Serous meningitis

Serous meningitis is one of the most serious brain diseases, characterized by inflammation of its membranes. Usually the cause is in viral damage or multiplication of bacterial and fungal flora, but most of the recorded cases of this disease were caused by viruses. Most often it is fixed in children of primary and preschool age.

It usually begins with the symptoms that are characteristic of purulent inflammation of the meninges - nausea and vomiting, headache. The main difference of this form of the disease from all the others is that the inflammation develops sharply, but it does not stand out as a stormy clinic. Rather, it proceeds in mild form, without disturbance of clarity of consciousness and passes without meningeal complications.

The diagnosis is established by the clinical manifestation and data of bacteriological analysis of cerebrospinal fluid, PCR analysis.

Treatment is aimed at eliminating the pathogen and alleviating the general condition - the appointment of painkillers, antipyretics, antiviral drugs. If, according to the plan of treatment, the patient's condition does not stabilize, antibacterial drugs related to broad-spectrum antibiotics are additionally prescribed.

[1], [2], [3], [4],

Causes of serous meningitis

The causes of serous meningitis can be very diverse. The form distinguishes between primary and secondary. In the case of primary inflammation, the disease state is an independent process. In the secondary manifestation, it arises as a complicated course of an existing infection of an infectious or bacterial nature.

The main cause is enterovirus, which occurs in patients of childhood. Rarely it develops as an aggravating manifestation of penetrating craniocerebral trauma or sepsis. When sepsis (infection of blood), the infectious agent spreads through the body with a blood stream. This leads to an inflammatory process, the formation of abscesses and diffuse purulent inflammation of the internal organs and brain. The most common types are:

• viral infection;
• fungal infection;
• bacteria (infection with a stick of Koch, pale treponema, etc.).

After establishing the cause of the disease and conducting the necessary tests, as well as identifying the nature of the pathogen, antimicrobial therapy and concomitant medication are prescribed. With timely assistance, recovery occurs in a short time and the risk of complications decreases, the course of the disease passes easily and without persistent indisposition in the post-infection period.

[5], [6], [7], [8]

Symptoms of serous meningitis

Symptoms of serous meningitis at an early stage are similar to a catarrhal phenomenon - fatigue, irritability, passivity appear, the temperature rises, uncomfortable sensations in the throat and nasopharynx. The next step is a temperature jump - it rises to 40 degrees, the condition worsens, there is a severe headache, accompanied by dyspeptic disorders, muscle spasms, delirium. Key manifestations of inflammation:

• the appearance of rigidity of the neck muscles;
• positive reaction in the Kernig sample;
• positive reaction in the Brudzinsky trial;
• "Cerebral" vomiting;
• violation of muscle activity of limbs, difficulty swallowing;
• significant hyperthermia - 38-40 degrees.

On the 5th-7th day after the onset of the disease, signs may appear weaker, the fever decreases. This period is most dangerous, because if you interrupt medical activities at the first manifestation of recovery, meningitis can develop again. Relapse is especially dangerous, as it can be accompanied by severe persistent brain damage and pathologies of the nervous system. Confirm the nature of the pathogens can be using a virological and serological study of blood and cerebrospinal fluid.

The incubation period of serous meningitis lasts from the moment the pathogen enters the nasopharyngeal mucosa until the first signs of the disease appear. It can take a period of time from two to five days, but in many respects the timing depends on the nature of the pathogen and the resistance of human immunity. In the prodromal stage, the disease manifests itself as a decrease in general tone, headaches, a slight increase in temperature and the flow is more like an ARVI. In the incubation stage, the person is already the carrier of the pathogen and releases it into the environment, therefore, when confirming the diagnosis, it is necessary to isolate as soon as possible all those who have been in contact with the patient.

But very often serous inflammation of the brain begins acutely - with high fever, vomiting, almost immediately the characteristic symptoms of inflammation of the membranes of the brain:

• the appearance of rigidity of the neck muscles;
• positive reaction in the Kernig sample;
• positive reaction in the Brudzinsky trial.

The prognosis is mostly favorable, but in rare cases there are complications - visual, hearing, persistent changes in the central nervous system. The first days after confirmation of the diagnosis, there are increased lymphocyte counts. A few days later, a moderate lymphocytosis.

How is serous meningitis transmitted?

