Purulent meningitis symptoms. What is the danger of purulent meningitis in adults? Find out the causes, symptoms and consequences

The most severe inflammatory disease of the central nervous system is purulent meningitis. This disease can affect a person at any stage of life, but most often it is diagnosed in children under the age of five.

What is purulent meningitis

This disease is characterized by an acute inflammatory nature, the infection affects the membranes of the brain, causing the formation of purulent foci. The development of purulent meningitis is provoked by pathogenic bacteria that enter the nervous system through the blood.

The disease is mainly affected by people with weak immunity, who have previously suffered from serious infectious diseases, with head injuries, as well as premature babies.

This disease is seasonal. Most often diagnosed in winter and spring.

If treatment is started in a timely manner, there are chances of a full recovery. In some cases, the disease leads to serious complications. The very substance of the brain in the course of the disease is not affected. However, cerebral edema and purulent accumulations in its cortex cause dangerous symptoms that can pose a threat to the patient's life.

Causes and types

It is customary to distinguish between primary and secondary type purulent meningitis, depending on the nature of the onset of the disease.

Primary disease occurs due to ingestion of external environment pathogenic bacteria, such as:

• Pneumococcus;
• hemophilic wand type "B";
• meningococcus;
• others microorganisms.

Infection occurs mainly by contact and airborne droplets.

Children are more likely to become infected because weak immunity can not cope even with the most dangerous pathogen. In the body of an adult, antibodies are produced throughout life to those infections that they may have encountered earlier. Therefore, they are diagnosed with meningitis less often.

The secondary form occurs only when any source of infection is present in the patient's body. This applies to acute respiratory diseases, otitis media, sinusitis, etc.

From the focus of the disease, microbes enter the cerebral cortex and become the cause of the development of purulent processes.

The risk of getting a secondary type of purulent meningitis is minimal among those people who have previously had a primary form.

Epidemiology

The peculiarity of the development of purulent meningitis depends on the bacteria that provoked the disease. In this regard, there are several types of diseases.

For meningococcal meningitis is characteristic acute course already in the initial stages, sometimes with symptoms colds. Sudden increase in body temperature, nausea, vomiting, constant headache. A day after the onset of the disease, the tension of the muscles of the back of the head is manifested.

The disease progresses rapidly - the patient has hallucinations, the aggressive state changes to passivity and loss concentration. Vision and hearing may be impaired. An obvious symptom is a rash over the body, which later increases in size and forms ulcers. A possible complication in the form of hemorrhages in the adrenal cortex leads to the death of the patient.

Often pneumococcal meningitis affects children and adults over the age of forty. Both skull injuries and inflammation of the ears or nasopharynx can become foci of infection. Meningitis of this type can also occur in the primary form of the disease.

Symptoms are similar to those of meningococcus. With untimely and inadequate treatment, there is a high probability of complications and death. The secondary form has a severe and protracted character, as well as frequent relapses. In the absence of proper treatment, death can occur within a week.

Meningitis-Hib It is caused by Haemophilus influenzae and is only of the secondary type. It can occur with otitis media, pneumonia or sinusitis. Most often, newborns and preschoolers are exposed to it.

The disease in the early stages develops gradually. There are frequent cases of a temporary imaginary improvement in well-being even before the start medical process. This type is characterized by a decrease in the secretion of cerebrospinal fluid.

Staphylococcal meningitis also refers to a secondary disease, as a complication after purulent inflammatory processes in the body, pneumonia and blood poisoning. This infection is resistant to medications, so treatment is difficult. Abscesses often develop. The disease carries a great danger to life.

Symptoms

On the early stages it is difficult to independently identify purulent meningitis, since the main symptoms are similar to other diseases. In the subsequent stages, the development of the underlying disease occurs.

First, a sick person feels a breakdown, drowsiness, manifestations of a cold, nausea, loose stools, a rash on the body that resembles chickenpox or rubella is not excluded.

In the secondary type of purulent meningitis, there are pains in the joints and bones, heat, discharge from the ears and nose, blurred vision. In case of exacerbation of pneumonia - cough, shortness of breath, discomfort in the chest area.

Signs in young children

It is difficult to determine what worries a child who has not yet learned to talk. In this case, parents should carefully monitor his behavior. The main symptoms of the disease are the following:

1. During sleep hands are constantly reaching for the head.
2. spring sticks out or sinks relative to the level of the cranial bone.
3. If a sick child is taken by the armpits and lifted, he will try to press down legs to the stomach.
4. In the supine position, the child tries throw back head back.
5. Appear spots or a rash on the body.
6. Arises chills, convulsions.

