unstable in the environment, at a temperature of 50 degrees Celsius it dies after 5 minutes, UV irradiation and 70% alcohol kill almost instantly). The source of the spread of infection is a sick person (including meningococcal nasopharyngitis) and a bacteria carrier; transmission occurs by airborne droplets.

The site of introduction (gate) is the mucous membrane of the nasopharynx. In the overwhelming majority of cases, the infectious process does not develop or local forms of the disease develop. When meningococcus overcomes local anti-infective barriers, hematogenous spread of infection occurs and a generalized meningococcal infection occurs, including the development of meningococcal meningitis, which, in the absence of adequate treatment, ends in death in more than 50% of cases. In the pathogenesis of the disease, toxins that are released after the death of bacteria in the bloodstream and damage to the walls of blood vessels play a role, which leads to hemodynamic disturbances, hemorrhages in organs and profound metabolic disorders. Hyperirritation of the meninges occurs, the development of purulent inflammation of the tissue and a rapid increase in intracranial pressure. Often, due to edema and swelling of the brain tissue, the brain becomes wedged into the foramen magnum and the patient dies from respiratory paralysis.

The latent period of illness is from 2 to 10 days. The onset is acute (even more correctly, acute). In the first hours of the disease, there is a sharp increasing increase in body temperature to 38.5 degrees and above, severe lethargy, fatigue, pain in the periorbital region, loss of appetite, and a sharp headache. A characteristic sign of a headache is a constant increase in its intensity, diffuse pain without clear localization, bursting or pressing in nature, causing true agony for the patient. At the height of the headache, vomiting occurs without preceding nausea, which does not bring any relief. Sometimes in patients with a severe uncontrolled course, mainly in children in an unconscious state, an uncontrollable cry is observed, accompanied by clasping their head with their hands - the so-called. “hydrocephalic cry” caused by a sharp increase in intracranial pressure. The appearance of the patients is etched in the memory - sharpening of facial features (Lafora’s symptom), meningeal posture on the 2-3rd day of the disease (still “coping dog”). Some patients develop hemorrhagic rashes on the body, resembling a star-shaped rash (an unfavorable sign). Over the course of 2-3 days, the severity of symptoms increases, hallucinations and delusions may appear. The degree of impairment of consciousness can vary from somnolence to coma; if untreated, death can occur at any time.

Slowly developing pathology. It is mainly secondary, developing in the context of existing tuberculosis in other organs. It has several periods of development, consistently developing over a long time:

1. prodromal (up to 10 days, characterized by mild symptoms of general malaise)

2. sensorimotor irritation (from 8 to 15 days, the appearance of initial cerebral and weak meningeal manifestations)

3. paresis and paralysis (attracts attention from the 3rd week from the onset of the infectious process in the form of changes and loss of consciousness, difficulty swallowing, speech).

Initially, a moderate increase in body temperature appears without pronounced jumps and rises, quite tolerable headaches of low intensity, well relieved by taking analgesics. In the future, headaches intensify, nausea and vomiting become involved. An invariable sign of tuberculous meningitis is a rise in temperature, fever, and the numbers and duration can vary from subfebrile to hectic values. Gradually, from the end of the second week, symptoms of disorientation and stupor appear and slowly increase, ending in deep “congestion” of the patient, stupor and coma. Dysfunction of the pelvic organs and abdominal pain develop. Meningeal symptoms also gradually develop, and truly classic symptoms (the “pointing dog” position) develop only in advanced cases.

Herpetic meningitis most often caused by herpes simplex viruses types 1 and 2, chickenpox virus and develops against a background of weakening of the body due to acute respiratory viral infections or serious immunosuppression, incl. AIDS. It is divided into primary (when the process develops during initial infection with the virus) and secondary (reactivation of the infection against the background of decreased immunity). Always an acute disease, the primary manifestations depend on the previous premorbid background. More often, against the existing background of acute respiratory viral infections, herpetic rashes of the perioral area and genital organs, a severe headache of a diffuse nature occurs, intensifying over time, and vomiting, which does not bring relief. All this can occur against the background of a moderate or high increase in body temperature and mild meningeal symptoms. Brain damage is often associated; in such cases, mental disorders (often aggression), hallucinations, disorientation, and generalized convulsions occur within 3-4 days. With proper treatment, the prognosis is usually quite favorable; in the absence of adequate treatment in conditions of impaired immunological resistance, death or persistent residual effects are possible.

Classification and stages of development of meningitis

The following types of infectious meningitis are distinguished:

2. According to the predominant course of the inflammatory process:

• purulent (meningococcal, pneumococcal, caused by Haemophilus influenzae)
• serous (viral)

3. Downstream:

• sharp (optionally - lightning fast)
• subacute
• chronic

4) By localization, severity, clinical forms, etc.

