Meningitis symptoms in children 3 to 4 years old. Recognizing Meningitis in Children: First Signs and Known Symptoms

There are diseases with which you can live for years, there are infections that can be treated at home and even carried on feet, but any sensible parent, when the child shows signs of meningitis, tries to get to the hospital as soon as possible. Meningitis is a dangerous disease that carries a real threat to life and a high risk of complications. It can lead to death in a few hours, and the consequences (paralysis, paresis, epilepsy, hydrocephalus) with untimely treatment remain for life.

Meningitis is most difficult in children, since the blood-brain barrier (between blood and nerve tissue) has a high permeability, but under certain conditions (weakened immunity, head or back injuries), you can get sick at any age.

The term itself comes from the Latin "meningos" - the meninges. Meningitis has been known for a long time, but a detailed clinical picture was described only at the end of the XIX century, and it began to be treated in the 50s of the XX century. Until now, according to statistics, every tenth person dies.

Meningitis is an inflammation of the membranes of the brain and (or) the spinal cord, which has an infectious nature. With a purulent form of the disease, cerebrospinal fluid (cerebrospinal fluid) is also involved in the inflammatory process, becomes cloudy and changes its composition.
The disease has several classifications according to various criteria:

By the nature of inflammation:

• purulent. Most cerebrospinal fluid cells are neutrophils, whose function is to protect against bacteria and fungi;
• serous, when lymphocytes responsible for the fight against viruses prevail in the cerebrospinal fluid.

By pathogenesis (features of occurrence):

• primary - an independent disease that is not a consequence of an infection of an organ or organism as a whole;
• secondary, arising as a complication after infection, when its pathogen passes through the blood-brain barrier and leads to inflammation.

By flow rate:

• reactive, requiring treatment during the first day;
• acute, developing in 2-3 days;
• subacute, inflammation in which can last more than 2 weeks;
• chronic when meningitis develops for longer than 4 weeks.

Meningitis is also distinguished depending on the place of occurrence of inflammation (cerebral, cerebrospinal, convexital, superficial, basal), according to localization (panningitis, pachymeningitis, leptomeningitis, arachnoiditis).

With treatment started in a timely manner, the effects of infectious meningitis in children can be minimized, and disappear altogether after some time. Sometimes there are difficulties with perception and attention, but after a few years (no more than five), the body will recover completely. Two years after the illness of the child, a pediatrician should observe.

Complications depend on the type of infection. So, purulent meningitis in children can cause problems with vision, hearing, psychomotor development, memory. The occurrence of adhesions in the shells of the brain after the disease disrupts the circulation and production of cerebrospinal fluid, which leads to an increase in intracranial pressure or hydrocephalus.

Basal meningitis (occurring at the base of the brain) causes a decrease in hearing, and vision. The serous form of the disease is slightly less dangerous, but without timely help will lead to the same consequences. After meningitis, the development of epilepsy is sometimes observed, but doctors suggest that this occurs in those who were predisposed to it.

Especially dangerous is the reactive form of meningitis, which can kill in a few hours, causing an infectious toxic shock: a change in blood coagulation, a drop in blood pressure, and a malfunction in the heart and kidneys.

Causes

For infectious meningitis in children, the pathogen must penetrate the blood-brain barrier. It can enter the body in the following ways:

1. Airborne.  When coughing and sneezing, apparently healthy people can transmit the infection. According to epidemiologists, there are up to 3 thousand passive carriers and 200-300 people with inflammation of only the nasopharynx per person who has suffered from the meningococcal form of the disease. Adenoviruses and enteroviruses are also transmitted in this way.
2. Fecal-oral.  So mainly enteroviruses are transmitted, causing not only intestinal infection, but also meningitis under certain conditions.
3. Hematogenous. The most frequent way. It is characteristic of secondary meningitis, when the blood carries the pathogen from the source of infection to the brain. HIV, cytomegalovirus and other infections can penetrate the blood through the placental barrier during pregnancy and cause inflammation of the brain in the baby in the womb.
4. Lymphogenic.  The causative agent moves through the lymphatic system.
5. Contact. Open trauma to the head or back can lead to the penetration of pathogenic microorganisms into the lining of the brain or cerebrospinal fluid.

The pathogen affects the incubation period of meningitis, for example, in children, enterovirus causes inflammation in a week, and meningococcus in 4 days.

