Inflammation of the pia mater of a serous nature, which can be caused by viruses (most often), bacteria, fungi, systemic diseases, tumors, cerebral cysts. In most cases, the disease is acute with fever, headache, meningeal symptom complex, and sometimes with damage to the cranial nerves. Diagnosis is based on epidemiological data, the results of a neurological examination, cerebrospinal fluid analysis, bacteriological and virological studies, EEG, and MRI of the brain. Therapy includes etiotropic treatment, dehydration, detoxification, antibiotic therapy, antipyretic, anticonvulsant, and neurometabolic drugs.

General information

Diagnosis of serous meningitis

Based on the characteristic clinical picture and the presence of a meningeal symptom complex (typical posture, rigidity of the posterior cervical muscles, positive Kerneg's symptoms, lower and upper Brudzinski's symptoms, in infants - Lesage's symptom), not only a neurologist, but also a local therapist or pediatrician can assume the presence of meningitis. A thorough study of the medical history (identifying contacts with sick individuals, determining the duration of the incubation period, the nature of the onset of the disease, etc.) and conducting additional examination methods are necessary to establish the type and etiology of meningitis.

Serous meningitis is accompanied by typical inflammatory changes in a clinical blood test, but usually the rise in ESR and leukocytosis are less pronounced than with purulent meningitis. To isolate the pathogen, bacterial culture of swabs from the throat and nose is carried out, and virological studies are carried out using PCR, RIF, and ELISA methods. In patients with immunodeficiency, immunological studies aimed at verifying the pathogen are not very informative, since they can give false results.

Serous meningitis can be confirmed by examining the cerebrospinal fluid. Serous inflammation of the soft cerebral membrane is characterized by slightly opalescent or transparent cerebrospinal fluid with a slightly increased protein content. Tuberculous and fungal meningitis are accompanied by a decrease in glucose levels. Cerebrospinal fluid leaks under increased pressure. In the first few days, neutrophilic leukocytosis may be observed, which resembles the picture of bacterial meningitis. Then lymphocytes begin to predominate in the cerebrospinal fluid, which is more typical for viral meningitis. Therefore, lumbar puncture must be repeated and the data from the study of cerebrospinal fluid must be compared at different periods of the disease.

In case of tuberculous and syphilistic etiology of meningitis, pathogens can be identified by microscopy of cerebrospinal fluid after special staining of smears. If serous meningitis is of viral origin, then the pathogen is not detected. If necessary, the following examinations may be additionally prescribed:

For the purpose of detoxification, infusion therapy is carried out, and to combat liquor-hypertensive syndrome - dehydration (introduction of diuretics: furosemide, acetazolamide). For febrility, antipyretics are prescribed (ibuprofen, paracetamol), for convulsive syndrome - detomidine, diazepam, valproic acid. At the same time, neuroprotective and neurotropic therapy is carried out - nootropics are prescribed (gamma-aminobutyric acid, piracetam, glycine), B vitamins, pig brain hydrolyzate, etc.

Forecast and prevention of serous meningitis

In the vast majority of cases, with correct and timely treatment, serous meningitis has a favorable outcome. Usually the temperature begins to subside already on the 3-4th day; a repeated wave of febrility is rarely observed. On average, serous meningitis lasts about 10 days, with a maximum of 2 weeks. As a rule, it passes without leaving any consequences. In some cases, after meningitis, liquor-hypertension syndrome, frequent cephalgia, asthenia, emotional instability, memory impairment, and difficulty concentrating may persist. However, these residual effects disappear within a few weeks or months. Tuberculous meningitis has a serious prognosis; without the use of anti-tuberculosis pharmaceuticals, it leads to death on the 23-25th day of illness. With a late start of anti-tuberculosis treatment, the prognosis is serious - relapses and complications are possible.

The best prevention of meningitis of any etiology is a strong immune system, i.e. healthy diet, active lifestyle, hardening, etc. Preventive measures should also include timely treatment of acute infections, isolation of sick people, vaccination against tuberculosis, drinking only purified or boiled water, thoroughly wash vegetables and fruits, maintain personal hygiene.

Serous meningitis is a serous inflammation that affects the pia mater of the brain, accompanied by the formation of serous exudate, which includes some elements of blood cells and 2-2.5% protein.

Serous meningitis most often affects children aged 3–6 years

The disease can either be caused by infectious agents (fungi, viruses, bacteria) or be of an aseptic, non-infectious nature.

The inflammatory process in serous meningitis does not lead to cell necrosis and is not complicated by purulent melting of tissue. Therefore, this disease, unlike purulent meningitis, has a more favorable prognosis.

Serous inflammation of the meninges most often affects children aged 3–6 years. In adults, serous meningitis is diagnosed extremely rarely, in patients 20–30 years old.

Causes and risk factors

In 80% of cases, the cause of serous meningitis in adults and children is a viral infection. The causative agents of the disease can be:

• paramyxoviruses.

Much less often, the development of serous meningitis is caused by a bacterial infection, for example, infection of the patient with Koch's bacillus (the causative agent of tuberculosis) or pale spirochete (the causative agent of syphilis). It is extremely rare that the disease has a fungal etiology.

Serous meningitis of an infectious nature develops in patients with weakened immunity, when the body's defenses are unable to cope with pathogenic microflora.

The routes of infection can be different (water, contact, airborne). The water transmission route is most typical for enteroviruses. That is why serous meningitis of enteroviral etiology is mainly diagnosed at the height of the swimming season, i.e. in the summer months.

Timely treatment of serous meningitis ensures rapid improvement in the condition of patients. The average duration of the disease is 10–14 days.

The development of aseptic serous meningitis is not associated with any infection. The reasons in this case may be:

• systemic diseases (periarteritis nodosa, systemic lupus erythematosus);
• tumors of the brain and its membranes.

In clinical practice, there is also a special form of serous meningitis - Armstrong's meningitis (lymphocytic viral choriomeningitis). The causative agent is a virus, and the reservoir of infection is rats and mice. The virus enters the human body through consumption of food and water contaminated with biological secretions of infected rodents (nasal mucus, feces, urine).

