Tuberculous meningitis

What is Tuberculous Meningitis -

Hematogenous dissemination of MBT into the nervous system, into the structures surrounding the brain or spinal cord, causes meningitis.

Tuberculous meningitis is an inflammation of the meninges. Up to 80% of patients with tuberculous meningitis have either traces of previous tuberculosis of other localizations, or active tuberculosis of another localization at the moment.

What provokes / Causes of Tuberculous meningitis:

Causative agents of tuberculosisare mycobacteria - acid-fast bacteria of the genus Mycobacterium. A total of 74 species of such mycobacteria are known. They are widespread in soil, water, humans and animals. However, tuberculosis in humans is caused by the conditionally isolated M. tuberculosis complex, which includes Mycobacterium tuberculosis (human), Mycobacterium bovis (bovine), Mycobacterium africanum, Mycobacterium bovis BCG (BCG strain), Mycobacterium microti, Mycobacterium canetti. Recently, it includes Mycobacterium pinnipedii, Mycobacterium caprae, phylogenetically related to Mycobacterium microti and Mycobacterium bovis. The main species characteristic of mycobacterium tuberculosis (MBT) is pathogenicity, which manifests itself in virulence. Virulence can vary significantly depending on environmental factors and manifest itself in different ways depending on the state of the macroorganism, which is exposed to bacterial aggression.

Tuberculosis in humans most often occurs when infected with human and bovine species of the pathogen. Isolation of M. bovis is observed mainly in rural areas, where the route of transmission is mainly alimentary. Avian tuberculosis is also noted, which occurs mainly in immunodeficient carriers.

The office belongs to prokaryotes (in their cytoplasm there are no highly organized organelles of the Golgi apparatus, lysosomes). There are also no plasmids characteristic of some prokaryotes that provide genome dynamics for microorganisms.

Shape - slightly curved or straight stick 1-10 microns × 0.2-0.6 microns. The ends are slightly rounded. They are usually long and thin, but the bovine pathogens are thicker and shorter.

The office is immobile, does not form microspores and capsules.
The bacterial cell differentiates:
- microcapsule - a wall of 3-4 layers 200-250 nm thick, firmly connected to the cell wall, consists of polysaccharides, protects mycobacterium from the external environment, does not have antigenic properties, but exhibits serological activity;
- cell wall - limits the mycobacterium outside, ensures the stability of cell size and shape, mechanical, osmotic and chemical protection, includes virulence factors - lipids, with the phosphatide fraction of which the virulence of mycobacteria is associated;
- homogeneous bacterial cytoplasm;
- cytoplasmic membrane - includes lipoprotein complexes, enzyme systems, forms an intracytoplasmic membrane system (mesosome);
- nuclear substance - includes chromosomes and plasmids.

Proteins (tuberculoproteins) are the main carriers of the antigenic properties of MBT and show specificity in delayed-type hypersensitivity reactions. These proteins include tuberculin. The detection of antibodies in the blood serum of patients with tuberculosis is associated with polysaccharides. Lipid fractions contribute to the resistance of mycobacteria to acids and alkalis.

Mycobacterium tuberculosis is aerobic, Mycobacterium bovis and Mycobacterium africanum are aerophiles.

In the organs affected by tuberculosis (lungs, lymph nodes, skin, bones, kidneys, intestines, etc.), a specific "cold" tuberculosis inflammation develops, which is predominantly granulomatous in nature and leads to the formation of multiple tubercles with a tendency to decay.

Pathogenesis (what happens?) During Tuberculous meningitis:

The hematogenous pathway of MBT penetration into the meninges is recognized as the main one. In this case, the defeat of the meninges takes place in two stages.

1. At the first stage, in primary tuberculosis, sensitization of the body develops, breakthrough of the MBT through the blood-brain barrier and infection of the vascular plexuses of the pia mater.
2. At the second stage, MBT from the choroid plexus enter the cerebrospinal fluid, causing a specific inflammation of the pia mater of the base of the brain - bacillary meningitis.

During the spread of MBT from the primary tuberculous focus or as a manifestation of miliary tuberculosis, microscopic tubercles appear in the brain tissue and meningeal membranes. Sometimes they can form in the bones of the skull or spine.

Tubercles can cause:
1.inflammation of the meningeal membranes;
2. the formation of a gray jelly-like mass at the base of the brain;
3. inflammation and narrowing of the arteries leading to the brain, which in turn can cause local brain damage.

These three processes form the clinical picture of tuberculous meningitis.

The pathological process involves not only the membranes of the brain and spinal cord, but also the vessels. All layers of the vascular wall suffer, but to the greatest extent - intima. These changes are considered by pathologists as a manifestation of hyperergic inflammation. So, with tuberculous meningitis, primarily the membranes and vessels of the brain are affected. The brain parenchyma is involved in the process to a much lesser extent. In the cortex, subcortex, trunk, spinal cord, foci of specific inflammation are found mainly near the affected vessels.

Symptoms of Tuberculous Meningitis:

Meningitis mainly affects children, especially young infants, much less often adults.

By localization, the main forms of tuberculous meningitis are distinguished: basilar meningitis; meningoencephalitis; spinal meningitis.

There are 3 periods of development of tuberculous meningitis:
1) prodromal;
2) irritation;
3) terminal (paresis and paralysis).

Prodromal period characterized by gradual (within 1-8 weeks) development. First appear headache, dizziness, nausea, sometimes vomiting, fever. There is a retention of urine and stool, the temperature is subfebrile, less often - high. However, there are cases of the development of the disease at normal temperatures.

Irritation period:8-14 days after the prodrome, there is a sharp increase in symptoms, body temperature 38-39 ° C, pain in the frontal and occipital region of the head. Drowsiness, lethargy, and depression of consciousness increase. Constipation without bloating, scaphoid abdomen. Photophobia, skin hyperesthesia, noise intolerance. Vegetative-vascular disorders: persistent red dermographism, spontaneously appear and quickly disappear red spots on the skin of the face and chest.

At the end of the first week of the irritation period (on the 5-7th day), an indistinct meningeal syndrome appears (stiff neck, Kernig and Brudzinsky symptom).

Typical manifestations of symptoms appear in the second period of irritation, depending on the localization of the inflammatory tuberculous process.

With inflammation of the meningeal membranes, headaches, nausea, and a stiff neck are observed.

With the accumulation of serous exudate at the base of the brain, irritation of the cranial nerves may occur with the following symptoms: blurred vision, eyelid paralysis, strabismus, unequally dilated pupils, deafness. Fundus papilla edema is present in 40% of patients.

The involvement of cerebral arteries in the pathological process can lead to loss of speech or weakness in the limbs. This can damage any area of \u200b\u200bthe brain.

With hydrocephalus of varying severity, exudate blocks some cerebrospinal connections with the brain. Hydrocephalus is the main cause of loss of consciousness. Pathological manifestations can be persistent and indicate a poor prognosis for unconscious patients.
When the spinal cord is blocked with exudate, motor neuron weakness or paralysis of the lower extremities can occur.

Terminal period (period of paresis and paralysis, 15-24th day of illness). The clinical picture is dominated by signs of encephalitis: lack of consciousness, tachycardia, Cheyne-Stokes respiration, body temperature 40 ° C, paresis, central paralysis.

In the spinal form in the 2nd and 3rd periods, girdle, very strong radicular pain, flaccid paralysis, bedsores are observed.

Diagnosis of Tuberculous meningitis:

Establishing a diagnosis:
- timely - within 10 days from the beginning of the irritation period;
- later - after 15 days.

The simultaneous presence of the following diagnostic features indicates a high likelihood of tuberculous meningitis:
1. Prodroma.
2. Syndrome of intoxication.
3. Functional disorders of the pelvic organs (constipation, urinary retention).
4. Scaphoid abdomen.
5. Craniocerebral symptoms.
6. The specific nature of the cerebrospinal fluid.
7. Corresponding clinical dynamics.

Since a tuberculosis infection can be found anywhere in the body, it is necessary to pay attention to the presence of:
1) tuberculosis lymph nodes;
2) X-ray signs of miliary pulmonary tuberculosis;
3) enlargement of the liver or spleen;
4) choroidal tuberculosis, detected by examination of the bottom of the eye.

The tuberculin test can be negative, especially in advanced stages of the disease (negative energy).

