Tuberculous meningitis lives a long time. Tuberculous meningitis: classification, pathogenesis, periods of progression, clinical picture. These require vigorous dehydration therapy

Meningitis is a severe infectious disease characterized by inflammation of the membranes 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 data shows that children under 5 years of age, young people aged 16 to 25 years and older people over 55 years of age are at risk. Meningitis is most severe in children and can lead to irreversible consequences, and in some cases, death. The disease affects the brain, so if not treated correctly, the person remains disabled. Most often, newborns suffer from severe consequences; in adults, meningitis is not so acute and is quickly treated.

Depending on the causes of meningitis, it can be bacterial, fungal or viral. Most complex shape The disease is bacterial meningitis. According to the type of inflammatory process, purulent and serous meningitis are distinguished. Serous meningitis is divided into two types: primary and secondary. The primary form of meningitis occurs due to low immunity and infection by various enteroviruses. The secondary form of the disease occurs after an infectious disease: measles, mumps, chickenpox and others.

Tuberculous meningitis caused by the tuberculosis bacillus. Previously, this disease was not treated and the person died. Modern medicine can 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. Encephalitic meningitis - this type of disease begins when an encephalitis infection enters the body. It is transmitted through a tick bite or by drinking raw milk from an infected animal.

Causes of meningitis

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

Other types of bacteria are also identified as causes of meningitis. This is group B streptococcus, which often affects newborns infected during or after childbirth. Listeria monocytogenes bacteria can cause meningitis in babies and older adults. After suffering an infectious disease, a person may develop meningitis, since his immunity is weakened and cannot resist bacteria. People with and are especially susceptible to this disease. Various injuries heads can cause meningitis.

Ways of transmission of meningitis

A pressing 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 occurring 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 a pathogenic microorganism into the membrane of the brain, meningitis is transmitted by airborne droplets.

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

Prevent the 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 places during outbreaks of the disease, avoiding prolonged exposure to public places. This also necessarily includes complete cessation of contact with the carrier of the infection for the period of his treatment.

However, if you do become infected with the disease, 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 first symptoms of the disease, you need to consult a doctor. With qualified diagnosis and correct treatment, it will recede irrevocably.

Symptoms of meningitis

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

One of the most pronounced and common signs of meningitis is acute headache, spreading throughout the entire region. The pain grows and cannot be tolerated. Then nausea appears and severe vomiting. The patient cannot tolerate sound and light stimuli.

Symptoms of meningitis appear in all patients to varying degrees. As a rule, they experience severe tension in the neck muscles. A person feels severe pain when tilting the head to the chest and straightening the legs at the knees. To relieve symptoms, the patient lies in a certain position. The person lies on his side, throwing his head back strongly, pressing his hands to his chest, and bending his legs at the knees and pressing 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 rapidly; at the first signs, you should not hesitate and immediately go to the hospital. Incubation period illness lasts from 2 to 10 days. The symptoms of meningitis are very similar to ordinary meningitis. The speed of development of the disease depends on the child’s immunity level: 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 become delirious, apathy, drowsiness, and irritability occur. Swelling of the tissues of the meninges begins, which impedes the flow of blood to organs and tissues, as in the case of a stroke. If help is untimely, the person falls into a coma and quickly dies.

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 age categories.

Typically, a disease such as aseptic meningitis is diagnosed and treated fairly quickly. However, for 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 exactly what this article will discuss.

Reasons for the development of the disease

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

The virus enters the human body through the traditional, airborne or food route through contact with a carrier. Then, penetrating through the tissues of the gastrointestinal tract or upper respiratory tract and palatine tonsils into the blood, enteroviruses spread throughout the body. When the body’s defense reaction is weakened, 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 disease in most cases. As for the reasons that, in addition to viral microorganisms, lead to aseptic meningitis, then, according to the nature of their origin, they can be divided into two categories: infectious and non-infectious.

As for non-infectious causes diseases, then these include previous injuries or diseases, as a result of which aseptic meningitis can develop. These include: infectious diseases, inflammatory processes, tumors, concussions and injuries, 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 identify using conventional methods. This presents some difficulty, but is not an insurmountable task. Rather, on the contrary, it narrows the circle possible diseases to make a diagnosis.

Signs of aseptic meningitis

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

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

significant and rapid increase in temperature;
state of fever, chills;
throbbing headache.

More specific symptoms characteristic of other types of meningitis, with the aseptic form, appear rather weakly 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 meningeal syndrome. It manifests itself when the patient, who is laid on his back, cannot tilt his head to his chest without bending his knees. Moreover, the bending of the legs occurs uncontrollably.

The danger of this type of disease lies precisely in the fact that 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 temperature, mild meningeal syndrome, headache and fever, you should not wait for further symptomatic confirmation.

Bacterial meningitis

Bacterial meningitis is an infectious disease expressed in inflammation of the tissues of the spinal cord and brain, and 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 and treatment methods that are different from other forms of meningitis. This is exactly what will be discussed in this article.

In addition to the genetic predisposition of some people to develop meningitis, there are also reasons why this disease can affect the body of each patient. These include the health status 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 pathogenic microorganism penetrates into 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, like any infectious disease, is transmitted by traditional, airborne or foodborne routes. This usually occurs upon contact with a carrier of the infection through a handshake, kiss, sneezing, or shared utensils and household items, which naturally suggests the need for strict adherence to personal hygiene rules.

The penetration of streptococcus bacteria into the body does not end the process of infection and development of the disease. Moreover, after transmission of infection has occurred, 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, this is: weakened immunity and a missed reaction of the body. Only with such additional factors do harmful bacteria that cause the disease penetrate into the blood and are transported to the brain. Therefore, if there is chronic diseases, bad habits or undergoing a course of therapies that negatively affect the immune system, the chance of getting meningitis increases significantly. This also explains the high susceptibility of patients to the disease younger age.

Amoebic (encephalitic) meningitis

Amoebic or encephalitic meningitis is a dangerous inflammation of the membranes of the brain, which is provoked by small free-living amoebae, 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. Encephalitic meningitis has different causes of development, symptoms and signs of manifestation, as well as treatment methods 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 into the blood, and then, transported through the circulatory system, reach the central nervous system, namely, the membranes of the brain. After this, amoebic meningitis begins to develop and the first signs of the disease appear.

