Etiology and clinical features
In addition to Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae, the disease in children can be caused by Pseudomonas aeruginosa, staphylococci, Klebsiella, and fungi. Different pathogens produce a specific clinical picture:
- Viral (serous) meningitis. Most commonly associated with enteroviruses (Coxsackie, ECHO), characterized by high incidence, myalgia, and polymorphic rash. They can also develop primarily (in mumps, poliomyelitis) or as a complication of childhood infections (measles, rubella).
- Tuberculous meningitis. Occurs as secondary involvement in primary tuberculosis. Characterized by low-grade fever and pronounced intoxication.
- Fungal meningitis. Distinguished by extremely severe toxicosis, seizures, and progressive hydrocephalus.
Differential diagnosis by CSF
Cerebrospinal fluid (CSF) analysis is the main criterion for determining the form of inflammation. Normally, CSF is colorless, flows out at a pressure of 130–180 mm H₂O, contains 2–8 cells per 1 µL (80–85% lymphocytes), protein 0.16–0.33 g/L, Pandy's test is negative, glucose 2.5–3.8 mmol/L.
| Parameter | Viral | Tuberculous | Purulent bacterial |
|---|---|---|---|
| Appearance | Clear / slight opalescence | Xanthochromic, marked opalescence | Turbid, greenish (purulent) |
| Cytosis (cells) | 20–800 (80–100% lymphocytes) | 200–700 (40–60% lymphocytes, 20–50% neutrophils) | 1,000–15,000+ (40–100% neutrophils) |
| Protein / Pandy's test | Normal or up to 1.0 g/L / weakly positive | 1.0–3.3 g/L / strongly positive (+++) | 0.66–16.0 g/L / strongly positive (+++) |
| Glucose | Normal | Severely decreased | Moderately decreased |
Principles of treatment
Treatment is carried out exclusively in an infectious diseases hospital.
- Etiotropic therapy. Antibiotics are prescribed in high doses to cross the blood-brain barrier (BBB). The drug of choice is benzylpenicillin sodium salt (300,000 IU/kg/day divided into 4 doses). For predominant meningococcemia, chloramphenicol is used (80–100 mg/kg/day).
- Relief of hyperthermia. A lytic mixture is administered parenterally: metamizole sodium (0.1 mL/year of life) combined with an antihistamine (0.2 mL/year of life).
- Pathogenetic treatment. Mandatory infusion therapy combined with dehydration to prevent brain edema.
Class and exam questions
What is the difference between meningism and meningitis?
In meningism, the meninges are irritated against the background of severe intoxication, and the clinical picture mimics meningitis. However, there is no inflammation in the CSF: macroscopy, biochemistry, and cytogram are normal.
Why is lumbar puncture contraindicated in brain edema?
Due to the high risk of herniation syndrome: the pressure differential can lead to coning of the cerebellar tonsils into the foramen magnum.
On what day does the CSF normalize with adequate treatment?
With a favorable prognosis, complete normalization of the cerebrospinal fluid occurs by the 10th–12th day, and clinical improvement is visible as early as days 5–7.
What else to study on this topic
- Features of dehydration and anticonvulsant therapy (dosages of furosemide, mannitol, magnesium sulfate)
- Follow-up care with a neurologist and management of residual effects
- Prognosis in meningoencephalitis and risk of neuropsychiatric deficits
- Anti-epidemic measures in the focus (quarantine, cultures, sanitation of carriers)
- Complete blood count changes in generalized infection
Master the entire topic in the Pediatrics course
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- Full study guide on "Meningitis" and another 3,738 pages of the subject
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Other topics from the section «Chapter 12. Infectious and parasitic diseases»
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