Diagnostic signs of tuberculous meningitis in the analysis of cerebrospinal fluid:
1. The pressure in the spinal canal is usually increased (liquid
the bone flows out in frequent drops or a stream).
2. CSF appearance: initially transparent, later (through
24 h), a fibrin mesh may form. If there is a blockade
spinal cord is yellowish in color.
3. Cellular composition: 200-800 mm3 (norm 3-5).
4. The protein content is increased (0.8-1.5-2.0 g / l), the norm is 0.15-
0.45 g / l.
5. Sugar: its content is reduced by 90%, but may be normal in the early stages of the disease or with AIDS. This indicator is important for differential diagnosis with viral meningitis, in which the sugar content in the spinal fluid is normal.
6. Bacteriological examination of CSF: MBT are found only in 10%, if the volume of spinal fluid is sufficient (10-12 ml). Flotation by centrifugation for 30 minutes at high speeds can reveal MBT in 90% of cases.

Tuberculosis of the meninges, central nervous system remains the leading cause of death in adults.

It is necessary to conduct differential diagnosiswith bacterial meningitis, viral meningitis, and HIV cryptococcosis meningitis. The first two have a sharp onset. Cryptococcous meningitis develops relatively slowly. The presence of tuberculosis in the family or the detection of tuberculosis in an organ makes the tuberculous origin of meningitis more likely. However, a reliable sign is obtaining cerebrospinal fluid (CSF) by spinal puncture.

Treatment for Tuberculous Meningitis:

If there is a suspicion of the presence of tuberculous meningitis, the patient must be urgently hospitalized in a specialized medical institution, in which X-ray examination, spinal puncture, laboratory examination can be performed, specific methods of anti-tuberculosis therapy are applied.

If untreated, the outcome is fatal. The earlier the diagnosis is made and the treatment is started, the clearer the patient's consciousness at the time of the start of treatment, the better the prognosis.

Prevention of Tuberculous meningitis:

Tuberculosis is one of the so-called social diseases, the occurrence of which is associated with the living conditions of the population. The reasons for the epidemiological ill-being of tuberculosis in our country are the deterioration of socio-economic conditions, a decrease in the standard of living of the population, an increase in the number of persons without a definite place of residence and occupation, and the intensification of migration processes.

Men in all regions suffer from tuberculosis 3.2 times more often than women, while the growth rate of the incidence in men is 2.5 times higher than in women. The most affected are persons aged 20-29 and 30-39 years.

The morbidity rate among contingents serving sentences in penal institutions of the Ministry of Internal Affairs of Russia is 42 times higher than the national average.

In order to prevent, it is necessary to carry out the following measures:
- Carrying out preventive and anti-epidemic measures adequate to the current extremely unfavorable epidemiological situation with regard to tuberculosis.
- early detection of patients and the allocation of funds for drug provision. This activity can also reduce the incidence of people who come into contact with patients in the outbreaks.
- Carrying out mandatory preliminary and periodic examinations when applying for work in livestock farms that are unfavorable for tuberculosis in cattle.
- an increase in the allocated isolated living space for patients suffering from active tuberculosis and living in populous apartments and hostels.
- timely (up to 30 days of life) primary vaccination for newborn children.

Which doctors should you contact if you have TB meningitis:

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Tuberculous meningitis is a secondary inflammation of the membranes of the spinal cord and brain in people with tuberculosis of various organs.

This disease, which is rare at present, mainly affects people between 40 and 65 years old, as well as children under 5 years old, although this rarely happens, since children are necessarily vaccinated against meningitis.

The causative agent of the disease is mycobacterium tuberculosis. This form is especially difficult, because the body was previously affected by tuberculosis - the immune system is weakened, there is no strength to fight the "misfortune".

How the infection is transmitted

The cause of tuberculous meningitis is an infection from patients with tuberculosis of organs: lungs, bones, genitals, mammary gland, kidneys, larynx and others. Contact infection is rare.

In the presence of tuberculosis of the bones of the skull or spine, the infection can spread to the lining of the brain. In about 17% of cases, infection occurs through the lymph.

Risk factors for developing the disease include:

• age - the elderly and children under 5 years of age have a weak immune system;
• seasonality - autumn and spring are a period of epidemics;
• other infections of the body, intoxication,.

Distinguish - types of disease

Tuberculous meningitis has different forms, differing in symptoms and appropriate treatment:

1. Basal - has cerebral meningeal symptoms in the form of inability to pull the head to the chest due to hardening of the occipital muscles, disturbances in cranial innervation and tendon reflexes.
2. Tuberculous - the most severe form of the disease, there are cerebral and meningeal symptoms (vomiting, paralysis of the limbs, etc.), as well as abnormal cranial innervation.
3. Tuberculous leptopachymeningitis - develops extremely rarely, at the beginning of the disease there are almost no symptoms or they are hardly noticeable.
   If one or more symptoms are found, having a provoking factor (tuberculosis of one of the organs), you should immediately seek help from a doctor. Tuberculous meningitis is dangerous for its complications and adverse consequences.

Meningeal symptoms

Children at risk

More often, tuberculous meningitis develops in young children due to the lack of formed immunity or parents' refusal to vaccination against tuberculosis.

Mostly infants, weak and premature children, as well as children from 3 to 5 years old are affected. Only in babies under one year old, the disease begins in an acute form, the temperature rises sharply, vomiting, convulsions begin, hydrocephalic syndrome and bulging of the large fontanel are noted.

In children over a year old, everything usually begins with malaise, loss of appetite, drowsiness. Then the temperature rises, and vomiting begins - this happens within a week. Meningeal symptoms usually appear after 1–3 weeks.

Features of the clinical picture

The symptoms of tuberculous meningitis are divided into three stages:

1. Prodromal period - lasts up to 6-8 weeks. Symptoms appear gradually: apathy, lethargy, drowsiness, weakness, and frequent headaches, which gradually become stronger, the temperature rises to 38 degrees, nausea and vomiting begin.
2. - signs of the disease intensify, the temperature rises, headaches in the back of the head, constipation, photophobia, intolerance to sounds, the appearance and disappearance of spots on the body. On the 6-7th day of this period, meningeal symptoms occur: stiff neck, Kernig's and Brudzinsky's symptom, hearing impairment, vision problems, speech impairment, decreased sensitivity of the limbs, hydrocephalus, increased sweating and salivation.
3. Terminal period - the last stage of the disease, paralysis also begins, heart rate increases, loss of consciousness, difficulty breathing, temperature up to 40 degrees. The last stage of the disease ends with the death of a person.

In young children, the symptoms are similar to those in adults, only their development occurs in an acute form and the periods are shortened.

The main symptoms characteristic of tuberculous meningitis that develops in children - on the 2nd day, convulsions, vomiting, fever may begin, the child screams, the fontanelle swells and pulsates.

In older children, the disease occurs gradually, the manifestation of symptoms is blurred. Meningitis can be determined by the way the child lies, if he constantly lies on his side, tucking his legs to his stomach, and throwing his head back is a sure sign of the disease.

Aims and methods of diagnosis

The diagnosis of this disease within 10 days is considered timely, after 15 days - late. The disease is determined by three signs: the presence of symptoms, determination of the focus of infection and the study of cerebrospinal fluid.

Tuberculosis infection can be in any organ of the patient, therefore:

• upon examination, attention is paid to the presence of tuberculosis of the lymph nodes;
• x-rays of the lungs are taken to detect tuberculosis;
• diagnose an enlarged liver and spleen;
• examination of the fundus is carried out.

CSF sampling indicates tuberculous meningitis if the cerebrospinal fluid flows in a stream or in rapid drops. A complete examination for changes in fluid indicates an accurate diagnosis.

In addition, blood is taken for general and biochemical analysis, held by and, lungs and other organs.

Health care

The therapy lasts a very long time and is carried out only in stationary conditions... After the treatment, which lasts up to a year, the patient is sent to a specialized sanatorium.

All treatment is aimed at destroying the tubercle bacillus and is carried out especially intensively for young children.

For example, if Streptomycin can be administered intramuscularly to an adult patient, then the child needs to do this in the spinal canal, because in infants the disease proceeds in an acute form, and the slightest delay can cost life.

The goal of treating tuberculous meningitis is to eliminate the focus of tuberculosis, treat inflammation of the membranes of the brain and exclude it, prevent complications, stop CNS lesions, and remove intoxication.

