Features of the lesion of the vascular bed in purulent meningitis in children

Abstract

Background. Purulent meningitis occupies one of the important places in the structure of neuroinfectious diseases in children and is the top ten places among the causes of death. The relevance of their study is due to the severity of the course, high rates of disability and deaths (839%). Damage to the vascular bed during neuroinfections, including purulent meningitis, is a mandatory component due to the predominantly hematogenous pathway of pathogens. The penetration of microorganisms through the blood-brain barrier into the cranial cavity and their hematogenous intrathecal circulation cause damage to the cerebral veins and arteries, leading to the development of vasculopathies and vasculitis. Aim: To determine the features of vascular disorders in purulent meningitis in children. Materials and methods. 100 children with purulent meningitis were examined, aged from 1 to 17 years 11 months, for the period since 2007 to 2020. All patients underwent neurological monitoring, etiological verification of diagnoses, determination of markers of endothelial dysfunction in the blood (D-dimer and desquamated endothelial cells), as well as MRI of the brain and MRI angiography. Results. A complex lesion of the vascular system in purulent meningitis in children was proved, associated with both structural and functional properties of the vascular wall, as well as damage to the vasomotor function of the endothelium. Conclusions. With purulent meningitis, there is damage to the vascular bed in the form of systemic vasculitis, including cerebral vessels, as evidenced by the presence of both markers of endothelial damage (desquamated endothelial cells and D-dimer) and changes in MRI and MRI angiography.