Puncture of cerebrospinal fluid in children for meningitis. Diagnosis of meningitis in children

REFERENCE! The disease is infectious and affects the pia mater of the spinal cord and brain.

The disease is characterized by cerebral, meningeal and general infectious syndromes. Cerebrospinal fluid is exposed pathological changes. The disease proceeds independently or is complicated by others.

Methods for diagnosing meningitis in a child

The disease can be diagnosed in children in various ways. The most effective of them will be given below.

General blood analysis

General analysis blood - reflects the presence of a bacterial or viral infection due to an increase in the level of leukocytes in the blood increases.

Leukocytes are the main indicator of the presence of infection in the human body. As a result of the data obtained, it is determined how much the leukocyte formula has shifted.

Lumbar puncture and cerebrospinal fluid examination

Lumbar puncture carried out by inserting a needle into spinal canal for the fence cerebrospinal fluid and its subsequent analysis. This method allows not only to diagnose the disease, but also to suggest the type of pathogen.

Indications for the method:

1. Neuroinfection is suspected.
2. Hemorrhage in the subarachnoid space is suspected.
3. Confirmation or refutation of metastatic and oncological processes in the structure of the brain.
4. Diagnosis of liquorrhea.
5. Diagnosis of cerebrospinal fluid fistulas.

With such indicators, lumbar puncture is mandatory, There are also relative indicators when the method is additional:

• the child has inflammatory polyneuropathy;
• febrile state, inexplicable.

The method is effective, but there are a number of contraindications:

1. Brain swelling. Lumbar puncture leads to increased intracranial pressure, the cerebellum is wedged into the occipital foramen. This could cause the child's death.
2. Volumetric processes take place in the structures of the brain.
3. The child has low blood clotting ability.
4. There is a skin inflammatory process at the puncture site.

The procedure is carried out as follows:

Each meningitis is determined by its own pathogen; changes in the cerebrospinal fluid are different for each pathogen.

Bacteroscopy and bacteriological analysis

A smear of cerebrospinal fluid is taken to confirm the diagnosis. By bacteroscopy of the smear, the causative agent of the disease is determined. Bacteriological analysis allows you to identify any quantity pathogenic microorganisms in the biological material under study.

The advantages of this method for diagnosing meningitis in children:

• specificity is high;
• the possibility of researching any biological fluid The child has;
• The sensitivity of microbes to medications is determined.

Disadvantages of the method:

• long wait for results;
• high demands are placed on material collection;
• carried out only experienced specialists in equipped bacteriological laboratories.

IMPORTANT: Sterile containers are used to collect material! The material is collected before antibiotics are taken. If the child is treated with antibiotics, the result will be distorted.

Serological study

To identify foreign microorganisms in the blood, a serological test is performed. The serological research method makes it possible to establish accurate diagnosis when the child is sick not only with meningitis, but also with autoimmune diseases.

With such ailments, organic tissue changes its properties so that the body begins to destroy its bodies, creating antibodies. By using serological method Antibodies are detected in blood serum, which makes it possible to accurately diagnose the disease. To carry out diagnostics, blood is taken from a vein.

X-ray and CT

X-ray – required method diagnostics for suspected meningitis. It has no contraindications. Indications for its implementation:

• cough with sputum production;
• chills;
• feverish condition;
• changes in blood tests.

IMPORTANT! X-rays can be done up to 3 times a year without fear for health. But, if a child has meningitis, then the diagnostic procedure is carried out more often - there is no need to be afraid of radiation, the consequences of the disease are worse.

Using computed tomography, ultra-precise diagnostics is performed. Unlike X-rays, the radiation dose is minimal. Using CT it is determined:

• places where the passage of blood vessels is disrupted;
• pulmonary thromboembolism is determined;
• tumor formation.

If the X-ray examination did not give the necessary results in identifying possible decay inflammatory infiltrate, CT is used.

Preparing the child

No special preparation is required before diagnosing meningitis. Culture tests are taken in the morning, on an empty stomach. Do not take antibiotics before donating blood. Computed tomography is not performed for diseases thyroid gland, bronchial asthma and cardiovascular diseases.

A referral for diagnostics is given by a pediatrician after a preliminary examination. The therapist is also responsible for issuing referrals. The procedures take place in clinics and private clinics.

