Symptoms of serous meningitis in children: incubation period of the disease, consequences, treatment and prevention. The main signs of serous meningitis Serous meningitis infectious diseases

Serous meningitis is a rapidly developing inflammatory process that affects the lining of the brain. In 80% of cases, it is caused by viruses and bacteria. The disease is more susceptible to children aged 3-6 years. In medical practice, there are cases of the disease in schoolchildren and adults, but their number is extremely small.

Symptoms of serous meningitis in children

The first symptoms of serous meningitis appear as early as 1-2 days and are called "meningeal syndrome". These include:

a rapid jump in body temperature up to 40 degrees;
constant headache (aggravated by movement of the eyes, bright light and loud sounds);
convulsions;
increased irritability;
weakness;
pain in muscles and joints;
problems in the gastrointestinal tract (nausea, vomiting, diarrhea, abdominal pain);
cough;
runny nose;
sore throat;
dry mouth;
pallor of the nasal triangle;
increased heart rate;
the appearance of spots on the skin;
impaired consciousness (slow reaction, stupor);
problems caused by nerve damage (strabismus, difficulty swallowing);
respiratory paralysis;
in infants, the fontanel swells;
I can't touch my chin to my chest.

Symptoms of serous meningitis can be expressed in varying degrees of intensity. After 3-5 days they pass. When they appear, you should immediately consult a doctor and begin treatment. Otherwise, the consequences of the disease can be serious and irreversible.

Causes of the disease

The causes of serous meningitis are distinguished by the nature of the occurrence:

primary - an independent inflammatory process;
secondary - a complication of an already existing infectious or bacterial disease.

The main causative agent are infections of the enterovirus group (Coxsackie, ECHO). The disease can also begin to develop as a result of viruses such as infectious mononucleosis, mumps, influenza, measles, herpes, adenovirus, arenavirus, Epstein-Barr virus (we recommend reading:).

In addition, the causative agents of the disease can be bacteria:

Koch's stick (tuberculosis);
syphilis;
pale treponema.

Determination of the cause of serous meningitis is necessary for the appointment of antimicrobial therapy. It is worth remembering that timely treatment allows you to quickly cope with the disease and minimizes the risk of any complications.

Who is at risk?

Because serous meningitis is an infectious disease, it primarily affects people with weak immune systems. That is why the disease most often occurs in children aged 3-6 years, because the protective functions of their body have not yet been fully formed.

Serous meningitis can also affect adults and school-age children. This is possible only as a result of severe exhaustion of the body, chronic diseases, regular stress, malnutrition, severe hypothermia, lack of vitamins and minerals. Often meningitis occurs in people with cancer and immunodeficiencies.

The risk group also includes people living in conditions that do not meet the requirements of sanitary standards. Such premises are an excellent place for the reproduction of various infections.

Ways of infection

Infections that cause serous meningitis enter the body in a variety of ways. Sometimes there is infection of the child from the mother during pregnancy, with blood transfusions and bites of insects and dogs. Such cases are extremely rare. The most common ways are airborne, water and contact. Let's consider each of them in more detail.

Airborne

Airborne infection is transmitted when it is located and multiplies on the mucous membrane of the respiratory tract of a sick person. During coughing, sneezing, kissing or talking, the virus enters the air through saliva, quickly spreads and settles on the nasopharyngeal mucosa of people around.

Water

In recent years, serous meningitis in children has become seasonal. The number of sick people increases significantly in the summer. The fact is that enteroviruses that provoke the disease do not die in the water, so during the swimming season there is a high probability of infection through the dirty water of various reservoirs and pools.

Contact

Viruses constantly settle on objects surrounding an infected person. Upon contact with such things, an infection occurs in a healthy body. Failure to follow the basic rules of personal hygiene, unwashed vegetables, poor quality drinking water can cause infection that provokes the development of serous meningitis.

The first signs of the disease and the incubation period

The incubation period of the disease is 2-10 days. It depends on the human immune system. The first signs by which meningitis can be recognized include:

Kernig's symptom - it is impossible to unbend the legs bent at a right angle;
tripod symptom - it is impossible to sit straight (the body is tilted forward, and the head and arms are back);
the upper symptom of Brudzinsky is automatic bending of the legs when the head is tilted forward;
the average symptom of Brudzinsky - during pressure in the lower abdomen, the legs are involuntarily pulled up to the body;
lower Brudzinsky syndrome - when you try to straighten one leg, the second will bend;
symptom of ankylosing spondylitis - when you press the cheekbone, the muscles of the face contract;
Pulatov's syndrome - painful sensations with a sharp touch of the skull.

Signs of damage to the cranial nerves can also be:

heat;
deterioration of vision and hearing;
double vision;
nystagmus - involuntary fluctuations of the eyes;
ptosis - drooping of the upper eyelid;
strabismus;
disturbance of consciousness;
increased agitation or drowsiness;
hallucinations.

A dangerous sign is the appearance of a rash. It has the appearance of red or pink spots that disappear when pressed. They first appear on the legs and quickly spread throughout the body. After a few hours, the spots become bluish in color with a darker center.

When such a rash appears, you should immediately call an ambulance team, otherwise a fatal outcome is possible. These spots are the necrosis of tissues as a result of the onset of blood poisoning, provoked by meningococcus.

