Fever in meningitis in adults and children

Inflammatory processes in the vast majority of cases are accompanied by a rise in body temperature - from subfebrile to hyperpyretic values. Meningitis, an inflammation of the cerebral membranes of the brain and/or spinal cord, is no exception. The temperature in meningitis can rise up to 41-42°C, and only in rare cases the disease runs smoothly, which, by the way, is considered a particularly dangerous condition: the absence of fever and hidden meningeal signs can cause incorrect diagnosis and, as a consequence, inappropriate treatment measures.

Depending on the type and course of meningitis, the fever may bother in different ways. In some cases, it is easily relieved, but sometimes it indicates the development of complications and even poses a potential threat to the patient's life. [1]

What is the temperature in meningitis?

There is no definite answer to this question, as much depends on the type of infectious agent, the form of meningitis, and the presence or absence of complications. The most common fever in meningitis is febrile (38-39°C), pyretic (39-41°C) and hyperpyretic (above 41°C).

As a rule, temperature indicators begin to rise when the infection spreads to the brain membranes. But in case of immune process failures, disruption of thermoregulatory mechanisms, fever may not be present, which is very dangerous, as it may cause misdiagnosis and loss of precious time.

Difficult to diagnose is also a disease that develops against the background of antibiotic therapy. In such a situation, temperature values are not particularly high and often do not cause concern, keeping in the range of 37.5-38.5°C. Only as the infectious process spreads, there is a sudden deterioration, the temperature rises, neurological signs appear. This development of symptoms is considered extremely unfavorable, and the incidence of fatalities is the highest.

Epidemiology

The causative agents of meningitis in most cases are bacteria (mainly meningococcus), less often - viruses, protozoa. The last place is occupied by fungal infection. Experts note that the development of fungal inflammation of the brain membranes is possible only against the background of weakened immune defense.

The most common fever in meningitis ranges from 38.6-39.6°C. In addition to fever, symptoms such as head pain, vomiting without relief, and meningeal signs (the most obvious being stiffness of the occipital muscles) are common.

Among viral lesions, enteroviral inflammation is the most common (in 74% of cases), and among chronic lesions, tuberculous meningitis is the most common.

Mortality from bacterial lesions is higher than from viral lesions (10% and 1%, respectively). In the absence of treatment, every second patient is fatal.

The disease has a worldwide prevalence, with the highest level in African countries. In Ukraine, Belarus, Russia, the incidence is about 1 case per hundred thousand population. The disease affects people of any age category, but more often the pathology affects young children, preschoolers and schoolchildren (about 65% of patients). The main risk group is children from newborn to 2 years of age (up to 40% of all patients).

Causes of the fever in meningitis

Fever in meningitis is a protective response of the body, which is formed under the influence of various factors. This response is provoked by external, or exogenous pyrogens - foreign substances that enter the circulatory system. They are often infectious pyrogens - in particular, viral toxins and metabolic products of pathogenic microorganisms. In addition, pyrogens can be of non-infectious origin - for example, if we are talking about individual lipids, proteins, protein-containing substances that enter the bloodstream from outside or are formed inside the body during inflammatory or allergic reactions, tumor decay, etc.

Primary pyrogens, when interacting with immune structures, stimulate the production of secondary (internal, endogenous) pyrogens, which are called cytokines. Cytokines influence the thermoregulatory brain center and cause temperature rise.

In general, inflammation and fever in meningitis can develop under the influence of bacteria (mainly meningococci), viruses (more often - enterovirus), protozoa (causative agents of malaria, toxoplasmosis), as well as fungal infection. Rarely, the "culprits" are Koch's bacillus (causative agent of tuberculosis) and pale spirochete (causative agent of syphilis).

There are different ways of infection: experts more often consider the water, contact, airborne route of infection. [2]

Risk factors

Infection most often occurs hematogenously - that is, with blood. Microbial and fungal infection can also spread to adjacent areas locally - for example, as a result of traumatic injury to the skull, or as a complication of otitis media.

Thus, risk factors for infection may include:

• prolonged or regular stay in closed public spaces (dormitories, barracks, etc.);
• visiting public swimming pools, saunas, baths, etc;
• sinusitis, acute or chronic form of purulent otitis media, mastoiditis;
• tuberculosis;
• drug addiction, alcohol abuse;
• immunodeficiency conditions (including HIV infection);
• prolonged therapy with immunosuppressors (after transplant operations) or corticosteroids (treatment of oncologic processes);
• diabetes mellitus, liver cirrhosis, oncopathologies, hemodialysis;
• pregnancy;
• skull fractures, skull base fractures, penetrating head wounds;
• neurosurgical interventions;
• the presence of implants draining the liquor;
• inflammatory processes in the bones of the skull or spinal column.