In public clinics, consultation and examination are often free of charge., if you use paid services, then the price starts from 1000 rubles. In special paid clinics, the price of consultation and examination of children starts from 3,000 rubles.

ATTENTION! If the child has dangerous symptoms (wet cough, elevated temperature, weakness) must be addressed for medical care. It is strictly forbidden to self-medicate - it is not clear what exactly the child is sick with.

If he has meningitis, only timely treatment, you cannot waste a single day, and during self-medication, precious time is lost.

Not only the means cannot be used traditional medicine, but also traditional medications without consulting a doctor. It is unknown what contraindications a child may take on medications; it is difficult to determine the dosage; all this must be done by a doctor.

Conclusion

To prevent a child from getting meningitis, preventive measures must be taken. Avoid hypothermia and strengthen your immune system. For this purpose they are used vitamin complexes. The child must eat rationally and receive vitamins and minerals from food. Walk more fresh air. And don't ignore any negative symptoms. If you have any suspicions, you know how to diagnose meningitis in children.

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Meningitis is a disease infectious course. Inflammatory processes in the membranes of the brain develop due to the ingress of harmful microbes. Any microorganism can cause meningitis. Modern infectious disease specialists came to this conclusion during research. The disease affects people at any age.

Meningitis is completely different in its development and causes of formation. Often the disease can recur for several years. Sometimes a person may get hurt once, but very seriously. Pathological condition poses a direct threat to life and is fraught with serious complications. Provoking factors may be purulent otitis media or sinusitis.

Often, a traumatic brain injury causes inflammation of the membranes of the brain and the patient’s well-being thereby worsens significantly. In most cases, the disease is characterized by formation due to infection by harmful microorganisms through entry through the bloodstream. There is a certain predisposition to the development of the disease at the level of immunity. Often entire families and generations suffer from meningitis.

Scientists have not yet identified a reliable effect of immunity on meningitis. However, the fact that boys get sick 4 times more often than girls has been proven based on statistical research. The course of the disease can be influenced by viruses, bacteria and fungi. IN last years cases are increasingly being identified. Especially dangerous condition causing complex purulent processes.

It is important to remember that young children are especially hard hit by meningitis. Moreover, the typical situation of development of the main symptoms is similar at any age:

1. The appearance of severe headaches, along with vomiting and nausea against the background of measles, rubella, chickenpox, mumps, etc.
2. A significant increase in temperature combined with pain in the neck and back, which intensifies when bending or turning the head.
3. The patient may be unconscious, experience convulsions, drowsiness, nausea, and vomiting.
4. Defeat skin rash of any nature with high fever.
5. Infants experience monotonous crying, a feverish state, and the fontanelle swells.

The above symptoms are not a reliable basis for confirming or refuting the diagnosis. Correct diagnosis carried out in a medical clinic.

Typical signs of meningitis with to varying degrees likelihood require appropriate treatment with exclusively individual approach to every patient. It is possible to confirm or refute the diagnosis only with the help of a spinal puncture.

A spinal cord puncture is performed, which in medicine is called a lumbar puncture. The essence of the technique is to insert a special needle into the area between the 3rd and 4th lumbar vertebrae. The liquid is examined for the content of proteins, glucose and other specific components.

Correct techniques when preparing and performing a puncture allow you to carry out the procedure quickly and with minimal painful sensations for the patient. A puncture for meningitis will not have negative consequences, if medical personnel have sufficient experience in conducting this diagnosis.

Compliance with all prescriptions and correct behavior after puncture is important for the patient himself. Irreversible changes in the body that lead to untimely treatment, can cause disability and even fatal outcome. In addition to cerebral edema, complex neurological disorders occur, which is not the most in the best possible way affects a person's life.

It is not recommended to refuse a puncture for meningitis. She's not just the only way determining inflammation in the spinal cord, but also allows us to identify which microorganisms provoked the disease. This plays a significant role in choosing the most suitable ways treatment.

Microbiological testing to identify the pathogen is only possible through lumbar puncture. During circulation, cerebrospinal fluid from the ventricles enters the space of the brain and spinal cord. An excess of this fluid characterizes meningitis.

Lumbar puncture is performed based on the following situations:

• with the probable presence of a neuroinfection;
• for diagnosing cancer;
• to detect liquorrhea;
• in order to exclude hemorrhage into the subarachnoid space.