Conservative medicine

Treatment is carried out in a complex manner with the use of specialized drugs: Streptomycin, PASK, Ftivazid and Saluzid.

Comprehensive treatment prevents the emergence of resistant tuberculosis macobacteria and has a beneficial effect on the removal inflammatory processbecause all of these drugs have anti-inflammatory effects. The combination and dosage is prescribed by the doctor depending on the severity of the disease, the tolerance of the drugs, the patient's condition.

At the same time, general strengthening therapy is prescribed: glucose systems, vitamins C, B1, B6, aloe. In case of complications, drugs are prescribed to eliminate them.

Even with mild forms of the disease, the patient is discharged from the hospital only six months later, if the patient has a good general condition and normal cerebrospinal fluid tests. After discharge, treatment continues for tuberculosis and complications of meningitis.

Dispensary observation is carried out for 2-3 years. Immediately after the sanatorium, the patient is enrolled in group 1 of the local dispensary residence and then transferred to 2 and 3.

Children are monitored by a phthisiatrician for a year in group A, then 2 years in group B, and the last 7 years in group C. If complications are noted, then follow-up by a neurologist, ophthalmologist, psychiatrist continues. The first 2-3 years, preventive courses are carried out for 3 months with Isoniazid in conjunction with Ethambutol.

Patients continue their labor activity if they have not been identified as having a disability. Light work is required, mental stress is unacceptable for a year after treatment.

ethnoscience

Folk remedies in the treatment of tuberculous meningitis perform a supportive function and alleviate the suffering of the patient. But you can use them in consultation with your doctor.

Decoctions and tinctures of herbs are recommended: lungwort, marshmallow, elecampane root. A pot of wisteria can be placed in the room where the patient is located - the phytoncides secreted by it disinfect the air and kill the tubercle bacillus.

At home, to alleviate the suffering of the patient, he should be provided with peace, both mental and physical, because his sensitivity to hearing, sight and touch to the skin is aggravated.

It is necessary to close windows with curtains, isolate the patient from sounds and touches to the body. Put ice or rags soaked in cold water on the head and limbs (arms and legs), changing them periodically as it warms up. It is important to know that the patient should be hospitalized as soon as possible in order to immediately begin treatment.

Is it dangerous?

The prognosis for treatment of tuberculous meningitis is favorable in 90% of cases if the diagnosis is made on time. If the diagnosis is made after 15 days of illness, then the consequences can be most dire. If the patient was immediately taken to the hospital, then a complete cure is possible even in young children.

A common complication is (paralysis of one side of the body), visual impairment, blindness. With the spinal form of meningitis, there may be paresis of the extremities and the development of pathologies of the pelvic organs.

In order to prevent

The following preventive actions are distinguished to prevent infection with tuberculosis:

By taking precautions you can reduce the risk of infection. If, nevertheless, it happened, you should not self-medicate, but you should urgently consult a doctor.

Tuberculosis can affect more than just the lungs. The causative agent of the disease (Koch's bacillus) penetrates into various systems of the human body. One of the most severe manifestations of this infection is tuberculous meningitis. In this disease, bacteria cause damage to the brain. Modern diagnostics allows you to identify this ailment in the early stages. In this case, the disease can be cured. However, the tuberculous process in the central nervous system remains an extremely dangerous pathology. A neglected disease can lead to the death of the patient.

What is this disease

Tuberculous meningitis - It is secondary. All patients either suffer from active tuberculosis, or have suffered from this disease in the past. Establishing the primary site of infection is sometimes very difficult.

Outbreaks of tuberculous meningitis of the brain are most often observed in winter or spring. However, a person can get sick at any time of the year. Children, the elderly and patients with severely reduced immunity are especially susceptible to this disease.

The causative agent and pathogenesis of the disease

The causative agent of the disease is Koch's bacillus. It is also called mycobacterium tuberculosis (MBT). This microorganism enters the brain in two stages:

1. First, the bacterium enters the blood from the primary lesion. From there, it is carried into the brain, overcoming the barrier between the circulatory and central nervous systems. Koch's bacillus causes damage to the vessels of the lining of the brain. This leads to the appearance of granulomas in the organ.
2. Together with the cerebrospinal fluid, bacteria enter the base of the brain. Infection of the meninges occurs, accompanied by their inflammation.

In this case, tubercles are formed in the brain. They are microscopic nodules or bumps in the lesion. Inflammation affects not only the tissues of the membranes, but also the vessels. There is a narrowing of the cerebral arteries, which leads to a violation of local blood circulation. Pathological changes also occur in the tissue of the organ, but they are less pronounced than in the membrane. A gray mass appears at the base of the brain with a jelly-like consistency.

Who is at risk

In addition to patients with tuberculosis, people who have been in contact with the patient are also at risk. This pathology is often observed in persons suffering from alcoholism and drug addiction. Bad habits have an extremely negative effect on the state of immunity. Tuberculous meningitis in HIV infection is quite common and severe. Also, people with traumatic brain injury have an increased risk of the disease.

Classification of the disease

In medicine, it is customary to distinguish several forms of tuberculous meningitis, depending on the localization of the affected areas:

1. Basilar meningitis. In this type of disease, the lesion affects the cranial nerves. Signs of irritation of the meninges are pronounced, but there are no intellectual impairments. The disease is difficult, it can recur, but with timely treatment, it ends with a full recovery.
2. Cerebrospinal meningoencephalitis. This is the most severe form of tuberculous meningitis. It proceeds with damage not only to the membranes, but also to the substance of the brain. In 30% of cases, the pathology ends in death. After recovery, severe complications are often noted: paralysis of the limbs and mental disorders.
3. Serous meningitis. Fluid (exudate) accumulates at the base of the brain. There are no signs of irritation of the meninges. This form is mild and usually results in complete recovery. Complications and relapses are not observed.

Stages of the disease

In the clinic of tuberculous meningitis, several stages of the disease can be distinguished:

• prodromal;
• stage of irritation (meningeal syndrome);
• terminal.

Pathology is characterized by gradual development. The prodromal stage can last up to 6-8 weeks. Then there are signs of irritation of the meninges, they are noted within 15-24 days. If untreated, the disease progresses to the terminal stage. Patients develop signs of encephalitis, paralysis, and the disease is often fatal. Next, we will consider in detail the symptoms and consequences of tuberculous meningitis at each stage.

Symptoms

The disease begins with a long period. At an early stage, the signs of the disease are nonspecific. Patients complain of headache in the evening, malaise, dizziness, nausea, loss of appetite. irritability. The body temperature may be slightly elevated, but there are cases of the onset of the disease without fever. Retention of urination and defecation is noted. Such a slow development of pathology is characteristic feature tuberculous meningitis.

Then comes the stage of irritation. The patient's headache intensifies, it becomes painful and is localized in the forehead and back of the head. The temperature rises sharply to 38-39 degrees. The patient becomes lethargic, lethargic and drowsy. His mind is confused. Red spots appear on the skin of the chest and face. which then quickly disappear.

At this stage, severe irritation of the receptors of the meninges occurs, which is called meningeal syndrome. Along with an intolerable headache, other specific symptoms of tuberculous meningitis occur:

1. Stiff neck. The patient has a sharp increase in the tone of the muscles of the neck, because of this it becomes difficult for him to tilt his head.
2. Kernig's symptom. The patient lies on his back. His leg is bent at the hip and knee joint... The patient cannot straighten the limb on his own due to an increase in the tone of the leg muscles.
3. Respiratory disorders. The patient breathes heavily and intermittently. He has a feeling of lack of air.
4. Fear of light and sound. The patient constantly lies with his eyes closed, does not speak much.
5. Increased production of saliva and sweat.
6. Jumps in blood pressure.

In the absence of therapy or insufficient treatment, the terminal stage of the disease sets in. Body temperature either rises to +41 degrees, or drops to +35. There is a strong tachycardia, the pulse rate reaches 200 beats per minute. The patient falls into a coma. In the late stage of the disease, death occurs due to respiratory paralysis.

Features of the disease in children

Tuberculous meningitis is more common in children than in adults. Usually babies under 5 years of age or adolescents are sick. The disease is accompanied by the same symptoms as in adults. However, children are more likely to have negative consequences of pathology, such as hydrocephalus. Sometimes the signs of the disease in the prodromal period resemble the clinical picture of acute poisoning. Severe vomiting, weight loss, high fever appear. Babies are already on initial stage there is swelling and tension of the fontanelle.

