Serous meningitis

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

It usually begins with symptoms characteristic of purulent inflammation of the meninges - nausea and vomiting, headache. The main difference between this form of the disease and all the others is that the inflammation develops rapidly, but is not distinguished by a stormy clinical picture. Rather, it proceeds in a mild form, without impairment of clarity of consciousness and passes without meningeal complications.

The diagnosis is established based on clinical manifestations and data from bacteriological analysis of cerebrospinal fluid and PCR analysis.

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

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Causes of serous meningitis

The causes of serous meningitis can be very diverse. According to the form, primary and secondary are distinguished. In case of primary inflammation, the painful condition is an independent process. In case of secondary manifestation, it occurs as a complicated course of an existing disease of infectious or bacterial nature.

The main underlying cause is an enterovirus, which occurs in children. Less frequently, it develops as an aggravating manifestation of penetrating craniocerebral trauma or sepsis. In sepsis (blood poisoning), the infectious agent is carried throughout the body by the bloodstream. 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 Koch's bacillus, 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 treatment are prescribed. With timely assistance, recovery occurs in a short time and the risk of complications is reduced, the course of the disease is easy and without persistent malaise in the post-infection period.

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Symptoms of serous meningitis

Symptoms of serous meningitis at an early stage are similar to a cold - fatigue, irritability, passivity, fever, unpleasant sore sensations in the throat and nasopharynx. At the next stage, a temperature jump occurs - it rises to 40 degrees, the condition worsens, a severe headache appears, accompanied by dyspeptic disorders, muscle spasms, delirium. Key manifestations of inflammation:

• the appearance of rigidity of the neck muscles;
• positive reaction to Kernig's test;
• positive reaction to Brudzinski's test;
• "brain" vomiting;
• impaired muscle activity of the limbs, difficulty swallowing;
• significant hyperthermia – 38-40 degrees.

On the 5th-7th day from the onset of the disease, the symptoms may be weaker, the fever decreases. This period is the most dangerous, since if treatment is interrupted at the first sign of recovery, meningitis may develop again. Relapse is especially dangerous, since it can be accompanied by severe persistent brain damage and pathologies of the nervous system. The nature of the pathogens can be confirmed using virological and serological testing 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. This can take from two to five days, but the time frame largely depends on the nature of the pathogen and the resistance of the human immune system. In the prodromal stage, the disease manifests itself as a decrease in general tone, headaches, a slight increase in temperature, and the course is more similar to acute respiratory viral infections. In the incubation stage, a person is already a carrier of the pathogen and releases it into the environment, so when the diagnosis is confirmed, it is necessary to isolate everyone who has been in contact with the patient as soon as possible.

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

• the appearance of rigidity of the neck muscles;
• positive reaction to Kernig's test;
• positive reaction to Brudzinski's test.

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

How is serous meningitis transmitted?

Inflammation of the meninges or meningitis develops rapidly. The main cause is representatives of the enterovirus group. 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 products - fruits and vegetables with dirt particles, when drinking water that is not suitable for drinking, when neglecting the rules of personal hygiene.
• Airborne infection. Infectious agents enter the mucous membranes of the nasopharynx upon contact with an already sick person or a carrier of the virus. Most often, pathogens are first released by patients into the environment, and then settle on the mucous membrane of the nose and throat of a healthy person.
• Waterborne infection. Possible when swimming in dirty water bodies, when there is a high risk of swallowing contaminated water.

Serous inflammation of the membrane of the brain is especially dangerous for children in the first year of life - during this period, the impact of infectious agents has such a detrimental effect on the child's brain and nervous system that it can cause delayed mental development and partial impairment of visual and auditory functions.

Acute serous meningitis

It develops when enteroviruses enter the body, as well as viruses that cause mumps, lymphocytic choriomeningitis, herpes simplex type 2, tick-borne encephalitis. In case of viral etiology of this disease, bacteriological examination of blood and cerebrospinal fluid will not give positive data, manifestation of lymphocytic pleocytosis is diagnosed, the content is slightly higher than normal.

The clinical picture of the disease differs from the picture of the purulent form. The course of the disease is milder, manifested by headaches, pain when moving the eyes, spasms in the muscles of the arms and legs (especially flexors), positive Kernig and Brudzinsky symptoms. In addition, the patient is bothered by vomiting and nausea, pain in the epigastric region, against the background of which physical exhaustion develops, photophobia develops. Persistent disturbances of consciousness, epileptic seizures, focal lesions of the brain and cranial nerves are also not recorded.