For the onset of the disease, it is not enough that the infection simply enters the body. The probability of transmission and reproduction of pathogens depends on the state of immunity - weakened due to lifestyle, chronic or congenital diseases, it is not able to withstand microorganisms. The child’s protective barriers are imperfect, so more than half of the cases are children under 5 years old.

Of particular danger are bacterial meningitis, since any purulent focus - otitis media, tonsillitis, abscess - can cause a disease. Most often, the causative agent of bacterial meningitis is meningococcus. If the immune system could not retain it in the nasopharynx, it penetrates the blood through the mucous membranes and can cause inflammation in any organ of the body, including the brain.

One of the worst forms of infectious meningitis in children is fulminant meningococcemia, when a large amount of meningococcus enters the bloodstream. It releases toxins that cause sepsis in a few hours, clogging of small vessels, skin hemorrhages, and bleeding disorders. The child in the first few hours (maximum per day) dies from heart or kidney failure.

Symptoms

Signs of the disease are practically independent of the type of pathogen. Often, meningitis in children manifests itself as an infectious lesion with non-specific symptoms inherent in other, less dangerous, diseases.

Symptoms that prevent meningitis:

1. Headache aggravated by head movement due to light and loud noises. It is especially worthwhile to be wary if it appears during any infectious disease (acute respiratory infections, cold sores on the lips, etc.) and is so strong that all other symptoms fade into the background.
2. Pain in the back and neck, accompanied by fever.
3. Nausea, vomiting (without any connection with food intake), drowsiness, blurred consciousness.
4. Any cramps. They are observed in a third of children with meningitis, and usually occur on the first day.
5. Constant crying, bulging fontanel, fever in children up to a year.
6. Rash with fever. In 80% of children, a typical rash with meningitis looks like quickly appearing pink spots, in the center of which hemorrhages occur after a couple of hours - this is a symptom of meningococcemia. The count goes on minutes and you need to get to the hospital as quickly as possible. Nevertheless, any rash accompanied by a fever can be a sign of a disease and must be shown to a doctor.
     With purulent meningitis, nonspecific symptoms are clearly manifested from the first hours (or days), with a viral sign, the symptoms gradually disappear in the future, and with a tuberculous form they increase with time.

Doctors distinguish a number of meningeal symptoms associated with impaired functioning of the senses, muscle tension, painful reaction to inflammation. The most important:

1. Stiffness (inelasticity) of the occipital muscles.  If you put your hand on the back of the head and try to bend your head to your chest, the muscles will be so constrained that this will be impossible. Strong tension causes a typical meningeal pose - lying on its side with its head thrown back and legs bent to the stomach.
2. Symptom Kernig.  The one lying on the back is gently bent at the right angle at the knee and hip joint; with meningitis in this position, he will not be able to straighten the knee. For children under 4 months of age, this is not a sign of meningitis.
3. Symptom of hanging Lassage (for children up to a year).  If you take the child under the armpits, he involuntarily bends his legs to his stomach and it is impossible to straighten them.
4. Symptom of Brudzinsky.  If a child lying on his back tilts his head to his chest, his legs and arms will also automatically begin to bend (upper symptom). When bending one leg, the second will also unconsciously repeat the movement (lower symptom).
5. Symptom of a “tripod”.  Sitting with outstretched legs, the child leans back, resting on his hands, or bends his legs.

In children under 3 years of age, especially with the rapid development of the disease, symptoms may be mild or one or two of them are present.

If the skin does not have characteristic hemorrhages, it is possible to accurately diagnose meningitis only with the help of spinal puncture and analysis of cerebrospinal fluid for signs of inflammation (an increase in the amount of protein, the presence of pus).

Also, a causative agent is detected in the cerebrospinal fluid. For the same purposes, a blood test is taken at the same time. To determine the presence and extent of damage to the meninges, neurosonography, electroencephalography, and magnetic resonance imaging are prescribed.

Treatment

For the treatment of meningitis in children, emergency hospitalization is primarily required. Help with the disease includes:

1. Antibiotics for bacterial meningitis. The choice of a specific drug depends on the pathogen. In particular, with the tuberculous form, regular streptomycin punctures are applied to the spinal canal. Viral meningitis involves observation and symptomatic treatment (with the exception of herpes infection or the identified Epstein-Barr virus when the antibiotic Acyclovir is used).
2. Normalization of intracranial pressure. With any meningitis, cerebrospinal fluid pressure increases, resulting in intense headaches. Removing a small portion of the cerebrospinal fluid (including while taking it for analysis) allows you to reduce pressure. Diuretics are also used.
3. Symptomatic treatment, including analgesic, antipyretic, vitamins, antiemetic.
4. Elimination of intoxication and restoration of water-salt balance using intravenous solutions.
5. Anticonvulsants (if necessary).
6. Hormonal anti-inflammatory therapy.