The mechanism of development of serous meningitis

The development of serous meningitis includes the following stages:

The infection enters the body and the inflammatory process begins. How long it takes depends only on the protective functions of the body. In this case, the active reproduction of the virus (incubation period) occurs.
As a result of this, there is a violation of hemodynamics and, as a result, an increase in cerebrospinal fluid (cerebrospinal fluid), which causes meningeal syndrome.
In the future, there is a thickening of the membranes of the brain, as a result of which serious complications can occur.

Ways to treat meningitis in children

Treatment of serous meningitis is carried out exclusively in a hospital under the supervision of specialists. This is necessary for constant monitoring and prevention of the development of severe complications. The course of therapy includes mandatory drug treatment and the creation of all conditions for a speedy recovery.

The therapy regimen is prescribed only after finding out the root cause of the disease (bacteria or virus):

Antibacterial drugs are used to treat meningitis caused by various kinds of bacteria. These include broad-spectrum antibiotics ("Ampicillin", "Bilmitsin", "Amoxicillin", etc.). Their feature is the addiction of bacilli to drugs, so it is not recommended to use them for more than a week. In this case, you just need to replace the medicine with another one.
With viral meningitis, antiviral drugs are prescribed (Acyclovir, Artepol, Interferon).
As the disease develops, a large amount of fluid accumulates in the head, which increases intracranial pressure. To remove fluid, diuretics are prescribed (Furosemide and Lasix). If there is no result, a lumbar puncture is done.

To reduce the number and intensity of seizures, sedatives are prescribed (Seduxen or Domosesdan). They are absolutely safe for children and are not addictive.

The following actions will also help to speed up recovery and alleviate the general condition of the child:

creating subdued lighting (in patients, sensitivity to bright light is significantly increased);
maintaining a calm psychological atmosphere (stress and nervous tension are contraindicated for the child);
taking multivitamin preparations (to maintain the protective functions of the body);
diet (it is not recommended to eat hot food, sweet, fatty, sour, salty).

Consequences of the disease

With timely access to a doctor, the consequences of viral meningitis are minimal or non-existent. At an advanced stage of the disease, as a result, there may be:

regular headaches;
sleep problems;
memory impairment;
poor perception of new information;
convulsions;
deterioration of hearing and vision (in rare cases, their complete loss is possible);
developmental delay;
speech disorder;
epilepsy;
violations in the work of the motor apparatus;
weakening of the muscles of the limbs;
paralysis.

Such consequences are possible only in the most severe cases. That is why, at the first signs of serous meningitis, it is necessary to immediately contact a specialist.

Only doctors can confirm the diagnosis and prescribe therapeutic measures. In such cases, it is impossible to self-medicate in any case, otherwise a fatal outcome is possible.

Prevention

To minimize the possible occurrence of viral meningitis, prevention is necessary, namely:

swim only in permitted and verified places;
observe personal hygiene and teach the child to do so;
wash all fruits and vegetables thoroughly;
drink boiled or purified water;
use personal towels and cutlery;
live a healthy life;
Healthy food;
temper;
during epidemics, stay away from large crowds of people;
follow the vaccination schedule.

Serous meningitis is a very dangerous and serious disease, equally for children and adults. With this disease, inflammation occurs in the membranes of the brain.

According to etiology, the following types of serous meningitis are distinguished: fungal, viral and bacterial (syphilitic, tuberculous, etc.) meningitis. In addition, there are primary and secondary forms.

Primary meningitis occurs due to a primary lesion of the meninges, which is not preceded by any infectious agents. Secondary damage to the meninges occurs after an infection, as a complication.

The most benign form of meningitis is the one that was caused by viral infections. The disease proceeds without serious complications, and with timely treatment by highly qualified specialists, it passes without a trace. If the treatment was late, or was not entirely adequate, then in the case of viral meningitis, the consequences for an adult or a child can be very sad.

How is serous meningitis transmitted and what is it?

What it is? Serous meningitis is a rapid lesion of the meninges of the brain, which is characterized by a serous inflammatory process, the causative agent of which can be viruses, bacteria or fungi.

Inflammation of the meninges develops rapidly. The main reason is representatives of the group of enteroviruses. It is easy to become infected or become a carrier of the virus in the following situations:

Contact infection. Bacteria and microorganisms enter the body with dirty food - fruits and vegetables with particles of dirt, when drinking unsuitable water for drinking, and neglecting the rules of personal hygiene.
Airborne serous meningitis is transmitted when the pathogen is localized in the mucous membrane of the respiratory tract. When coughing, sneezing, infectious agents, being in the air in the form of an aerosol, enter the body of a healthy person with contaminated air.
This virus is most likely to catch when swimming - in ponds, pools, and the highest chance of getting infected in people with weak immunity.

Especially dangerous is serous inflammation of the lining of the brain for children of the first year of life - during this period, exposure to infectious agents has such a detrimental effect on the children's brain and nervous system that it can cause mental retardation, partial impairment of visual and auditory functions.

Specific Symptoms

When examining a person with serous meningitis, the symptoms are expressed in excessive tension of the neck muscle group, their rigidity, that is, the inability to bring the chin to the chest.

