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Meningitis - Symptoms and Treatments
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Meningitis - Symptoms and TreatmentsFRMeningitis: síntomas, tipos y vacunaESMeningitis: tipos, sintomas e tratamentoBRSintomi of meningitis e vaccinoIT
December 2017
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| meningitis |
Definition
Meninging meningitis
causes
sYMPTOMS
Risk factors
Bacterial meningitis
Meningococcal meningitis
Pneumococcal meningitis
Tuberculous meningitis
Other bacterial meningitis
Viral meningitis
Herpetic meningitis
Signs that need to alert
Meningitis: first symptoms
Diagnostic
Complications
aftermath
Treatment
Prevention
Vaccination
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Meningitis: Do you know the first symptoms?
Meningitis: Do you know the first symptoms?
Meningitis is the inflammation of the central nervous system (CNS) membranes called meninges.
Meningitis is most often infectious and commonly causes fever, headache and neurological signs. There are two types of infectious meningitis: viral meningitis, which is usually benign, and bacterial, which is more dangerous and needs to be treated urgently. Bacterial meningitis due to meningococcus requires treatment of the patient's environment because of its contagious nature. Meningitis mainly affects children and young adults.
Meninging meningitis
In its most severe form, it is described as lightning and can be deadly. In this case, the inflammation is of bacterial origin and the germ in question is mainly meningococcus. Invasive meningococcal infections mostly affect the youngest. Those under 5 represent 38% of cases, then the disease decreases before experiencing a new peak incidence between 14 and 20 years.
The picture is typically that of a young child, who has clinical signs of meningism with headaches, high fever, a stiff and painful neck, difficulty coping with light called photophobia or sounds, called phonophobia. Quickly, may appear on the skin purpura dit fulminans because of its rapid installation, characterized by dark red spots that do not disappear when pressure is exerted on it.
In this case, the EMS must be contacted for the implementation of emergency treatment with antibiotics. Meningitis meningitis can be fatal, but early management, a cure without sequelae is possible.
causes
Different infectious agents are involved in meningitis. The inflammation may be caused by a virus, in this case it is the most common type of meningitis (about 70% of cases of meningitis), usually mild, seasonal. A bacterium may be involved: this type of meningitis is less common but potentially more severe, potentially life-threatening. Bacterial meningitis can be associated with the same neurological signs as encephalitis and is referred to as "meningoencephalitis". A parasite can be involved in very rare cases.
sYMPTOMS
Common symptoms of viral or bacterial meningitis are fever, severe headache, stiffness in the neck, vomiting, limitation of lower limb elevation (Kernig's sign), and involuntary flexion of the lower extremities forced flexion of the neck (sign of the neck of Brudzinski).
Risk factors
Age (infants, elderly), community life (eg crèche, school, canteen and confined spaces), which promotes the transmission of infectious agents through the respiratory tract, and the weakening of the immune system are all risk factors.
Bacterial meningitis
Meningococcal meningitisMeningococcal meningitis is caused by a germ present in the throat, which is transmitted exclusively by inhalation of saliva droplets thrown into the air through the nose and throat of an infected person. Contamination therefore requires close contact with a person carrying this germ. There are several types of meningococci: B and C in the majority of cases in France, more rarely A, Y and W135. Meningococcal meningitis is a serious condition requiring emergency management. The incidence in France is one case per 100,000 inhabitants. Although rare, meningococcal meningitis (of bacterial origin) is a serious infection whose diagnosis can be fatal (10% of cases). Usually occurring between early winter and spring, this infection mostly affects children and adolescents.
Meningococcal meningitis is transmitted from person to person by droplets of respiratory or pharyngeal secretions (cough, postilion, etc.). Close and prolonged contact (sneezing, kissing, etc.), community life, shared cutlery and others favor the spread of the bacteria. The incubation period lasts between 2 and 10 days, the average being 4 days.
Depending on the form of the disease and its more or less early diagnosis, the symptoms will not be exactly the same.
Classic forms: fever, headache, photophobia (fear of light), stiffness in the neck, nausea and vomiting.
Severe forms: necrotic or purpuric ("blue" spots that do not fade on pressure) that gradually spread over the body.
Meningitis is a fatal disease: about 5% to 10% of patients die between 24 and 48 hours after the onset of symptoms. In addition, the disease can cause brain damage, partial deafness and / or learning disabilities in 10% to 20% of survivors.
As soon as the symptoms appear, it is necessary to consult as soon as possible the emergencies of the nearest hospital.
Vaccination is possible for two of the serogroups, A and C. The divalent vaccine in question is effective only after the age of 18 months and remains effective for 3 years. A so-called "tetravalent" vaccine effective on serogroups A, C, W 135 and Y is available in specialized centers and can be done under certain conditions (particular destinations, epidemic context proven at W 135, etc.). In the context of an epidemic infection, the management of secondary cases and their protection constitute a form of prevention.
Like all bacterial infections, meningococcal meningitis is treated with antibiotics. For the treatment to be as effective as possible, it must intervene as soon as possible. The patient's entourage and all persons who have been in close contact within the 10 days prior to hospitalization should also be given short-term preventive antibiotics.