Prevention of meningitis includes, first of all, strengthening the immunity of children: hardening, walking, balanced nutrition.

In addition, for children at risk (up to 5 years of age, with weakened immunity after illness or due to genetic causes), the following methods of reducing the risk of disease should be used:

• Prevention of airborne infections: restricting contact with patients, avoiding public places during epidemics, using cotton-gauze dressings. Meningococcus, pneumococcus, haemophilus influenzae perish quickly under the influence of fresh air and ultraviolet radiation, so it is often necessary to ventilate the premises and open windows.
• The prevention of infections transmitted by the oral-fecal route occurs through the observance of the usual hygiene rules: thorough washing of hands, fruits and vegetables, boiling water when it is suspected that dangerous microorganisms may enter it.
• Vaccination. Unfortunately, there is no universal vaccination against meningitis, but routine vaccination can protect against some diseases, after which complications can go to the brain. Vaccines against the main causative agents of bacterial meningitis (hemophilus influenzae, pneumococcus, meningococcus) are not included in the Russian vaccination calendar, but they are certified and can be made at the request of the child's parents.

Meningitis is one of the most serious and dangerous infectious diseases, especially often affecting children from 1 year to 5 years. Due to the ingress of bacteria, viruses, fungi, some protozoa onto the membranes of the brain, inflammation occurs, with untimely treatment leading to serious complications up to death.

At the first possible symptoms of meningitis, it is necessary to go to the hospital as soon as possible, since infectious toxic shock in some cases develops very quickly - in a few days or even hours. Strengthening the immune system, preventing infections of various nature and vaccination will help protect the child from the disease.

Useful Video on Meningitis in Children

Meningitis is a serious pathological condition characterized by cerebral edema and damage to the meninges. Most often, meningitis occurs in children due to the anatomical and physiological characteristics of the body and unformed immunity. The membranes of the brain and spinal cord are inflamed, but the brain cells themselves are not involved in the process. The disease is characterized by severe symptoms, and if treatment is not started in a timely manner, the disease can cause severe complications, posing a threat to the life of the child.

Causes

The reasons for the development have been studied by doctors quite well. It is known that meningitis in newborns and older children is caused by viruses:

•   , or ;
•   and some others.

No less often, bacterial agents, meningococci, protozoa, and others provoke the disease. Atypical forms of the disease caused by tubercle bacillus, fungi and even helminths are somewhat less common.

Note that the infection occurs when the carrier comes in contact with a healthy person, therefore outbreaks may occur in kindergartens and schools, since children actively contact each other there. The disease has an incubation period when symptoms are absent, but the child has already become a source of infection for others, which contributes to the spread of inflammation.

The following categories of children are most susceptible to the disease:

• premature
• born due to abnormal pregnancy or pregnancy with complications;
• sick in infancy with purulent inflammatory diseases (, and some others).

The disease can develop in a baby who has suffered a birth injury or, in infancy, has suffered open or closed traumatic injuries to the brain or spinal cord. Children suffering from impaired functioning of the nervous system are also subject to meningitis.

Classification

Outbreaks are usually noted in winter or spring. Infection occurs in the following ways:

• household (through infected toys, etc.);
• alimentary (when eating contaminated products);
• airborne;
• vector-borne (mosquito bites).

The causative agents that cause meningitis in children can enter the children's body vertically, through the placenta, or spread through the body through the lymphatic system. Depending on which meninges are damaged, there are three forms of meningitis:

• the most rare form is in which inflammation of the arachnoid membranes occurs;
• pachymeningitis, when hard membranes are involved in the inflammation process;
• one of the most common forms is leptomeningitis, when inflammation affects both the arachnoid and the main, soft membranes.

Classification depending on the pathogen divides meningitis into two main forms - bacterial and. Viral is more common. These two forms have subspecies, depending on the immediate pathogen. So, allocate:

• pneumococcal meningitis - caused by streptococcus (severe complication);
• meningococcal - the causative agent of diplococcus;
• staphylococcal - in most cases, newborns or children undergoing chemotherapy are susceptible;
• hemophilic - causes a hemophilic bacillus;
• escherichia - excites the virus of the same name.