There are also several meningeal symptoms, such as:

Kernig's symptom - the inability to straighten the leg bent at a right angle.
Symptom Brudzinsky: lower - if you unbend one bent leg, this leads to reflex flexion of the second leg, upper - if the head is bent, the legs involuntarily bend.

All these symptoms of serous meningitis can be expressed to varying degrees, to a lesser or greater extent, in very rare cases, these signs can be combined with a generalized lesion of other organs.

signs

In the prodromal, or intermediate stage between the incubation period and the disease itself, there is a slight increase in temperature, weakness, loss of appetite.

On average, the period lasts up to 3 weeks, and then there are direct signs of serous meningitis:

the temperature rises to 38 degrees and even higher;
sharp headache in the forehead and temples;
pain in the eyes, pain when looking from one object to another;
nausea, vomiting;
photophobia;
dizziness.

In children, in addition to the described symptoms, there are:

hallucinations;
rave;
swelling of the fontanel in young children;
convulsions.

Some patients have only a slight malaise, which is often attributed to overwork. That is why, if serous meningitis is suspected, it is necessary to conduct a diagnosis.

Symptoms of serous meningitis in children

Adults get sick with serous meningitis very rarely, since their immunity is already “familiar” with many different infections. But the children's body is just beginning to "master" the world, including learning new viruses. Therefore, their body reacts violently to the infection. Serous meningitis in children is quickly diagnosed and easily treated.

At the very beginning, this disease in children is very acute, and its symptoms are pronounced, that is, the child's temperature rises, which sometimes reaches 40 degrees, the child feels pain in the muscles and a constant headache appears. In addition, with the disease, diarrhea and vomiting are possible, the child becomes restless, his stomach may hurt or cramps may appear, and the patient may become delirious in a dream.

Very often, against the background of the main symptoms, serous meningitis in children is also manifested by signs - sore throat, cough, runny nose, eye sensitivity. The child becomes easier in a darkened room in a pose on his side with his head thrown back.

Serous meningitis in adults: symptoms

In the case of this type of meningitis, the first symptoms in adults are mild. These can be: general weakness, weakness, mild headache, sore throat and sore throat, cough, runny nose.

Such symptoms are typical for various acute respiratory viral infections that are easily treatable, so most patients do not pay much attention to them, in extreme cases, they begin to take various drugs aimed at improving well-being.

Obvious symptoms of serous meningitis in adults are:

high body temperature;
migraine-type headache that does not stop even after taking an anesthetic;
vomiting without nausea, regardless of food intake;
chills, fever, clouding of consciousness;
state of delirium, hallucinations;
abdominal pain, indigestion, diarrhea;
irritability;
lack of appetite;
convulsions, loss of consciousness (in severe cases).

In the cerebrospinal fluid of the patient, an increased level of lymphocytes is noted. Diagnosis is based on the data of lumbar puncture, laboratory diagnostics of blood and urine.

Treatment

If there is any suspicion of meningitis, you should immediately call an ambulance and hospitalize the child or adult in a hospital.

In view of the viral etiology of the disease, the use of antibiotics is impractical. Arpetol, interferon, acyclovir can play a significant role in the treatment of serous meningitis in children and adults.

With immunodeficiency, the patient is prescribed a course of normal human immunoglobulin, donor and placental gamma globulin. If serous meningitis is provoked by measles, then anti-measles immunoglobulin is used, influenza - anti-influenza.

Dehydration is essential to reduce intracranial pressure, so diuretics are prescribed - Lasix, Furosemide. At temperatures above 38C, paracetamol, ibuprofen are used. Also, each patient is prescribed antihistamines, which relieve fever and the main signs of meningeal syndrome. Such drugs include suprastin, tavegil and the well-known diphenhydramine.

With timely adequate treatment, serous meningitis in children, unlike purulent ones, is benign, does not last long and rarely causes complications.

Consequences of serous meningitis

According to doctors, half of the patients who have recovered from meningitis still feel health problems for many years. After meningitis, patients complain of difficulty remembering information, spontaneous muscle contractions, and mild migraine-like pain.

But these complications are typical for mild forms of the disease. If the disease proceeded difficult, then a person may even lose hearing or vision. In addition, some forms of this disease can provoke a disruption in the functioning of the brain and difficulties with mental activity.

In fairness, it must be said that, fortunately, such consequences of the disease occur only in one and a half percent of all those who have undergone this disease. But in very rare and complex cases, this disease can even lead to death.

Serous meningitis is an inflammatory disease affecting the lining of the brain and spinal cord. Most often, the cause of its development are viruses (cause approximately 80% of cases), some bacteria (tuberculosis bacillus, pale treponema), pathogenic fungi.

Inflammation of a serous nature can also occur with some systemic diseases, tumor lesions of the brain, its membranes or skull bones. In general, serous meningitis is milder than purulent meningitis and, unlike the latter, most often occurs in children under 6–8 years of age against the background of reduced immunity.