Symptoms of serous meningitis

The incubation period for viral serous meningitis ranges from 3 to 18 days. The disease begins with a sudden increase in body temperature to high values ​​(40-41 °C). Intense headache and symptoms of intoxication appear, which include:

• pain in muscles and joints;
• general weakness;
• brokenness;
• lack of appetite.

With viral serous meningitis, the temperature curve is often biphasic: body temperature remains at high values ​​for 3-4 days, after which it drops to low-grade (below 38 °C), and after a few days it rises again to 40-41 °C.

The headache is constant and is not relieved by the use of conventional painkillers. It intensifies under the influence of external stimuli (noise, sharp sound, bright light).

Other symptoms of serous meningitis of viral etiology are:

• nausea;
• repeated vomiting that does not bring relief;
• hyperesthesia (general and cutaneous), i.e. increased sensitivity to irritants.

Patients tend to lie in a darkened and quiet room, avoiding unnecessary head movements. To alleviate the condition, they take a forced pose, called the “pointing dog pose” (lying on its side, head thrown back as much as possible, arms and legs bent at the joints and pressed forcefully to the body).

Viral serous meningitis in adults and children is in many cases accompanied by the appearance of a symptom complex characteristic of ARVI (sore throat, cough, nasal congestion, conjunctivitis).

When the cranial nerves are damaged, the following appear:

• drooping upper eyelid;
• difficulty swallowing;

A characteristic symptom of serous meningitis is severe rigidity (tension) of the muscles of the back of the neck, due to which the patient cannot reach the chin with the sternum.

Patients may experience drowsiness and mild daze. More severe disturbances of consciousness, such as stupor or coma, are not typical for serous meningitis and, if present, a different diagnosis should be considered.

In children, due to the disease, a tearful and capricious state develops, and convulsions may occur. When the fontanelles are not closed, their bulging is clearly visible. If a child is lifted by the armpits and held in weight, he bends his legs at the knee and hip joints, pulling them towards his stomach. This phenomenon is called the hanging sign or Lessage sign.

Some types of serous meningitis have a special clinical picture; we will consider them separately.

Acute lymphocytic choriomeningitis

In this form, not only the pia mater, but also the plexuses of blood vessels of the ventricles of the brain are drawn into the serous inflammatory process. The incubation period lasts from 6 to 13 days. In about half of patients, the onset of the disease is gradual. There is general malaise, pain and sore throat, nasal congestion, and body temperature rises. The manifestation of symptoms of serous meningitis occurs only at the time of the second wave of increased body temperature. In the other half of patients, the disease occurs suddenly with a sharp increase in body temperature, cephalalgia (headache), severe intoxication and the appearance of symptoms characteristic of serous meningitis.

Tuberculous meningitis

Serous meningitis, the causative agent of which is Koch's bacillus, occurs in patients suffering from tuberculosis of various locations (lungs, genitals, kidneys, larynx). It has a subacute character. Tuberculous meningitis begins with a prodromal period, which lasts up to 15-20 days. Characteristic for him:

• decreased appetite;
• low-grade fever (37.5–38 °C);
• moderate headache;
• increased sweating;
• general weakness;
• decreased physical and mental performance.

Meningeal symptoms develop gradually. Some patients experience mild ptosis, mild strabismus, and decreased visual acuity.

If specific anti-tuberculosis therapy is not carried out, then focal neurological symptoms (paresis, aphasia, dysarthria) appear over time.

Fungal meningitis in patients with HIV infection

Paramyxoviral serous meningitis is characterized by a rapid onset. In patients, body temperature quickly rises to high levels, intense headache occurs, nausea and vomiting appear, and pronounced meningeal syndrome develops. In addition, it is characteristic:

• seizures;
• paresis;
• ataxia (impaired coordination of movements);
• stomach ache;
• signs of damage to the cranial nerves.

The penetration of the mumps virus into other organs is accompanied by the development of adnexitis, orchitis, and pancreatitis.

Diagnostics

It is possible to assume that a patient has serous meningitis based on the characteristic clinical picture, especially the following signs:

• “cooper dog pose”;
• positive symptoms of Brudzinsky, Kerneg;
• muscle stiffness in the back of the neck;
• positive Lesage sign (in children of the first years of life).

To establish the cause that caused the development of the inflammatory process in the meninges, it is necessary to collect an anamnesis, paying attention to the characteristics of the onset of the disease and the presence of contact with sick individuals.

To identify the pathogen, virological studies are carried out using ELISA, RIF, PCR methods, and bacterial culture of discharge from the nose and throat is also performed.

Confirmation of the diagnosis of serous meningitis is possible based on the results of laboratory testing of cerebrospinal fluid. A sign of serous inflammation is an increased content of protein in the cerebrospinal fluid. With tuberculous and fungal meningitis, a decrease in glucose concentration is observed in the cerebrospinal fluid. The predominance of neutrophils in the cerebrospinal fluid is characteristic of bacterial serous meningitis, but if the disease has a viral etiology, then lymphocytes predominate.

In syphilitic and tuberculous serous meningitis, pathogens are identified by microscopy of cerebrospinal fluid smears stained in a special way.

Additional diagnostic methods include ophthalmoscopy, RPR test (diagnosis of syphilis), tuberculin tests, ECHO-EG, MRI of the brain, electroencephalography.

Serous meningitis must be differentiated from subarachnoid hemorrhage, arachnoiditis, tick-borne encephalitis, purulent meningitis of meningococcal, pneumococcal or any other etiology.

Treatment of serous meningitis

If serous meningitis is suspected, the patient is hospitalized. In the hospital, etiotropic therapy is started. For herpetic meningitis, acyclovir is prescribed; for other types of viral meningitis, interferons are prescribed. If the patient has a reduced immune response, then immunoglobulin is used simultaneously with antiviral drugs.

Identifying the causative agent of serous meningitis requires some time. Therefore, after collecting material for bacterial culture, the patient begins to be administered broad-spectrum antibiotics.

Treatment of serous meningitis caused by mycobacterium tuberculosis is carried out with anti-tuberculosis drugs.

In addition, syndromic therapy is carried out. Non-steroidal anti-inflammatory drugs are used to reduce body temperature. With increased intracranial pressure, diuretics are prescribed for the purpose of dehydration. Relief of convulsive syndrome requires the use of valproic acid and tranquilizers. In case of severe intoxication syndrome, detoxification therapy is necessary.