Rare varieties are salmonella and listeriosis meningitis.

If we talk about the classification depending on the nature of the course, then purulent and serous meningitis are equally common. In newborns, it mainly occurs when the inflammatory process is serous in nature, and the disease proceeds with less severe symptoms than with a purulent form.

Serous meningitis is confirmed by the presence of lymphocytes in the lumbar fluid. More often viral - bacteria lead to development. This diagnosis is made when neutrophils predominate in the lumbar fluid. Both serous and purulent meningitis without timely treatment cause irreparable damage to the health of children, can lead to death.

First symptoms

The disease always develops suddenly against the background of well-being. Symptoms are more pronounced in older children, and meningitis in newborns occurs at the initial stage almost imperceptibly.

The incubation period is 2 to 10 days, depending on the state of the child’s immune system. An incubation period of such a duration allows the pathogen to enter the meninges and cause inflammatory processes. After a specified period of time, the first symptoms of meningitis in children of intoxication appear:

• sharp (up to 40 degrees);
• confusion, delirium;
• intolerable headache up to loss of consciousness;
• sharp abdominal pains;
• nausea and vomiting;
• the appearance of muscle pain;
• photophobia.

Meningitis in newborns is manifested by the anxiety and irritability of the child, the compaction of the fontanel, which becomes even slightly convex. In infants, meningitis can be suspected by the following signs:

• a sharp jump in temperature to critical levels;
• stiff neck (when the child is lying with his head thrown back);
• the appearance of vomiting;
• the occurrence of seizures.

When the first symptoms appear, the child needs urgent medical attention. In its absence, the clinical picture is supplemented by symptoms of further brain damage. Signs of meningitis in children with progression of inflammation:

• spasm of the occipital muscles when, when asked to tilt the head forward, the child cannot do this;
• impaired consciousness until the onset of a coma;
• oculomotor disorders;
• cramps, which can lead to muscle injury and respiratory or cardiac arrest.

The specific position of the child is characteristic of the disease - lying on its side with legs bent at the legs and head thrown back. Light and sound fear, blepharospasm, rash are noted.

Diagnostics

The first symptoms give an idea of \u200b\u200bthe general inflammatory process in the meninges, but specific signs characteristic of meningitis help doctors confirm the diagnosis:

1. A symptom of Kernig, when the child has tension in the back of the thigh when trying to bend the leg in the knee and hip joints.
2. Symptom of Brudzinsky. The child is laid on his back and bent one leg in the hip and knee joints. A positive symptom is indicated when the second leg begins to bend reflexively.

Blood and urine tests are performed, but the final diagnosis is made after evaluating the results of lumbar puncture as the only reliable method for confirming meningitis.

Treatment features

The treatment of meningitis depends on the form (serous or purulent), the pathogen and the stage of the disease. With serous viral meningitis, antibacterial drugs are not prescribed, since antibiotics do not act on viruses. Medical measures for viral meningitis:

• dehydration therapy;
• prescribing anticonvulsants;
• desensitizing treatment.

To defeat viral serous meningitis, it is necessary to take interferon, DNAase, RNAase, lytic mixture and some other medications as indicated. Symptomatic treatment is also required - taking antipyretic, analgesic drugs.

For the treatment of purulent forms, bacterial meningitis, antibiotics are prescribed taking into account the sensitivity of the pathogen. Usually a combination of several antibacterial drugs is used.

Along with antibiotic treatment, symptomatic therapy and pathogenetic treatment are carried out.

The consequences of meningitis in children can be very severe - from the development of paresis and paralysis, pneumonia to severe with the onset of coma. However, complications can be avoided if medication is started in a timely manner: with a correctly diagnosed and well-chosen therapeutic course, the symptoms of meningitis begin to subside already on the 3rd - 4th day, and the child’s condition stabilizes.

Prevention

Prevention is the best way to protect your child from meningitis. Today, vaccination against meningitis is carried out by both public and private medical institutions.

With outbreaks of meningitis, vaccination will be the only reliable means of protecting the child from the disease. According to statistics, when in groups where there is an outbreak of meningitis, children are vaccinated, the spread of the disease can be stopped.

Vaccination against meningitis involves the introduction of a drug that protects against hemophilic infection - the main cause of meningitis in children. The vaccine is shown not only when an outbreak of infection has occurred in the school, but also if there is a sick person in the house. In some countries, meningitis vaccine is included in the vaccination calendar and is done regularly, in others it is carried out only according to epidemiological indications.