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

• Contact infection. Bacteria and microorganisms get into the body with dirty food - fruits and vegetables with particles of dirt, when drinking unsuitable water, while disregarding the rules of personal hygiene.
• Airborne infection. Agents of an infectious nature get on mucous nasopharynx at contact with already ill person or with the carrier of a virus. Most often, pathogens are first released by the patients into the environment, and then settle on the nasal mucosa and pharynx of a healthy person.
• Waterway of infection. Perhaps when swimming in dirty water, when the risk of ingestion of contaminated water is high.

Especially dangerous is the serous inflammation of the brain envelope for children of the first year of life - during this period, the effect of infectious agents is so detrimental to the children's brain and nervous system that can cause mental retardation, a partial disturbance of visual and auditory functions.

Acute serous meningitis

It develops when enteroviruses enter the body, as well as viruses that cause parotitis, lymphocytic choriomeningitis, herpes simplex of the second type, tick-borne encephalitis. With the viral etiology of this disease, a bacteriological study of blood and cerebrospinal fluid will not give positive data, a manifestation of lymphocytic pleocytosis is diagnosed, the content is slightly higher than normal.

The clinical picture of the disease differs from that of a purulent form. The course of the disease is easier, manifested by headaches, painful eye movements, spasms in the muscles of the hands, legs (especially flexors), positive symptoms of Kernig and Brudzinsky. In addition, the sick person is disturbed by vomiting and nausea, in the epigastric region, against which physical exhaustion develops, and photophobia develops. Persistent violations of consciousness, epileptic seizures, focal brain lesions and cranial nerves are also not fixed.

When diagnosing the first thing it is important to exclude the possibility of secondary inflammation of the meninges or the presence of concomitant bacterial, fungal and parasitic diseases. The main diagnostic methods for detecting the pathogen-PCR and CSF, according to the diagnostic data, are prescribed treatment. If the pathogen is Epstein-Barr virus or herpes, antiviral drugs are prescribed. In the rest, the treatment is symptomatic - antiemetic, antipyretics, analgesics.

Acute serous meningitis does not give serious complications and is easily treated, recovery comes on the 5th-7th day of the illness, but headaches and general malaise can last from several weeks to several months.

[9], [10], [11]

Secondary serous meningitis

Meningoencephalitis occurs with accompanying viral conditions caused by the virus of mumps, herpes, etc. Most often the cause of this process is still parotitis. It is manifested, like acute meningitis - the temperature rises, severe pain in the head, eyes burst from the light, nausea, vomiting, stitching in the abdomen. The main role in the diagnosis of confirmation of the defeat of the meninges is played by the positive reaction of Kernig and Brudzinsky, accompanied by rigidity of the neck muscles.

Serious changes are recorded only with moderate and severe forms of the disease, but in general the secondary form of inflammation of the meninges passes easily enough. More severe cases are characterized by the proliferative phenomenon of not only salivary glands and brain envelopes, but also pancreatitis, inflammatory processes in the testicles. The course of the disease is accompanied by fever, the main cerebral symptoms, dyspeptic disorders, laryngitis, pharyngitis, sometimes a runny nose. After 7-12 days with a mild course, the general condition improves, but even for 1-2 months a person can be the carrier of the pathogen and pose a danger to others.

Viral serous meningitis

It is considered one of the most common uncomplicated forms of this disease. It is caused by Coxsackie viruses, mumps, herpes simplex, measles, enteroviruses and sometimes adenoviruses. The onset of the disease is acute, begins with a sharp rise in temperature, painful sensations in the throat, sometimes a runny nose, dyspeptic disorders, muscle spasms. In severe cases - blurred consciousness and diagnosing sopor, coma. Signs of meningeal syndrome are manifested on the second day - it is the rigidity of the neck muscles, Kernig's syndrome, Brudzinsky's syndrome, increased pressure, very severe headaches, cerebral vomiting, and abdominal pain. In the analysis of cerebrospinal fluid, a marked form of cytosis, many lymphocytes.

The prognosis for practically all adults with viral non-swelling inflammation of the meninges is favorable - a full recovery occurs in 10-14 days. In just a few cases of illness, those who have recovered suffer from headaches, hearing and vision disorders, impaired coordination and exhaustion. Children of the first year of life can develop persistent development dysfunctions - insignificant mental retardation, inhibition, decrease in hearing, sight.

Enterovirus serous meningitis

This is a kind of meningitis caused by Coxsackie and ECHO viruses. It happens as a single-fixed case of infection, and can be epidemic. Most often they are infected with children in the summer-spring time, especially the epidemic spreads in the collective - in kindergartens, schools, camps. You can get infected from a sick person or a child, as well as from a healthy carrier, this type of inflammation of the meninges spreads mainly by airborne droplets or when hygiene rules are not respected.

