According to WHO (World Health Organization) statistics, infectious diseases of the brain and spinal cord occupy a leading position in the list of all diseases of the central nervous system. Ever since the time of Hippocrates and Avicenna, humanity has suffered from these diseases, which have successfully stepped into the age of progress and information technology. One such disease is meningitis.

What is meningitis?

The term meningitis comes from Latin, which in translation means "meninx" - the meninges, "itis" - an inflammatory process. Thus, meningitis is an inflammation of the meninges. Briefly try to deal with the anatomical and histological structure brain, meninges, and messages of some structures with others.

The human brain consists of a hard (duramater) and soft (piamater) meninges, between which there is an arachnoid membrane, separated from the soft shell by the subarachnoid space. All these shells communicate with each other with a special cerebrospinal fluid - cerebrospinal fluid. Liquor washes the structures and tissues of the brain and spinal cord, performing trophic, protective, excretory functions. With specific inflammation (serous reactive meningitis, purulent meningitis), the composition of the CSF will change accordingly. Based on the anatomical structure, the following forms are distinguished:

• Leptomeningitis - inflammation of the pia mater
• Pachymeningitis - inflammation of the dura mater
• Arachnoiditis - inflammation of the arachnoid

Meningitis is different

The doctor looks at the tomogram of the brain

Reactive meningitis is a type of meningitis.
Clinicians and WHO propose the following classification of meningitis:

1. By type of exciter:
   1. Bacterial (meningococcal, tuberculosis, staphylococcal, pneumococcal)
   2. Caused by fungi (candidiasis)
   3. Protozoan
   4. Viral (Coxsackie and ECHO enteroviruses, mumps)
2. The nature:
   1. Primary - self-inflammation of the membranes of the brain (neutropic agents aimed at damaging the nervous system)
   2. Secondary - as a complication against the background of a local infectious process or general infections
3. According to the method of entry:
   1. Airborne
   2. Lymphogenous (spread by lymphatic drainage)
   3. Perineural (along the path of the cranial nerves)
   4. Contact (for injuries, diseases of the upper respiratory tract)
   5. Hematogenous
4. By the nature of the inflammatory process:
   1. Serous
   2. Purulent
5. With the flow:
   1. Fulminant form (reactive meningitis)
   2. Acute
   3. subacute
   4. Chronic
6. By severity:
   1. Light
   2. Moderate
   3. heavy

What happens to the body "inside"?

Bacteria enter the human body and cause inflammation

As can be seen from the classification, an infectious agent can enter the body through the mucous membrane of the pulmonary system (bronchi, nasopharynx), gastrointestinal tract. Then the microorganism spreads by lymphogenous or hematogenous way, getting into the meninges. Locally, the invasion of an infectious agent almost immediately leads to swelling and inflammation of the meninges, increased secretion of cerebrospinal fluid and impaired outflow, which leads to hydrocephalic hypertension, irritation of the cranial nerves and meninges.

In the event that the infectious agent is a bacterium, a purulent infiltration of the meninges occurs, with an accumulation of lymphocytes and plasma cells. As a result, specific inflammatory mediators (prostaglandins, enkephalins, leukotrienes) are released, which contribute to the expansion of the vessels of the membranes and the accumulation of pus along the deep veins of the brain. The white matter of the brain becomes edematous, filled with blood. The subarachnoid space is filled with purulent-liquid content, which spreads throughout the brain and flows into its furrows.

What happens to the body "outside"?

The girl has a high temperature after infection

The clinical picture of reactive meningitis and its symptoms consist of the following components:

• infectious symptoms with reactive meningitis arise as a result of intoxication of the body with the waste products of an infectious agent. They include chills; fever (t> 37'C); muscle pain; tachycardia and tachypnea (increased heart rate and breathing); loss of appetite; change in the skin - a grayish or pale skin tone, with the generalization of the process and the transition to a state of sepsis, skin rashes in the form of vesicles and papules are possible; lethargy or restlessness; a change in the composition of the blood - an increased content of leukocytes and ESR. At reactive meningitis main symptoms in the first hours of the development of the disease, disturbed consciousness and convulsive seizures may appear, the lethality in their presence increases significantly.
• Cerebral symptoms:
  Presented by dizziness, headache, nausea, vomiting. Headache occurs as a result of damage to the sympathetic nervous system and irritation of the receptors of the meninges and cerebral vessels by the inflammatory process, the action of pathogen toxins and the mechanical action of the accumulated cerebrospinal fluid. Headache is characterized as sharp, intense, arching. The intensity of the headache increases when exposed to light, noise, tactile stimuli. Nausea and vomiting central genesis(associated with irritation of the n.vagus vomiting centers and the reticular formation), is not associated with food intake and does not bring relief. Psychomotor agitation or lethargy may be observed.
• meningeal symptoms

Reactive meningitis causes a violation of the tone of the muscles of the back of the head, which is manifested by an increase in muscle resistance when the head is bent to the chest - stiff neck.
In a severe form of meningitis, the following is detected:

• Kernig's sign - leg bent at the knee and hip joint, cannot be unfolded.
• The upper symptom of Brudzinksky - when the neck is bent, the legs are bent at the knee joint.
• The average symptom of Brudzinsky is flexion of the legs with pressure on the pubic joint.
• The lower symptom of Brudzinsky is flexion of the leg on the opposite side.
• Bekhterev's symptom is a pronounced pain syndrome when tapping on the zygomatic arch.
• The pose of the "pointing dog" - the head is extended as much as possible and the legs are bent to the stomach.
• Symptoms of liquor - increased pressure, cerebrospinal fluid flows out in a jet. Turbid cerebrospinal fluid - purulent meningitis, transparent - serous. Increase in protein. Decreased levels of glucose in the cerebrospinal fluid.

Diagnostics

The doctor diagnoses meningitis

Reactive meningitis is diagnosed on the basis of the patient's complaints, his medical history, the above symptoms and laboratory and instrumental data. In favor of reactive meningitis can be attributed to the growing symptoms, rapidly progressive deterioration of the patient's condition. The main triad for making a diagnosis is:

• Specific symptoms of meningitis (meningeal)
• Data for the presence of an infectious process
• Cerebrospinal fluid changes

Additional studies that indirectly indicate ongoing reactive meningitis include:

• Skull x-ray
• Bacterioscopy with isolation of the pathogen on nutrient media
• MRI and CT
• Fundus examination (to detect intracranial hypertension)

Treatment

Treatment of meningitis

Treatment depends on the type of pathogen causing meningitis.

• With bacterial meningitis, the patient must be isolated and begin to administer antibiotics: drugs of the group penicillin series with drugs that have a bactericidal effect - cephalosporins, gentamicin. For viral and fungal infections, antiviral (acyclovir) and antifungal (ketoconazole, flucanosole)
• With severe intoxication with loss of fluid and electrolytes, detoxification and restorative therapy should be carried out - intravenous administration Ringer's solution, 0.9% NaCl, with forced diuresis - mannitol, furosemide.
• In the presence of convulsions - diazepam.

Course and forecast

The course and prognosis of meningitis

Mortality in reactive meningitis is quite high. This is due to the fact that the immune response of a weakened organism is not able to cope with the growing number of pathogenic microbes, their generalization and cytopathic action. In some cases, there is a decrease in sodium ions in the plasma, as a result of which fatal convulsions may occur. Sometimes there is septic shock - tachycardia, tachypnea, hyperthermia, increased leukocytosis. Perhaps a violation of blood clotting, deafness and blindness.

Meningitis is an inflammatory disease that affects the soft membranes of the brain and spinal cord. The etiological factor can be bacteria, viruses and fungi.

Until the end of the twentieth century, mortality from bacterial meningitis was almost 100% of cases, since medicine at that time did not have drugs that could cure a patient from a dangerous disease. Today, the picture is more rosy - doctors have learned to diagnose the disease in time, and the pharmacological market offers many different drugs that are active against the pathogen. The percentage of deaths in different forms of meningitis is different, so it is more convenient to consider each form separately.

Even with modern treatment technologies, mortality in some types of meningitis is high

meningococcal meningitis

Meningococcal meningitis is caused by meningococcus, a pathogenic gram-negative microorganism that, when ingested, releases a powerful endotoxin that provokes the onset of cerebral and meningeal symptoms. The disease is transmitted by airborne droplets when sneezing, coughing, from a sick person or a healthy carrier of meningococcus. The disease begins acutely with high fever and chills, the next day a characteristic hemorrhagic rash appears on the patient's skin (red rashes that do not disappear with pressure), neurological and meningeal symptoms join.

In the absence of specific adequate treatment or late diagnosis of the disease, mortality is high - above 50%.

In the case of timely detection of the disease and proper treatment, the mortality rate is 5%. In most cases, death occurs as a result of severe toxic infection, a high concentration of the pathogen in the blood. Children before school age the disease is more difficult to carry, so the mortality rate among children is higher.

Pneumococcal meningitis

Pneumococcal meningitis is caused by Streptococcus pneumonie - pneumococcus, transmitted by airborne droplets from a sick person or from a healthy carrier of the microorganism. There are two forms of pneumococcal meningitis: reactive and protracted, with episodes of relapse.

Reactive pneumococcal meningitis is more common in school-age children. It is characterized by a sudden onset with a rise in temperature to high numbers and is accompanied by a severe toxic lesion with impaired consciousness and pronounced meningeal symptoms. There may be impaired mobility of the limbs and convulsions. Often, on the 3rd-4th day of illness, a convulsive-coma status develops, the infection spreads to other organs, including the heart.

pneumococci

In the absence of treatment, mortality reaches 100% of cases, with timely diagnosis and early drug therapy, improvement occurs within a week from the onset of the disease, but the prognosis is most often unfavorable due to the development of serious neurological abnormalities.

