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Kindergarten 82 Tomsk – Viral meningitis – incubation period, first signs and treatment options

Viral meningitis is an inflammatory process in the area of ​​the serous membranes of the brain. Less often, the disease affects the spinal cord, which is provoked by a viral infection.

Among all the varieties of meningitis in adults and children, the viral one proceeds quite favorably. Most often, children get sick, while adults – much less often. Pathology is transmitted through the air (airborne), as well as through contaminated food and water (fecal-oral).

What is it?

Viral meningitis is an inflammatory process in the serous membranes of the brain or, in rare cases, the spinal cord, caused by a viral infection.

Causes of occurrence

Viruses are transmitted both by airborne droplets and oral-fecal (through contaminated water and products). The disease is seasonal, as the number of cases increases sharply in the summer. That is why during the diagnosis of the disease, the doctor should pay attention to its clear seasonality.

Viral meningitis can be both an independent disease and a complication after an infectious disease. Laboratory tests such as culturing and serological tests can identify the exact causative agent in 30-70% of all cases. A study of the patient’s cerebrospinal fluid proves that at least two-thirds of cases of viral meningitis are caused by enteroviruses.

Disease can also be caused by:

• in 70-80% of cases ECHO viruses;
• Coxsackievirus types A and B;
• Epstein-Barr virus;
• bunyaviruses;
• HSV type 2;
• mumps virus;
• togaviruses;
• arenaviruses;
• adenoviruses;
• cytomegalovirus.

All these viruses are resistant to freezing, exposure to 70% alcohol, ether, and are able to maintain their high activity at room temperature for a couple of days. Such viruses are inactivated only when heated, ultraviolet irradiation, drying, exposure to chlorine-containing substances and formalin.

Symptoms of viral meningitis in children and adults

Viral meningitis is characterized by a serous form and an acute course, and often by an erased meningeal syndrome. It is generally accepted that the incubation period from the penetration of the virus into the meninges to the first signs of the disease is 2-4 days. However, this fact cannot be taken into account in acute diseases, such as mumps, or latent ones, such as type 1 herpes.

1. With viral meningitis, the first symptom is fever – the temperature exceeds 40 degrees, hallucinations and feverish delirium may begin. In addition, the disease is accompanied by a syndrome of disruption of the gastrointestinal tract – there are severe pains in the abdomen, debilitating vomiting.
2. On the second third day of illness, meningeal symptoms become predominant – a severe headache that does not go away from analgesics, lethargy and drowsiness, or, on the contrary, riot and hallucinations. In babies, the fontanel protrudes and pulsates. Runny nose and cough may appear. However, such vivid symptoms as with bacterial meningitis almost never happen – convulsions and coma are not recorded in patients with viral meningitis.

As a rule, viral meningitis occurs in two waves of increasing symptoms. The first wave begins with a rapid rise in temperature and vomiting, then the meningeal syndrome progresses, after a week all clinical signs subside for 2-3 days and flare up with renewed vigor. The total duration of the disease is 14-17 days.

Meningeal signs

• The characteristic posture of a patient diagnosed with viral meningitis is lying on his side with his head thrown back, legs pulled up to his stomach;
• Kernig’s symptom – when the leg is bent at the hip joint, it is impossible to straighten it at the knee joint. This does not allow you to make too tense hamstring muscles;
• Brudzinsky’s syndrome – when the patient lies on his back, when the head is tilted to the chest, his legs involuntarily bend at the knees;
• Stiff neck (excessive tension of the occipital muscles) – in the supine position, the patient cannot touch his chest with his chin.

Diagnosis

To diagnose viral meningitis, a lumbar puncture is done to examine the CSF. During the procedure, a clear liquid flows out under pressure. Immediately after the removal of the cerebrospinal fluid, the patient feels better. In the punctate, a large number of lymphocyte cells is determined, as well as an increased protein content against the background of a normal amount of sugar. The virus cannot be detected in the cerebrospinal fluid, it is contained only in the serous membranes. An indirect sign of viral meningitis with a characteristic clinical picture will be the absence of bacteria in the cerebrospinal fluid, the appearance of which indicates bacterial meningitis.

