Signs of meningitis in children

Many people have heard about the terrible word "meningitis", periodically they meet in the mass media plots of cases of incidence of meningitis, and very often referred to meningitis with a fatal outcome. Such "horror stories" are really not groundless: the mortality rate of children under one year in Russia from this disease is 15%.

Meningitis is a common neuroinfectious disease in children, which is characterized by inflammation of the brain envelopes. The incidence in children is ten times higher than in adults, and 80% of cases are children from three months to three years old. I would like to note one more important feature: outbreaks of this disease occur every 10 years, so the parents' suspicion in this matter is especially urgent.

Classification of meningitis in children

Depending on the etiology of the pathogen:

• viral;
• bacterial;
• fungal.

Depending on the nature of the exudate:

• serous;
• purulent.

Depending on the origin:

• primary (meningococcal, hemophilic, etc.);
• secondary (as a complication of the underlying disease).

The causes of the development of meningitis

In the first place among the causes of meningitis in children are bacteria. The main "culprit" is meningococcus, which is detected in 60% of cases, the second place is haemophilic rod type B and pneumococcus. In 10% of cases, there are viral meningitis caused by enteroviruses, which are characterized by the defeat of children of preschool and school age. Meningococcal carriers are up to 50% of the adult population, but not all are ill. Children, because of immaturity of immune reactions, suffer much more often, especially at the age of up to 5 years. Meningococcus actively multiplies in the nasopharynx, then gets into the blood and with the blood flow to the brain. An infection spreads from a sick person during sneezing, coughing, and talking. Seasonality is also characteristic: the winter-spring period.

Clinical signs of meningitis in children

If we are talking about meningitis in children, then classically always considered meningococcal meningitis. The incubation period averages from 2 to 5 days. Leading are the following syndromes:

• infectious-toxic;
• meningeal;
• syndrome of cerebrospinal hypertension.

"The first violin" is an infectious-toxic syndrome, since a child can die before the manifestation of the meningitis itself as such, and in children of early age, classical meningeal symptoms may be absent altogether. The disease begins suddenly, against a background of complete well-being, often the mother can even accurately indicate the time. The body temperature sharply rises to 40 degrees, there is an intense headache of a bursting nature, a tremendous chill, pain in the eyeballs, dizziness.

The child refuses to eat, nausea and vomiting "fountain", which does not bring relief, expressed the phenomenon of excoxicosis. The patient has hyperesthesia, increased sensitivity to external stimuli: bright light, noise, touch intensify the headache and worsen the patient's condition. The child has increased tendon reflexes, there are signs of convulsive readiness (twitching, tremor of the chin, flinches), and in severe cases tonic-clonic convulsions. Unfortunately, seizures in infants are often the first symptom, before the meningeal syndrome appears. The level of consciousness varies from stunning to coma.

In older children, there is a pronounced psychomotor agitation, delirium, hallucinations. 12 hours after the onset of the disease, meningeal syndrome appears: positive symptoms of Brudzinsky, Kernig, stiff neck, and by the end of the first day - the position of the "dog".

With severe intoxication, tendon reflexes fade, general muscle hypotension appears, Babinsky pathological reflexes, clonus stop, lesion oculomotor nerves (strabismus, anisocaria, ptosis, or lower eyelid), facial nerve damage (facial asymmetry), hearing disorder. As the edema-swelling of the brain increases, the child becomes stupid from coma.

A valuable diagnostic criterion of meningococcal meningitis is the presence of hemorrhagic necrotic rash, which occurs in 90% of cases during the generalization of infection. The cause of hemorrhagic rash is thrombosis of the skin of the skin with the formation of necrosis (areas of necrosis of tissues), after which, when recovering, scars remain. The rash on average appears 6 hours after the onset of the disease, it can be of different sizes and irregular stellate shape, dense to the touch. Typical localization of the rash is the trunk, lower limbs, buttocks, eyelids and sclera.

Diagnostics

General blood analysis. In the analysis results, leukocytosis is observed with a shift to the left up to the myelocytes, increased ESR.

Lumbar puncture and examination of cerebrospinal fluid.Likvor is prescribed in three test tubes and delivered to the laboratory no later than two hours later. Liquor is cloudy, milky white, flows out under pressure. The neutrophil count reaches several thousand, the amount of protein is increased, and the glucose is reduced.

Bacterioscopy.For a bacterioscopic examination, take the material from the CSF, nasopharynx, punctate skin, blood smears.

Bacteriological analysis.For this analysis, the sampling of material from the CSF, urine, nasopharyngeal mucosa, and cadaveric material (in case of an unfavorable outcome) is done, and they are sown on nutrient media.

Serological examination of blood.With the help of this analysis, the presence of specific antibodies in the reaction of indirect hemagglutination and counter immunoelectrophoresis, PCR, is determined.

Treatment of meningitis in children

At any suspicion of a meningitis at the child urgent hospitalization in a hospital!!! No self-medication at home, since every minute is expensive. With a lightning-fast form of the disease, a lethal outcome is possible in 6 hours from the onset of the disease!

Light forms are treated in conditions of an infectious disease department, and generalized ones are treated in the intensive care unit.

General principles of therapy:

• antibacterial therapy (levomycitin, cephalosporin, meropenem);
• hormonal preparations;
• Infusion therapy (maintenance of BCC and detoxification);
• relief of cerebral edema;
• anticonvulsant therapy;
• plasmapheresis;
• hemosorption;
• inotropic support.

Complications

Prior to the appearance of effective antibiotics complications were of a massive nature and were expressed in the form of deafness, blindness, loss of intelligence up to idiocy, persistent paralysis, paresis, epilepsy persisted. At present, meningitis remains a rather dangerous disease, but timely access to specialists gives a chance for recovery with rational antibiotic therapy even without complications. High mortality is maintained in infants and with lightning-fast forms.

Only a doctor can confirm or remove a diagnosis of any meningitis (bacterial, viral or fungal), and this disease should be treated only in a hospital.

After suffering meningitis, especially bacterial, it is necessary to monitor the child's neurologist and oculist for one year.

"Inter" TV channel, "Doctor Komarovsky's School" program on "Meningitis"

Meningitis - Dr. Komarovsky's School - Inter

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