Purulent meningitis is an inflammatory disease bacterial nature, affecting the membranes (mainly the soft membrane) of the brain and spinal cord, may be infectious primary or secondary in 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 occur periodically, caused by 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, the pathology is more often observed in men.
Types of purulent meningitis
Based on etiology, there are two large groups of forms of purulent meningitis – primary and secondary. This division is quite 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 characteristics:
- Primary forms of purulent meningitis occur when a person is infected with pathogenic bacteria of a certain type - from the group of meningococcus, pneumococcus, and 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 into meninges from the external environment (after medical manipulations, surgical operations, for traumatic brain injuries).
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. Based on these characteristics, the following clinical types of the disease are distinguished:
- Lightning type. The most severe form - only a few hours pass from the development of symptoms to the death of the patient from cerebral edema. Most often occurs with purulent meningitis in children and weakened adults.
- Acute 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.
- Abortive type. A rare form of purulent meningitis in adults, in which the symptoms of the underlying disease are quite mild. Manifestations of general intoxication come to the fore.
- 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, and occasionally (only in secondary forms) – injection and contact. The disease is most often caused by infection with the following bacteria:
- Haemophilus influenzae (Haemophilus influenzae). According to medical statistics, the pathogen is detected in almost 50% of cases of purulent meningitis and affects people at any age.
- Meningococcus (Neisseria meningitidis). It causes about 20% of cases of the disease, and it is its strains that most often lead to epidemic outbreaks of meningitis.
- Pneumococcus (Streptococcus pneumoniae). Causes purulent meningitis in 10–13% of all cases of the disease. The course of the pathology is severe, mortality reaches 50%.
In some cases, infection with staphylococci, E. coli, salmonella, Pseudomonas aeruginosa and some other bacteria leads to the development of the disease. A significant variety of pathogens of purulent meningitis complicates treatment, since in many respects the effectiveness therapeutic measures depends on correctly selected antibacterial drugs.
The disease always begins acutely, the incubation period lasts from several hours to 5–7 days. The first symptoms of purulent meningitis are high fever (up to 40–41 °C), severe headaches, nausea, and vomiting, which is profuse and repeated. Many patients experience seizures - the frequency of their development in pathology increases with decreasing age of the patient. Often, against the background of fever, hallucinations, delusions, and psychomotor agitation develop. From the first day of the disease, tension (rigidity) is determined. occipital muscles, painful sensations are detected when moving the neck.
To prevent secondary purulent meningitis, it is necessary to promptly identify and eliminate potentially dangerous foci of infection in the body - otitis media, sinusitis, chronic abscesses, dental pathologies.
With inflammation of the meninges caused by meningococcal infection, a hemorrhagic rash develops - spots various localizations and sizes that do not fade when pressed. Also, when infected with this pathogen, skin necrosis may develop, especially in areas exposed to pressure. On days 2–4 of the course of the pathology, signs of damage to the cranial nerves are often recorded - strabismus, ptosis of the eyelids, anisocoria, deterioration of vision and hearing. The occurrence of nystagmus, hyperkinesis, disorders muscle tone speaks of involvement in pathological process nervous tissue of the brain - the development of meningoencephalitis.
Diagnostics
To diagnose purulent meningitis, instrumental and laboratory research methods are used. When examined by a neurologist, the stiffness of the neck muscles and the presence of specific meningeal symptoms are determined:
- Kernig's sign.
- Brudzinski's symptoms.
- 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:
- Fence cerebrospinal fluid through spinal puncture. The liquor is cloudy and flows out under pressure. Subsequently, using microscopy, neutrophils are determined in it, and when inoculated on nutrient media, the pathogen is isolated.
- General and biochemical analysis blood. Pathogen bacteria can be isolated in it (bacteremia), and strong leukocytosis is determined due to an increase in the level of neutrophils and an increase in ESR.
