Meningoencephalitis (meningitis encephalitis): causes, symptoms, diagnosis and treatment

Meningitis encephalitis is a viral, fungal or bacterial disease manifested by inflammation of the membranes of the brain and spinal cord. It can lead to death if you do not take urgent diagnostic and therapeutic measures.

History

There is an opinion that in the time of Hippocrates and Avicenna knew about the existence of this disease. Could they heal her? Rather, there is no yes, because in the modern world, it is not always possible to determine the problem in time and react to it. The first documented case was recorded in Scotland in 1768, but then the connection with the pathogen was not clearly visible. The epidemic began talking in the early nineteenth century in Geneva, and although it managed to cope, it was not the last. Throughout the past and before last century, meningitis encephalitis appeared in Africa, Europe and the United States.

Until the end of the twentieth century, mortality from meningitis reached almost one hundred percent, but after penicillin was successfully used against this disease in 1944, the number of lives saved began to increase. Vaccines against common bacterial pathogens, as well as the invention of glucocorticoid drugs, also helped.

Causes

According to the etiological sign, this disease can be divided into three categories:

- infectious (provoked by a specific pathogen);
- Infectious-allergic (autoimmune lesions of the brain membranes in response to infection, vaccination or rheumatic disease);
- toxic (exposure to irritating substances that cause inflammation).

There are also primary and secondary encephalitic meningitis. As you might guess, the primary disease is called, when the focus of infection is located directly in the brain. This occurs with internal injuries (bruises, bruises), viral or infectious diseases. Secondary disease appears as a complication, for example, otitis, sinusitis, tuberculosis or syphilis.

Epidemiology

Previously, because of population crowding, non-observance of sanitary and hygienic norms and poor nutrition, encephalitic meningitis appeared mainly in children under five years of age. But now such cases are rare due to the development of medicine and the improvement of living conditions.

Most often they get sick at the end of winter or early spring. At this time, avitaminosis and reduced immunity are clearly manifested, as well as sharp changes in temperature and humidity. Its contribution is also made by a constant stay in closed, poorly ventilated rooms.

Meningitis encephalitis is widespread, but most often it occurs in African countries. In Russia, the first outbreak of this disease occurred before the outbreak of World War II, the second in the eighties of the last century, and the last in 1997.

Causal agent

The most common are meningococcal and pneumococcal encephalitic meningitis. Streptococcus pneumoniae has more than eighty antigenic species. The body itself is immobile, prefers aerobic space, but in critical situations can temporarily dispense with oxygen. The shape of the bacterium is oval, with a diameter less than a micrometer, it is immobile, has no spores. It develops well on the blood at the temperature of the human body. Pneumococcal encephalitic meningitis is transmitted by airborne droplets from a sick or convalescent person. The microorganism is quite resistant to the effects of drugs, including antibiotics.

Pathogenesis

The disease begins with the fact that the pathogen enters the upper respiratory tract and is fixed to the mucosa of the nasal or oropharynx. Virulence factors that have pneumococcus (capsule, teichoic acid, substance C) stimulate the production of prostaglandins, activate the complement system and neutrophilic leukocytes. All this together does not cause encephalitic meningitis. The reasons for its appearance are deeper. Where the pathogen colonized the mucosa, inflammation develops in the form of otitis, maxillary sinusitis, frontal sinusitis, or tonsillitis. Bacteria multiply, their toxins depress the immune system of the body, and with blood flow they spread throughout the body, affecting the heart, joints and, among other things, the shell of the brain.

Clinic

In the clinic, three forms are distinguished, which takes meningitis encephalitis:

- acute, accompanied by adrenal insufficiency and often ending with a lethal outcome;
- lingering, when the symptoms increase gradually;
- recurrent, with small light intervals.

For the acute form, a sudden onset of a complete well-being with a sharp rise in temperature to pyretic digits (39-40 degrees) is characteristic. There are pallor, sweating, cyanosis, possible loss of consciousness and cramps, as well as paresis of facial muscles. In infants and infants, anxiety manifests itself in a monotonous, unceasing cry. From the increase in intracranial pressure, there may be divergence of the seams of the skull, as well as the bulging of the fontanelle. On the second day of the disease, there are characteristic meningeal symptoms, such as stiff neck muscles. After three to four days, the patient falls into a coma, and progressive edema (due to the inflammatory reaction) leads to an obliquity of the medulla oblongata.