Mortality from meningitis caused by pneumococcus is high - it is 28-50%, even in spite of timely treatment.

In most cases, death occurs on the third day of illness, the main causes are widespread cerebral edema and purulent damage to the medulla and ventricles.

Meningitis due to Haemophilus influenzae

Meningitis caused by Haemophilus influenzae is scientifically called HIB meningitis. This form of the disease is the third most common - it takes 5-25% of all cases. Among preschool children, HIB meningitis is in second place in terms of frequency of diagnosis (up to 50% of cases).

Clinically, the disease can proceed in different ways: both acute and gradual onset of the disease are characteristic. The first symptoms are fever, headaches, catarrhal phenomena; meningeal and neurological symptoms appear 4-5 days after the onset of the disease. In young children, frequent regurgitation, prolonged crying, bulging of a large and small fontanel are noted.

This is what a hemophilic rod looks like

The disease is difficult to diagnose while taking antibiotics in doses insufficient to eliminate the pathogen, since the clinical manifestations in this case are erased, the temperature does not rise to high numbers. In such a situation, the risk of serious complications increases - the process spreads to the substance and ventricles of the brain, the patient's condition deteriorates sharply.

In general, HIB infection is milder than others - meningeal symptoms and fever are moderate, pain is weaker.

Currently, mandatory vaccination against pneumococcal infection has been introduced into the vaccination calendar. Prior to the introduction of routine HIB vaccination, there were approximately 370,000 cases of pneumococcal meningitis worldwide, with approximately 100,000 deaths. Currently, the mortality rate for this form of meningitis is about 5% in developed countries and about 30% in developing countries. Often there are cases of unfavorable outcome due to the preservation neurological symptoms.

Viral meningitis

Viruses of various groups provoke serous inflammation of the meninges. The causative agents can be various subspecies:

• Echoviruses.
• The mumps virus.
• Coxsackievirus type A and B.
• adenovirus.
• Cytomegalovirus, etc.

The disease begins with symptoms that are characteristic of the pathogen; clinical manifestations of meningitis begin later, so they often talk about a two-wave course of the disease. Viral serous inflammation of the meninges is easier than purulent meningitis - the temperature rises to moderate numbers, meningeal symptoms appear only on the 3-5th day of illness and are moderately expressed, despite intense headaches. Often, a diagnostic puncture of the cerebrospinal fluid alleviates the patient's condition, making the cephalalgia moderate. The lethality of this type of disease is low - no more than 1-2% of cases, a lethal outcome is observed in debilitated patients with severe concomitant diseases.

Tuberculous meningitis

Meningitis caused by mycobacterium tuberculosis has always ended in death in the past. Nowadays, the disease is becoming more common, and often it is meningitis that is the first symptom of the presence of a tuberculosis infection in the human body. Often, the symptoms of the disease are atypical, which complicates the diagnosis and makes it difficult to select the right treatment, due to which the mortality rate is quite high - up to 15-25%.

The manifestations of the disease increase gradually, with a rise in temperature and headache. Then, by 3-10 days from the onset of the disease, meningeal symptoms appear, followed by cerebral ones. In the absence of treatment at the stage of clinical manifestations, the patient dies by the end of the first month, but often even a specific drug therapy does not allow to cure the patient if the disease was diagnosed late.

Koch wand

Treatment with antibacterial agents such as rifampicin and aminoglycoside antibiotics can cause temporary improvement, but makes diagnosis much more difficult. Mycobacteria are practically not identified in the cerebrospinal fluid, the diagnosis is confirmed by detecting tubercle bacillus antigens by ELISA (enzymatic immunoassay) and assessing the condition of the lungs (milary tuberculosis is often observed).

Meningitis is a deadly disease, one of the ten most common causes of death in patients, so it is important to start appropriate treatment on time to prevent unpleasant consequences and death.

Meningitis is an inflammation of the lining of the brain and spinal cord. The process is triggered by an infection, the causative agent of which can be various pathogenic bacteria. These include meningococcus, Pseudomonas aeruginosa, staphylococcus and others. They enter the body by airborne droplets, when eating contaminated food, as well as in a household way, for example, through common items or when visiting public places.

Reactive meningitis, the symptoms of which involve lightning-fast spread and course of the disease, requires special attention. To understand how to prevent and stop a deadly disease, it is important to know the causes of its occurrence, as well as the main symptoms and methods of therapy.

The most common causative agent of meningitis is meningococcal bacillus, which is transmitted by airborne droplets. You can catch the infection anywhere: in a hospital or clinic, in public transport, in a store, and so on. Infection of children occurs, as a rule, during epidemics in kindergartens, schools and other educational institutions.

In addition, other types of bacteria are capable of infecting the membranes of the brain, it can be staphylococcus or enterovirus infection. The following diseases also act as a provocateur of the disease:

• mumps;
• rubella;
• measles;
• otitis;
• sinusitis;
• purulent lesions and abscesses;
• furunculosis.

Often, trauma to the skull and spine can provoke reactive meningitis. The risk group includes immunocompromised children and adults with established or latent immunodeficiency.

Signs of pathology

This life-threatening illness, like other disorders, has its own characteristic symptoms. For the reactive type of the disease, the hallmark is the rate of development of symptoms.

To the first clinical signs include:

• clouding of consciousness;
• increase in body temperature;
• drowsiness;
• fatigue;
• fever
• muscle weakness;
• urge to vomit and nausea;
• severe headaches radiating to the back and cervical spine;
• increased sensitivity to light;
• violation of the heart rhythm;
• shortness of breath
• paresis of the limbs;
• hearing and visual impairment;
• skin manifestations.

For infants, a symptom of meningitis is also swelling and tension in the region of the large fontanel.

Headaches that occur when the meninges are damaged do not go away when taken medicines. Posture helps relieve soreness, which is also a kind of sign of meningitis. If, with the head thrown back and the legs bent at the knees, pressed to the stomach, it becomes easier, it can be assumed that the person has an infectious reactive meningitis.

Diagnosis and treatment

The rapid onset of symptoms is a cause for concern and immediate medical attention. Rash, fever and headaches give rise to suspicion of a meningococcal infection in a patient. Only a specialist will be able to establish an accurate diagnosis and determine the pathogen after conducting the necessary studies and laboratory tests.

The cerebrospinal fluid allows you to find out which infection is the causative agent. Its sampling is carried out using a lumbar puncture. A general blood test is also quite informative, but it only helps to determine the presence of an inflammatory process. With meningitis, leukocyte counts and erythrocyte sedimentation rate are overestimated. Reactive meningitis causes a change in the quality characteristics of urine. It can detect traces of protein, as well as blood elements.

After confirmation of the diagnosis, whether it is a child or an adult, hospitalization and intensive care are necessary.

Treatment involves the patient being in a hospital. He is given sodium salt solutions intravenously to prevent dehydration, as well as plasma substitutes to reduce bacterial activity. Reactive meningitis often accompanies acute adrenal insufficiency. In such cases, corticosteroids are prescribed. If convulsions and muscle spasms are observed among the symptoms, antispasmodics and muscle relaxants are included in the treatment regimen.

To suppress the activity of pathogenic bacteria, carry out antibiotic therapy. Drugs that are active against infection are administered strictly by the clock in doses prescribed by the doctor. With meningitis, the penicillin group is most often used, as well as cephalosporins and macrolides.

Since the symptoms grow quite rapidly and the patient's condition worsens, the drugs are administered intravenously, and only when they improve, they switch to medicines in tablets. To prevent cerebral edema, diuretics are prescribed (most often Furosemide). If the symptoms are already obvious, Sorbilact is administered as part of the infusion therapy.

The mainstay of meningitis prevention is vaccination. Of course, it cannot fully guarantee security, but it reduces the risk of infection. During epidemics, it is recommended to refrain from visiting crowded places, as well as adhere to a number of simple rules:

• observe the rules of personal hygiene;
• if infection is suspected, immediately contact a medical institution;
• leaving the familiar area, to study the epidemiological situation;
• avoid contact with carriers of the infection.

Since the household route of transmission of pathogenic bacteria is quite common, it is recommended to avoid sharing personal hygiene items with other people so as not to get sick.

Forecast

Reactive meningitis without treatment is fatal. Only the patient who applied for help in time can count on a favorable result. The prognosis for recovery largely depends on the general condition of the body, the presence of concomitant diseases and the age of the patient.

Middle-aged people are easier to cope with the disease than the elderly and children who have reduced body defenses.

In infants, the disease develops so rapidly that therapy in most cases does not guarantee full recovery. If the child can be saved, severe complications often appear in the form of blindness, paralysis and developmental delays.

Only a timely visit to a medical institution increases the chances of recovery and helps prevent premature death from cerebral edema.

Pneumococcus
pneumococci long time may be on the mucous membrane oral cavity and upper respiratory tract and cause no symptoms. However, with a decrease in the body's defenses, the infection is activated and spread by blood. The difference between pneumococcus is its high tropism ( preference) to brain tissue. Therefore, already on the second or third day after the disease, symptoms of damage to the central nervous system develop.

Pneumococcal meningitis can also develop as a complication of pneumococcal pneumonia. In this case, pneumococcus from the lungs with a lymph flow reaches the meninges. Meningitis is highly lethal.

Haemophilus influenzae
Haemophilus influenzae has a special capsule that protects it from the immune forces of the body. A healthy body is infected by airborne droplets ( when sneezing or coughing), and sometimes contact ( in case of non-observance of hygiene rules). Getting on the mucous membrane of the upper respiratory tract, Haemophilus influenzae with a blood or lymph flow reaches the meningeal membranes. Further, it is fixed in the soft and arachnoid membrane and begins to multiply intensively. Haemophilus influenzae blocks the villi of the arachnoid, thereby preventing the outflow of cerebral fluid. In this case, the fluid is produced, but does not depart and the syndrome of increased intracranial pressure develops.