Purulent meningitis

Purulent meningitis - infectious inflammation membranes of the brain, accompanied by the formation and release of purulent masses. This disease can occur in patients belonging to any age category. Purulent meningitis often 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. These are the ones that will be discussed in this article.

The causes of a disease such as purulent meningitis are the penetration of pathogenic microorganisms into 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, staphylococci are involved 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. Entry of the pathogenic microorganism into human body, most often occurs through the traditional airborne or food route.

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

Then, penetrating through the tissues of the upper respiratory tract or stomach, harmful bacteria enter the blood. And the causative agent of meningitis reaches the membranes of the brain through the hematogenous route, transported by the circulatory system. Then, after entering 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 indeed the penetration of bacteria into the blood itself, is possible only with a weakened immune system. Then the disease progresses quickly and without obstacles. This fact also explains why the disease so often affects children’s bodies, 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, occurs in people with or who have recovered from tuberculosis.

The cause of a disease such as tuberculous meningitis is the spread of harmful pathogens from the source of inflammation in the respiratory system 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 microbacteria.

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 carriers of dangerous tuberculosis microbacteria.

It is also characteristic that when harmful microorganisms enter the body of a healthy person, the immune system which works properly, tuberculosis bacteria are almost always destroyed. Therefore, the conditions necessary for the full development of the disease include weakened immunity and a low rate of the body’s defense reaction. It is the poorly developed immune system that is the reason that tuberculous meningitis occurs in children.

First of all, when it enters the respiratory system, the disease is localized there. 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 entry of the disease-causing virus into the human body. This disease can affect quite large groups of patients, in terms of age categories, and is quite dangerous. Viral meningitis occurs most often in children.

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

The main cause of this disease, as mentioned above, is a virus that causes a disease in the child’s body. This provocateur enters the child’s body, as with any other infectious disease, through airborne droplets or food through contact with a 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 disruptions and may even be destroyed. This is why viral meningitis so often affects children. The child’s body’s immunity is not fully developed and cannot cope with the virus of this disease.

Thanks to such conditions, the causative agent of meningitis penetrates into the blood and, according to blood vessels reaches the central nervous system. After reaching the brain, the virus promotes 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 membrane 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 spreads extremely quickly from person to person. Therefore, every adult needs to know and understand what can provoke meningitis, what are the symptoms of its manifestation and characteristics of its course, as well as methods of treatment.

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

Most often, this disease occurs due to enteroviruses entering 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 entry of enterovirus into a 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 disease virus enters the child’s body: hugs, coughs, sneezing, kisses, shared dishes, household items (toys).

As for the water transmission route 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 in the warm season.

Entering a child’s body with a still weak immune system, the disease virus easily penetrates through the skin and mucous membranes into the blood. Then, transported by the blood circulation, the pathogen reaches the membrane of the brain. And after this, 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 of different ages and both sexes equally. Infectious meningitis has its own characteristics of occurrence (causes), symptoms and treatment methods that are different from other forms of meningitis. This is exactly 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 causative microorganism into it. Moreover, the role of such a pathogen in this case can be played by harmful viruses, bacteria or even fungus.

Infectious meningitis, like any disease of this type, is transmitted by traditional, airborne or foodborne routes. This usually occurs upon contact with a carrier of the infection through a handshake, kiss, sneezing, or shared utensils and household items, which naturally suggests the need for strict adherence to personal hygiene rules. In this regard, the ways of transmitting the 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 the mere fact of 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 membranes of the brain and has a fungal nature of development. This disease has no age limits in affecting patients, therefore it is equally dangerous for all age groups of patients.

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

As mentioned above, cryptococcal meningitis has a fungal nature of development. And, therefore, like other infectious diseases, the cause of the occurrence of this disease in the patient’s body is the pathogenic microorganism. In this case, a fungus.

Penetration of the pathogenic microorganism into the tissue of the brain membrane 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, subject to reduced functioning of the body’s defense systems, the pathogen enters the bloodstream and, thanks to the well-functioning work circulatory system moves into 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 that have a fungal nature of development usually develop in people who have already suffered from diseases that have weakened their immunity, including those with hemoblastosis, diabetes, AIDS, malignant tumors. A disease such as cryptococcosis is a fairly common case after long-term therapy using antibacterial, corticosteroid, and immunosuppressive drugs.

Symptoms of disease development

Symptoms of a disease such as cryptococcosis are extremely difficult to identify. This is explained by the parallel or subsequent development of meningitis after another illness. Therefore, in order to monitor an additionally developing disease, it is recommended to periodically conduct diagnostics for inflammation of the meninges throughout the underlying disease.

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

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

an increase in temperature by several levels (up to 37.8-38? C);
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 specific signs of the disease, one can obtain a strong basis for a preliminary diagnosis.

As for the specific symptoms of the disease, these include the usual signs of brain damage. Their list includes:

intense throbbing headache;
dizziness;
nausea and vomiting not associated with meals;
photophobia and sound sensitivity;
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, he tilts his head towards chest.

Meningitis in infants

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

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

Symptoms of meningitis in newborns

There is a set of signs of the development of the disease that can appear in both infants and adult patients. However, due to the fact that a newborn child cannot show or talk about what hurts, in this case it is worth paying attention to a larger range of factors. So, the symptoms of a disease such as meningitis in an infant will manifest themselves as follows:

significant increase in temperature;
state of fever, chills;
convulsions and twitching;
enlargement and pulsation of the fontanel;
diarrhea;
nausea and profuse vomiting;
reduction or complete absence appetite;
a state of general weakness of the body.

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

Meningeal syndrome

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

Lesage's symptoms

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

Lesage's sign is also called the pointing dog pose. Its essence lies in the fact that when a baby is held by the armpits, he involuntarily pulls his legs towards his stomach and throws his head back.

Causes

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 the carrier of the infection, which can be adults or small children.