After the viral agent enters the body, the first signs appear in a day or three: reddening and puffiness of the pharynx, lymph nodes increase, stomach pain in the stomach and soreness of the spilled character worsen, the temperature rises. The next stage of the disease passes when the pathogen penetrates directly into the blood and spreads through the bloodstream to concentrate in the nervous system, which leads to an inflammatory process in the brain's shell. At this stage, the meningeal syndrome becomes pronounced.

The course of the disease in general dynamics rarely entails serious complications. On the second-third day, the brain syndrome disappears, but on the 7-9th day of the disease it is possible to return the clinical symptoms of serous inflammation and the temperature can also rise. In children under one year, the process is sometimes accompanied by the formation of inflammatory foci of the meningeal shells of the spinal cord, persistent CNS damage.

[12], [13], [14], [15], [16]

Serous meningitis in adults

It flows quite easily and does not cause serious complications. The causes of it - viral agents, bacteria and fungi, the primary inflammation of the meninges are caused by the Coxsackie virus, entero virus Echo. Secondary cases are caused by a virus that causes poliomyelitis, mumps, and measles.

In adulthood, viral inflammation occurs in uncomplicated form, but this does not mean that this form does not require treatment. The beginning looks like a cold - the head hurts, the throat is swollen, there are muscle pains and dyspeptic phenomena, meningeal syndrome and in severe cases of seizures. By the end of the first week of illness, the temperature is fixed at the normal mark, do not disturb muscle spasms and headache. This stage requires special observation, since the likelihood of relapse increases, and the first signs of CNS and intracranial nerve pathologies may appear.

The most effective way to identify the pathogen is a serological and bacteriological analysis of blood and cerebrospinal fluid, PCR. After that, specific antibacterial and antiviral treatment is appointed in combination with antipyretic, antiemetic, analgesic and sedative drugs.

Serous meningitis in adults is treatable, and the earlier it starts, the less risk of disease return and the development of complications.

Serous meningitis in children

It flows heavier than in adults and, if untimely, can lead to serious complications. The incubation period lasts about 2-4 days, more often those who attend events with a large concentration of children of different ages are sick - school and preschool institutions, mugs, various sections, camps. The primary cause of the disease are viruses that cause measles, parotitis, herpes, various Eneroviruses, etc. Initially, the inflammation of the cerebral casing is similar to other forms of meningitis - also a severe headache, dyspepsia, cerebral syndrome. The main difference between the virus form and others is a sharp, acute onset of the disease, with a relatively clear consciousness.

The diagnosis is confirmed by PCR data, analysis of cerebrospinal fluid. After determining the nature of the pathogen, a treatment plan is prescribed - in the case of a viral etiology, a course of antiviral drugs is prescribed, if other pathogens are identified, antibiotics, antifungal medicines. In addition to eliminating the cause of inflammation of the meninges, treatment measures are aimed at alleviating the general condition - for this purpose prescribe antipyretic, analgesic, antiemetic, soothing medications.

Serous meningitis in children ends rather quickly and without complications, but for babies the first year of life is dangerous.

Complications of serous meningitis

Complications of serous meningitis for an adult represent a minimal danger, but for children of the first year of life are especially dangerous. Most often, the effects of inflammation of the meninges make themselves felt in the weighed flow, with unqualified drug therapy or failure to comply with medical prescriptions.

Disturbances that occur in the severe course of the inflammatory pathology of the meninges:

• Violation of the auditory nerve - deafness, dysfunction of coordination of movements.
• Weakening of visual function - lowering of the severity, strabismus, uncontrolled movements of eyeballs.
• Reduced vision and motor activity of the eye muscles are completely restored, but persistent hearing disorders are mostly irreversible. The consequences of meningeal pathology transferred in childhood are subsequently manifested in the retardation of the intellect, deafness.
• The development of arthritis, endocarditis, pneumonia.
• The threat of strokes (because of the obstruction of cerebral vessels).
• Epileptic seizures, high intracranial pressure.
• Development of cerebral edema, lungs, entailing death.

With the timely application of qualified medical assistance, severe systemic changes can be avoided and there will be no relapse during treatment.

