How is encephalitic meningitis transmitted: causes, treatment and consequences

Causes and forms of the disease

Encephalitic meningitis can be either a primary or secondary disease. In the first case, the infection enters the body through an insect bite. The secondary form of pathology develops as a result of complications when the body is infected with the herpes virus or during autoimmune processes.

Secondary can also appear against the background of bacterial diseases of the maxillary sinuses, middle ear and upper respiratory tract.

In rare cases, the disease may develop as a response to the injected serum during vaccination with the encephalitis virus. Such cases are considered the most dangerous due to the rapid increase in symptoms. Post-vaccination development of meningoencephalitis quickly leads to disability or death.

Causes

The development of the disease is caused by the penetration of infectious agents into the brain structures. If the disease appears as a result of a tick bite, they speak of the primary form of encephalitic meningitis.

The secondary type of pathology develops in people with weakened immunity. In addition, it is observed in persons who have suffered from certain infectious diseases, including rubella, mumps, measles, pneumonia, sinusitis or otitis media.

The development of encephalitic meningitis, the causes of which are a decrease in immune defense, is due to the lack of a proper barrier to prevent viral elements from entering the brain tissue or membranes, as well as the activation of severe inflammatory processes.

Routes of infection and development of the disease

With this type of meningitis, the causes of the disease are often transmission of the virus through a tick bite. In this case, the disease develops within 2-25 days from the moment the virus enters the body. During this period, symptoms gradually increase.

In rare cases, infection can be caused by eating the milk of animals infected with the virus. In this case, the symptoms increase faster, within one week.

Methods of infection with the secondary form of the disease are bacterial lesions of the ENT organs. The infection enters the meninges through the bloodstream, provoking the onset of the inflammatory process.

The secondary form of the disease also develops against a background of reduced immunity, as a result of diseases such as measles or influenza. The most common cause of the disease is pneumococcal infection.

How to protect yourself

The main preventive measure is vaccination of all people who are at risk in their place of residence. But vaccination against encephalitis does not always serve as a 100% guarantee that a person will not get sick when the virus enters the body.

Vaccination is the best way to protect against encephalitis

To protect yourself from this terrible disease, you need to take your health seriously and follow some recommendations:

do not refuse vaccination;
treat all diseases, especially those of viral and bacterial etiology;
monitor your immunity and strengthen it;
when characteristic symptoms appear, do not expect the disease to go away on its own, but contact a doctor;
do not self-medicate;
when visiting tick habitats (forest, grove, planting), you must take precautions - wear closed clothes and shoes;
If a bite occurs, you must go to the hospital and have the tick tested.

Encephalitic meningitis cannot be contracted from another person; only viral meningitis is transmitted by airborne droplets. But to prevent the disease, you need to take care of your immune system, this will avoid frequent infectious diseases and reduce the risk of infection with encephalitis.

Symptoms and signs of the disease

The rate of increase in symptoms is different for each patient and depends on the characteristics of the body and the state of the immune system. The initial symptom of the disease is headache, without clear localization. Some patients complain of migraines - headaches on only one side of the head.

At the initial stage, encephalitic meningitis is accompanied by the following symptoms:

apathy;
fast fatiguability;
constant fatigue;
mood swings;
lack of appetite;
aching muscle pain;
pain in the joints.

After some time, the acute phase of meningoencephalitis begins, which is characterized by the following symptoms:

increase in body temperature up to 400 C;
swelling of the mucous membranes;
runny nose;
discomfort in the throat and when swallowing.

The temperature is not reduced with the help of antipyretics.

Further, the appearance of meningeal, cerebral or focal syndrome is possible, depending on the degree of the inflammatory process.

Meningoencephalitis (encephalitic meningitis): causes, symptoms, diagnosis and treatment

Encephalitic meningitis is a viral, fungal or bacterial disease manifested by inflammation of the membranes of the brain and spinal cord. It can be fatal if immediate diagnostic and therapeutic measures are not taken.