Keep in mind that vaccination does not protect the child from meningitis if the disease is caused by viruses or non-specific pathogens. In most cases, vaccination will become an effective means of prevention, but complications can arise in a child after an injection, therefore, not all doctors recommend that children take this prophylaxis and not all parents agree to vaccinate a child. It is important to strengthen immunity, observe personal hygiene rules, and isolate children with suspected meningitis from the team.

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Meningitis is a serious illness, which is an inflammation of the lining of the spinal cord and brain. Despite the fact that for many years, scientists have been trying to fight this disease, it is difficult, especially in children. In its course, it is the child (especially the small one) that has features that you need to know about.

Despite the fact that all children can suffer from meningitis in different ways, there are a number of symptoms characteristic of all its forms. The following manifestations are related to meningeal symptoms:

• headache, strong and aggravated by external factors (loud sound, bright light);
• vomiting without nausea, not related to food;
•   (39–40 ° C), not responding to conventional antipyretic drugs;
• the baby may complain that he does not feel the back of his head and back; gently lay it on your back and ask him to press his chin to his chest - he will not be able to do this because of the numbness of the muscles;
• in the baby, you can notice the bulging of the large fontanel, its strong tension;
• it is more convenient for the patient to lie on his side, with his legs close to his stomach and his head thrown back;
• with meningitis, a rash can begin, sometimes reaching up to large bright bard spots throughout the body.

Since the meningeal symptom can be recognized by parents at home, it is urgent to go to the hospital at its first manifestations. Moreover, various factors can become the causes of meningococcal infection.

Causes of the disease

The causes of this disease in children can be:

• viruses, bacteria, fungi, protozoa;
•   and birth injuries in newborns;
• problems with the nasopharynx and middle ear in young children (up to a year);
• prematurity;
• reduced immunity;
• diseases of the nervous system;
• injuries of the spinal cord and brain.

Therefore, children suffering from such abnormalities and health problems are at risk. The incubation period of the disease is from 1 to 10 days.

Types of Meningitis

Meningitis among children is divided into two groups.

• 1. Purulent

Caused by a bacterial infection. It amazes the smallest children who are not even one year old. Most often, they begin with severe chills, fever, vomiting, and headaches. Meningeal syndromes are very pronounced.

• 2. Serous

The reason is a viral infection. In children, this type of disease is most often found. It can be caused by mumps viruses (), some intestinal viruses (ECHO,). It affects children from 1 to 8 years. It starts unexpectedly - with a sharp jump in temperature to 39–40 ° C and above. Such an acute period lasts from 3 to 5 days, and full recovery can be expected in 2 weeks.

The outcome of both forms of the disease depends on a timely visit to a doctor and the adequacy of treatment, but in case of serous meningitis there is more chance of a quick recovery without consequences. Purulent type and diagnosed, and treated with difficulty.

Diagnostics

Diagnosis of serous childhood meningitis is not difficult, in contrast to purulent, which is recognized only during laboratory examinations. If meningitis is suspected, the following procedures are prescribed for children:

1. Spinal fluid puncture.
2. General blood analysis.
3. CSF analysis.
4. Bacterioscopic examination of blood smears and cerebrospinal fluid sediment.
5. Bacteriological cultures of blood, cerebrospinal fluid, mucus from the nasopharynx.

There are many analyzes, all this is done for an accurate diagnosis. Before taking a puncture from a child, he is sent for examination to the ENT specialist, neurologist, neurosurgeon and hematologist in order to avoid consequences.

Self-medication in case of meningitis is unacceptable. Treatment of the child should be carried out under the supervision of a doctor in a hospital. This disease is dangerous in that the patient's condition can worsen at any time and become critical. Then emergency resuscitation measures are carried out, possible only in a clinical setting. The course of treatment involves taking antiviral and antibacterial agents and will depend on the form of the disease.

• 1. Treatment of serous meningitis

Therapy in these cases is aimed primarily at reducing intracranial pressure. Therefore, diuretic drugs are administered to the patient, desensitizing (relieving allergies) and general strengthening agents, various vitamins are prescribed.

• 2. Treatment of purulent meningitis

Here, the therapy is based solely on antibacterial drugs, which are prescribed only according to the results of laboratory tests. Intravenously, with the help of droppers, anti-toxic agents and diuretics are administered.