The absence of fever in meningitis occurs with poor immune system function, morphofunctional immaturity of the body, sometimes - with a mild form of viral lesion.

Pathogenesis

Fever in meningitis begins when the pathogen spreads to the brain membranes. Head and spinal structures have protection from damaging external influences in the form of connective tissue membranes. Through the brain membranes pass nerve fibers and blood vessels. If it enters the bloodstream, the infection through the hematogenous pathway spreads to internal organs, brain and spinal cord, including affecting the cerebral membranes. Vascular walls are damaged, vascular permeability increases. At the same time, fluid accumulation occurs, hydrocephalus is formed, which leads to compression of nearby brain departments. Blood circulation is disturbed, the functional capacity of certain parts of the brain suffers. The probability of infection spreading to the brain matter increases.

In the process of decay of pathogenic pathogens (viruses, bacteria), leukocytes, auxiliary cellular structures, metabolic products are released in the form of endogenous and exogenous pyrogens, which causes an increase in body temperature. Endogenous pyrogens begin to be synthesized as a reaction to the introduction of infection into the body. And exogenous pyrogens are microorganisms and products of their vital activity. [3]

Symptoms of the fever in meningitis

Meningitis can occur in serous and purulent forms, and fever is noted in the vast majority of cases. With serous inflammation in the liquor is dominated by lymphocytes, and with a purulent process, the number of neutrophils increases. Purulent meningitis, in turn, is subdivided into primary and secondary, which depends on whether there was another, the main focus of infection in the body. In addition, experts distinguish tuberculous, syphilitic, hemorrhagic, fungal, lystreliosis meningitis, etc.

Despite the great variety of infectious agents and the underlying causes of inflammation in the brain membranes, the clinical picture of the disease is largely similar. At the same time, the first common signs are fever and headache - the most common symptoms that are noted in almost all patients. They are caused by the development of an inflammatory reaction and irritation of the end segments of the trigeminal nerve and the autonomic nervous system.

No less often noted stiffness of the occipital muscles against the background of the same increase in temperature, depression of consciousness, increased light and sound sensitivity. [4]

First signs

The initial symptomatology of different forms of pathology may differ. For example, meningococcal meningitis manifests itself suddenly: the temperature rises sharply, chills appear. The basic symptomatology is noted during the first 24-48 hours. Hemorrhagic rashes may form on the skin.

Pneumococcal meningitis most often develops against a background of previous inflammation of the lungs, otitis media or maxillary sinusitis. Pathology is prone to a rapid increase in symptomatology, the temperature rise is pronounced, at the same time there are disorders of consciousness and convulsions.

Viral meningitis is characterized by symptoms corresponding to the type of virus, and specific meningeal symptoms appear later. Unlike a disease of microbial origin, in viral lesions the temperature rise is moderate.

Tuberculous meningitis starts with a sudden fever, followed a few days later by head pain and vomiting. From about day 10, there are signs of brain damage.

Meningitis that develops as a secondary disease on antibiotic therapy is difficult to diagnose. In this case, the temperature and headache are moderate and initially may not cause concern (temperature values are within 38°C). Later, a sudden deterioration is noted, neurological symptoms appear. If not promptly recognized and acted upon, the patient may die.

Is the fever brought down by meningitis?

Meningococcal infection is characterized by a rapid rise in temperature to high values (38.5-40°C). The moment of intense fever is difficult to miss, so in most cases, close people or the patient himself can clearly indicate the exact clinical onset of the disease. Another peculiarity is that such a temperature does not respond well to antipyretic drugs, reluctantly decreasing only by 1-1.5°C, after which it rises again. Even if the temperature normalizes after taking antipyretics, after a few hours, a new spike to the previous values is observed.

Qualitatively bring the temperature values to normal is possible only in fungal meningitis, or in a mild course of the disease.

How long does a fever last in meningitis?

The temperature curve can be different, which depends on the peculiarities of the infectious process, the severity of the disease, the presence of complications, etc. However, most often you can observe such variations in the temperature trend:

1. Indicators rise to 38-40 °, held at high positions for several days (about 3-5 days, less often - up to 7-14), after which the temperature normalizes.
2. The temperature curve has a wavy character: high values are held for 2-3-5 days, then decreased and 2-3 days are within normal limits, then rise again for 1-2-3 days and again finally normalized.