Story

There is an opinion that in the times of Hippocrates and Avicenna they knew about the existence of this disease. Could they cure her? More likely no than yes, because even in the modern world it is not always possible to identify a problem in time and respond to it.

The first documented case was recorded in Scotland in 1768, but at that time the connection with the pathogen was not clearly visible. They started talking about the epidemic at the beginning of the nineteenth century in Geneva, and although it was managed, it was not the last.

Throughout the last and century before last, encephalitic meningitis appeared in Africa, Europe and the USA.

Until the end of the twentieth century, the mortality rate from meningitis reached almost one hundred percent, but after penicillin was successfully used against the disease in 1944, the number of lives saved began to increase. Vaccines against common bacterial pathogens also helped, as did the invention of glucocorticoid drugs.

Causes

Based on etiology, this disease can be divided into three categories:

– infectious (provoked by a specific pathogen); – infectious-allergic (autoimmune damage to the membranes of the brain in response to infection, vaccination or rheumatic disease);

– toxic (exposure to irritating substances that provoke inflammation).

There are also primary and secondary encephalitic meningitis. As you might guess, a disease is called primary when the source of infection is located directly in the brain. This occurs with internal injuries (bruise, hematoma), viral or infectious diseases. A secondary disease appears as a complication, for example, of otitis media, sinusitis, tuberculosis or syphilis.

Epidemiology

Previously, due to overcrowding, non-compliance with sanitary and hygienic standards and poor nutrition, encephalitic meningitis occurred mainly in children under five years of age. But now such cases are rare thanks to the development of medicine and improved living conditions.

Most often they get sick in late winter - early spring. At this time, vitamin deficiency and decreased immunity are clearly manifested, as well as sudden changes in temperature and humidity. Constant stay in closed, poorly ventilated areas also contributes.

Encephalitic meningitis is widespread throughout the world, but it is most common in African countries. In Russia, the first outbreak of this disease occurred before the outbreak of World War II, the second in the eighties of the last century, and the last in 1997.

Pathogen

The most common are meningococcal and pneumococcal encephalitis meningitis. Streptococcus pneumoniae has more than eighty antigenic species. The organism itself is motionless, prefers aerobic space, but in critical situations it can temporarily do without oxygen.

The bacterium is oval in shape, less than a micrometer in diameter, it is immobile and does not have spores. It develops well on blood media at human body temperature. Pneumococcal encephalitis meningitis is transmitted by airborne droplets from a sick or recovering person.

The microorganism is quite resistant to the effects of drugs, including antibiotics.

Pathogenesis

The disease begins when the pathogen enters the upper respiratory tract and attaches itself to the mucous membrane of the nasopharynx or oropharynx. The virulence factors that pneumococcus has (capsule, teichoic acid, substance C) stimulate the production of prostaglandins and activate the complement system and neutrophilic leukocytes.

All this together does not cause encephalitic meningitis. The reasons for its appearance are deeper. Where the pathogen has colonized the mucous membrane, inflammation develops in the form of otitis, sinusitis, frontal sinusitis or tonsillitis.

Bacteria multiply, their toxins suppress the body's immune system, and through the bloodstream they spread throughout the body, affecting the heart, joints and, among other things, the lining of the brain.

Clinic

In the clinic, there are three forms that encephalitic meningitis takes:

– acute, accompanied by adrenal insufficiency and often ending in death; – prolonged, when symptoms increase gradually;

– recurrent, with small light intervals.

The acute form is characterized by a sudden onset against a background of complete well-being with a sharp increase in temperature to pyretic levels (39-40 degrees). There is pallor, sweating, cyanosis, possible loss of consciousness and convulsions, as well as paresis of the facial muscles. In infants and infants, anxiety manifests itself as a monotonous, incessant cry.

