What is purulent meningitis and what are the consequences. Purulent meningitis: causes, manifestations, methods of diagnosis and treatment

Purulent meningitis is an inflammatory process of the soft membrane of the brain due to the penetration of various microorganisms into it (streptococci, pneumococci or meningococci). Purulent meningitis is manifested by the following symptoms:

• heat;
• Strong headache;
• vomit;
• nausea;
• malfunctions of the cranial nerves;
• manifestation of meningeal symptoms;
• disorder of consciousness;
• hyperesthesia;
• uncontrolled psychomotor agitation.

Diagnosis of purulent meningitis is based on the collected clinical picture and cerebrospinal fluid analysis results. The main treatment for purulent meningitis will be antibiotic therapy, as well as the use of glucocorticosteroids, anticonvulsants, tranquilizers and decongestants. Symptomatic therapy can also be carried out.

Purulent meningitis is a disease characterized by its bacterial etiology. This disease is rare: no more than 3 cases per 100 thousand people. The risk of purulent meningitis is high among all categories of the population and age groups, but children under the age of five are most often affected. Most often, they infect children with a weakened immune system. The peak is in winter-spring.

An interesting fact is that in the first half of the 90s of the 20th century, everything began to become infected with purulent meningitis. less people. In addition, the number of deaths and cases that were accompanied by severe consequences after suffering purulent meningitis has significantly decreased.

Causes of purulent meningitis

The main causative agent leading to infection with purulent meningitis is considered to be meningococcal infection. However, in last years scientists have proven that not only it leads to the disease, but also Haemophilus influenzae and pneumococci. In half of all cases, the causative agent of purulent meningitis will be Haemophilus influenzae, while meningococcus accounts for no more than 20%, and pneumococci - only 12-13%.

Purulent meningitis also occurs in newborns. The reason for this will be a streptococcal infection or salmonellosis. In addition, infected coli may also be the main causative agent.

Regarding the ways the pathogen enters the human body, purulent meningitis is classified into:

• primary: development is facilitated by the hematogenous spread of the pathogen from the nasal cavity, where it enters when a person breathes; it is easy to become infected by contact with patients (airborne droplets or contact); direct infection of the meninges occurs in the case of an open traumatic brain injury, skull fracture or any other open injury paranasal sinuses nose (or mastoid process); non-observance of hygiene rules during neurosurgical operations is another possible reason infection;
• secondary: arises on the basis of an already existing primary focus, from which the infection spreads to the brain area; the nature of the spread of infection can be both contact (with a brain abscess or osteomyelitis of the cranial bones) and hematogenous, spread from any focus of infection is characteristic, but most often with sinusitis or otitis media.

If the causative agent of purulent meningitis enters the body through the blood-brain barrier, then immunity is weakened. The latter can also be caused by SARS or frequent stressful situations, as well as physical overwork, change of climatic zones.

Classification of purulent meningitis

Regarding the severity of symptomatic manifestations, the following forms of purulent meningitis are distinguished:

• light;
• moderate;
• severe (inherent in people with severely reduced immunity or those who have previously had their spleen removed).

Regarding the features of the course of the disease, they talk about purulent meningitis:

• fulminant (characterized by a very rapid development of symptoms in the form of an increase in cerebral edema, which contributes to confusion and the onset of vital functions);
• abortive (has erased symptoms, where the first place is given to intoxication);
• acute (occurs more often than others; it has traditional cerebral and meningeal symptoms);
• recurrent (characteristic in the case of a running form, with no timely treatment or in the case when a chronic type of focus of purulent infection is observed in the body).