Usually, before the development of purulent meningitis, a child has bronchitis, pneumonia, otitis media, or conjunctivitis.

If the above symptoms appear, parents should immediately seek medical help.

In newborns, the disease is fleeting. In the absence of urgent and adequate treatment, death can occur within three days.

Symptoms in adults

Most of the signs of purulent meningitis in the initial stage of the disease can be simply ignored or temporarily alleviated with simple medications. This only delays the start of treatment and leads to an exacerbation of the disease.

The main signals for concern are:

• chronic headaches pain, accompanied by a feeling of internal pressure in the cranium, increased pain when moving the head in different directions, loud sounds or bright lights;
• tension muscles in the occipital region - a sick person, lying on his back, is forced to tilt his head back;
• constant nausea and vomiting, regardless of the number of meals;
• high temperature, strong sweating, chills;
• decline concentration attention, ignoring speech appeals from the outside, aggressive behavior, hallucinations;
• convulsions limbs and spontaneous urination;
• visual impairment and strabismus.

The appearance of such symptoms indicates the seriousness of the progression of the disease and requires emergency care physicians. The patient is sent to the hospital as soon as possible for diagnosis and treatment plan.

Diagnostics

To establish an accurate diagnosis, the attending physician examines the patient's medical history in detail. Diseases that were previously transferred, possible foci of chronic infections, contacts with infected people, and injuries are taken into account.

• Analysis blood. Confirmation of the disease may be a change in the number of leukocytes, an increase in the erythrocyte sedimentation rate, a decrease in hemoglobin concentration, or a decrease in the number of platelets.
• Analysis urine.
• Computer tomography or MRI.
• Radiography.

But the main method for diagnosing purulent meningitis is spinal puncture. For this, material is taken using a syringe with a needle, which is inserted between the third and fourth lumbar vertebrae into the space between the spinal cord and the membrane.

In case of illness, the cerebrospinal fluid will have high blood pressure, cloudy consistency of green or yellow tint, depending on the type of infection. In this case, an excessive amount of protein is determined.

If there is a suspicion of a secondary type of disease, a procedure is carried out to identify infectious foci. The patient may be referred to an ophthalmologist, otolaryngologist or neurologist.

The main confirmation of the disease is detection in the fluid a large number neutrophils.

Features of treatment

After studying the results of the analyzes, it is established infectious agent and treatment is given.

Adults and seriously ill children are in the hospital of the infectious diseases department or intensive care unit.

First of all, an antibiotic is introduced into the patient's body that can stop the further progression of the inflammatory process. The dosage is set to the maximum, and the regularity of admission is more than once every four hours. With the help of diuretics, swelling of the brain is removed.

In parallel, the patient is prescribed drugs to reduce the severity of symptoms (headaches, nausea, fever).

In the secondary form of the disease, the infectious focus is treated.

A craniotomy may be performed to remove the pus.

When the patient's condition improves, he is discharged from the hospital for further treatment Houses.

In the future, for two years, children are regularly observed by a neurologist, pediatrician and infectious disease specialist. At first, the examination is carried out once a quarter, in the future this period is six months. Adults are under the supervision of a therapist, psychiatrist, infectious disease specialist and neurologist.

In case of deterioration of the state of health, the schedule of visits to doctors changes.

Recovery after trepanation

The rehabilitation process after surgical intervention and removal of pus from the meninges is difficult. The patient experiences severe pain, fatigue. He has swelling of the face and head.

You can rise to your feet only a day after the operation. The patient remains under the supervision of doctors in the hospital for 2 to 14 days. Depending on the circumstances, medications may be prescribed to relieve pain, swelling, and cramps.

After discharge at home, you should do household chores that do not require maximum physical and mental effort.

Restoring health after trepanation can take up to two months, taking into account the age of the person and the complexity of the disease.

During rehabilitation, some activities and habits should be abandoned:

• driving transport facilities;
• use alcoholic drinks;
• stay for a long time in motionless state;
• significant physical loads;
• activities related to sharp head movements.

Consequences and prognosis

According to statistics, every seventh patient diagnosed with purulent meningitis does not survive. A high chance of recovery is given by timely and correct treatment. It should be borne in mind that this disease will not go away on its own, and it will not be possible to recover without the help of doctors.

Due to the rapid progression of the disease, it is urgent to contact a medical institution.

Allocate a row possible consequences transferred purulent meningitis in both children and adults:

• frequent headaches pain, dependent on pressure drops in the external environment;
• epileptic seizures, paralysis, hydrocephalus;
• decline attention concentration, memory impairment;
• backlog in development in children;
• worsening hearing, vision, speech, pathology internal organs;
• intracranial hypertension.