Increased intracranial pressure may cause divergence of the sutures of the skull, as well as bulging of the fontanel. On the second day of the disease, characteristic meningeal symptoms appear, such as stiffness of the neck muscles. After three to four days, the patient falls into a coma, and progressive swelling (due to the inflammatory reaction) leads to herniation of the medulla oblongata.

Meningeal symptoms

These are signs characteristic of inflammation of the meninges. They appear in the first hours after the onset of the disease and help to accurately diagnose.

Pointer dog pose (head thrown back, limbs brought towards the body).
Rigidity of the muscles of the neck and back of the head (the doctor is unable to passively bend the patient’s head due to increased tone of the extensor muscles).
Kernig's sign (the doctor bends the patient's leg at the hip and knee joint, but when trying to straighten it, he encounters resistance).
Upper Brudzinski symptom (when the head is bent, the legs are pulled towards the body).
Medium Brudzinski's sign (bending of the legs when pressing in the suprapubic region).
Lower Brudzinski's symptom (When one leg is passively flexed, the other is also brought toward the abdomen).
Lessage's sign (the infant is lifted, supported by the armpits, while his legs are drawn closer to the body).
Mondonesi's sign (painful pressure on the eyeballs).
Bekhterev's symptom (pain when tapping on the zygomatic arch).
Increased sensitivity to irritants, fear of light and sound.

In children

For an adult, it is difficult to endure a disease such as encephalitic meningitis. The consequences in children can be even more tragic, since they rarely complain of illness, do not notice insect bites and have reduced immunity. Boys get sick more often than girls, and the disease is more severe.

To protect your child, you need to dress him warmly in the spring and autumn, consult a doctor promptly at the slightest sign of illness, and examine him outside every couple of hours in the summer for tick bites and other blood-sucking insects.

Diagnostics

It is first of all important for the doctor to confirm the diagnosis of “encephalitic meningitis”. Is he contagious? Undoubtedly.

Therefore, the patient must be placed in a separate box or in the infectious diseases department, having previously conducted an epidemiological survey. Then you need to collect an anamnesis of life and health, find out complaints.

Physical examination consists of checking meningeal signs and taking temperature. For laboratory tests, blood and cerebrospinal fluid are taken.

A general blood test shows an increase in the level of leukocytes with a predominance of young forms, the absence of eosinophils and a sharply increased ESR to sixty millimeters per hour.

The liquor will be cloudy, opalescent, with a greenish tint. It is dominated by neutrophils and protein, and the amount of glucose is reduced.

To determine the pathogen, blood, sputum or cerebrospinal fluid are inoculated onto a nutrient medium.

Treatment

If an emergency room doctor or emergency room suspects encephalitic meningitis, the patient is immediately hospitalized in a neurological hospital. Treatment begins immediately, without waiting for laboratory confirmation of the diagnosis. Strict bed rest and a high-calorie diet are observed.

They begin with symptomatic and pathogenetic therapy. First of all, you need to cleanse the body of toxins produced by bacteria, as well as reduce intracranial pressure and thin the blood.

To do this, the patient is given intravenous saline with glucose and diuretics. Because excessive flooding of the body can lead to herniation of the medulla oblongata and instant death.

In addition, drugs to improve microcirculation, vasodilators and nootropics support brain activity.

Etiological therapy consists of antibiotic therapy (benzylpenicillins, fluoroquinolones, cephalosporins).

Exodus

It all depends largely on how quickly and successfully the encephalitic meningitis was treated. The consequences may be minor if help is provided in a timely manner. And at the same time, with a severe and rapid course of the disease, the mortality rate reaches eighty percent. There may be several reasons for this:

– cerebral edema and herniation; – cardiopulmonary failure; – sepsis;

– DIC syndrome.

Prevention

Encephalitic meningitis can be prevented; for this purpose, children from two to five years of age are vaccinated among those who are at risk. It is also recommended for people over sixty-five years of age. This vaccine is included in the official WHO vaccination schedule and is used in most countries of the world.