Symptoms of purulent meningitis

• The onset of purulent meningitis is usually acute and is characterized by a sharp increase in body temperature up to 39-40°C. Along with the temperature, a characteristic chill appears, a severe headache of an increasing nature, nausea and vomiting. The patient's condition may be characterized by agitation of the psychomotor type, confusion, manifestations of delirium.
• About 40-45% of patients are characterized by convulsive syndrome. The so-called shell symptoms: neck stiffness, Kernig's symptom, Guillain's symptom, are usually expressed in the first hours of the disease, intensifying more and more on the 3rd-4th day.
• Additional symptoms of purulent meningitis will be hyperesthesia, a decrease in abdominal reflexes, which is observed against the background of already increased activity of deep reflexes. It is not excluded the occurrence of a diffuse rash, which has a hemorrhagic character.
• Under the focal symptoms that accompany purulent meningitis, understand, first of all, a violation of the functioning of the cranial nerves. Most often, the oculomotor nerves are affected, which leads to double vision, further development of strabismus, and may fall upper eyelid or anisocoria (marked difference in pupil size) may appear. Neuritis is much less common facial nerve, damage may occur trigeminal nerve or dysfunction optic nerves, which is expressed in a partial loss of the field of view and a decrease in its sharpness. There is also a violation of the functioning of the vestibulocochlear nerve, which in medicine is called progressive hearing loss.
• Severe focal symptoms indicate ongoing spread inflammatory processes occurring in the brain, as well as the development of vascular abnormalities similar to the manifestations of ischemic stroke, which is explained by the presence of vasculitis, cerebral thrombosis or reflex spasm.
• If the inflammatory process completely extends to the substance of the brain, then we are already talking about meningoencephalitis. In this case, purulent meningitis unfolds with the addition of a special focal symptomatology inherent in encephalitis (paresis or paralysis, impaired sensitivity, slurred speech, the occurrence of pathological reflexes, muscle excitability).
• Symptoms such as hallucinations, vestibular ataxia, hyperkinesis, sleep disturbance, memory and behavioral disorders are not excluded.
• If the purulent process further spreads to the ventricles of the brain, then a spastic attack may occur, unfolding like hormetonia with flexion contractures of the arms or extensor legs.

Diagnosis of purulent meningitis

Usually, the diagnosis of purulent meningitis is made on the basis of detailed symptoms in the form of meningeal and neurological manifestations, damage to the cranial nerves.

Lumbar puncture

It is more difficult to diagnose purulent meningitis in the case of an abortive course or in its secondary occurrence against the background of already existing symptoms of a septic focus. To make a final diagnosis, a lumbar puncture is performed, which determines whether the pressure of the cerebrospinal fluid is increased, and whether its color has changed, whether clouding has occurred.

smear microscopy

With further examination of the cerebrospinal fluid, an increased content of protein substances and cellular elements can be detected. Usually, the pathogen is determined by microscopy of a smear taken from cerebrospinal fluid, as well as when it spreads to a nutrient medium.

Additional diagnostic measures

During the diagnosis, a blood test and an analysis of the separated elements of the skin rash are also carried out. If a specialist has an assumption about the presence of purulent meningitis of a secondary nature, then an additional examination is prescribed, the purpose of which is to identify the primary infectious focus. For this, the patient is sent for a consultation with a pulmonologist, otolaryngologist or general practitioner. Effective diagnostic measures here will be otoscopy, x-ray of the paranasal sinuses, x-ray of the lungs.

Differential diagnosis is carried out with viral meningitis, subarachnoid hemorrhage, meningism, which is also observed in typhus, leptospirosis and severe cases of influenza.

Complications of purulent meningitis

The most serious complication of purulent meningitis is cerebral edema, which compresses the brain stem, disrupting the functioning of the vital centers located in it. Acute swelling occurs on the 3rd day from the onset of the disease. In case of lightning current acute form manifests itself in the first hours.

In their clinic, complications of purulent meningitis are most often expressed in motor disturbances, confusion, impaired normal breathing and functioning on the part of of cardio-vascular system(in the form of tachycardia, bradycardia, arterial hypotension or arterial hypertension).

Other complications of purulent meningitis may include:

• septic shock;
• subdural empyema;
• adrenal insufficiency;
• purulent arthritis;
• pneumonia;
• pyelonephritis;
• infective endocarditis;
• cystitis;
• septic panophthalmitis.

Treatment of purulent meningitis

With purulent meningitis, patients are treated only in a hospital. Patients should immediately undergo a lumbar puncture with further bacterioscopic examination of the cerebrospinal fluid. After the etiology of meningitis is established, the patient is prescribed a course of antibiotics. The latter often involves the use of ampicillin with drugs from the cephalosporin family, including cefotaxime, ceftriaxone, and ceftazidime. If the causative agent of purulent meningitis is not identified, initial therapy consists of intramuscular injection of aminoglycosides or their combination with ampicillin. At severe forms purulent meningitis, intravenous antibiotics may be prescribed.

Dehydration therapy with mannitol and furosemide may be prescribed to reduce swelling of the brain. If we talk about the pathogenetic type of treatment, then it involves the use of dexamethasone or prednisolone, in a word, glucocorticosteroids. The prescribed doses will depend on the severity of the disease. In addition, doctors prescribe symptomatic therapy. If the patient also has disturbed sleep, then tranquilizers are prescribed. In order to stop psychomotor agitations and eliminate seizures, lytic mixtures are prescribed, as well as valproic acid or diazepam. Infusion therapy will be prescribed in the presence of infectious-toxic shock.

