Purulent and serous: why is it important
It is impossible to distinguish them by external signs in the first hours, so tactics always proceed from the worst option: hospitalization and examination, rather than waiting.
- Bacterial (purulent) meningitis - caused by meningococcus, pneumococcus, hemophilus influenzae. Develops quickly, over hours, is severe and requires immediate intravenous antibiotics
- Viral (serous) meningitis - most often enteroviruses. It is much easier, usually ends in recovery, antibiotics are not needed
- Tuberculous meningitis - develops slowly, over weeks, with increasing headache and weakness
- Fungal - mainly in people with immunodeficiency
Symptoms
The classic triad is high fever, severe headache and stiff neck. But it does not happen to everyone, especially infants and the elderly.
- A sharp, growing headache that is not relieved by conventional analgesics
- Vomiting that is not associated with food and does not bring relief
- Inability to tilt your head forward due to neck muscle tension
- Photophobia, sound intolerance, person lies facing the wall
- Confusion, dazedness, seizures
- With meningococcal infection - hemorrhagic rash, most often on the legs and buttocks
Features in children under one year old
- Bulging and tension of the large fontanel
- Monotonous, high-pitched scream that cannot be calmed down
- Throwing back the head, arched back pose
- Refusal of breast and bottle, vomiting
- Unusual lethargy or, conversely, severe anxiety when picked up
- Infants may not have a stiff neck; its absence does not exclude anything.
Diagnostics
- Осмотр с проверкой менингеальных знаков.
- Люмбальная пункция — решающее исследование: анализ спинномозговой жидкости отличает гнойный менингит от серозного и определяет возбудителя.
- КТ головного мозга перед пункцией — при нарушении сознания, судорогах, очаговых симптомах.
- Посевы крови и ликвора, ПЦР на основные возбудители.
- Общий и биохимический анализ крови, показатели воспаления.
Lumbar puncture causes a lot of fear in patients, but it is a safe procedure performed below the end of the spinal cord. Without it, it is impossible to make a diagnosis and choose treatment, and refusing it costs time, which is not available with meningitis.
Treatment and prevention
- Intravenous antibiotics are started immediately, without waiting for culture results - with bacterial meningitis, every hour matters
- Glucocorticosteroids in some cases reduce the risk of complications, including hearing loss
- Intensive care: combating cerebral edema, maintaining blood pressure, anticonvulsants
- For viral meningitis - supportive treatment; in most cases recovery occurs
- Contact persons with meningococcal infection are prescribed antibiotic prophylaxis
Prevention is real and effective: there are vaccines against meningococcus, pneumococcus and Haemophilus influenzae type b. They are included in the vaccination schedules of many countries and are especially important for young children, people without a spleen and people with immunodeficiency.