Forms of serous meningitis

The classification of the disease is based on the etiology and type of pathogen. There are several main varieties of serous meningitis, which, in addition to the causes of the pathology, have a number of clinical features:

viral forms. They are the most common types of serous meningitis. Most often, the causative agents are the Epstein-Barr virus, enteroviruses, paramyxoviruses, Coxsackie virus, less often - influenza, measles, polio viruses.
bacterial forms. In most cases, there is purulent inflammation with a more severe course. The exceptions are Mycobacterium tuberculosis and syphilis pathogens (spirochetes or pale treponemas). Isolated forms of serous meningitis caused by these infectious agents are extremely rare. Usually, inflammation of the meninges in this case is part of a complex symptom complex with damage to other organs and systems (miliary tuberculosis, neurosyphilis).
fungal forms. They are extremely rare in people with a greatly reduced activity of the immune system (with AIDS, radiation sickness, after chemotherapy). The causative agents are fungi from the genus Candida or (less often) Cryptococcus.
Other forms. This group includes varieties of the disease caused by protozoal invasion (toxoplasmosis), systemic and autoimmune pathologies, tumors of the nervous system and skull bones. Serous meningitis in adults most often belongs to this group.

Causes of serous meningitis

The main cause of serous meningitis is infection of the membranes of the brain and spinal cord with viruses, some types of bacteria or fungi, sometimes the disease occurs as a result of autoimmune tissue damage in systemic diseases. However, in a healthy person, the infection process is complicated by a number of factors - first of all, the activity of the immune system and the presence of the blood-brain barrier.

Viral forms of serous meningitis are often complicated by the transition of the inflammatory process to the brain tissue, thereby leading to the development of meningoencephalitis.

Viral forms of serous meningitis in young children can occur as a result of primary infection with enterovirus, Epstein-Barr virus and other pathogens. At an older age, inflammation of the meninges occurs against the background of an already existing viral disease, for example, mumps, influenza, measles. In this case, the primary disease reduces the activity of the body's defenses and additionally creates a significant reservoir of infection, which facilitates the development of meningitis.

In adults, viral forms of serous meningitis, with the exception of acute lymphocytic choriomeningitis, occur only against the background of immunodeficiency. It is caused by a virus carried by rodents (eg rats) and excreted in their urine and feces. This type of pathogen can cause disease in perfectly healthy people.

Bacterial types of serous meningitis in adults and children (tuberculous and syphilitic forms) occur against the background of an existing underlying disease - tuberculosis of various organs or syphilis. The latter at the terminal stages of development is complicated by neurosyphilis - damage to the central nervous system, including the meninges.

Fungal forms of meningitis always occur against the background of a strong decrease in immunity. In all cases of the disease, pathogens penetrate the meninges by the hematogenous route - from the "entrance gate" or the primary focus of infection in the body.

Symptoms of serous meningitis of viral etiology, despite a wide variety of pathogens, are quite similar. The incubation and prodromal periods take from 5 to 20 days from the moment of infection with the virus, but in some cases the disease develops due to the pathogen persisting in the body. An example of this form of pathology is meningitis caused by herpes viruses (for example, the Epstein-Barr virus). In this case, it can take several months or even years from the moment of infection to the development of the disease. In the prodromal period, nonspecific symptoms may appear - weakness, fatigue, drowsiness, a slight increase in temperature.

Viral serous meningitis in children usually begins acutely, with a rise in temperature to 40–41 ° C, however, the phenomena of increased intracranial pressure (repeated vomiting, severe headache, convulsions) are much less pronounced than in the purulent form of the disease. On the 2-3rd day from the onset of the disease, neck stiffness occurs, meningeal symptoms are recorded - Kernig, Brudzinsky, Guillain. In most cases, a combination of high fever and signs of irritation of the meninges are the only manifestations of the disease. Sometimes they are joined by signs of damage to the nervous system - strabismus, a change in mental state, convulsions, paresis. This indicates the involvement of the brain and nerves in the process and adversely affects the prognosis of the consequences of serous meningitis.

Tuberculous meningitis, unlike viral meningitis, is characterized by a gradual increase in manifestations. A patient with tuberculosis of the lungs, bones, skin or other organs first experiences headaches, nausea, vomiting for no reason for several weeks. Then, these symptoms of serous meningitis are joined by typical, but mild symptoms of Kernig, Brudzinsky, muscle tension in the back of the head and neck. In the absence of treatment, the cranial nerves are damaged, primarily the oculomotor nerves, which is manifested by strabismus, anisocoria, and accommodation disorders.

Syphilitic meningitis can occur both acutely and with slow development.

Treatment of serous meningitis is divided into etiotropic (aimed at eliminating the pathogen) and symptomatic.

Diagnostics

To diagnose serous meningitis of viral etiology, the method of neurological examination, the collection of cerebrospinal fluid (puncture), and serological diagnostic methods are used. When examining and questioning the patient, a special role is assigned to the study of the anamnesis - what viral diseases he suffered shortly before the development of symptoms of inflammation of the meninges. Quite often, this allows you to pre-determine the pathogen even before receiving the results of serological tests. The main criteria for the presence of serous meningitis are the so-called meningeal symptoms detected during a neurological examination:

Kernig's symptom - the patient, lying on his back and bending his leg at the hip joint, is unable to straighten it (unbend at the knee).
Brudzinsky's symptoms are a group of neurological manifestations that are recorded in meningitis of any nature. The patient bends his legs if he bends his head forward (upper symptom) or presses on the pubis (pubic symptom). Pressure on the cheek causes the shoulders to rise and the arms to flex at the elbows (cheek symptom).
Guillain's symptom - the patient is pressed on the region of the quadriceps femoris muscle, which leads to flexion of the second limb in the thigh and knee.