Depending on the severity of the disease, some patients manage to recover without any health complications.

Prevention

Purulent meningitis refers to those types of disease that are most often caused by infectious agents that enter the human blood. Therefore, first of all, you need to monitor your health.

In addition, preventive vaccination shows high efficiency in combating meningitis. Doctors recommend that children be vaccinated before admission to kindergarten or school, as well as people with weak immunity.

For the purpose of timely diagnosis and treatment, you should consult a doctor at the first symptoms. It should be remembered that running form purulent meningitis can lead not only to disability, but also to death.

Purulent inflammation meninges is extremely dangerous pathology regardless of the age of the patient. Children have symptoms of this disease and it often proceeds especially hard. Moreover, this disease can lead to the development of very severe long-term consequences, and therefore it is very important to recognize the presence of this disease at an early age. early stages. How does purulent meningitis proceed in children, what are the consequences, symptoms of its cause, how not to start the disease, what should be done immediately if something happens?

What is this disease?

This disease is characterized by the rapid development of purulent inflammation of the meninges, brain and (or) spinal cord. In view of the immaturity of immunity, children are more susceptible to this pathology than adults.

The following conditions are predisposing factors: weakened immunity, frequent hypothermia, a history of diseases or injuries of the central nervous system, general exhaustion, any diseases that lead to a weakening of the body.

In children, this disease develops especially rapidly. Already in the first days of the disease, the patient's condition is significantly disturbed, convulsions, respiratory and cardiac disorders, clouding or a complete lack of consciousness may appear.

Purulent meningitis - causes of the disease

Purulent meningitis is an infectious disease. The causative agent of the disease is most often meningococcus (Neisseria meningitidis) - a gram-negative microorganism from the genus Neisseria. The path of penetration of bacteria into the human body is most often airborne, but others are possible: fecal-oral, vertical (from mother to fetus during childbirth), and so on. Infection occurs through contact with a sick person.

An adult, with a satisfactory state of immunity, can be a carrier of this infection. In such patients, only mild malaise and catarrhal symptoms are noted. respiratory tract(cough, itching in the nose, as well as runny nose, sneezing).

Infection of the child occurs during contact with the carrier of the infection. Meningococcus is characterized by a fairly high virulence (contagiousness), which means that even a few minutes of being in the same room with a sick person is enough for infection.

Even in children, the causes of meningitis are as follows: ECHO, adenoviruses, polio virus, cytomegaloviruses, Coxsackie enteroviruses and some others.

Etiological factor meningitis has an important prognostic value. If the infection is characterized by a bacterial nature and is caused by meningococci, the patient develops a stable long-term immunity, which practically prevents the development of this disease in the future.

The same cannot be said if the disease is caused by viruses. With any weakening of immunity, subject to contact with the pathogen, a person can again become infected with this pathology.

The disease can be primary and secondary. In the second case, the infection spreads with blood or lymph from other organs, for example, with otitis media or frontal sinusitis.

Purulent meningitis - symptoms of the disease

Manifestations of purulent meningitis depend on the age of the child. If the patient is less than a year old, the baby becomes capricious, refuses to eat and drink, he develops adynamia (moves little), vomiting and loose stools may occur.

At an older age, the disease manifests itself as follows: vomiting occurs (which does not bring relief), severe headache, insomnia, lethargy, complete lack of appetite, loose stools, emotional arousal and aggressiveness appear, eventually turning into inhibition and drowsiness.

Regardless of age, a condition called hyperesthesia develops - a sharp increase in sensitivity. Even the slightest touch to the skin causes a sharp pain.

Body temperature almost always rises, and to quite impressive values. It is not uncommon when during hospitalization the doctor of the emergency room registers a temperature of 39-40 degrees.

Diagnosis of the disease in early age(up to a year) is fraught with certain difficulties. The baby's whims can be frequent, and therefore parents sometimes just give of great importance another "protest" of the child.

However, at this age, a tremor of the limbs may appear, and muscle tone may decrease. Important diagnostic value has a strong pulsation of a large fontanel.

In some cases, but not always, numerous hemorrhagic rashes, red or Pink colour, quite densely covering significant areas of the body.

Symptoms of the disease develop rapidly. If in the morning the child felt completely satisfactory, by the evening his condition may already be extremely difficult.

Purulent meningitis - the consequences of the disease

Timely diagnosis and timely treatment in conditions medical hospital reduce the likelihood of complications of purulent meningitis. With this approach, it is almost always possible to completely cure the patient.