At the moment, in third world countries the public is still afraid of the diagnosis of “encephalitic meningitis”. Can he be cured? Yes, definitely. But success depends on how quickly help was provided and how.

Source: https://fb.ru/article/258508/meningoentsefalit-meningit-entsefalitnyiy-prichinyi-simptomyi-diagnostika-i-lechenie

Classification

In clinical neurology, meningoencephalitis is classified according to etiology (nature) and the nature of morphological changes. To select adequate treatment, the type of disease is determined at the diagnostic stage. According to the type of infectious agent, they are divided into:

viral meningoencephalitis (infectious agents are cytomegalovirus, enteroviruses, influenza viruses, herpes simplex (herpetic meningoencephalitis), rabies virus, measles, chickenpox virus (varicella meningoencephalitis) and others);
bacterial meningoencephalitis (caused by streptococci, meningococci, pneumococci, Haemophilus influenzae);
protozoal meningoencephalitis (develops as a result of damage by protozoa (amoebic, toxoplasmic));
fungal (diagnosed mainly in patients with immunodeficiency, for example, as part of neuroAIDS).

According to the type of inflammatory process, the following are distinguished:

serous meningoencephalitis (proceeds with the formation of serous discharge, accompanied by lymphocytosis - an increase in the number of lymphocytes in the blood);
purulent meningoencephalitis (with the appearance of pus, clouding of the cerebrospinal fluid);
hemorrhagic, which is characterized by impaired permeability of vascular walls and small capillary hemorrhages.

According to the nature of development, the disease is divided into the following types:

lightning fast (in most cases, it ends in death within a few hours);
acute (develops over 1-2 days);
subacute (symptoms increase over 7-10 days);
chronic (the disease occurs with exacerbations and remissions over several months or years).

Symptoms in adults

The general clinical picture of meningoencephalitis is characterized by a combination of general infectious, meningeal, liquor-hypertensive symptoms. Characteristic signs of all types of disease are:

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increase in body temperature to 39-40°C;
intense headache;
nausea, vomiting;
loss of appetite;
apathy;
increased fatigue;
chills;
clouding of consciousness;
increased blood and intracranial pressure;
extreme agitation or drowsiness;
violation of orientation in space;
impaired coordination of movements;
tachycardia (rapid heartbeat);
dyspnea;
skin rash;
increased sensitivity to light and sound;
convulsions;
vestibular ataxia (impaired coordination of movements);
pale skin;
asymmetry of tendon reflexes;
drooping upper eyelid;
the appearance of facial asymmetry;
swallowing disorder.

Meningoencephalitis in children

Meningoencephalitis in newborns is often viral in nature, less often intrauterine infection is possible (occurs against the background of an infectious disease of the mother (rubella, measles, mononucleosis) in the first trimester of pregnancy).

The general clinical picture does not differ from the signs of the disease in an adult (headache, fever, vomiting, convulsions, skin rash, involuntary eye twitching).

The disease is accurately diagnosed if the following symptoms are present:

Kernig (impossibility of bending the leg at the knee with a bent hip joint);
Hermann (involuntary extension of the big toes when flexing the neck);
Brudzinsky (involuntary bending of the legs when tilting the head);
Severe pain when pressing on the eyelids of closed eyes.

Syndromes with encephalitic meningitis

Meningeal syndrome is characterized by extensive damage to the meninges. In this case, the following signs are observed:

excruciating headache;
symptoms of body intoxication;
increased reaction to stimuli;
phono- and photo sensitivity;
weakening of the muscles of the neck and occipital region.

These symptoms arise due to irritation of certain receptors located in the pia mater of the brain.

The cerebral syndrome is characterized by a combination of the following neurological symptoms:

psychomotor disorders;
confusion;
hallucinations;
sleep disorders;
rave.

The danger of this condition is the risk of developing coma.

Focal syndrome manifests itself differently, depending on the location of the source of infection. In the secondary form of the disease, vestibular disorders and damage to the facial nerves are often observed.