[17], [18], [19], [20], [21]

Consequences of serous meningitis

The consequences of serous meningitis, with the observance of treatment and competent rehabilitation after recovery, are expressed only in half of all cases of the disease. Basically, they manifest themselves in general malaise, headaches, memory loss and memory speed, sometimes involuntary muscle spasms appear. With complex forms, the consequences will be more serious, up to a partial or complete loss of the ability to see and hear. Similar violations are observed only in isolated cases and with timely organized drug therapy it is easy to avoid.

If the disease has proceeded as a complicated course of another disease, then the problems that were associated with the root cause will be more troubling. Regardless of which form the person fell ill (primary or secondary), treatment should begin immediately. In general, antibacterial, antifungal and antiviral drugs are used for this, as well as a complex of medicines for symptomatic therapy and relief of general condition.

After the transferred pathological condition, the person requires special care and gradual recovery - this is a program of vitamin nutrition, moderate exercise and activities aimed at the gradual restoration of memory and thinking.

[22], [23], [24], [25], [26]

Diagnosis of serous meningitis

Diagnosis is carried out in two directions - differential and etiological. For etiological differentiation resort to the serological method - RSK, and an important role in the isolation of the causative agent is played by the neutralization reaction.

As for the distinctive diagnosis, its conclusion depends on the clinical data, the epidemiological report and the virological conclusion. When diagnosing, pay attention to other types of disease (tuberculosis and inflammation of the meninges caused by influenza, mumps, polio, Coxsackie, ECHO, herpes). Due attention is paid to the confirmation of meningeal syndrome:

1. Rigidity of the neck muscles (a person can not touch the breast with his chin).
2. Kernig's positive test (when the leg is bent at 90 degrees in the hip and knee joint, a person can not unbend it at the knee because of the hypertonicity of the flexors).
3. Positive result of the test of Brudzinsky.

It consists of three stages:

• A person can not press his head against his chest - his legs are pulled to his stomach.
• If you click on the area of pubic adhesion - the legs bend in the knees and hip joints.
• When checking the symptom according to Kernig on one leg, the second involuntarily bends in the joints simultaneously with the first.

[27], [28], [29], [30], [31], [32],

Liquor in case of serous meningitis

Liquor in serous meningitis has an important diagnostic value, because the nature of its components and the results of bacteriological inoculation can be concluded about the causative agent of the disease. The cerebrospinal fluid is produced by the ventricles of the brain, normally its daily volume is no more than 1150 ml. To take a sample of the biomaterial (CSF) for diagnosis, perform a special manipulation - a lumbar puncture. The first milliliters obtained are usually not collected, since they have an admixture of blood. For the analysis, several milliliters of CSF, collected in two test tubes, are needed for general and bacteriological studies.

If in the collected example there are no signs of inflammation, then the diagnosis is not confirmed. With non-inflammatory inflammation in the punctate, leukocytosis is observed, the protein is usually slightly elevated or normal. In severe forms of pathology, neutrophilic pleocytosis is fixed and the content of protein fractions is much higher than the permissible parameters, the sample when punctured is not dripping, but under pressure.

Liqvor not only helps to conduct accurate differentiation with other forms of this disease, but also to isolate the pathogen, severity, to select antibacterial and antifungal drugs for therapy.

Differential diagnosis of serous meningitis

Differential diagnosis of serous meningitis is aimed at a more detailed study of the patient's anamnesis, current symptoms and serological findings. Despite the fact that the meningeal complex is characteristic for all types of inflammation of the meninges, in some of its forms there are significant differences. In the case of viral etiology, general meningeal manifestations may be mild or absent altogether - mild headache, nausea, pain and abdominal pain. Lymphocytic choriomeningitis is characterized by violent symptoms - severe headaches, repeated cerebral vomiting, a feeling of squeezing in the head, pressure on the eardrums, a pronounced cramping of the cervical muscles, a pronounced symptom of Kernig and Brudzinsky, with the lumbar puncture the cerebrospinal fluid flows under pressure.

The pathological process caused by the virus of poliomyelitis is accompanied by characteristic signs for this disease - Lasega, Amossa, etc. When carrying out SMP, the liquor flows under a slight pressure. Often the disease is accompanied by nystagmus (due to the defeat of the medulla oblongata).

The tubercular form, unlike the serous, develops slowly, occurs in people with chronic tuberculosis. The temperature rises gradually, the general condition is sluggish, depressed. There is a lot of protein in the spinal punctate, the presence of Koch's rod is determined, the collected material is covered with a specific film through time.

Differential diagnosis, mostly still based on virological and immunological examination of CSF and blood. This gives the most accurate information about the nature of the pathogen.