- Other studies to determine the condition of other organs and systems, prevent complications and identify primary focus infections (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 of the disease, treatment begins immediately with broad-spectrum antibiotics, in other cases antibacterial agents prescribed after receiving the results of a bacteriological study of the cerebrospinal fluid. Diuretics are necessary to reduce cerebral edema and associated neurological impairment and complications.
The occurrence of nystagmus, hyperkinesis, and muscle tone disorders indicates the involvement of the nervous tissue of the brain in the pathological process - the development of meningoencephalitis.
Steroid drugs are most often prescribed as anti-inflammatory drugs, the dosage and need for which depends on the severity of the manifestations and the severity of the patient's condition. Symptomatic treatment purulent meningitis may include anticonvulsants (for seizures), tranquilizers (for psychomotor agitation and sleep disorders). During the recovery period, nootropic drugs, mineral and vitamin complexes, and a special diet are recommended.
Complications
The earliest and most serious complication of purulent meningitis is acute edema brain, leading to compression of vital nerve centers in the trunk and death due to respiratory and circulatory disorders. In the case of a fulminant course of the disease, the development of edema can occur within a few hours after the onset of the disease, in the case of acute forms - on 2–3 days.
Other complications of pathology during the peak period may include septic shock, uveitis, panophthalmitis, adrenal insufficiency. Late consequences of purulent meningitis include neurological disorders, weakened vision, hearing, memory, endocarditis and pyelonephritis.
Features of purulent meningitis in children
Purulent meningitis in children infancy often develops gradually, the causative agents being staphylococci, streptococci, coli. The first manifestation of the disease in infants is bulging and tension of the large fontanel.
When infected with meningococcus, the symptoms of meningococcemia in children under 3–4 years of age are much more severe than in older patients. Hemorrhagic rash and necrosis can occupy significant areas of the skin; septic shock, damage to the heart, kidneys and others very often develops internal organs. In rare cases, meningitis in early age leads to delay psychomotor development and dementia.
Forecast
According to statistics, the mortality rate for purulent inflammation of the meninges reaches 12–15%. The prognosis depends on the timeliness of hospitalization of the patient and the correct selection of drugs for antibacterial therapy. If you consult a doctor early and start proper treatment, the prognosis is conditionally favorable.
The consequences of purulent meningitis can be hearing loss, some neurological disorders, and memory loss. After an illness at an early age, slow mental development may occur.
Preventive measures
The most effective measure to prevent the disease is vaccination - immunological drugs used to prevent infection with the most common pathogens (meningo- and pneumococci, Haemophilus influenzae).
To prevent secondary purulent meningitis, it is necessary to promptly identify and eliminate potentially dangerous foci of infection in the body - otitis media, sinusitis, chronic abscesses, dental pathologies.
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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 is most often diagnosed in children under five years of age.
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 mainly affects people with weak immune systems who have previously had severe illnesses. 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 is a chance full recovery. In some cases, the disease leads to serious complications. The brain substance itself is not affected during the disease process. 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 primary and secondary types of purulent meningitis, depending on the nature of the disease.
Primary disease occurs due to the entry of pathogenic bacteria into the human body from the external environment, such as:
- Pneumococcus;
- hemophilic stick type "B";
- meningococcus;
- other microorganisms.
Infection occurs mainly by contact and airborne droplets.
Infection occurs more often in children because weak immunity may not cope even with not the best dangerous pathogen diseases. Throughout life, the body of an adult produces antibodies to those infections that they may have encountered previously. Therefore, meningitis is diagnosed less often in them.
The secondary form occurs only when there is some source of infection in the patient’s body. This applies to acute respiratory diseases, otitis media, sinusitis, etc.
From the source of the disease, microbes enter the cerebral cortex and become the cause of the development of purulent processes.
The risk of developing a secondary type of purulent meningitis is minimal among those people who have previously suffered from the primary form.
Epidemiology
The peculiarity of the development of purulent meningitis depends on the bacteria that provoked the disease. In this regard, several types of disease are distinguished.