To protect brain cells from damage, it is necessary to use neurotropic and neuroprotective drugs (pig brain hydrolyzate, B vitamins, nootropics).

Possible complications and consequences of serous meningitis

After serous meningitis, some patients continue to have the following symptoms for several months:

• headaches;
• decreased concentration.

Gradually these phenomena pass.

The inflammatory process in serous meningitis does not lead to cell necrosis and is not complicated by purulent melting of tissue. Therefore, this disease, unlike purulent meningitis, has a more favorable prognosis.

The consequences of serous meningitis of tuberculous etiology can be much more serious. Untimely initiation of specific therapy for the disease leads to chronicity of the inflammatory process; in severe cases, patients die 23-25 ​​days from the onset of the first symptoms.

Forecast

Timely treatment of serous meningitis ensures rapid improvement in the condition of patients. The average duration of the disease is 10–14 days. In most cases, serous meningitis ends in complete recovery.

Prevention

Prevention of the development of serous meningitis includes:

• healthy lifestyle (eating properly, playing sports, giving up bad habits);
• vaccination against tuberculosis, measles, mumps;
• adequate treatment of infectious diseases;
• compliance with personal hygiene requirements.

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One of the serious infectious diseases is meningitis. It can be primary or occur against the background of other inflammatory processes. The disease most often affects children, but infection of the adult population is possible. One form of inflammation of the membranes of the brain is serous meningitis. Most often it is caused by viral agents.

The disease is characterized by the development of inflammation of the meninges with the formation of serous exudate. Unlike purulent meningitis, the pathology in most cases is milder. However, this does not exclude serious complications of the disease if treatment is untimely or inadequate.

The main symptoms of meningitis include intoxication and severe headache. If pathology is detected, hospital treatment is required.

History of the study of the disease

The first mentions of serous meningitis are found in ancient sources. A similar disease was described by scientists such as Hippocrates and Avicenna. Robert Witt published a complete clinical picture of the pathology in his works. He described the disease in detail using the example of tuberculous meningitis, which is one of the types of serous inflammation of the meninges. Robert Witt told the world about this disease in the 18th century. At that time, treatment of this pathology was impossible due to the lack of necessary medications. In the 19th and 20th centuries, there were several epidemic outbreaks of viral meningitis in the Americas, Europe and Africa.

The etiology of the disease was unknown for many years. For this reason, only symptomatic treatment was carried out. The first suggestion about a possible etiological factor was made by the scientist Weikselbaum. He associated the pathology with infection of the meninges by bacterial agents. However, his assumption was wrong. In the 20th century, doctors from the famous Obukhov Hospital were actively studying the etiology of this disease. In the second half of the 20th century, a connection between meningitis and viral particles was established. To date, many causative agents of serous inflammation of the meninges are known.

Causes

The etiological factors for the development of serous meningitis include infection of the membranes of the brain by various pathogens. In most cases, these include viruses. However, serous inflammation can also be provoked by certain types of bacteria, as well as pathogenic fungi. Infectious agents penetrate the meninges in various ways. The most common of them is the hematogenous route.

The causative agents of serous inflammation of the meninges include the following microorganisms:

• Enteroviruses. They are represented by several groups. The most common include Coxsackie and ECHO.
• Epstein-Barr virus. This is a rather dangerous pathogen that causes various pathologies, in particular infectious mononucleosis and lymphoma.
• Measles and mumps virus. In these cases, meningitis is a complication of an infectious disease.
• Herpes simplex viruses and CMV. These infections lead to the development of serous inflammation of the meninges in people with reduced immunity.
• Adenoviruses often affect children.
• Koch's stick. In most cases, meningitis occurs in the disseminated form of tuberculosis.
• Treponema pallidum. Serous inflammation of the meninges is a complication of long-term syphilis.
• Fungi of the genus Candida. They are opportunistic microorganisms and lead to the development of meningitis only in cases of severe immunodeficiency.

Viruses enter the central nervous system through the hematogenous route

In addition to the listed pathogens, inflammation of the meninges can be caused by benign formations (cysts), oncological and systemic pathologies. In most cases, meningitis is a complication of other diseases. Primary serous inflammation of the meninges is diagnosed less frequently than secondary. Identifying the cause of meningitis is important for choosing treatment options.

Transmission routes

The route of penetration of viruses into the membranes of the brain can be different. The period of time when the pathogen has already penetrated, but specific manifestations of the disease have not yet been observed, is called the incubation period. For viral meningitis it lasts from 2 to 4 days.

There are 3 routes of infection:

• Contact.
• Water.
• Airborne.

Infection through contact is possible if hygiene is not observed. In sick people, viruses are found on the mucous membranes and skin, wound surfaces, and in the oral cavity. From open areas of the body, pathogens reach household items and food products. As a result of this, they can easily enter the body of healthy people. The likelihood of contracting the virus increases if there are scratches, wounds or cracks on the surface of the mucous membranes or skin. People with reduced immunity are most often infected.

The water route of infection predominates in the summer. Some viruses live in various rivers and lakes, causing outbreaks of meningitis epidemics. The infection is transmitted both by bathing and by drinking contaminated water. Most often, enteroviral meningitis pathogens enter the body this way.

Airborne infection is predominant in the cold season. Pathogenic viruses are localized on the mucous membranes of the nose and mouth. In people with normal immunity, these pathogens cause the common cold. However, with a decrease in the body's defenses, they can lead to the development of meningitis.

Classification of pathology

Depending on the pathogen, viral, fungal and bacterial serous meningitis are distinguished. A separate type of pathology is aseptic inflammation of the meninges. It is caused by various systemic diseases and tumors. This classification is based on the etiology of meningitis.

In origin, inflammation can be primary or secondary. More often, meningitis is a complication of infectious diseases, such as rubella, measles, mumps, influenza, etc. In some cases, infection of the meninges occurs immediately, that is, primary inflammation occurs.

