Meningococcal infection of the infant. Signs and symptoms of meningococcemia in children and adults. Tired of the constant drinking

Meningococcal infection is an acute infectious disease caused by various types of meningococcus. It is characterized by a variety of clinical manifestations: from nasopharyngitis (inflammation of the nasal mucosa and pharynx) and bacterial carriage to common, severe in the form of meningococcemia (presence of meningococcal infection in the blood), meningitis and meningoencephalitis (inflammation of the membranes of the brain).

The mechanism of development of meningococcal infection

The causative agent of meningococcal disease is the Gram-positive diplococcus Neisseria meningitides. In shape, these pathogens resemble coffee beans. He quickly dies in environment, when boiled, it dies quickly - within a few seconds, under the action of disinfectants - after a few hours. Meningococcal disease only affects humans. The causative agent is secreted from the mucous membrane of the nasopharynx, from cerebrospinal fluid(liquor), blood, discharge (exudate) of skin rashes.

Meningococcus secretes allergenic substances.

The source of infection can only be a sick person or a bacteriocarrier. greatest danger it presents at the onset of the disease, especially in the presence of inflammatory phenomena in the nasopharynx, and the disease proceeds in a common form (meningitis, sepsis, meningoencephalitis). "Healthy" bacteria carriers without acute inflammation in the nasopharynx are less dangerous, but the disease is widely spread by carriage. The duration of the bacteriocarrier in meningococcal infection is on average 2-3 weeks, in individuals- 6 or more weeks (in the presence of a chronic inflammatory focus in the nasopharynx).

Meningococcal infection is spreading by airborne droplets through infected droplets of mucus secreted from the nasopharynx and upper respiratory tract. Since meningococcus dies quickly in the external environment, the duration of contact with a sick child, the crowding of children in rooms (rooms), especially in poorly ventilated rooms, are important for infection. in public places. Often, young children become infected from parents, close relatives who are either carriers or patients with a localized form of infection. Susceptibility to the disease is not very high (infectiousness index - 10-15%).

Children of the first three months practically do not get this infection. There have been cases of the disease in the neonatal period and intrauterine infection. In children of the first year of life - high percent lethal outcome. The outcome of the disease primarily depends on timely diagnosis and adequate treatment.

Three factors play a major role in the development of meningococcal infection: meningococcus, endotoxin (a substance contained inside the microbe and released into the body when it dies) and an allergenic substance. The entrance gate for the pathogen, through which it enters the body, is the mucous membrane of the nasopharynx and oropharynx, and possibly the bronchi. More often, no pathological processes are detected at the site of the introduction of an infectious agent, that is, the so-called “healthy” carriage. In 10-15%, the pathogen penetrates into the thickness of the mucous membrane, and in this place occurs inflammatory process with the formation of symptoms of meningococcal nasopharyngitis. In some cases (1-2%), meningococcus passes local defense barriers and enters the lymphogenous bloodstream. It can be meningococcemia (meningococcal sepsis) - with the bloodstream, infectious agents penetrate into various organs and tissues: skin, joints, kidneys, adrenal glands, lungs, inner lining of the heart and others. In some cases, meningococcus also passes the blood-brain barrier, which ensures the exchange of substances between blood and nerve cells, causing symptoms of purulent inflammation of the membranes and the substance of the brain (meningitis or meningoencephalitis).

In 60% of cases, the spread of the meningococcal process is preceded by an acute respiratory disease. Hyperacute meningococcal sepsis, occurring with infectious-toxic shock, develops as a result of the mass penetration of the pathogen into the bloodstream and the circulation of meningococcal toxin in the blood plasma.

When meningococci enter the lining of the brain, meningitis develops. The inflammatory process is characterized by the penetration of special cells - neutrophils - into the pia mater. Substances with a strong destructive effect are released from neutrophils. Under their action, destruction (destruction) of collagen and elastic fibers, basement membranes, which are part of the blood-brain barrier - the regulator of metabolism between blood and nerve cells, occurs. There is an increase in its permeability, as a result of which the infection penetrates deep into the medulla, and a meningoencephalitis clinic develops. Some young children with purulent inflammation meninges, instead of increasing intracranial pressure, its decrease is observed (hypotension - cerebral collapse). This is based on neuro-reflex shifts, leading to an imbalance in the water-salt balance. Such clinical forms of meningococcal infection as endocarditis, arthritis, pneumonia, occur due to meningococcemia and are rare.

After a meningococcal infection or after a long bacteriocarrier, specific antibodies begin to be produced in the human body. From the first days of illness, their concentration gradually increases, reaching maximum figures by 5-7 days. After 3-4 weeks, the level of antibodies decreases.

A low concentration of specific antibodies is observed in young children.

In the case of the development of nasopharyngitis (inflammation of the nasal and pharyngeal mucosa), a moderate inflammatory process occurs at the site of the introduction of the pathogen. In the trachea and bronchi, superficial inflammation is first observed, then it becomes more pronounced. Inflammation extends to the surfaces of the cerebral hemispheres, the base of the brain and meninges spinal cord. Then, the inflammatory purulent process from the surface penetrates deep into the substance of the brain, encephalitis develops. With untimely therapy or in completely untreated patients, ependymatitis (inflammation of the ventricles of the brain) is noted. At the same time, fluid is localized in the ventricles, and purulent-fibrinous deposits and edema are located on the walls of the ventricles. Possible blockage of purulent contents of the outflow tract of cerebrospinal fluid with the development of dropsy of the brain - hydrocephalus. Purulent-fibrinous inflammation occurs by 5-6 days.

With meningococcemia, hemorrhages, vascular thrombosis, necrosis (necrosis) of various organs and tissues occur. For lightning-fast meningococcemia, extensive damage to capillaries, blood circulation disorders in them, and damage to various organs and body systems are characteristic.

Classification of meningococcal infection

1. Localized forms:

• meningococcal disease,
• acute nasopharyngitis;

2. Generalized forms:

• meningococcemia (meningococcal sepsis),
• meningitis,
• meningoencephalitis;

3. Mixed form: meningitis and meningococcemia.

4. Rare forms:

• meningococcal endocarditis,
• pneumonia,
• iridocyclitis,
• arthritis, etc.

Clinical manifestations of meningococcal infection in children

Incubation period meningococcal infection lasts from 2 to 10 days.

Acute nasopharyngitis occurs in 80% of all cases of meningococcal disease. It comes in three forms: mild, moderate and severe.