In terms of frequency of occurrence, meningitis caused by Haemophilus influenzae is in third place after meningococcal and pneumococcal meningitis.

This route of infection is characteristic of all primary meningitis. For secondary meningitis, dissemination of the pathogen from the primary chronic focus of infection is characteristic.

The primary site of infection may be:

• inner ear with otitis;
• paranasal sinuses with sinusitis;
• lungs in tuberculosis;
• bones in osteomyelitis;
• injuries and wounds in fractures;
• jaw and teeth in inflammatory processes in the jaw apparatus.

Otitis media
Otitis media is an inflammation of the middle ear, that is, the cavity located between the eardrum and the inner ear. Most often, the causative agent of otitis media is staphylococcus aureus or streptococcus. Therefore, otogenic meningitis is most often staphylococcal or streptococcal. Middle ear infection can reach the meninges as in acute period disease, as well as chronic.

Routes of infection from the middle ear to the brain :

• with blood flow;
• through the inner ear, namely through its labyrinth;
• by contact with destruction in the bone.

sinusitis
Inflammation of one or more paranasal sinuses is called sinusitis. The sinuses are a kind of air corridor that communicates the cranial cavity with the nasal cavity.

Types of paranasal sinuses and their inflammatory processes :

• maxillary sinus- its inflammation is called sinusitis;
• frontal sinus - its inflammation is called frontal sinusitis;
• lattice labyrinth- its inflammation is called ethmoiditis;
• sphenoid sinus- its inflammation is called sphenoiditis.

Due to the proximity of the paranasal sinuses and the cranial cavity, the infection spreads very quickly to the meningeal membranes.

Ways of spread of infection from the sinuses to the meningeal membranes :

• with blood flow;
• with lymph flow;
• by contact ( in the destruction of the bone).

In 90 to 95 percent of cases, sinusitis is caused by a virus. However, viral sinusitis can rarely cause meningitis. As a rule, it is complicated by the addition of a bacterial infection ( with the development of bacterial sinusitis), which can subsequently spread and reach the brain.

The most common causative agents of bacterial sinusitis are:

• Pneumococcus;
• hemophilic bacillus;
• moraxella catharalis;
• golden staphylococcus aureus;
• pyogenic streptococcus.

Pulmonary tuberculosis
Pulmonary tuberculosis is the main cause of secondary tuberculous meningitis. Tuberculosis is caused by Mycobacterium tuberculosis. Pulmonary tuberculosis is characterized by a primary tuberculosis complex, in which not only lung tissue is affected, but also nearby vessels.

Components of the primary tuberculosis complex:

• lung tissue ( as tuberculosis pneumonia develops);
• lymphatic vessel (tuberculous lymphangitis develops);
• lymph node ( tuberculous lymphadenitis develops).

Therefore, most often, mycobacteria reach the meninges with lymph flow, but they can also be hematogenous ( with blood flow). Having reached the meninges, mycobacteria affect not only them, but also the blood vessels of the brain, and often the cranial nerves.

Osteomyelitis
Osteomyelitis is a purulent disease in which the bone and surrounding soft tissues are affected. The main causative agents of osteomyelitis are staphylococci and streptococci, which enter the bone due to trauma or through the bloodstream from other foci ( teeth, boils, middle ear).

Most often, the source of infection reaches the meninges with blood flow, but with osteomyelitis of the jaw or temporal bone, it enters the brain by contact, due to bone destruction.

Inflammatory processes in the jaw apparatus
Inflammatory processes in the jaw apparatus affect both bone structures ( bone, periosteum) and soft tissues ( The lymph nodes). Due to the proximity of the bone structures of the jaw apparatus to the brain, the infection spreads with lightning speed to the meninges.

Inflammatory processes of the jaw apparatus include:

• osteitis- damage to the bone base of the jaw;
• periostitis- damage to the periosteum;
• osteomyelitis- damage to both bone and bone marrow;
• abscesses and phlegmon in the jaw apparatus- limited accumulation of pus in the soft tissues of the jaw apparatus ( e.g. at the bottom of the mouth);
• purulent odontogenic lymphadenitis- defeat lymph node jaw apparatus.

Inflammatory processes in the jaw apparatus are characterized by contact dissemination of the pathogen. In this case, the pathogen reaches the meningeal membranes due to bone destruction or abscess rupture. But the lymphogenous spread of the infection is also characteristic.

The causative agents of infection of the jaw apparatus are:

• green streptococcus;
• white and golden staphylococcus aureus;
• peptococcus;
• peptostreptococcus;
• actinomycetes.

A special form of meningitis is rheumatic meningoencephalitis, which is characterized by damage to both the meninges and the brain itself. This form of meningitis is the result of a rheumatic attack ( attack) and is mainly characteristic of childhood and adolescence. Sometimes it can be accompanied by a large hemorrhagic rash and is therefore also called rheumatic hemorrhagic meningoencephalitis. Unlike other forms of meningitis, where the patient's movements are limited, rheumatic meningitis is accompanied by strong psychomotor agitation.

Some forms of meningitis are the result of generalization of the initial infection. So, borreliosis meningitis is a manifestation of the second stage of tick-borne borreliosis ( or Lyme disease). It is characterized by the development of meningoencephalitis ( when both the membranes of the brain and the brain itself are damaged) in combination with neuritis and radiculitis. Syphilitic meningitis develops in the second or third stage of syphilis when a pale treponema of the nervous system is reached.

Meningitis can also be the result of various surgical procedures. For example, postoperative wounds, venous catheters and other invasive medical equipment can be the gateway of infection.
Candidal meningitis develops against the background of a sharply reduced immunity or against the background of prolonged antibacterial treatment. Most often, people with HIV infection are susceptible to the development of candidal meningitis.

Signs of meningitis

The main signs of meningitis are:

• chills and temperature;
• headache;
• neck stiffness;
• photophobia and hyperacusis;
• drowsiness, lethargy, sometimes loss of consciousness;

Some forms of meningitis may cause:

• rash on the skin, mucous membranes;
• anxiety and psychomotor agitation;
• mental disorders.

Chills and temperature

Fever is the dominant symptom in meningitis. It occurs in 96 - 98 percent of cases and is one of the very first symptoms of meningitis. The rise in temperature is due to the release of pyrogenic ( fever-inducing) substances by bacteria and viruses when they enter the blood. In addition, the body itself produces pyrogenic substances. Leukocyte pyrogen, which is produced by leukocytes in the focus of inflammation, has the greatest activity. Thus, the increase in temperature occurs due to increased production of heat both by the body itself and by pyrogenic substances of the pathogenic microorganism. In this case, a reflex spasm of the vessels of the skin occurs. Vasospasm entails a decrease in blood flow in the skin and, as a result, a drop in skin temperature. The patient feels the difference between internal heat and cold skin as chills. Violent chilliness accompanied by trembling all over. Muscle tremors are nothing more than an attempt by the body to warm up. Terrific chills and a rise in temperature to 39 - 40 degrees are often the first sign of the disease.

Headache

Severe diffuse progressive headache, often accompanied by vomiting, is also early sign diseases. Initially, the headache is diffuse and is caused by the phenomenon of general intoxication and fever. In the stage of damage to the meninges, the headache grows and is caused by swelling of the brain.

The cause of cerebral edema is:

• increased secretion of cerebrospinal fluid due to irritation of the meninges;
• violation of the outflow of cerebrospinal fluid up to the blockade;
• direct cytotoxic effect of toxins on brain cells, with their further swelling and destruction;
• increased vascular permeability and, as a result, the penetration of fluid into the brain tissue.

As intracranial pressure increases, the headache becomes bursting. At the same time, the sensitivity of the scalp is sharply increased and the slightest touch to the head causes severe pain. At the peak of the headache, vomiting occurs, which does not bring relief. Vomiting may be repeated and does not respond to antiemetic medications. Headache is provoked by light, sounds, head turns and pressure on the eyeballs.

In infants, there is bulging and tension of the large fontanel, a pronounced venous network on the head, and in severe cases, the divergence of the sutures of the skull. This symptomatology, on the one hand, is due to the syndrome of increased intracranial pressure ( due to cerebral edema and increased secretion of cerebrospinal fluid), and on the other hand, the elasticity of the bones of the skull in children. At the same time, monotonous "brain" crying is observed in young children.

Stiff neck

Neck stiffness occurs in more than 80 percent of meningitis cases. The absence of this symptom may be observed in children. The patient's posture, characteristic of meningitis, is associated with muscle rigidity: the patient lies on his side with his head thrown back and his knees brought to his stomach. At the same time, it is difficult for him to bend or turn his head. Neck stiffness is one of the early symptoms meningitis and, along with headache and fever, forms the basis of the meningeal syndrome, which is caused by irritation of the meninges.

Photophobia and hyperacusis

Painful sensitivity to light ( photophobia) and to the sound ( hyperacusis) are also common symptoms in meningitis. Like hypersensitivity these symptoms are due to irritation of receptors and nerve endings in the meninges. They are most pronounced in children and adolescents.

However, the opposite symptoms can sometimes be observed. Yes, in defeat auditory nerve, with the development of neuritis, hearing loss may occur. In addition to the auditory nerve, it can also be affected optic nerve which, however, is extremely rare.