Laboratory research methods used for serous meningitis of any etiology:

Lumbar puncture. Sampling and subsequent analysis of cerebrospinal fluid is necessary to determine the form of the disease. Liquor is transparent, slightly scatters the light passing through it (opalescent). With its microscopic examination, a significant number of lymphocytes is determined.
Serological tests. Detection of antigens of viruses, bacteria or fungi can be carried out in blood or cerebrospinal fluid. This allows you to accurately and reliably determine the nature of the pathogen. It plays a decisive role in the choice of treatment for serous meningitis.

Additional examinations may also be prescribed: electroencephalography, magnetic resonance imaging of the brain, Echo-EG (echoencephalography), tuberculin tests, RPR test (Rapid Plasma Reagin - anticardiolipin test), ophthalmoscopy.

Differential diagnosis of serous meningitis is carried out with purulent forms of the disease, tumor lesions of the meninges, subarachnoid bleeding, tick-borne encephalitis, arachnoiditis.

Treatment of serous meningitis

Treatment of serous meningitis is divided into etiotropic (aimed at eliminating the pathogen) and symptomatic. Therapeutic measures directed directly against the disease-causing agent can only be taken after determining its nature - that is, obtaining the results of serological tests. With viral inflammation of the meninges, antiviral drugs are prescribed. Therapy of tuberculous, syphilitic or fungal forms of serous meningitis is carried out with antibiotics and antifungal agents.

Symptomatic therapy often comes down to the appointment of anti-inflammatory drugs from the group of steroids - they reduce the severity of the process and reduce the likelihood of developing negative consequences of serous meningitis. In addition, vitamin therapy, a special diet can be shown. If one of the causes of the disease was a decrease in immunity, immunostimulating drugs are prescribed as an adjuvant.

During the recovery period, nootropic agents are used that improve the processes of microcirculation and metabolism in the nervous system.

Complications

Viral forms of serous meningitis are often complicated by the transition of the inflammatory process to the brain tissue, thereby leading to the development of meningoencephalitis. In childhood, damage to the nerve centers can have serious consequences - from strabismus and paresis to mental disorders and dementia. At the same time, complications caused by a viral infection are less stable and, with the right approach to treatment, can be reversible.

In adults, viral forms of serous meningitis, with the exception of acute lymphocytic choriomeningitis, occur only against the background of immunodeficiency.

Meningoencephalitis of a tuberculous or syphilitic nature develops more slowly, but leads to severe irreversible brain damage. One of the late complications of tuberculous meningitis is the development of adhesions that impede the circulation and outflow of CSF, which can cause hydrocephalus (in children) or a chronic increase in intracranial pressure (in adults).

Forecast

With properly prescribed treatment, serous meningitis is characterized by a more favorable prognosis than the purulent-inflammatory variety of the disease. The exception is the tuberculosis form. Despite the slower course, it is more difficult to treat and has more severe consequences.

The prognosis is also affected by the level of activity of the immune system - with a significant immunodeficiency, the likelihood of complications, up to death, increases.

Prevention measures

There is no specific prevention of serous meningitis, but vaccines against mumps, measles, influenza, and chicken pox prevent the development of diseases caused by these viruses.

Contact with sick people (both children and adults) should be avoided, since many pathogens of this disease are transmitted by airborne droplets.

Rodent vectors are controlled to prevent acute lymphocytic choriomeningitis in endemic areas.

In order to avoid the development of tuberculous and syphilitic forms of meningitis, it is necessary to observe measures to prevent these diseases (screening measures, exclusion of contact with patients).

Preventive measures are especially important for people with reduced immunity - with immunodeficiency, undergoing treatment for cancer.

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Meningitis is an inflammation of the lining of the brain or spinal cord. It is assumed that this disease was known to Hippocrates and Avicenna, but until the end of the 19th century, the etiology remained a mystery. In 1887, the bacteriologist A. Weikselbaum proved the bacterial nature of the infection. Later, in the middle of the 20th century, a possible viral, fungal and protozoal onset of the disease was also established.

With serous meningitis in the cerebrospinal fluid, there is a predominance of lymphocytic cells, and with purulent meningitis - neutrophils.

An exception is enteroviral meningitis, in which neutrophils predominate in the cerebrospinal fluid in the first week.

Serous meningitis is predominantly caused by viruses.

Serous meningitis is more common in children than in adults.

According to ICD 10, enteroviral meningitis belongs to code A 87.0, and serous meningitis according to ICD 10 is in the viral subgroup - under code A 87. 9.

Epidemiology

Children under 7 years of age are at risk, adults rarely get sick. The disease is characterized by seasonality with a maximum prevalence from February to April. However, the increase in the number of infected occurs already in November.

Such a dependence on the time of year is due to favorable weather conditions (high humidity levels and sudden temperature changes), as well as weakened immunity and beriberi. With a wide distribution, it reaches the scale of epidemics with a frequency of 10-15 years.