If complications develop, or if it is a severe course of the infectious process, in such situations, the temperature curve is difficult to predict and may be different for each individual case.

Temperature in meningitis in an adult

In adult patients, bacterial meningitis is more common, the causative agents of which are pneumococcus and meningococcus. These microbes do not cause the development of the disease if they are in the nasopharynx. But when they get into the bloodstream, cerebrospinal fluid and soft tissues of the brain, give rise to the formation of an inflammatory reaction.

No less often the pathology becomes a consequence of various diseases and craniocerebral traumas.

Fever in meningitis refers to the common symptoms of the inflammatory process. Indicators are most often high (exceeding 39 ° C), accompanied by pain in the head, irritability, leg pain, vomiting, dizziness, rashes on the body. Often draw attention to cold extremities against the background of high temperature.

The duration of the temperature rise is individual. In some cases, high values do not show a tendency to decrease for 7-14 days.

Temperature in meningitis in children

A number of signs are known to identify the disease in childhood. The difficulty is that, in addition to fever, there are other characteristic symptoms, but not in all cases the child can independently describe and indicate the problem. Therefore, the main task of parents and loved ones is to timely pay attention to a wide range of manifestations. So, for childhood meningitis is characterized by such features:

• the temperature rises and reaches high values (often above 40°C);
• there is a febrile condition with severe chills;
• Against the background of fever in meningitis appear convulsions, muscle twitching;
• can be bothered by diarrhea;
• the child is nauseous and vomiting does not provide relief;
• the baby's refusing to eat;
• there's a lot of weakness.

Because of the severe pain in the head, the child may be excited, irritable, restless, but this state is abruptly replaced by drowsiness. The use of antipyretics such as Panadol or Ibuprofen helps little, or not for long, and after a couple of hours the temperature rises again.

Complications and consequences

Inflammation of the cerebral membranes is dangerous not only because of fever: delayed or incorrect treatment is often fraught with serious complications that will make themselves known even after several years. The age of the patient is almost irrelevant: the development of adverse effects is possible in both adults and children.

Adult patients are more likely to report the onset of problems such as frequent head pain, impaired hearing and vision, recurrent seizures, and other symptoms that do not let up for six months to several years.

In pediatric patients (especially in early childhood), there is a high probability of inhibition of intellectual development, disorders of basic brain functions and the nervous system in general.

Cerebral edema is considered to be one of the most dangerous complications. Signs of its development are sharp changes in cardiac activity and blood pressure, increased dyspnea and the appearance of pulmonary edema. If timely measures are not taken, the patient dies of respiratory paralysis.

Another unfavorable complication is infectious-toxic shock, which is a shock state provoked by exo- and endotoxins of microbes or viruses. The main signs of shock development are: a sharp rise in temperature, nausea and diarrhea, sunburn-like rashes, pain in the head and muscles, and fever.

The most common adverse effects of meningitis are thought to be:

• the development of paralysis;
• nervous system malfunction;
• mental disorders;
• epilepsy;
• hormonal disorders, etc.

The main conditions to prevent the appearance of complications are timely referral to a doctor, proper diagnosis and treatment of the disease. [5]

Diagnostics of the fever in meningitis

The basis for diagnosis is a careful collection of anamnestic data and examination of the patient, as well as evaluation of general cerebral and meningeal signs.

If the temperature rises, laboratory tests are necessarily prescribed:

• A general blood test (to detect inflammatory changes);
• general urine examination (to exclude or confirm kidney damage);
• examination of cerebrospinal fluid withdrawn during cerebrospinal puncture;
• Biochemical blood test (to assess the extent of damage to other organs);
• bacteriologic seeding of mucous discharge from the nasopharyngeal area (pneumococcus, meningococcus);
• Bacteriologic analysis of cerebrospinal fluid and blood (if the purulent form of the inflammatory process is suspected);
• stool analysis for enterovirus infection and poliomyelitis (PCR);
• IgM analysis to mumps (if mumps is suspected), IgM analysis to herpes virus types 1 and 2 (if herpesvirus infection is suspected);
• study of acid-base balance of blood, blood coagulation test (in case of complicated course of the disease, the development of infectious-toxic shock).

Blood cultures are performed in all patients with suspected meningitis before antibiotic therapy. If the tuberculous origin of the pathology is suspected, a search for the primary infectious focus and microbiological examination is performed. A tuberculin test in central nervous system tuberculosis is inadvisable.