Drowsiness, lethargy, sometimes loss of consciousness

Drowsiness, lethargy and loss of consciousness are observed in 70 percent of cases and are later symptoms of meningitis. However, with fulminant forms, they develop on the 2nd - 3rd day. Lethargy and apathy are due to both general intoxication of the body and the development of cerebral edema. For bacterial meningitis ( pneumococcal, meningococcal) there is a sharp depression of consciousness up to coma. Newborn children at the same time refuse to eat or often spit up.

As cerebral edema increases, the degree of confusion worsens. The patient is confused, disoriented in time and space. Massive cerebral edema can lead to compression of the brain stem and inhibition of vital centers, such as respiratory, vascular. At the same time, against the background of lethargy and confusion, pressure drops, shortness of breath appears, which is replaced by noisy shallow breathing. Children are often drowsy and lethargic.

Vomit

With meningitis, a single vomiting is rarely observed. As a rule, vomiting is often repeated, repeated and is not accompanied by a feeling of nausea. The difference between vomiting in meningitis is that it is not associated with eating. Therefore, vomiting does not bring relief. Vomiting can be at the height of a headache, or it can be provoked by exposure to irritating factors - light, sound, touch.

This symptomatology is due to the syndrome of increased intracranial pressure, which is the main one in meningitis. However, sometimes the disease can be accompanied by a syndrome of low intracranial pressure ( cerebral hypotension). This is especially common in young children. Their intracranial pressure is sharply reduced, up to collapse. The disease proceeds with symptoms of dehydration: facial features are sharpened, muscle tone is reduced, reflexes fade. Symptoms of muscle stiffness may disappear.

Rash on skin, mucous membranes

Hemorrhagic rash on the skin and mucous membranes is not an obligatory symptom of meningitis. According to various data, it is observed in a quarter of all cases of bacterial meningitis. Most often, it is observed with meningococcal meningitis, since meningococcus damages the inner wall of blood vessels. Skin rashes occur 15 to 20 hours after the onset of the disease. At the same time, the rash is polymorphic - roseolous, papular, rash in the form of petechiae or nodules are observed. The rash is always irregular in shape, sometimes protruding above the level of the skin. The rash tends to merge and form massive hemorrhages that look like purplish-blue spots.

Hemorrhages are observed on the conjunctiva, oral mucosa and internal organs. Hemorrhage with further necrosis in the kidney leads to the development of acute renal failure.

convulsions

Seizures occur in one fifth of meningitis cases in adults. In children, convulsions of a tonic-clonic nature are often the onset of the disease. The younger the child, the more likely it is to develop seizures.

They can proceed according to the type of epileptic convulsions, or a tremor can be observed. separate parts body or individual muscles. Most often in young children there is a tremor of the hands, which later turns into a generalized seizure.

These convulsions both generalized and local) are the result of irritation of the cortex and subcortical structures of the brain.

Anxiety and psychomotor agitation

As a rule, the excitation of the patient is observed in a later stage of meningitis. But in some forms, for example, in rheumatic meningoencephalitis, this is a sign of the onset of the disease. Patients are restless, excited, disoriented.
With bacterial forms of meningitis, excitation appears on the 4th - 5th day. Often, psychomotor agitation is replaced by loss of consciousness or transition to a coma.
Anxiety and unmotivated crying begins meningitis in infants. At the same time, the child does not fall asleep, cries, is excited by the slightest touch.

Mental disorders

Mental disorders in meningitis are so-called symptomatic psychoses. They can be observed both at the beginning of the disease, and in a later period.

Mental disorders are characterized by:

• excitement or vice versa inhibition;
• rave;
• hallucinations ( visual and sound);

Most often, mental disorders in the form of delusions and hallucinations are observed with lymphocytic choriomeningitis and meningitis caused by tick-borne encephalitis virus. Encephalitis Economo ( or lethargic encephalitis) are characterized by visual colorful hallucinations. Hallucinations can be observed at high temperatures.
Mental disorders are more common in children with tuberculous meningitis. They have an anxious mood, fears, vivid hallucinations. Tuberculous meningitis is also characterized by auditory hallucinations, impaired consciousness of the oneiroid type ( the patient experiences fantastic episodes), as well as a disorder of self-perception.

Features of the onset of the disease in children

In children in the clinical picture of meningitis in the first place are:

• fever;
• convulsions;
• vomiting fountain;
• frequent vomiting.

Infants are characterized by a sharp increase in intracranial pressure with bulging of a large fontanel. A hydrocephalic cry is characteristic - a child suddenly cries out against the background of confused consciousness or even unconsciousness. The function of the oculomotor nerve is disturbed, which is expressed in strabismus or drooping of the upper eyelid ( ptosis). Frequent damage to the cranial nerves in children is explained by damage to both the brain and the meninges ( that is, the development of meningoencephalitis). Children are much more likely than adults to develop meningoencephalitis because the blood-brain barrier is more permeable to toxins and bacteria.

In infants, attention should be paid to the skin. They may be pale, cyanotic ( blue) or pale grayish. A clear venous network is visible on the head, the fontanel pulsates. The child can constantly cry, scream and tremble at the same time. However, with meningitis hypotensive syndrome the child is lethargic, lethargic, constantly sleeping.

Symptoms of meningitis

Symptoms that appear with meningitis can be grouped into three main syndromes:

• intoxication syndrome;
• craniocerebral syndrome;
• meningeal syndrome.

Syndrome of intoxication

Intoxication syndrome is caused by a septic lesion of the body, due to the spread and multiplication of infection in the blood. Patients complain of general weakness, fatigue, weakness. The body temperature rises to 37 - 38 degrees Celsius. Periodically there is a headache, aching character. Sometimes signs of SARS come to the fore ( acute respiratory viral infection): nasal congestion, cough, sore throat, aching joints. The skin becomes pale and cold. Appetite decreases. Due to the presence of foreign particles in the body, the immune system is activated, which tries to destroy the infection. In the early days, a rash may appear on the skin in the form of small red dots, which are sometimes accompanied by itching. The rash disappears on its own within a couple of hours.

In severe cases, when the body is unable to fight the infection, it attacks the skin vessels. The walls of blood vessels become inflamed and clogged. This leads to ischemia of skin tissues, small hemorrhages and skin necrosis. Constricted areas of the skin are especially vulnerable ( back and buttocks in a patient lying on his back).

craniocerebral syndrome

Craniocerebral syndrome develops as a result of intoxication of the body with endotoxins. infectious agents ( most often meningococcus) are distributed throughout the body and enter the bloodstream. Here they are subject to attack by blood cells. With increased destruction of infectious agents, their toxins enter the bloodstream, which adversely affect its circulation through the vessels. The toxins cause intravascular coagulation and the formation of blood clots. The medulla is especially affected. Blockage of cerebral vessels leads to metabolic disorders and accumulation of fluid in the intercellular space in the brain tissues. The result is hydrocephalus cerebral edema) with increased intracranial pressure. This causes sharp headaches in the temporal and frontal region, intense, excruciating. The pain is so unbearable that the patients groan or cry out. In medicine, this is called a hydrocephalic cry. The headache is aggravated by any external stimulus: sound, noise, bright light, touch.

due to swelling and high blood pressure various parts of the brain that are responsible for the functioning of organs and systems suffer. The center of thermoregulation is affected, which leads to a sharp increase in body temperature up to 38 - 40 degrees Celsius. This temperature cannot be lowered by any antipyretics. The same explains the profuse vomiting ( vomiting fountain) that does not stop for a long time. It appears with increased headache. Unlike vomiting in case of poisoning, it is not associated with food intake, and does not bring relief, but only worsens the patient's condition. In severe cases, the respiratory center is affected, resulting in respiratory failure and death.
Hydrocephalus and impaired circulation of cerebral fluid causes convulsive attacks in various parts of the body. Most often they are of a generalized nature - the muscles of the limbs and torso are reduced.

Progressive cerebral edema and increasing intracranial pressure can lead to damage to the cerebral cortex with impaired consciousness. The patient cannot concentrate, is unable to perform the tasks given to him. Sometimes hallucinations and delusions appear. Psychomotor agitation is often observed. The patient randomly moves his arms and legs, the whole body twitches. Periods of excitement are replaced by periods of calm with lethargy and drowsiness.

Sometimes cranial nerves are affected due to cerebral edema. More vulnerable are the oculomotor nerves that innervate the muscles of the eye. With prolonged squeezing, strabismus, ptosis appears. When defeated facial nerve the innervation of mimic muscles is disturbed. The patient cannot close his eyes and mouth tightly. Sometimes you can see the sagging of the cheek on the side of the affected nerve. However, these disturbances are temporary and disappear after recovery.

meningeal syndrome

The main characteristic syndrome in meningitis is the meningeal syndrome. It is caused by a violation of the circulation of cerebrospinal fluid against the background of increased intracranial pressure and cerebral edema. The accumulated fluid and edematous tissue of the brain irritates the sensitive receptors of the vessels of the meninges and spinal nerve roots. There are various pathological muscle contractions, abnormal movements and the inability to bend the limbs.

Symptoms of meningeal syndrome are:

• characteristic pose of "cocked the trigger";
• neck stiffness;
• Kernig's symptom;
• Brudzinski's symptoms;
• Gillen's symptom;
• reactive pain symptoms ankylosing spondylitis, palpation of nerve points, pressure on the ear canal);
• Lessage's symptom ( for children).

characteristic posture
Irritation of sensitive receptors of the membranes of the brain causes involuntary muscle contraction. When exposed to external stimuli ( noise, light), the patient assumes a characteristic posture similar to a cocked trigger. The occipital muscles contract and the head leans back. The stomach is drawn in and the back is arched. The legs are bent at the knees to the stomach, and the arms to the chest.