Treatment during the recovery period

When it comes to therapy recovery period after suffering purulent meningitis of the acute phase, then the use of neuroprotective or nootropic substances, as well as vitamin therapy and other restorative therapy are indicated here.

Treatment of secondary purulent meningitis

With secondary purulent meningitis, the treatment of patients should involve the elimination, first of all, of the primary septic focus, including possible application surgery in the form of a sanitizing operation (in the case of otitis media), removal of an intracerebral abscess, frontotomy or sphenotomy.

Prognosis of purulent meningitis

According to statistics, about 15% of all cases of purulent meningitis are fatal. If the diagnosis was made in a timely manner, and treatment was started urgently, then the prognosis of the disease will be favorable.

It should be said that after a person has been ill with purulent meningitis, he may develop asthenia with characteristic liquor-dynamic disorders and inherent hearing loss of a neurosensory nature. Also, in some cases, there may be an implicit focal symptomatology.

Such severe complications after suffering purulent meningitis, such as complete deafness, hydrocephalus, amaurosis, dementia or epilepsy, are very rare today.

Prevention of purulent meningitis

The proven sure way to prevent purulent meningitis is to vaccinate. Typically, the goal will be to counter infection with major pathogens such as Haemophilus influenzae, pneumococcus, or meningococcus. This vaccination is not mandatory, but highly recommended.

Vaccination is usually given to young children (usually under 5 years of age), as well as to people who have been diagnosed with an immunodeficiency state due to the development of HIV infection in the body.

Interestingly, vaccination is also prescribed for people after the removal of the spleen, thymus, or after immunosuppressive therapy in cancer patients. Speaking of vaccination against meningococcal infection, then it is indicated for children older than 18-20 months, and is mandatory if the disease has been diagnosed in at least one family member. In those areas that are considered the most prone to the spread of meningococcal purulent meningitis, vaccination should be carried out regularly, especially for people with immunodeficiency, as well as those who have traumatic brain injuries. Vaccinations should be carried out among children who often suffer from otitis media, pneumonia, or simply have low immunity.

– 20% of cases;

According to statistics, purulent meningitis occurs in 3.3 out of 100 thousand people.

For purulent meningitis the incubation period is most often 2 to 5 days.

Symptoms of the disease

The disease begins acutely with an increase in temperature to 39 - 40 degrees and is accompanied by chills.

The main symptoms in the early stages of the disease:

By the third day, the intensity of symptoms increases, hypersensitivity to auditory, tactile and visual stimuli.
The patient complains of too bright light, loud noises and painful touches.

Often there are more severe violations such as paralysis, partial memory loss. This suggests that the inflammation passed to the brain tissue and led to the development of meningoencephalitis.

Depending on the localization of the focus of inflammation, the following symptoms are added:

• impaired vision and hearing;
• hallucinations;
• rave;
• psychomotor agitation;
• double vision.

Diagnostic methods

For the diagnosis of purulent meningitis carry out the following tests:

• blood analysis;
• Analysis of urine;
• puncture of the cerebrospinal fluid.

First of all, pay attention to the presence of meningeal symptoms.:

Also, on examination, the extinction of the abdominal reflexes and the strengthening of the deep ones are revealed.

In some cases, a rash appears on the body especially in the mouth area. This symptom is more typical for children, but also occurs in adults. If present, fragments of the rash are also taken for analysis.

When collecting cerebrospinal fluid, its cloudy color, the presence of pus and the high pressure with which it flows out are noted. During laboratory tests reveal a high protein content and neutrophilic pleocytosis in the cerebrospinal fluid, low sugar and chloride levels, in the blood - a high number of leukocytes and an increase in ESR.

If secondary meningitis is suspected, x-rays of the lungs and sinuses are taken to identify the initial source of infection.

Treatment

Treatment of purulent meningitis lasts about two weeks and is carried out only in the inpatient department under the constant supervision of an infectious disease specialist and a neurologist. This is due to the fact that only the doctor will make the correct diagnosis, prescribe the appropriate therapy, depending on changes in the patient's condition.

Self-treatment will lead to a deterioration in the condition, the development of complications and, possibly, the death of the patient.