Treatment of meningitis

It is quite easy to determine meningitis, but the diagnosis must be confirmed by a doctor. Since the disease develops rapidly, you cannot hesitate for 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 determine the causative agent, the patient undergoes a spinal puncture. If you consult a doctor in a timely manner, meningitis can be treated well and does not cause complications. Treatments for meningitis include several drugs and vaccines to eliminate the pathogen:

The main treatment for meningitis is antibacterial therapy. At the first symptoms of the disease, broad-spectrum antibiotics from the group of penicillins, cephalosporins and macrolides are immediately used. Broad-spectrum medications are prescribed to immediately eliminate the pathogen. The results of a cerebrospinal fluid analysis 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 when severe forms For diseases, medications 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 medication for at least a week after his normal temperature has stabilized.
Diuretics can be used to treat meningitis. When using diuretics, fluid is simultaneously injected into the patient's body. Diuretics promote strong leaching of calcium from the body, so the patient is prescribed a vitamin complex.
For meningitis, detoxification therapy is used. It is necessary to reduce the symptoms of intoxication. The patient is given intravenous saline, glucose solution and other drugs.

The duration of treatment for meningitis varies and depends on the degree of development of the disease and the patient’s condition. In children, this disease can cause various complications; in adults, it is quickly treated without consequences. After completing therapy in the hospital, it is necessary to continue treatment at home and 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

Measures to prevent meningitis primarily include mandatory vaccination. Vaccination will help prevent the development of many diseases that lead to meningitis. Vaccinations should be given to children at an early age. Vaccines against bacterial and viral meningitis include vaccinations against Haemophilus influenzae type B, against infections that cause pneumonia and other diseases. Vaccination should be given to children between 2 months and 5 years of age, as well as children over 5 years of age who suffer from severe illnesses. Before the invention of the vaccine, bacteria were considered the most common cause of bacterial meningitis, but vaccination has been able to combat it.

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

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

avoiding 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 your hands before eating, after transport and public places, use antibacterial agents;
do not drink raw water, treat vegetables and fruits with boiling water, boil milk;
avoid swimming in stagnant bodies of water;
strengthen the child’s immunity from an early age.

Consequences of the disease

Meningitis is dangerous because untimely or incorrect treatment can lead to serious complications that will last for many years. Moreover, it does not matter at what age the disease was suffered. Consequences after meningitis occur in both adults and children.

In older patients, the list describing complications after meningitis includes: regular headaches, decreased hearing, significant visual impairment, epileptic seizures and many other deteriorations in the body's functioning that can haunt the patient from several months to several years.

As for the consequences of meningitis for children, in this case the situation is even more dangerous. If the 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 may cause a delay mental development, violations of the basic functions of the brain and the entire nervous system of the child’s body.

Moreover, the threat of death from the disease exists not only for children. To answer the question of whether it is possible to 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 is also common in adults. When this complication of the infectious disease meningitis occurs, the patient’s indicators begin to change dramatically blood pressure and palpitations, shortness of breath increases and pulmonary edema develops. The result of this process is paralysis of the respiratory tract. It is not difficult to guess what the consequences are after such a complication of meningitis - the death of the patient.

Another complication called infectious-toxic shock leads to the same consequences. Without contacting doctors at the first manifestations of the disease, complications of the disease cannot be dealt with.

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 proper 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 dysfunction and others. This disease, even during treatment, can have a negative effect on the body. When the drugs are administered, blood pressure decreases significantly, the functioning of the urinary system deteriorates, and 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 arise real threat In life, at the first symptoms of the disease, you need to consult a doctor.

Tuberculous meningitis is an inflammation of the soft membrane of the brain. In most cases, the disease is a complication of another form of tuberculosis. The category of people who have already suffered from this inflammatory process in any form is no exception. The disease is most often diagnosed in adults. The main risk group is people aged 40–70 years.

If treatment of the disease is not started in a timely manner, death cannot be ruled out.

Etiology

The etiology of this disease is well studied. The most common provoking factors for development pathological process are the following:

any localization;
weakened immune system;
severe infectious diseases;
intoxication of the body;
open brain injuries.

Due to certain etiological factors The acid-resistant bacterium Mycobakterium enters the body. This serves as a prerequisite for the development of tuberculous meningitis. But it should be noted that the development of an inflammatory disease is more likely if a person has a severely weakened immune system.

Pathogenesis

Due to certain etiological factors, the provoking bacterium enters the body through the hematogenous route (with the blood). After this, the infectious organism settles on the soft membrane of the brain, where it begins to reproduce. At this stage, the human body tries to develop protection. A capsule is formed that temporarily localizes the infection. As the infection progresses, the capsule ruptures and infectious organisms enter the cerebrospinal fluid. Thus, tuberculous meningitis develops.

General symptoms

At the initial stages, tuberculous meningitis may not make itself felt at all, since the pathological process develops slowly. As this complication of tuberculosis develops, the symptoms become more pronounced.

A person affected by the infection may experience the following symptoms:

apathy;
drowsiness;
weakness and malaise;
increased body temperature;
frequent headaches;
changes in tone in the muscles of the neck and back of the head;
nausea, occasionally vomiting.

In more severe cases, the patient may experience partial paralysis, which is associated with disturbances in the functioning of the nervous system and brain.

In addition to the above symptoms, some patients may be diagnosed with heart rhythm disturbances - or.

Stages of disease development

IN official medicine It is customary to distinguish the following stages of development of tuberculous meningitis:

prodromal(feeling worse, headaches appear);
excitement(symptoms of muscle stiffness, intense headaches appear, muscle pain, vomiting, and psychological disorders also begin);
oppression(possible paralysis, coma).

Detection of the disease at an early stage of development practically eliminates the risk of serious complications, but subject to correct treatment. Therefore, at the first symptoms you should immediately consult a doctor.

Diagnostics

At the first signs, you should immediately consult a therapist. After a thorough personal examination and medical history, a comprehensive diagnosis is carried out.

Laboratory tests consist only of general analysis blood and urine. If necessary, a biochemical blood test may be prescribed.