Stiff neck
Due to the increased tone of the extensors of the neck, stiff neck appears. When trying to turn the head, bend to the chest, pain appears, which forces the patient to throw his head back.
Any movement of the limbs that causes tension and irritation of the spinal membrane causes pain. All meningeal symptoms are considered positive if the patient cannot perform a certain movement, as it causes acute pain.

Kernig's sign
With Kernig's symptom, in a supine position, it is necessary to bend the leg at the hip and knee joint. Then try to straighten your knee. Due to the sharp resistance of the flexor muscles of the lower leg and severe pain, this is almost impossible.

Brudzinsky's symptoms
Brudzinski's symptoms are aimed at trying to provoke the characteristic meningeal posture. If you ask the patient to bring his head to his chest, it will cause pain. He will reflexively bend his knees, thereby loosening the tension of the spinal membrane and the pain will subside. If you press on the pubic region, the patient will involuntarily bend the legs at the hip and knee joints. When examining Kernig's symptom on one leg, during an attempt to straighten the leg at the knee, the other leg involuntarily bends at the hip and knee joint.

Gillen's sign
If you squeeze the quadriceps femoris muscle on one leg, you can see an involuntary contraction of the same muscle on the other leg and flexion of the leg.

Reactive pain symptoms
If you tap with a finger or a neurological hammer on the zygomatic arch, there is a contraction of the zygomatic muscles, an increase in headache and an involuntary pain grimace. Thus, a positive symptom of Bechterew is determined.
When pressing on the external auditory meatus and on the exit points of the facial nerves ( brow ridges, chin, zygomatic arches) also appear pain and a characteristic pain grimace.

I> Symptom Lessage
In infants and young children, all these meningeal symptoms are mild. Increased intracranial pressure and cerebral edema can be detected by feeling a large fontanelle. If it is enlarged, bulges and pulsates, then the baby has significantly increased intracranial pressure. Infants are characterized by Lessage's symptom.
If the baby is taken under the armpits and lifted, then he involuntarily assumes the characteristic “cocked trigger” pose. He instantly throws his head back and bends his legs at the knees, pulling them to his stomach.

In severe cases, when the pressure in the spinal canal increases and the membranes of the spinal cord become inflamed, the spinal nerves are affected. At the same time, motor disorders appear - paralysis and paresis on one or both sides. The patient cannot move his limbs, move, do any work.

Diagnosis of meningitis

With pronounced symptoms, the patient should contact the ambulance service with further urgent hospitalization in the infectious diseases hospital.

Meningitis is an infectious pathology and therefore it is necessary to contact an infectious disease specialist. If the course of the disease is sluggish, with an erased picture, then the patient, due to the headaches that disturb him, may initially turn to a neurologist.
However, the treatment of meningitis is carried out by the joint efforts of an infectious disease specialist and a neuropathologist.


Diagnosis of meningitis includes:

• questioning and neurological examination at the doctor's appointment;
• laboratory and instrumental examinations ( blood test, spinal puncture, computed tomography).

Survey

To diagnose meningitis, your doctor needs the following information:

• What diseases does the patient suffer from? Does he have syphilis, rheumatism or tuberculosis?
• If this is an adult, has there been contact with children?
• Was the disease preceded by trauma, surgery or other surgical procedures?
• Does the patient suffer from chronic pathologies such as otitis media, sinusitis, sinusitis?
• Has he recently had pneumonia, pharyngitis?
• What countries or regions has he visited recently?
• Was there a temperature, and if so, for how long?
• Has he taken any treatment? ( antibiotics or antivirals taken can erase the clinical picture)
• Does it irritate the light, sounds?
• If there is a headache, where is it located? Namely, is it localized or spilled over the entire skull?
• If there is vomiting, is it food related?

Neurological examination

Neurological examination aimed at identifying characteristic symptoms with meningitis, namely:

• stiff neck and symptom and Brudzinsky;
• Kernig's symptom;
• Lessage's symptom in infants;
• symptoms of Mondonesi and Bechterew;
• study of the cranial nerves.

Neck stiffness and Brudzinski's sign
The patient is in a supine position on the couch. When the doctor tries to bring the patient's head to the back of the head, a headache occurs and the patient throws his head back. At the same time, the patient's legs reflexively bend ( Brudzinski's symptom 1).

Kernig's sign
The patient lying on his back is bent at the hip and knee joint at a right angle. Further extension of the leg at the knee with a bent hip is difficult due to the tension of the thigh muscles.

Symptom Lessage
If you take a child armpits and lift, then there is an involuntary pulling of the legs to the stomach.

Symptom of Mondonesi and Bechterew
Symptom Mondonesi is a slight pressure on the eyeballs ( eyelids are closed). Manipulation calls headache. Bekhterev's symptom is to identify painful points when tapping with a hammer on the zygomatic arch.

Sensitivity is also examined during a neurological examination. With meningitis, hyperesthesia is observed - increased and painful sensitivity.
With complicated meningitis, symptoms of damage to the spinal cord and its roots are revealed in the form of motor disorders.

Examination of the cranial nerves
The neurological examination also includes examination of the cranial nerves, which are also often affected in meningitis. Most often, the oculomotor, facial and vestibular nerves are affected. To examine the group of oculomotor nerves, the doctor examines the reaction of the pupil to light, movement and position. eyeballs. Normally, the pupil constricts in response to light. With paralysis of the oculomotor nerve, this is not observed.

To study the facial nerve, the doctor checks the sensitivity of the face, corneal and pupillary reflex. Sensitivity in this case can be lowered, increased, asymmetric. Unilateral or bilateral hearing loss, staggering and nausea indicate damage to the auditory nerve.

The attention of the doctor is also attracted by the patient's skin, namely the presence of a hemorrhagic rash.

Laboratory studies include:

• latex tests, PCR method.

General blood analysis
In a general blood test, signs of inflammation are revealed, namely:

• Leukocytosis. The increase in the number of leukocytes is more than 9 x10 9 . With bacterial meningitis, 20 - 40 x 10 9 is observed, due to neutrophils.
• Leukopenia. Reducing the number of leukocytes less than 4 x 10 9 . It is observed in some viral meningitis.
• Shift of the leukocyte formula to the left- an increase in the number of immature leukocytes, the appearance of myelocytes and metamyelocytes. This shift is especially pronounced in bacterial meningitis.
• Increased erythrocyte sedimentation rate- more than 10 mm per hour.

Sometimes anemia may be present:

• decrease in hemoglobin concentration less than 120 grams per liter of blood;
• decrease in the total number of erythrocytes less than 4 x 10 12 .

In severe cases:

• thrombocytopenia. Decreased platelet count less than 150 x 10 9 . Seen in meningococcal meningitis.

Blood chemistry
Changes in the biochemical analysis of blood reflect violations of the acid-base balance. As a rule, this manifests itself in a shift in the balance towards an increase in acidity, that is, towards acidosis. As a result, creatinine levels rise above 100 - 115 µmol/liter), urea ( above 7.2 - 7.5 mmol / liter), the balance of potassium, sodium and chlorine is disturbed.

Latex tests, PCR method
To determine the exact causative agent of meningitis, latex agglutination or polymerase chain reaction methods are used ( PCR). Their essence is to identify the antigens of the pathogen, which is contained in the cerebrospinal fluid. In this case, not only the type of pathogen is determined, but also its type.
The latex agglutination method takes 10 to 20 minutes, and the agglutination reaction ( gluing) is carried out before the eyes. The disadvantage of this method is the low sensitivity.
The PCR method has the highest sensitivity ( 98 - 99 percent), and its specificity reaches 100 percent.

Cerebrospinal puncture

Cerebrospinal puncture is essential in making a diagnosis of meningitis. It consists in introducing a special needle into the space between the soft and arachnoid spinal cord at the level lumbar. In this case, spinal fluid is taken for the purpose of its further study.

Technique of cerebrospinal puncture
The patient is in the supine position with legs bent and brought to the stomach. Piercing the skin in the interval between the fifth and fourth lumbar vertebrae, a needle with a mandrel is inserted into the subarachnoid space. After a feeling of “falling through”, the mandrin is removed, and a glass tube is brought to the pavilion of the needle to collect spinal fluid. As it flows out of the needle, pay attention to the pressure under which it flows. After the puncture, the patient needs rest.
The diagnosis of meningitis is based on inflammatory changes in the cerebrospinal fluid.

Instrumental examination includes

• an electroencephalogram ( EEG);
• computed tomography ( CT).

Electroencephalography
EEG- This is one of the methods for studying the work of the brain by recording its electrical activity. This method is non-invasive, painless and easy to use. It is very sensitive to any slightest changes in the work of all brain structures. All types of brain activity are recorded using a special device ( electroencephalograph) to which the electrodes are connected.

EEG technique
The ends of the electrodes are attached to the scalp. All bioelectrical signals received from the cerebral cortex and other brain structures are recorded as a curve on a computer monitor or printed on paper. In this case, samples with hyperventilation are often used ( the patient is asked to breathe deeply) and photostimulation ( in a dark room where the study is carried out, the patient is exposed to bright light).

Indications for the use of EEG are:

• epileptic seizures;
• seizures of unknown etiology;
• attacks of headaches, dizziness and neurological disorders of unknown etiology;
• sleep and wake disturbances, nightmares, sleepwalking;
• trauma, tumors, inflammatory processes and circulatory disorders in the medulla.

With meningitis, the EEG indicates a diffuse decrease in the bioelectrical activity of the brain. This study It is used in cases of residual effects and complications after meningitis, namely with the appearance of epileptic seizures and frequent convulsions. An EEG helps to determine which brain structures have been damaged and what type of seizures. In other cases of meningitis, this type of study is not informative. It only confirms the presence of damage to brain structures.

