Purulent meningitis: the first signs, diagnosis and treatment

Purulent meningitis is a disease of an infectious nature that develops as a result of the penetration of the bacterial flora through the blood-brain barrier with the damage to the membranes of the brain. On average, 4 cases per 100 thousand people per year are recorded. It is one of the most severe inflammatory diseases of the central nervous system.

It is very important not to miss the first signs of the disease, timely diagnosis for the appointment of timely treatment and a more favorable prognosis. About purulent meningitis, read this article.

Classification of purulent meningitis

The main sign of purulent meningitis is the presence of purulent exudate with predominance of neutrophilic pleocytosis.

Purulent meningitis is divided into two large groups:

• primary (are an independent nosology. A typical example is meningococcal meningitis);
• secondary (are a complication of other diseases. For example, with otitis, sinusitis).

The following meningitis is distinguished by localization:

• generalized (convectional meningitis with meningococcal infection, when the whole convex surface of the brain is affected);
• limited (basal meningitis with lesion of the base of the brain in tuberculous meningitis).

There are several variants of the clinical course of this nosology:

• lightning fast;
• sharp;
• subacute;
• chronic.

The severity of the course of this disease can be represented in the following form:

• easy flow;
• moderate severity;
• heavy current;
• extremely severe course of meningitis.

Clinic of purulent meningitis

Depending on the pathogen caused by inflammation in the brain, the clinic has its own characteristics. In general, the whole group of bacterial meningitis is characterized by a rapid onset with a rapid increase in symptoms. Summarized, the following alarming signs can be singled out:

• an intense headache, which is often accompanied by vomiting that does not bring relief. In addition, the headache is potentiated by bright light, noise, and touch;
• severe hyperesthesia;
• presence of a meningeal symptom (rigidity of the occipital muscles, positive symptoms of Kernig, Brudzinsky);
• frequent vomiting, which does not bring relief, and absence of stool disorder;
• high body temperature (more than 39 degrees), which does not decrease after taking antipyretics;
• presence of convulsions or convulsive activity;
• impairment of consciousness (from stunning to deep coma) or inadequate behavior of a patient with psychomotor agitation;
• presence of severe intoxication syndrome: general weakness, myalgia (muscle pains), arthralgia (joint pain), refusal to eat, ringing in the ears, dizziness;
• Skin rash of hemorrhagic nature (typical of meningococcal infection).

In epidemiological terms, primary purulent meningitis is caused mainly by meningococcal, pneumococcal and hemophilic rod.

Meningococcal meningitis.Characterized by an acute onset, the symptoms of nasopharyngitis are rarely possible. The temperature of the body rises sharply to the febrile figures, chills, hyperesthesia, an intense headache accompanied by nausea and vomiting. A day later, meningeal syndrome builds up, stiff neck muscles appear. The patient's condition progressively worsens - psychomotor agitation with hallucinations can be replaced by stun and sopor. Possible damage to the cranial nerves (often visual and auditory with a subsequent complication in the form of deafness and blindness). A clear symptom of meningococcal infection is the presence of a characteristic patchy-populous hemorrhagic rash, which in severe cases leads to necrosis of the skin. A specific complication of meningococcal infection is the Waterhouse-Frideriksen syndrome (hemorrhage in the adrenal cortex), the lethality at which is 100%.

Pneumococcal meningitis.Most often, children and adults are over 40 years old. Sources of infection are unsanitary foci: otitis, sinusitis, mastoiditis, craniocerebral trauma. Pneumococcal meningitis can proceed as a primary bacterial meningitis, its clinical picture is very similar to meningococcal. Characterized by the same severe course and high lethality and complications in the absence of timely adequate treatment.

Pneumococcal secondary meningitis begins subacute, proceeds less severely, but is characterized by a more protracted course and frequent relapse, since therapy is usually prescribed late. Perhaps the appearance of a rash, as with meningococcal infection, septic flow. The lethal outcome often occurs on the 8-10th day due to late diagnosis and etiotropic treatment.

Meningitis caused by a hemophilic rod.Most often newborns and children under 5 years old. The disease develops in the presence of foci of chronic infection: pneumonia, otitis, rhinitis, sinusitis. The onset of the disease is gradual, leaking and wavy. Periods of imaginary improvement may occur even in the absence of treatment. This disease is characterized by cerebral hypotension, and cerebrospinal fluid can be obtained only with a syringe. With the development of cerebral hypotension, the disease is very difficult due to the development of excoxicosis.

Staphylococcal meningitis.Is a secondary meningitis against the background of abscesses, pneumonia, osteomyelitis of the skull bones, with sepsis. It flows hard, it is difficult to treat because of the resistance of staphylococcus to antibiotics. A characteristic feature is the tendency to abscessing. Mortality is very high.

Isolated meningeal syndrome does not always indicate the presence of meningitis. Meningeal symptoms can be observed in any other infectious diseases, intoxications, brain tumors, but the cerebrospinal fluid is not inflammatory at the same time. This phenomenon is called meningism and is associated with increased intracranial pressure.

Diagnosis of purulent meningitis

For the diagnosis of purulent meningitis, it is important to collect an epidemiological anamnesis: the transferred diseases, the presence of foci of chronic infection, trauma, contact with sick people.

One of the most important studies is the analysis of cerebrospinal fluid. With purulent meningitis, it will be cloudy, whitish or yellow, and sometimes greenish, which characterizes a particular pathogen. Cytosis is rapidly growing - up to 1000 or more cells due to neutrophils, the amount of protein increases, and the reactions of Pandi and Nonne Apelta become positive.

In addition to the analysis of cerebrospinal fluid, the following examination is necessary:

• a clinical blood test (it will determine leukocytosis with a shift of the formula to the left, perhaps even to young forms. With the development of a septic condition, it is necessary to make a blood test for sterility);
• urinalysis clinical;
• CT, MRI study;
• radiography of paranasal sinuses, lungs, skull;
• consultation of a neurologist, infectious diseases specialist, if necessary, a neurosurgeon.

Treatment of purulent meningitis

The success of treatment and recovery depends on the timeliness of adequate therapy. Such patients are necessarily treated, depending on the degree of severity, either in the infectious inpatient department or in the intensive care unit. The specific patient is prescribed appropriate therapy, but the following principles of therapy can be generalized:

• antibiotic therapy (with the possibility of express diagnostics of the pathogen, etiotropic antibacterial therapy is prescribed. If there is no way to verify the pathogen, antibiotics are first empirically administered, followed by their rotation);
• anti-edema therapy aimed at eliminating brain edema;
• correction of respiratory function, cardiovascular system, water-salt metabolism;
• anticonvulsant therapy;
• Neuroprotection.

With timely treatment, the prognosis for recovery is favorable.

Ural State Medical University, educational film "Meningococcal meningitis":