Light form. Usually, nasopharyngitis begins acutely (against the background of complete health) with an increase in body temperature to 38-38.5 ° C. There may be complaints of nasal congestion, runny nose, headache, weakness. In some cases, body temperature does not change, the condition is satisfactory. Inflammatory changes in the nasopharynx are mild. In many patients, there are no changes in the peripheral blood; a moderate increase in the number of neutrophils is possible.

Medium form. An increase in body temperature to more high values- 38.5-39 °С. The sick child is lethargic, inactive, weak, nasal congestion, runny nose are noted. On examination, redness and swelling of the posterior wall of the pharynx, an increase in lymphoid follicles, swelling of the lateral ridges, and a slight mucous discharge are observed.

Severe form. There is an increase in body temperature up to 40-40.5 ° C. For symptoms characteristic of moderate form, vomiting, spasms, pains in a stomach join. It is possible to identify meningeal symptoms: stiffness of the occipital muscles, while the child cannot bend his head forward, Kernig's symptom (it is impossible to straighten the bent leg), etc. In the peripheral blood, an increase in the level of leukocytes up to 15 x 109 g / l, an increase in the level of neutrophils, a shift in the leukocyte formula to the left, ESR increases to 20-30 mm/h. Therefore, such conditions are often diagnosed as SARS with convulsive syndrome or viral meningitis. In the cerebrospinal fluid, there is an increase in cerebrospinal fluid pressure. The outcome and course of nasopharyngitis in most cases are favorable, the temperature drops to normal values ​​after 1-4 days. Completely the child recovers in 5-7 days.

Diagnosis of meningococcal nasopharyngitis difficult due to poor clinical data. Confirms the diagnosis of nasopharyngitis is the release of the pathogen from the discharge of the nasopharynx. In some cases, acute nasopharyngitis precedes the onset of common forms of meningococcal disease.

Meningococcemia (bacteremia, meningococcal sepsis) is a form of meningococcal infection in which the pathogen enters and circulates in the blood. At the same time, in addition to general toxic manifestations and damage to the skin, it is possible to damage various internal organs(spleen, lungs, kidneys, adrenal glands), joints, eyes. The disease usually has an acute onset wellness, suddenly. In some cases, parents can indicate the hour of the onset of the disease. There is an increase in body temperature to high values, chills, vomiting. At an early age, convulsive seizures, a disorder of consciousness often develop. Within 1-2 days, all clinical manifestations gradually increase. At the end of the first - beginning of the second day from the onset of the disease, a rash appears on the skin. Meningococcal infection is characterized by a hemorrhagic rash in the form of asterisks that have an irregular shape. It is dense to the touch, rising above the surface of the skin. Appears simultaneously on the entire skin, but more massive on the lower parts of the arms, legs, buttocks, eyelids. In the case of a severe course, rashes appear on the face, upper parts of the body. Rash elements ranging in size from pinpoint to large hemorrhages with necrotic changes in the center. Then dead tissue is torn off with the formation of defects and scars. In very difficult and advanced cases develops gangrene of the nail phalanges, fingers, toes, auricles. In some patients, hemorrhagic rashes are preceded by spotty-nodular rashes, the reverse development of rashes depends on the nature and prevalence of elements on the skin. A spotty-nodular rash disappears without a trace after 1-2 days.

In 37% of cases of meningococcemia, joint damage is noted - synovitis or arthritis. In most cases, it affects small joints fingers and toes; less often - large joints: elbow, ankle, wrist, knee. 2-4 days after the onset of meningococcal sepsis, body temperature rises again, pain in the joints appears. The skin over the joint is changed, reddened; joints are swollen, movements are limited due to pain. Sick children try to spare the affected limbs. With inflammation of the joints of the hand, the hand is in an unbent state, the fingers are spread out, the hand is raised. Most often, the involvement of the joints in the process proceeds according to the type of polyarthritis - damage to several joints - or monoarthritis - damage to one joint. The course of such arthritis is favorable, the function of the joints is restored in full.

In the blood with meningococcemia, there is an increase in leukocytes, an increase in the level of neutrophils, an increase in ESR up to 50-70 mm / h, but in patients with light forms ESR may be within normal limits.

There are mild, moderate and severe forms of the disease. The severity of meningococcemia depends on the severity of symptoms of toxic effects, impaired consciousness, degree of fever, on the abundance and nature of the hemorrhagic-necrotic rash and changes in blood circulation in the body.

There is also a fulminant form of meningococcemia (hyperacute meningococcal sepsis), which is very difficult. In this case, the disease begins acutely with a sharp increase in body temperature, chills, headache, with the appearance of an abundant amount of hemorrhagic elements. The rash quickly merges, forming extensive hemorrhages. At first, blood pressure is kept at normal values, then it quickly decreases with the appearance of circulatory failure: increased heart rate, muffled heart sounds, pale skin, cyanosis of the fingertips. The skin is cold to the touch, covered with sticky sweat, facial features are sharpened. Young children have vomiting, diarrhea, convulsions, loss of consciousness due to the development of cerebral edema (neurotoxicosis).

Characterized by a decrease muscle tone, meningeal symptoms are detected. At the end stages of the disease, vomiting is observed. coffee grounds”, nosebleeds, hemorrhages in internal organs with a decrease in their function. Arterial pressure is reduced, the pulse is frequent, weak, sometimes not even palpable. Blueness of the skin, bluish-purple spots appear on the limbs and trunk. The body temperature decreases, there is a decrease in urine output up to the absence of urine. In the blood - leukocytes are increased, their decrease is possible, which is a poor prognostic sign. This form of the disease can be considered as an infectious-toxic shock caused by the mass circulation of pathogens in the bloodstream, followed by their death and the release of endotoxin. With absence emergency treatment death occurs within 12-24 hours.

Meningococcal meningitis. This form also begins acutely, with an increase in body temperature to 39-40 ° C. A sick child groans, holds his head, shows restlessness, sleeps poorly, eats, does not play. Excitation can turn into lethargy, indifference to the environment. Gain pain even with a light touch to the patient - hypersensitivity is one of the leading symptoms of meningococcal meningitis. Often in the first days of the disease, vomiting occurs, not associated with food intake. The next important sign of meningitis is convulsions that appear from the first day of illness and persist for 2-3 days. For 2-3 days, meningeal symptoms occur: stiffness of the occipital muscles, Kernig's symptom, etc.