Possible risks and contraindications

A prerequisite for puncture is the absence of contraindications. This applies to complex conditions of the patient’s body, which can provoke a deterioration in well-being. These include:

• structural lesions of the brain of volumetric flow;
• cerebral edema;
• poor blood clotting;
• pathological disorders in the back area where the procedure should be performed.

Puncture for meningitis takes place in operating conditions. Lying on your side, with your legs pressed to your chest and your head down, allows for optimal expansion of the intervertebral spaces. The doctor will be able to perform all manipulations with maximum precision. For obese people, the puncture is performed in a sitting position.

Certain anesthetics are used for pain relief. They are introduced into the puncture site in three stages. At the same time, a needle must be inserted to withdraw the test fluid. The rapid flow of liquid into the test tube indicates the presence of intracranial hypertension. If there is an admixture of blood in it, then there may be hemorrhage into the subarachnoid space.

Injury to blood vessels during puncture during meningitis can lead to the obtained fluid turning reddish. Important nuance consists also in the fact that it is necessary to carry out preliminary collection of the test liquid. All manipulations must be carried out quickly and accurately in order to avoid possible trauma to the ligaments and membranes of the spinal sections.

Puncture in children

There is no place for self-medication in children. Postponing a visit to the doctor even for hours can be dangerous unpredictable consequences. According to statistics, despite technological progress in medicine, mortality from meningitis has not decreased over the past 50 years.

The incubation period lasts about 10 days. It is especially difficult at the age of 6 months. It often causes quite dangerous complications. Clinical picture development is similar to the symptoms of the disease in adults. The first signs begin to appear suddenly.

Children aged 2 to 10 years are initially worried about fever, which gradually turns into drowsy state. In newborns, the fontanelle thickens. Kids become capricious and irritable. Older children, from 7 to 12 years old, may be unconscious with meningitis. This manifestation may include severe headaches, a sudden increase in blood pressure and the development of a rash on the skin.

Of primary importance in full examination has a puncture for meningitis in children. The procedure is performed under sterile conditions by inserting a needle into the lower back. The specifics of the puncture are absolutely identical to performing such a mini-operation on an adult.

Each child requires more thorough examination before carrying out such diagnostics. There are more contraindications due to a fragile growing body than in an adult. In addition to puncture for meningitis, blood tests must be performed. Almost always prescribed CT scan and electroencephalography. Comprehensive examination allows you to make an accurate diagnosis and, based on the specifics of the disease, begin adequate treatment.

After a puncture for meningitis, the child is shown a complete bed rest for up to three days. It all depends on individual reaction on synthetic drugs used for pain relief. At first you need to lie only on your stomach to avoid pressure on the puncture site.

Recommended drinking plenty of fluids, not cold and not hot. The child should be in a room where there are no strangers and preferably under the constant supervision of adults. Sometimes intravenous plasma substitutes are prescribed.

If a child, after a puncture for meningitis, begins to complain of chills, discomfort in the neck area, a feeling of tightness, you need to urgently consult a doctor. This also applies to any discharge or numbness at the puncture site.

Consequences

Relief of the disease in children by early stages allows you to successfully restore health in short period time. After an appropriate period of treatment, children can lead familiar image life. Timely seeking help from a doctor does not have undesirable consequences. The child’s body recovers after just a short rehabilitation.

Puncture for meningitis in children provokes the most minimal consequences. There is no pain during the procedure. This is all thanks to unique thin needles designed for similar procedures

. Gradual anesthesia with triple injection of anesthetic plays an important role here.

1. Very rarely, as a result of incorrect manipulations or insufficient qualifications of the doctor, a puncture for meningitis can provoke undesirable consequences:
2. Hemorrhagic complications. These consequences include internal traumatic brain injuries, which manifest themselves as hematomas. Violations of diagnostic technique during puncture can damage blood vessels and provoke bleeding.
3. Postpuncture syndrome. Intracranial vessels are displaced and dilated when epithelial cells enter the spinal cord. Teratogenic factor, characterized by the formation of epidermoid tumors. Elements of the skin enter the spinal canal, and as a result, neoplasms develop. Bottom part
4. the back, legs, and lower back begin to hurt more and more often over time. Direct trauma, this condition is determined by damage nerve endings
5. when manipulating the needle. The lesion may affect the intervertebral discs. Various infections and even another type of meningitis develop.
6. Liquorodynamic complications represent the occurrence of acute pain syndrome against the background of an existing tumor. Changes in the liquor composition are observed when air enters when inserting a needle, chemical substances
7. , microparticles from anesthetics and more.