For meningococcal meningitis is characteristic acute course already in the initial stages, sometimes with symptoms colds. A sharp increase in body temperature, nausea, vomiting, constant headache. A day after the onset of the disease, tension in the muscles of the back of the head appears.
The disease progresses rapidly - the patient experiences hallucinations, the aggressive state changes to passivity and loss of concentration. Vision and hearing may deteriorate. The obvious symptom is a rash over the body, which subsequently increases in size and forms ulcers. Possible complication in the form of hemorrhages in the adrenal cortex leads to the death of the patient.
Often pneumococcal meningitis affects children's body and adults over the age of forty. Foci of infection can be both skull injuries and inflammation of the ears or nasopharynx. Meningitis of this type can also occur in the primary form of the disease.
The symptoms are similar to meningococcus. If it is untimely and not adequate treatment there is a high probability of complications and death. The secondary form is severe and protracted, as well as frequent relapses. Without proper treatment, death can occur within a week.
Meningitis-Hib is caused by Haemophilus influenzae and is only of the secondary type. It can occur with otitis media, pneumonia or sinusitis. It most often affects newborn children and preschoolers.
In the first stages, the disease develops gradually. There are often cases of temporary imaginary improvement in well-being even before starting healing process. This species 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, making treatment difficult. Abscesses often develop. The disease poses a great danger to life.
Symptoms
In the initial stages, it is difficult to independently identify purulent meningitis, since the main symptoms are similar to other diseases. In subsequent stages, the underlying disease develops.
At first, a sick person feels a loss of strength, drowsiness, symptoms of a cold, nausea is not excluded, loose stool, a rash on the body that resembles chickenpox or rubella.
With the secondary type of purulent meningitis, pain in the joints and bones, high fever, discharge from the ears and nose, and blurred vision are observed. In case of exacerbation of pneumonia - cough, shortness of breath, discomfort in the area chest.
Signs in young children
It is difficult to determine what is bothering a child who has not yet learned to speak. In this case, parents should carefully monitor his behavior. The main symptoms of the disease are the following:
- During sleep hands constantly reach for the head.
- fontanel sticks out or sinks relative to the level of the cranial bone.
- If you take a sick child by the armpits and lift him up, he will try to press legs to stomach.
- In a lying position, the child tries throw back head back.
- Appear spots or rash on the body.
- Arises chills, convulsions.
Usually, before the development of purulent meningitis, a child experiences 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 may occur in within three days.
Symptoms in adults
Most of the signs of purulent meningitis at the initial stage of the disease can be simply ignored or temporarily alleviated with the help of simple medications. This only delays the start of treatment and leads to an exacerbation of the disease.
The main signs of concern are:
- chronic headaches pain, accompanied by a feeling of internal pressure in the skull, increased pain syndrome when moving your head in different directions, loud sounds or bright lighting;
- 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, severe sweating, chills;
- decline concentrations attention, ignoring verbal requests 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 doctors Patient in as soon as possible is sent to the hospital for diagnostics and a plan for his treatment.
Diagnostics
To establish accurate diagnosis The attending physician studies the patient's medical history in detail. Diseases that were previously suffered and possible foci are taken into account chronic infections, contacts with infected people, injuries.
- Analysis blood. Confirmation of the disease may be a change in the number of white blood cells, 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 tap. To do this, material is collected using a syringe with a needle, which is inserted between the third and fourth lumbar vertebrae into the space between spinal cord and shell.
In case of illness, the cerebrospinal fluid will have high blood pressure, cloudy consistency of a green or yellow hue, 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 the detection of a large number of neutrophils in the fluid.
Features of treatment
After studying the test results, the infectious pathogen is identified and treatment is prescribed.
Adults and seriously ill children are hospitalized in the infectious diseases department or intensive care unit.
First of all, an antibiotic is introduced into the patient’s body, which can stop further progression of the inflammatory process. The maximum dosage is set, and the frequency of administration is more than once every four hours. With the help of diuretics, swelling of the brain is relieved.