Therapy has three main areas:

1. Antibiotics penicillin series: Ceftriaxone, Cefotaxime, Meronem. They are used to inhibit the ability to reproduce microorganisms and their destruction.
2. A dropper with saline and vitamins to relieve symptoms of intoxication.
3. Drugs to reduce intracranial pressure.

Important! Don't take medicines without a doctor's prescription. This will lead to the development side effects and cause deterioration of the patient's well-being.

Health implications

Purulent meningitis without proper treatment leads to the development of many complications that are dangerous to health and life:

• headache;
• attention disorders;
• cerebrospinal syndrome;
• slow motion activity;
• slow pace of thinking;
• personality disorders: tearfulness, irritability, capriciousness.

Prevention

The main way to prevent the disease is vaccination against a bacterial infection. In Russia, it is carried out at the request of the patient. In addition, timely and competent treatment of concomitant diseases is necessary to prevent secondary meningitis.

This is especially true for infections that cause inflammation. Also, doctors recommend taking measures to strengthen immunity.

• balanced diet;
• vitamin therapy;
• active lifestyle;
• hardening;
• rejection of bad habits.

Purulent meningitis is dangerous disease, which without proper treatment leads to the development of multiple serious complications. It is characterized by inflammation of the meninges and without therapy causes secondary inflammation of the brain. It is important to remember that meningitis, like any other disease, is easier to prevent than to cure.

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Group of infectious diseases nervous system, characterized by the development of general infectious, cerebral, meningeal syndromes and inflammatory changes in the cerebrospinal fluid of a purulent nature - purulent meningitis. From this article you will learn its causes and symptoms, as well as how it is treated in a child.

Causes of purulent meningitis

In the structure of neuroinfection is 20 - 30%. In 90% of cases, the causative agents are meningococcus, Haemophilus influenzae, pneumococcus. Less common are staphylococci, Escherichia, Salmonella, Pseudomonas aeruginosa, Klebsiella, Listeria, fungi of the genus Candida, etc.

The causative agent of the disease

The causative agent is Neisseria meningitidis, a gram-negative diplococcus. The source of infection is a patient with any form of meningococcal infection or a carrier of meningococcus. Incubation period primary purulent meningitis lasts on average from 2 to 5 days.

Ways of transmission - airborne, contact-household. Mostly the symptoms of the disease appear in children under 5 years of age. Typical winter-spring seasonality.

Symptoms of purulent meningitis

The disease begins acutely with a rise in body temperature to 39-40 ° C and above, chills, pronounced symptoms of intoxication (lethargy, weakness, refusal to eat and drink, headache). In the future, the kids become restless, the headache increases, intensifies with sound and light stimuli, head turns; the phenomena of a hyperesthesia are sharply expressed. There is repeated vomiting that is not associated with eating and does not bring relief. The patient is pale, the sclera are injected; tachycardia, muffled heart sounds. From 2 to 3 days from the onset of the disease, meningeal symptoms (stiff neck muscles, symptoms of Kernig and Brudzinsky) are detected.

The main signs of purulent meningitis

Newborns have such a symptom as a monotonous cry; a large fontanel bulges, tense; venous network on the head and eyelids; positive symptom"suspension" (Lessage). In severe cases, drowsiness appears, turning into stupor, convulsions and unstable focal symptoms of purulent meningitis are possible.

In 30 - 40% of cases, purulent meningitis is combined with meningococcemia (hemorrhagic rash on the skin of a petechial and / or "star" nature, etc.)

Diagnosis of the disease

Supporting and diagnostic signs of purulent meningitis:

• characteristic epidemiological anamnesis;
• an increase in body temperature to 39-40 ° C and above;
• severe intoxication;
• Strong headache;
• repeated vomiting;
• meningeal symptoms;
• possible oppression of consciousness (up to coma);
• convulsions are possible;
• the presence of other foci.

Laboratory diagnostics

Primary purulent meningitis is diagnosed by several methods:

Specific diagnostic methods:

• Bacteriological - sowing the pathogen from pharyngeal mucus, blood, cerebrospinal fluid and determining its sensitivity to antibiotics; bacterioscopic - detection of a pathogen in a smear of pharyngeal mucus, blood, cerebrospinal fluid.
• Express methods - detection of the pathogen antigen in the material with subsequent serotyping (RNGA, RLA, RCA).
• Serological - an increase in the titer of specific antibodies by 4 times or more in paired blood and cerebrospinal fluid samples taken in the first days of the disease and after 2 weeks.