In addition:

1. White blood cells are detected in a clinical blood test. In a biochemical blood test, as a rule, a high content of proteins, namely the globulin fraction.
2. It is possible to isolate the culture of enteroviruses from feces, nasopharyngeal swabs, by seeding.

To determine the specific pathogen, a serological test is performed, which will identify the genus and class of the virus based on the RNA components (polymerase chain reaction). This is important to rule out specific meningitis.

Treatment of viral meningitis

For adults, viral meningitis is not dangerous. Hospitalization is needed for children, pregnant women, the elderly, patients with a weak immune system, that is, all those for whom the infection can cause severe complications and be fatal.

With the development of viral meningitis, symptomatic treatment is prescribed:

1. To reduce intoxication, saline is prescribed intravenously, to which Prednesolone and vitamin C are added once.
2. Metoclopramide-based drugs, such as Cerucal, are prescribed to stop vomiting.
3. At high temperatures, antipyretics based on paracetamol (Panadol), ibuprofen (Mig, Nurofen) are indicated.
4. To eliminate headaches, relief of intracranial hypertension, a lumbar puncture is prescribed. In addition, diuretics based on Furosemide are prescribed to reduce intracranial pressure.
5. When signs of gastroenteritis are attached, a dairy-free diet, enzyme preparations are indicated.
6. Patients are shown bed rest, preferably in a darkened room.
7. Antispasmodics, such as Drotaverine, Papaverine, are indicated for relief of abdominal pain.
8. Antibiotics are prescribed to prevent bacterial complications.

Children are additionally prescribed:

1. Antiviral therapy, if the disease is caused by the herpes simplex virus, Acyclovir is prescribed, if adeno- or enteroviruses, then Arbidol;
2. For convulsions Seduxen or Domocedan;
3. To increase immunity Interferon, Immunoglobulin.

Almost all adults with viral meningitis recover, but a few have headaches, mild intellectual disability, weakness, or incoordination.

As for children, the prognosis is not so favorable, especially in infants, they may develop serious complications: intellectual impairment, learning difficulties, deafness, etc.

Prevention

Viral meningitis can be effectively prevented by good hygiene, avoiding swimming in water, drinking boiled or bottled water. To prevent infectious diseases in Russia, according to the calendar, children are vaccinated against poliomyelitis, measles and mumps. Vaccinations simultaneously protect children from complications of infections in the form of viral meningitis. Annual seasonal influenza vaccination is the prevention of infection and complications of the disease.

Viral meningitis is an inflammatory process in the area of ​​the serous membranes of the brain. Less often, the disease affects the spinal cord, which is provoked by a viral infection.

Among all the varieties of meningitis in adults and children, the viral one proceeds quite favorably. Most often, children get sick, while adults – much less often. Pathology is transmitted through the air (airborne), as well as through contaminated food and water (fecal-oral).

What is it?

Viral meningitis is an inflammatory process in the serous membranes of the brain or, in rare cases, the spinal cord, caused by a viral infection.

Causes of occurrence

Viruses are transmitted both by airborne droplets and oral-fecal (through contaminated water and products). The disease is seasonal, as the number of cases increases sharply in the summer. That is why during the diagnosis of the disease, the doctor should pay attention to its clear seasonality.

Viral meningitis can be both an independent disease and a complication after an infectious disease. Laboratory tests such as culturing and serological tests can identify the exact causative agent in 30-70% of all cases. A study of the patient’s cerebrospinal fluid proves that at least two-thirds of cases of viral meningitis are caused by enteroviruses.

Disease can also be caused by:

• in 70-80% of cases ECHO viruses;
• Coxsackievirus types A and B;
• Epstein-Barr virus;
• bunyaviruses;
• HSV type 2;
• mumps virus;
• togaviruses;
• arenaviruses;
• adenoviruses;
• cytomegalovirus.