Complications

Tuberculous meningitis is dangerous because it can cause severe complications from the central nervous system. Most often, dropsy of the brain (hydrocephalus) is noted. This pathology occurs due to the adhesions in the meninges.

Approximately 30% of patients after suffering an illness remain cranial nerve paralysis and paresis of the extremities. In more rare cases, there is a sharp deterioration in vision and hearing. Some patients have epileptic seizures.

Diagnostics

It is necessary to conduct differential diagnosis tuberculous meningitis with a bacterial and viral form of inflammation of the meninges, since the signs of these pathologies are similar. However, if the disease is caused by meningococcal bacteria or viruses, then it always begins acutely. A gradual onset is characteristic only for tuberculous lesions of the meninges.

An important diagnostic test is a lumbar puncture. With tuberculous meningitis, the following pathological changes are noted in the cerebrospinal fluid:

1. Cerebrospinal fluid pressure increases.
2. There is an increased protein content.
3. The number of cellular elements is many times higher than the norm.
4. The presence of Koch's wand is detected.
5. The sugar content is lowered.

It is also necessary to establish the localization of the primary focus of mycobacteria. For this, additional methods for diagnosing tuberculous meningitis are used:

• x-ray of the lungs;
• fundus examination;
• examination of the lymph nodes, spleen and liver;
• test with tuberculin (Mantoux reaction).

To assess the neurological condition of the patient, CT and MRI of the brain are prescribed.

A phthisiatrician or neurologist makes a diagnosis based on a comprehensive examination.

Treatment methods

The intensive stage of treatment of this pathology is carried out only in a hospital setting. Patients are prescribed combined treatment with several anti-tuberculosis drugs:

• "Streptomycin".
• Isoniazid.
• "Rifampicin".
• "Pyrazinamide".
• "Ethambutol".

Assign 4-5 drugs at the same time in various combinations. This scheme is followed for the first 2-3 months. Then only two types of medicine are left: Isoniazid and Rifampicin. The general course of treatment for the disease is quite long, it takes about 12-18 months.

To prevent the development of complications, glucocorticoid hormones are prescribed: "Dexamethasone" or "Prednisolone". Also, to prevent neurological disorders, B vitamins, glutamic acid, and Papaverine are administered.

During illness, the production of antidiuretic hormone decreases in patients. This leads to cerebral edema. To relieve this symptom, angiotensin receptor antagonists are prescribed: Lorista, Diovan, Teveten, Mikardis.

The patient must be kept to bed for 30 to 60 days. Only in the third month of illness, doctors allow a person to get up and walk. The patient is periodically given spinal punctures. Based on their results, the effectiveness of the prescribed treatment is assessed.

In severe cases of hydrocephalus, surgical intervention is indicated - ventriculoperitoneal shunting. In this operation, a catheter is inserted into the ventricle of the brain and excess fluid is removed. It helps to lower intracranial pressure and reduce cerebral edema.

Forecast

The prognosis for life directly depends on the degree of pathology. If treatment is started in the early stages, then the disease is completely cured. The neglected forms of pathology end fatally in 50% of cases.

In about a third of patients, after recovery, neurological consequences remain: paresis of the limbs, paralysis of the cranial nerves. They can last for 6 months.

With timely treatment, the patient can return to his usual lifestyle after a while. Disease in childhood can negatively affect mental development.

Dispensary observation

After being discharged from the hospital, the patient needs to be registered at the anti-tuberculosis dispensary for 2 - 3 years, regularly visit the doctor and take tests. During this time, he needs to take Tubazid and Pask drugs according to a special scheme. A year after the course of therapy in the hospital, the question of the patient's further performance is being decided.

If the patient has pronounced consequences of the transferred disease, then he is recognized as disabled and in need of care. If the patient persists with moderate residual effects, then he is considered unfit for work, but without the need for care.

If the patient has fully recovered and does not have any consequences of the illness, then the person returns to his usual work. However, heavy physical labor and exposure to cold are contraindicated for him.

Prevention

Disease prevention is about preventing infection with tuberculosis. People suffering from an active form of pathology are allocated a separate living space if they live in a hostel or communal apartment. This is necessary in order to avoid infecting others.

Early detection of tuberculosis plays an important role in prevention. For this, tuberculin tests, fluorography are used. regular medical examinations. Babies need to receive BCG vaccine during the first month of life. This will help avoid a dangerous illness and complications in the future.

Shoshina Vera Nikolaevna

Therapist, education: Northern Medical University. Work experience 10 years.

Articles written

Mycobacterium tuberculosis penetrated into the meninges provokes tuberculous meningitis. Treatmentthis disease - a long and complex process, because it is based not only on a standard set of measures for meningitis, but also on anti-tuberculosis.

the disease appears abruptly, completely incapacitating a person. Let's figure out what it is and how to deal with it.

Causes of occurrenceillness

For the first time, tuberculous meningitis was diagnosed as a separate disease at the end of the 19th century. It was then that the analysis of cerebrospinal fluid showed the presence of mycobacterium tuberculosis in it. A century after this discovery, physicians came to a consensus that the main patients suffering from this disease are children and adolescents. Now this border has shifted a little, and adults have become more sick with this disease.

Tuberculous meningitis mainly affects people who have been diagnosed with:

• alcoholism, drug addiction;
• hypotrophy;
• reduced immunity.

The elderly are also at risk. But more than 90% of cases of tuberculous meningitis is a secondary disease that has developed due to the fact that a person is sick or had tuberculosis. Most often, the primary localization of the disease is diagnosed in the lungs. In cases where localization is not established, such tuberculous meningitis will be designated "isolated".

Typically, the source of tuberculous meningitis is tuberculosis, which affects the following organs:

• lungs (disseminated type);
• genitals;
• bones;
• mammary gland;
• kidneys;
• larynx.

It is extremely rare to get sick with this disease by contact. This is possible in two cases:

1. When the bacteria from the bones of the skull passes to the cerebral membrane.
2. When a patient is sick with tuberculosis of the spine, and the bacteria has entered the lining of the spinal cord.

Interesting! More than 15% of diseases of this type occur inlymphogenous infection.

The main route for these bacteria to enter the meninges is through the bloodstream. And this is due to the fact that the blood-brain barrier has increased permeability. Tissue damage occurs in the following order:

• choroid plexuses of the soft shell;
• cerebrospinal fluid, where the inflammatory process in the soft and arachnoid membrane is provoked;
• the substance of the brain.

Each step can cause changes in the vessels of the brain: from necrosis to thrombosis, and this disrupts blood circulation in the organ, leading to complications and worsening of the patient's condition. In adult patients, the inflammatory process in the membranes of the brain has focal localization with adhesions and scars, and in children it provokes hydrocephalus.

Symptomatology by course and clinical forms

The symptoms of tuberculous meningitis differ depending on the stage of the disease and what is its clinical form. When diagnosing, the sounded symptoms will be an excellent help in choosing a treatment and making an accurate diagnosis.

Symptoms during the course

Doctors divide tuberculous meningitis into 3 courses:

Premonitorywhich lasts about 7-14 days. During this period, the tuberculous form of meningitis is difficult to identify, because the symptoms are nonspecific. She is inherent in:

• strong headache;
• a sharp deterioration in well-being, increased irritability and apathy;

• nausea and vomiting due to increased headache;
• non-staggering heat.

Irritation, in which all the previous symptoms increase, the body temperature rises to 39-40 degrees. The following symptoms characteristic of meningitis also join:

• hypersensitivity to sounds, light, touch;
• drowsiness and lethargy;
• the skin becomes covered with spots of scarlet color, since vegetative vascular system malfunctions;
• the muscles of the back of the head become rigid;
• consciousness becomes confused and inhibited;
• pointing Dog Pose.

Paresis and paralysis, which is characterized not only by sensory imbalance, but also by loss of consciousness and central paralysis. And:

• disturbances in the heart and respiratory rhythm;
• convulsions;
• an increase in body temperature up to 41 degrees and above, or, conversely, a rapid drop in this indicator;
• paralysis of the centers of the brain responsible for the work of the heart and respiration, which leads to death.