Nonspecific diagnostic methods: lumbar puncture - cerebrospinal fluid is cloudy, neutrophilic pleocytosis is noted up to 1000-5000 cells in 1 μl or more; the protein level is increased; the content of sugar and chlorides is not changed (in severe cases it decreases); in the clinical analysis of blood - leukocytosis with a neutrophilic shift to immature forms, increased ESR.

Differential diagnosis is carried out with serous meningitis and meningism syndrome.

If purulent meningitis of the brain is suspected, the child must be hospitalized in a specialized hospital, with impaired consciousness and breathing - in the intensive care unit.

On the prehospital stage to reduce intracranial pressure, it is necessary to carry out:

• dehydration - lasix 1-2 mg/kg;
• with symptoms of cerebral edema - dexazone 0.5-1 mg / kg or prednisone 2 mg / kg;
• with convulsions - seduxen in the age dosage.

If breathing is disturbed, it is necessary to supply humidified oxygen through a mask, intubation, and mechanical ventilation. With hyperthermia, a lytic mixture is administered (analgin with pipolfen and papaverine). Conducted in the hospital complex treatment including etiotropic, pathogenetic and symptomatic therapy.

Medication treatment

The choice of etiotropic antibacterial agents is determined by the proposed etiology and the ability of the drug to penetrate the blood-brain barrier. Given the etiological structure of the disease in children under 5 years of age (meningococci, pneumococci, Haemophilus influenzae, rarely staphylococci, salmonella, Escherichia), chloramphenicol succinate (80-100 mg / kg / day) is used for starting therapy in children at this age.

Treatment of children over 5 years of age is carried out with benzylpenicillin sodium salt (300 thousand units / kg / day), since most diseases are caused by meningococcus. After bacteriological isolation, biotyping and serotyping of the pathogen, antibiotic therapy is adjusted in accordance with the sensitivity of the isolated strain. Reserve drugs are III-IV generation cephalosporins (cefotaxime, ceftriaxone, ceftazidime, cefoperazone, cefpirome, cefepime), carbapenems (meropenem), monobactams (aztreonam). Duration antibacterial treatment is at least 10-14 days.

Indications for the abolition of antibiotics are: the disappearance of symptoms of intoxication, persistent normalization of body temperature, normalization of the hemogram, sanitation of cerebrospinal fluid (the number of cells is not more than 30 in 1 μl, 70% of them are lymphocytes). In order to prevent candidiasis with massive and prolonged antibiotic therapy, the appointment of nystatin, diflucan is indicated.

How to cure purulent meningitis?

Pathogenetic treatment is aimed at reducing intoxication, intracranial hypertension and normalization of cerebral hemodynamics. For the purpose of dehydration, furosemide, diacarb are used; detoxification therapy includes intravenous infusion of rheopolyglucin, glucose-salt solutions; for improvement cerebral circulation prescribe trental, cavinton, instenon.

With the development of edema-swelling of the brain, therapeutic measures begin after providing adequate respiratory support (humidified oxygen, intubation, mechanical ventilation). The volume of infusion therapy is reduced to 2/3 of the physiological need; mannitol, reogluman are used as starting solutions. Anticonvulsant therapy for this type of meningitis in a child includes the introduction of Relanium, GHB, sodium thiopental, 2% chloral hydrate solution in an enema.

In severe cases, weakened babies are given immunostimulating therapy:

• immunoglobulin for intravenous administration(pentaglobin, endoglobulin, sandoglobulin),
• leuco suspension,
• fresh frozen plasma
• UV blood.

In the period of convalescence, the treatment of meningitis is continued with drugs that improve microcirculation, immunomodulators (Dibazole, herbal adaptogens), according to indications - dehydration (diacarb, diuretic) and anticonvulsant (luminal).

Dispensary observation

After the disease, children are observed by a pediatrician, an infectious disease specialist and a neuropathologist with instrumental methods studies (EEG, ECHO-EG, neurosonography). During the first year after discharge from the hospital, examinations by specialists are carried out 1 time in 3 months, in the second year - 1 time in 6 months. Deregistration is carried out in the absence of symptoms, residual effects not earlier than 2 years after the disease.

How to treat purulent meningitis?

Treatment of patients in the acute period.

Therapy at the prehospital stage:

Dehydration - Lasix 1-2 mg/kg/day IM.

Treatment with antipyretics - paracetamol.

At a body temperature of 38.5 "C and above - lytic mixture (w / m):

• papaverine solution 2% - ml / year.

