ASEPTIC MENINGITIS (ADULT)

DESCRIPTION

Aseptic meningitis, serous meningitis, lymphocytic meningitis, viral meningitis - a disease in which inflamed soft and gossamer obolchki brain. Characterized by acute onset, meningeal symptoms, fever, pleocytosis and negative culture results. Clinical signs of this disease are headache, fever, meningeal signs, and in some cases - of cranial nerves, confusion and sleepiness. Chronic subclinical aseptic menigit frequently observed in patients with HIV. A modest increase in protein levels in the CSF, moderate lifotsitarny pleocytosis, the index of the immunoglobulin and sometimes - oligoclonal antibodies.

REASONS

The most common causes of aseptic meningitis are:

• Viral infections, which are caused by:

Enterovirus (eg, hand, foot, mouth disease, conjunctivitis), a sexually transmitted disease (eg, herpes, syphilis, HIV) and other viruses such as West Nile virus, rabies, mumps;

• Parasitic infections (eg, Lyme disease);
• Mycoplasma (a type of pneumonia);
• Tuberculosis;
• Fungal infections;
• Bacterial meningitis, which was not fully healed;
• Some medications, such as ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs);
• Autoimmune diseases (eg, sarcoidosis, Behcet's disease);
• Cancer that has spread to the meninges;
• Infection of the spinal cord.

Most disease is transmitted mainly by airborne droplets when an infected person sneezes or coughs, or through kissing. However, like any other viral disease is not transmitted to all who are close to the patient.Likely to contract meningitis 1:100 000.

SYMPTOMS

The first symptoms of viral meningitis - fever and general intoxication. Fever may be added to the general malaise, myalgia (muscle pain), nausea, vomiting, abdominal bolyuv, diarrhea. Often patients with viral meningitis and some feel sleepy stupor. Severe symptoms such as severe confusion, coma, this disease is not typical, so if they are observed in a patient, it is necessary to make a new survey.

Already on 1-2-day since the beginning of the first symptoms appear distinct meningeal syndrome:

• severe headache;
• vomiting;
• lethargy and drowsiness;
• Sometimes the excitement and anxiety;
• often leads to increased sensitivity to irritants, rigidity (increased tone) of the muscles at the back;
• signs of pronounced hypertensive syndrome;
• may cough, runny nose, sore throat, stomach.

It should also be noted that the cerebrospinal fluid flows under pressure, transparent. The amount of protein in it is normal, increased cell count (a few tens or even hundreds of cells in 1 mm 3), is dominated by lymphocytes (often initially neutrophils), sugar and chloride were normal. Temperature in 3 - 5 days is usually reduced, meningeal symptoms disappear, but the cerebrospinal fluid is normal until later. Frequent repeated after an interval of temperature waves in 1 - 5 days. Described recurrent meningeal syndrome. disease can manifest described common symptoms without acute meningeal syndrome, but the cerebrospinal fluid is inflammatory changes. However, the disease can occur with significant clinical symptoms of meningitis in cerebrospinal fluid unchanged, noted only increase its pressure (hypertension-nual syndrome). Epidemic myalgia (synonyms: disease Bornholm pleurodynia.) Is characterized by acute, often sudden onset, fever, sometimes with initial fever, headache, acute paroxysmal pain, localized in the muscles of the chest, abdomen (usually in the epigastric region), in the back and limbs . Method of biopsy revealed degenerative and necrotic changes in striated muscle. Often there is vomiting, sometimes spotty rash. The disease can occur in two or even three waves at intervals of 2 - 4 days. Repeated waves manifested by fever and muscle pain resumed. The total duration of the disease an average of 3 - 7 days. Sometimes misdiagnosed as appendicitis, acute pancreatitis, cholecystitis, occasionally these patients undergo surgery.

TREATMENT

Aseptic meningitis patients to be hospitalized in the infectious disease clinic at the high contagiousness of enteroviral meningitis infektsiy.Aseptichesky - acute and self-Relieves disease. But it can simulate life-threatening infections of the central nervous system, potentially treatable. symptomatic treatment of viral meningitis: 

• analgesics,
• diuretics,
• tranquilizers,
• antihistamines
• bed rest.

Antiviral drugs are prescribed in severe sluchayah.Izmeneniya of the cerebrospinal fluid are most pronounced in the 4th to 6th day, but the high content of white blood cells in it can persist for several nedel.Lechenie antimicrobial shown in cases where the source cell count not quite typical of viral infection. If changes of cerebral spinal fluid are not typical of viral meningitis or the response to treatment in a patient is atypical, a repeated puncture to determine the clinical picture and an accurate diagnosis.