If treatment is started late, with the appearance of neurological symptoms, the prognosis is significantly aggravated. Most often in this case, children can experience hearing loss, up to complete deafness, or loss of vision.

In addition, there may be problems with the emergence of speech skills, which will negatively affect mental development, make it difficult to learn and form the most important social experience.

An inflammatory process that occurs in the pia mater of the brain when pyogenic microorganisms (pneumococci, meningococci, streptococci, etc.) penetrate into it. Purulent meningitis is characterized by high body temperature, intense headache, nausea, vomiting, disorders of the cranial nerves, early onset meningeal symptoms, hyperesthesia, disorder of consciousness, psychomotor agitation. It is possible to diagnose purulent meningitis on the basis of a typical clinical picture and data from the analysis of cerebrospinal fluid. Purulent meningitis is an indication for mandatory antibiotic therapy. Decongestants, glucocorticosteroids, tranquilizers, anticonvulsants etc. symptomatic therapy.

General information

Purulent meningitis is an inflammation of the meninges (meningitis) that has a bacterial etiology. Purulent meningitis occurs with a frequency of 3.3 cases per 100,000 population. All age categories are susceptible to the disease, but most often purulent meningitis develops in children under 5 years of age. It is noted that purulent meningitis often occurs against the background of a weakened state immune system. An increase in the incidence is observed in the winter-spring period. Since the beginning of the 90s of the last century, there has been a significant decrease in the incidence of purulent meningitis, a decrease in the number of deaths and cases of development severe complications.

Causes of purulent meningitis

The development of purulent meningitis can lead not only meningococcal infection, but also pneumococci, Haemophilus influenzae and other bacteria. Almost half of the cases of purulent meningitis are due to Haemophilus influenzae. In 20% of cases, the cause of purulent meningitis is meningococcus, in 13% of cases - pneumococcus. In newborns, purulent meningitis often results from streptococcal infection, salmonellosis, or E. coli infection.

Depending on the mechanism of penetration of the pathogen into the membranes of the brain in neurology, primary and secondary purulent meningitis are distinguished. Primary purulent meningitis develops with hematogenous spread of the pathogen from the nasal cavity or pharynx, where it enters from the external environment. Infection occurs from sick persons and carriers by airborne droplets and contact. Direct infection of the meninges is possible with a skull fracture and open craniocerebral injury, open injuries of the mastoid process and paranasal sinuses, insufficiently careful observance of asepsis rules during neurosurgical interventions.

Secondary purulent meningitis occurs against the background of a primary septic focus in the body, the infection from which penetrates into the membranes of the brain. Contact spread of pyogenic microorganisms can be observed with brain abscess, osteomyelitis of the skull bones, septic sinus thrombosis. Hematogenous and lymphogenous spread of the pathogen is possible from an infectious focus of any localization, but most often occurs with long-term infections of the ENT organs (acute otitis media, chronic purulent otitis media, sinusitis).

The penetration of pathogens of purulent meningitis through the blood-brain barrier is facilitated by a weakened state of the body's immune system, which can be caused by frequent SARS, hypovitaminosis, stress, physical overload, and a sharp change in climate.

Classification of purulent meningitis

Depending on the severity clinical manifestations purulent meningitis is classified into mild, moderate and severe forms. Severe forms of the disease are observed mainly against the background of a sharp decrease in immunity and in patients with a removed spleen.

According to the characteristics of the course, fulminant, abortive, acute and recurrent purulent meningitis are distinguished. The most common acute purulent meningitis with typical cerebral and meningeal symptoms. The fulminant course of purulent meningitis from the first hours of the disease is characterized by a rapid increase in cerebral edema, leading to impaired consciousness and vital functions. The abortive variant is distinguished by its erased clinical picture, in which the symptoms of intoxication come to the fore. Recurrent purulent meningitis can occur with insufficient or belated treatment of the acute form of the disease, as well as in the presence of a chronic focus in the body. purulent infection.

Symptoms of purulent meningitis

The incubation period of primary purulent meningitis lasts on average from 2 to 5 days. Typically acute onset with a sharp rise in body temperature to 39-40°C, severe chills, intense and growing headache, nausea and repeated vomiting. Psychomotor agitation, delirium, impaired consciousness may be observed. In 40% of cases, purulent meningitis occurs with a convulsive syndrome. Shell symptoms specific for meningitis (symptom of Kernig, Brudzinsky, Guillain, neck stiffness) are expressed from the first hours of the disease and intensify on the 2nd-3rd day. Severe hyperesthesia and a decrease in abdominal reflexes against the background of a general increase in deep reflexes are typical. Perhaps the appearance of a diffuse hemorrhagic rash.