All these viruses are resistant to freezing, exposure to 70% alcohol, ether, and are able to maintain their high activity at room temperature for a couple of days. Such viruses are inactivated only when heated, ultraviolet irradiation, drying, exposure to chlorine-containing substances and formalin.

Symptoms of viral meningitis in children and adults

Viral meningitis is characterized by a serous form and an acute course, and often by an erased meningeal syndrome. It is generally accepted that the incubation period from the penetration of the virus into the meninges to the first signs of the disease is 2-4 days. However, this fact cannot be taken into account in acute diseases, such as mumps, or latent ones, such as type 1 herpes.

1. With viral meningitis, the first symptom is fever – the temperature exceeds 40 degrees, hallucinations and feverish delirium may begin. In addition, the disease is accompanied by a syndrome of disruption of the gastrointestinal tract – there are severe pains in the abdomen, debilitating vomiting.
2. On the second third day of illness, meningeal symptoms become predominant – a severe headache that does not go away from analgesics, lethargy and drowsiness, or, on the contrary, riot and hallucinations. In babies, the fontanel protrudes and pulsates. Runny nose and cough may appear. However, such vivid symptoms as with bacterial meningitis almost never happen – convulsions and coma are not recorded in patients with viral meningitis.

As a rule, viral meningitis occurs in two waves of increasing symptoms. The first wave begins with a rapid rise in temperature and vomiting, then the meningeal syndrome progresses, after a week all clinical signs subside for 2-3 days and flare up with renewed vigor. The total duration of the disease is 14-17 days.

Meningeal signs

• The characteristic posture of a patient diagnosed with viral meningitis is lying on his side with his head thrown back, legs pulled up to his stomach;
• Kernig’s symptom – when the leg is bent at the hip joint, it is impossible to straighten it at the knee joint. This does not allow you to make too tense hamstring muscles;
• Brudzinsky’s syndrome – when the patient lies on his back, when the head is tilted to the chest, his legs involuntarily bend at the knees;
• Stiff neck (excessive tension of the occipital muscles) – in the supine position, the patient cannot touch his chest with his chin.

Diagnosis

To diagnose viral meningitis, a lumbar puncture is done to examine the CSF. During the procedure, a clear liquid flows out under pressure. Immediately after the removal of the cerebrospinal fluid, the patient feels better. In the punctate, a large number of lymphocyte cells is determined, as well as an increased protein content against the background of a normal amount of sugar. The virus cannot be detected in the cerebrospinal fluid, it is contained only in the serous membranes. An indirect sign of viral meningitis with a characteristic clinical picture will be the absence of bacteria in the cerebrospinal fluid, the appearance of which indicates bacterial meningitis.

In addition:

1. White blood cells are detected in a clinical blood test. In a biochemical blood test, as a rule, a high content of proteins, namely the globulin fraction.
2. It is possible to isolate the culture of enteroviruses from feces, nasopharyngeal swabs, by seeding.

To determine the specific pathogen, a serological test is performed, which will identify the genus and class of the virus based on the RNA components (polymerase chain reaction). This is important to rule out specific meningitis.

Treatment of viral meningitis

For adults, viral meningitis is not dangerous. Hospitalization is needed for children, pregnant women, the elderly, patients with a weak immune system, that is, all those for whom the infection can cause severe complications and be fatal.

With the development of viral meningitis, symptomatic treatment is prescribed:

1. To reduce intoxication, saline is prescribed intravenously, to which Prednesolone and vitamin C are added once.
2. Metoclopramide-based drugs, such as Cerucal, are prescribed to stop vomiting.
3. At high temperatures, antipyretics based on paracetamol (Panadol), ibuprofen (Mig, Nurofen) are indicated.
4. To eliminate headaches, relief of intracranial hypertension, a lumbar puncture is prescribed. In addition, diuretics based on Furosemide are prescribed to reduce intracranial pressure.
5. When signs of gastroenteritis are attached, a dairy-free diet, enzyme preparations are indicated.
6. Patients are shown bed rest, preferably in a darkened room.
7. Antispasmodics, such as Drotaverine, Papaverine, are indicated for relief of abdominal pain.
8. Antibiotics are prescribed to prevent bacterial complications.