In children under one year old, these signs are weakly expressed, but Lessage's symptom often appears (if you lift the child, holding his armpits, he bends the legs), trembling of the hands, pulsation of the large fontanel, tilting of the head. The child takes a characteristic pose: the head is thrown back, the legs are pulled up to the stomach and bent at the knees. When cerebral edema is attached, there may appear focal symptoms; a rapidly passing lesion of the cranial nerves, etc. Also, rashes of herpes on the lips are often observed. The face of a sick child is usually pale, suffering. There is an increase in heart rate, muffled heart sounds, pressure in severe form is reduced.

Breathing is frequent, superficial; some children, especially young children, have a disorder of the stool - diarrhea. The tongue is dry, the patient is tormented by thirst, sometimes an enlargement of the liver and spleen is detected. Due to intoxication manifestations, changes are noted in the urine - cylinders, protein, and an admixture of blood appear in it. In the blood - an increase in the level of leukocytes; in some patients, on the contrary, a decrease in the level of leukocytes is possible. Also characteristic is an increase in the number of eosinophils, a shift of the leukocyte formula to the left, an ESR increased to 45-70 mm/h. At mild form there are practically no changes in the blood.

The most characteristic changes in the cerebrospinal fluid: by the end of the first day, the cerebrospinal fluid acquires a milky-white or yellowish-green color, becomes cloudy (normally it is transparent). CSF pressure rises to 300-500 mm Hg. Art. But sometimes the pressure is reduced or does not change at all. In the cerebrospinal fluid, neutrophilic leukocytosis up to several thousand in 1 μl is observed. Protein increased to 1-4.5 g / l, high content protein indicates a severe form of the disease. Sugar and chlorides are somewhat reduced.

Meningococcal meningoencephalitis - inflammation of the membranes and the brain itself. It often develops in young children. The disease is dominated by signs of brain damage: impaired consciousness, motor agitation, convulsive adjustments, damage to the cranial nerves. Perhaps the development of hemiparesis - limitation of movements in the limbs on the one hand; movement disorders, decreased muscle tone. Sick children do not hold their heads, it is difficult for them to sit and walk. Meningeal symptoms are rare, often the most pronounced stiffness of the muscles of the back of the head, Kernig's symptom.

Meningococcal meningitis and meningococcemia This form is the most common. The rash appears before they occur brain symptoms. Complete cleansing of the cerebrospinal fluid, that is, the removal of the pathogen, also occurs much faster.

The course of meningococcal infection without timely treatment is long and severe (from 4-6 weeks to 3 months). Sometimes there is an undulating course with alternating exacerbation and subsidence of the process.

With various forms of meningococcal infection, death can occur with cerebral edema in the case of a hyperacute or fulminant course of the disease. This complication occurs as a result of neurotoxicosis, circulatory disorders, metabolic processes.

Cerebral edema is characterized by a sharp headache, impaired consciousness, agitation, vomiting, convulsions. The pupils are initially narrow, then dilate. There is strabismus, involuntary movements of the eyeballs, the pupils become different sizes. Meningeal symptoms are pronounced, muscle tone is high. Due to the infringement of the brain in the foramen magnum, the pulse becomes rare, arrhythmic, blood pressure is reduced, breathing is noisy (Cheyne-Stokes), fever, redness of the face, cyanosis, sweating. Developing oxygen starvation organs and tissues. Death is possible from respiratory arrest.

Children in the first months of life - the development of cerebral hypotension (decrease in CSF pressure) is possible as a result of a decrease in the production of cerebrospinal fluid, a violation of its dynamics, fluid loss due to frequent vomiting, diarrhea, dehydration therapy aimed at removing water from the body. The patient's facial features are pointed, the eyes are sunken, with dark circles around, the skin is dry, the large fontanel also sinks. Muscle tone is reduced, meningeal symptoms become less distinct, reflexes fade away. Convulsions, stunned or coma are possible. The pressure in the spinal canal is low.

With the transition of the inflammatory process to the ventricles of the brain, ependymatitis develops. The main symptoms: drowsiness, motor agitation, stunning or coma, increased muscle tone with head tilting back, convulsions, vomiting, sensory disturbances, trembling of the limbs. In young children - bulging of a large fontanel until the seams diverge. When examining the fundus - congestive discs optic nerves. A typical posture of a sick child: legs crossed at the lower leg, extended. The fingers are clenched into a fist, the hands are fixed. In cerebrospinal fluid: increased protein level, yellow coloration. If the cerebral fluid is obtained from the ventricles, then it has a purulent character with the presence of meningococci.

Diagnosis of meningococcal infection in children

Diagnosis is usually not difficult. For meningococcal infection, an acute sudden onset, high body temperature, vomiting, headache, increased sensitivity, meningeal symptoms, hemorrhagic stellate rashes are typical.

In children of the first year of life, intoxication of the body, anxiety, trembling of the hands, chin, convulsive seizures, tension and bulging of the large fontanel, Lessage's "suspension" symptom, the "pointing dog" posture, when the child lies on its side and presses bent legs to the stomach, are expressed.

Of great importance are spinal tap and results laboratory examination. Bacterioscopic examination of the sediment of cerebrospinal fluid and blood smears is also used; sowing on nutrient media of cerebrospinal fluid, blood, mucus from the nasopharynx.

At bacteriological examination 0.3-0.5 ml of cerebrospinal fluid and blood are inoculated on a special medium, the answer is given on the fourth day. In the diagnosis of meningococcal infection are also used serological methods research. These methods are highly sensitive and are used to detect small amounts of specific antibodies (TPHA) or meningococcal toxin (MEIT). Enzyme immunoassay and radioimmune research methods are being developed and used.

With timely and adequate treatment quite favorable prognosis.

After suffering a meningococcal infection, asthenic syndrome is observed for some time. Children quickly get tired, irritable, whiny, capricious.

Treatment of meningococcal infection in children

All patients with or suspected of having meningococcal disease without fail hospitalized in a specialized department. Therapy severe forms happening in intensive care unit or intensive care units. With common forms, the drug of choice is penicillin in large doses (at the rate of 200-400 thousand units per 1 kg of body weight per day). Children up to three months of age - 400-500 thousand units / kg per day. The course of treatment is on average 5-8 days with a favorable course. For the purpose of control, a lumbar puncture is performed. A second antibiotic can be prescribed when pneumonia or kidney inflammation and other complications are attached.