Symptoms of the disease

Intoxication, cerebral symptoms and focal manifestations correspond to serous meningitis in adults. First of all, general weakness and increased body temperature develop. Intoxication is accompanied by headache, body aches, and decreased ability to work. These symptoms appear during the incubation period and last for several days, sometimes weeks. General cerebral manifestations are characterized by severe headache. As a result of pressing and bursting unpleasant sensations, fear of light and noise appears.

With meningitis developing against the background of an acute respiratory viral infection, general cerebral symptoms are preceded by a runny nose, sore throat, nausea, conjunctivitis or pain when swallowing. As the general condition worsens, it becomes easier for the patient to stay in a dark and quiet room. Any irritants cause increased headaches.

To alleviate the condition, a person takes a specific pose. His legs are pressed to his stomach, his arms are to his chest, and his head is thrown back. This body position is called the “pointing dog pose.”

In some cases, focal symptoms are detected. They develop due to irritation of the brain by inflamed membranes. Manifestations depend on the affected area. These include: visual or hearing impairment, decreased sensitivity in the body, paresis of the limbs. Sometimes a convulsive syndrome develops.

Specific signs include meningeal symptoms. With serous inflammation they may be mild. Typical symptoms include neck stiffness and Kernig's sign. An increase in the tone of the cervical muscles is detected with the patient lying on his back. The patient is asked to press his head to his chest. If the muscles are stiff, the patient cannot perform this movement.

To check for Kernig's sign, the patient is placed on his back. One leg must be bent at the knee and hip joints. The symptom is positive if there is excessive muscle tension. It reaches such force that a person cannot straighten his leg. Brudzinski's symptoms in serous meningitis may be absent or mildly expressed.

Features in children

Characteristic signs of inflammation of the meninges in children are an increase in body temperature up to 40 degrees, refusal to breastfeed, constant crying, headache, aggravated by touch, noise and bright light. The child may experience nausea, vomiting and diarrhea. Unlike adults, children have more pronounced dyspeptic syndrome. Consciousness may be impaired. Most often it is stupor or stupor.

The distinctive symptoms of serous meningitis in young children are bulging of a large fontanel and convulsions against a background of high fever. If you lift the baby by the armpits in a vertical position, you will notice that he reflexively presses his legs to his stomach. This indicates a positive Lessage sign.

Meningitis is often preceded by catarrhal symptoms

Serous viral meningitis in children of the first year of life can be complicated by encephalitis and hydrocephalus. Subsequently, these pathologies lead to mental retardation. Such consequences do not occur if antiviral therapy is carried out in a timely manner.

Certain forms of the disease

Specific forms of the disease include acute lymphocytic choriomeningitis, inflammation caused by Mycobacterium tuberculosis, mumps virus and fungi. These types of pathology have a longer incubation period and characteristic features. Acute lymphocytic choriomeningitis develops within 1–2 weeks. In some cases, symptoms may masquerade as the flu or a common viral upper respiratory tract infection. This form of meningitis is characterized not only by damage to the membranes, but also to the vessels located in the ventricles of the brain. There is damage to the cranial nerves and hypertensive-hydrocephalic syndrome. Other organs, such as the heart, lungs, and kidneys, are also subject to inflammation. Another name for the pathology is Armstrong's disease. The virus is transmitted by mice.

Meningitis of tuberculous etiology may have a chronic course. If left untreated, it leads to irreversible changes in the nervous system. In addition to specific symptoms, cough, sweating, and weight loss are noted. The incubation period lasts up to 3 weeks.

Fungal meningitis more often occurs against the background of HIV infection or primary immunodeficiencies. A feature of this form of pathology is the blurred clinical picture. The body temperature does not exceed subfebrile values, the headache is mild, and there are no muscle symptoms. There is general weakness, drowsiness, and lethargy.

Meningitis due to mumps in most cases it develops 1–3 weeks after the infection manifests itself. It is more often observed in the male population. A pronounced clinical picture with a predominance of neurological symptoms and intoxication is characteristic.

Diagnostics

If meningitis is suspected, blood and urine tests are performed, the general condition and the presence of specific muscle symptoms are assessed. The main material for research is cerebrospinal fluid. It should have a transparent or opalescent color. Lymphocytes predominate. Purulent meningitis, unlike serous meningitis, is characterized by an increase in the number of neutrophils.

In addition to the analysis of cerebrospinal fluid, swabs from the throat and nose, and serological tests are carried out. For differential diagnosis, echoEG, electroencephalography, and MRI of the brain are performed.

Study of Kernig's sign

Treatment of the disease

Timely initiation of therapy will help improve the prognosis of the pathology and avoid complications. It includes the prescription of antiviral, analgesic, diuretic and immunomodulatory drugs. Treatment is carried out in an infectious diseases hospital. After the cerebrospinal fluid has been examined and serological diagnostics have been carried out, etiotropic therapy can be selected. For viral infections, these are drugs containing interferon. If meningitis is a complication of herpes, Acyclovir is prescribed.

All patients are administered saline solutions to reduce intoxication. They cannot be infused in large quantities due to the risk of cerebral edema. To reduce body temperature, antipyretic medications are used - Ibufen, Paracetamol. For tuberculous etiology of meningitis, specific treatment with antibiotics is necessary.

Complications of pathology

Possible consequences of serous meningitis are inflammation of the brain (encephalitis), hydrocephalus, and cerebral edema. In severe cases they can be fatal. If proper treatment is not carried out, the patient develops complications such as hearing loss, blurred vision, systematic headaches, and cramps of certain muscle groups. Young children may develop physical or mental retardation.

Forecast for life

Most often, the prognosis for serous viral meningitis is favorable. The effectiveness of therapy is noticeable already on days 3–4. On average, the course of treatment lasts about 2 weeks. In most cases, there is complete recovery and no complications.

An exception may be tuberculous and fungal meningitis. These forms of pathology require long-term treatment. Inadequate therapy can lead to the death of the patient. These forms of inflammation are characterized by relapses.

Disease prevention

To avoid the development of meningitis, nonspecific prophylaxis has been developed. It consists of supporting the immune system with the help of vitamin therapy, hardening, and maintaining a healthy lifestyle. During outbreaks of infection, places where large numbers of people gather should be avoided. If viruses are detected in bodies of water, swimming in it is prohibited. Children should be warned about hand hygiene and the need to wash fruits and vegetables.