Complications of meningitis

Complications observed with meningitis of meningococcal nature (less often with other forms of meningitis) can be early and late, associated both with a catastrophe of the nervous system and other parts of the body. The main ones:

Diagnosis of meningitis

The primary diagnostic search includes an examination by an infectious disease specialist and a neurologist and, if possible meningitis is suspected, conducting the leading diagnostic test - a lumbar puncture.

It involves inserting a hollow needle into the subarachnoid space of the spinal cord at the level of the lumbar spine. The purpose of this study is to clarify the type, properties and nature of changes in cerebrospinal fluid, to determine possible pathogens and treatment options for this type of meningitis.

Depending on the etiological agent causing meningitis, the properties of the cerebrospinal fluid differ; here are their main types and characteristics:

1. Bacterial meningitis (including meningococcal meningitis):

• high pressure cerebrospinal fluid (over 200 mm of water column)
• the leaking liquid is yellow-green, viscous, with significant cell-protein dissociation, flows out slowly
• high cell content (neutrophilic pleocytosis 1000 per µl and above)
• increase in protein level 2-6 g/l and above
• drop in chloride and sugar levels

2. Serous meningitis (including viral):

• CSF pressure is normal or slightly increased
• The cerebrospinal fluid is clear, flowing out when punctured is 60-90 drops per minute
• the number of cellular elements in the cerebrospinal fluid (cytosis) is less than 800 per µl
• protein concentration up to 1 g/l and below
• glucose is within normal limits

3. Tuberculous meningitis:

• moderate increase in liquor pressure
• transparent in appearance, sometimes opalescent film
• moderate number of cells (up to 200 per µl, predominantly lymphocytes)
• protein increased to 8 g/l
• glucose and chlorides are reduced

In addition to determining the physicochemical properties of cerebrospinal fluid, methods are widely used today to isolate and identify the causative agent of the disease, which can play a decisive role in therapy and prognosis. The most significant are the cultivation of native cerebrospinal fluid in nutrient media (search for bacterial, fungal pathogens), PCR of cerebrospinal fluid (polymerase chain reaction) to identify the nucleic acids of the pathogen, ELISA (enzyme-linked immunosorbent assay) of cerebrospinal fluid, blood, urine, etc. with to determine antigens and antibodies of possible causative agents of meningitis, microscopy of cerebrospinal fluid and nasopharyngeal mucus, clinical and biochemical blood tests. An MRI of the brain is quite informative.

Etiotropic therapy (aimed at getting rid of the pathogen) depends on the specific situation (research conducted, doctor’s experience, algorithms) and may include the prescription of antibacterial drugs, including anti-tuberculosis (for meningitis of a bacterial, tuberculous nature, the situation is unclear), antiviral agents (for herpetic meningitis, other viral pathogens), antifungal agents (for fungal infections). Preference is given to the intravenous administration of drugs under the control of the patient’s condition and periodic monitoring of the cerebrospinal fluid (control lumbar puncture).

Pathogenetic and symptomatic therapy is aimed at interrupting the pathogenesis, improving the action of etiotropic drugs and improving the general condition of the patient. This may include the use of hormones, diuretics, antioxidants, vascular agents, glucose, etc.

Severe and life-threatening forms of meningitis should be kept in intensive care units and intensive care units under constant supervision of medical personnel.

Forecast. Prevention

The prognosis for the development of meningitis depends on its causative agent. With bacterial meningitis (taking into account the fact that in 60% of cases it is meningococcal meningitis), the prognosis is always (even in modern hospital conditions) very serious - mortality can reach 10-15%, and with the development of generalized forms of meningococcal infection - up to 27%. Even with a successful outcome, there is a high risk of residual effects, such as intellectual impairment, paresis and paralysis, ischemic stroke, etc.

It is impossible to predict the development of certain disorders; it is only possible to minimize their occurrence by timely contacting a doctor and starting treatment. With viral meningitis, the prognosis is more favorable; in general, mortality is no more than 1% of all cases of the disease.

Prevention of meningitis includes specific and non-specific activities.

Nonspecific- healthy lifestyle, strengthening the immune system, maintaining good hygiene, using repellents, etc.

Specific prevention is aimed at developing immunity against certain pathogens of infectious meningitis; this is vaccination, for example, against meningococcal infection, pneumococcus, and Haemophilus influenzae. Vaccinations are most effective in children's groups, since children are most susceptible to developing meningitis, and vaccination reliably reduces their incidence rate.