In parallel, the patient is prescribed medications to reduce the severity of symptoms (headaches, nausea, fever).
In the secondary form of the disease, the infectious focus is treated.
In order to remove pus, craniotomy may be performed.
When the patient's health improves, he is discharged from the hospital for further treatment at home.
Subsequently, for two years, children are regularly observed by a neurologist, pediatrician and infectious disease specialist. At first, the survey is carried out once a quarter, then this period is six months. Adults are under the supervision of a therapist, psychiatrist, infectious disease specialist and neurologist.
If your health condition worsens, the schedule for visiting doctors changes.
Recovery after trepanation
Rehabilitation process after surgical intervention and removing pus from the meninges is difficult. The patient experiences severe pain, fatigue. He has swelling of the face and head.
You can get up on 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, you should do household chores at home that do not require maximum physical and mental effort.
Restoring health after trepanation can take up to two months, taking into account the person’s age and the complexity of the disease.
During rehabilitation, you should give up some activities and habits:
- driving transport facilities;
- use alcoholic drinks;
- staying for a long time in motionless condition;
- 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 provided by timely initiation 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 necessary to urgently contact a medical facility.
Select a row possible consequences suffered purulent meningitis in both children and adults:
- frequent headaches pain, depending on pressure differences in the external environment;
- epileptic seizures, paralysis, hydrocephalus;
- decline concentration, memory impairment;
- lag in development in children;
- deterioration hearing, vision, speech, pathology of internal organs;
- intracranial hypertension.
Depending on the severity of the disease, some patients are able to recover without any health complications.
Prevention
Purulent meningitis is one of those types of diseases that are most often caused by infectious agents that enter the human blood. Therefore, first of all, it is necessary to monitor your health.
In addition, preventive vaccination shows high effectiveness in counteracting meningitis. Doctors recommend vaccinations for children before entering kindergarten or school, as well as for people with weak immune systems.
With the aim of timely diagnosis and treatment, you should consult a doctor at the first symptoms. It should be remembered that an advanced form of purulent meningitis can lead not only to disability, but also to death.
People with weakened immune systems, premature babies, patients who have suffered infectious or inflammatory diseases, as well as head injuries are primarily at risk of a dangerous disease. The peak of the disease occurs in the winter-spring period, when the body is especially weakened, and if the necessary treatment is not started in time, the consequences can be very serious, even fatal.
Purulent meningitis bacterial origin– the disease is quite rare, and it develops due to specific microorganisms – meningococci. Medical research showed that the causative agents of the disease can also be Haemophilus influenzae and pneumococci. However, the most common cause of the disease is viruses. The disease can be transmitted by airborne droplets to the fetus from a sick mother, and the baby may become infected during childbirth. In adults, infection can also occur when the infection is accidentally introduced into a person’s bloodstream through sexual contact.
As a rule, for the development of the disease there must be several reasons, for example: a weakened human body, a virus, insufficient blood supply to the brain. Young children with weakened bodies (premature babies, children with various abnormalities in the brain, babies who were infected in the womb) are especially susceptible to this disease. The main prerequisite for the appearance of the disease in newborns is streptococcal infection, salmonella, and sometimes the cause is infected E. coli.
Purulent meningitis can be divided into two types:
- Primary, which arise due to meningococci, pneumococci, herpetic infections.
- Secondary – complications after serious illnesses, for example, otitis media, pneumonia, caries and other serious diseases.
Depending on the severity of the disease, purulent meningitis can be mild, moderate, severe, or extremely severe. Depending on the speed of development mechanisms, it can be divided into fulminant, acute, subacute, chronic. According to localization, diseases are generalized (affecting the entire convex surface brain) and limited.
The following categories of people are at risk of contracting purulent meningitis:
- those suffering from immunodeficiency;
- alcohol and drug abusers;
- with cerebral circulatory disorders;
- suffering from atherosclerosis;
- with reduced immunity;
- survivors of hypothermia;
- susceptible nervous tension, frequent stress.