Other complications occur after a violation of the puncture technique. This is the development of radiculitis, myelitis or arachnoid. Dizziness, vomiting, and nausea may occur in the first hours after the puncture. However, they are not dangerous and pass quickly. A puncture for meningitis is performed to extract and subsequently study the cerebrospinal fluid. Currently this is the only possible method dangerous disease. Doctors identify the normality or pathology of the fluid when it is directly removed.

The effectiveness of the procedure for meningitis is often influenced by extraneous factors. These include obesity, dehydration, back surgery, and more. Sometimes the lumbar puncture needs to be repeated again, with a more thorough step-by-step diagnosis.

Lumbar puncture is a manipulation in which a needle is inserted into the subarachnoid space for diagnostic or therapeutic purposes. More often this technique performed for diseases such as meningitis (inflammation meninges). With this disease this manipulation is one of the key stages in diagnosis, as it allows you to confirm or exclude the presence of the diagnosis itself, as well as clarify the pathogen that caused this or that type of meningitis.

The patient in the lying and sitting position during lumbar puncture

When most patients hear the word “lumbar puncture,” they imagine a dangerous and quite painful procedure. However, it must be said that if the personnel performing this procedure have sufficient skills and the patient himself follows the rules of preparing for the puncture and following a gentle regimen after it, then usually the lumbar puncture takes place quite quickly, with less pain. And the consequences of puncture on meningitis with such correct behavior of the patient and medical staff are either absent or minimal.

General information

Meningitis is a fairly serious disease that can lead to subsequent irreversible changes, disability and even death. The basis of this disease is inflammation of the membranes of the brain, as well as the spinal cord. During inflammatory process production of excess cerebrospinal fluid is triggered, causing damage medulla, as well as a decrease in blood circulation in the microvascular bed. All this can lead to a serious complication - cerebral edema, which is already classified as emergency conditions and requires intensive activities. In addition, meningitis is accompanied by neurological disorders, which in the future can seriously affect later life person.

If meningitis is suspected, the patient should be hospitalized as soon as possible

Meningitis itself may have various factors, triggering its development. Usually there are purulent and aseptic varieties. Purulent appearance meningitis occurs due to the action of bacteria (pneumococci, meningococci and Staphylococcus aureus, as a consequence of surgical interventions). The aseptic type of meningitis is caused by viruses. Aseptic meningitis can be triggered by the action of herpes viruses, enteroviruses, and choriomeningitis viruses.

Such features require specific treatment, since the therapy for bacterial or viral meningitis is different. But in order to determine the treatment method and the causative agent, a special microbiological study of the cerebrospinal fluid is necessary, which is what a lumbar puncture allows.

The puncture mechanism itself is based on the following principle. Cerebrospinal fluid (or cerebrospinal fluid) is formed in special areas of the brain - the ventricles. It is produced choroid plexuses, which are located at the bottom of the ventricles. After this, the cerebrospinal fluid circulates through the ventricular system and exits into the subarachnoid space of the spinal cord and brain. Functions cerebrospinal fluid are that it maintains constant levels of intracranial pressure, absorbs head impacts, and also performs various trophic (nutritional) functions for brain tissue. Since the cerebrospinal fluid also washes the membranes, it is a kind of reservoir for bacteria and viruses during meningitis.

Taking cerebrospinal fluid for examination

Therefore, a lumbar puncture, which allows penetration into the subarachnoid space, makes it possible to take samples of cerebrospinal fluid and examine them for the presence of an infectious or viral agent.

Indications for manipulation

Lumbar puncture must be performed when following situations:

• Suspicion of a neuroinfection. A striking example These diseases are precisely meningitis. It can also be encephalitis,
• Suspicion of hemorrhage in the subarachnoid space.
• The need to confirm or exclude oncological and metastatic processes in the structures of the brain (meninges).
• Diagnosis of conditions such as liquorrhea.
• The need to diagnose liquor fistulas. In this case, the injection of a special X-ray contrast agent is also added to the lumbar puncture.
• Prevention and exclusion of neuroleukemia in hematological oncology patients.

