Meningitis in children

Despite the undoubt­ed advances in med­i­cine, mor­tal­i­ty from menin­gi­tis is still high. What is menin­gi­tis?

Menin­gi­tis and its types

Menin­gi­tis is a dis­ease in which the lin­ing of the brain or spinal cord becomes inflamed. The causative agents of infec­tion are bac­te­ria, virus­es, fun­gi. The trans­mis­sion mech­a­nism is air­borne from patients or car­ri­ers of meningo­coc­cus when talk­ing, cough­ing, sneez­ing. In med­i­cine, the fol­low­ing types of menin­gi­tis are dis­tin­guished:

• Bac­te­r­i­al — the causative agents of bac­te­r­i­al menin­gi­tis are pneu­mo­coc­ci, meningo­coc­ci, strep­to­coc­ci, sal­mo­nel­la, staphy­lo­coc­ci, Pseudomonas aerug­i­nosa.
• Viral — can be pri­ma­ry, caused by a viral infec­tion, and sec­ondary, as a com­pli­ca­tion of infec­tious viral dis­eases such as measles, influen­za, rubel­la, chick­en pox, epi­der­mal paroti­tis and oth­ers.
• Fun­gal — can occur when the ner­vous sys­tem is dam­aged by fun­gi (mycoses). About 20 types of fun­gi can affect the brain, most often cryp­to­coc­ci and fun­gi such as Can­di­da. Fac­tors that pre­dis­pose to menin­gi­tis in fun­gal infec­tions are dia­betes, long-term antibi­ot­ic treat­ment, alco­holism, and drug use.

Menin­gi­tis can also be caused by the sim­plest tox­o­plas­ma and amoe­ba.

Symp­toms

Symp­toms of the dis­ease depend on the type of pathogen, which in each case will be dif­fer­ent and have dif­fer­ent sever­i­ty.

In severe forms of bac­te­r­i­al and viral menin­gi­tis, the fol­low­ing symp­toms are observed: rash on the first day of ill­ness, severe headache, vom­it­ing not asso­ci­at­ed with food intake, pal­lor, pro­nounced con­vul­sive symp­tom, loss of con­scious­ness. Unfa­vor­able are the Water­house-Fridrek­sen syn­drome, the ful­mi­nant form of meningo­coc­cal infec­tion and ful­mi­nant pur­pu­ra. Already in the first hours of the dis­ease, pur­ple spots appear on the skin, an abun­dant rash that forms hem­or­rhages.

With fun­gal menin­gi­tis, the main meningeal symp­toms are observed, hydro­cephalus, mycotic aneurysms, and spinal lesions may devel­op lat­er.

Diag­no­sis

Reli­ably diag­nose menin­gi­tis is pos­si­ble only with spinal punc­ture. Thus, it is pos­si­ble to iso­late the pathogen, reduce the pres­sure of the cere­brospinal flu­id, which will alle­vi­ate the headache and addi­tion­al­ly intro­duce antibi­otics.

In bac­te­r­i­al menin­gi­tis, cere­brospinal flu­id leaks under pres­sure, is white, and has an increased pro­tein con­tent. Addi­tion­al data can be obtained using a com­plete blood count, bac­te­ri­o­log­i­cal exam­i­na­tion of nasopha­ryn­geal mucus, CSF.

Treat­ment

Menin­gi­tis can be treat­ed only in a med­ical insti­tu­tion. Ther­a­py of menin­gi­tis involves the use of antibi­otics of the peni­cillin series — ben­zenepeni­cillin, amox­il, amox­i­clav, fle­mox­in and oth­ers. The course of treat­ment is 5–7 days.

To reduce intracra­nial pres­sure, pre­scribe lasix, torasemide under the cov­er of asparkam. To restore the func­tion­ing of nerve cells and blood ves­sels, pirac­etam and nootropil are pre­scribed. For an anti-inflam­ma­to­ry effect, hydro­cor­ti­sone, dex­am­etha­sone, methyl­pred­nisolone can be used. With time­ly treat­ment start­ed with­in 2–3 days, the child’s well-being improves, then com­plete recov­ery occurs.

Untime­ly access to a doc­tor is fraught with com­pli­ca­tions that can lead to infec­tious-tox­ic shock, cere­bral ede­ma, acute adren­al insuf­fi­cien­cy, hydro­cephal­ic syn­drome, cere­broas­the­nia, and as a result, death.

Pre­ven­tion

Spe­cif­ic pro­phy­lax­is involves urgent immu­niza­tion with type A meningo­coc­cal vac­cine of all peo­ple who have had con­tact with the patient: fam­i­ly mem­bers, employ­ees of child care facil­i­ties, chil­dren in kinder­gartens and schools. In order to pre­vent the spread of infec­tion, con­tact peo­ple are iso­lat­ed until the results of a bac­te­ri­o­log­i­cal study are obtained. They are mon­i­tored for 10 days. The sick per­son is admit­ted to the team 5 days after dis­charge from the med­ical insti­tu­tion after a dou­ble neg­a­tive result of the study of mucus from the nasophar­ynx. For 2 years, a child who has had menin­gi­tis is mon­i­tored by a doc­tor.

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