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Meningitis is an inflammatory process which happens in covers of a head and spinal cord. In this case distinguish a pachymeningitis (an inflammation of a firm cover of a brain) and a pia-arachnitis (an inflammation of soft and web covers of a brain).
According to specialists, cases of an inflammation of a soft meninx which can be designated the term "meningitis" are more often diagnosed. Causative agents of this disease are various microorganisms of pathogenic type: viruses, protozoa, bacteria. Most often children and teenagers, and also people of old age get sick with meningitis. Serous meningitis most often affects children at preschool age. Viral meningitis has easier symptoms and a current, than bacterial meningitis.
Types of meningitis
According to character of an inflammation in covers, and also to changes in cerebrospinal liquid meningitis is subdivided into two look: serous meningitis and purulent meningitis. At the same time dominance in cerebrospinal liquid of lymphocytes is characteristic of serous meningitis, and existence of bigger quantity of neutrophils – of purulent meningitis.
Also meningitis is divided on primary and secondary. Meningitis primary arises without existence in an organism of the patient of infectious diseases, and secondary is shown as complication, both systemic infection, and an infectious disease of a certain body.
If to trace prevalence of inflammatory process in a meninx, then meningitis is subdivided into a disease of generalized and limited character. So, basal meningitis arises on the basis of a brain, konveksitalny meningitis — on a surface of cerebral hemispheres.
It is dependent on speed of the beginning and further progressing of an illness meningitis subdivide on fulminant, acute (slow), subacute, chronic.
According to an etiology distinguish viral meningitis, bacterial, fungal, protozoan meningitis.
Clinical picture of meningitis
Diseases which passed into a chronic form (a sarcomatosis, a sarcoidosis, syphilis, toxoplasmosis, leptospirosis, a lymphogranulomatosis, a brucellosis, etc.) can be a peculiar incitement to development of meningitis.
Infection of covers of a brain can happen hematogenous, perineural, lymphogenous, chrezplatsentarny in the ways. But generally transfer of meningitis is carried out in the airborne or contact way. At a contact way of infection activators can get on brain covers in view of existence of a purulent infection of a middle ear, okolonosovy bosoms, existence of pathologies of teeth, etc. For an infection at meningitis the mucous membrane of a nasopharynx, bronchial tubes, a gastrointestinal tract acts as entrance gate. Getting in such a way to an organism, the activator extends lymphogenous or a hematogenous way to brain covers. Clinical displays of meningitis are followed existence of hypostasis and inflammatory process in a meninx and adjacent brain fabric, disturbance of microcirculation in brain vessels. Because of too strong secretion of cerebrospinal liquid and its slow resorption the normal level of intracranial pressure can be broken and be shown a brain edema.
Manifestation of pathological changes at purulent meningitis which proceeds sharply does not depend on the activator. After the activator gets into brain covers in the way through a lymph or blood, inflammatory process strikes all subarachnoid space of a head and spinal cord. If the zone of an infection has accurate localization, then purulent inflammatory process can be limited.
At infection hypostasis of covers and substance of a brain takes place. Sometimes there is a flattening of gyruses in view of existence of internal hydrocephaly. At patients with serous viral meningitis hypostasis of covers and substance of a brain is observed, at the same time likvorny spaces extend.
Regardless of what etiology of a disease, symptoms of meningitis are, as a rule, similar at different forms of an illness.
So, symptoms of meningitis provalyatsya by all-infectious signs: the patient has a feeling of a fever, heat, the increased body temperature, existence of signs of an inflammation in peripheral blood (increase in SOE, existence of a leukocytosis). Emergence of an enanthesis is in certain cases possible. At an early stage of meningitis at the patient the slowed-down frequency of reductions of heart can be observed. Not in development of meningitis this sign is replaced by tachycardia. At the person the respiratory rhythm is broken and becomes frequent.
As a meningeal syndrome nausea and vomiting, a headache, fear of light, a skin hyperesthesia, existence of rigidity of cervical muscles and other signs is shown. In this case meningitis symptoms at first are shown by a headache which in process of a course of a disease becomes more intensive. Display of a headache provokes irritation of pain receptors in covers of a brain and in vessels in view of development of an inflammation, influence of toxin and increase of intracranial pressure. Character of pain – arching, pain can be very intensive. At the same time pain can be localized in a forehead and in occipital area, giving to a neck and a backbone, even sometimes affecting extremities. Even in the onset of the illness at the patient vomiting and nausea can be shown, at the same time these phenomena are not connected with food. Meningitis at children, and in more exceptional cases and at adult patients can be shown by spasms, existence of nonsense, psychomotor excitement. But in the course of a further course of a disease these phenomena are replaced by the general stupor and drowsiness. At later stages of a disease these phenomena sometimes pass into a coma.