When diagnosing, it is important to first exclude the possibility of secondary inflammation of the meninges or the presence of concomitant bacterial, fungal and parasitic diseases. The main diagnostic methods for identifying the causative virus are PCR and CSF; treatment is prescribed according to the diagnostic data. If the causative agent is the Epstein-Barr virus or herpes, antiviral drugs are prescribed. Otherwise, treatment is symptomatic - antiemetics, antipyretics, painkillers.

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

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Secondary serous meningitis

Meningoencephalitis occurs with concomitant viral conditions caused by the mumps virus, herpes, etc. Most often, the cause of this process is still mumps. It manifests itself like acute meningitis - the temperature rises, there is a strong headache, the eyes water from the light, nausea, vomiting, and abdominal pain. The main role in the diagnosis of confirmation of damage to the meninges is played by a positive Kernig and Brudzinsky reaction, accompanied by rigidity of the neck muscles.

Serious changes are recorded only in moderate and severe forms of the disease, but in general the secondary form of inflammation of the meninges passes quite easily. More severe cases are characterized by proliferative phenomena not only of the salivary glands and meninges, but also pancreatitis, inflammatory processes in the testicles. The course of the disease is accompanied by fever, the main brain symptoms, dyspeptic disorders, laryngitis, pharyngitis, and sometimes a runny nose. After 7-12 days with a mild course, the general condition improves, but for another 1-2 months the person can be a 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, with a sharp increase in temperature, sore throat, sometimes a runny nose, dyspeptic disorders, muscle spasms. In severe cases - clouding of consciousness and diagnosis of stupor, coma. Signs of meningeal syndrome appear on the second day - this is rigidity of the neck muscles, Kernig syndrome, Brudzinsky, high blood pressure, very severe headaches, cerebral vomiting, abdominal pain. In the analysis of cerebrospinal fluid, a pronounced form of cytosis, many lymphocytes.

The prognosis for almost all adults with viral non-purulent inflammation of the meninges is favorable - full recovery occurs in 10-14 days. Only in a few cases of the disease, those who have recovered suffer from headaches, hearing and vision disorders, impaired coordination and exhaustion. Children in the first year of life can develop persistent developmental dysfunctions - minor mental retardation, inhibition, hearing and vision loss.

Enteroviral meningitis serous

This is a type of meningitis caused by the Coxsackie and ECHO viruses. It can be either a single recorded case of infection or an epidemic. Most often, children become infected in the summer and spring, and the epidemic spreads especially quickly in groups - in kindergartens, schools, and camps. You can become infected from a sick person or 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 observed.

After the viral agent enters the body, the first signs appear in a day or three - redness and swelling of the throat, enlarged lymph nodes, abdominal pain and diffuse soreness, and fever. The disease moves to the next stage when the pathogen penetrates directly into the blood and, spreading through the bloodstream, concentrates in the nervous system, which leads to an inflammatory process in the brain membrane. At this stage, meningeal syndrome becomes pronounced.

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

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Serous meningitis in adults

It proceeds quite easily and does not cause serious complications. Its causes are viral agents, bacteria and fungi, primary inflammation of the meninges is caused by the Coxsackie virus, enterovirus Echo. Secondary cases are caused by the virus that causes poliomyelitis, mumps, measles.

In adulthood, viral inflammation occurs in an uncomplicated form, but this does not mean that this form does not require treatment. The onset is similar to a cold - a headache, a swollen throat, muscle pain and dyspeptic symptoms, meningeal syndrome and, in severe cases, convulsions appear. By the end of the first week of the disease, the temperature is fixed at a normal level, muscle spasms and headache do not bother. This stage requires special observation, since the likelihood of relapse increases, and the first signs of pathologies of the central nervous system and intracranial nerves may also appear.

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

Serous meningitis in adults is treatable, and the sooner it is started, the lower the risk of the disease returning and complications developing.

Serous meningitis in children

It is more severe than in adults and if not treated in a timely manner can lead to serious complications. The incubation period lasts about 2-4 days, those who attend events with a large crowd of children of different ages - schools and preschool institutions, clubs, various sections, camps - are more likely to get sick. The primary cause of the disease are viruses that cause measles, mumps, herpes, various enteroviruses, etc. At first, inflammation of the meninges is similar to other forms of meningitis - there is also a severe headache, dyspeptic disorders, and a brain syndrome appears. The main difference between the viral form and others is the sudden, 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 case of viral etiology, a course of antiviral drugs is prescribed, if other pathogens are detected - antibiotics, antifungal drugs. In addition to eliminating the cause of inflammation of the meninges, treatment measures are aimed at alleviating the general condition - for this purpose, antipyretic, analgesic, antiemetic, sedative medications are prescribed.