CT scan

CT is a method of layer-by-layer study of the structure of organs, in this case brain. The method is based on circular transillumination of the organ by an X-ray beam with further computer processing. The information captured by X-rays is translated into graphical form in the form of black and white images.

CT technique
The patient lies on the table of the tomograph, which moves towards the frame of the tomograph. For a certain time, the X-ray tube moves in a circle, taking a series of pictures.

Detectable symptoms on CT
CT scan shows the structures of the brain, namely gray and white matter brain, meninges, ventricles of the brain, cranial nerves and vessels. Thus, the main syndrome in meningitis is visualized - the syndrome of increased intracranial pressure and, as a result, cerebral edema. On CT, edematous tissue is characterized by reduced density, which can be local, diffuse, or periventricular ( around the ventricles). With severe edema, expansion of the ventricles and displacement of brain structures are observed. With meningoencephalitis, heterogeneous areas of low density are found, often bordered by a zone of increased density. If meningoencephalitis occurs with damage to the cranial nerves, then signs of neuritis are visualized on CT.

Indications for the use of CT
The CT method is necessary in the differential diagnosis of meningitis and volumetric brain processes. In this case, spinal puncture is initially contraindicated and is done only after computed tomography. However, CT is less informative than MRI ( magnetic resonance imaging). MRI is able to detect inflammatory processes both in the brain tissues and in the meninges.

Treatment of meningitis

The treatment of meningitis is complex, it includes etiotropic therapy ( aimed at eradicating the infection), pathogenetic ( used to eliminate the development of cerebral edema, increased intracranial pressure syndrome) and symptomatic ( aimed at the destruction of individual symptoms of the disease).

Eliminate the cause of meningitis

Elimination of the causes of bacterial ( meningococcal, staphylococcal, streptococcal) meningitis

A drug	Mechanism of action	How it is applied
benzylpenicillin	has a bactericidal effect against streptococci, pneumococci and meningococci	for 4.000.000 units. intramuscularly every 6 hours. For children, the dose is calculated based on 200.000 - 300.000 IU. per 1 kg of weight per day. The dose is divided into 4 doses
ceftriaxone	has a bactericidal effect against streptococci, pneumococci and Escherichia coli	adults, 2 grams intravenously every 12 hours. Children 50 mg per 1 kg of body weight per day in 2 divided doses
ceftazidime	effective against group B hemolytic streptococci, listeria and shigella	2 grams every 8 hours
meropenem	effective against hemolytic streptococci and Haemophilus influenzae	2 grams every 8 hours. Children: 40 mg per kg body weight three times a day
chloramphenicol	effective against Escherichia coli, Shigella and Treponema pallidum	50 - 100 mg per kg of body weight per day, the dose is divided into 3 doses ( interval every 8 hours)

With meningococcal meningitis, penicillin therapy is advisable; with streptococcal and staphylococcal meningitis - a combination of penicillins and sulfa drugs ( ceftriaxone, ceftazidime); with meningitis caused by Haemophilus influenzae ( H.influenzae) - a combination of chloramphenicol and sulfonamides.

Elimination of the causes of tuberculous meningitis

A drug	Mechanism of action	How it is applied
isoniazid	has a bactericidal effect against the causative agent of tuberculosis	15 to 20 mg per kg of body weight per day. The dose is divided into three divided doses and taken half an hour before meals.
ftivazid	anti-tuberculosis drug	40 mg per kg of patient weight per day
streptomycin	active against Mycobacterium tuberculosis, gonococci, Klebsiella, Brucella	1 gram per day intramuscularly. When combined with other drugs ( for example, with ftivazid) streptomycin is administered every other day

The average duration of treatment for tuberculous meningitis is 12 to 18 months.

Elimination of the causes of meningitis caused by malarial plasmodium or toxoplasma

Elimination of the causes of herpetic meningitis, as well as meningitis caused by the Epstein-Barr virus

There is no specific treatment for other types of viral meningitis. Basically, treatment for viral meningitis is pathogenetic and is aimed at reducing intracranial pressure. Corticosteroids are used by some clinicians for viral meningitis, but evidence of their effectiveness is mixed.

Elimination of the causes of candidal meningitis

Symptomatic treatment

Symptomatic treatment consists in the use of diuretics, drugs that compensate for the deficiency of fluid, vitamins, painkillers and antipyretics.

A drug	Mechanism of action	How it is applied
20% mannitol solution	increases the pressure in the plasma, and, thereby, promotes the transition of fluid from the tissue ( in this case from the brain) V bloodstream. Reduces intracranial pressure	at the rate of 1.5 g per kg of body weight, injected intravenously
furosemide	inhibits Na reabsorption in the tubules, thereby increasing diuresis	in case of cerebral edema, the drug is administered by jet, in a single dose of 80-120 mg, most often combined with colloidal solutions; with moderate edematous syndrome in the morning on an empty stomach one or two tablets ( 40 - 80 mg)
dexamethasone	used to prevent complications, prevent hearing loss	initially 10 mg intravenously four times a day, then switched to intramuscular injections
hemodez	has a detoxifying effect	300 - 500 ml of a solution heated to 30 degrees is injected intravenously at a rate of 40 drops per minute
vitamin B1 and B6	improve tissue metabolism	administered intramuscularly at 1 ml daily
cytoflavin	has a cytoprotective protects cells) action	10 ml of the solution is diluted in 200 ml of 5% glucose solution and administered intravenously, drip for 10 days
acetaminophen	has analgesic and antipyretic	one to two tablets 500 mg - 1g) every 6 hours. Maximum daily dose is 4 grams, which equals 8 tablets
calcium carbonate	Corrects in conditions of acidosis acid-base balance	5% solution 500 ml administered intravenously
cordiamine	stimulates metabolism in brain tissue	intramuscularly or intravenously, 2 ml from one to three times a day

Anticonvulsant therapy

If meningitis is accompanied by convulsions, psychomotor agitation, anxiety, then anticonvulsant therapy is prescribed.

Anticonvulsant therapy for meningitis

A drug	Mechanism of action	How it is applied
diazepam	has a calming, anti-anxiety and anticonvulsant effect	with psychomotor agitation, 2 ml ( 10 mg) intramuscularly; with generalized seizures, 6 ml ( 30 mg) intravenously, then repeat an hour later. The maximum daily dose is 100 mg.
chlorpromazine	has an inhibitory effect on the central nervous system	2 ml intramuscularly
a mixture of chlorpromazine + diphenhydramine	has a calming effect, relieves stress	with pronounced psychomotor agitation, chlorpromazine is combined with diphenhydramine - 2 ml of chlorpromazine + 1 ml of diphenhydramine. To prevent hypotension, the mixture is combined with cordiamine.
phenobarbital	has an anticonvulsant and sedative effect	50 - 100 mg 2 times a day, orally. Maximum daily dose 500mg

From the very first minutes of the patient's admission to the hospital, it is necessary to carry out oxygen therapy. This method is based on the inhalation of a gas mixture with an increased concentration of oxygen ( since pure oxygen is toxic). The method is indispensable, since cerebral edema in meningitis is accompanied by oxygen starvation ( cerebral hypoxia). With prolonged hypoxia, brain cells die. Therefore, as soon as the first signs of hypoxia appear ( cyanosis of tissues is observed, breathing becomes superficial) requires oxygen therapy. Depending on the severity of the patient's condition, it can be performed using an oxygen mask or by intubation.

In traumatic meningitis with the presence of purulent foci in the bones, in addition to intensive antibiotic therapy, surgical intervention with the removal of the purulent focus. Surgical treatment is also indicated in the presence of purulent foci in the lungs.

Patient Care

People who have had meningitis need special care, which is based on diet, proper daily routine and a balanced distribution of physical activity.

Diet
When recovering from meningitis, food should be taken in small portions, at least five to six times a day. The patient's diet should ensure a decrease in the level of intoxication of the body and the normalization of metabolism, water-salt, protein and vitamin balance.

The menu should be balanced and include products containing easily digestible animal proteins, fats and carbohydrates.

These products include:

• lean meat - beef or pork tongue, veal, rabbit meat, chicken, turkey;
• lean fish - herring, salmon, tuna;
• eggs - boiled or soft-boiled, as well as steamed omelettes, soufflé;
• dairy and sour-milk products - kefir, curdled milk, cottage cheese, mild cheese, koumiss;
• milk fats - cream, butter, sour cream;
• low-fat broths and soups prepared on their basis;
• vegetables and fruits with a low content of coarse fiber - zucchini, tomatoes, cauliflower, cherries, cherries, plums;
• dried wheat bread, crackers, rye flour products, bran.

When cooking meat, fish and vegetables, preference should be given to these types of heat treatment like boiling, stewing, steaming.

When caring for a patient after meningitis, the consumption of animal fats should be minimized, as they can provoke metabolic acidosis. It is also worth minimizing the consumption of easily digestible carbohydrates, which can cause intestinal fermentation processes, cause allergies and inflammation.

The diet of a person who has had meningitis should not contain the following foods:

• fatty meats - lamb, pork, goose, duck;
• cooked pork and fish products by smoking or salting;
• sweet drinks, desserts, creams, mousses, ice cream;
• fresh wheat bread, puff pastries, muffins;
• whole milk;
• buckwheat, pearl barley, legumes;
• vegetables and fruits with coarse vegetable fiber - carrots, potatoes, cabbage, red and white currants, strawberries;
• dried fruits;
• spicy and fatty sauces and dressings for dishes based on mustard, horseradish.

Water regime
In order to improve metabolism and accelerate the removal of toxins from the body, the patient should consume about two and a half liters of fluid per day.

You can drink the following drinks:

• loosely brewed tea;
• tea with milk;
• rosehip decoction;
• dining room mineral water;
• jelly;
• fresh fruit compote;
• natural sweet and sour fruit juices.