Children are additionally prescribed:

1. Antiviral therapy, if the disease is caused by the herpes simplex virus, Acyclovir is prescribed, if adeno- or enteroviruses, then Arbidol;
2. For convulsions Seduxen or Domocedan;
3. To increase immunity Interferon, Immunoglobulin.

Almost all adults with viral meningitis recover, but a few have headaches, mild intellectual disability, weakness, or incoordination.

As for children, the prognosis is not so favorable, especially in infants, they may develop serious complications: intellectual impairment, learning difficulties, deafness, etc.

Prevention

Viral meningitis can be effectively prevented by good hygiene, avoiding swimming in water, drinking boiled or bottled water. To prevent infectious diseases in Russia, according to the calendar, children are vaccinated against poliomyelitis, measles and mumps. Vaccinations simultaneously protect children from complications of infections in the form of viral meningitis. Annual seasonal influenza vaccination is the prevention of infection and complications of the disease.

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Should I declare an epidemic? Chelyabinsk doctors called the real numbers of people suffering from meningitis | 74.ru

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In Chelyabinsk – lower and more expensive. Compare steles “City of labor prowess” in other regions and their cost Specialists freed up about 40 beds to be ready for the flow of patients. However, they note – nothing special, just an increase in the incidence.

Every day about 15 children of both kindergarten and school age are admitted to the eighth children’s infectious diseases hospital. In total, the rise of enterovirus infection put 279 South Ural children in hospital beds. But the diagnosis of “serous meningitis” was confirmed to date only in 48 of them. And only one teenager ended up in intensive care with a neglected condition, but today he has been safely discharged home.

“Our hospital is the only one in the whole city and region that deals with neuroinfections, in particular, meningitis,” says Olga Lopatina, chief physician of Children’s City Clinical Hospital No. 8. – Today we are talking about an increase in the incidence of enterovirus infection, which may or may not lead to the development of serous meningitis. Such growth happens in waves once every three to four years, just like with influenza. The last time we saw this was in 2013. In addition, enterovirus manifests itself year-round, but the peak of its activity occurs in the summer – early autumn. The main route of distribution is still water: unboiled or water from an unknown source and bathing in reservoirs.

Olga Lopatina advises to keep drinking regimen, personal hygiene and no longer swim respiratory infection and severe muscle pain – look like a “cold”, in the form of a rash and runny nose – masquerade as an allergy or dermatitis. Enterovirus can even pretend to be chickenpox – give the same characteristic red spots and vesicles. But the dislocation will “surrender” it: with an enterovirus, the palms and feet will turn red, and with chickenpox, more often the scalp.

Very rarely, but enterovirus may be accompanied by manifestations of meningism (not to be confused with meningitis) – reactions of the nervous system, such as fever, headache. In this case, we are talking about irritation or damage to the nervous system, the membranes of the brain, and enterovirus infection can manifest itself as meningitis and even meningoencephalitis. Fortunately, the percentage of such manifestations is small – one or two for the entire number of cases. And so far in the practice of doctors of the eighth pediatric case this season has not been.

Children with signs of neuroinfection end up in the admissions ward of the eighth children’s hospital

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“Untreated serous meningitis, of course, will not pass without a trace,” warns Marina Vorobieva, head of the admissions department with infectious boxes at Children’s City Clinical Hospital No. 8. – You should consult a doctor as soon as the corresponding symptoms appear – headache, fever, vomiting, especially if contact is already known. And the doctor will decide whether it is meningitis or not, and how to treat it. We treat meningitis quite intensively, so the disease goes away without any serious consequences if it is “pure” meningitis. During the year, then there may be headaches due to changes in the weather and increased fatigue, but meningitis itself does not affect mental activity.