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

Complications of serous meningitis

Complications of serous meningitis for an adult are minimally dangerous, but for children in the first year of life they are especially dangerous. Most often, the consequences of inflammation of the meninges make themselves known in the case of aggravated course, unqualified drug therapy or failure to comply with medical prescriptions.

Disorders that occur in severe cases of inflammatory pathology of the meninges:

• Disruption of the auditory nerve – hearing loss, dysfunction of motor coordination.
• Weakening of visual function – decreased visual acuity, strabismus, uncontrolled movements of the eyeballs.
• The decrease in vision and motor activity of the eye muscles are fully restored, but persistent hearing disorders are mostly irreversible. The consequences of meningeal pathology suffered in childhood later manifest themselves in intellectual delay and hearing loss.
• Development of arthritis, endocarditis, pneumonia.
• Risk of strokes (due to obstruction of cerebral vessels).
• Epileptic seizures, high intracranial pressure.
• Development of cerebral and pulmonary edema, leading to death.

If you seek qualified medical help in a timely manner, severe systemic changes can be avoided and there will be no relapses during treatment.

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Consequences of serous meningitis

The consequences of serous meningitis, with proper treatment and proper rehabilitation after recovery, are expressed only in half of all cases of the disease. Basically, they manifest themselves in general malaise, headaches, decreased memory and memorization speed, sometimes involuntary muscle spasms appear. In complex forms, the consequences will be more serious, up to partial or complete loss of the ability to see and hear. Such violations are observed only in isolated cases and with timely organized drug therapy, this can be easily avoided.

If the disease proceeded as a complicated course of another disease, then the person who has recovered will be more bothered by the problems that were associated with the underlying cause. Regardless of what form the person has fallen ill with (primary or secondary), treatment measures should begin immediately. Basically, antibacterial, antifungal and antiviral drugs are used for this, as well as a complex of drugs for symptomatic therapy and relief of the general condition.

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

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Diagnosis of serous meningitis

Diagnostics is carried out in two directions - differential and etiological. For etiological differentiation, they resort to the serological method - RSK, and the neutralization reaction also plays an important role in isolating the pathogen.

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

1. Stiff neck muscles (the person cannot touch the chin to the chest).
2. Positive Kernig test (with the leg bent at 90 degrees at the hip and knee joint, the person cannot straighten it at the knee due to hypertonicity of the flexors).
3. Brudzinski test result is positive.

It consists of three stages:

• A person cannot press his head to his chest - his legs are pulled up to his stomach.
• If you press on the pubic symphysis area, the legs bend at the knees and hip joints.
• When checking the Kernig symptom on one leg, the second one involuntarily bends at the joints simultaneously with the first.

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Liqueur for serous meningitis

Cerebrospinal fluid in serous meningitis has an important diagnostic value, since the nature of its components and the results of bacteriological culture can be used to determine the causative agent of the disease. Cerebrospinal fluid is produced by the ventricles of the brain, and its daily volume is normally no more than 1150 ml. To take a sample of biomaterial (CSF) for diagnostics, a special manipulation is performed - a lumbar puncture. The first milliliters obtained are usually not collected, since they contain an admixture of blood. For analysis, several milliliters of CSF are needed, collected in two test tubes - for general and bacteriological examination.

If there are no signs of inflammation in the collected sample, the diagnosis is not confirmed. In case of non-purulent inflammation, leukocytosis is observed in the puncture, the protein is usually slightly elevated or normal. In severe forms of pathology, neutrophilic pleocytosis is recorded and the content of protein fractions is significantly higher than the permissible values, the sample during the puncture does not flow out drop by drop, but under pressure.

Liquor not only helps to accurately differentiate from other forms of this disease, but also to identify the pathogen, the degree of severity, and select antibacterial and antifungal drugs for therapy.