These indications are called absolute, that is, those in which a puncture is necessary and is key. There are also relative indications - those in which lumbar puncture is either not fundamental, or additional method. Usually this:

• Various processes accompanied by demyelinating processes.
• Polyneuropathy inflammatory in nature.
• Unexplained fever.

Contraindications

There are a number of contraindications to performing a lumbar puncture

However, in addition to the indications for puncture, there are also conditions whose presence requires abandoning this manipulation.

• Brain swelling. At this state A lumbar puncture will lead to changes in intracranial pressure, which in turn can lead to herniation of the cerebellum into the foramen magnum and death. This is the most important and first contraindication to lumbar puncture.
• Any large-scale processes in the structures of the brain.
• Conditions with low blood clotting ability.
• Inflammatory conditions at the puncture site.

Methodology

Lumbar puncture is performed in the following way. patient on operating table They are asked to take a characteristic position: lying on their side, their knees should be brought to their chest, and their head should be tilted forward. This position is necessary to widen the intervertebral spaces, which provides the doctor performing the procedure with greater comfort. The puncture can also be performed while sitting (especially in obese patients).

The puncture site itself is located at the level of the 3-4 lumbar vertebrae. A convenient guideline for identifying the 4th vertebra is a line that can be visually drawn connecting the ridges iliac bones. The skin at the site of manipulation is treated with some kind of antiseptic, and then proceed to local anesthesia. For this, an anesthetic is used, which is administered in 3 ways sequentially: intradermal, subcutaneous and during the puncture. A needle with a mandrel is inserted parallel to the spinous processes and carefully moved forward until a feeling of failure is felt, which will mean that the needle has passed through the ligaments and hard shell, after which a test sample of liquor fluid is taken in order to confirm the correct placement of the needle. After that, a clean test tube is inserted into which the liquid is collected.

The appearance and color of the liquid, as well as the nature of its flow into the test tube, are carefully assessed.

If the fluid does not flow in the form of rare drops, but often and quickly, this indicates possible intracranial hypertension. It is also necessary to check for the presence of red coloration of the liquid, which may indicate injury to the vessel during manipulation or hemorrhage into the subarachnoid space.

Consequences

Only a specially trained doctor with the necessary tools can take a puncture correctly.

As mentioned above, if the patient correctly follows all the recommendations prescribed to him and medical personnel, complications after the puncture are minimal. However, there are still some situations that can appear even with competent manipulation. They make up a small percentage in the overall summary of all cases, but you should not forget about them:

• Herniation of brain structures or dislocation of midline structures.
• Pain syndrome with damage to the nerve roots.
• Headache.
• Hematomas developing as a result of injury small vessels along the puncture needle.

Also, a separate group of complications are complications of puncture when performed in pregnant women. Such patients, especially in the first trimester, may be at risk for miscarriages in response to puncture.

Patients with heart disease and a spinal puncture require close attention, since when vasovagal reactions are triggered, the consequences can be catastrophic, as breathing or cardiac activity may stop.

Features of cerebrospinal fluid in meningitis

Each meningitis is determined by the type of its pathogen, resulting in changes in the cerebrospinal fluid for each of them.

Therefore, knowing certain visual features of cerebrospinal fluid and its microbiological characteristics, you can make a correct differential diagnosis of the types of meningitis and begin correct treatment.

CSF examination confirms the diagnosis of meningitis

The bacterial type of meningitis is characterized by next view cerebrospinal fluid:

• Opaque color of the liquor.
• The predominance of the percentage of leukocytes over lymphocytes.
• The number of neutrophils and segmented cells is over 1000 per 1 cubic millimeter.
• Presence of a positive bacterial culture.
• Low level glucose.

Aseptic or viral meningitis is characterized by the following cerebrospinal fluid:

• Clear-looking liquor.
• The predominance of the percentage of lymphocytes over leukocytes.
• No inoculated bacterial culture.

Individual diagnostic features liquor has tuberculous meningitis:

• Opalescent, cloudy appearance of cerebrospinal fluid in a test tube.
• The number of lymphocytes is over 100 per cubic millimeter.
• Low glucose levels.
• Bacteria that can be identified by staining.

Microbiological examination of cerebrospinal fluid

Such features of tuberculous meningitis indicate that it is impossible to make a correct diagnosis only based on visual data of the cerebrospinal fluid, since without knowing microbiological research, you can make a diagnostic error.