Serous meningitis is a polyetiological disease that is characterized by inflammation of the membranes of the brain and spinal cord of a non-purulent nature.

The main feature of serous meningitis is the non-purulent nature of the exudate (lymphocytes predominate in the cerebrospinal fluid). They are characterized by a milder course and a more favorable prognosis for recovery.

Classification of serous meningitis

Depending on the agent that caused the disease, serous meningitis is divided into several types:

• caused by viruses, that is, viral. The main “culprits” are the Coxsackie and Echo viruses;
• caused by bacteria, that is, bacterial. The causes are pathogens that cause syphilis and tuberculosis;
• caused by fungi. So-called opportunistic infections: fungi of the genus Candida, Coccidioides immitis.

Depending on the origin, serous meningitis is divided into:

• primary (the agent directly caused damage to the meninges, for example, enteroviruses);
• secondary (as a complication of another infection: measles, influenza meningoencephalitis, etc.).

How do people usually get this disease? I would like to note that this pathology is more common in children, and among adults it mainly affects people with immunodeficiency. The incubation period takes on average several days. Seasonality is also characteristic: summer season. The following routes of infection are distinguished:

• airborne (the pathogen is in the patient’s respiratory tract and is transmitted by coughing, sneezing, or talking);
• contact (pathogenic agents, being on the mucous membranes, land on various objects, therefore, without adhering to the rules of personal hygiene, you can become infected and get sick);
• water (outbreaks of enterovirus infection are most often recorded in the summer, when swimming in open water).

Symptoms of enteroviral serous meningitis

The disease debuts with fever and severe headache.

After a short prodromal period, a high body temperature of up to 40 degrees C and general signs of intoxication appear in the form of severe general weakness, pain in muscles and joints, and malaise. The patient is also worried about abdominal pain, bloating, and upset stool. The disease progresses in waves; after a slight decrease in temperature, a repeat suppository may be performed on the 4th day. If a mild course is observed, then on the 5th day the body temperature normalizes. Throughout this time, the patient is bothered by a constant intense bursting headache, which intensifies with the slightest movements. At the peak of the headache, vomiting is possible, which does not bring relief, and hallucinations are possible. Due to hyperesthesia (increased sensitivity to the slightest irritants), it is easier for the patient to be in a darkened, quiet room or to wrap his head in a blanket. Bright lights, loud sounds, and touching make headaches worse. Serous meningitis is much easier than purulent meningitis, so there are no pronounced disorders of consciousness, the patient may be stunned. Clinical examination reveals positive meningeal syndrome, as well as Kernig and Brudzinski syndromes.

Lymphocytic choriomeningitis

This disease is also called Armstrong's meningitis. Not only the meninges are involved in the inflammatory process, but pneumonia, myocarditis, and mumps are also observed. Infection occurs from domestic mice. The disease occurs more often in the winter-spring period of the year. The process also involves the choroid plexuses of the ventricles of the brain, which ultimately leads to hypertensive-hydrocephalic syndrome. The disease begins abruptly, with increased body temperature, vomiting, and headache. The patient experiences severe agitation and often experiences visual and auditory hallucinations. Neurological symptoms may include unstable damage to the optic, auditory, and sometimes abducens and oculomotor nerves. After 10 days, the patient's condition improves significantly, but the headache may persist for several more weeks.

Secondary serous meningitis can develop with influenza, herpes, and measles.

Diagnosis of serous meningitis

The presence of meningeal syndrome alone does not allow verification of the diagnosis. With any type of cerebral edema, the phenomena of meningism are observed. To confirm the diagnosis, data from the medical history, examination of the patient, clinical and laboratory examination data, as well as the diagnosis of lumbar puncture (puncture of cerebrospinal fluid) are taken into account. Serous cerebrospinal fluid is characterized by transparency and a predominance of lymphocytes. In controversial cases, a CT examination is performed according to indications, and the most accurate are PCR and ELISA, which are related to rapid diagnostics.

Serous meningitis is one of the serious diseases of the brain, characterized by inflammation of its membranes. Usually the cause is a viral infection or the proliferation of bacterial and fungal flora, but most of the recorded cases of this disease were caused by viruses. Most often it is recorded in children of primary school and preschool age.

It usually begins with symptoms characteristic of purulent inflammation of the meninges - nausea and vomiting, headache. The main difference between this form of the disease and all others is that inflammation develops sharply, but does not become a violent clinic. Rather, it occurs in a mild form, without disturbing the clarity of consciousness and passes without meningeal complications.

The diagnosis is established by clinical manifestations and data from bacteriological analysis of cerebrospinal fluid and PCR analysis.

Treatment is aimed at eliminating the pathogen and alleviating the general condition - prescribing painkillers, antipyretics, and antivirals. If, according to the treatment plan, the patient’s condition does not stabilize, additional antibacterial drugs belonging to broad-spectrum antibiotics are prescribed.

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ICD-10 code

A87.8 Other viral meningitis

Causes of serous meningitis

The causes of serous meningitis can be very diverse. Based on their form, they distinguish between primary and secondary. With primary inflammation, the painful condition is an independent process. With a secondary manifestation, it occurs as a complicated course of an existing disease of an infectious or bacterial nature.

Symptoms of serous meningitis

Symptoms of serous meningitis at an early stage are similar to a cold - fatigue, irritability, passivity appear, the temperature rises, and an unpleasant, raw sensation in the throat and nasopharynx. At the next stage, the temperature jump occurs - it rises to 40 degrees, the condition worsens, a severe headache appears, accompanied by dyspeptic disorders, muscle spasms, and delirium. Key manifestations of inflammation:

• positive reaction with Brudzinsky's test;
• "brain" vomiting;
• impaired muscle activity of the limbs, difficulty swallowing;
• significant hyperthermia - 38-40 degrees.

On days 5-7 from the onset of the disease, the symptoms may become weaker and the fever decreases. This period is the most dangerous, since if treatment is interrupted at the first sign of recovery, meningitis may develop again. A relapse is especially dangerous, as it can be accompanied by severe, persistent brain damage and pathologies of the nervous system. The nature of the pathogens can be confirmed using virological and serological examination of blood and cerebrospinal fluid.

