Encephalitic meningitis is a viral, fungal or bacterial disease that manifests itself as inflammation of the membranes of the brain and spinal cord. It can be fatal if not promptly diagnosed and treated.
History
There is an opinion that at the time of Hippocrates and Avicenna they knew about the existence of this disease. Could they heal her? Rather no than yes, because even in the modern world it is not always possible to identify the problem in time and respond to it. The first documented case was recorded in Scotland in 1768, but then the connection with the pathogen was not clearly visible. The epidemic was talked about at the beginning of the nineteenth century in Geneva, and although it was managed to be de alt with, it was not the last. Throughout the past and the century before last, encephalitis meningitis appeared in Africa, Europe and the USA.
Until the end of the twentieth century, the death rate from meningitis reached almost one hundred percent, but after penicillin was successfully used against this disease in 1944, the number of lives saved began to increase. Vaccines against common diseases have also helpedbacterial pathogens, as well as the invention of glucocorticoid drugs.
Reasons
By etiology, this disease can be divided into three categories:
- infectious (provoked by a specific pathogen);
- infectious-allergic (autoimmune damage to the membranes of the brain in response to infection, vaccination or rheumatic disease); - toxic (exposure to irritating substances, causing inflammation).
There are also primary and secondary encephalitic meningitis. As you might guess, the disease is called primary when the focus of infection is located directly in the brain. This occurs with internal injuries (bruise, hematoma), viral or infectious diseases. A secondary disease appears as a complication, such as otitis media, sinusitis, tuberculosis or syphilis.
Epidemiology
Previously, due to overcrowding, poor sanitation and poor nutrition, encephalitis meningitis occurred mainly in children under five years of age. But now such cases are rare due to the development of medicine and the improvement of living conditions.
Most often get sick in late winter - early spring. At this time, vitamin deficiency and a decrease in immunity, as well as sudden changes in temperature and humidity, are clearly manifested. The constant stay in closed, poorly ventilated rooms also contributes.
Encephalitic meningitis is ubiquitous, but most common in Africa. In Russia, the firstan outbreak of this disease occurred before the outbreak of World War II, the second - in the eighties of the last century, and the last - in 1997.
Pathogen
The most common meningococcal and pneumococcal encephalitis meningitis. Streptococcus pneumoniae has more than eighty antigenic varieties. The body itself is motionless, prefers aerobic space, but in critical situations it can temporarily do without oxygen. The shape of the bacterium is oval, less than a micrometer in diameter, it is immobile, has no spores. It develops well on blood media at human body temperature. Pneumococcal encephalitis meningitis is transmitted by airborne droplets from a sick or convalescent person. The microorganism is quite resistant to the effects of drugs, including antibiotics.
Pathogenesis
The disease begins with the fact that the pathogen enters the upper respiratory tract and is fixed on the mucous membrane of the nasopharynx or oropharynx. The virulence factors that pneumococcus has (capsule, teichoic acid, substance C) stimulate the production of prostaglandins, activate the complement system and neutrophilic leukocytes. All of these together do not cause encephalitis meningitis. The reasons for its appearance are deeper. Where the pathogen has colonized the mucosa, inflammation develops in the form of otitis media, sinusitis, frontal sinusitis or tonsillitis. Bacteria multiply, their toxins depress the body's immune system, and with the blood flow theyspread throughout the body, affecting the heart, joints, and, among other things, the membranes of the brain.
Clinic
In the clinic, there are three forms that encephalitic meningitis takes:
- acute, accompanied by adrenal insufficiency and often fatal;
- protracted, when symptoms increase gradually;- recurrent, with small light intervals.
The acute form is characterized by a sudden onset against the background of complete well-being with a sharp rise in temperature to pyretic numbers (39-40 degrees). There are pallor, sweating, cyanosis, possible loss of consciousness and convulsions, as well as paresis of the facial muscles. In infants and infants, anxiety is manifested by a monotonous incessant cry. From an increase in intracranial pressure, a divergence of the sutures of the skull is possible, as well as a bulging of the fontanel. On the second day of illness, characteristic meningeal symptoms appear, such as stiff neck muscles. After three to four days, the patient falls into a coma, and progressive edema (due to the inflammatory reaction) leads to herniation of the medulla oblongata.