Therapy in the hospital:

Shown bed rest for the entire acute period. The diet is age-appropriate, complete, mechanical and chemical sparing, rich in vitamins and microelements.

Etiotropic therapy for this type of meningitis:

Drugs of choice:

• chloramphenicol succinate 80-100 mg/kg/day (no more than 2 g per day) after 6 hours IM or IV;
• benzylpenicillin sodium salt 300 thousand units / kg / day after 4 hours / m or / in.

Reserve drugs:

3rd generation ceflosporins:

• cefotaxime 150 mg/kg/day 8 hours IM or IV;
• ceftriaxone 150 mg/kg/day 12 hours IM or IV.

Carbapenems:

• meronem 40 mg/kg 8 h i.v. The duration of the course of treatment is at least 10-14 days.

Pathogenetic therapy of purulent meningitis:

Detox:

• oral rehydration (tea, fruit drink, juices, etc.);
• intravenous infusion of glucose-salt (10% glucose, 0.9% NaCl, Ringer) and colloidal (rheopolyglucin, rheomacrodex) solutions.

Ratio 1:3.

Dehydration:

• lasix 0.1-0.2 ml/kg/day IM for 1-2 days;
• diacarb 0.06-0.25 mg once on an empty stomach according to the scheme 3 - 2 - 3 (3 days are prescribed, 2 days are a break, 3 days are prescribed, etc.) for 3-4 weeks.

treatment with drugs that improve cerebral circulation:

• trental 5 - 10 mg / kg / day;
• Cavinton 0.5-1.0 mg / kg / day. The course of treatment is 3-4 weeks.

Symptomatic therapy for purulent meningitis:

Antipyretic - paracetamol 10-15 kg / kg 3 times a day.

At a body temperature of 38.5 ° C and above - a lytic mixture:

• analgin solution 50% - 0.1 ml / year;
• pipolfen solution 2.5% - 0.15 ml / year;
• papaverine solution 2% - 0.1 ml / year.

Multivitamins with trace elements.

In the treatment of meningitis occurring with cerebral edema, the therapy is added:

Glucocorticosteroids:

• dexamethasone 0.5-1 mg/kg/day IM, IV;
• prednisone 2 mg/kg/day IM, IV.

Anticonvulsants:

• seduxen up to 10-30 mg/kg/day;
• GHB 50-100 mg/kg;
• luminal 10 mg/kg.

Respiratory support - humidified O 2 , endotracheal intubation, mechanical ventilation.

Treatment of patients with purulent meningitis in the period of convalescence:

Drugs that improve metabolic processes in the brain:

• Cavinton 0.5-1.0 mg/kg + Pantogam 0.125-0.5 g orally 3 times a day;
• picamilon 1 mg/kg orally 3 times/day;
• piracetam: 3-7 years - 0.4-0.8 g; 7-12 years old - 0.4 (0.8) - 1.2 (2.0) g; 12 - 16 years - 0.8 - 2.4 g orally 2 times a day. Course 1 - 1.5 months.

Herbal adaptogens - preparations of echinacea, zamanihi, Chinese magnolia vine (1 drop per year of life 3 times a day).

Dehydration (according to indications) - diacarb, diuretic herbal teas.

Vitamin therapy - lifepack junior +, lifepack senior, antiox +, detox +, mega, beauty, brain-o-flex, bisque, active, chromvital +, nutrimax +, ursul, hyper, mystic, passilat, winex.

Purulent meningitis is treated with a course of 1 - 1.5 months.

Anticonvulsants (if indicated).

Clinical follow-up with a neurologist for at least 2 years with instrumental research methods (EEG, EchoEG, neurosonography). Examination frequency: in the first year - 1 time in 3 months, in the second year - 1 time in 6 months. For 3 months, a sparing regime - it is forbidden to run, jump, stay in the sun.

Consequences of purulent meningitis

Edema-swelling of the brain - the most common complication acute period of this type of meningitis - manifested:

• change of consciousness (stunning, stupor);
• convulsions;
• unstable focal symptoms (hemiparesis, ataxia).

Increasing cerebral edema leads to compression of the brain stem, which contributes to a further disorder of consciousness up to coma, an increase in epileptic seizures with a transition to epistatus, a violation of vital functions, bilateral motor disorders that first form a decortication posture, then decerebration. The decortication posture for purulent meningitis is characterized by a flexion position upper limbs(hands clenched into fists are shown in the wrist and elbow joints hands) and extensor position of the legs. Posture of decerebration - a sharp hypertonicity of the limbs in the extensor type.