The incubation period of serous meningitis lasts from the moment the pathogen enters the nasopharyngeal mucosa until the first signs of the disease appear. This can take a period of time from two to five days, but the timing largely depends on the nature of the pathogen and the resistance of the person’s immune system. In the prodromal stage, the disease is manifested by a decrease in general tone, headaches, a slight increase in temperature and the course is more similar to ARVI. In the incubation stage, a person is already a carrier of the pathogen and releases it into the environment, therefore, when the diagnosis is confirmed, it is necessary to isolate everyone who had contact with the patient as soon as possible.

But very often, serous inflammation of the brain begins acutely - with high fever, vomiting, and almost immediately characteristic symptoms of inflammation of the meninges appear:

• the appearance of stiffness in the neck muscles;
• positive reaction with the Kernig test;
• positive reaction with Brudzinski's test.

The prognosis is generally favorable, but in rare cases there are complications - visual impairment, hearing impairment, and persistent changes in the central nervous system. The first days after confirmation of the diagnosis, increased levels of lymphocytes are observed. A few days later - moderate lymphocytosis.

How is serous meningitis transmitted?

Inflammation of the meninges or meningitis develops rapidly. The main reason is representatives of the enterovirus group. You can easily become infected or become a carrier of the virus in the following situations:

• Contact infection. Bacteria and microorganisms enter the body with dirty food - fruits and vegetables with dirt particles, when drinking water that is not suitable for drinking, and when personal hygiene rules are neglected.
• Airborne infection. Infectious agents enter the mucous membranes of the nasopharynx upon contact with an already sick person or a carrier of the virus. Most often, pathogens are first released by patients into the environment, and then settle on the nasal and pharyngeal mucosa of a healthy person.
• Water route of infection. Possible when swimming in dirty waters, when the risk of ingesting contaminated water is high.

Serous inflammation of the lining of the brain is especially dangerous for children in the first year of life - during this period, exposure to infectious agents has such a detrimental effect on the children's brain and nervous system that it can cause mental retardation and partial impairment of visual and auditory functions.

Acute serous meningitis

It develops when enteroviruses enter the body, as well as viruses that cause mumps, lymphocytic choriomeningitis, herpes simplex type 2, and tick-borne encephalitis. With the viral etiology of this disease, a bacteriological examination of blood and spinal fluid will not give positive data; the manifestation of lymphocytic pleocytosis is diagnosed, the content is slightly higher than normal.

The clinical picture of the disease differs from the picture of the purulent form. The course of the disease is milder, manifested by headaches, pain when moving the eyes, spasms in the muscles of the arms and legs (especially flexors), positive Kernig and Brudzinski symptoms. In addition, the patient is bothered by vomiting and nausea, pain in the epigastric region, against the background of which physical exhaustion develops and photophobia develops. Persistent disturbances of consciousness, epileptic attacks, focal lesions of the brain and cranial nerves are also not recorded.

Acute serous meningitis does not cause severe complications and is easily treated, recovery occurs on the 5th-7th day of illness, but headaches and general malaise can last from several weeks to several months.

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Secondary serous meningitis

Meningoencephalitis occurs with concomitant viral conditions caused by mumps virus, herpes virus, etc. Most often, the cause of this process is mumps. It manifests itself like acute meningitis - the temperature rises, severe pain in the head, eyes water from the light, nausea, vomiting, pain in the stomach. The main role in diagnosing confirmation of damage to the meninges is played by a positive Kernig and Brudzinsky reaction, accompanied by stiffness of the neck muscles.

Serious changes are recorded only in moderate and severe forms of the disease, but in general, the secondary form of inflammation of the meninges goes away quite easily. More severe cases are characterized by a proliferative phenomenon not only of the salivary glands and meninges, but also by pancreatitis, inflammatory processes in the testicles. The course of the disease is accompanied by fever, basic cerebral symptoms, dyspeptic disorders, laryngitis, pharyngitis, and sometimes a runny nose. After 7-12 days, with a mild course, the general condition improves, but for another 1-2 months a person can be a carrier of the pathogen and pose a danger to others.

Viral serous meningitis

It is considered one of the most common uncomplicated forms of this disease. Caused by coxsackie viruses, mumps, herpes simplex, measles, enteroviruses and sometimes adenoviruses. The onset of the disease is acute, beginning with a sharp increase in temperature, painful sensations in the throat, sometimes a runny nose, dyspeptic disorders, and muscle spasms. In severe cases - clouding of consciousness and diagnosing stupor, coma. Signs of meningeal syndrome appear on the second day - rigidity of the neck muscles, Kernig syndrome, Brudzinski syndrome, increased blood pressure, very severe headaches, cerebral vomiting, pain in the abdomen. The analysis of spinal fluid shows a pronounced form of cytosis and many lymphocytes.

The prognosis for almost all adults with viral non-purulent inflammation of the meninges is favorable - complete recovery occurs in 10-14 days. In just a few cases of the disease, survivors suffer from headaches, hearing and vision disorders, poor coordination and exhaustion. Children in the first year of life may develop persistent developmental dysfunctions - minor mental retardation, lethargy, decreased hearing and vision.

Enteroviral serous meningitis

This is a type of meningitis caused by the Coxsackie and ECHO viruses. It can be either a single recorded case of infection or it can be in the nature of an epidemic. Most often, children become infected with it in the summer and spring, and the epidemic spreads especially quickly in communities - in kindergartens, schools, and camps. You can become infected from a sick person or child, as well as from a healthy carrier; this type of inflammation of the meninges spreads mainly through airborne droplets or when hygiene rules are not followed.

After the viral agent enters the body, within a day or three the first signs appear - redness and swelling of the pharynx, enlarged lymph nodes, abdominal pain and diffuse pain, and a rise in temperature. The disease moves to the next stage when the pathogen penetrates directly into the blood and, spreading through the bloodstream, concentrates in the nervous system, which leads to an inflammatory process in the lining of the brain. At this stage, meningeal syndrome becomes pronounced.

The course of the disease in general dynamics rarely entails severe complications. On the second or third day, the brain syndrome disappears, but on days 7-9 of illness, the clinical symptoms of serous inflammation may return and the temperature may also rise. In children under one year of age, the process is sometimes accompanied by the formation of inflammatory foci of the meningeal membranes of the spinal cord and persistent damage to the central nervous system.