Focal symptoms accompanying purulent meningitis most often consist in dysfunction of various cranial nerves. The most commonly observed damage to the oculomotor nerves, leading to double vision, the development of strabismus, drooping of the upper eyelid and the appearance of a difference in the size of the pupils (anisocoria). Less common is neuritis of the facial nerve, damage to the trigeminal nerve, dysfunction optic nerve(loss of visual fields, decreased visual acuity) and vestibulocochlear nerve (progressive hearing loss). More severe focal symptoms indicate the spread inflammatory changes on the substance of the brain or on the development of vascular disorders such as ischemic stroke due to vasculitis, reflex spasm or thrombosis of cerebral vessels.

With the transition of the inflammatory process to the substance of the brain, they speak of the development of meningoencephalitis. At the same time, purulent meningitis proceeds with the addition of focal symptoms characteristic of encephalitis in the form of paresis and paralysis, speech disorders, changes in sensitivity, the appearance of pathological reflexes, increased muscle tone. Hyperkinesis, hallucinatory syndrome, sleep disturbances, vestibular ataxia, behavioral and memory disorders are possible. Spreading purulent process on the ventricles of the brain with the development of ventriculitis is manifested by spastic seizures of the type of hormetonia, flexion contractures of the arms and extensor legs.

Complications of purulent meningitis

An early and formidable complication that can be accompanied by purulent meningitis is cerebral edema, leading to compression of the 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. Clinically, it is manifested by motor restlessness, impaired consciousness, respiratory distress, and of cardio-vascular system(tachycardia and arterial hypertension, in the terminal stage giving way to bradycardia and arterial hypotension).

Among other complications of purulent meningitis, there may be: septic shock, adrenal insufficiency, subdural empyema, pneumonia, infective endocarditis, pyelonephritis, cystitis, septic panophthalmitis, etc.

Diagnosis of purulent meningitis

Typical Clinical signs, the presence of meningeal symptoms and focal neurological symptoms in the form of damage to the cranial nerves, as a rule, allow the neurologist to assume that the patient has purulent meningitis. It is more difficult to diagnose in cases where purulent meningitis has an abortive course or occurs a second time against the background of symptoms of an existing septic focus of another localization. To confirm purulent meningitis, it is necessary to perform a lumbar puncture, during which an increased pressure of the cerebrospinal fluid, its turbidity or opalescent color is detected. Subsequent examination of the cerebrospinal fluid determines an increased content of protein and cellular elements (mainly due to neutrophils). Identification of the pathogen is carried out during microscopy of smears of cerebrospinal fluid and during its seeding. culture media.

For diagnostic purposes, they also perform a blood test and separated elements. skin rash. Under the assumption of the secondary nature of purulent meningitis, additional examinations aimed at finding the primary infectious focus: consultation with an otolaryngologist, pulmonologist, therapist; radiography of the paranasal sinuses, otoscopy, radiography of the lungs.

It is necessary to differentiate purulent meningitis from viral meningitis, subarachnoid hemorrhage, meningism phenomena in other infectious diseases (typhus, leptospirosis, severe forms influenza, etc.).

Treatment of purulent meningitis

All patients with purulent meningitis are subject to treatment in a hospital setting. Such patients should immediately undergo a lumbar puncture and bacterioscopic examination of the cerebrospinal fluid. Immediately after the establishment of the etiology of meningitis, the patient is prescribed antibiotic therapy. In most cases, it is a combination of ampicillin with cephalosporin drugs (ceftriaxone, cefotaxime, ceftazidime). With purulent meningitis unknown etiology initial therapy is intramuscular injection aminoglycosides (kanamycin, gentamicin) or their combination with ampicillin. Severe purulent meningitis may require intravenous or intrathecal antibiotics.

In order to reduce hydrocephalus and cerebral edema in purulent meningitis, dehydration therapy (furosemide, mannitol) is prescribed. Pathogenetic treatment of purulent meningitis also includes the use of glucocorticosteroid drugs (dexamethasone, prednisolone), the doses of which depend on the severity of the disease. Along with this, the necessary symptomatic therapy is performed. In case of sleep disorders, tranquilizers are prescribed; for the relief of psychomotor agitation and convulsions - lytic mixtures (chlorpromazine, diphenhydramine, trimeperidine), diazepam, valproic acid; with hypovolemia and the development of infectious-toxic shock, infusion therapy is performed.