The first mass outbreak of meningitis in Russia dates back to 1940. For every 10,000 inhabitants, there were 5 patients. Presumably, the disease has become so widespread due to the rapid migration of people. The next outbreak occurred in the early 70s, however, a reliable cause was established only in 1997. Scientists have found that the cause was a new strain of meningococcus that appeared in China. Residents of the USSR did not develop strong immunity to this strain.

Meningitis occurs in all countries on the planet, however, the highest prevalence is typical for third world countries. The prevalence rate is 40-50 times higher than in Europe.

According to official statistics in Western countries, 3 people are affected by the bacterial form per 100,000 people, and 11 by the viral form. In South America, the number of cases reaches 46 people, in Africa the figure reaches critical values - up to 500 patients per 100,000 people.

Causes (etiology)

The vast majority of the cause of meningitis of the soft membranes of the brain are viruses:

human herpesvirus type 4;
cytomegaloviruses;
adenoviruses;
influenza virus;
measles viruses;
rubella virus;
chickenpox virus;
paramyxoviruses.

The incubation period for serous meningitis depends on the pathogen.

In isolated cases, the serous type of the disease is diagnosed as a complication of a bacterial infection (syphilis or tuberculosis). It is extremely rare that the fungal nature of the disease is detected.

How is serous meningitis transmitted?

Ways of transmission - airborne (sneezing, coughing), contact-household (contact with skin or objects) and water (in summer through swimming in open water). The source of infection is a sick person or carrier of the virus.

Also known is a non-infectious (aseptic) form of the disease that accompanies oncological pathologies.

Pathogenesis

There are 2 ways of penetration of the pathogen to the soft membranes of the brain:

hematogenous - a pathogen from the area near the underlying inflammatory focus penetrates into the bloodstream and reaches the soft membranes.
lymphogenous - the virus spreads with the flow of lymph.
contact is realized due to the migration of viruses from the ENT organs located in close proximity to the brain.

When pathogens reach the soft membranes of the brain, they actively reproduce and form a focus of inflammation. Until the introduction of effective treatment, patients with meningitis died at this stage, mortality rates were close to 90%.

Signs of infection in children

The first signs of serous meningitis in children are similar to those of other infectious diseases. These include:

a sharp increase in body temperature, often to critical values \u200b\u200b(40 ° C);
prolonged acute pain in the head;
recurring vomiting fountain;
photophobia;
the appearance of meningeal signs;
numbness of the neck muscles, it is difficult for the child to tilt and turn his head;
indigestion, decrease or complete loss of appetite;
children very often have prolonged diarrhea;
in the case of contact penetration of the virus into the brain, a sharp change in the behavior of the child is noted: excessive activity or passivity, hallucinations are not excluded.

Important: you should immediately consult a doctor at the first signs of a manifestation of viral meningitis in a child.

Timely diagnosis and an adequately designed course of therapy will avoid serious consequences and complications.

Symptoms of serous meningitis in children

Minor signs of the disease may appear on the first day after infection with the virus, while the infection itself is in a latent phase. The typical clinical picture is observed 7-12 days after infection.. The main symptoms of serous viral meningitis in a child include:

subfebrile fever, chills;
excessive sensitivity to external factors (light, sound);
confusion, loss of orientation in time and space. Serous meningitis in children in severe form can lead to a coma;
refusal of food;
vomiting fountain;
violation of the chair;
convulsive symptoms;
on palpation, there is an increase and soreness of the lymph nodes, which indicates the penetration of the virus into the lymphatic system;
Kernig's symptom is specific for serous meningitis. In this case, the patient cannot independently unbend the legs in the knee joint as a result of excessive tension of the hip muscles;

the lower symptom of Brudzinsky, which is characterized by involuntary movement of the lower extremities as a result of tilting the head;
ankylosing spondylitis - a spasm of the facial muscles that occurs in response to a mechanical effect on the facial arch;
Pulatov's symptom - pain syndrome even with light tapping on the parietal and occipital region;
Mendel's symptom is manifested in pain when pressed in the area of the external auditory canal;
in newborn children, Lesage's symptom is diagnosed - pulsation and an increase in the membrane over the fontanel. When lifting the child under the armpits, the head involuntarily tips back, and the legs are reflexively drawn up to the stomach.

Symptoms of serous meningitis in adults

The disease is more susceptible to young men from 20 to 30 years. Pregnant women are included in the risk group, since at this time the natural defenses of the body are significantly reduced.

Signs of the viral form of serous meningitis in adults are similar to those in children: the general condition worsens, weakness, pain in the head and neck, fever, impaired consciousness and confusion of orientation.

In adult patients with high immunity, the disease can proceed in a sluggish form, while all symptoms are mild and their relief occurs soon after the start of therapy. The outcome is a complete recovery, without consequences.

In addition to the above symptoms characteristic of children, adults may experience atypical manifestations of viral meningitis:

there is a sharp deterioration in vision, the development of strabismus is possible;
hearing loss;
cough, runny nose, sore throat, difficulty swallowing;
pain syndrome in the abdominal region;
convulsive contractions of the limbs;
epileptic seizures without movement disorders;
heart palpitations and high blood pressure;
behavioral changes - aggressiveness, delirium and irritability.