As for instrumental analyses, the following research methods are used:

fluorography;
test for tuberculosis (Mantoux);
cerebrospinal fluid puncture;

Based on the results obtained, the doctor can make an accurate diagnosis and prescribe the correct treatment.

Treatment

Treatment of tuberculous meningitis is carried out only inpatiently. On initial stages Patients with tuberculous meningitis may be prescribed the following drugs:

isoniazid;
rifampicin;
pyrazinamide;
streptomycin.

The dosage and frequency of administration are determined only by the attending physician. On average, the duration of therapy lasts about 6–12 months. But, the duration of treatment may vary depending on the general condition of the patient and the form of development of the disease.

In addition to special-purpose drugs, the patient is prescribed medications to strengthen the immune system. Also, during the period of treatment of tuberculous meningitis, the patient should eat well and in a timely manner.

It should be noted that tuberculous meningitis is a kind of last stage in the development of this pathological process. Therefore, all infectious and inflammatory diseases must be treated to the end so as not to cause such complications.

Treatment with folk remedies

Traditional medicine offers many remedies for the treatment of tuberculous meningitis. But, you can take any of them only as prescribed by your doctor.

The traditional method of treatment involves taking herbal decoctions from the following herbs:

lungwort;
marshmallow infusion;
elecampane root;

From the above herbs you can prepare both decoctions and tinctures. But, they should be used on the recommendation of a doctor. Self-medication is not acceptable.

Prevention

Although tuberculous meningitis dangerous disease, it can be prevented if simple preventive measures are applied in practice.

For children effective measure Prevention of the disease is vaccination. This vaccination should be done at 7 and 14 years of age.

In addition, the following rules should be applied in practice:

regular ventilation of the room and wet cleaning;
compliance with personal hygiene rules;
regular examination by a therapist;
undergoing fluorography.

Such preventive measures make it possible, if not to completely avoid this disease, then to significantly reduce the risk of its formation. It is much easier to prevent any disease than to treat it later.

Self-medication with such a diagnosis is strictly contraindicated.

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Diseases with similar symptoms:

Syndrome chronic fatigue(abbr. CFS) is a condition in which mental and physical weakness occurs, caused by unknown factors and lasting from six months or more. Chronic fatigue syndrome, the symptoms of which are believed to be to some extent associated with infectious diseases, is also closely associated with the accelerated pace of life of the population and with the increased flow of information literally falling on a person for subsequent perception.

Tuberculous meningitis is understood as a secondary ongoing inflammatory process of the meninges in patients who have confirmed tuberculosis of one form or another. Tuberculous meningitis can affect many organs and body systems, including the central nervous system.

Koch stick

Despite modern diagnostics and the ability to identify the disease in the early stages of its manifestation, tuberculous meningitis poses a serious danger to the patient’s quality of life, even to the point of death. The main risk of developing tuberculous meningitis is children under 5 years of age, adolescent children, elderly patients and patients with immunodeficiency diseases. Most diseases occur in the winter or spring, but do not forget that the likelihood of contracting tuberculous meningitis in adults and children early age there is always.

The main causative agent of the disease is Mycobacterium tuberculosis (abbreviated MBT). The onset of the disease is characterized by infection of the meninges with tuberculosis in pre-existing tuberculosis of any localization. It seems possible to establish the focus of the primary tuberculosis lesion only in 5% of all clinical cases. The defeat occurs in two stages:

Hematogenous route (through blood), when infection of the choroid plexuses of the meninges occurs.
Liquorogenic spread, when Mycobacterium tuberculosis has a pathogenic effect on the meninges of the base of the brain with subsequent allergic reactions in vessels.

Almost 85% of patients have active tuberculosis at the moment or cured tuberculosis of absolutely any location.

Classification by clinical factors

The tuberculous form of meningitis can spread and concentrate in absolutely any anatomical zone. Therefore, there are three basic forms of tuberculous meningitis:

Basal. The form is characterized by clearly manifested meningeal signs, expressed by various neuralgia, muscle tension in the occipital region, changes in cranial innervation, and reflex reactions of tendons to mechanical stress.
Meningoencephalitis and meningoencephalomyelitis. It is characterized by a particularly aggravated course, when severe vomiting, widespread headaches, confusion, unsteady gait, severe paresis of the limbs, hydrocephalus, and other symptoms appear.
Tuberculous leptopachymeningitis. The disease is extremely rare and occurs with symptoms that gradually increase in intensity.

If primary symptoms characterizing tuberculous meningitis appear, you should consult a doctor and begin treatment in a hospital.

Symptoms in young children and adults differ little from the general clinical picture. The treatment process often takes long time(6 months or more).

Causes, pathogenesis

There are the most vulnerable groups of people for the incidence of tuberculous meningitis

The onset of the disease does not occur spontaneously in a completely healthy body. The main risk group consists of the following groups of patients:

having a reduced immune response to external stimuli;
affected by various viral infections, especially in autumn or spring;
patients with intoxication of the body of various etiologies;
survivors of traumatic brain injury.

The development of a pathogenic condition in young children and adults occurs after infection of the patient’s nervous system with mycobacteria due to a violation of the vascular barrier protection. This occurs due to the high sensitivity of the brain vessels, its membranes to external influences or weak immunity (often in the elderly). Such mycobacteria can be found throughout the living world. They are found in both humans and livestock. With the primary attachment of the office to the brain tissue and meningeal membranes, microtuberculomas arise, which can also be localized in the spine, in bone tissue skulls Such tuberculomas can provoke the following:

cause focal abscess in the meningeal membranes;
form effusion and adhesive process at the very base of the brain;
cause inflammation of important arteries, narrowing of their lumens, which can lead to local brain disorders.

Tuberculous meningitis is characterized by these main factors, which, in turn, form the overall clinical picture its development and course. The destructive process involves not only the membranes of the spinal cord or brain, but also vascular system. A similar situation is typical for sick young children and the elderly.