Instrumental diagnostics is prescribed individually according to the indications and does not have a strict algorithm. CT or MRI of the head (with contrast), electrocardiogram, chest radiography (relevant for pneumococcal meningitis) may be prescribed.

Differential diagnosis

Meningitis with fever should be differentiated from such diseases and conditions:

• local infectious processes affecting the central nervous system (empyema, abscess);
• tumors in the brain;
• subcutaneous hemorrhage;
• Non-infectious processes or infections outside the central nervous system that cause irritation of the cerebral membranes (without cerebrospinal fluid changes);
• Tumor meningitis, which develops when cancer metastasizes to the membranes or they become involved in the process of lymphoproliferation;
• Systemic connective tissue pathologies with aseptic inflammation (e.g., systemic vasculitis);
• reaction to treatment with immunoglobulin preparations (intravenous injection), as well as co-trimoxazole, carbamazepine, cytosinarabinoside.

Fever in meningitis of different origins has different characteristics:

• Purulent (pneumococcal, staphylococcal, meningococcal or streptococcal) meningitis - the temperature rises significantly (above 39-40°C), with chills.
• Serous viral (enterovirus, mumps, etc.) meningitis - moderate fever is noted, in some cases has a biphasic character, can be short-term (from three days to one week).
• Tuberculous meningitis - subfebrile fever is noted, intoxication symptoms predominate.
• The phenomenon of meningism on the background of general infectious lesions and somatic pathologies - the features of the temperature depend on the underlying disease.

Treatment of the fever in meningitis

Treatment measures for fever in meningitis should be carried out immediately. The patient is urgently hospitalized in an infectious disease or otolaryngology department, depending on the origin of the disease. If there are suspicions of tuberculosis etiology, the patient is referred to a tuberculosis clinic.

Temperature in meningitis is reduced with non-steroidal anti-inflammatory drugs - in particular, paracetamol or ibuprofen. In case of bacterial infection, broad-spectrum antibiotics are prescribed at the same time, without waiting for the results of bacteriological diagnosis. When these results are obtained, therapy can be adjusted. As the development of the infection is suppressed, the temperature will also decrease.

In case of viral disease prescribe antiviral drugs, in case of fungal infection - antifungal agents. If there is a seizure syndrome - it is appropriate to use anticonvulsants and drugs that reduce intracranial pressure.

In order to stop the development of inflammatory reaction and qualitative reduction of temperature, corticosteroids, in particular dexamethasone, are prescribed. If necessary, a ventilator is connected.

If meningitis is proven to be secondary, the underlying pathology (sinusitis, tuberculosis, etc.) must be addressed. [6]

Example treatment regimen for an adult patient with bacterial inflammation:

• cefotaxime intravenously 2-3 g every 6 hours (can be replaced by ceftriaxone 2 g every 12 hours);
• vancomycin 1 g every 8-12 hours for 2 weeks;
• infusion therapy, enteral and parenteral nutrition;
• anti-edema and anti-inflammatory therapy with dexamethasone as intravenous injection of 8-10 mg every 6 hours, for 3-4 days.

Prevention

Measures to prevent meningitis with fever include, first of all, vaccination. The vaccines used are:

• Group A meningococcal vaccine;
• A+C vaccine;
• "Meningo A+C";
• "Mencevax ACWY."
• "Menugate."
• "Menactra."

Vaccination is recommended for special groups of people who have an increased risk of meningitis:

• persons in contact with people who have contracted meningococcal disease;
• patients with spleen disease or after splenectomy;
• persons with cochlear implants;
• tourists and people visiting countries endemic for meningococcal disease;
• Workers in outpatient and research laboratories who face a high probability of infection;
• long-term residents of hostels, communal apartments, barracks, etc.

The vaccine is administered once and is estimated to be 90% effective. Immunity builds up in about 5 days and lasts for 3-5 years. [7]

Other preventive measures include the following:

• Avoiding contact with meningitis patients;
• preventive medication as prescribed by a doctor if there has been contact with an infected person;
• wearing a medical mask during epidemic seasons of infectious pathologies;
• Regular hand washing when you get home, as well as before eating and after using transportation or the restroom;
• Excluding the use of untreated raw water, boiling milk, washing fruits and vegetables before eating;
• avoid bathing in non-flowing water bodies, public swimming pools;
• Strengthening immune defenses.

Meningitis is a dangerous pathology that is often fatal due to its rapid development and sudden severe increase in temperature. To prevent unfortunate consequences, it is important to react in time to the emerging pathological signs and report them to the doctor. Fever in meningitis is one such important sign that indicates the need for urgent medical attention.