Treatment of meningitis abroad
Meningitis is a life-threatening inflammation that affects the brain lining. Illness can develop in any age, including infants less than 1 year old. Greatest hazard represents the bacterial meningitis. Lethality in these cases varies from 10 to 15% in different countries.
Meningitis demands the timely diagnostics and treatment to save patient’s life and prevent the irreversible neurological disorders.
Causes of Meningitis
Meningitis is a disease of infectious origin. Most often, the brain lining inflammation is caused by viruses or bacteria. Rarely,it can be caused by:
- Protozoa (amoebas)
Meningitis can be serous or purulent depending on the contents of cerebrospinal fluid. Serous type is met more often. As statistics says, one out of three patients has purulent meningitis, and two other have the serous one.
Purulent meningitis is usually caused by the bacteria; serous type is caused by the viruses. But there are also exceptions. For instance, tuberculosis and syphilis are bacterial infections, but they cause a serous meningitis.
Main causative agents of the viral meningitis are:
- ECHO viruses group
- Epidemic parotitis virus (“mumps”)
- Lymphocytic choriomeningitis virus
Bacterial pathogens can be met at different rate in different age. Most often, infants up to 1 year old can suffer from meningitis because of:
- E. coli
Bacterial meningitis can be caused by three types of microorganisms:
- Haemophilus influenzae - 10% of cases
- Meningococcus - 60% of cases
- Pneumococcus - 30% of cases
There could be primary and secondary brain lining inflammation. Primary form occurs as an independent disease (e.g. meningococcal meningitis). Secondary form infection gets into the brain linings from the other foci. Secondary form of meningitis can occur as a complication after the surgery as well.
Symptoms of Meningitis
Meningitis is a disease that can be caused by various infectious causative agents. Therefore, clinical course of the disease and its symptoms have their own peculiar signs among the patients. There are also general symptoms.
Three basic syndromes develop while having meningitis:
- General intoxication (fever, muscle pain, fatigue and other signs of infectious process)
- Inflammation changes of cerebrospinal fluid (detected while testing cerebrospinal fluid, CSF)
- Meningeal syndrome (associated with the irritation of the brain lining)
Meningeal syndrome symptoms, in their turn, are divided into three groups. They include:
Symptoms of hyperesthesia (hypersensitivity). Patient cannot stand the light and noise. Headache is increasing high volumeof the noise. Skin sensitivity is increased.
Reactive pain phenomena. When touching some spot of the patient’s body the increased or occurrence of pain sensations is observed.
- Tapping the zygomatic arch causes headache
- Pain when pressing the eyeballs
- Mydriasis is observed during passive flexion of the patient's head
Muscle contractions. Some muscle group of a patient might strain. These can be neck (it’s impossible to touch the chest with the chin), back muscles, muscles on the rear surface of the legs.
A doctor defines the characteristic symptoms that point to the muscle contractions:
- “Gundog pose” (a patient is arched back and cannot straighten up, that’s why lays on the side)
- Kernig symptom (when a leg is bent at the hip joint, it is impossible to straighten the knee)
- Guillain symptom (bending a leg at the knee and hip joint in response to compression of the opposite leg quadriceps thigh)
Many other signs of muscle contractions can be defined: several Brudzinskiy symptoms, Herman and Gordon symptoms etc. They are determined by the doctor during the examination of the patient.
Meningitis - Diagnostics
Cerebrospinal fluid test is a principaltest in meningitis diagnostics. Also, nasopharyngeal mucus may be used as biological material for the analysis.
Patient is ordered the lumbar puncture to take the spinal fluid for analysis. A needle is injected into the lumbar spine section. Bone marrow ends there, so there is not risk to damage it.
Characteristics of the cerebrospinal fluid indicating meningitis:
- Increased pressure of cerebrospinal fluid
- Fluid will be turbid, of yellowish or greenish color for the purulent meningitis
- Pleocytosis - a significant increase in cells in the cerebrospinal fluid (neutrophils or lymphocytes)
- An increase in protein content (purulent meningitis)
- Glucose level is below normal
Normally, it’s not that hard to detect meningitis in a patient. Doctor’s main task on the diagnostics level is to find out what causative agent is a reason of the illness as the treatment scheme depends on it.
Following diagnostics variants are applied to detect bacteria or viruses in CSF:
- Bacterioscopy (biomaterial is being studied under the microscope)
- Bacteriological examination (inoculation of culture media)
- PCR (polymerase chain reaction, reveals the DNA or RNA of the pathogen)
- Reaction of latex agglutination
- Method of counter-immunoelectrophoresis
- Fluorescent antibody method
- Fluorescence response
- Reaction of pale treponemes immobilization
ELISA (enzyme-linked immunosorbent assay) and indirect hemagglutination reaction is rarely used since these tests take time, and meningitis can occur quite quickly.ELISA is used for suspected tuberculosis.
MRI is applied to find the meningitis complications (hydrocephalus, brain abscess, thrombosis of venous sinuses).
Treatment of Meningitis abroad
Meningitis is treated conservatively. Patient is prescribed the causal treatment, pathogenic and symptomatic therapy.
Goal of the causal therapy is to kill the causative agent. No cause – no disease.
Different medicines are prescribed here depending on the type of pathogen:
- Bacterial meningitis requires penicillin antibiotics, cephalosporins and also carbapenems as the reserve drugs (if other antibiotics are ineffective)
- Tuberculous meningitis requires several medicines: streptomycin, ethambutol, isoniazid; rifampin is added if necessary
- Viral meningitis don’t usually require causal treatment, but interferons and glucocorticoids can be indicated for the severe forms
- Protozoal meningitis is treated by sulfadimine and chloridin
- Fungal meningitis requires the indication of amphotericin B and 5-flucytosine
Pathogenic therapy aims at the removal of the consequences of the causative agent presence in patient’s brain lining and at the support of vital functions. Therapy is chosen depending on the clinical situation.
Main directions of the pathogenic therapy are:
- Control of blood electrolytes content and its timely correction
- Control of intracranial pressure
- Prevention of brain edema
- Prevention or relief of infectious-toxic shock
- Neuroprotective therapy (to protect the brain from permanent damage)
- Struggle with hemorrhagic syndrome
Symptomatic medicines are also applied. Purpose of their prescription is to improve patient’s tolerance to the basic treatment and to improve patient’s life quality during the treatment course and to relieve his suffering.
Painkillers, sleeping pills, diazepam are prescribed to stop seizures. Vitamins and general tonic medicines are also ordered.
Meningitis - Prognosis
Majority of patients having meningitis are dying within several weeks without treatment. Those few, who survive, suffer their whole life from motor disorders, epilepsy, headaches, blindness, and other consequences of the illness.
Since the development of effective antibacterial medicines the lethality due meningitis has decreased. Least favourable prognosis has the fulminant clinical form of the disease, as in this case a patient often dies even before he receives the causal therapy. Old or weak patient are also in the risk group to have the lethal result if they have purulent meningitis.
If treatment was started in time, the prognosis is favourable. Terms of recovery depend on the etiology and severity of the illness. Hospital stay may take from few days (for viral meningitis) up to several weeks. Residual neurologic symptoms are not observed among most of the patients and the ability to work is fully restored.