IN recovery period after the acute phase of purulent meningitis, nootropic and neuroprotective drugs, vitamin therapy and restorative treatment are recommended. Treatment of patients with secondary purulent meningitis should include the elimination of the primary septic focus, including through surgical intervention (sanitizing operation

Prevention of purulent meningitis

To date, the most effective way to prevent purulent meningitis is vaccination. Vaccinations are carried out against the main pathogens of purulent meningitis: Haemophilus influenzae, meningo- and pneumococci. In Russia, these vaccines are not considered mandatory and are administered according to indications or at the request of patients.

Vaccination against Haemophilus influenzae is carried out mainly in children aged 3 months to 5 years and people suffering from immunodeficiency states as a result of HIV infection, immunosuppressive therapy for cancer, removal of the thymus or spleen, etc. Vaccination against meningococcal infection recommended for children over 18 months and adults. Children under 18 months of age are vaccinated according to epidemic indications (for example, if meningococcal purulent meningitis is diagnosed in one of the family members). In regions dangerous for meningococcal purulent meningitis, vaccination should be carried out in patients with immunodeficiency and people with anatomical defects of the skull. Vaccination against pneumococcal infection is indicated for frequently ill children, patients with frequent pneumonia and otitis, in cases of reduced immunity.

Purulent meningitis - inflammatory disease bacterial nature, affecting the membranes (mainly soft) of the brain and spinal cord, may be of an infectious primary or secondary nature.

It is registered in all countries of the world, the frequency of occurrence ranges from 3 (developed countries) to 200 cases per 10,000 population. Epidemic outbreaks of purulent meningitis periodically occur due to the emergence of new strains of the pathogen or the transfer of old ones to other regions of the planet. Children under five years of age are more susceptible to the disease; among adults, pathology is more often observed in men.

Types of purulent meningitis

According to the etiological basis, two large groups of forms of purulent meningitis are distinguished - primary and secondary. Such a division is rather arbitrary, since it is not always possible to reliably determine the source of the infection that caused the disease. Each of these groups is characterized by a certain set of features:

• Primary forms of purulent meningitis occur when a person is infected with pathogenic bacteria of a certain type - from the group of meningococcus, pneumococcus, Haemophilus influenzae.
• Secondary forms of purulent meningitis develop in the presence of a focus of bacterial infection in other organs or as a result of the introduction of bacteria to the meninges from the external environment (after medical manipulations, surgical operations, with traumatic brain injury).

The course of purulent meningitis varies in speed and severity of symptoms. Such differences are due to the nature of the pathogen, the reactivity of the body, the state of the immune system and a number of other factors. According to these signs, the following clinical types of the disease are distinguished:

1. Lightning type. The most severe form - from the development of symptoms to the death of the patient from cerebral edema, takes only a few hours. Most often occurs with purulent meningitis in children and debilitated adults.
2. Sharp type. The most common variant of purulent inflammation of the meninges. It is characterized by a rapid increase in symptoms and a severe general condition.
3. abortive type. A rare form of purulent meningitis in adults, in which the symptoms of the underlying disease are quite blurred. At the forefront are manifestations of general intoxication.
4. recurrent type. The rarest form of purulent bacterial meningitis, in which periods of improvement alternate with exacerbations over many weeks or months.

The cause of the disease is the penetration of pathogenic bacteria into the membranes of the brain and spinal cord and their further reproduction with the development of purulent inflammation. The main route of entry of the pathogen into the membranes (both in primary and secondary purulent meningitis) is hematogenous, occasionally (only in secondary forms) - injection and contact. Most often, the disease is caused by infection with the following bacteria:

1. Haemophilus influenzae. According to medical statistics, the pathogen is determined in almost 50% of cases of purulent meningitis, which affects people at any age.
2. Meningococcus (Neisseria meningitidis). Causes about 20% of cases of the disease, and it is its strains that most often lead to epidemic outbreaks of meningitis.
3. Pneumococcus (Streptococcus pneumoniae). Causes purulent meningitis in 10-13% of all cases. The course of pathology is severe, mortality reaches 50%.

In some cases, infection with staphylococci, Escherichia coli, salmonella, Pseudomonas aeruginosa and some other bacteria leads to the development of the disease. A significant variety of causative agents of purulent meningitis complicates the treatment, since the effectiveness of therapeutic measures largely depends on properly selected antibacterial drugs.

The disease always has an acute onset, duration incubation period ranges from several hours to 5–7 days. The first symptoms of purulent meningitis are high fever (up to 40-41 ° C), severe headaches, nausea, vomiting, which is profuse and repeated. Many patients experience convulsions - the frequency of their development in pathology increases with a decrease in the age of the patient. Often, against the background of fever, hallucinations, delirium, psychomotor agitation develop. From the first day of the course of the disease, tension (rigidity) of the occipital muscles is determined, with movements of the neck, painful sensations are determined.