Main symptoms characteristic of the disease
As a rule, purulent meningitis is characterized by a symptom such as an increase in body temperature to forty degrees. On early stage the disease is very similar to other viral diseases. The patient feels chills, and may experience vomiting and nausea. The viral form of meningitis is accompanied by a runny nose, cough, weakness and other typical signs of ARVI. Arises constant pain in my head. If purulent meningitis is a complication of otitis, sinusitis, pneumonia, osteomyelitis of the skull bones, then the patient’s temperature rises, weakening of the body, lethargy, deterioration of health, runny nose, discharge from the ears, pain in the bones, chest, shortness of breath, cough.
It is very important for parents to pay attention to the main signs of the disease in children and promptly seek help from a qualified specialist. In infants, purulent meningitis usually lasts about seven days, and if the necessary treatment is not started in time, it can be fatal. With lightning-fast development acute form illness, the baby can die within three days. It is important for parents of children under three years of age to pay attention to the following symptoms of purulent meningitis:
- the baby sleeps quite soundly, although he has restless sleep;
- rash on the body;
- convulsions;
- inappropriate behavior of the child, crying;
- the baby lies on his side with his head thrown back, legs tucked under him;
- symptoms of Meitus, Lessage.
Then they begin to appear specific symptoms diseases. A person may begin to delirium, his consciousness becomes confused, and his psyche becomes disturbed. The patient stops recognizing people and may fall into a coma. A rash appears, which is accompanied by hemorrhage. A constant headache can be relieved only with painkillers, and then only for a short time. Photophobia may develop. Often the patient cannot bend his head and is unable to fully straighten his legs (Kerning's symptom). A person may develop an uncontrollable condition in which spontaneous flexion of the hip and knee joints occurs. With viral meningitis, red spots appear on the patient’s body, which disappear when pressed with glass. At meningococcal infection spots appear Brown and when pressed with glass they do not disappear. The consequences of purulent meningitis can be very serious for the patient’s life, therefore, at the first manifestations of purulent meningitis, it is necessary to call an ambulance.
Two days after the onset of the disease, loss of vision, partial hearing loss, strabismus, and double vision may occur. As a rule, purulent meningitis has incubation period, which lasts from two to five days. Partial memory loss, speech impairment, hallucinations, sudden involuntary movements in various muscle groups, partial paralysis may indicate a severe form of purulent meningitis. At this moment, it is important to turn to specialists for help, if this has not been done before, since the patient’s life is at risk. If you lose time and do not go to the hospital on time, a fatal outcome cannot be ruled out. terrible disease.
Cerebral edema is the most serious complication of purulent meningitis. As a rule, it can develop on the third day of the disease, although with fulminant meningitis, the acute form can appear already in the first hours. It is characterized by the following symptoms: decrease or increase blood pressure, rapid heartbeat, confusion, breathing problems. Complications of purulent meningitis also include: pneumonia, cystitis, adrenal failure, purulent arthritis, septic shock.
Diagnosis and drug treatment
Thanks to clearly defined signs, identifying this disease is absolutely easy. However, in addition to the presence of characteristic symptoms of the disease and a personal examination by a specialist, it is necessary to conduct laboratory (general and biochemical blood tests) and instrumental tests ( CT scan, lumbar puncture, X-ray of the lungs, sampling of cerebrospinal fluid). Puncture of the cerebrospinal fluid is decisive in identifying purulent meningitis: in the cerebrospinal fluid the level of protein will be increased and the concentration of glucose will be decreased, and the Pandey and None-Appelt tests will be positive. A large number of neutrophils detected in a small amount of fluid or tissue removed by puncture for diagnostic purposes is the main sign of purulent meningitis. Stagnation in the fundus - another one of the symptoms of the disease. On late stages disease, the protein concentration in the blood can increase to 10 grams/liter, and a blood test can detect a large number of leukocytes, neutrophils, and the absence of eosinophils.