Meningeal symptoms
These are signs characteristic of inflammation of the meninges. They appear in the first hours after the onset of the disease and help to make an accurate diagnosis.
- Position of a pointing dog (head thrown back, limbs brought to the body).
- Rigidity of the muscles of the neck and neck (passively bend the headthe patient's doctor fails because of the increased tone of the extensor muscles).
- Kernig's symptom (the doctor bends the patient's leg at the hip and knee joint, but encounters resistance when trying to straighten it).
- Upper Brudzinski's symptom (when the head is bent, the legs are pulled towards the body).
- Mean Brudzinski's sign (leg flexion with suprapubic pressure).
- Lower Brudzinski's sign (When one leg is passively flexed, the other is also brought to the abdomen).
- Lessage's symptom (the baby is lifted, supporting the armpits, while his legs are pressed against the body).
- Mondonesi's symptom (painful pressure on the eyeballs).
- Bekhterev's symptom (pain during tapping on the zygomatic arch).
- Increased sensitivity to stimuli, light and sound fear.
In children
It is difficult for an adult to endure such a disease as encephalitic meningitis. The consequences in children can be even more tragic, as they rarely complain of ailments, do not notice insect bites and have reduced immunity. Boys get sick more often than girls, and the disease is more severe.
To protect your child, you need to dress him warmer in the spring-autumn period, consult a doctor in time at the slightest sign of illness, and examine him outside every couple of hours in the summer for tick bites and other blood-sucking insects.
Diagnosis
For the doctor firstit is important to confirm the diagnosis of encephalitic meningitis. Is he contagious? Undoubtedly. Therefore, the patient must be placed in a separate box or in the infectious diseases department, after conducting a preliminary epidemiological survey. Then it is necessary to collect an anamnesis of life and he alth, to find out complaints. The physical examination consists of checking for meningeal signs and taking temperature. For laboratory tests, blood and cerebrospinal fluid are taken.
In the general blood test, there is an increase in the level of leukocytes with a predominance of young forms, the absence of eosinophils and a sharply increased ESR up to sixty millimeters per hour. Liquor will be cloudy, opalescent, with a greenish tint. It is dominated by neutrophils and protein, and the amount of glucose is reduced. To determine the pathogen, blood, sputum or cerebrospinal fluid is sown on a nutrient medium.
Treatment
If an ambulance or emergency room doctor suspects encephalitis meningitis, the patient is immediately hospitalized in a neurological hospital. Treatment begins immediately, without waiting for laboratory confirmation of the diagnosis. Strict bed rest, high-calorie diet is observed.
Start with symptomatic and pathogenetic therapy. First of all, you need to cleanse the body of toxins that bacteria produce, as well as reduce intracranial pressure and thin the blood. For this, the patient is intravenously injected with saline with glucose and diuretics. Because excessive flooding of the body can lead to herniation of the medulla oblongata and instant death. In addition, drugs to improvemicrocirculation, vasodilators and nootropics support brain activity.
Etiological therapy consists of antibiotic therapy (benzylpenicillins, fluoroquinolones, cephalosporins).
Exodus
Everything depends largely on how quickly and successfully began to treat encephalitis meningitis. The consequences can be minor if help is provided in a timely manner. And at the same time, with a severe and rapid course of the disease, mortality reaches eighty percent. There may be several reasons for this:
- cerebral edema and herniation;
- cardiopulmonary failure;
- sepsis;- DIC.
Prevention
Meningitis encephalitis is preventable by vaccinating children between two and five years of age among those at risk. It is also recommended for people over sixty-five years of age. This vaccine is included in the official WHO vaccination schedule and is used in most countries of the world.
At the moment, in third world countries, the public is still afraid of the diagnosis of encephalitis meningitis. Can we heal it? Yes, definitely. But success depends on how quickly help is provided and how.