Symptoms of clinical forms

Tuberculous meningitis is usually divided into 3 main clinical forms:

Basilar, which in most cases has a prodromal period lasting from 7 to 35 days with its characteristic symptoms. With the transition of the disease during the period of irritation, cephalalgia, fountain vomiting and anorexia join the existing symptoms. The patient feels tired and constantly wants to sleep. Signs of impaired brain function gradually appear:

• strabismus;
• drooping of the upper eyelid;
• hearing loss;
• decreased visual function;
• stagnation of the optic nerve;
• asymmetry of the face;
• dysphonia and dysarthria.

Meningoencephalitis, which most often occurs in the third period of the course of the disease. It is characterized by all encephalitis symptoms that remain untreated, they can be fatal:

• spastic paresis and / or paralysis;
• partial and / or complete loss of sensitivity;
• loss of consciousness;
• respiratory depression;
• tachycardia and arrhythmia;
• bedsores.

Spinal, which is rarely diagnosed. Most often, it begins with signs of damage to the cerebral membranes, which in the second or third period of the course of the disease are supplemented with girdle pains, since bacteria infect the spinal roots. In the future, the pain becomes constant and intense, and even narcotic pain medications do not relieve them. There is a failure in bowel and bladder emptying, and later flaccid paralysis is added.

Diagnostics and treatment

Tuberculous meningitis and its diagnosis is the profile of two specialists: a phthisiatrician and a neurologist. And the diagnosis begins with laboratory research cerebrospinal fluid, which is taken with the help of lumbar. Its changes are detected already at the prodrome stage. When analyzing fluid, special attention is paid to glucose levels. The worst predictions are given to those patients who have this level of low.

The following studies are also used in the diagnosis:

• microscopy;
• PCR diagnostics;
• differential diagnostics;
• chest x-ray to identify foci of inflammation;
• Ultrasound of the abdomen;
• analysis of gastric secretions;
• analysis of fluids from the bone marrow, lymph nodes, liver;
• tuberculosis test;

All this makes it possible to identify tuberculous meningitis. Treatment is prescribed specific, based on anti-tuberculosis therapy. Many healthcare providers choose to use a treatment regimen that includes Ethambutol, Isoniazid, Pyrazinamide, and Rifampicin. They are first used parenterally and later internally. Usually, improvement occurs after two months, at the same time they stop taking Ethambutol and Pyrazinamide, and the dose of Isoniazid will be significantly reduced. The rest of the drugs are used for another 9-10 months.

Along with these medications, medications are taken that will be prescribed by a neurologist. Most often, this treatment regimen is based on:

1. Dehydrants (Furosemide, Mannitol and Hydrochlorotazide).
2. Disintoxicants ( saline solutions and Dextran infusion).
3. Appointment of glutamic acid and vitamin complex.
4. Glucocorticoids, which are injected into the subarachnoid space.
5. Other remedies aimed at relieving symptoms.

For the first two months, the patient is prescribed bed rest, which is gradually reduced. By the end of the third month, light walking is permitted. Puncture and analysis of cerebrospinal fluid will show the effectiveness of treatment. After the end of the patient's treatment long time kept under medical supervision, and twice a year he undergoes a course of anti-relapse drugs.

Prognosis, complications and prevention

A few decades ago, due to the lack of drugs for tuberculosis, this disease ended in the death of the patient, which occurred in the second week after the disease. Now almost 92% of all patients are recovering. But only if the diagnosis and treatment were timely. If not, then the consequences of the disease will be sad and serious. Most often it is cerebral hydrocephalus, but not uncommon epileptic seizuresas a residual after illness.

Treatment of complications depends on themselves:

1. Occlusive hydrocephalus is treated with glucose injections, magnesium sulfate, and plasma injected into a vein.
2. Central and peripheral paralysis - massage, gymnastics, as well as Proserin and Dibazol.
3. Tuberculosis in the lungs, joints, or other localization can have extensive foci. They are removed surgically, but only after a year has passed since the meningitis is cured.
4. Treatment in specialized sanatoriums.

Preventive measures at the national level include:

• isolated rooms for such patients;
• early diagnosis measures to reduce the number of TB patients and their contact with others;
• children within a month from the moment of their birth.

Certain preventive measures for personal performance, no. Usually this is the observance of personal hygiene, correct and healthy image life. Otherwise, all other actions are entrusted to the state, and all because this disease is classified as social. And outbreaks of tuberculosis occur during periods when the standard of living in the country falls.

At such moments, the number of citizens leading an asocial lifestyle increases. This is what leads to tuberculous meningitis.

Statistics! The stronger sex is always more often and more difficult to get sick with tuberculosis, in contrast to women. The incidence rate in men is 3.5 times higher, as is the growth rate of the disease - 2.5 times. The risk group is people aged 20-29 and 30-40 years.

Life after illness

Dispensary observation is carried out for recovered patients for 2-3 years. Assessment of their working capacity is carried out no earlier than 12 months after recovery. Treatment is always inpatient. If there are residual effects after a disease of pronounced severity, then such a patient is recognized as disabled and the one who needs care and supervision.

If the residual effects are less pronounced, then disability is recognized, but the need for outside care is not. But often neither residual effects, there are no contraindications to work, so after a while the patient returns to professional activity and to his usual way of life.

Sometimes literally an hour is enough to understand that the disease has struck the body, but nothing can be done. The treatment will be long, painstaking and will take a year of a happy life. To prevent this from happening, monitor your health and take all its signals of malfunctions seriously and go to the doctor. The sooner the disease is identified, the easier it will be to cure.

Meningitis is a serious infectious disease characterized by inflammation of the lining of the brain and spinal cord. It occurs both independently and against the background of other infectious diseases.

No one is immune from meningitis, but according to the data, children under the age of 5, young people between the ages of 16 and 25, and the elderly over 55 are at risk. Meningitis is difficult most often in children and can lead to irreversible consequences, and in some cases to death. The disease affects the brain, therefore, with the wrong treatment, a person remains disabled. Most often, newborns suffer from severe consequences; in adults, meningitis is not so acute and is quickly treated.

Depending on the cause of meningitis, it can be bacterial, fungal, or viral. The most difficult form of the disease is bacterial meningitis. Purulent and serous meningitis is distinguished by the type of inflammatory process. Serous meningitis is divided into two types: primary and secondary. The primary form of meningitis occurs due to low immunity and damage to various enteroviruses. The secondary form of the disease occurs after an infectious disease: measles, mumps, chickenpox and others.

Tuberculous meningitis is caused by the tubercle bacillus. Previously, this disease was not treated and the person died. Modern medicine is able to cure tuberculous meningitis, only 15-25% of all cases are fatal. Cryptococcal meningitis is a form of fungal meningitis. The process of inflammation of the brain and spinal cord is caused by the fungus cryptococcus. Encephalitis meningitis - this type of disease begins when an encephalitis infection enters the body. It is transmitted by tick bites or by ingesting raw milk from an infected animal.

The causes of meningitis

The main cause of meningitis is viruses or bacteria that invade the soft membranes of the brain and spinal cord. In adults, the most common bacterial meningitis is caused by the bacteria streptococcus and meningococcus. If they are in the nasal cavity or throat, the disease does not develop, but in the case of infection of the blood and cerebrospinal fluid, soft tissues of the brain, they provoke meningitis.

Other types of bacteria are also distinguished among the causes of meningitis. This is group B streptococcus, which often affects newborns infected during or after childbirth. Listeria monocytogenes bacteria can cause meningitis in toddlers and the elderly. After an infectious disease, a person can get meningitis, since his immunity is weakened and cannot resist bacteria. People with and are especially susceptible to this disease. Various head injuries can cause meningitis.

Ways of transmission of meningitis

The actual question among patients is whether meningitis is transmitted by airborne droplets, like most infectious diseases. The answer to this question depends on the cause of the disease. So, if meningitis develops as a result of internal processes in the brain, it is not contagious to others and is not transmitted. In the case when the disease is provoked by the penetration of the pathogen microorganism into the brain membrane, meningitis is transmitted by airborne droplets.

It is characteristic that meningitis is transmitted from person to person, not only as is traditionally accepted when infected with infectious diseases. In addition to airborne droplets, meningitis can be infected by food or through any contact with a carrier of the disease. In this case, the methods of contracting such a disease as meningitis are varied: sneezing, coughing, kissing, using common dishes, household items, and staying in the same room with a sick person for a long time.