Treatment of purulent meningitis should be carried out only after a diagnosis has been made and strictly as prescribed by the attending physician, since this disease can lead to irreversible consequences in the patient's body. Self-medication is strictly prohibited. According to statistics, fifteen percent of cases of the disease end in the death of the patient. Treatment of purulent meningitis is carried out only in the infectious diseases department of the hospital. Before starting therapy, it is necessary to identify the cause of the disease. Then the specialist makes an appointment necessary antibiotics, which penetrate the physiological barrier between the circulatory and central nervous systems and can also protect the patient’s brain.
If the disease is caused by pneumococcus, the patient is prescribed Vancomycin along with Pefloxacin. Light form The disease is treated with tetracycline antibiotics and sulfonamides. If the disease is caused by staphylococcus, the required treatment period is no more than seven days. In particularly severe cases, antibiotics may be administered intravenously. When the patient’s body temperature normalizes, the patient’s health improves, and the leukocytes in the blood decrease, the attending physician may stop taking antibiotics. In addition, depending on the cause of the disease, the patient can also be examined by specialists such as an ophthalmologist, pulmonologist, otorhinolaryngologist, and prescribed treatment if necessary. To increase the body's immune forces, the patient is prescribed immunoglobulins and interferons. To relieve intoxication and dehydration of the body, restorative and restorative substances, such as glucose, albumin and others, can be administered. As a rule, therapy for purulent meningitis includes taking medications:
- anti-inflammatory drugs;
- glucocorticosteroids;
- anti-edema medications;
- anti-convulsants.
Sometimes surgical intervention is necessary, especially if secondary signs of purulent meningitis are detected.
If the correct diagnosis is made and treatment is started in a timely manner, then serious complications: complete deafness, epilepsy, disorders of the brain can be avoided.
One of the reliable ways to protect against the development of purulent meningitis is vaccination, which is carried out among children under five years of age, as well as among adults who have been found to have an immunodeficiency state due to the development of HIV infection in the body. Vaccination is also recommended in mandatory children over 18–20 months, one of whose family members has suffered from purulent meningitis, as well as children with weak immunity, often suffering from otitis media and pneumonia.
In order to prevent the occurrence of serious complications of purulent meningitis, you must be attentive to your own health, as well as the well-being of your loved ones, and at the first symptoms of the disease, be sure to seek help from specialists in order to prevent the development of irreversible processes in the body.
Purulent meningitis is an inflammatory process of the meninges, which occurs due to the entry and activation of pathogenic microflora. A distinctive feature of the disease is the extremely rapid increase in meningeal symptoms, which is due to the active accumulation of pus. Absence qualified assistance provokes the development of death.
The inflammatory process is provoked by bacteria: meningococci, pneumococci, hemophilus influenzae. In the presence of weakened immunity, these bacteria easily circulate in the bloodstream and settle in various tissues and organs, affecting the meninges.
Children under 5 years of age are at risk, as their immunity is in the process of formation. The disease also affects people with immunodeficiencies and chronic diseases of inflammatory origin.
Purulent meningitis in children is often caused by streptococcus and salmonella. In the absence of proper hygiene and frequent contact with sick people, the risk of developing meningitis increases several times.
Considering the way pathogenic bacteria enter brain cells, there are two types of meningitis:
- Primary - is a consequence of a long-term respiratory disease, when bacteria from a sick person enter the mucous membrane of the nasopharynx of a healthy person, are activated and spread along with the blood to the brain. Another cause is trauma to the skull and nose, which results in open wound. Lack of proper processing and non-compliance with aseptic rules provokes the entry of various bacteria into the blood.
- Secondary – is a consequence of localized inflammatory purulent processes occurring in the body. Most often these are chronic sinusitis, rhinitis, and otitis media of the middle ear. As soon as the immune system weakens and is unable to contain the number of bacteria, they become active and begin to circulate freely throughout the body, ending up in the brain.