[33], [34], [35], [36], [37], [38], [39]

Treatment of serous meningitis

Treatment of serous meningitis requires special attention. Depending on what tactics will be undertaken in the early days of the disease, a further forecast of medical prescriptions depends. Drug therapy for non-swelling inflammation of the meninges is performed in the hospital - so the person receives the necessary care and you can observe all the changes in the state of health, carry out the necessary diagnostic manipulations.

Appointment largely depends on the severity of pathological changes, the nature of the pathogen and the general condition of the patient. According to the study of CSF and PCR, specific therapy is prescribed - in the viral form it is antiviral (Acyclovir, etc.), for bacterial - broad-spectrum antibiotics or specific antibacterial (Ceftriaxone, Meropenem, Ftivazide, Chloridine, etc.), and also antifungal (Amphotericin B, Fluocytosine), if the detected pathogen belongs to the group of fungi. Also, measures are being taken to improve the general condition - detoxification drugs (Polysorb, Gemodez), pain relievers, antipyretics, antiemetics. In some cases, when the course of the disease is accompanied by high blood pressure, diuretics and sedatives are prescribed. After full recovery, a course of rehabilitation is performed, including exercise therapy, myostimulation, electrophoresis, and psycho-rehabilitation.

Treatment can be carried out at home, but only if the disease is easy, and the patient's health and compliance with the principles of drug prescription is controlled by the infectious disease doctor.

Treatment of serous meningitis in children requires special attention and a responsible attitude towards compliance with all medical prescriptions. In childhood, this disease is often accompanied by complications, especially it is dangerous for infants of the first year of life, when the consequences are persistent and can cause mental retardation, deafness, poor vision.

Most of the recorded cases of the non-purulent form of inflammation of the meninges are caused by viruses, so antibiotic therapy does not give the proper result. Assign Acyclovir, Arpetol, Interferon. If the child's condition is severe and the body is weakened, immunoglobulins are injected intravenously. With significant hypertension, diuretics are additionally prescribed - Furosemide, Lasix. In severe forms, when the disease is accompanied by severe intoxication, glucose is injected intravenously, Ringer's solution, Hemodez - this promotes adsorption and elimination of toxins. With severe headaches and high pressure, spinal puncture is performed. Otherwise, therapeutic measures are symptomatic - antiemetic, anesthetic and antipyretics, vitamins are recommended.

Treatment, subject to the instructions of the doctor, ends in recovery after 7-10 days and is not accompanied by prolonged complications.

Prevention of serous meningitis

The prevention of serous meningitis is aimed at preventing the causative agent from entering the organism of this disease. General preventive rules should include:

• Activities that prohibit swimming in polluted water in the summer-autumn period.
• Use only boiled, purified or water for spilling from certified wells.
• Careful preparation of products for cooking, competent heat treatment, washing hands before eating, after visiting crowded places.
• Compliance with the daily routine, active lifestyle, quality nutrition according to the costs of the body. Additional use of vitamin complexes.
• During the seasonal outbreak, refuse to attend mass performances and limit the circle of contacts.
• Carry out a regular wet cleaning of the room and the processing of the toys of the child.

In addition, the serous form of inflammation of the meninges can be secondary, which means that it is necessary to timely treat varicella, measles, mumps, and flu. This will help to eliminate the risk of inflammation of the membranes of the brain and spinal cord, as well as the adult and the child. Do not neglect the preventive rules, because it is easier to prevent infection than to treat it and recover from complications associated with it.

Prognosis of serous meningitis

The prognosis of serous meningitis has a positive dynamics, but the end result largely depends on the state of the patient's immune system and the timing of seeking medical help. A non-uniform change in the shells of the brain most often does not cause persistent complications, is quickly treated and does not relapse on the 3rd-7th day of the disease. But if the root cause of tissue degeneration is tuberculosis, without specific drug treatment, the disease ends lethal. Treatment of serous form of tuberculous meningitis is protracted, requires in-patient treatment and care for six months. But if the prescriptions are observed, such residual pathologies as weakening of memory, sight and hearing, pass.

In childhood, especially in infants up to a year, the nasal form of inflammation of the meninges can cause serious complications - epileptic seizures, visual impairment, hearing loss, developmental lag, low learning ability.

In adults, in rare cases, after a previous illness, persistent memory disorders are formed, concentration of attention, coordination, regularly disturbing severe pain in the frontal and temporal parts. The disorders last from several weeks to six months, after which, with proper rehabilitation, a full recovery occurs.