Prevent transmission of meningitis healthy person you can strictly adhere to the rules of prevention of infectious diseases and personal hygiene. This may include: wearing a medical mask in crowded areas during outbreaks, avoiding prolonged exposure to public places. It also necessarily includes the complete cessation of contact with the carrier of the infection during the period of his treatment.

However, if, nevertheless, infection with the disease occurred, it is important to know that self-medication will not bring relief, but will only contribute to the development of complications. In order to quickly get rid of the disease meningitis, at the very first symptoms of the disease, you must consult a doctor. With qualified diagnosis and correct treatment, it will irrevocably retreat.

Meningitis symptoms

Meningitis symptoms develop quickly and are easy to spot. The temperature rises sharply to 40 degrees, there is pain in muscles, joints, general weakness and lethargy are observed. Among characteristic symptoms Meningitis in adults is characterized by the formation of a rash, a runny nose and sore throat, like with a cold, pneumonia, disorders of the gastrointestinal tract, and disruption of the salivary glands.

One of the most prominent and common signs of meningitis is an acute headache that spreads to the entire area. The pain grows and cannot be tolerated. Then nausea and severe vomiting appear. The patient does not tolerate sound and light stimuli.

The symptoms of meningitis appear to varying degrees in all patients. As a rule, they have a strong tension in the occipital muscles. A person feels severe pain when bending the head to the chest and extending the legs at the knees. To relieve symptoms, the patient lies in a certain position. The man lies on his side, his head thrown back strongly, presses his hands to his chest, and bends his legs at the knees and presses them to his stomach.

The symptoms of meningitis in children are the same as in adults, but there may be additional signs of the disease. Among them are: diarrhea and regurgitation of food, drowsiness, apathy and weakness, constant crying and loss of appetite, swelling in the fontanel area. Meningitis develops at a rapid pace, at the first signs you can not hesitate and immediately go to the hospital. Incubation period illness is 2 to 10 days. The signs of meningitis are very similar to those of normal or. The rate of development of the disease depends on the level of the child's immunity: the lower it is, the faster it affects the body.

One day after the first symptoms appear, the person's condition becomes critical. The patient may be delusional, there is apathy and drowsiness, irritability. Edema of the tissues of the meninges begins, which makes it difficult for blood to flow to organs and tissues, as in a stroke. With untimely assistance, a person falls into a coma and dies quickly.

Aseptic meningitis

Aseptic meningitis is an inflammation of the membranes of the brain and spinal cord, provoked in the human body, most often by a viral pathogen. This disease can develop in patients of all ages.

Usually, a disease such as aseptic meningitis is diagnosed and treated fairly quickly. However, for the timely diagnosis of the disease, it is necessary to know and understand the causes of the disease and the signs of its manifestation. This is what will be discussed in this article.

The reasons for the development of the disease

The main cause of aseptic meningitis in the human body is the pathogen microorganism. In this case, a virus (enterovirus) acts as the causative agent of the disease.

The penetration of the virus into the human body is carried out, by the traditional, airborne or food route, upon contact with the carrier. Then, penetrating through the tissues of the organs of the gastrointestinal tract or upper respiratory tract and palatine tonsils into the bloodstream, enteroviruses are carried throughout the body. With a weakened protective reaction of the body, pathogens transported by the circulatory system penetrate the membranes of the brain or spinal cord and provoke the development of the disease.

As mentioned above, enteroviruses are the cause of the development of the disease in most cases. As for the causes that, in addition to viral microorganisms, lead to aseptic meningitis, then, by the nature of their origin, they can be divided into two categories, infectious and non-infectious.

As for the non-infectious causes of the disease, they include previously suffered injuries or diseases, as a result of which aseptic meningitis may develop. These include: infectious diseases, inflammation, tumors, concussions and trauma, exposure to chemotherapy.

A feature of the aseptic type of disease is, in particular, that the bacteria and viruses that provoked the disease are extremely difficult to detect by conventional methods. This presents some difficulty, but it is not an insurmountable task. On the contrary, it narrows the circle possible diseases to make a diagnosis.

Signs of aseptic meningitis

Symptoms of a disease such as aseptic meningitis appear quite clearly and are the first persistent signal that you need to see a doctor immediately. It is extremely important to remember that such a dangerous and fraught disease must be treated in the early stages. And for this you need to respond in a timely manner to the symptoms manifested by the disease.

First of all, you should pay attention to general indicators health conditions. Usually, they are subject to the following changes:

• significant and rapid rise in temperature;
• a state of fever, chills;
• throbbing headache.

More specific signs characteristic of other types of meningitis, with aseptic form, appear rather weak and develop at a slow pace. But, nevertheless, their presence can be traced.

The main symptom of the development of any form of meningitis is the meningeal syndrome. It manifests itself if the patient, laid on his back, cannot tilt his head to the chest without bending the knees. Moreover, the bending of the legs occurs uncontrollably.

The danger of this type of disease lies precisely in the fact that the specific signs of meningitis appear 4-5 days after the onset of the disease, which can lead to serious consequences. Therefore, in the presence of high fever, mild meningeal syndrome, headache and fever, one should not wait for further symptomatic confirmation.

Bacterial meningitis

Bacterial meningitis is an infectious disease that manifests itself in inflammation of the tissues of the spinal cord and brain, and is provoked in the body by bacteria of the streptococcal group. The prevalence of this disease is quite insignificant, but the disease can easily be transmitted from person to person and cause epidemics among the population.

This type of disease has its own characteristics of occurrence (causes), symptoms of manifestation and methods of treatment, which are different from other forms of meningitis. This is what will be discussed in this article.

In addition to the genetic predisposition of some peoples to the development of meningitis, there are also reasons why this disease can affect the body of every patient. These include the state of health and age of the patient, as well as external pathogens.

Bacterial meningitis, like any other form of this disease, is provoked in the human body when a pathogen microorganism enters it. In the case of the form of the disease discussed in this article, the role of such a pathogen is played by harmful bacteria of the streptococcal group.

Bacterial meningitis is transmitted, like any infectious disease, by the traditional, airborne or food route. This happens, as a standard, upon contact with the carrier of the infection through a handshake, kiss, sneeze or common dishes and household items, which by itself suggests the need for strict adherence to the rules of personal hygiene.

The process of infection and development of the disease does not end with the penetration of streptococcus bacteria into the body. Moreover, after the transmission of infection has taken place, there are two options for the development of events: meningitis and its absence.

The fact is that for the development of the disease, appropriate conditions are needed. In the case of meningitis, these are: a weakened immune system and a throughput reaction of the body. Only with such additional factors do harmful bacteria-causative agents of the disease penetrate into the blood and are transported to the brain. Therefore, in the presence of chronic diseases, bad habits or a course of therapy that negatively affects immunity, the chance of getting meningitis increases significantly. This also explains the high incidence of disease in younger patients.

Amebic (encephalitis) meningitis

Amebic or encephalitis meningitis is a dangerous inflammation of the membranes of the brain, which is provoked by small free-living amoebas, quite often for a long period of time, living in the human body.

This disease usually affects younger patients, putting children, adolescents and adults under 30 years of age at risk. Encephalitis meningitis has different causes of development, symptoms and signs of manifestation, as well as methods of treatment and consequences from other forms of the disease. A detailed discussion of each of these factors will be provided in this article.

With a weakened protective reaction of the body, harmful microorganisms easily penetrate the bloodstream, and then, transported through the circulatory system, reach the central nervous system, namely, the lining of the brain. After this, amoebic meningitis begins to develop and the first signs of the disease appear.

Purulent meningitis

Purulent meningitis is an infectious inflammation of the membranes of the brain, accompanied by the formation and release of purulent masses. This disease can occur in patients belonging to any age group. Often, purulent meningitis occurs in children.

In order to understand how to deal with this disease, you need to know and be able to identify its symptoms. The described form of the disease has its own characteristics of manifestation, causes of development and methods of treatment. It is about them that will be discussed in this article.

The causes of a disease such as purulent meningitis consist in the penetration of pathogenic microorganisms to the membranes of the brain. The causative agents in this situation are usually harmful bacteria. These include streptococci, pneumococci, staphylococci, Pseudomonas aeruginosa and other pathogenic microorganisms. Most often, it is staphylococci that take part in the development of the disease, which is why this meningitis is often called staphylococcal.