Confirmation of the diagnosis is always based on a combination of the visual qualities of the cerebrospinal fluid and its microbiological properties.

Treatment control

Approximately by the third week of treatment, it is necessary to assess how meningitis regresses under the influence of drugs. For this they use repeated puncture. It is used to analyze changes cellular composition, as well as the absence of a bacterial culture in the cerebrospinal fluid, which is a sign of clinical recovery.

Meningitis - serious disease, which is an inflammation of the membrane of the spinal cord and brain. Despite the fact that scientists have been trying to fight this disease for many years, it is difficult, especially in children.

Meningitis is a serious disease that is an inflammation of the lining of the spinal cord and brain. Despite the fact that scientists have been trying to fight this disease for many years, it is difficult, especially in children. During its course, it is the child (especially the little one) who has characteristics that you need to know about.

Signs and symptoms

Although all children experience meningitis differently, there are a number of symptoms that are common to all forms. Meningeal symptoms include the following:

• headache, severe and aggravated by external factors (loud noise, bright light);
• vomiting without nausea, not related to food in any way;
• high temperature (39-40 C), not responding to conventional antipyretic drugs;
• the baby may complain that he does not feel the back of his head and back; gently place him on his back and ask him to press his chin to his chest; he will not be able to do this due to muscle stiffness;
• in a baby you can notice a bulging of the large fontanel and its strong tension;
• It is more comfortable for the patient to lie on his side, with his legs tucked close to his stomach and his head thrown back;
• With meningitis, a rash may begin, sometimes reaching large, bright burgundy spots all over the body.

Since the meningeal symptom can be recognized by parents at home, at its first manifestations it is necessary to immediately go to the hospital. Moreover, the causes of meningococcal infection can be various factors.

The causes of this disease in children can be:

• viruses, bacteria, fungi, protozoa;
• sepsis and birth injuries in newborns;
• problems with the nasopharynx and middle ear in young children (up to one year);
• prematurity;
• reduced immunity;
• diseases of the nervous system;
• spinal cord and brain injuries.

Therefore, children suffering from such deviations and health problems are at risk. Incubation period illness lasts from 1 to 10 days.

Types of meningitis

Meningitis among children is divided into two groups.

1. Purulent
Called bacterial infection. It affects the youngest children, who are not even one year old. Most often they start with severe chills, fever, vomiting and headaches. Meningeal syndromes at the same time very clearly expressed.

2. Serous
The cause is a viral infection. This type of disease most often occurs in children. It can be caused by viruses mumps(mumps in children), some intestinal viruses (ECHO, Coxsackie). Affects children from 1 to 8 years of age. Starts unexpectedly with sharp jump temperatures up to 39 40 C and above. This acute period lasts from 3 to 5 days, and full recovery hopefully in 2 weeks.

The outcome of both forms of the disease depends on timely consultation with a doctor and the adequacy of treatment, but in the case serous meningitis more chances for fast recovery without consequences. The purulent type is both diagnosed and treated with difficulty.

Diagnostics

Diagnosis of serous childhood meningitis does not present any difficulties, unlike purulent, which is recognized only during laboratory examinations. If meningitis is suspected, children are prescribed the following procedures:

1. Cerebrospinal fluid puncture.
2. General blood analysis.
3. CSF analysis.
4. Bacterioscopic examination of blood smears and cerebrospinal fluid sediment.
5. Bacteriological cultures of blood, cerebrospinal fluid, mucus from the nasopharynx.

There are a lot of tests, all this is done to make an accurate diagnosis. Before taking a puncture from a child, he is sent for examination to an ENT specialist, neurologist, neurosurgeon and hematologist in order to avoid consequences.

Self-medication in case of meningitis is unacceptable. Treatment of the child should be carried out under the supervision of a doctor in a hospital setting. This disease is dangerous because the patient’s condition can worsen at any time and become critical. Then emergency resuscitation measures, possible only in clinical settings. The course of treatment involves taking antiviral and antibacterial agents and will depend on the form of the disease.

1. Treatment of serous meningitis
Therapy in these cases is aimed primarily at reducing intracranial pressure. Therefore, the patient is given diuretics, desensitizing (relieving allergies) and restoratives, various vitamins.

2. Treatment of purulent meningitis
Here therapy is based solely on antibacterial drugs, which are assigned only based on the results laboratory research. Anti-intoxication and diuretics are administered intravenously using droppers.