Also, in the treatment of meningococcal infection, ampicillin and oxacillin are used intramuscularly at a dose of 200-300 mg / kg per day; with meningoencephalitis, the dose is increased to 400-500 mg / kg (6 times a day).

Simultaneously with antibiotic therapy, it is advisable to use measures aimed at combating toxic phenomena and normalizing metabolism. In this case, patients are injected intravenously with gemodez, reopoliglyukin, 5-10% glucose solution, albumin, etc. The total volume of intravenous fluid should not exceed 30-40, maximum 50 ml / kg of the weight of the sick child. It is better to administer the liquid in two doses - in the morning and in the evening. At the same time, diuretics are administered to remove excess fluid (lasix, murosemide). In severe forms and cerebral edema, mannitol, urea can be prescribed. In order to improve microcirculation, heparin is administered (100-200 IU/kg of body weight per day 4 times), trental, chimes. For meningoencephalitis with convulsive syndrome, prednisolone 2-5 mg/kg or dexazone 0.2-0.5 mg/kg are used for 1-3 days. Also with convulsions - seduxen, GHB, phenobarbital, aminosine, promedol.

The outcome of meningococcal infection depends on adequate administration of antibiotics, sufficient use of infusion therapy and treatment directed at the pathogen.

Prevention of meningococcal infection in children

In the prevention of meningococcal infection great importance has the isolation of a sick child and a carrier. In the case of the development of a common form or if it is suspected, patients must be hospitalized in specialized departments or in boxes, semi-boxes. When a meningococcal infection is detected, an emergency notification is sent to the Center for State Sanitary and Epidemiological Surveillance (TSKSEN). In the epidemiological focus, clinical observation of other children is mandatory, while the nasopharynx and skin are examined, body temperature is measured for 10 days.

Patients with common forms of meningococcal infection and nasopharyngitis are discharged from hospitals only after complete recovery, without bacteriological examination for carriage of the pathogen. Those who have recovered are allowed back to children's institutions after a single negative result of a bacteriological examination, which is carried out five days after discharge from the hospital. Final disinfection in the foci of meningococcal infection is not necessary.

Immunoprophylaxis

Children who have been in contact with patients with a common form of meningococcal infection are given normal immunoglobulin at a dose of 1.5 ml for children under 1 year old, 3 ml - from 2-7 years old, once intramuscularly, but no later than the 7th day after the discovery of the first case. diseases.

There is also active immunization against infection. For this, meningococcal vaccine preparations are used.

meningococcal A vaccine used for children over 1 year old. Children from 1 to 8 years old are given 25 micrograms of the vaccine, children over 8 years old and adults - 50 micrograms each. The drug is injected subcutaneously into the upper third of the shoulder or subscapular region.

Cuban vaccine administered to children older than 3 months. and adults. Spend 2 injections of this drug with an interval of 1.5-2 months. It is administered intramuscularly into the external lateral muscle of the thigh or into the shoulder.

Complications after administration of meningococcal vaccines are rare. Local reactions are possible: soreness and redness of the skin at the injection site for 1-2 days or general reactions: weakness, malaise, fever.

There are no contraindications to vaccination. During routine vaccination, drugs are not administered to children with chronic decompensated diseases, patients with malignant tumors, hemoblastoses, and in the acute period of infectious diseases. But in case of a threat of infection with meningococcal infection, vaccination is carried out for all children without exception.

Features of the rash with meningococcemia

• 1. The appearance of a rash is preceded by a maculopapular rash, it rises above the surface of the skin.
• 2. When pressed next to the papular element, the rash disappears, and with meningococcemia it does not disappear, and may even intensify.
• 3. Rash of different sizes and elements of the rash tend to merge.
• 4. Rash stellate.
• 5. Elements of the rash have a purple-bluish color.
• 6. Foci of necrosis appear in the center of the elements.
• 7. On the fingers, toes, foci of necrosis may appear and form.
• 8. Meningococcemic rash begins on the shins, thighs, buttocks, lower abdomen
• 9. As the severity increases, the rash appears on the chest, face (this is a generalization of the rash). This is a poor prognostic sign. Subsequently, scars form at the sites of large necrosis. The basis for the appearance of a generalized rash is a violation of hemostasis.

bacterial meningitis

Criteria for the clinical diagnosis of nasopharyngitis

Nasopharyngitis outside the focus is difficult to put.

In meningitis, nasopharyngitis is characterized by:

• 1. dry nasopharyngitis (i.e. mucous membranes are irritated, but there is no discharge from the nose).
• 2. dry cough
• 3. sore throat
• 4. subfebrile temperature 1-3-5 days
• 5. the back wall of the pharynx is edematous, hyperemic, parchment, with a cyanotic shade of hyperemia
• 6. the patient is all dry, in contrast to the viral patient
• 7. both generalized and localized forms are often accompanied by herpetic eruptions
• 8. unlike respiratory infections in the blood - leukocytosis is insignificant
• 9. there are no severe forms of nasopharyngitis. They are usually light or medium-heavy.

Nasopharyngitis can exist either independently, or it can be a forerunner of a generalized form that appears after 3-4 days. The generalized form occurs after nasopharyngitis in 20% of cases.

Generalization of the process is facilitated by:

• 1. failure of immunoglobulin G, complement C3 and C5
• 2. previous SARS, more often influenza
• 3. DPT vaccination children with violation of vaccination rules (For example, immediately after illness)
• 4. TBI on the eve of the disease, because in case of brain injury, the permeability of the blood-brain barrier of the brain increases, which contributes to the unhindered penetration of the microbe into the brain.

Meningococcal disease is an acute infectious disease caused by the bacterium Neisseria meningitidis and is characterized by a polymorphism of clinical manifestations. Distinguish localized forms of infection (meningococcal nasopharyngitis, bacteriocarrier), as well as generalized (meningococcemia, meningitis, meningococcemia in combination with meningitis). The greatest danger is meningococcemia, which is characterized by a high mortality rate. Meningococcemia is mainly found among children.

The reasons

The causative agent of meningococcal infection is the diplococcus Neisseria meningitidis. Under a microscope, bacteria look like beans or coffee beans, arranged in pairs. Meningococcus is ubiquitous. However, the bacterium is not very stable in the external environment. So, at a temperature of 50 degrees, it dies in five minutes, and at -10 degrees - in two hours. Direct sunlight kills bacteria in 2-8 hours. That is why cases of meningococcal infection are rare. The infection is characterized by a seasonal increase in the incidence in winter and spring periods. Periodically, with an interval of ten to fifteen years, an increase in the incidence is recorded.