• Antibiotics

In both cases, penicillin-type antibiotics are prescribed: amoxil, flemoxin, benzylpenicillin. They are used for treatment no longer than 5-7 days. Piracetam or Nootropil is prescribed to restore nerve cells and blood vessels. Dexamethasone, Kenalog, hydrocortisone and methylprednisolone are anti-inflammation therapies.

• Rehabilitation

After a course of treatment, the child is allowed to lead a familiar lifestyle, since meningitis does not damage the basic systems of the child’s body.

• Complications after Meningitis

If a child’s meningococcal infection was detected in a timely manner, doctors and parents took all possible measures aimed at eliminating the disease, there is no need to be afraid of serious consequences. If the appeal to the hospital was not timely, with purulent forms, as well as if the baby has deviations in health, there may be consequences such as:

• complete deafness;
• blindness;
• mental and physical developmental delay;
• toxic shock;
• edema, swelling of the brain;
• acute adrenal insufficiency;
• cerebral asthenia.

It is sad, but sometimes meningitis leads to death.

Prevention

Due to the fact that the treatment of childhood meningitis is a complex and lengthy process, the prevention of this disease is relevant. First of all, parents of those children who are at risk should think about it. The most effective preventative measures are:

• vaccinations for meningitis that are given to children at an early age: different vaccines are now used for this purpose - meningococcal, pneumococcal conjugation (injected at the age of two years) and polysaccharide (administered to those over 5 years old), measles rubella, measles Mumps protects against meningitis as well as the chickenpox vaccine;
• chemoprophylaxis for everyone who was in contact with a person with meningitis;
• since the disease is transmitted by airborne droplets, it is necessary to refrain from contact with carriers of infection, using gauze bandages and respirators.

Meningitis is a dangerous and serious disease that you must protect your child from. If the circumstances are stronger, parents need to take all measures for the speedy recovery of the baby. Only in this way can the grave consequences and complications of this disease be avoided.

The disease is very dangerous, requires urgent treatment. Often has an unfavorable prognosis, ends with disability or death.

Meningitis

The disease is characterized by inflammation of the lining of the brain of various origins. It affects mainly preschool children from 3 years.

The most susceptible to the disease are premature babies, children who have had purulent inflammatory diseases in their infants, have suffered a birth injury, and have experienced a negative impact of a pathologically ongoing pregnancy. It is believed that an important factor in the development of pathology is a genetic predisposition.

Among other factors, poor nutrition, chronic overwork, metabolic disturbance, and decreased immunity are noted.

The disease is transmitted:

• contact-household way;
• when eating contaminated foods;
• when swimming in pools or open waters;
• transmissible;
• through the placenta from mother to fetus.

Classification

Different types of meningitis are distinguished depending on the origin, pathogen, lesion area, and course features.

Meningitis in children is an infectious and inflammatory disease in which the membranes of the brain and spinal cord are affected. Meningitis is characterized by a complex of cerebral, common infectious and meningeal symptoms.

In children, meningitis is diagnosed many times more often than in adults

The proportion of meningitis in the structure of all organic lesions of the nervous system is 27-29%, depending on the epidemic situation. The incidence rate among children under 14 years old is 10 cases per 100 thousand of the population. Moreover, in about 80% of cases, children under 5 years old become ill.

The vascular plexuses, meninges, and ependyma (the membrane that lines the ventricles of the brain and the central channel of the spinal cord from the inside) are a protective barrier to the central nervous system. For this reason, the inflammatory process often affects the shell of the brain and spinal cord.

The membranes of the brain and spinal cord are hard, arachnoid and soft. Accordingly, with the course of the infectious and inflammatory process in one of the meninges, pachymeningitis, arachnoiditis and leptomeningitis are secreted. In case of damage to all the membranes, they speak of panningitis. The most common inflammation of the soft membranes of the brain and spinal cord.

Causes and Risk Factors

Infectious agents for meningitis in children can be viruses, bacteria, microscopic fungi, protozoa.

The penetration of the pathogen into the cranial cavity and the lining of the brain occurs in the following ways:

• contact-household (through contaminated items);
• fecal-oral (with food, water);
• airborne (from sick people and carriers of infection);
• transmissible (with bites of blood-sucking arthropods);
• hematogenous, lymphogenous (with blood and / or lymph flow from the affected organs);
• segmental-vascular (along regional vessels from the primary focus of infection, located near bypassing the common bloodstream);
• perineural (along the tissues surrounding the nerves);
• transplacental (from a pregnant woman to the fetus).