Only the attending physician can correctly diagnose serous meningitis in children and adults. It is important to go to the hospital as soon as possible at the first signs of the disease in order to select and implement a course of therapy as soon as possible. Such tactics will avoid complications and consequences of the disease, the most severe of which is a fatal outcome.

Primary diagnosis

The first stage of diagnosis consists of a triad of specific syndromes:

meningeal complex of symptoms similar in etiology and pathogenesis. The complex consists of clinical manifestations affecting the membranes of the brain and the organ as a whole. There are cases of critically severe headache, in which patients fell into an unconscious state. Often - patients scream and groan in pain, clasp their heads in their hands.

Diagnosis of shell (meningeal) symptoms consists of a neurological examination of the patient, with testing the reaction to light, sound and mechanical stress. With serous meningitis, each of these tests gives the patient a sharp pain.

general syndrome of intoxication of the human body;
pathological changes occurring in the cerebrospinal fluid. This symptom is given a leading place in the diagnosis.

Even with the manifestation of the two previous symptoms, in the absence of inflammatory processes in the cerebrospinal fluid, the diagnosis of meningitis is not made.

Specific Methods

If it is difficult to make an accurate diagnosis in medicine, additional diagnostic methods are used. A bacteriological study of exudate of the nasal passages and cerebrospinal fluid is carried out.

In order to identify bacterial cells (Neisseria meningitidis) and microscopic fungi in the biomaterial, the fixed preparation is Gram-stained and microscoped. A pure culture is obtained by culturing the biomaterial on blood agar media. Then the pathogen is identified by biochemical and antigenic properties.

This technique is used exclusively for the diagnosis of a bacterial infection (with purulent meningitis), since the cultivation of viruses on nutrient media is impossible. Therefore, for their isolation, serological diagnostics (enzymatic immunoassay) is used - the identification of the titer of specific antibodies. A 1.5-fold increase in titer is diagnostically significant.

The polymerase chain reaction method is considered the "gold standard". In this case, specific sections of the nucleic acid (DNA or RNA) of the pathogen are identified. The advantages of the technique are short terms, the highest sensitivity, a guarantee of results and reliability even at the stage of antibiotic therapy.

Treatment of serous meningitis

The first signs of the disease can appear as early as a day after contact with a sick person. Therefore, if you suspect a possible infection, you should immediately consult a doctor. It is strictly forbidden to independently select a treatment regimen. According to statistics: 95% of cases in which alternative therapy methods are used end in the death of the patient.

When the diagnosis is confirmed, the patient is hospitalized in a special department of the infectious diseases hospital. In severe forms of the disease, the patient is placed in intensive care until stable relief of symptoms. The patient must be under round-the-clock medical supervision. personnel, as a sharp deterioration in the condition is possible.

Etiotropic therapy

Methods of etiotropic therapy are aimed at the destruction of the pathogen and its complete removal from the human body. The bacterial form of meningitis requires mandatory antibiotic therapy. If it is impossible to isolate and identify strains (difficult-to-cultivate forms, lack of time for bac. research), the antibiotic is selected empirically.

At the same time, preference is given to antibacterial drugs with a wide range of effects, in order to cover all possible variants of pathogens. Required injection of the drug.

With the viral nature of the infection, preparations based on interferon and glucocorticosteroids are used. The selection of medications is carried out taking into account the species of the viral infection.

With a herpes infection, anti-herpetic drugs are prescribed.

Be sure to prescribe diuretics that increase the excretion of urine and fluid from the body.

Symptomatic treatment is carried out: antipyretic and analgesic drugs, anticonvulsant therapy, diuretics (with cerebral edema), etc. When selecting a regimen for the treatment of serous meningitis in young children, the minimum age for each drug must be taken into account.

Consequences of serous meningitis in children

With the timely provision of qualified medical care, the prognosis of serous meningitis is favorable. The outcome of the disease is complete recovery after a week of treatment. However, pain in the head can persist for several weeks.

Possible options for complications with a delay in diagnosis and therapy:

hearing loss;
epilepsy;
hydrocephalus;
mental retardation in younger patients.

Self-medication or drawing up an illiterate therapy regimen leads to death.

Measures to prevent serous meningitis by contact

It is recommended to limit contact with a sick person, communication only using gauze bandages or respirators; obligatory thorough washing of hands after communication; avoid traveling to countries with a high incidence rate and swimming in water bodies in their territory.

Vaccination

Currently, vaccines have been developed against some pathogens of serous meningitis (measles, rubella, etc.).

There are also vaccines against the main pathogens of purulent meningitis.

Diseases, one way or another connected with the brain, are among the most dangerous. These include serous meningitis - inflammation of the pia mater of the brain of a serous nature. In our article, we tried to tell as fully as possible about the pathogenesis, etiology and treatment of serous meningitis in children, prognosis and preventive measures.

Description of the disease

Serous meningitis most often occurs in preschool children from 3 to 6 years old, less often in schoolchildren. This is the period when the body is in the active stage of growth, all the resources of the body are directed to development, and therefore the body is weakened. At the same time, the immune system is not fully formed: it is easier for bacteria, viruses and other pathogenic microorganisms to penetrate the child's body and infect it.