The source of meningococcal infection is a person:

1. Bacteria carrier;
2. A patient with meningococcal nasopharyngitis;
3. A patient with a generalized form of meningococcal infection.

The main source of infection is the bacterial carrier. The mechanism of transmission is airborne, when a sick person (carrier) releases bacteria with saliva into the external environment. Neisseria meningitidis get on the mucous membrane of the nasopharynx. An inflammatory process occurs at the site of the introduction of bacteria. If microorganisms remain in the mucous layer and do not penetrate further, carriage develops; if they already penetrate the submucosal layer, meningococcal nasopharyngitis develops.

If the bacteria overcome the protective barriers of the mucous and submucosal membranes and penetrate into the bloodstream, meningococcemia develops. In the blood, as a result of the action of protective mechanisms, bacteria are destroyed, and endotoxin, a pathogenicity factor, is released. Clinically, this is manifested by severe intoxication, as well as the appearance of subcutaneous hemorrhages (endotoxin increases the permeability of the vascular wall). With blood flow, meningococci spread throughout the body and are able to settle in different organs. In particular, when a bacterium enters the brain, meningitis develops.

About 80% of cases of meningococcal infection occur in children, with half of them between the ages of one and five years, the remaining 20% ​​occur in young people aged eighteen to thirty years. Among adults, bacteriocarrier is more observed.

Symptoms of meningococcemia

Meningococcemia is a meningococcal sepsis that occurs with severe symptoms of toxicosis. The course of meningococcemia can be mild, moderate, heavy, and also very heavy (lightning form). Duration incubation period 1-10 days, but more often 5-7.

The disease occurs acutely, the temperature at the moment rises to 39-41 degrees.

Often, the parents of a sick child can even name the exact time when the child fell ill, so it happens suddenly and with vivid clinical manifestations.

Simultaneously with fever, other signs of intoxication occur: severe weakness, muscle pain, loss of appetite, thirst, pallor of the skin. In addition, there are signs such as:

• Increased heart rate;
• Lowering blood pressure;
• Increased respiratory movements;
• Dyspnea;
• Decreased urination;
• Stool retention/diarrhea;
• Skin rash.

Skin rash is the most characteristic and very significant symptom. Moreover, the rash can appear already in the first hours after the onset of the disease. Most often, the elements of the rash occur on the legs, feet, buttocks, arms, hands. Rashes have a stellate irregular shape from a few millimeters to centimeters. To the touch, the elements are dense, protrude slightly above the surface of the skin.

In severe forms of the disease, the rash can spread throughout the body, and on the limbs take the form of extensive hemorrhages with clear edges, resembling cadaveric spots. The face usually remains free from rashes, except that elements can appear on the ears, the tip of the nose. In especially severe cases, areas of hemorrhage merge and form a zone of continuous damage like high boots and gloves. Such changes are usually incompatible with life.

AT initial period diseases, in parallel with a hemorrhagic rash, roseolous-papular elements may appear on the body, but they disappear after a couple of days.

Hemorrhages also occur on the mucous membrane of the eyes, conjunctiva, sclera.

The abundance of skin rash, its nature, the speed of spread are an important criterion for the severity of the patient's condition.

In the future, small rashes become pigmented and then disappear. Large hemorrhages are covered with crusts, and after their rejection, scars are determined. In addition, necrosis and gangrene of the fingers, hands, feet, ears, nose are possible.

Fulminant meningococcemia

This is a very severe, extremely unfavorable form of meningococcal infection from a prognostic point of view. Sometimes death develops several hours after the onset of the first symptoms. In fact, fulminant meningococcemia is a toxic shock.

Suddenly, the body temperature rises above 40 degrees, chills, muscle pain, increased heart rate, and increased blood pressure appear.

From the very first hours of the disease, a profuse, rapidly spreading hemorrhagic rash appears on the skin. In addition, extensive reddish-cyanotic spots appear, shifting with a change in body position.

Against this background, the body temperature drops sharply to 36.6 degrees and even less. The following symptoms occur:

• drop in blood pressure;
• Increased heart rate;
• Increased breathing;
• Strong headache;
• Pale skin, cyanosis;
• Violation of consciousness;
• convulsions;
• Anuria;
• Bloody vomiting, diarrhea, nosebleeds are possible.

Death occurs as a result of cardiac or respiratory arrest.

Meningococcemia with meningitis

Meningococcemia rarely occurs in isolation, in 2/3 of cases in combination with meningitis.

Against the background of fever, weakness, hemorrhagic eruptions, there is a bursting excruciating headache, vomiting that does not bring relief. Increased pain cause bright light, sounds, change of position. The doctor detects meningeal signs, as well as revitalization or inhibition of tendon reflexes, the appearance of pathological reflexes. There are signs of damage to the cranial nerves, often III, IV, VI, VII.

Small children adopt a specific “pointing dog” position, when the child is on his side with his head thrown back and his knees brought to his stomach.

At the onset of the disease develops psychomotor agitation, soon replaced by a disorder of consciousness. Sometimes several hours pass from the onset of the disease to the development of a coma, the infectious process can be so aggressive. The patient may experience convulsions complicated by apnea.

Complications

Against the background of meningococemia in the acute period of the disease, the following complications may occur:

• Infectious-toxic shock;
• Acute renal failure (ARF);
• DIC;
• Acute adrenal insufficiency (synonymous with Waterhouse-Frideriksen syndrome);
• Edema and herniation of the brain;
• Cerebral hypotension syndrome;
• Pulmonary edema;
• myocardial infarction;
• Panophthalmitis.

Important! In the absence of treatment for meningococcemia, death is observed in almost one hundred percent of cases. Even with the timely start of therapy, out of a hundred patients, ten to twenty people die. Often after past infection severe irreversible complications develop: deafness, blindness, epilepsy, hydrocephalus, dementia.