The exact symptoms depend on several factors:

localization of the source of infection;
patient immunity;
form of the disease;
rate of development of pathology.

Symptoms of extensive damage to the brain and its membranes - disruption of the cardiovascular system and respiratory organs - are unfavorable. Extensive damage to brain tissue often leads to irreversible consequences, including death.

Complications

The consequences of meningoencephalitis are extremely serious, and in 80% of cases among children there is death. There is a chance of recovery if the patient is hospitalized in time and treatment is started before brain damage occurs. The lowest survival rate is in newborn children, who can become infected from their mother during intrauterine development.

If a baby gets meningoencephalitis, then there is also a low chance of survival . Moreover, in a situation where the baby can be saved, he often remains disabled with a central nervous system disorder. As a result, mental retardation, paresis and epilepsy are observed.

Other side effects include loss of vision, memory problems up to complete loss, and mental disorders. Even adults experience disturbances in mental activity, as well as epilepsy. At best, with proper treatment, a person will experience long-term headaches and dizziness. Sometimes the consequences go away after a long time, but they can last a lifetime.

Encephalitic meningitis is easier to prevent by avoiding provoking factors than to cure. Children especially need to be protected because they have less chance of recovery. Without treatment, the infection will not go away, and the likelihood of death is extremely high.

Diagnosis of pathology

The diagnosis is made based on a spinal tap analysis. This allows you to detect inflammation and determine its nature. Treatment is carried out only after identifying the causative agent of the disease.

Meningitis is accompanied by a significant increase in intracranial pressure, so taking fluid for analysis is also first aid, helping to quickly reduce high blood pressure.

Diagnosis and therapy

To make a diagnosis, an analysis of the spinal cord is performed, for this purpose a puncture of the cerebrospinal fluid is taken and the causative agent is identified. One of the advantages of this procedure is the reduction of intracranial pressure, a significant increase in which is a manifestation of meningitis.

Laboratory analysis of cerebrospinal fluid is required to make a diagnosis.

Usually after the puncture the patient feels some relief. Having established a diagnosis, the doctor prescribes drug therapy, which includes antibacterial drugs, antiviral, anti-inflammatory and immunomodulators.

Additionally, the doctor may prescribe hormonal therapy. The course of treatment depends entirely on the stage of the disease and the degree of damage to the meninges and brain.

Therapy is always comprehensive and includes not only symptomatic medications, but also medications to improve cellular metabolism, improve blood circulation, vitamins and tonics.

Treatment of the disease

Treatment is prescribed after determining the pathogen and the degree of infection of the meninges. Therapy is selected taking into account the characteristics of the disease in a particular patient.

The basis of treatment is antibacterial or antiviral therapy. At the same time, symptomatic treatment is prescribed.

General strengthening measures are used - taking vitamins and immunomodulators. Some time after the start of antibacterial therapy, treatment is supplemented with drugs whose action is aimed at improving brain metabolism, protecting brain neurons and stimulating its work. These are drugs from the group of neuroprotectors and medications that stimulate local metabolic processes. Since the disease is accompanied by psychosomatic disorders, the patient is recommended to take sedatives and antioxidants.

After relief of inflammation, the patient faces a long period of rehabilitation, during which drug treatment is supplemented with physical therapy.

In children

Possible risks

The consequences of meningitis must be identified and treated promptly.

If you seek help in a timely manner, there is a high probability of a favorable outcome without further development of dangerous consequences. In other cases, the patient may face irreversible neurological disorders, such as epilepsy, impaired cognitive function of the brain and mental disorders.

Recovery from an illness is a difficult and long process. The duration of the rehabilitation course depends on many factors, including the severity of the symptoms suffered, as well as the stage and form of the disease. The prognosis largely depends on timely seeking help when initial symptoms are detected.

The patient must register with a local clinic and undergo regular examinations for the next few years after the illness. This allows you to identify possible violations and consequences in a timely manner, and take timely measures to eliminate them.