As for how purulent meningitis is transmitted, there are several stages. The penetration of the microorganism-causative agent of the disease into the human body, most often, occurs by the traditional airborne droplets or food.

Infection can occur through any contact with the carrier of the infection. Coughing or sneezing, shaking hands, or using common household items are enough to transmit harmful bacteria.

Then, penetrating the tissues of the upper respiratory tract or stomach, harmful bacteria enter the bloodstream. And the causative agent of meningitis reaches the meningitis membranes by the hematogenous route, transported by the circulatory system. Then, after getting into the tissues of the membranes of the brain, the development of the disease begins.

A special characteristic of this disease is that its development, and the very penetration of bacteria into the blood, is possible only with weakened immunity. Then the disease progresses quickly and without hindrance. This fact also explains that the disease so often affects the child's body, whose immunity is not yet fully developed.

Tuberculous meningitis

Tuberculous meningitis is an inflammation of the meninges that occurs as a secondary disease after tuberculosis. This form of the disease is quite rare and, in most cases, in people who are sick or have had tuberculosis.

The cause of such a disease as tuberculous meningitis is the spread of harmful pathogens from the focus of inflammation in the respiratory organs to the brain. As mentioned above, most often, this type of disease is secondary, against the background of the development of tuberculosis. The main causative agent of both diseases is acid-fast bacteria, or, in other words, tuberculosis bacteria.

Tuberculous meningitis is transmitted, like tuberculosis itself, by airborne droplets or food through contact with a carrier of the infection. In the case of the spread of this disease, people, animals and even birds can be a carrier of dangerous microbacteria of tuberculosis.

It is also characteristic that when harmful microorganisms enter the body of a healthy person, whose immune system is working well, tuberculosis bacteria are almost always destroyed. Therefore, as conditions necessary for the full development of the disease, a weakened immunity, a low rate of the body's defense reaction is meant. It is a poorly developed immune system that causes tuberculous meningitis to manifest itself in children.

First of all, when it enters the respiratory system, the disease is localized in them. Then, penetrating into the blood, tuberculosis microbacteria are transported by the circulatory system to the meninges. It is from this moment that the development of a secondary disease called tuberculous meningitis begins.

Viral meningitis

Viral meningitis is an inflammation of the membranes of the brain and spinal cord, which is triggered by the ingestion of a virus that causes the disease into the human body. This disease can affect quite extensive, in terms of age categories, groups of patients, and it is quite dangerous. The most common viral meningitis occurs in children.

This disease is one of the most well-curable forms of meningitis, but it also has its own risks. In order to clearly understand all the features and deterioration of this ailment, you need to know the features of its manifestation, the reasons for its development, as well as the features of the course and treatment.

The main cause of this disease, as mentioned above, is a virus that causes a disease in a child's body. The penetration of this provocateur into the child's body, as with any other infectious disease, occurs by airborne droplets or food through contact with the carrier of the infection.

A feature of the further development of the disease is that with normal functioning of the immune system, this virus may not provoke serious malfunctions, and even be destroyed. This is why viral meningitis so often affects children. The immunity of the child's body is not fully developed and cannot cope with the virus of this disease.

Due to these conditions, the causative agent of meningitis enters the bloodstream and, through the blood vessels, reaches the central nervous system. After reaching the brain, the virus contributes to the development of inflammation of its membranes.

Serous meningitis

Serous meningitis is an infectious disease characterized by the manifestation of a serous inflammatory process in the tissues of the lining of the brain and spinal cord. Children of preschool and school age are most susceptible to this disease, which is why the question of how serous meningitis manifests itself in children is relevant for all parents.

This disease is dangerous and extremely quickly transmitted from person to person. Therefore, every adult needs to know and understand what can provoke meningitis, what are the symptoms of its manifestation and features of its course, as well as methods of treatment.

The cause of serous meningitis is the penetration into the human body of the pathogen microorganism. Such microorganisms can be viruses, bacteria or fungus. However, due to the fact that in more than 80% of cases, it is viruses that provoke the disease, it is often called, especially when manifested in children, as serous-viral meningitis.

Most often, this disease occurs due to the entry of enteroviruses into the body. This also explains the fact that serous meningitis often occurs as a secondary disease as one of the viral diseases (measles, syphilis, AIDS, etc.).

It has been established that the entry of enterovirus into the child's body can occur in two main ways: airborne and waterborne. Airborne transmission of infection from a carrier to a healthy person is the traditional route for diseases of this kind. With any contact with a sick person (no matter with a child or an adult), the virus of the disease enters the child's body: hugs, coughs, sneezes, kissing, common dishes, household items (toys).

As for the waterway of transmission of the disease, in this case we are talking about the high content of harmful microorganisms in water bodies in summer. This explains the periodic epidemics of diseases during the warm season.

Getting into a child's body with a still weak immune system, the virus of the disease freely penetrates through the skin and mucous membranes into the blood. Then, transported by blood circulation, the causative agent of the disease reaches the lining of the brain. And after that, the development of serous meningitis begins.

Infectious meningitis

Infectious meningitis is a dangerous inflammatory disease that affects the tissues of the spinal cord and brain. As a primary infectious disease, meningitis is provoked by various microorganisms, which explains the diversity in the course of the disease, the expression of symptoms and treatment.

This type of disease can be easily transmitted from person to person and can affect patients. different ages and both sexes equally. Infectious meningitis has its own characteristics of occurrence (causes), symptoms of manifestation and methods of treatment, different from other forms of meningitis. This is what will be discussed in this article.

The main reason why a disease such as infectious meningitis develops in the human body is the penetration of the pathogen microorganism into it. Moreover, the role of such a pathogen, in this case, can be played by harmful viruses, bacteria or even a fungus.

Infectious meningitis is transmitted, like any disease of this type, by the traditional, airborne or food route. This happens, as a standard, upon contact with the carrier of the infection through a handshake, kiss, sneeze or common dishes and household items, which by itself suggests the need for strict adherence to the rules of personal hygiene. In this regard, the ways of transmission of an infection of a disease called meningitis to another person are not much different from other diseases.

The peculiarity of the development of the disease is that the infection process is not limited to one fact of the penetration of pathogenic microorganisms into the body. Moreover, with normal functioning of the body's defense system, meningitis may not occur.

Cryptococcal meningitis

Cryptococcal meningitis (cryptococcosis) is an inflammatory disease that affects the lining of the brain and has a fungal nature. This disease has no age limits in the defeat of patients, therefore, it is equally dangerous for all age groups of patients.

For timely diagnosis and treatment, as well as in order to prevent the development of the disease, it is worth knowing and understanding what the causes, symptoms and characteristics of the disease are. A description of all the described parameters can be found in this article.

As mentioned above, cryptococcal meningitis is fungal in nature. And, therefore, as in other infectious diseases, the cause of this disease in the patient's body is the pathogen microorganism. In this case, the fungus.

The penetration of the pathogen microorganism into the tissue of the lining of the brain occurs in a standard way for this disease. The fungus enters the surface of the tonsils and upper respiratory tract by airborne droplets or food. Then, under the condition of reduced work of the body's defense systems, the pathogen enters the bloodstream and, thanks to the well-oiled work of the circulatory system, moves into the brain tissue.

A distinctive feature of the occurrence of cryptococcosis is that, as an independent disease, it is extremely rare. All diseases of the nervous system of the body, which have a fungal nature of development, usually develop in people who have already had diseases that weakened their immunity, including those with hemoblastosis, diabetes mellitus, AIDS, malignant tumors... A disease such as cryptococcosis is a fairly common case after long-term therapy with antibacterial, corticosteroid, immunosuppressive drugs.

Symptoms of the development of the disease

Symptoms of a disease such as cryptococcosis are extremely difficult to identify. This is due to the parallel or subsequent development of meningitis after another disease. Therefore, in order to track an additionally developing ailment, during the course of the underlying disease, it is periodically recommended to carry out diagnostics for inflammation of the meninges of the brain.

Symptoms of a disease such as cryptococcal meningitis can be roughly divided into two categories: general infectious and specific meningeal. At the same time, signs common to all infectious diseases can be easily lost against the background of the main ailment, which cannot be said about specific ones.