Meningitis in newborns can occur when passing through the birth canal, as well as against the backdrop of an unfavorable course of pregnancy and childbirth, intrauterine infection, prematurity, and a lack of oxygen from the placenta (fetal hypoxia).

In primary meningitis in children, the mucous membranes of the respiratory and digestive tract usually serve as the entry gates of infection. The source of infection is a sick person or carrier.

In addition, meningitis in children can occur against a background of purulent diseases, childhood infections, acute respiratory viral infections, infectious diseases of the gastrointestinal tract, open craniocerebral and spinal cord injuries, cracks and fractures of the base of the skull, and surgical operations.

To protect the child from the most dangerous types of meningitis, vaccination with meningococcal, pneumococcal and hemophilic vaccines is necessary.

Factors contributing to the development of the disease are chronic malnutrition, hypothermia, changing climatic conditions, stressful situations. At risk are children with disorders of the functioning of the nervous system.

In the winter-spring period, the maximum number of cases of meningitis in children is recorded.

Forms of the disease

Depending on the etiological factor, meningitis is distinguished:

• bacterial;
• rickettsial;
• spirochetous;
• fungal;
• protozoal;
• helminthic;
• mixed.

By the nature of the inflammatory process, meningitis in children happens:

• serous (lymphocytes predominate in the cerebrospinal fluid, the cerebrospinal fluid is transparent);
• purulent (neutrophils prevail in the cerebrospinal fluid, the cerebrospinal fluid is cloudy).

According to the pathogenesis, meningitis is distinguished:

• primary (develop as an independent disease);
• secondary (occur against the background of other diseases).

Depending on the prevalence of the pathological process, meningitis:

• limited;
• generalized.

Children who have undergone meningitis are subject to medical observation with periodic detailed examination (ultrasonography, electroencephalography, echoencephalography).

The pace of the course distinguishes such forms of meningitis in children:

• lightning fast;
• spicy;
• subacute;
• chronic

Depending on the severity, the following forms of the disease are distinguished:

• light
• moderate severity;
• heavy
• extremely heavy.

Depending on the localization of the pathological process:

• pachymeningitis;
• arachnoiditis;
• meningitis;
• panningitis.

Symptoms of Meningitis in Children

The clinical picture of meningitis with different forms of the disease has its own characteristics. In this case, regardless of the form of the disease, the course of meningitis in children is characterized by the development of cerebral, general infectious and meningeal symptoms.

Among the cerebral symptoms of meningitis in children, intense headaches are distinguished (they can be bursting, localized in the occipital or frontotemporal region, diffuse, and radiating to the neck). Pain is aggravated by sudden movements, light and sound stimuli. Nausea and vomiting are observed that are not associated with eating (they can occur with increased headache, a change in body position), while vomiting does not bring relief. Often in children, there are disorders of consciousness, convulsions, weakening of the muscles of one half of the body, and impaired eye movements.

Meningeal symptom complex in children

Generally infectious signs of meningitis in children are manifested by a sharp increase in body temperature and chills, tachycardia, and a decrease in appetite. Breathing is shallow and rapid, the skin is pale or hyperemic, hemorrhagic rashes may appear on the skin.

Meningeal syndrome:

• hypersensitivity to irritants (hyperesthesia, hyperacusis, uncontrolled contraction of the circular muscle of the eye);
• Cocked pose - the patient lies on his side, his head is thrown back, upper and lower extremities are bent;
• stiff neck muscles - due to tension of the occipital muscles, the patient cannot tilt his head and touch the chin of the chest.

For a reason with meningitis in infants there is a pronounced venous network on the head and eyelids, as well as a swelling of the large fontanel. In children under 3 years of age, all signs of meningeal syndrome are rare.

Diagnostics

To make an initial diagnosis, a collection of complaints and anamnesis, an objective examination of the patient are carried out. Suspicion of meningitis is an indication for lumbar puncture with taking samples of cerebrospinal fluid for biochemical and cytological laboratory tests, as well as for the detection of an infectious agent. In order to identify the causative agent, bacteriological culture is carried out on the nutrient medium of the blood, punctate elements of the rash and material obtained from the mucous membrane of the nasopharynx. The DNA of an infectious agent is determined by studying the cerebrospinal fluid by polymerase chain reaction.

The incidence rate of meningitis among children under 14 years of age is 10 cases per 100 thousand of the population. Moreover, in about 80% of cases, children under 5 years old become ill.