Symptoms of the disease

Headache with tuberculous meningitis is usually very intense

Important symptoms characterizing tuberculous meningitis are signs that constantly increase in duration and intensity of manifestations. The incubation period of the disease can last up to six weeks, and during this time the patient can experience minor or pronounced changes in the psychosomatic state:

the occurrence of apathy or, on the contrary, increased excitability;
high fatigue even from minor stress (physical, mental, while awake);
deterioration in sleep quality, loss of appetite;
the occurrence of severe headaches, intensifying at nightfall;
increase in temperature (sometimes to high values);
vomiting, severe malaise.

Meningeal syndrome manifests itself in stiffness of the neck muscles along with severe headaches, Kerning's symptom (determined with the patient in the supine position).

Rigidity of the muscles of the occipital region, at the same time, is considered the earliest sign of tuberculous meningitis. This applies to symptoms of the disease in young children and adults. If a doctor quickly and reliably identifies meningeal syndrome in a complex of symptoms, this significantly increases the chances of making an accurate diagnosis almost instantly.

Checking Kernig's sign

The main signs of health problems with meningeal syndrome in adults or young children and adolescents:

disorders and disorders of secretory functions ( increased sweating, increased amount of saliva);
persistent disturbances in breathing (intermittent breathing is noted, as if the patient does not have enough air);
sudden changes in blood pressure up or down;
alternating high temperature (up to 40 ° C) and low temperature (up to 35 ° C);
photophobia, reaction to minor noises;
coma, confusion.

It is worth noting that vomiting, coma, confusion with high temperature- signs late stage development of the disease. Here, tuberculous meningitis usually ends in the death of the patient as a result of paralysis of the respiratory and vasomotor centers.

Diagnostic measures

Diagnosis of the disease is usually divided into two stages:

Timely detection of the disease (within 10 days from the date of infection);
Late diagnosis, when 15 days have passed since the onset of the disease.

Diagnosis of the disease includes anamnesis, examination and additional research methods.

There is a set of indicators on the basis of which a diagnosis of tuberculous meningitis in adults and children can be made:

prodromal syndrome (factors preceding the disease);
signs general intoxication;
functional disorders urinary system and intestines;
nausea, vomiting, head thrown back, stomach retracted (visually resembles the shape of a boat);
manifestation of symptoms from the cranial nerves;
cerebrospinal fluid (CSF) has characteristic changes in cytosis and biochemical composition;
clinical dynamics with a progressive course.

Staging final diagnosis requires additional methods research and medical examinations of both adults and children, due to the presence of another localization of mycobacterium tuberculosis:

definition of tuberculosis lymph nodes;
analysis of X-ray examination for signs of miliary or focal tuberculosis of pulmonary tissue;
examination of the spleen and liver for changes in volume (usually increasing);
examination of the fundus for possible detection of chorioretinal tuberculosis.

Performing a lumbar puncture

Analysis of cerebrospinal fluid (CSF) and indicators characteristic of tuberculous meningitis:

increased blood pressure;
examination of the CSF for transparency, which after a day can form a fibrin network;
options cellular composition vary from 200 to 800 mm3, when the norm is 3-5;
increased protein content;
reduction of sugar to 90% (this condition is common with AIDS);
bacteriological analysis of cerebrospinal fluid, the presence of Mycobacterium tuberculosis.

It is important to conduct the study correctly to subsequently differentiate tuberculous meningitis from bacterial, viral and HIV cryptococcal meningitis.

Treatment and prevention

Treatment of the disease in both adults and children is carried out urgently and only within the walls of a specialized medical institution, where it is possible to quickly perform the necessary additional diagnostics (lumbar puncture, x-rays, studies of biological materials) and carry out special methods of anti-tuberculosis therapy.

If there is no treatment for tuberculous meningeal infection or the tactics are inadequate, then the disease can cause not only serious complications, but in some cases lead to the death of the patient.

Treatment of tuberculous meningitis comes down to the use of specific and nonspecific agents

There are no other outcomes for untreated disease.

The main preventive measures include:

conducting regular inspections and notifications in the event of an epidemiological situation regarding tuberculosis;
early diagnosis, isolation of tuberculosis patients from society for further treatment;
periodic medical examinations of applicants for production activities in livestock farms and farms;
the need to provide separate housing for patients with active tuberculosis;
timely vaccination in children, and primary vaccination in newborns.

The prognosis for tuberculous meningitis often depends on prompt, reliable diagnosis and timely treatment. In such cases, there is practically no risk of complications, and the adult patient can continue to continue his usual lifestyle. In children, the course of the disease can provoke persistent disturbances in mental and physical development.

Tuberculous meningitis is predominantly a secondary tuberculous lesion (inflammation) of the soft, arachnoid membranes and less of the hard membrane, occurring in patients with various, often active and widespread, forms of tuberculosis. Tuberculosis in this localization is the most severe. In adults, tuberculous meningitis often serves as a manifestation of exacerbation of tuberculosis and may be its only established localization.

Tuberculosis of the central nervous system, tuberculous meningitis - the most severe form of extrapulmonary tuberculosis, occurs at any age, but 8-10 times more often in young children. Most cases of this pathology are observed during the first 2 years of MBT infection.

Pathogenesis

In the pathogenesis of tuberculous meningitis, sensitization of the body plays an important role, leading to disruption of the blood-brain barrier under the influence of various nonspecific factors that reduce protective reactions:

injuries, especially to the head;
hypothermia;
hyperinsolation;
viral diseases;
neuroinfections.

In addition, it should be taken into account that the infection “breaks through” into the nervous system when the vascular barrier is disrupted in a certain hyperergic state of the vessels, when the necessary immunobiological conditions are created for this: contact with a patient with tuberculosis, difficult material and living conditions, severe intercurrent diseases; in children - early age, lack of BCG vaccination; in adults - alcoholism, drug addiction, HIV infection, etc.

There are several theories about the pathogenesis of tuberculous meningitis:

hematogenous;
liquorogenic;
lymphogenous;
contact

Most scientists adhere hematogenous-liquorogenic theory occurrence of tuberculous meningitis. According to this theory, the development of meningitis occurs in two stages.

First stage, hematogenous, occurs against the background of general bacteremia. MTB in conditions of hypersensitization and decreased protective forces organisms with primary, disseminated tuberculosis penetrate the blood-brain barrier; in this case, the choroid plexuses of the ventricles of the brain are affected.