With these syndromes, hyperreflexia, pathological foot signs are noted. The level of damage to the brain stem is determined by the dysfunction cranial nerves: oculomotor (pupil size, reaction to light, position eyeballs), facial (weakness and / or asymmetry of the facial muscles) or bulbar (functions of swallowing, sound pronunciation). Purulent meningitis of the brain with progressive edema leads to the dislocation of the trunk and the development of the herniation syndrome (respiratory and cardiac arrest).

Acute hydrocephalus is manifested by bulging and tension of the large fontanel, divergence of the skull sutures, an increase in the circumference of the head, and an expansion of the cerebrospinal fluid spaces (determined by ultrasound and computed tomography brain).

Cerebral infarction is noted on the 1st week. diseases of purulent meningitis and is manifested by focal symptoms of loss of functions.

Subdural effusion occurs more often in children early age. The usual localization of the effusion is in the frontal regions of the brain, parasagitally. Leading diagnostic criteria are:

• persistent fever for more than 3 days. against the background of adequate antibiotic therapy or an inexplicable rise in body temperature after its decrease on the 3rd - 5th day of illness;
• deterioration, depression of consciousness, the appearance of local convulsions, hemiparesis;
• lack of pulsation of the fontanel with its compaction, sometimes local hyperemia;
• asymmetric luminescence focus during diaphanoscopy;
• the presence of effusion on ultrasound and computed tomography of the brain.

In the future, a child with purulent meningitis may experience drowsiness, vomiting, stiff neck muscles, congestion in the fundus, sharp increase protein content in cerebrospinal fluid.

The syndrome of inappropriate secretion of antidiuretic hormone (ADH) or the syndrome of water intoxication develops as a result of damage to the hypothalamic structures of the central nervous system and is characterized by an extremely serious condition; high intracranial pressure; reduced osmolarity of blood and cerebrospinal fluid; hyponatremia (

Syndrome of ventriculitis (ependymatitis) with purulent meningitis is characterized by the spread purulent process on the ependyma of the ventricles of the brain and manifests itself:

• bulging and tension of the large fontanel, headache, divergence of the sutures of the skull, dilatation of the veins of the fundus, frequent vomiting, progressive disorder of consciousness, convulsions;
• the development of opisthotonus (stretched and crossed legs in the lower parts of the legs, fingers clenched into fists, flexed hands) and cachexia central genesis;
• slight lymphocytic pleocytosis with a high protein content in the cerebrospinal fluid.

Adverse Outcomes: asthenovegetative syndrome; minimal brain dysfunction syndrome; hypertensive-hydrocephalic syndrome; paresis and paralysis; hyperkinesis; ataxia; adhesive arachnoiditis; epilepsy; hypothalamic syndrome, etc.

Now you know why purulent meningitis occurs in children, what symptoms it manifests and how to treat it.

Purulent meningitis is a purulent inflammation of the membranes of the brain caused by streptococci, pneumococci, staphylococci, Pseudomonas aeruginosa, intestinal microbes, etc. Purulent meningitis occurs in people of all ages.

Risk factors include: smoking, insolation, frequent stress, hypothermia, excessive alcohol consumption, pharyngitis, tonsillitis, acute respiratory infections.

The reasons

Most often, the causative agents of purulent meningitis are representatives of the bacterial microflora - meningococci, pneumococci, Haemophilus influenzae (influenza stick), Pseudomonas aeruginosa, different kinds staphylococci and streptococci, gonococci, salmonella, E. coli, causative agents of typhoid fever and listeriosis.

But sometimes purulent meningitis also develops with a fungal infection (more often it still has a non-purulent, serous character) - cryptococcosis, coccidioidosis and candidiasis. The cause of purulent meningitis can also be protozoa, for example, some types of amoebas.

1. Primary purulent meningitis, caused by meningococcus, is transmitted mainly by airborne droplets: infection with meningitis occurs when sneezing, coughing, kissing, through objects contaminated with saliva, and so on.
2. Secondary meningitis, which is a complication of some other inflammatory processes (rhinogenic, otogenic, odontogenic, and so on), as a rule, is not contagious.