Specific antibodies in the patient's blood serum can be determined using methods such as enzyme-linked immunosorbent assay, indirect (passive) hemagglutination reaction, immunofluorescence reaction, complement fixation reaction.

In addition, X-ray examination of the skull, neurosonography, electroencephalography, and magnetic resonance imaging of the brain may be required.

Differential diagnosis of meningitis in children with traumatic brain injuries, brain tumors, diabetic coma, subarachnoid hemorrhage, arteriovenous malformation, Reye's syndrome is necessary.

Treatment of meningitis in children

When making a primary diagnosis, the child is hospitalized in an infectious diseases hospital.

In the acute period of the disease, bed rest, rest and a sparing diet are indicated.

The choice of anti-infective drug depends on the type of pathogen. In bacterial forms of meningitis, patients are prescribed antibiotics (intramuscularly or intravenously), in the case of a severe course of the disease, antibacterial drugs can be injected directly into the spinal canal (endolumbar). The duration of antibiotic therapy is on average 1.5-2 weeks. In the case of meningitis of viral etiology, antiviral therapy is performed. With fungal meningitis, antimycotic drugs are indicated. With the protozoal form, antiprotozoal drugs, corticosteroids, antihistamines are prescribed.

In addition to anti-infective therapy, patients are shown symptomatic and pathogenetic treatment. To reduce craniocerebral pressure, dehydrating drugs are prescribed.

In order to maintain homeostasis, the introduction of colloidal and glucose-salt solutions, plasma, albumin is indicated. The use of anticonvulsants, antianemic drugs may be required. For the prevention of cerebral edema, diuretic drugs are used (it is necessary to take into account their ability to flush calcium from the body). To prevent cerebral ischemia, neurometabolic drugs, nootropics are prescribed.

In the case of a severe form of the disease, patients are shown mechanical ventilation, oxygen therapy, ultraviolet irradiation of blood.

After treatment is completed, patients require follow-up for two years.

Possible complications and consequences

With meningitis, mild, moderate, and severe neurological complications may develop. Complications of serous meningitis develop less frequently and are easier than purulent.

Meningitis in children is complicated by the following pathological conditions:

• encephalitis, myelitis;
• cerebral edema;
• disseminated intravascular coagulation syndrome;
• panophthalmitis;
• epileptic seizures;
• hydrocephalus (at the same time there are disturbances in the psyche, movements, coordination, a lag in development);
• general or partial violation of the normal pace of mental development (lethargy or increased excitability, aggressiveness, indifference, etc.);
• delayed development of speech in children who have suffered meningitis before the formation of speech function;
• cerebrosthenic syndrome (manifested by rapid fatigue, increased irritability, sleep disturbance, headaches, as well as neurotic syndromes);
• minimal cerebral dysfunction (impaired attention, impaired behavioral reactions, which are most noticeable during physical, intellectual and emotional stress).

Forecast

The prognosis of meningitis in children depends on the form and severity of the course of the disease, as well as the timeliness of diagnosis and the adequacy of the treatment regimen. With a timely diagnosis and correctly selected treatment, the prognosis is favorable.

Fatal outcome is recorded in 1–5% of cases of the disease.

In the winter-spring period, the maximum number of cases of meningitis in children is recorded.

With the untimely diagnosis of purulent meningitis and the pathogen's resistance to antibacterial drugs, the mortality rate increases tens of times (up to 50%).

Children who have undergone meningitis are subject to medical observation with periodic detailed examination (ultrasonography, electroencephalography, echoencephalography).

Prevention

The most effective method that can prevent the development of the disease is a vaccine against meningitis in children. It is not included in the vaccination calendar, therefore, it is carried out in two cases:

• at the request of the parents;
• without fail in case of an unfavorable meningitis epidemic situation.

To protect the child from the most dangerous types of meningitis, vaccination with meningococcal, pneumococcal and hemophilic vaccines is necessary.

A number of experts believe that before a child reaches two years of age, meningitis vaccination is not effective enough due to the age-related characteristics of the immune system. Others believe that vaccination is possible in this case, but revaccination will be required after 3 months and after 3 years.

In addition, in order to avoid the development of meningitis, it is recommended to adhere to a number of measures:

• timely treatment of diseases against which meningitis may develop;
• avoiding contact with people with meningitis;
• compliance with personal hygiene;
• avoiding swimming in open water, especially with stagnant water;
• avoidance of drinking tap water (drink only boiled and / or bottled water);
• wash fruits and vegetables thoroughly before eating.

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