Generally infectious signs of this type of meningitis are usually chronic. These include:

• an increase in temperature by several marks (up to 37.8-38? С);
• a state of fever.

Against the background of constantly elevated, albeit slightly, body temperature, diseases of the respiratory tract, ears, and oral cavity may develop. Therefore, a prolonged change in body temperature should serve as a signal that meningitis is developing in the body. In combination with the specific signs of the disease, you can get a good reason for a preliminary diagnosis.

As for the specific symptoms of the disease, they include the signs common to brain damage. Their list includes:

• intense throbbing headache;
• dizziness;
• nausea and vomiting not associated with meals;
• photophobia and fear of sound;
• soreness of the neck muscles;

The main symptom indicating the development of meningitis in the patient's body is meningeal syndrome. Its manifestation is that the patient's legs will involuntarily bend at the knees if, when taking a horizontal position, tilt his head to chest.

Meningitis in infants

In newborns, this disease is rare. The incidence of meningitis in infants ranges from 0.02% to 0.2%, depending on the weight of the newborn and his state of health.

It is extremely important for the parents of the baby to know the causes of the disease, to be able to recognize its symptoms and to understand the features of treatment, in order to know how to behave when the baby develops meningitis. All of the above issues will be described in this article.

Symptoms of meningitis in newborns

There are a number of signs of the development of the disease that can occur in both infants and adults. However, due to the fact that a newborn child cannot show or tell that he is in pain, in this case, it is worth paying attention to a wider range of factors. So, the symptoms of a disease such as meningitis in infants will manifest as follows:

• significant temperature rise;
• a state of fever, chills;
• convulsions and twitching;
• increase and pulsation of the fontanelle;
• diarrhea;
• nausea and profuse vomiting;
• decreased or complete lack of appetite;
• a state of general weakness of the body.

Signs of meningitis in infants are also reflected in the behavior of the child. A newborn baby, due to a severe headache, due to inflammation, is very agitated, restless, the state of irritation is replaced by drowsiness. An experienced parent will be able to notice that the complex of the above signs of the disease can be inherent in any ailment of an infectious nature. That is why there are specific signs of the disease for an accurate diagnosis of the disease.

Meningeal syndrome

Meningeal syndrome is the main specific symptom that determines the presence of an inflammatory disease meningitis in the meninges. The peculiarity of its manifestation lies in the fact that if you try to tilt the patient's head to the chest while he is in a horizontal position, his legs will bend uncontrollably at the knees. This test works well for both children and adults.

Lesage symptoms

Due to the fact that in newborn children, the symptoms of a disease such as meningitis are very weak, an examination of the fontanelle (non-fused bones of the skull) is carried out to confirm the suspicions. When meningitis occurs, the area becomes inflamed and throbbing.

The Lesage symptom is also called the Pointing Dog Pose. Its essence lies in the fact that when the baby is held by the armpit area, he involuntarily pulls his legs to his stomach and throws his head back.

Causes of occurrence

Infection of a newborn child usually occurs in a way that has become traditional for this type of disease. We are talking about the transmission of pathogens by airborne droplets from a carrier of infection, which can be adults or the same small children.

Meningitis treatment

It is fairly easy to diagnose meningitis, but a doctor must confirm the diagnosis. Since the disease develops rapidly, one cannot hesitate a minute. Treatment of meningitis is carried out only under the supervision of doctors in the hospital, it cannot be treated at home. To confirm the disease, as well as to determine the pathogen, the patient undergoes a spinal puncture. With timely access to a doctor, meningitis is well treated and does not cause complications. Methods for treating meningitis include several drugs and vaccines to eliminate the pathogen:

• The main treatment for meningitis is antibiotic therapy. At the first symptoms of the disease, broad-spectrum antibiotics from the group of penicillins, cephalosporins and macrolides are immediately used. Broad-spectrum drugs are prescribed to immediately eliminate the pathogen. The results of the analysis of cerebrospinal fluid will not be ready immediately, and it is almost impossible to determine the causative agent of meningitis in a blood test. Antibiotics are administered to the patient intravenously, and in severe forms of the disease, drugs can be injected into the spinal canal. The duration of the course of antibacterial treatment is determined by the doctor, but the patient will receive medications for at least a week after his normal temperature stabilizes.
• Diuretic drugs can be used to treat meningitis. When using diuretics, fluid is simultaneously injected into the patient's body. Diuretics contribute to a strong leaching of calcium from the body, so a vitamin complex is prescribed to the patient.
• For meningitis, detoxification therapy is used. It is necessary to reduce the symptoms of intoxication. The patient is injected intravenously with saline, glucose solution and other drugs.

The duration of treatment for meningitis is different and depends on the degree of development of the disease, the patient's condition. In children, this disease can give various complications, in adults it is quickly treated without consequences. After the completion of therapy in the hospital, it is necessary to continue treatment at home, to strengthen the immune system. The patient can recover health within one year, so it is not always possible to return to work or school.

Prevention of meningitis

Prevention of meningitis primarily includes mandatory vaccination. Vaccination will help prevent the development of many diseases that lead to meningitis. Vaccination should be given to children at an early age. Vaccines against bacterial and viral meningitis include vaccinations against Haemophilus influenzae type B, infections that cause pneumonia and other diseases. Vaccination should be given to a child aged 2 months to 5 years, as well as children over 5 years old who suffer from serious diseases. Before the vaccine was invented, bacteria were thought to be the most common cause of bacterial meningitis, but vaccination has been able to defeat it.

Meningococcal vaccine is able to protect against the major bacteria that cause meningitis. It must be done by a child aged 11-12 years. This type of vaccination should be given to students living in dormitories, recruits, patients with immune deficiencies, as well as tourists and workers traveling to countries where an epidemic of meningitis may break out, for example, countries in Africa. It is necessary to carry out compulsory vaccination against other infectious diseases:, and others.

Other measures to prevent meningitis include maintaining personal hygiene and cleanliness:

• exclusion of contact with people with meningitis;
• after contact with an infected person, it is necessary to receive a preventive course of medication;
• wear a disposable medical mask during epidemics of influenza and other infectious diseases;
• wash hands before eating, after transport and public places, use antibacterial agents;
• do not drink raw water, process vegetables and fruits with boiling water, boil milk;
• exclude swimming in stagnant bodies of water;
• strengthen the child's immunity from an early age.

Consequences of the disease

Meningitis is dangerous because its untimely or incorrect treatment can lead to serious complications that will remind of themselves for many years. Moreover, it does not matter at all at what age this disease was transferred. The consequences after meningitis are manifested in both adults and children.

In older patients, the list describing complications after meningitis includes: regular headaches, hearing loss, significant visual impairment, epileptic seizures, and many other impairments in the body that can pursue a patient from several months to several years.

As for the consequences of meningitis for children, then, in this case, the situation is even more dangerous. If a disease occurs in the first years of a child's life, the probability of death is very high. If the disease was defeated, then it can cause mental retardation, disruption of the basic functions of the brain and the entire nervous system of the child's body.

Moreover, the threat of a fatal outcome of the disease exists not only for children. As an answer to the question of whether you can die from meningitis, let's talk about one of its most serious complications. We are talking about .

This complication is more common in younger patients, but often in adults. With the onset of this complication of an infectious disease meningitis, the patient's indicators begin to change sharply blood pressure and palpitations, shortness of breath increases and pulmonary edema develops. The result of this process is paralysis of the respiratory tract. What are the consequences after such a complication of meningitis, it is not difficult to guess - the death of the patient.

Another complication called infectious toxic shock leads to the same consequences. Without going to the doctors at the first manifestations of the disease, it is impossible to cope with the complications of the disease.

If we talk about the general list, the consequences of meningitis affect the health of men, women and children. This indicates the urgent need for correct treatment and correct rehabilitation after illness.

The most common consequences of meningitis include: disruption of the nervous system, mental disorders, epilepsy, dropsy (excessive accumulation of fluid in the brain), hormonal dysfunctions, and others. This disease, even during treatment, can have a negative effect on the body. With the introduction of drugs, blood pressure is significantly reduced, the work of the urinary system worsens, calcium is washed out of the bones.

It is important to know and always remember that timely diagnosis and correct treatment can save not only the patient's health, but also his life. Therefore, in order to avoid the consequences that pose a real threat to life, at the first symptoms of the disease, you need to consult a doctor.