For the prevention of secondary purulent meningitis, it is necessary to timely identify and eliminate potentially dangerous foci of infection in the body - otitis, sinusitis, chronic abscesses, dental pathologies.

With inflammation of the meninges caused by meningococcal infection, a hemorrhagic rash develops - spots of various localization and sizes that do not turn pale when pressed. Also, when infected with this pathogen, the development of skin necrosis is possible, especially in places subject to pressure. On the 2nd–4th day of the course of the pathology, signs of damage to the cranial nerves are often recorded - strabismus, ptosis of the eyelids, anisocoria, visual impairment and hearing loss. The occurrence of nystagmus, hyperkinesia, disorders of muscle tone indicates the involvement of the nervous tissue of the brain in the pathological process - the development of meningoencephalitis.

Diagnostics

For the diagnosis of purulent meningitis, instrumental and laboratory methods research. When examined by a neurologist, the rigidity of the occipital muscles and the presence of specific meningeal symptoms are determined:

1. Kernig's sign.
2. Brudzinski's symptoms.
3. Guillain's sign.

These manifestations, in combination with other symptoms of purulent meningitis, clearly indicate the presence of the disease. In addition, to confirm the diagnosis and determine the nature of the pathogen, a number of laboratory tests are carried out:

1. Collection of cerebrospinal fluid by spinal puncture. Liquor is cloudy, flows out under pressure. Subsequently, with the help of microscopy, neutrophils are determined in it, when sown on nutrient media, the pathogen is isolated.
2. General and biochemical analysis blood. Bacteria of the pathogen (bacteremia) can be isolated in it, and strong leukocytosis is also determined due to an increase in the level of neutrophils, an increase in ESR.
3. Other studies to determine the state of other organs and systems, prevent complications and identify the primary focus of infection (if secondary purulent meningitis is suspected).

Differential diagnosis is made with viral, tuberculous and fungal forms of meningitis, as well as subarachnoid hemorrhage.

Treatment

Treatment of purulent meningitis includes taking antibacterial, diuretic and anti-inflammatory drugs and a number of other drugs, if indicated. In severe cases, treatment is started immediately with antibiotics. a wide range actions, otherwise antibacterial agents prescribed after receiving the results of a bacteriological study of the cerebrospinal fluid. Diuretics are needed to reduce cerebral edema and associated neurological disorders and complications.

The occurrence of nystagmus, hyperkinesia, disorders of muscle tone indicates the involvement of the nervous tissue of the brain in the pathological process - the development of meningoencephalitis.

As anti-inflammatory drugs, steroid drugs are most often prescribed, the dosage and the need to prescribe them depend on the severity of the manifestations and the severity of the patient's condition. Symptomatic treatment of purulent meningitis may include anticonvulsants (with convulsions), tranquilizers (with psychomotor agitation and sleep disturbances). During the recovery period, it is recommended nootropic drugs, mineral-vitamin complexes, special diet.

Complications

The earliest and most formidable complication of purulent meningitis is acute cerebral edema, leading to compression of the vital nerve centers in the trunk and death due to respiratory and circulatory disorders. With a lightning-fast course of the disease, the development of edema can occur within a few hours after the onset of the disease, in case acute forms- for 2-3 days.

Other complications of the pathology during the peak period can be septic shock, uveitis, panophthalmitis, adrenal insufficiency. TO late consequences purulent meningitis include neurological disorders, impaired vision, hearing, memory, endocarditis and pyelonephritis.

Features of purulent meningitis in children

Purulent meningitis in infants often develops gradually, the causative agents are staphylococci, streptococci, coli. The first manifestation of the disease in infants is the bulging and tension of the large fontanel.

When infected with meningococcus, the phenomena of meningococcemia in children under 3–4 years of age are much more severe than in older patients. Hemorrhagic rash and necrosis can occupy large areas of the skin, very often septic shock develops, damage to the heart, kidneys and other internal organs. In rare cases, meningitis at an early age leads to delayed psychomotor development and dementia.

Forecast

According to the statistics, mortality in purulent inflammation membranes of the brain reaches 12-15%. The prognosis depends on the timeliness of hospitalization of the patient, the correct selection of drugs for antibiotic therapy. With early visit to the doctor and the onset proper treatment the prognosis is conditionally favorable.

The consequences of purulent meningitis may be hearing loss, some neurological disorders, memory loss. After a disease suffered at an early age, mental retardation may occur.

Preventive measures

Most effective measure prevention of the disease is vaccination - immunological preparations used to prevent infection by the most common pathogens (meningo- and pneumococci, Haemophilus influenzae).