How to distinguish an enterovirus infection that can turn into meningitis?

Photo: Polina Avdoshina (infographic)

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“Meningitis is a triad: vomiting, headache, fever,” explains Marina Vladimirovna. – Vomiting – both single and ten times, but not bringing relief, headache, especially the frontal region, temperature – both 37.2 and high under 40. All this is a reason to call a doctor at home and even hospitalization.

It is possible to catch and identify an enterovirus that has or has not affected the nervous system and brain only with the help of research.

– To make a diagnosis of serous meningitis, a study of the cerebrospinal fluid is required, – adds Olga Viktorovna. – It’s a lumbar puncture. If any changes are found in the cerebrospinal fluid, then we are looking for what caused them. If the cerebrospinal fluid is not changed, then this is the same infection that occurs with manifestations of meningism. Enterovirus infection is characterized by irritation of the meninges even without inflammation. And if there is inflammation, then this is serous meningitis, and unlike purulent, it is not difficult.

True, you still have to lie in the hospital – from five to seven days to an average of three weeks. If there is an infection in the cerebrospinal fluid, the child receives complex treatment, and then the puncture is taken again without fail to make sure that the infection is gone. Improvements in the condition are noticeable after five to seven days: the temperature drops, appetite appears, but the doctors continue treatment anyway, because the infection takes longer to leave the cerebrospinal fluid.

No one is immune from the enterovirus. So far, according to experts, patients over 12 years old are isolated cases. But this is just the beginning, the incidence is on the rise. It is quite possible that the enterovirus will “walk” until the end of September and will reach both adults and adolescents.

“Children get sick more this year: practically no babies of the first two years of life came to us,” notes the head physician. – But there are hearths in kindergartens – these are preschoolers, and schoolchildren – when the school year begins, there will be more of them. In the meantime, there are outbreaks in children’s country camps, intra-family, when all family members are ill. There are not so many adults, maybe because the summer was not so hot, and few people went swimming.

Marina Vorobieva warns that self-treatment for enterovirus infection is dangerous

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An increase in enterovirus infection is noted throughout Russia and even abroad, but we have a different virus. In Turkey, it is coxsackie virus, and “our” strain is ECHO H30. If the child attended kindergarten with the sick person, then leaving him at home no longer makes sense. It is better to take antiviral drugs. Another thing is if the group is in quarantine, and the child is just going to attend kindergarten, then it is better to wait and sit at home.

Now in the eighth children’s hospital all 122 beds of the infectious ward are allocated for enteroviruses and meningitis. According to doctors, this is a common practice when additional beds are deployed during the period of an increase in the incidence.

– We have to deliver additional beds to the wards, we occupy the space of classrooms, – says Olga Lopatina. – When there is an influx, the conditions of stay, of course, become less comfortable. We and dads with children are lying, so we have to take into account the gender! In previous years, we had an increase in rotavirus infection, which was much more difficult and dangerous, intensive care units were overcrowded there. We are ready for the growth of this or that infection, this is a predictable situation. This is not an epidemic, but a natural increase.

There is an increase in the incidence, but there is no epidemic, experts are sure

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Let us remind you that doctors insist that cases of meningitis are not related. At the same time, they believe that this figure is not the limit and new cases of the disease are possible. Training was conducted in city polyclinics, the medical staff were reminded of the symptoms of the infection and methods of dealing with it. Representatives of the city health department, the committee on education and Rospotrebnadzor visited kindergarten No. 157, the pupil of which was hospitalized due to a dangerous illness.

Anatoly Semyonov, Chief State Sanitary Doctor for the Chelyabinsk Region, announced the need for additional measures to prevent infection. Children were forbidden to swim in the pools, and MUP “POVV” was ordered to strengthen control over water quality.

How to protect yourself from the disease of the season, read our material.

74.ru keeps a record of cases of meningitis in children.