Second stage, liquorogenic, accompanied by the penetration of MTB from the choroid plexuses into the cerebrospinal fluid; further along the course of the cerebrospinal fluid to the base of the brain, where they settle in the area from the chiasm of the optic tract to the medulla oblongata and adjacent parts of the cerebellum. A specific inflammation of the soft meninges at the base of the brain develops - basilar meningitis.

M. V. Ishchenko (1969) proved the existence of a lymphogenous route of infection of the meninges, which he observed in 17.4% of patients. In this case, MBT from the upper cervical fragment of the jugular chain of lymph nodes affected by tuberculosis along the perivascular and perineural lymphatic vessels reach the meninges.

In addition, when the tuberculosis process is localized in the spine, skull bones, or inner ear, the infection is transferred to the meninges by liquorogenous and contact routes. The meninges can also become infected from pre-existing tuberculosis foci (tuberculomas) in the brain due to the activation of tuberculosis in them.

In the vast majority of cases, TM develops in patients with pulmonary or extrapulmonary tuberculosis of any form and at various phases of the process . In young children, inflammation of the meninges can develop against the background of tuberculosis of the intrathoracic lymph nodes or primary tuberculosis complex, complicated by hematogenous generalization. However, in 15% of patients, meningitis can occur in the absence of visible tuberculous changes in the lungs and other organs (“isolated” primary meningitis). Early diagnosis tuberculous meningitis determines success in treatment.

Tuberculosis of the central nervous system manifests itself in damage to the brain and its membranes, which is a consequence of hematogenous dissemination in both primary and secondary tuberculosis. Tuberculous inflammation of the meninges is localized, as a rule, at the base of the brain. The shells take on a greenish-yellowish jelly-like appearance with individual grayish tubercles on the surface. Microscopic examination reveals inflammatory infiltrates in the walls of small vessels, consisting of leukocytes and lymphocytes. Thickening of the walls of blood vessels leads to narrowing of the lumen and the appearance of blood clots. Typical tuberculous granulomas and infiltrates of a specific nature may occur. Infiltrates may also undergo cheesy necrosis.

The spread of inflammation to adjacent tissues and the development of destructive vasculitis leads to the appearance of foci of softening of the brain substance. In later periods, adhesions of the meninges are detected and, as a result, hydrocephalus.

Initially, the inflammatory process is localized at the base of the brain behind the optic chiasm, involving the infundibulum, mastoid body, quadrigeminal region and cerebral peduncles.

The pia mater becomes cloudy, gelatinous, and translucent. Along the olfactory tracts, near the optic chiasm, on the lower surface frontal lobes rashes of small tuberculous tubercles are visible in the brain and in the Sylvian fissures. The ventricles of the brain are filled with clear or slightly cloudy fluid. When the Sylvian fissure is affected, the process often involves the middle cerebral artery. Necrosis of the vessel wall or thrombosis may develop, which leads to ischemia of a certain area of the brain and irreversible consequences. With tuberculous meningitis, changes are always found in the hypothalamic-pituitary region, and the fundus and the adjacent region of the third ventricle are affected. This localization entails damage to the numerous vegetative centers located here. Subsequently, dysfunctions of the cranial nerves - optic, oculomotor, trochlear, abducens, trigeminal, facial - are added. As the process progresses, the pons is involved in the inflammatory process and medulla, disorders of the cranial nerves (IX, X, XII) appear. Death occurs from vasomotor paralysis and respiratory centers, which are located in the medulla oblongata.

Clinical picture

There are three main forms:

basal meningitis (damage to the pia mater at the base of the brain);
meningoencephalitis;
cerebrospinal leptopachymeningitis.

During tuberculous meningitis there are three periods:

premonitory;
period of irritation of the central nervous system;
period of paresis and paralysis.

Prodromal period lasts 1-3 weeks (in children usually 7 days). At this time, insufficiently typical and inconsistent symptoms arise that do not allow a timely diagnosis. The disease develops gradually. The prodrome period is characterized by intermittent headaches, apathy, lethargy, daytime drowsiness, alternating with excitability (anxiety, moodiness), loss of appetite, low-grade fever bodies. At the end of the prodromal period, vomiting not associated with food intake and a tendency to retain stool occur. During this period of the disease, bradycardia is noted.

During the period of irritation of the central nervous system- 8-15th day of illness (irritation of the central nervous system) - all of the listed symptoms increase in intensity, especially headache, which becomes constant (in the forehead and back of the head), and vomiting. Vomiting is constant and very early symptom. Vomiting typical for tuberculous meningitis is characterized as fountain-like. Decreased appetite leads to complete anorexia, which leads to rapid and dramatic loss of body weight. Body temperature reaches high numbers - 38-39 °C. Symptoms of irritation of the meninges are added - stiff neck, positive Kernig, Brudzinsky symptoms, the intensity of which increases towards the end of the second week of the disease. As a consequence of irritation of the nervous system, hyperesthesia of the analyzers, photophobia, tactile hypersensitivity, and increased irritation of hearing occur. Abdominal reflexes usually disappear, tendon reflexes may be decreased or increased. Autonomic disorders are expressed in tachycardia, increased blood pressure, increased sweating, red dermographism and Trousseau spots. At the same time, lesions of the cranial nerves are noted: most often - oculomotor, abducens, facial, which is revealed in the form of drooping eyelids, strabismus, smoothing of the nasolabial fold, anisocoria. When examining the fundus, congestive disc nipples or optic neuritis, tuberculous tubercles on choroid. Defeat optic nerve can lead to complete blindness. By the end of the second period, which lasts approximately one week, the patient is in characteristic pose- lies on his side with his legs pulled up to his stomach and his head thrown back. Signs of confusion appear, the patient is negative and severely inhibited. Tuberculous meningitis is serous meningitis.

