Purulent meningitis is a purulent inflammation of the cerebral membranes caused by streptococci, pneumococci, staphylococci, Pseudomonas aeruginosa, intestinal microbes, etc. The disease with purulent meningitis occurs in people of all ages.
The risk factors are: smoking, insolation, frequent stress, hypothermia, excessive alcohol consumption, pharyngitis, angina, ARI.
The causes of
The most common pathogens of purulent meningitis are representatives of bacterial microflora - meningococci, pneumococci, hemophilic rod( influenza rod), Pseudomonas aeruginosa, various kinds of staphylococci and streptococci, gonococci, salmonellae, E. coli, causative agents of typhoid and listeriosis.
But sometimes purulent meningitis develops in case of a fungal infection( more often it still has a non-purulent, serous character) - cryptococcosis, coccidioidosis and candidiasis. The cause of purulent meningitis can be and protozoa, for example, some species of amoeba.
- Primary purulent meningitis , caused by meningococcus, is transmitted mainly by airborne droplets: infection with meningitis occurs during sneezing, coughing, kissing, through saliva-contaminated objects and so on.
- Secondary meningitis , which is a complication of some other inflammatory processes( rhinogenic, otogenic, odontogenic, etc.), is usually not infectious.
Secondary purulent meningitis
Secondary purulent meningitis occurs in the presence of a purulent focus in the body. They can develop either as a result of a direct transition of infection from purulent foci to the membranes of the brain, for example, with purulent otitis or sinusitis, thrombosis of the dura of the dura mater, abscess of the brain, or by metastasis from purulent foci located at a distance, for example, with abscesses or bronchiectasislung, ulcerative endocarditis, etc. Purulent meningitis sometimes complicates penetrating wounds of the skull.
The causative agents of secondary purulent meningitis can be various bacteria: pneumococci, staphylococci, Afanasyev-Pfeiffer's haemophilic rod, salmonella, Pseudomonas aeruginosa, lerelli.
Symptoms of purulent meningitis
At the outset, meningitis in adults manifests itself as a symptom similar to many other diseases. Having noticed them, you need to see a doctor as soon as possible to prevent formidable complications. Later, purulent meningitis develops, the symptoms of which are quite specific.
The incubation period is 1-5 days. The disease develops sharply: a strong chill, the body temperature increases to 39-40 ° C.
An intense headache with nausea or repeated vomiting arises and is rapidly growing. There may be nonsense, psychomotor agitation, convulsions, impaired consciousness. In the first hours, shell symptoms are revealed( stiff neck muscles, Kernig symptom), which increase by the 2-3 day of the disease.
- Kerning Symptom - the diseased person is unable to fully extend his legs.
- The symptom of Brudzinsky is the patient's uncontrolled flexion of the hip and knee joints.
Deep reflexes are animated, the ventral ones are reduced. In severe course, lesions of the cranial nerves are possible, especially III and VI pairs( ptosis, anisocoria, strabismus, diplopia), less often - VII and VIII pairs. On the 2-5th day of the disease, often there are herpetic eruptions on the lips.
Sometimes there are also various skin rashes( often in children) of hemorrhagic nature, which indicates a meningococcemia. Cerebrospinal fluid is cloudy, purulent, flows under increased pressure.
Neutrophilic pleocytosis is detected( up to several tens of thousands of cells per 1 μl), increased protein content( up to 1-16 g / l), reduced sugar and chloride levels. In smears of the sediment of the cerebrospinal fluid after coloring according to Gram, meningococcus is detected. It can also be isolated from mucus taken from the pharynx. In the blood - leukocytosis( up to 30 - 109 / L) and an increase in ESR.
In children of preschool age, the disease often takes the form of meningoencephalitis, in which the leading symptoms are motor activity, confusion, signs of lesion of the cranial nerves - strabismus, paralysis of the face and larynx. In such a course, the stage of paralysis comes rather quickly, and with blockage of the liquor ducts, pus develops hydrocephalus.
In the case of development of meningococcal septicemia, there are pronounced syndromes of increasing vascular permeability and intravascular coagulation. At the same time on the skin formed irregular foci of hemorrhages, protruding above the surface of the skin, and necrosis - areas of necrosis.
Complications of
Complications and consequences of meningitis in adults are very dangerous for human health and life, they can be avoided if treatment of the disease is started in a timely manner.
The consequences of purulent meningitis include:
- cerebrosthenic syndrome;
- headache;
- increased fatigue;
- instability of attention;
- inability to prolong the voltage;
- irritability;
- capriciousness;
- tearfulness;
- fussiness;
- excessive motor activity;
- general lethargy;
- slow thinking.
An early and formidable complication, which 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 form - in the first hours.
Forecast
According to some reports, in 14% of cases purulent meningitis leads to a lethal outcome. However, with timely started and correctly conducted treatment, purulent meningitis has a generally favorable prognosis.
After the meningitis, asthenia, cerebrovascular-dynamic disorders, sensorineural hearing loss, and some weak focal symptoms can be observed. Severe sequelae of purulent meningitis( hydrocephalus, amaurosis, deafness, dementia, epilepsy) in our time are a rarity.
Treatment of purulent meningitis
Purulent meningitis with competent and timely treatment recedes completely after two weeks. At the first signs of illness the patient must be hospitalized and identified in the intensive care unit.
First of all, the doctor prescribes the administration of antibacterial drugs that have an effect directly on the brain. If no improvement occurs after three days of taking the drugs of this group, a repeated puncture of the cerebrospinal fluid is prescribed. And then the drugs are changed.
For the removal of symptoms of intoxication with purulent meningitis in adults, intravenous fluids are administered. Also, diuretic drugs are used to remove toxins from the blood. Soothing agents are prescribed in cases of severe and frequent seizures. And for the restoration of cerebral circulation special drugs are prescribed.