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Serous meningitis in adults

It proceeds quite easily and does not cause serious complications. Its causes are viral agents, bacteria and fungi; primary inflammation of the meninges is caused by the Coxsackie virus, Echo enterovirus. Secondary cases are caused by the virus that causes polio, mumps, and measles.

In adulthood, viral inflammation occurs in an uncomplicated form, but this does not mean that this form does not require treatment. The onset is similar to a cold - headache, swollen throat, muscle pain and dyspeptic symptoms, meningeal syndrome and, in severe cases, convulsions. By the end of the first week of illness, the temperature is fixed at a normal level, muscle spasms and headaches are not disturbing. This stage requires special observation, since the likelihood of relapse increases, and the first signs of pathologies of the central nervous system and intracranial nerves may appear.

The most effective way to identify the pathogen is a serological and bacteriological analysis of blood and spinal fluid, PCR. After this, specific antibacterial and antiviral treatment is prescribed in combination with antipyretic, antiemetic, analgesic and sedative drugs.

Serous meningitis in adults is treatable, and the earlier it is started, the lower the risk of the disease returning and developing complications.

Serous meningitis in children

It is more severe than in adults and, if not treated promptly, can lead to serious complications. The incubation period lasts about 2-4 days; those who attend events with large concentrations of children of different ages - school and preschool institutions, clubs, various sections, camps - get sick more often. The root cause of the disease are viruses that cause measles, mumps, herpes, various enteroviruses, etc. At first, inflammation of the lining of the brain is similar to other forms of meningitis - it also suffers from severe headaches, dyspeptic disorders, and cerebral syndrome manifests itself. The main difference between the viral form and others is the sudden, acute onset of the disease, with relatively clear consciousness.

The diagnosis is confirmed by PCR and analysis of spinal cerebrospinal fluid. After determining the nature of the pathogen, a treatment plan is prescribed - for a viral etiology, a course of antiviral drugs is prescribed, if other pathogens are identified, antibiotics and antifungal drugs are prescribed. In addition to eliminating the cause of inflammation of the meninges, therapeutic measures are aimed at alleviating the general condition - for this, antipyretic, analgesic, antiemetic, and sedative medications are prescribed.

Serous meningitis in children ends quite quickly and without complications, but it is dangerous for babies in the first year of life.

Complications of serous meningitis

Complications of serous meningitis for an adult pose minimal danger, but for children in the first year of life they are especially dangerous. Most often, the consequences of inflammation of the meninges make themselves felt when the course is aggravated, due to unqualified drug therapy or non-compliance with medical prescriptions.

Disorders that occur during severe inflammatory pathology of the meninges:

• Impaired functioning of the auditory nerve - hearing loss, dysfunction of motor coordination.
• Weakening of visual function - decreased acuity, strabismus, uncontrolled movements of the eyeballs.
• Decreased vision and motor activity of the eye muscles are completely restored, but persistent hearing impairment is mostly irreversible. The consequences of meningeal pathology suffered in childhood later manifest themselves in intellectual delay and hearing loss.
• Development of arthritis, endocarditis, pneumonia.
• Threat of strokes (due to obstruction of cerebral vessels).
• Epileptic seizures, high intracranial pressure.
• Development of cerebral and pulmonary edema, leading to death.

If you seek qualified medical help in a timely manner, severe systemic changes can be avoided and there will be no relapses during treatment.

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Consequences of serous meningitis

The consequences of serous meningitis, subject to treatment and proper rehabilitation after recovery, are expressed only in half of all cases of the disease. Basically, they manifest themselves in general malaise, headaches, decreased memory and memorization speed, and sometimes involuntary muscle spasms appear. In complex forms, the consequences will be more serious, including partial or complete loss of the ability to see and hear. Such violations are observed only in isolated cases and with timely organized drug therapy this can be easily avoided.

If the disease occurred as a complicated course of another disease, then the person who has recovered from the disease will be more concerned about the problems that were associated with the root cause. Regardless of what form a person is ill with (primary or secondary), treatment measures should begin immediately. Basically, antibacterial, antifungal and antiviral drugs are used for this, as well as a complex of drugs for symptomatic therapy and alleviation of the general condition.

After suffering a pathological condition, a person requires special care and gradual recovery - this is a vitamin nutrition program, moderate physical activity and activities aimed at the gradual restoration of memory and thinking.

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Diagnosis of serous meningitis

Diagnosis is carried out in two directions - differential and etiological. For etiological differentiation, they resort to the serological method - RSC, and the neutralization reaction also plays an important role in isolating the pathogen.

As for the distinctive diagnosis, its conclusion depends on clinical data, epidemiological summary and virological conclusion. When diagnosing, pay attention to other types of disease (tuberculosis and inflammation of the meninges caused by influenza, mumps, polio, Coxsackie, ECHO, herpes). Due attention is given to confirming meningeal syndrome:

1. Rigidity of the neck muscles (the person cannot touch the chin to the chest).
2. Positive Kernig test (with the leg bent at 90 degrees at the hip and knee joint, a person cannot straighten it at the knee due to hypertonicity of the flexors).
3. Positive result of the Brudzinski test.

Consists of three stages:

• A person cannot press his head to his chest - his legs are pulled towards his stomach.
• If you press on the area of ​​the pubic fusion, the legs bend at the knees and hip joints.
• When checking the Kernig symptom on one leg, the second involuntarily bends at the joints simultaneously with the first.

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Liqueur for serous meningitis

Liqueur in serous meningitis has an important diagnostic value, since the nature of its components and the results of bacteriological culture can make a conclusion about the causative agent of the disease. Cerebrospinal fluid is produced by the ventricles of the brain; normally its daily volume is no more than 1150 ml. To take a sample of biomaterial (CSF) for diagnosis, a special manipulation is performed - lumbar puncture. The first milliliters obtained are usually not collected because they contain blood. The analysis requires several milliliters of CSF collected in two test tubes - for general and bacteriological examination.