Diagnostics

Meningococcemia has its own characteristic handwriting, so it is not difficult for a doctor to suspect an infection in the presence of symptoms. The following methods are used to confirm the diagnosis:

Treatment

The central link in the treatment of meningococcemia is the appointment of antibiotics. With meningococcal infection, chloramphenicol succinate is effective. When treated with this drug, endotoxic reactions develop much less frequently than when treated with penicillins. Levomycetin succinate is administered intramuscularly at 50-100 ml per day in three to four doses. In the fulminant form of the disease, the drug is administered intravenously every four hours until blood pressure stabilizes, after which they switch to intramuscular administration of chloramphenicol. Duration of taking the drug for at least ten days. Somewhat less often, drugs from the cephalosporin group are used: ceftriaxone, cefotaxime.

Pathogenetic therapy is aimed at combating toxicosis. These drugs are used:

• Detoxification agents: Ringer's solution, 5% glucose solution, plasma and its substitutes, albumin;
• Furosemide - for the prevention of cerebral edema;
• Anticonvulsants (sibazon);
• Vitamins C, group B;
• Glutamic acid;
• Glucocorticosteroids (hydrocortisone, prednisolone) - in severe infections.

Important! Meningococcemia is a very dangerous infectious disease. Only timely treatment can save the life of the patient.

Grigorova Valeria, medical commentator

Meningococcal infection is one of the most severe acute infectious diseases with various clinical manifestations of localized or generalized forms of the infectious process.

The danger of infection lies in the fact that it can have a very rapid, fulminant development of severe forms with a high risk of death and possible influence on the neuropsychic subsequent development of the child.

Only humans get this infection. Susceptibility to meningococcus is low. The most common infection among children: up to 80% of all patients. Children of any age are susceptible to the disease, quite often the infection affects children in the first year of life.

The disease caused by meningococcus can be severe.

The disease is caused by various strains (varieties) of meningococcus. The source of infection of the child may be a sick person or a "healthy" carrier of meningococcus. The number of such carriers in meningococcal infection is very large: for one case of a generalized form of the disease, there are from 2 to 4 thousand healthy carriers of this microbe.

Carriers are usually adults, although they do not know about it, and children mainly get sick.

The causative agent lives in the nasopharynx and is released into the external environment when sneezing, talking. The danger increases when inflammation occurs in the nasopharynx. Fortunately, meningococcus is very unstable in environmental conditions: it survives no more than half an hour.

Infection occurs by airborne droplets with very close (at a distance of up to 50 cm) and prolonged contact. The infection has a pronounced winter-spring seasonality with a peak incidence from February to April.

Periodic increases in the incidence rate are recorded after about 10 years, which is associated with a change in the strain of the pathogen and the lack of immunity to it. There are both isolated cases of morbidity in children, and massive ones in the form of outbreaks and epidemics. In the period between epidemics, young children get sick more, and more older children during the epidemic.

Meningococcus is sensitive to antibiotics, sulfa drugs.

When the pathogen enters the mucous membrane of the nasopharynx, it most often does not cause inflammation: this is how a “healthy” carriage is formed. But sometimes inflammatory changes occur in the nasopharynx, a localized form of the disease develops: meningococcal nasopharyngitis.

Much less often (in 5% of sick children), the microbe enters the bloodstream and spreads to various organs. This is how meningococcal sepsis (meningococcemia) develops.

A pronounced toxic syndrome occurs as a result of the destruction of meningococci (under the action of antibodies or antibiotics produced) and the release of a significant amount of endotoxin. This can cause the development of infectious-toxic shock.

In addition to the internal organs (lungs, joints, adrenal glands, retina, heart), meningococcus can also affect the central nervous system: the membranes and substance of the brain and spinal cord. In these cases, purulent meningitis (or meningoencephalitis) develops. In severe cases, pus covers the brain in the form of a cap.

After past illness and even as a result of the carriage of meningococcus, strong immunity is developed.

Symptoms

The incubation period can last from 2 to 10 days, it is usually short: 2-3 days.

Allocate localized and generalized clinical forms of meningococcal infection.

Localized:

• asymptomatic meningococcal carriage;
• meningococcal nasopharyngitis.

Generalized:

• meningococcemia (meningococcal sepsis);
• meningitis (inflammation of the meninges);
• meningoencephalitis (inflammation of both membranes and brain matter);
• mixed form (a combination of meningococcemia and meningitis).

Rare forms include: arthritis caused by meningococcus, pneumonia, iridocyclitis, endocarditis.

Asymptomatic meningococcal carriage is the most common form of the disease (develops in 99.5% of all infected). More commonly seen in adults. The condition does not show any signs, and the person is unaware of his infection.

Meningococcal nasopharyngitis develops in 80% of patients with meningococcal infection. It manifests itself with symptoms common to the inflammatory process in the nasopharynx: acute onset, sore throat, nasal congestion, dry cough, headache. The temperature may rise in the range of 37.5 ° C. The general condition and well-being of the child suffer little.

On examination, redness in the pharynx and swelling of the mucosa, sometimes redness of the conjunctiva, scanty mucopurulent discharge from the nose are revealed. More often, the condition is regarded as a manifestation of an acute respiratory disease. The correct diagnosis is made only in the focus of infection when examining contact persons.

The duration of the disease is from 2 to 7 days; ends with recovery. But often (about 30% of cases) this form precedes the subsequent development of a generalized form of infection.

Meningococcemia develops acutely, suddenly. Its manifestations are growing very quickly. Parents can specify the exact time of onset of the illness, not just the date. The temperature rises sharply with chills (up to 40 ° C), which is difficult to reduce with antipyretics. There is recurrent vomiting and severe headache, thirst.

But the main and most characteristic sign of meningococcal sepsis is a rash. It manifests itself already in the first day of the disease, less often on the second. The earlier a rash appears from the onset of the disease process, the more severe the course and prognosis of the disease.

More often it is localized on the thighs, legs, lower abdomen, buttocks. The rash spreads quickly, literally "growing before our eyes." The appearance of rashes on the face indicates the severity of the process. This is an unfavorable prognostic sign.

The size of the rash can be different: from small punctate hemorrhages to large irregular (“star-shaped”) elements of purple-bluish color. The rash is a hemorrhage into the skin, it does not disappear with pressure, it is located on a pale background of the skin. Spotted rashes last 3-4 days, become pigmented and disappear.

In the center of large elements of the rash, tissue necrosis (necrosis) may develop after a couple of days. The necrotic surface is covered with a crust, after its discharge, ulcers form, which scar very slowly (up to 3 weeks or more).

Necrosis can also occur on the tip of the nose, phalanges of the fingers, auricles with the development of dry gangrene.