Antibiotics

In both cases, antibiotics are prescribed penicillin series: amoxil, flemoxin, benzylpenicillin. They are used for treatment for no longer than 5–7 days. Piracetam or nootropil is prescribed to restore nerve cells and blood vessels. Dexamethasone, Kenalog, hydrocortisone and methylprednisolone are anti-inflammatory therapies.

Rehabilitation

After the course of treatment, the child is allowed to lead a normal lifestyle, since meningitis does not damage the main systems of the child’s body.

Complications after meningitis

If meningococcal infection the child was identified in a timely manner, doctors and parents accepted everything possible measures aimed at eliminating the disease, there is no need to be afraid serious consequences. If going to the hospital was not timely, if purulent forms, and also if the baby has health problems, the following consequences may be observed:

• complete deafness;
• blindness;
• mental and physical developmental delay;
• toxic shock;
• edema, swelling of the brain;
• acute adrenal failure;
• Cerebroasthenia.

As sad as it may be, sometimes meningitis can lead to death.

Prevention

Due to the fact that the treatment of childhood meningitis is a complex and protracted process, prevention is important of this disease. First of all, parents of those children who are at risk should think about it. The most effective preventive measures are:

• vaccinations against meningitis, which are given to children in early age: Now used for this purpose different vaccines meningococcal, pneumococcal conjugation (injected before the age of two years) and polysaccharide (injected into those who are already over 5 years old), trivaccine against measles rubella, measles, mumps and protects against meningitis, as well as the chickenpox vaccine;
• chemoprophylaxis for anyone who has been in contact with a person with meningitis;
• Since the disease is transmitted by airborne droplets, it is necessary to refrain from contact with carriers of the infection, using gauze bandages and respirators.

Meningitis is dangerous and serious illness, from which you must definitely protect your child. If the circumstances turn out to be stronger, parents need to take all measures to get well soon baby. This is the only way to avoid the serious consequences and complications of this disease.

Meningitis

A.Etiology. Meningitis is a complication of bacteremia. In children over 2 years of age, pathogens causing acute bacterial meningitis the most common are Haemophilus influenzae type B (60-65%), meningococci and pneumococci. Streptococci are less common Staphylococcus aureus, gram-negative enterobacteria. With the introduction of vaccination against Haemophilus influenzae type B, the incidence of meningitis caused by this organism has decreased sharply.

b.Survey

1) U infants the first manifestations of meningitis are nonspecific - severe crying, irritability, anorexia, vomiting, drowsiness, bulging fontanelles. Meningeal symptoms are rare and there may be no fever. Special attention refer to impaired consciousness. One of the first symptoms of meningitis may be seizures, so in combination with fever they are an indication for CSF examination.

2) In children over 1 year of age, meningeal symptoms due to meningitis are more common. The indication for lumbar puncture is Brudzinski's symptom (when the neck is flexed while lying on the back, involuntary flexion of the legs in the hip joints is observed).

3) Meningitis must be excluded in case of bacteremia.

4) If meningitis is suspected, a lumbar puncture is performed. Plasma glucose is preliminarily determined for comparison with the glucose level in the CSF.

5) Relative contraindication to lumbar puncture is disc swelling optic nerve. Before performing a puncture, a consultation with a neurosurgeon is necessary. This symptom is not typical for acute bacterial meningitis, so other diseases, such as a brain abscess, should be excluded.

6) Conduct tuberculin test, culture of blood, feces, urine, joint fluid, abscess contents, discharge from the middle ear, etc.; bacterioscopy of smears and culture from all foci of infection. The levels of BUN, electrolytes and osmolarity of plasma and urine are determined, and radiography is performed chest. For infants, head circumference is measured.

V.Diagnosis meningitis is diagnosed only on the basis of the results of a lumbar puncture.

1) In bacterial meningitis, the CSF is turbid, its pressure is increased, the number of leukocytes is more than 100 μl -1, neutrophils predominate, the protein level is increased, the glucose level is less than half its level in plasma. Bacterioscopy of a Gram-stained CSF smear reveals the pathogen. All of these signs are not always present, therefore, with any of them, especially if neutrophils predominate in the CSF, meningitis should be suspected. CSF culture is indicated to confirm the diagnosis.

2) Determination of capsular polysaccharide antigens allows you to quickly identify the pathogen in some bacterial meningitis.