Schedule
The main factors in recovery from meningitis are:

• bed rest;
• lack of stress;
• timely sound sleep;
• psychological comfort.

Going to bed should be done no later than 10 pm. In order for the healing effect of sleep to be most noticeable, the air in the room must be clean, with a sufficient level of humidity. Water procedures help to relax before going to bed - a bath with herbal infusions or sea salt.
Foot massage helps to improve well-being and relax. You can do this procedure yourself, or use the Kuznetsov applicator. You can buy this product in pharmacies or specialized stores.

Distribution of physical activity
Return to an active lifestyle should be gradual, in accordance with the doctor's recommendations. You need to start with daily walks in the fresh air, exercises in the morning. Complicated physical activity should be excluded. You also need to minimize sun exposure.

Rehabilitation of patients after meningitis

After discharge from the infectious diseases hospital, the patient is sent to specialized rehabilitation centers and ambulatory treatment Houses. Rehabilitation therapy begins in the hospital with an early recovery of the patient. All activities must be in strict sequence at different stages of recovery. Rehabilitation should be comprehensive and include not only recovery procedures, but also visits to specialist doctors. All activities and loads should be adequate for the physical condition of the patient and gradually increase. It is also necessary to constantly monitor the effectiveness of these rehabilitation measures and correct methods if necessary. Recovery is carried out in three stages - in a hospital ( during treatment), in a sanatorium, in a clinic.

The complex of all rehabilitation measures includes:

• medical nutrition;
• physiotherapy exercises;
• physiotherapy ( myostimulation, electrophoresis, heating, massage, water procedures, etc.);
• medical correction;
• psychotherapy and psychorehabilitation;
• sanitary-resort rehabilitation;
• vocational rehabilitation
• social rehabilitation.

Rehabilitation programs are selected individually, depending on the age of the patient and the nature of the dysfunction.

At mild form meningitis, which was diagnosed in time and the correct course of treatment started, there are practically no residual effects. However, such cases are rare in medical practice especially if children have meningitis.

Often, the primary symptoms of meningitis are overlooked or mistaken for symptoms of other illnesses ( colds, poisoning, intoxication). In this case, the disease progresses with damage to the nervous structures, which recover very slowly after treatment or do not recover at all.

Residual phenomena

Possible residual effects after suffering meningitis include:

• headaches depending on meteorological conditions;
• paresis and paralysis;
• hydrocephalus with increased intracranial pressure;
• epileptic seizures;
• mental disorders;
• hearing impairment;
• violation of the endocrine system and autonomic nervous system;
• defeat cranial nerves.

Recovery of patients with such complications of meningitis is long and requires special attention and treatment.

Elimination of complications of meningitis

In the case of paresis and paralysis, which lead to movement disorders, it is necessary to undergo a rehabilitation course with various types of massage, water procedures, therapeutic gymnastics, acupuncture. Consultations and supervision of the neurologist are obligatory.

With fulminant forms of meningitis or undiagnosed forms, when the circulation of cerebrospinal fluid is disturbed and it accumulates in large quantities in the cavities of the brain, hydrocephalus develops with high intracranial pressure. This is especially common in children. Headaches persist, mental disorders, mental retardation are noted. Periodically there are convulsions and epileptic seizures. The introduction of such children into public life undergoes some difficulties, therefore, first of all, they must undergo courses of psychotherapy and psycho-rehabilitation. They are under dispensary observation and must regularly visit a neurologist, neuropathologist and psychiatrist.

Hearing loss most often occurs when the inner ear becomes infected and inflamed. For the recovery of patients resort to physiotherapy ( electrophoresis, heating). In cases of deafness, patients need special training ( the language of the deaf and dumb) and special hearing aids.

Due to malfunctions in the nervous system, all organs and systems suffer, especially the endocrine and immune systems. Such people are more susceptible to environmental factors. Therefore, in the rehabilitation period, it is necessary to carry out measures to strengthen immunity. They include vitamin therapy, heliotherapy ( solar procedures ), sanatorium rehabilitation.
Damage to the cranial nerves is more often accompanied by strabismus, facial asymmetry, ptosis ( omission of the eyelid). With adequate anti-infective and anti-inflammatory treatment, their risk is minimal, and they resolve on their own.

Terms of incapacity for work

Depending on the severity of meningitis and the presence of complications, the period of disability varies from 2 to 3 weeks ( in mild serous forms of meningitis) up to 5-6 months or more. In some cases, an early start to work is also possible, but with easier working conditions. With lungs serous meningitis residual effects are rare, and the period of disability is from three weeks to three months. With purulent meningitis with various residual effects ( hydrocephalus, epileptic seizures ) period of disability is about 5 - 6 months. Only in the case of complete regression of symptoms can the convalescent return to work ahead of schedule, but with certain restrictions on work. It is necessary to alternate physical and mental loads and dose them correctly. The worker must be exempt from night shifts and overtime for at least six months. If the symptoms of complications return, then the sick leave is extended for another couple of months.

If, within 4 months after discharge from the hospital, the symptoms of complications do not disappear and the disease becomes chronic, the patient is sent for a medical and social examination to determine the disability group.

The main indications for referral to a medical and social examination are:

• persistent and severe complications that limit the life of the patient;
• slow recovery of functions, which leads to a long period of disability;
• chronic forms meningitis or persistent relapses with disease progression;
• the presence of the consequences of the disease, due to which the patient cannot perform his work.

To undergo a medical and social examination, you must first undergo an examination by specialists and provide their conclusions.

The main package of analyzes and consultations consists of:

• general and biochemical blood tests;
• all results of bacteriological, serological and immunological studies during the period acute meningitis;
• the results of the analysis of cerebrospinal fluid in dynamics;
• results of psychological and psychiatric research;
• results of consultations with an ophthalmologist, otorhinolaryngologist, neurologist and neuropathologist.

Children with severe motor, mental, speech, auditory disorders ( full recovery is not possible) are registered for disability for a period of one to two years. After this period, the children again undergo a medical and social examination. Children with persistent speech and mental disorders, with frequent epileptic seizures and hydrocephalus, a disability group is assigned for two years. In case of severe complications ( deafness, dementia, deep paresis and paralysis) the child is assigned a disability group before reaching the age of 18.

Disability Determination System

Adults are awarded three different categories of disability, depending on the severity of complications and the degree of disability.

If, as a result of meningitis, the patient is limited in the ability to self-service due to blindness, decreased intelligence, paralysis of the legs and arms, and other disorders, he is given the first group of disability.

The second group of disability is given to patients who cannot perform work in their specialty under normal working conditions. In these patients, motor functions are significantly impaired, some changes in the psyche are observed, epileptic seizures, deafness appear. Also included in this group are patients with chronic and recurrent forms of meningitis.

The third group of disability includes persons with partial disability. These are patients with moderate motor functions, moderate hydrocephalus with maladjustment syndrome. The third group includes all cases in which a person has difficulties in performing work in his specialty, and it is necessary to reduce qualifications or reduce the amount of work. This includes cases with epileptic seizures and intellectual impairment.

The third group of disability is determined at the time of retraining or training in a new profession and new employment.

Dispensary observation

After suffering from meningitis, it is necessary dispensary observation for a period of at least 2 years, depending on the severity of the disease and complications. In mild forms of meningitis, the observation of doctors in the clinic is once a month for the first three months, then once every three months during the year. At purulent meningitis, severe forms with complications, visits to doctors should be at least twice a month for the first three months. The following year, an examination is required every three months and once every six months during the second year. Mandatory visits to such specialists as a neuropathologist, psychiatrist, therapist and infectious disease specialist. According to the testimony of specialists, dispensary observation can be extended.

Prevention of meningitis

Prevention is specific and non-specific. Vaccination refers to specific prevention.

Vaccination

Essential vaccines to prevent bacterial and viral meningitis- This:

• Meningococcal vaccine - provides protection against a number of bacteria that can cause meningitis. This vaccine is given to children 11-12 years old, and is also recommended for first-year students living in a hostel, recruit soldiers, tourists visiting places where there are epidemics of this disease;
• Haemophilus influenzae type B vaccine- Designed for children aged two months to five years;
• pneumococcal vaccine- can be of two types: conjugative and polysaccharide. The first category of vaccine is intended for children under two years of age, as well as for children at risk, whose age does not exceed five years. The type 2 vaccine is recommended for the elderly, as well as for middle-aged people whose immunity is weakened or there are certain diseases of the chronic type;
• Measles, rubella and mumps vaccines- are introduced to children in order to prevent meningitis, which can develop against the background of these diseases;
• Chickenpox vaccine.

Vaccinated children and adults may experience various side effects in the form of weakness, flushing or swelling at the injection sites. In most cases, these symptoms disappear after one to two days. In a small percentage of patients, vaccines can cause severe allergic reactions, which manifest as edema, shortness of breath, high temperature, tachycardia. In such cases, you should contact your doctor, giving the date of vaccination and the time of occurrence of side effects.

Non-specific prophylaxis

Non-specific prophylaxis of meningitis is a series of measures aimed at increasing the body's immunity and preventing contact with possible pathogens.

What should be done?

To prevent meningitis, you need to:

• strengthen immunity;
• follow a balanced diet;
• observe the rules of personal hygiene and precautions;
• to vaccinate.

Strengthening immunity
Hardening strengthens the body's immune system, increasing its resistance to the effects of negative environmental factors. Hardening activities should begin with air baths, for example, with exercises in a room with an open window. Subsequently, classes should be moved to the open air.
Water procedures are an effective method of hardening, which should be resorted to if the body is healthy. It is worth starting with dousing with water, the temperature of which is not lower than +30 degrees. Further, the temperature must be gradually reduced to +10 degrees. When drawing up a schedule and choosing the type of hardening manipulations, one should take into account the individual characteristics of the body and consult a doctor.
Helps to increase the body's resistance to walking and doing various outdoor sports. If possible, you should choose places away from highways and roads, closer to green spaces. Sun exposure is beneficial for the production of vitamin D.