Clinical symptoms in meningococcemia can grow very rapidly, especially with a fulminant variant of the course of the disease. Hemorrhage in the conjunctiva or sclera of the eyes may appear even earlier than a skin rash. Other manifestations of hemorrhagic syndrome may also occur: bleeding (nose, stomach, kidney) and hemorrhages in various organs.

Due to impaired blood supply and metabolic processes due to toxicosis, with meningococcemia, children have symptoms of damage to the kidneys, cardiovascular system, lungs, eyes, liver, and joints. All children develop shortness of breath, increased heart rate, low blood pressure.

When the kidneys are involved in the process, changes appear in the urine (protein, erythrocytes and leukocytes). The defeat of the joints is characterized by the occurrence of pain in large joints and their swelling, limitation of range of motion.

In the case of hemorrhage in the adrenal glands, acute adrenal insufficiency develops due to hormone deficiency, which can cause death. Such a complication, as well as acute renal failure, is possible with a fulminant form of meningococcemia (hyperacute sepsis).

Clinically, adrenal insufficiency is manifested sharp drop blood pressure, vomiting, the appearance of bluish spots on the skin against a background of sharp pallor, frequent weak pulse, severe shortness of breath and subsequent violation of the rhythm of breathing, a drop in temperature below normal. In the absence of qualified assistance, death can occur even in a few hours.

Extremely rare chronic form meningococcemia with periodic relapses. It can last for several months.

If the meninges are involved in the pathological process, then the child's condition deteriorates sharply.

Purulent meningococcal meningitis is also characterized by an acute onset. A sharp diffuse headache appears, small children react to it with the appearance of anxiety, piercing crying. The temperature with chills can rise to 40 ° C and does not decrease after the child takes antipyretic drugs.

The headache intensifies in response to any stimulus: loud sound, light, even touch: in young children this manifests itself as a symptom of "repulsion of mother's hands." Increased headache is noted at the slightest movement, when turning the head.

There is no appetite. Repeatedly repeated vomiting does not bring relief. It has nothing to do with eating. Diarrhea may also appear, especially at an early age. The child is pale, lethargic, the pulse is quickened, the blood pressure is reduced.

Muscle tone is increased. The child's posture in bed is characteristic: lying on his side, "curled up", with his legs drawn to his stomach and his head thrown back.

In small children, bulging, tension and pulsation of a large fontanel are noted. Sometimes there is a divergence of the seams between the bones of the skull. When dehydrated small child through vomiting and liquid stool the fontanel sinks.

Babies may experience reflex constipation and lack of urination.

Sometimes children have motor restlessness, but there may also be lethargy, drowsiness and lethargy. In small children, you can notice the trembling of the chin and arms.

When the process spreads to the substance of the brain, meningoencephalitis develops, which is manifested by symptoms such as impaired consciousness, mental disorders, motor excitation and convulsions.

On examination, the doctor reveals focal symptoms: paresis (or paralysis), pathological changes from the cranial nerves (oculomotor disorders, hearing and vision loss). In severe cases, when cerebral edema occurs, swallowing, speech, cardiac activity and respiration may be impaired.

With a mixed form, both the clinical manifestations of meningitis and the symptoms of meningococcemia may predominate.

In the course of the generalized form of the disease, rare forms can also develop: damage to the joints, heart, retina and lungs. But if meningococcus enters the lungs with air immediately, then meningococcal pneumonia can develop primarily.

Diagnostics

During the examination, the doctor assesses the condition of the large fontanel in young children and checks for meningeal symptoms.

To diagnose meningococcal infection, the following methods are used:

• a survey of parents and a child (if possible by age): allows you to find out the presence of contact with sick people, clarify complaints, the dynamics of the development of the disease and the sequence of symptoms;
• examination of the child by a doctor: assessment of the severity of the condition and identification of a number of clinical signs of the disease (temperature, skin color, rash, meningeal symptoms, the condition of a large fontanel in young children, convulsions, etc.);

In the case of generalized forms of the disease, the diagnosis can already be made on the basis of clinical manifestations. To confirm the diagnosis, laboratory diagnostic methods are used (it is carried out already in a hospital after an emergency hospitalization of a child):

• clinical examination of blood and urine: in the blood with meningococcal infection, there are increased total number leukocytes, an increase in the number of stab and segmented leukocytes, the absence of eosinophils and accelerated ESR; urinalysis allows you to evaluate the work of the kidneys;
• clinical examination (bacterioscopy) of a thick drop of blood and cerebrospinal fluid sediment to detect meningococci;
• bacteriological method: culture of mucus from the nasopharynx, culture of cerebrospinal fluid, blood culture to isolate meningococcus and determine its sensitivity to antibiotics;
• a biochemical blood test (coagulogram, liver and kidney complex) allows you to assess the severity of the child's condition;
• a serological blood test (paired sera taken at an interval of 7 days) can detect antibodies to meningococcus and an increase in their titer; diagnostic is a 4-fold increase in titer;

Additional examination methods:

• consultations of a neurologist, ENT doctor and oculist (examination of the fundus);
• in some cases, echoencephalography is performed (ultrasound examination of the brain to diagnose complications of the disease), computed tomography;
• according to indications, an ECG, echocardiography can be prescribed.

Treatment

At the slightest suspicion of meningococcal infection, an urgent hospitalization of the child is carried out.

At home, it is possible to treat carriers of meningococcus and meningococcal nasopharyngitis (in the absence of other children in the family at preschool age).

For the treatment of nasopharyngitis of meningococcal etiology, the following is prescribed:

• antibiotics (Tetracycline, Erythromycin, Levomycetin) orally at an age-appropriate dosage;
• gargling with a 3% solution of baking soda, a solution of furacilin;
• irrigation of the pharynx with Ectericide.

Treatment of generalized forms includes:

• antibacterial therapy;
• hormonal drugs;
• detoxification therapy;
• symptomatic treatment.

In order to influence meningococcus, Penicillin and Levomycetin-succinate are prescribed. And the choice of antibiotic, and its dosage, and the duration of the course depend on the clinical form of the disease, the severity, age and body weight of the child and his other individual characteristics.

In the treatment of meningitis and meningoencephalitis, high doses of antibiotics are used to overcome the blood-brain barrier and create a sufficient concentration of the antibiotic in the brain substance. Preferably, Penicillin is prescribed.