In view of irritation of covers of a brain the reflex muscle tension is observed. Most often the patient has a Kernig's sign and a stiff neck. If at the patient the illness proceeds in a severe form, then other symptoms of meningitis are shown. So, the patient throws back kzad the head, pulls in a stomach, straining a front abdominal wall. At the same time in a prone position of a leg will be attracted to a stomach (a so-called meningeal pose). In some cases at the patient the malar symptom of Bekhterev, strong morbidity of eyeglobes which is shown after pressing or at the movement by eyes is shown. The patient badly reacts to strong noise, loud sounds, pungent smells. Best of all in a similar condition of people feels, lying in the dark room without the movement and blindly.
Meningitis at children of chest age is shown by tension and protrusion of a fontanel, and also existence of a symptom of "suspension" of Le Sage.
At meningitis manifestations of a venous hyperemia, a papilledema are possible. If the disease proceeds hard, then expansion of pupils, a diplopia, squint can be symptoms of meningitis. It is difficult for person to swallow, developing of paresis and paralyzes of extremities, bad coordination of movements, and existence of a tremor is possible. These symptoms of meningitis indicate defeat and covers, and brain substance. Similar is possible at the last stage of a disease.
Bacterial meningitis, as a rule, begins sharply, at the same time pronounced meningeal symptoms take place. Slower development is characteristic only of tubercular meningitis. In most cases at bacterial meningitis the level of sugar is lowered, and protein level — is increased.
Elderly people can have an atypical course of meningitis. So, headaches can slightly be absent or shown, but at the same time trembling of hands, legs, the heads is observed. There is a drowsiness, apathy.
Diagnosis of meningitis
As a rule, the diagnosis "meningitis" is established, being guided by existence of three symptoms of meningitis:
— presence of an all-infectious syndrome;
— existence of the shell (meningeal) syndrome;
— changes of inflammatory character in cerebrospinal liquid.
At the same time it is impossible to diagnose meningitis, being guided by existence only of one of the called syndromes. Results of a number of virologic, bacteriological methods of research are important for statement of the correct diagnosis. Diagnosis of meningitis is carried out also by visual examination of cerebrospinal liquid. At the same time the specialist without fail considers the general epidemiological situation and features of a clinical picture.
Patients at whom signs of irritation of a meninx take place should carry out a lumbar puncture. In the course of this procedure cerebrospinal fluid for the subsequent research is taken with use of a fine needle which is entered in the bottom of a back. Also current status of liquor is defined, existence of a large number of cells is defined (pleocytosis), and also as far as their structure changed. Also special tests which allow to define difference between bacterial and viral meningitis are used.
Complications of meningitis
Owing to bacterial meningitis the person can have an injury of a brain. So, the heaviest complications of this illness are epilepsy, deafness, a delay of intellectual development at meningitis in children. If not to begin the correct and timely treatment of meningitis, then the illness can provoke a lethal outcome. In especially hard cases the death occurs in few hours.
Treatment of meningitis
At treatment of meningitis it is very important to define, first of all, what activator provoked development of an illness. However it is necessary to treat this disease only in the conditions of a hospital. Viral meningitis, as a rule, proceeds rather easily therefore to the patient it is strongly recommended to drink a lot of liquid for the purpose of the prevention of dehydration of an organism. For treatment of meningitis analgetics, febrifugal drugs are used. Generally the person recovers approximately in two weeks.
At bacterial meningitis, especially if provoked it meningokokk, treatment should be appointed and made very urgently. If bacterial meningitis is diagnosed for the patient, then generally for treatment antibiotics of a wide profile are used. The most often used drug at this form of an illness is penicillin. According to researchers, this means can destroy about 90% of causative agents of meningitis. Also immediate treatment penicillin appoint sick for which purulent meningitis is diagnosed.
Also medicines which can reduce intracranial pressure, means with febrifugal influence are applied to treatment of meningitis at children and adults. Often in complex therapy also nootropic drugs, antioxidants, drugs which stimulate activity of a brain blood-groove are appointed.
It is important to consider that if adults who recovered from meningitis not always need constant further control from physicians, then meningitis at children – an occasion to regularly visit the doctor and after full treatment.
It is important to patients who stay at a recovery stage to avoid strong loadings and physical, and emotional character, not to happen too long under direct beams of the sun, not to drink a lot of liquid and to try to use as little as possible salt. Alcohol should be excluded in general.
Prevention of meningitis
Today vaccination against separate causative agents of meningitis is successfully applied (a vaccine against a pneumococcus, a hemophilic stick). It is important to consider that vaccination gives quite notable effect in questions of protection against meningitis, however does not guarantee the absolute prevention of infection. However, having even caught an illness, the person to whom vaccination was done, will have meningitis in much easier form. After an inoculation the vaccine acts on an extent of three years.
It is important as methods of prevention of meningitis to follow the basic rules of everyday hygiene. It is important to pay special attention to regular washing of hands, personal objects (lipstick, ware, a toothbrush, etc.) not to give for use to strangers. In case of close contact with sick meningitis it is important to see a doctor immediately. The specialist can appoint reception of certain drugs for the purpose of prevention.
Section: Brain diseases