For the prevention of secondary purulent meningitis, it is necessary to timely identify and eliminate potentially dangerous foci of infection in the body - otitis, sinusitis, chronic abscesses, dental pathologies.

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The development of the disease depends on the microbe-causative agent and on the state of the human immune system. If the painful symptoms are ignored, the pathology leads to irreversible consequences.

Mechanism of infection

Purulent meningitis is a bacterial disease in which the membranes of the brain become inflamed. main reason The occurrence of purulent meningitis is the penetration into the body of the causative agent of the disease - Neisseria meningitidis - meningococcal infection. Depending on the method of penetration of microbes, primary and secondary meningitis is distinguished.

In primary meningitis, pathogens enter the body through contact with an infected person. Microorganisms enter the meninges through the nasopharynx. Direct infection can occur with traumatic brain injuries, non-compliance with aseptic rules during operations.

Interesting! There is 1 sick person per hundred carriers of meningococcal infection.

Secondary meningitis develops due to infection with staphylococcal, streptococcal infection, Escherichia, Haemophilus influenzae. Bacteria enter the brain through the paranasal sinuses, caries-affected teeth, inflamed ears. Microbes are able to penetrate barriers in case of pneumonia, furunculosis, stomach diseases.

The increase in symptoms indicates the progression of inflammation and its spread to the brain. As a result, vascular dysfunction appears due to spasms of the cerebral capillaries. Meningoencephalitis develops, which causes paralysis, speech disorders.

Diagnostic methods

To make a diagnosis, it is necessary to collect an anamnesis: identify the focus of infection, identify concomitant diseases, learn about contact with infected people.

Most important research– analysis of spinal fluid. With purulent meningitis, the cerebrospinal fluid will be cloudy, with a yellow or green tint. The color of the liquid indicates a specific pathogen. The results show an increase in cytosis, protein concentration.

In addition to the study of spinal material, the patient must undergo the following examinations:

• clinical analysis blood to detect leukocytosis;
• Analysis of urine;
• computed tomography;
• X-ray of the lungs, skull.

You will also need to consult with an infectious disease specialist, a neurologist.

Therapeutic activities

Treatment of purulent meningitis is carried out in conditions medical institution. After emergency lumbar puncture antibiotic therapy is prescribed. Ampicillin with Cefotaxime is usually used. At severe course disease drugs are administered intravenously. To reduce cerebral edema and eliminate hydrocephalus, Mannitol and Furosemide are used as dehydration agents.

Note! As a result of studies, it has been established that the incidence rates among young patients are 10 cases per 100,000 children.

It is also important to choose the right symptomatic treatment based on the cause of the disease. Sleep disorders are treated with sedatives convulsive syndrome- Diazepam, Chlorpromazine. With the development anaphylactic shock carry out infusion treatment. IN rehabilitation period it is recommended to take multivitamin complexes, neuroprotective medications.

Prevention measures

Vaccination is the most effective method to prevent the development of a meningeal infection. : meningococci, pneumococci, Haemophilus influenzae. It is especially important to vaccinate children on time (from 3 months to 5 years), as the disease causes high mortality among newborns. Due to the ease of transmission of purulent meningitis, adults are recommended to be vaccinated in the presence of immunodeficiency, frequent pneumonia, and otitis media.

Doctors are required to isolate the patient in a timely manner to minimize the risk of spreading the infection.

Possible complications and prognosis

Inflammation of the meninges is the most dangerous condition for the life of an adult and a child. After all, even when providing the necessary therapeutic measures immunosuppressed people develop many consequences, one of which is death.

Neurological complications after meningitis are recorded in 20% of patients, the main part is the elderly and children.

In a severe course of the disease, cerebral edema develops, provoking clinical death. To prevent this condition, it is required to introduce electrolyte solutions into the body.

Other serious complications include:

• sepsis;
• hydrocephalus, elevating intracranial pressure;
• multiple organ failure, in which the heart muscle, kidneys are affected;
• asymmetry of the face, strabismus due to damage to the nerves of the skull;
• arrhythmia, which leads to the spread of pathogens on the inner heart membranes;
• empyema, in which pus flows under the base of the skull;
• prolonged convulsive syndrome;
• hearing loss;
• coma.

In the absence of therapy, the mortality rate is 50%. The most unfavorable prognosis is typical for pneumococcal meningitis: fatal outcome diagnosed in 20% of cases.

After recovery, it is necessary to visit a neurologist regularly. Competent rehabilitation measures are required, including taking medications, exercise therapy, massage, therapeutic baths. A complex approach in treatment helps to minimize undesirable consequences.