Pneumococcal meningitis
It is related to Streptococcus pneumoniae: the mode of contamination is similar to that of meningococcal meningitis, knowing that the bacterium can also be transmitted by contact with objects soiled by respiratory secretions. Pneumococcal meningitis is more common in winter and spring, and particularly affects babies and the elderly, as immunity is usually acquired from the age of 5 years. Head trauma or ENT intervention is added to the risk factors for transmission of this infection.
Tuberculous meningitis
Tuberculous meningitis is a form of meningitis caused by the bacillus of Koch. It is mainly manifested by violent headaches resulting from inflammation of the meninges. Other symptoms occur gradually, including fatigue, mood disorders and insomnia. The sign of Kernig is revealing: the patient is unable to lift his legs perpendicularly when lying down. The diagnosis can be made after a lumbar puncture and a CT scan. Treatment is based on antibiotic therapy (isoniazid, rifampicin, etc.).
Other bacterial meningitisMany germs are involved in other types of bacterial meningitis, which account for about 10% of cases such as haemophilus influenzae (in infants), Koch's bacillus, Streptococcus B, Escherichia coli, Listeria monocytogenes (in the child) and staphylococcus aureus (in the context of an infection contracted in hospital, after an operative procedure in particular).
Viral meningitis
Viral meningitis is an inflammation of the meninges (a membrane that covers the brain and spinal cord) caused by a virus. Viral meningitis, which is much more frequent, is benign and spontaneously favorable. Many viruses are involved: enterovirus, adenovirus and infectious mononucleosis, measles mumps, rubella, chickenpox, etc. The treatment is essentially symptomatic (analgesic).
Herpetic meningitis
There are several types of meningitis depending on the cause responsible. Herpetic meningitis is caused by Herpes Simplex virus (HSV). It is characterized mainly by headache, fever and stiffness of the neck. Some patients also suffer from hallucinations and become aggressive. Lumbar puncture is used to study the cerebrospinal fluid and identify the virus. Cerebral computed tomography and electroencephalogram may be indicated. Aciclovir is the first-line antiviral treatment.
Signs that need to alert
Necrotic purpura or "purpura fulminans" (cutaneous hemorrhagic lesion manifested by spots on the skin of purple or purplish pigmentation), poorly supported fever, respiratory disorders, photophobia (discomfort to light with excessive sensitivity), general malaise, cold hands and feet, very bad-looking, septic shock, and / or confusion, agitation, convulsions, and disturbances of consciousness (encephalitic syndrome) are manifestations that must alert.
In the presence of the symptoms mentioned above, contact the Emergency Medical Assistance Service (EMS) by dialing 15 or 112 on a mobile phone.
Meningitis: first symptomsDiagnostic
In case of suspicion of meningitis, an emergency consultation must be made. The presence of a purpura, red spots of sudden appearance that do not disappear with the pressure, must be sought. The management of meningitis suspicion is hospitable with the achievement of a lumbar puncture which is a collection of cerebrospinal fluid performed near the spine. Analysis of this fluid in the laboratory (appearance, number and type of cells, biochemistry, direct bacteriological examination and culture) may confirm meningitis and determine whether it is caused by a virus or bacteria. In some cases, a CT scan can be performed before the puncture. At the same time, a blood test will be made and put into culture.
Meningitis of bacterial origin requires treatment with antibiotic therapy, the choice of which is oriented according to the results of the direct examination of CSF, and some signs of severity.
Complications
Untreated, or late management, bacterial meningitis can lead to complications such as sepsis, bilateral deafness, coma, memory problems, recurrence, cranial nerve palsy, behavioral disorders , mental retardation, epilepsy, and in dramatic situations lead to death.
aftermath
In general, viral meningitis evolves spontaneously to healing between 3 and 8 days. Unlike bacterial meningitis, viral meningitis does not normally result in sequelae. That said, vision and hearing disorders and paralysis can occur in some cases.
Potentially lethal, bacterial meningitis requires antibiotic therapy to prevent complications. If management is late, the patient may have neurological sequelae. These sequelae include impaired vision (even blindness), hearing loss, language and memory problems, paralysis and gangrene.
Treatment
The treatment of meningitis should be fast. If purpura is associated with meningeal syndrome, antibiotics are given even before the results of the lumbar puncture, sometimes even before its completion if the puncture can not be performed in sufficient time. In case of serious signs, they will be given after the blood test and before the puncture. In other cases, cerebrospinal fluid analysis is needed to know if antibiotics are needed. Corticosteroids may also be prescribed depending on the case.
Prevention
Bacterial meningitis with meningococcus is contagious by respiratory contact, it is necessary to be very careful and put in place measures of isolation in case of suspicion. If the identified germ is meningococcus, the entourage and professionals who have been in contact with the patient should take preventive treatment. A statement of the case to the Regional Health Agency is also mandatory. Vaccination is now recommended for children. Other bacteria or viruses responsible for meningitis are prevented by vaccination (mumps, poliomyelitis ...).
Vaccination
Vaccination is possible for the prevention of certain types of meningococcal meningitis:AT ; C; W135 and B14. A vaccine is also available for (partial) prevention of pneumococcal meningitis inand prevention of Haemophilus influenzae (two injections before the age of 18 months).
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