Secondary purulent meningitis affects people in more mature age who have chronic illnesses and do not have natural protection. This can be caused by lifestyle, as well as harmful working conditions.
An indirect reason that allows pathogenic bacteria to become active is weak immunity. The reasons may be:
- frequent stress and lack of proper rest;
- long-term respiratory diseases;
- congenital immunodeficiencies;
- poor nutrition, causing acute vitamin deficiencies.
When bacteria enters human body the situation can develop in two ways: either the immune system immediately starts working and prevents foreign agents from entering the brain, or against the background of its weakening pathogenic microflora quickly spread by blood throughout the body.
Forms of diseases
Taking into account the peculiarities of the course of the disease, the following forms are distinguished:
- Fulminant – within 2-3 hours from the moment of debut, meningeal symptoms develop with a further increase in cerebral edema. Absence medication assistance provokes death.
- Acute - occurs with the development of all characteristic symptoms, and with early diagnosis and treatment it is well and quickly relieved, without causing life-threatening complications.
- Recurrent (chronic) – develops due to undertreatment or neglect of the acute form of the disease, as well as the progression of purulent foci in the body against the background of a pathologically weakened immune system.
- Abortive - is the most dangerous type because it has an erased clinical picture, which hinders early diagnosis. There are signs of intoxication, and stiff neck and pain in the head are practically absent or mild.
According to the severity of the disease, purulent meningitis can be mild, moderate and severe. The prognosis of 85% depends on the severity.
Clinical manifestations
The incubation period of purulent meningitis varies from 2 to 5 (sometimes 10) days, which is due to the peculiarities of immunity. The onset of the disease may be various shapes, manifested by the following symptoms of general intoxication:
- A sharp increase in body temperature to critical levels, which cannot be stabilized when using any antipyretic drugs. A person suffers from chills, which is accompanied by fever and the release of profuse sticky sweat.
- Intense thirst and dryness of the mucous membranes, which cannot be eliminated even with plenty of fluids. If a person drinks a large amount of liquid at one time, vomiting immediately follows, which only intensifies the increasing dehydration.
- Severe migraine-type headache localized in the temples and back of the head. The pain intensifies when exposed to sound and light stimuli, as well as movement.
- Nausea and vomiting, cramping pain in the abdomen, which are in no way related to a disorder of the digestive tract and develop reflexively.
- Impaired consciousness, speech and quality of vision, which indicates damage to the large nerves supplying the brain.
- Shell symptoms (Guillain's, Brudzinsky's, Kernig's symptoms) are visualized in the first hours after the onset of the disease.
- Stiff neck muscles, which provokes the need to throw the head back. This position reliably indicates the presence of meningitis.
- A characteristic diffuse rash in the extremities and abdomen.
- Decreased reflexes and coma.
Active discharge of pus, which is natural process, irritates the meninges, causing an increase in intracranial pressure. This in turn causes a number of additional complications in the form of disruption visual function, deafness and impaired consciousness.
In the absence of proper treatment and the spread of pus into the deep layers of the meninges, meningoencephalitis develops. It is diagnosed by characteristic manifestations:
- paresis and paralysis of the whole body;
- absence or incoherence of speech;
- violation or lack of sensitivity of the skin;
- pathological and spontaneous reflexes;
- hallucinations;
- cardiovascular pathologies.
In some cases, characteristic meningeal symptoms may be completely absent, making diagnosis difficult. Symptoms of intoxication and severe headache should be examined by a specialist.
Diagnostics
A preliminary diagnosis is made based on an assessment of external clinical manifestations and collecting a primary medical history. The doctor examines the patient, recording three main signs of meningitis:
- severe headache and its relief when tilting the back of the head;
- reflex flexion of the second leg during mechanical flexion of the first;
- high temperature, which is not knocked down by anything.