The composition of the cerebrospinal fluid is changed: its pressure is increased due to increasing hydrocephalus to 300-500 mm of water. Art. (normally 50-150 mm water column), it is transparent, colorless, and can be opalescent. The protein content increases to 0.8-1.5 g/l and higher (normally 0.15-0.33 g/l) mainly due to globulins (Pandey and Nonne-Apelt globulin reactions are sharply positive), and falls out in the cerebrospinal fluid fibrin mesh in the form of an hourglass 12-24 hours after sampling. After centrifuging the test tube, a smear is made from the sediment on the glass and stained with Ziehl-Neelsen. This makes it possible to detect MBT. Pleocytosis reaches 200-700 cells per 1 ml (normally 3-5-8, in young children - up to 15 per 1 µl), has a lymphocytic-neutrophilic character, less often - neutrophilic-lymphocytic in the early stages of diagnosis. As the duration of the disease increases, the cytosis becomes persistently lymphocytic. It should be noted that the number of cells in the cerebrospinal fluid can periodically reach large numbers of 1000-2000, which may make it difficult differential diagnosis. The glucose level was reduced to 1.5-1.6 mmol/l (normally 2.2-2.8 mmol/l), chlorides - to 100 mmol/l (normally 120-130 mmol/l), mycobacterium tuberculosis in cerebrospinal fluid are detected in 10-20% of patients using simple bacterioscopy and culture. With meningoencephalitis and spinal meningitis, the composition of the cerebrospinal fluid changes even more.

Terminal period of paresis and paralysis also lasts about a week (15-24th day of illness) and is characterized by signs of meningoencephalitis: complete loss of consciousness, convulsions, central (spastic) paresis and paralysis of the limbs. Tachycardia, disturbance of the Cheyne-Stokes breathing rhythm, thermoregulation is disrupted - hyperthermia up to 41 ° C or a sharp drop in temperature below normal. Cachexia develops and bedsores appear. Next comes death as a result of paralysis of the respiratory and vasomotor centers.

Spinal form of meningitis is relatively rare. During this process, inflammatory changes occur from the membranes of the brain to the membranes of the spinal cord, all this manifests itself against the background of meningoencephalitis. Meningeal symptoms are accompanied by radicular disorders, paraparesis, blockade of the cerebrospinal fluid pathways with protein-cell dissociation (very high level protein with moderately expressed cytosis). The course of the disease is long and an unfavorable outcome is possible.

In blood tests for tuberculous meningitis, a decrease in the level of hemoglobin and red blood cells, an increase in ESR to 25-50 mm/h, moderate leukocytosis and shift are observed leukocyte formula to the left, lymphocytopenia, monocytosis, absence of eosinophils. Tuberculin tests, as a rule, negative.

The development of tuberculous meningitis in a child, according to the majority of domestic and foreign clinicians, occurs mainly in the first 3-9 months of MTB infection. The most difficult questions diagnoses of this form of tuberculosis occur when meningitis is the first clinical manifestation tuberculosis and there is no information about contact with the patient, there is no tuberculin diagnostic data. The presence of a vaccination mark on the shoulder from BCG vaccination at birth does not allow doctors to think about the possibility of the tuberculous nature of the disease. And this is a mistake. According to the city children's tuberculosis hospital, in the last 10-12 years, among those sick with tuberculous meningitis, 60% of children were vaccinated with the BCG vaccine.

Young children are characterized by a short (3 days) prodromal period, an acute onset of the disease; in the first days of the disease, convulsions and focal symptoms of damage to the central nervous system occur, meningeal symptoms are mild, and there is no bradycardia. There is an increase in bowel movements up to 3-5 times a day, which in combination with vomiting resembles dyspepsia. The fontanel is tense and bulging and there is no exicosis. Hydrocephalus develops quickly. Sometimes there is only a slight increase in body temperature, drowsiness and protrusion of the fontanel. The prognosis may be unfavorable if a spinal puncture is not performed and treatment is not started on time.

Differential diagnosis with meningitis of other etiology

(bacterial, viral, fungal), encephalitis, poliomyelitis, abscess and brain tumor and other diseases that have similar clinical symptoms, should be based on indicators of the cerebrospinal fluid, the presence of MBT in it, the presence of other localizations of tuberculosis (radiographs of the lungs and tomograms of the mediastinum are required), contact with tuberculosis patients, acute or gradual onset of the disease, the nature of the course of the disease, and the epidemic situation. Carrying out tuberculin diagnostics and serological tests, PCR, blood and cerebrospinal fluid tests can confirm the fact of infection and the activity of tuberculosis infection.

Diagnosis of tuberculous meningitis should be very quick, no later than the 10th day of illness from the first vomiting, which appears already in the prodromal period. Timely treatment with anti-tuberculosis drugs is highly effective, without consequences.

In situations where the diagnosis of meningitis is difficult, when the tuberculous etiology of the disease cannot be proven, but is not removed in diagnostic searches, therapy with the three main anti-tuberculosis drugs (rifampicin, isoniazid, streptomycin) should be immediately started and differential diagnosis should be continued against this background.

Treatment

Chemotherapy. Treatment of patients with tuberculous meningitis must be comprehensive and carried out in specialized institutions. During the first 24-28 weeks, treatment should be carried out in a hospital, then, for 12 weeks, in a sanatorium. Use 4 chemotherapy drugs during 6 month, then - 2 tuberculostatics until the end of the main course against the background of pathogenetic therapy.

Dehydration therapy for meningeal tuberculosis is more moderate than for other meningitis. Diuretics are prescribed: lasix, furosemide, diacarb, hypothiazide, in severe cases - mannitol (intravenous 15% solution at the rate of 1 g of dry matter per 1 kg of body weight), 25% solution of magnesium sulfate - intramuscularly for 5 - 10 days; a 20-40% glucose solution is administered intravenously, 10-20 ml, after 1-2 days, a total of 6-8 injections; unloading lumbar punctures 2 times a week. Control lumbar punctures are performed in the 1st week of treatment 2 times, and then 1 time per week, from the 2nd month 1 time per month until the composition of the cerebrospinal fluid is normalized, after which - according to indications. Detoxification therapy is also indicated - the introduction of rheopolyglucin, gelatinol, saline solutions under the control of diuresis.