Differential diagnosis of serous meningitis

Differential diagnostics of serous meningitis is aimed at a more detailed study of the patient's medical history, current symptoms and serological findings. Despite the fact that the meningeal complex is characteristic of all types of inflammation of the meninges, significant differences are observed in some of its forms. In viral etiology, general meningeal manifestations may be weakly expressed or absent altogether - moderate headache, nausea, pain and colic in the abdomen. Lymphocytic choriomeningitis is characterized by stormy symptoms - severe headaches, repeated cerebral vomiting, a feeling of squeezing in the head, pressure on the eardrums, pronounced spasm of the neck muscles, a pronounced symptom of Kernig and Brudzinsky, during a lumbar puncture, cerebrospinal fluid flows out under pressure.

The pathological process caused by the polio virus is accompanied by the signs characteristic of this disease - Lasegue, Amoss, etc. During the emergency medical procedure, the cerebrospinal fluid flows out under slight pressure. The disease is often accompanied by nystagmus (due to damage to the medulla oblongata).

The tuberculosis form, unlike the serous form, develops slowly and is found in people suffering from chronic tuberculosis. The temperature rises gradually, the general condition is sluggish, depressed. There is a lot of protein in the spinal puncture, the presence of Koch's bacillus is determined, the collected material is covered with a specific film after a while.

Differential diagnostics is mainly based on virological and immunological examination of CSF and blood. This provides the most accurate information about the nature of the pathogen.

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Treatment of serous meningitis

Treatment of serous meningitis requires special attention. Depending on what tactics are taken in the first days of the disease, the further prognosis of medical prescriptions depends. Drug therapy for non-purulent inflammation of the meninges is carried out in a hospital - so a person receives the necessary care and it is possible to observe all changes in well-being, carry out the necessary diagnostic manipulations.

The prescription largely depends on the severity of pathological changes, the nature of the pathogen and the general condition of the patient. Based on the CSF and PCR studies, specific therapy is prescribed - for the viral form, these are antiviral drugs (Acyclovir, etc.), for the bacterial form - broad-spectrum antibiotics or specific antibacterial drugs (Ceftriaxone, Meropenem, Phthivazid, Chloridine, etc.), as well as antifungal drugs (Amphotericin B, Fluorocytosine), if the identified pathogen belongs to the fungal group. Measures are also taken to improve the general condition - detoxifying drugs (Polysorb, Hemodez), painkillers, antipyretics, antiemetics. In some cases, when the course of the disease is accompanied by high blood pressure, diuretics and sedatives are prescribed. After complete recovery, a rehabilitation course is carried out, including exercise therapy, myostimulation, electrophoresis, and psychorehabilitation is also mandatory.

Treatment can also be carried out at home, but only if the disease is mild and the patient’s well-being and compliance with the principles of medication prescriptions are monitored by an infectious disease specialist.

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

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

Treatment, if the doctor’s instructions are followed, ends with recovery in 7-10 days and is not accompanied by long-term complications.

Prevention of serous meningitis

Prevention of serous meningitis is aimed at preventing the pathogen from entering the body. General preventive rules should include:

• Measures prohibiting swimming in polluted water bodies during the summer-autumn period.
• Drink only boiled, purified water or tap water from certified wells.
• Careful preparation of food for cooking, proper heat treatment, washing hands before eating and after visiting crowded places.
• Maintaining a daily routine, leading an active lifestyle, eating quality food according to the body's expenditure. Additional use of vitamin complexes.
• During the seasonal outbreak, avoid attending mass performances and limit your circle of contacts.
• Conduct regular wet cleaning of the premises and treat the child's toys.

In addition, the serous form of inflammation of the meninges can be secondary, which means that it is necessary to promptly treat chickenpox, measles, mumps, and flu. This will help eliminate the risk of inflammation of the membranes of the brain and spinal cord, both in adults and in children. Do not neglect 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 positive dynamics, but the final result largely depends on the state of the patient's immune system and the timing of seeking medical help. Non-purulent changes in the membranes of the brain most often do not cause persistent complications, are quickly treated and do not relapse on the 3rd-7th day of the disease. But if the underlying cause of tissue degeneration is tuberculosis, without specific drug treatment the disease ends fatally. Treatment of the serous form of tuberculous meningitis is protracted, requires inpatient treatment and care for six months. But if the prescriptions are followed, such residual pathologies as weakening of memory, vision and hearing pass.

In childhood, especially in babies under one year old, the non-purulent form of inflammation of the meninges can cause serious complications - epileptic seizures, visual and hearing impairments, developmental delays, and poor learning ability.

In rare cases, adults develop persistent memory disorders after an illness, concentration and coordination decrease, and severe pain in the frontal and temporal parts regularly bothers them. The disorders persist from several weeks to six months, after which, with proper rehabilitation, complete recovery occurs.