G.Treatment. Immediately after taking material for culture, IV antibiotics are prescribed. The choice of antibiotic is determined by the results of bacterioscopy of Gram-stained CSF smears and the age of the child. If gram-negative bacilli are detected, children over 2 months of age are prescribed dexamethasone, as it prevents hearing loss due to meningitis caused by Haemophilus influenzae type B.

1) If in children older than 2 months there is no reason to suspect a rare pathogen, choose any of two treatment regimens: ampicillin (300-400 mg/kg/day IV, the dose is divided and administered every 6 hours) in combination with chloramphenicol (100 mg/kg /day intravenously, the dose is divided and administered every 6 hours); or cefotaxime (150 mg/kg/day IV, divided dose and administered every 8 hours) or ceftriaxone (75-100 mg/kg/day IV, divided dose and administered every 12-24 hours). If the pathogen is Haemophilus influenzae, sensitive in vitro to ampicillin, ampicillin is additionally prescribed. For meningitis caused by Pseudomonas aeruginosa, the drug of choice is ceftazidime. For meningococcal or pneumococcal meningitis, the drug of choice is benzylpenicillin, and third-generation cephalosporins are used as a reserve drug. We prefer the combination of ampicillin and chloramphenicol because it is the most effective and safe.

2) The duration of treatment is determined individually. Standard courses of antibiotic therapy: meningitis caused by Haemophilus influenzae - 7-10 days, meningitis caused by meningococci - 5-7 days, meningitis caused by pneumococci - 10-14 days.

3) Dexamethasone, 0.6 mg/kg/day IV (dose divided and administered every 6 hours), is prescribed during the first 4 days of antimicrobial therapy. The drug is administered simultaneously with the antibiotic or immediately after it.

4) It is necessary to identify in time arterial hypotension, bleeding and ADH hypersecretion syndrome. The latter occurs in the first 72 hours of treatment, and until it is eliminated, fluid intake is limited to 3/4 of the minimum water requirement. At the same time, in most cases, patients with meningitis are admitted to the hospital 12-24 hours after the onset of the disease, when they are already developing dehydration. Therefore, before limiting fluid intake, it is necessary to restore BCC. Maintaining normal blood pressure and blood supply to the brain is more important than preventing ADH hypersecretion syndrome.

5) During the treatment period, monitor heart rate, blood pressure, respiratory rate and body temperature. Conducted daily neurological examination and diaphanoscopy (with an open fontanel), measure the head circumference.

6) At severe course or if therapy is unsuccessful, lumbar puncture is repeated every 24-48 hours. An indicator of the effectiveness of treatment is the disappearance of the pathogen from the CSF 24-48 hours after the start of therapy.

7) The persistence of fever is most often due to phlebitis, a reaction to medicines, hospital infection accompanying viral infection or subdural effusion. The latter occurs in acute period disease in 50% of children and is often asymptomatic. Prolonged (more than 7 days) or recurrent fever is an indication for lumbar puncture. In this case, it is necessary to exclude foci of infection in the subdural space, bones, joints, pericardium and pleural cavity. In some cases, CT scanning is indicated to confirm subdural effusion.

8) At the end of antimicrobial therapy, we do not repeat the lumbar puncture because recurrence of bacterial meningitis after stopping antibiotics is rare. For uncomplicated meningitis, at the final stage of treatment, you can switch to intramuscular administration (ceftriaxone, 50-75 mg/kg intramuscularly 1 time per day) or oral administration (chloramphenicol in the same doses as for intravenous administration). In the latter case, monitor the level of the drug in the blood.

9) Persons who have close contact at home or in day care with a patient with meningitis caused by Haemophilus influenzae type B or Neisseria meningitidis are indicated for examination and preventive treatment. If the causative agent is Haemophilus influenzae type B, the risk of meningitis for family members under 6 years of age is 0.5%, if the causative agent is Neisseria meningitidis, the risk for all ages is 0.5%.

10) All children with Haemophilus influenzae type B infections are recommended to be treated with rifampicin to eliminate nasopharyngeal carriage. The drug is prescribed at a dose of 20 mg/kg (maximum 600 mg) once a day for 4 days (Red Book, American Academy of Pediatrics, 1991).

J. Gref (ed.) "Pediatrics", Moscow, "Practice", 1997