Serous meningitis is an inflammatory process of the internal pia mater. The disease has the ICD-10 code A87.8 and is categorized as "other viral meningitis".

IMPORTANT! Outbreaks of serous meningitis in childhood are more common in summer.

The peculiarity of this form of meningitis is that it affects the inner membranes of the brain, and sometimes the brain itself. It also differs from other forms of meningitis in its manifestation features: the first symptom is a sharp and severe increase in temperature, which disappears without a trace after a few days, and reappears a few days later.

Another characteristic feature of serous meningitis is that it does not cause necrosis of individual tissues and the release of purulent exudate.

Ways of infection and causes

About 80% of infections are caused by viruses.

The causative agents are enteroviruses, influenza virus, herpes, cytomegalovirus, adenovirus, Epstein-Barr virus, paramyxovirus, polio and measles viruses.

The second most common source is bacterial infections (tuberculosis, syphilis), the third is fungal infections.

Infection occurs in the following ways:

airborne(when talking to a patient, with sneezing, coughing, breathing);
contact(with tactile contact with the patient or objects on which there is an infection);
water(while bathing during an outbreak of enteroviral meningitis).

Serous meningitis of a non-infectious type (secondary) can occur against the background of brain tumors, cysts and some systemic diseases (measles, chickenpox, poliomyelitis, mumps).

REFERENCE! In medical practice, there are cases of infection with viral lymphocytic choriomeningitis, or Armstrong's meningitis. The source of the disease is water and products contaminated with biological products (urine, saliva, feces) of infected mice and rats.

Symptoms

If serous meningitis is caused by viruses, the incubation period lasts from 3 to 18 days. After an infection enters the body, the following symptoms are observed:

Fever, an increase in body temperature up to 40 degrees, sometimes in two stages (a sharp increase - normalization - a repeated increase in a few days).
Severe, persistent headaches, which are aggravated by moving the head, eyes, in bright light, sharp sounds.
Weakness and general weakness, lethargy, drowsiness.
Pain in muscles and joints.
Nausea and vomiting.
Weight loss.

IMPORTANT! The acute period of serous meningitis lasts 3-5 days.

Although the symptoms may resemble the flu, food poisoning, tick-borne encephalitis, and some other diseases, meningitis has some distinctive features:

taking analgesics does not relieve headaches, the temperature does not go astray;
the patient is unpleasant to touch, the presence of any sensory stimuli, i.e. he prefers to be in a dark, quiet place alone;
an infected child often lies on his side, pressing his knees to his chest, and his head thrown back.

REFERENCE! There is a simple way to help distinguish serous meningitis from other diseases. Put the baby on the table and try to press the chin to the chest. With meningitis, this is almost impossible.

Other meningeal symptoms include:

inability to straighten the leg bent at a right angle (Kernig's symptom);
Brudzinsky's symptom: if one leg is unbent, the second bends reflexively, or if the head bends, the legs involuntarily bend.

Development mechanism

Serous meningitis is predominantly a viral disease. It goes through several stages:

incubation period. When a virus enters the child's body (with food, water, through household items, while breathing, etc.), it penetrates to the membranes of the brain through the blood, lymph, cerebrospinal fluid and begins to actively multiply. Invading the tissue membranes, the virus causes inflammation, the first signs of the disease appear, including fever. The period can last up to 14 days.
IMPORTANT! If at this stage the disease was not detected, a severe course begins. In 90% of cases, it ends in death.
Pathogens provoke active selection transparent serous-fibrous fluid, due to which milliary tubercles appear in the affected area.
reproductive stage. The virus infects the walls of the vessels of the brain, a nonspecific allergy occurs. Normal tissue is replaced by connective tissue.
Cerebral edema occurs some brain centers are affected.

If the child has a strong immune system, the virus will die before it reaches the meninges.

Treatment

If serous meningitis is diagnosed, the child is placed in a hospital.

Medical complex treatment is used, which includes taking drugs:

antibacterial / antiviral;
immunoglobulin (with reduced immunity);
broad-spectrum antibiotics;
diuretics (drugs that remove excess fluid from the body so that cerebral edema does not form);
antispasmodics (medicines that reduce headaches);
solutions to reduce the symptoms of intoxication (intravenously);
antipyretic (at a temperature above 38 degrees);
vitamins of group B, C and others.

Effects

Despite the severe acute period of the disease, which can last up to two weeks, serous meningitis, with timely treatment, does not pose a serious threat to the health of the child and passes without a trace. In this, the serous type is much more benign than the purulent one.

Rarely, the consequence of serous meningitis is liquor-hypertension syndrome. In some cases, if the disease has been neglected, frequent headaches, asthenia, emotional problems (frequent mood swings, tearfulness, capriciousness), memory impairment, and difficulty concentrating may persist after recovery. As a rule, these effects finally disappear after a few weeks or months.

Tuberculous meningitis is known to be the most terrible consequences. If the diagnosis was not made on time, anti-tuberculosis drugs were not prescribed, a lethal outcome is possible after 3-4 weeks. If treatment was started late, relapses and complications may occur.

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