The prognosis of tuberculous meningitis in children under 3 years of age is usually less favorable than in older age groups. The later the diagnosis of this difficult process is before the start of specific treatment, the less likely it is for complete recovery. One of the most common and dangerous complications tuberculous meningitis is hydrocephalus.

Death of such patients occurs in 20-100% of cases, depending on the stage of the process. In the absence of effect from conservative therapy and persistent disorders of the cerebrospinal fluid circulation, correction of hydrocephalus can be carried out through cerebrospinal fluid shunt operations, when, with the help of permanent implantation of special drainage systems, excess cerebrospinal fluid from the ventricles or subarachnoid spaces is removed into the extracranial serous cavities or into the bloodstream.

These operations provide stable correction of the cerebrospinal fluid circulation in 80-95% of cases. Under our supervision there were two children with tuberculous meningitis who underwent CSF shunt surgery in the treatment of hydrocephalus with favorable results. clinical effect. In some cases, this can save the patient’s life, but the use of these interventions should be limited due to the risk of generalization of infection. Tuberculostatic therapy after surgery should continue for at least 18 months.

After recovery, the child is observed in an anti-tuberculosis dispensary until the age of 18 and is not subjected to any preventive vaccinations.

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

This disease, rare at present, mainly affects people from 40 to 65 years of age, as well as children under 5 years of age, although this rarely occurs, since children are required to be 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 “scourge”.

How the infection is transmitted

The cause of tuberculous meningitis is infection from organs affected by tuberculosis: lungs, bones, genitals, breast, kidneys, larynx and others. Infection rarely occurs through contact.

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

Risk factors for developing the disease include:

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

It is necessary to distinguish between types of disease

Tuberculous meningitis has different shapes, characterized by symptoms and appropriate treatment:

Basal– has cerebral meningeal symptoms in the form of the inability to pull the head to the chest due to hardening of the neck muscles, disruption of cranial innervation and tendon reflexes.
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.
Tuberculous leptopachymeningitis– develops extremely rarely, at the beginning of the disease there are almost no symptoms or they are barely noticeable.
If you detect one or more symptoms, having a provoking factor (tuberculosis of one of the organs), you must immediately seek help from a doctor. Tuberculous meningitis is dangerous due to its complications and adverse consequences.

Meningeal symptoms

Children at risk

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

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

In children older than one year, it usually begins with malaise, decreased appetite, and drowsiness. Then the temperature rises and vomiting begins - this happens within a week. Meningeal symptoms usually appear within 1-3 weeks.

Features of the clinical picture

Symptoms of tuberculous meningitis are divided into three stages:

Prodromal period– lasts up to 6-8 weeks. Symptoms appear gradually: apathy, lethargy, drowsiness, weakness, and frequent headaches that gradually become stronger, the temperature rises to 38 degrees, nausea and vomiting begin.
– 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 and Brudzinski's sign, hearing loss, vision problems, speech impairment, decreased sensitivity of the limbs, hydrocephalus, increased sweating and salivation.
Terminal period– the last stage of the disease, paralysis begins, heart rate increases, loss of consciousness, difficulty breathing, temperature up to 40 degrees. The last stage of the disease ends in 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 developing in children are: on the 2nd day, convulsions, vomiting, fever may begin, the child screams, the fontanel swells and pulsates.

In older children, the onset of the disease is gradual, and the manifestation of symptoms is blurred. Meningitis can be determined by the way the child lies; if he constantly lies on his side, with his legs tucked to his stomach and his head tilted back - this is a sure sign of the disease.

Goals and methods of diagnosis

Diagnosis of this disease within 10 days is considered timely, after 15 days - late. The disease is determined by three criteria: the presence of symptoms, identification of the source of infection and examination of the cerebrospinal fluid.

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

during examination, pay attention to the presence of tuberculosis of the lymph nodes;
X-rays of the lungs are performed to detect tuberculosis;
Enlarged liver and spleen are diagnosed;
The fundus is examined.

Collection of cerebrospinal fluid indicates tuberculous meningitis if the cerebrospinal fluid flows in a stream or in quick drops. A complete examination for changes in the fluid indicates an accurate diagnosis.

In addition, blood is taken for general and biochemical analysis, and the lungs and other organs are performed.

Health care

Therapy lasts a very long time and is carried out only in a hospital setting. After treatment, which lasts up to a year, the patient is sent to a specialized sanatorium.

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

For example, if the drug Streptomycin can be administered intramuscularly to an adult patient, then this must be administered to a child into the spinal canal, because in infants the disease occurs in an acute form, and the slightest delay can cost life.

The goal of treatment of tuberculous meningitis is to eliminate the source of tuberculosis, treat inflammation of the meninges and eliminate it, prevent complications, relieve damage to the central nervous system, and relieve intoxication.

Conservative medicine

Treatment is carried out comprehensively using specialized drugs: Streptomycin, PAS, Ftivazid and Salyuzid.

Complex treatment prevents the emergence of resistant macobacterium tuberculosis and has a beneficial effect on relieving the inflammatory process, because all these drugs have an anti-inflammatory effect. The combination and dosage are prescribed by the doctor depending on the severity of the disease, tolerability of the drugs, and the patient’s condition.

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

Even with mild forms of the disease, the patient is discharged from the hospital only after six months, if the patient is in good health. general state And normal indicators cerebrospinal fluid tests. After discharge, treatment for tuberculosis and complications of meningitis continues.

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 observed 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 observation by a neurologist, ophthalmologist, or psychiatrist continues. During the first 2-3 years, preventive courses are carried out for 3 months with Isoniazid in combination with Ethambutol.

Patients continue their work activities unless they are determined to have 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 after consulting your doctor.

Herbal decoctions and tinctures are recommended: lungwort, marshmallow, elecampane root. You can put a pot of wisteria in the room where the patient is - the phytoncides it secretes disinfect the air and kill the tuberculosis bacillus.

At home, to alleviate the suffering of the patient, he should be provided with peace, both mental and physical, because he has heightened sensitivity to hearing, vision and touching the skin.

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

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, the consequences can be the most dire. If the patient is immediately taken to the hospital, then complete recovery is possible even in small 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 limbs and the development of pathologies of the pelvic organs.

For prevention purposes

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

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