To clarify the diagnosis, the following studies are used:
- Lumbar puncture - in the presence of purulent meningitis, the cerebrospinal fluid comes out under pressure, bubbles slightly, has a cloudy consistency and a characteristic gray-green tint. At microbiological research the causative agent of meningitis is detected, as well as the degree of progression of the purulent-inflammatory process.
- MRI and CT - helps to determine the presence of primary and secondary inflammatory foci, as well as the degree of their progression.
Differential diagnosis requires separating purulent meningitis from viral meningitis, as well as diseases with similar manifestations: typhus, severe forms of influenza, leptospirosis.
Treatment options
Treatment of purulent meningitis, regardless of severity, is carried out in a hospital setting, where the initial diagnostic procedure is a lumbar puncture. As soon as data is obtained about which pathogenic microorganisms provoked meningitis, appropriate antibiotic therapy is selected. Preference is given to cephalosporin antibiotics that have an extended spectrum of action: Ceftriaxone, Cefazolin, Cefix, Cefotaxime.
In case of unknown etiology of the disease or doubts on the part of doctors, which requires a number of additional diagnostic procedures, the patient is initially administered Gentamicin or Kanamycin. After confirmation of the etiology of the disease, treatment is continued with other antibiotics that have a less harmful effect on the body.
Antibacterial therapy involves the administration of maximum doses of drugs, which will quickly eliminate the spread of pathogenic microbes throughout the body.
Along with antibiotics, the patient undergoes detox therapy, which is aimed at removing waste and toxins from the body, as well as replenishing the lytic composition of the blood. Infusion solutions are prescribed that help normalize the condition in the shortest possible time.
In cases where there are kidney problems, as confirmed by a urine test, hemodialysis may be required. Artificial cleansing of the blood from waste and toxins greatly facilitates the work of the paired organ, normalizing all metabolic processes.
To reduce brain swelling and prevent the development of hydrocephalus, diuretics are prescribed. With their help, all fluid entering the body by infusion is freely excreted naturally, without accumulating in tissues and organs.
Glucocorticosteroids are prescribed to block the body's reaction, which in the presence of purulent meningitis can be pathological. Hormonal agents control the functioning of brain centers and also reduce pain.
Symptomatic therapy involves the use of painkillers, anticonvulsants and muscle relaxants. In the presence of high blood pressure, antihypertensive drugs are used in combination with diuretics.
In a state of infectious-toxic shock, they produce resuscitation measures, aimed at maintaining all vital processes in the body. May be required surgery for the rehabilitation of localized foci of damage in the brain.
After cupping acute period and improving the general condition of the patient, the doctor may prescribe antipsychotics and nootropics that improve cerebral circulation, as well as normalizing the functioning of the central and peripheral nervous system.
The consequences of purulent meningitis can be the most unpredictable. The mild form usually resolves quickly and does not cause life-threatening complications. In the presence of a weakened immune system, an advanced form of meningitis and improper treatment, complications such as:
- visual and hearing impairment;
- paresis of limbs without possibility full recovery motor activity;
- problems with speech and coordination of movements;
- swelling of the brain (hydrocephalus);
- partial or complete absence of reflexes;
- death.
Because the characteristic symptoms purulent meningitis may be absent for quite a long time, it is important not to forget about the need to consult a specialist. If there is any suspicion of meningitis, treatment should be started only after complex diagnostics and specialist recommendations. Self-medication can be ineffective and life-threatening.
Prevention
Acute purulent meningitis can be prevented if:
- Strengthen immunity.
- Eat right, saturating your body with vitamins and minerals.
- Avoid contact with sick people using personal protective equipment during periods increased risk respiratory diseases.
- Treat any inflammatory processes in the body in a timely manner, preventing them from becoming chronic.
Forecast
Purulent meningitis in adults with adequate treatment has a favorable prognosis, in which a full recovery can be achieved during the rehabilitation period. In children, the prognosis is worse due to reduced immunity. An unfavorable prognosis and a high degree of mortality are observed in old age and in the presence of autoimmune processes.