If there are no signs of inflammation in the collected sample, then the diagnosis is not confirmed. With non-purulent inflammation, leukocytosis is observed in the punctate; the protein is usually slightly elevated or normal. In severe forms of pathology, neutrophilic pleocytosis is recorded and the content of protein fractions is significantly higher than acceptable values; when punctured, the sample flows out not drop by drop, but under pressure.

Liquor not only helps to accurately differentiate from other forms of this disease, but also to identify the pathogen, severity, and select antibacterial and antifungal drugs for therapy.

Differential diagnosis of serous meningitis

Differential diagnosis of serous meningitis is aimed at a more detailed study of the patient’s medical history, current symptoms and serological conclusion. Despite the fact that the meningeal complex is characteristic of all types of inflammation of the meninges, in some of its forms significant differences are observed. With a viral etiology, general meningeal manifestations may be mild or absent altogether - moderate headache, nausea, pain and cramping in the abdomen. Lymphocytic choriomeningitis is characterized by violent symptoms - severe headaches, repeated cerebral vomiting, a feeling of squeezing in the head, pressure on the eardrums, pronounced spasm of the neck muscles, a pronounced Kernig and Brudzinsky sign; during a lumbar puncture, cerebrospinal fluid flows out under pressure.

The pathological process caused by the polio virus is accompanied by signs characteristic of this disease - Lasegue, Amossa, etc. During EMS, cerebrospinal fluid flows out under slight pressure. Often the disease is accompanied by nystagmus (due to damage to the medulla oblongata).

The tuberculous form, unlike the serous one, develops slowly and occurs in people suffering from chronic tuberculosis. The temperature rises gradually, the general condition is sluggish and depressed. Spinal puncture contains a lot of protein, the presence of Koch's bacillus is determined, and the collected material is covered with a specific film over time.

Differential diagnosis is mainly based on virological and immunological examination of CSF and blood. This provides the most accurate information about the nature of the pathogen.

Treatment of serous meningitis

Treatment of serous meningitis requires special attention. Depending on what tactics will be taken in the first days of the disease, the further prognosis of medical prescriptions depends. Drug therapy for non-purulent inflammation of the meninges is carried out in a hospital - this way the person receives the necessary care and can observe all changes in well-being and carry out the necessary diagnostic manipulations.

Prescription largely depends on the severity of pathological changes, the nature of the pathogen and the general condition of the patient. According to the study of CSF and PCR, specific therapy is prescribed - for the viral form, these are antiviral drugs (Acyclovir, etc.), for the bacterial form, broad-spectrum antibiotics or specific antibacterial drugs (Ceftriaxone, Meropenem, Ftivazid, Chloridine, etc.), and also antifungal (Amphotericin B, Fluorocytosine), if the identified pathogen belongs to the group of fungi. Measures are also being taken to improve the general condition - detoxification medications (Polysorb, Hemodez), painkillers, antipyretics, antiemetics. In some cases, when the course of the disease is accompanied by high blood pressure, diuretics and sedatives are prescribed. After complete recovery, a course of rehabilitation is carried out, including exercise therapy, myostimulation, electrophoresis, and psychorehabilitation is also required.

Treatment can be carried out at home, but only if the disease is mild, and the patient’s well-being and compliance with the principles of medication prescriptions are monitored by an infectious disease specialist.

Treatment of serous meningitis in children requires special attention and a responsible attitude towards compliance with all medical prescriptions. In childhood, this disease is often accompanied by complications; it is especially dangerous for babies in the first year of life, when the consequences are persistent and can cause mental retardation, hearing loss, and poor vision.

Most of the recorded cases of non-purulent inflammation of the meninges are caused by viruses, so antibacterial therapy does not give the desired result. Acyclovir, Arpetol, Interferon are prescribed. If the child’s condition is severe and the body is weakened, immunoglobulins are administered intravenously. In case of significant hypertension, diuretics are additionally prescribed - Furosemide, Lasix. In severe forms, when the disease is accompanied by severe intoxication, glucose, Ringer's solution, Hemodez are injected intravenously - this promotes the adsorption and elimination of toxins. For severe headaches and high blood pressure, a spinal tap is performed. The rest of the treatment measures are symptomatic - antiemetics, painkillers, antipyretics, and vitamins are recommended.

Treatment, subject to the doctor's instructions, ends with recovery after 7-10 days and is not accompanied by long-term complications.

Prevention of serous meningitis

Prevention of serous meningitis is aimed at preventing the causative agent of this disease from entering the body. General preventative rules should include:

• Measures prohibiting swimming in polluted water bodies in the summer and autumn.
• Drink only boiled, purified or bottled water from certified wells.
• Careful preparation of products for cooking, proper heat treatment, washing hands before eating and after visiting crowded places.
• Maintaining a daily routine, maintaining an active lifestyle, quality nutrition according to the body’s expenses. Additional use of vitamin complexes.
• During a seasonal outbreak, avoid attending mass performances and limit your circle of contacts.
• Carry out regular wet cleaning of the premises and treatment of the child’s toys.

In addition, the serous form of inflammation of the meninges can be secondary, which means that it is necessary to promptly treat chickenpox, measles, mumps, and influenza. This will help eliminate the risk of inflammation of the membranes of the brain and spinal cord, both in adults and in children. You should not neglect preventive rules, because it is easier to prevent infection than to treat it and recover from complications associated with it.

Prognosis of serous meningitis

The prognosis of serous meningitis has a positive trend, but the final result largely depends on the state of the patient’s immune system and the timing of seeking medical help. Non-purulent changes in the membranes of the brain most often do not cause persistent complications, are quickly treated and do not relapse on days 3-7 of the disease. But if the root cause of tissue degeneration is tuberculosis, without specific drug treatment the disease is fatal. Treatment of the serous form of tuberculous meningitis is protracted and requires inpatient treatment and care for six months. But if the instructions are followed, residual pathologies such as weakening of memory, vision and hearing disappear.

In childhood, especially in babies under one year of age, a non-purulent form of inflammation of the meninges can cause serious complications - epileptic seizures, visual impairment, hearing impairment, developmental delays, low learning ability.

In rare cases, after an illness, adults develop persistent memory disorders, decreased concentration and coordination, and regularly experience severe pain in the frontal and temporal parts. The disorders persist from several weeks to six months, after which, with proper rehabilitation, complete recovery occurs.