Encephalitis meningitis is a viral, fungal, or bacterial disease that is manifested by inflammation of the membranes of the brain and spinal cord. It can be fatal if urgent diagnostic and therapeutic measures are not taken.
History
It is believed that during the time of Hippocrates and Avicenna they knew about the existence of this disease. Could they heal her? More likely no than yes, because in the modern world it is not always possible to identify a problem in time and respond to it. The first documented case was recorded in Scotland in 1768, but then the connection with the pathogen was not clearly visible. They started talking about the epidemic in the early nineteenth century in Geneva, and although they managed to cope with it, it was not the last. Throughout the past and the century before last, encephalitis meningitis has appeared in Africa, Europe and the USA.
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 saved lives began to increase. Vaccines against common bacterial pathogens, as well as the invention of glucocorticoid drugs, also helped.
Causes
On the etiological basis, this disease can be divided into three categories:
- infectious (provoked by a specific pathogen);
- infectious-allergic (autoimmune damage to the meninges in response to infection, vaccination or rheumatic disease);
- toxic (exposure to irritating substances that provoke inflammation).
Primary and secondary encephalitis meningitis are also distinguished. 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 (bruise, hematoma), viral or infectious diseases. A secondary disease appears as a complication, for example, otitis media, sinusitis, tuberculosis or syphilis.
Epidemiology
Previously, encephalitis meningitis occurred mainly in children under five due to crowded populations, poor hygiene and poor nutrition. But now such cases are rare thanks to the development of medicine and the improvement of housing conditions.
Most often they get sick at the end of winter - the beginning of spring. At this time, vitamin deficiency and a decrease in immunity, as well as sharp changes in temperature and humidity, are clearly manifested. The constant stay in closed, poorly ventilated rooms also contributes to this.
Encephalitis meningitis is ubiquitous, but it is most commonly found 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.
Pathogen
The most common meningococcal and pneumococcal encephalitis meningitis. Streptococcus pneumoniae has more than eighty antigenic species. The body itself is motionless, prefers aerobic space, but in critical situations it can temporarily do without oxygen. The bacterial form is oval, with a diameter of less than a micrometer, it is motionless, has no spores. It develops well in blood environments at human body temperature. Pneumococcal encephalitis meningitis is transmitted by airborne droplets from a sick or recovering 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 on the mucosa of the nasopharynx or oropharynx. The virulence factors that pneumococcus has (capsule, teichoic acid, substance C) stimulate the production of prostaglandins, activate the complement system and neutrophilic white blood cells. All this together does not cause encephalitis meningitis. The reasons for its appearance are deeper. Where the pathogen colonized the mucosa, inflammation develops in the form of otitis media, sinusitis, frontitis or tonsillitis. Bacteria multiply, their toxins inhibit the body’s immune system, and with the flow of blood they spread throughout the body, affecting the heart, joints and, among other things, the lining of the brain.
Clinic
The clinic distinguishes three forms that encephalitis takes:
- acute, accompanied by adrenal insufficiency and often ending in death;
- lingering, when symptoms increase gradually;
- recurrent, with small bright intervals.
For the acute form, a sudden start is characteristic against the background of complete well-being with a sharp increase in temperature to pyrethic numbers (39-40 degrees). There are pallor, sweating, cyanosis, possible loss of consciousness and cramps, as well as paresis of the facial muscles. In infants and infants, anxiety is manifested by a monotonous incessant cry. From an increase in intracranial pressure , divergence of sutures of the skull, as well as bulging fontanel, are possible. On the second day of the disease, characteristic meningeal symptoms appear, such as stiff neck muscles. After three to four days, the patient falls into a coma, and progressive edema (due to an inflammatory reaction) leads to a wedge in the medulla oblongata.
Meningeal symptoms
These are signs characteristic of inflammation of the meninges. They appear in the first hours after the onset of the disease and help to accurately diagnose.
- Pose of a gundog dog (bowed head, limbs brought to the body).
- Stiff neck and neck muscles (the doctor fails to passively bend the patient’s head because of the increased tone of the extensor muscles).
- Symptom Kernig (the doctor bends the patient’s leg in the hip and knee joints, but meets resistance when trying to straighten it).
- The upper symptom of Brudzinsky (when bending the head, legs are pulled up to the body).
- The average symptom of Brudzinsky (bending of the legs with pressure in the suprapubic region).
- The lower symptom of Brudzinsky (With passive bending of one leg, the second also leads to the stomach).
- Symptom of Lessage (a baby is lifted, supporting by the armpits, while his legs are pressed to the body).
- Symptom Mondonesi (painful pressure on the eyeballs).
- Symptom of ankylosing spondylitis (pain while tapping the zygomatic arch).
- Hypersensitivity to irritants, photophobia.
In children
It is difficult for an adult to endure a disease such as encephalitis meningitis. The consequences in children can be even more tragic, as they rarely complain of malaise, do not notice insect bites and have reduced immunity. Boys get sick more often than girls, and the disease goes worse.
To protect your child, you need to dress him warmer in the spring and autumn, consult a doctor on time at the slightest sign of malaise, and examine him every couple of hours on the street in the summer for tick bites and other blood-sucking insects.
Diagnostics
For a doctor, it is first and foremost important to confirm the diagnosis of encephalitis meningitis. Is he contagious? Of course. Therefore, the patient must be placed in a separate box or in the infectious ward, after conducting a preliminary epidemiological survey. Then it is necessary to collect an anamnesis of life and health, to find out complaints. Physical examination consists of checking meningeal signs and measuring temperature. For laboratory tests, blood and cerebrospinal fluid are taken.
In the general blood test, an increase in the level of leukocytes with a predominance of young forms, the absence of eosinophils and a sharply increased ESR to sixty millimeters per hour are noted. The liquor will be cloudy, opalescent, with a greenish tint. 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 sown on a nutrient medium.
Treatment
If an ambulance or emergency room doctor suspects encephalitis meningitis, then the patient is immediately hospitalized in a neurological hospital. Treatment begins immediately, without waiting for laboratory confirmation of the diagnosis. A strict bed rest, a high-calorie diet is observed.
Begin with symptomatic and pathogenetic therapy. First of all, you need to cleanse the body of toxins that bacteria produce, as well as reduce intracranial pressure and thin the blood. For this, the patient is injected saline with glucose and diuretics. Because excessive flooding of the body can lead to a wedge in the medulla oblongata and instant death. In addition, drugs to improve microcirculation, vasodilators and nootropics support brain activity.
Etiological therapy consists of antibiotic therapy (benzylpenicillins, fluoroquinolones, cephalosporins).
Exodus
It all depends on how quickly and successfully encephalitis meningitis has been treated. The consequences may be minor if assistance is provided in a timely manner. And at the same time, with a severe and rapid course of the disease, mortality reaches eighty percent. There may be several reasons for this:
- cerebral edema and its wedging;
- cardiopulmonary failure;
- sepsis;
- DIC.
Prevention
Encephalitic meningitis can be prevented by vaccinating children from two to five years old among those at risk. It is also recommended for people after sixty-five years. This vaccine is included in the official WHO vaccination schedule and is used in most countries of the world.
At the moment, in third world countries, the public is still afraid of the diagnosis of encephalitis meningitis. Can he be cured? Yes, of course. But success depends on how quickly assistance was provided and how.