Secondary purulent meningitis

Secondary purulent meningitis occurs when there is a purulent focus in the body. They can develop either as a result of a direct transfer of infection from purulent foci to the membranes of the brain, for example, with or, thrombosis of the sinuses of the dura mater, brain abscess, or by metastasis from purulent foci located at a distance, for example, with abscesses or bronchiectasis of the lungs, ulcerative endocarditis, etc. Purulent meningitis sometimes complicates penetrating wounds of the skull.

The causative agents of secondary purulent meningitis can be various bacteria: pneumococci, staphylococci, Haemophilus influenzae Afanasiev-Pfeiffer, salmonella, Pseudomonas aeruginosa, listerella.

Symptoms of purulent meningitis

At the very beginning, meningitis in adults is manifested by symptoms similar to many other diseases. Noticing them, you need to see a doctor as soon as possible to prevent formidable complications. Later, actually purulent meningitis develops, the symptoms of which are quite specific.

The incubation period is 1-5 days. The disease develops acutely: severe chills, body temperature rises to 39-40°C.

An intense pain in the head occurs and rapidly increases with nausea or repeated vomiting. Possible delirium, psychomotor agitation, convulsions, impaired consciousness. In the first hours, shell symptoms (stiff neck muscles, Kernig's symptom) are detected, increasing by the 2-3rd day of illness.

1. Kerning's symptom - the sick person is not able to fully straighten his legs.
2. Brudzinski's symptom is an uncontrolled flexion of the hip and knee joints.

Deep reflexes are animated, abdominal ones are reduced. In severe cases, lesions of the cranial nerves are possible, especially III and VI pairs (ptosis, anisocoria, strabismus, diplopia), less often - VII and VIII pairs. On the 2-5th day of illness, herpetic eruptions often appear on the lips.

Sometimes there are also various skin rashes(more often in children) of a hemorrhagic nature, which indicates meningococcemia. Cerebrospinal fluid is turbid, purulent, flows out under high pressure.

Neutrophilic pleocytosis (up to several tens of thousands of cells in 1 µl), increased protein content (up to 1-16 g/l), reduced level sugar and chlorides. Meningococcus is found in smears of CSF sediment after Gram stain. It can also be isolated from mucus taken from the throat. In the blood - leukocytosis (up to 30-109 / l) and.

In preschool children, the disease often takes the form of meningoencephalitis, in which the leading symptoms are motor activity, confusion, signs of damage to the cranial nerves - strabismus, paralysis of the face and larynx. With such a course, the stage of paralysis sets in rather quickly, and when the cerebrospinal fluid ducts are blocked with pus, hydrocephalus develops.

In the case of the development of meningococcal septicemia, the syndromes of increased vascular permeability and intravascular coagulation are pronounced. In this case, foci of hemorrhages form on the skin. irregular shape, protruding above the surface of the skin, and necrosis - areas of necrosis.

Complications

Complications and consequences of meningitis in adults are very dangerous for human health and life, they can be avoided if treatment of the disease is started in a timely manner.

The consequences of purulent meningitis include:

• cerebrosthenic syndrome;
• increased fatigue;
• instability of attention;
• inability to long-term stress;
• irritability;
• capriciousness;
• tearfulness;
• fussiness;
• excessive physical activity;
• general lethargy;
• slow thinking.

An early and formidable complication that can be accompanied by purulent meningitis is cerebral edema, leading to compression brain stem with vital centers located in it. Acute cerebral edema, as a rule, occurs on the 2-3rd day of the disease, with a lightning-fast form - in the first hours.

Forecast

According to some reports, purulent meningitis is fatal in 14% of cases. However, with timely started and correctly carried out treatment, purulent meningitis has a generally favorable prognosis.

After suffering meningitis, asthenia, liquor-dynamic disorders, sensorineural hearing loss, and some mild focal symptoms can be observed. Severe consequences of purulent meningitis (hydrocephalus, amaurosis, deafness, dementia,) are rare in our time.

Treatment of purulent meningitis

Purulent meningitis with proper and timely treatment recedes completely after two weeks. At the first signs of the disease, the patient must be hospitalized and placed in the intensive care unit.

First of all, the doctor prescribes an appointment antibacterial drugs that have an effect directly on the brain. If after three days of taking the drugs of this group there is no improvement, a second puncture of the cerebrospinal fluid is prescribed. And then the drugs change.

To relieve symptoms of intoxication in purulent meningitis in adults, intravenous infusions of solutions are prescribed. Diuretic drugs are also applicable to remove toxins from the blood. Sedatives are prescribed in cases of severe and frequent convulsions. And to restore cerebral circulation, special drugs are prescribed.