Meningeal symptoms

These are signs that are characteristic of inflammation of the membranes of the brain. They manifest themselves in the first hours after the onset of the disease and help to accurately diagnose.

1. Pose of the dog (head thrown back, limbs brought to the body).
2. Stiff neck muscles and occiput (passively bend the patient's head to the doctor is not possible because of the increased tone of the extensor muscles).
3. Symptom of Kernig (the doctor bends the patient's leg in the hip and knee joint, but when trying to unbend it meets resistance).
4. The upper symptom of Brudzinsky (with bending of the head there is a pulling of the legs to the trunk).
5. The average symptom of Brudzinsky (flexing of the legs when pressing in the suprapubic region).
6. The lower symptom of Brudzinsky (with the passive bending of one leg the second is also brought to the stomach).
7. Symptom Lessuga (nursing a child lift, supporting the armpits, while the legs of him are pressed against the body).
8. Symptom of Mondonzi (painful pressure on the eyeballs).
9. Symptom of Bechterew (pain while tapping along the zygomatic arch).
10. Hypersensitivity to irritants, light and sound.

Children

For an adult, it is difficult to transfer such a disease as encephalitic meningitis. The consequences in children can be even more tragic, since they rarely complain of ailments, do not notice insect bites and have reduced immunity. Boys are sick more often than girls, and the disease is more difficult.

To protect your child, you need to dress it warmer in the spring and autumn period, in time to see a doctor at the slightest sign of ailment and every couple of hours to inspect it on the street in the summer for bites of ticks and other bloodsucking insects.

Diagnostics

First of all, it is important for the doctor to confirm the diagnosis of "encephalitic meningitis". Is it contagious? Certainly. Therefore, the patient must be placed in a separate box or in the infectious disease department, after conducting an epidemiological survey. Then you need to collect anamnesis of life and health, learn complaints. Physical examination consists in checking meningeal signs and measuring temperature. For laboratory tests, blood and liquor are taken.

In the general analysis of blood there is an increase in the level of leukocytes with a predominance of young forms, the absence of eosinophils and a sharply increased ESR up to sixty millimeters per hour. Liquor will be cloudy, opalescent, with a greenish tinge. It is dominated by neutrophils and protein, and the amount of glucose is reduced. To determine the causative agent, blood, sputum or cerebrospinal fluid is sowed on a nutrient medium.

Treatment

If an ambulance or an emergency room has a suspicion of encephalitis meningitis, the patient is immediately hospitalized in a neurological hospital. Treatment begins at the same time, without waiting for a laboratory confirmation of the diagnosis. Complied with strict bed rest, high-calorie diet.

Begin with symptomatic and pathogenetic therapy. First of all, you need to cleanse the body of toxins, which produce bacteria, and reduce intracranial pressure and dilute blood. For this, the patient is intravenously injected with saline and glucose and diuretics. Because excessive flooding of the body can lead to the obliquity of the medulla oblongata and instant death. In addition, drugs to improve microcirculation, vasodilators and nootropics support the activity of the brain.

Etiological therapy consists in antibiotic therapy (benzylpenicillins, fluoroquinolones, cephalosporins).

Exodus

It all depends a lot on how quickly and successfully began to treat encephalitic meningitis. The consequences can be negligible if assistance is provided in a timely manner. And at the same time, with a severe and rapid course of the disease, lethality reaches eighty percent. The reasons for this may be several:

- edema of the brain and wedging it;
- cardiopulmonary insufficiency;
- sepsis;
- DIC-syndrome.

Prevention

Meningitis encephalitis can be prevented by vaccinating children from two to five years of age among those at risk. It is also recommended to people after sixty-five years. This vaccine is part of the WHO official vaccination schedule and is used in most countries of the world.

At the moment in the third world countries the public is still afraid of the diagnosis of "encephalitic meningitis". Will he be cured? Yes, certainly. But success depends on how quickly help was provided and how.