Diet
A balanced healthy diet is an important factor in the prevention of meningitis. In order to provide effective resistance to bacteria and viruses, the body should receive a sufficient amount of protein, fats, carbohydrates, vitamins and minerals.

The diet should include the following elements:

• Plant and animal proteins Immunoglobulins synthesized from amino acids help the body resist infections. Contains protein in meat, poultry, eggs, sea fish, legumes;
• Polyunsaturated fats- increase the endurance of the body. Included in nuts, fatty fish, linseed, olive and corn oils;
• Fiber and complex carbohydrates are required to strengthen the immune system. They are part of cabbage, pumpkin, dried fruits, wheat and oat bran, products made from wholemeal flour. Also with these products the body receives B vitamins;
• Vitamins of groups A, E, C- are natural antioxidants, increase the barrier resistance of the body. Contained in citrus fruits, sweet peppers, carrots, fresh herbs, apples;
• P vitamins- Immunity stimulants. Included in blackcurrant, eggplant, blueberries, dark grapes, red wine;
• Zinc- increases the number of T-lymphocytes. Found in quail eggs, apples, citrus fruits, figs;
• Selenium- activates the formation of antibodies. This element is rich in garlic, corn, pork liver, chicken and beef;
• copper and iron- provide Good work blood supply systems and are found in spinach, buckwheat, turkey meat, soybeans;
• calcium, magnesium, potassium- elements necessary to strengthen the immune system. The source of these substances are dairy products, olives, egg yolk, nuts, dried fruits.

Problems of the gastrointestinal tract have a negative impact on the immune background. To maintain the intestinal microflora, low-fat dairy products should be consumed. These products include: kefir, fermented baked milk, yogurt. Also beneficial bacteria, which synthesize amino acids and aid digestion, are found in sauerkraut, soaked apples, kvass.

Getting the necessary complex of vitamins from the diet is quite difficult. Therefore, the body should be supported with vitamins of synthetic origin. Before using these drugs, you need to consult a doctor.

Hygiene rules and precautions
In order to prevent the likelihood of bacterial meningitis, you should observe next rule:

• for drinking and cooking use bottled water, filtered or boiled;
• vegetables and fruits before use should be poured over with boiling water;
• before eating, wash your hands with soap;
• to exclude the use of other people's handkerchiefs, toothbrushes, towels and other things of a personal nature.

You should be careful in crowded places. A person who is coughing or sneezing should turn away or leave the room. Those whose profession involves constant contact with a large number of people ( salesman, hairdresser, usher) you must have a gauze bandage with you. In transport and other public places, when grasping door handles or handrails, gloves should not be removed.

Some forms of meningitis are carried by insects.

Therefore, going to the forest or park, you need:

• use insect and tick repellents;
• dress in tight, closed clothing;
• wear a headdress.

If a tick is found on the skin, the insect should be removed with tweezers, after watering it with alcohol or vodka. Do not crush or tear off the tick, as the virus is in it salivary glands. After completing all the manipulations, the wound should be treated with an antiseptic.

In order to prevent meningitis, swimming in lakes, ponds and other bodies of water with stagnant water should be avoided. If you are going to travel to countries where epidemics of a viral or other type of meningitis are not uncommon, you should make the necessary vaccines. Also visiting exotic places, doctors recommend taking antifungal drugs. It is mandatory to refrain from contact with animals and insects during tourist trips.

In residential and office premises, it is necessary to maintain required level cleanliness and systematically carry out the destruction and prevention of rodents and insects.
If one of your family members has meningitis, you need to isolate the patient, reducing contact of any kind with him as much as possible. If communication with a person infected with meningitis is unavoidable, you should consult a doctor. The doctor will prescribe an antibiotic depending on the nature of the disease and the type of contact.

What should not be done?

To prevent meningitis, you should not:

• trigger otolaryngological diseases ( otitis, sinusitis, sinusitis);
• neglect preventive treatment in the presence of chronic diseases;
• ignore the calendar preventive vaccinations;
• do not comply with sanitary and hygienic standards at work and at home;
• eat dirty fruits and vegetables;
• do not take precautions when interacting with the patient;
• ignore protection methods when visiting potentially dangerous places ( transport and other public places).

Meningitis - causes, symptoms, complications and what to do? - Video

Reactive meningitis is an acute infectious inflammatory disease sections of the brain and spinal cord. It occurs in people of any age, but most often premature newborns, people with back injuries, and diseases of the central nervous system get sick.

A feature of this disease is its suddenness, spontaneity, transience. Therefore, it is also called "fulminant meningitis" - it can kill adults in one day, and small children in a few hours. This is what distinguishes it from other forms.

Causes of the disease

The causative agent of the disease is meningococcal bacillus, which spreads by airborne droplets. Therefore, you can get infected by visiting a clinic, while riding in transport, a store, and so on.

For children attending kindergartens, there is a chance of getting an infection there during an epidemic. In addition to meningococcal bacillus, enterovirus infection or other varieties can be the cause of the lesion.

Measles, rubella, parotitis can provoke reactive meningitis. The provocateurs of the disease are otitis media, sinusitis, furunculosis, lung abscess and other purulent diseases, as well as the presence and back injuries. Premature and weakened children are also at risk.

Features of the disease in children

In young children, the disease can develop in utero if the mother is already sick with meningitis or another disease that provoked a corresponding infection in the newborn.

Childhood reactive meningitis strikes a child at lightning speed and can lead to death within a few hours. In all cases, there are complications that can occur immediately or occur later.

Symptoms of the disease

Reactive meningitis is manifested by the following characteristic symptoms:

Adults and children tend to lie down in the “pointing dog” position: pressing their legs to their stomachs and throwing their heads back, all this happens while lying on their side. This is also one of the signs of meningitis.

How is the diagnosis made?

An accurate diagnosis can only be made with a lumbar puncture. Only this study can distinguish from other diseases similar in symptoms.

But such a study takes time, so blood is urgently taken for general and biochemical analysis. In addition, an examination of the fundus, x-ray of the skull, and.

An accurate diagnosis of the patient is made on three main grounds: specific symptoms of meningitis, signs indicating infection of the patient, and changes in the cerebrospinal fluid.

Health care

Treatment of reactive meningitis is carried out only in a hospital, most often in the intensive care unit. For young patients and adults, the principle of treatment is almost the same, there can only be prescriptions for different groups of antibiotics, but this depends on the patient's well-being and the reaction of his body to the drug. Young patients always have complications that occur immediately with the disease or later.

The goal of therapy is to prevent unfortunate consequences for the patient, as well as to start treatment as early as possible.

Start antibiotic treatment immediately a wide range exposure at the highest possible doses. For this, drugs from the groups of penicillins, cephalosporins and macrolides are used.

In 20% of cases, the cause of the disease is never identified, which is why antibiotics are immediately prescribed, acting on all harmful microorganisms.

If the patient's condition worsens, the drug can be injected into the spinal canal. A course of antibiotics is prescribed for a period of at least 10 days, but if there are purulent foci in the brain area, then the course is extended.

If the drugs used: Penicillin, Ceftriaxone and Cefotaxime do not help, and the patient is threatened with fatal complications, then Vancomycin and Carbapenem are used, which have serious side effects.

In addition, therapy is carried out to relieve symptoms with the following drugs:

• antispasmodics and muscle relaxants - the removal of cramps and spasms in the muscles;
• glucocorticoids - improving the functioning of the adrenal glands;
• Furosemide - prevention of cerebral edema;
• Sorbilact - if there is already swelling;
• for general therapy, administration is carried out using droppers saline solutions, plasma substitutes, antipyretics.

In the first hours of treatment, all drugs are administered intravenously - this is how the drug works most effectively, helping to avoid the occurrence of toxic shock. It is on time that the treatment started will help to cope with the disease without serious consequences for the patient.

Before the arrival of the ambulance, it is necessary for the patient to ensure physical and mental peace, to create maximum comfort, because all his feelings are aggravated.

It is necessary to close the windows with curtains, isolate from noise and screaming, to reduce the pain syndrome, put ice or rags soaked in cold water on the head, arms to the elbows and legs to the knees, changing them as they warm up. The patient can be given a drug for headache.

Complications and prognosis

In reactive meningitis, the prognosis can be favorable for middle-aged people if treatment is started in a timely manner. For infants and the elderly, treatment often does not bring any effect, since the course of the disease passes rapidly, symptoms and complications arise on the rise.

Possible complications of fulminant meningitis are:

• DIC - the formation of clots in the blood, spots on the skin merge into one spot, gangrene may begin on the hands and feet, as well as blood accumulations in the mouth, in the eyes and sclera;
• mental retardation in children;
• paralysis;
• deafness;
• septic shock;
• blindness;
• decrease in sodium ions in the blood.

In the case of all points of treatment, mortality from reactive meningitis occurs in 10% of all cases.

The main point of prevention of fulminant meningitis is vaccination, however, vaccination does not guarantee complete protection against infections.

In addition, crowded places should be avoided, especially during the epidemic. Patients with meningitis should be isolated from healthy ones, sending them to a hospital. All personal hygiene procedures must be strictly observed. Going on a trip or a trip, study the situation with infections in the area.

If you find symptoms similar to meningitis in yourself or your loved ones, you should immediately consult a doctor, but it is better to call ambulance. Only timely and proper treatment gives a chance to avoid death or serious consequences for the patient.