With meningococcemia prehospital stage(in the clinic or by the staff of the ambulance) Prednisolone and Levomycetin-succinate are introduced, and not Penicillin, which has a detrimental effect on meningococcus. When the microbe dies, endotoxin is released in large quantities, and an infectious-toxic shock may develop. And Levomycetin just will not allow the reproduction of the pathogen.

Hormonal drugs (Prednisolone, Hydrocortisone) are used in cases of severe infection in order to suppress the violent reaction of the immune system to the penetration of the pathogen and to maintain blood pressure at the proper level.

In case of developed infectious-toxic shock, treatment is carried out in the intensive care unit.

The following are used as detoxification agents: 10% glucose solution, plasma and plasma substitutes, Ringer's solution, Reopoliglyukin, etc. Plasmapheresis and ultraviolet irradiation blood.

Symptomatic therapy includes the appointment of anticonvulsants (Sibazon, Relanium, Sodium oxybutyrate), cardiac agents (Korglikon, Kordiamin), diuretics (Lasix), vitamins (C, group B), heparin under the control of the blood coagulation system.

To reduce cerebral hypoxia, oxygen therapy and cerebral hypothermia are used (an ice pack is applied to the head).

If breathing is disturbed, the child is connected to an artificial respiration apparatus.

Prognosis and outcomes of the disease

In the recovery period, weakness and increased intracranial pressure may be noted, which disappear after a few months.

A more severe prognosis in children under one year old. They have in rare cases can develop severe consequences in the form of hydrocephalus, epilepsy.

Complications of meningococcal infection are divided into specific and nonspecific. Specific (developing on early stage diseases):

• infectious-toxic shock;
• acute cerebral edema;
• bleeding and hemorrhage;
• acute adrenal insufficiency;
• acute heart failure;
• pulmonary edema, etc.

Non-specific (due to other bacterial flora):

• pneumonia;
• otitis, etc.

Specific complications are manifestations of the pathological process itself. Any of them can cause the death of a child.

After the disease, residual effects and complications may be detected.

Functional residuals:

• asthenic syndrome, the manifestation of which at an early age is emotional instability and motor hyperactivity, disinhibition, and at an older age - reduced memory and fatigue;
• vegetovascular dystonia during puberty in adolescents.

Organic complications:

• hydrocephalus ( increased amount fluid in the cranial cavity)
• increased intracranial pressure;
• child's lag in psychomotor development;
• hearing loss or loss;
• epileptiform (convulsive) syndrome;
• paresis with movement disorders.

Dispensary observation of children

Convalescent children are subject to medical supervision after the infection. To resolve the issue of admission to children's institution the child is examined 2-4 weeks after discharge from the hospital.

Subsequently, quarterly examinations by a pediatrician and a neurologist are carried out in the first year and 2 times a year in the second. According to indications, consultations of other specialists (oculist, psychoneurologist, audiologist) are appointed.

During dispensary observation can be carried out and additional methods examinations (echoencephalography, electroencephalography, rheoencephalography, etc.). When identifying residual effects it is recommended to provide the child with a sparing regimen, good rest and long sleep, an age-appropriate diet. Treatment is carried out according to the appointment of specialists.

As prescribed by a neurologist, courses of treatment with nootropics (Piracetam, Aminalon, Nootropil) can be carried out. With organic lesions of the central nervous system, aloe, lidase (improve the resorption of inflammation), Diacarb (to reduce intracranial pressure), Actovegin and Cerebrolysin (with delayed psychomotor development) can be prescribed.

At movement disorders physiotherapy exercises, physiotherapy (electrical stimulation, electrophoresis, acupuncture, etc.) are widely used.

Prevention

• early detection and hospitalization of patients;
• measures in the focus of infection: identification of carriers of meningococcus and their treatment, 10-day observation of those in contact with the patient and their 2-fold examination (nasopharyngeal swab), admission of contact children to kindergarten only after a negative examination result;
• discharge of a sick child from the hospital only after a 2-fold negative bacteriological analysis mucus from the nasopharynx (produced 3 days after the course of treatment with an interval of 1 or 2 days);
• limiting contact of infants with adults and older children;
• during the outbreak of the disease, the exclusion of holding mass events with overcrowding of children;
• treatment of chronic foci of infection;
• hardening of children;
• vaccination (with the Meningo A + C vaccine): schoolchildren (when more than 2 cases of meningococcal infection are registered at school) and children before traveling to a region unfavorable in terms of the incidence of this infection. The use of the vaccine in children is possible from 1.5 years; immunity is formed by the 10th day and is maintained for 3-5 years.

Summary for parents

Meningococcal infection - serious disease especially for young children. The danger of this infection is not only in the acute period (due to the development of complications and a threat to life), but also after recovery (quite serious consequences can remain for life).

Considering the likelihood of a very rapid development of the disease, one should not delay the time of going to the doctor with any disease of the child. Only correct and timely treatment can save the child.

It must be remembered that a spinal tap (which parents are so afraid of) is a necessary diagnostic procedure that will help the doctor prescribe the right treatment.

Which doctor to contact

If a child has symptoms of inflammation of the nasopharynx, you should usually contact your pediatrician. With a rapid rise in temperature, a deterioration in the child's condition, a severe headache, and especially the appearance of a skin rash, you should urgently call " ambulance". Treatment is carried out in an infectious diseases hospital. The child is examined by a neurologist, ophthalmologist, ENT doctor, if necessary, a cardiologist and other specialists.

Average:

Meningococcemia is a disease caused by the bacteria Neisseria meningitidis. It is a generalized form of meningococcal infection. The disease is characterized by an acute course and a variety of clinical symptoms.

With meningococcemia, or, in other words, with meningococcal sepsis, according to statistics, the mortality rate is 75%. But even the survivors will no longer be completely healthy as before. The disease leaves a trail in the form of serious complications:

• mental retardation in children;
• hearing loss;
• paralysis of cranial nerves;
• other cosmetic defects.

Very rarely there is a chronic or recurrent course of the pathological process. Bacteria die from exposure to direct sunlight within 2-8 hours, the seasonal rise is winter and spring.

In 80% of cases, the infection affects children aged 1 to 5 years, so the disease is considered mainly in children. The remaining 20% ​​are the younger generation aged 18-30.

Causes of development and danger

Meningococcemia is a disease that is dangerous because it occurs suddenly, proceeds quickly, often taking a person's life in just a few hours. Even with conditional easy course, children endure it extremely hard. The causative agent of the disease is the bacteria Neisseria meningitidis, and the source of infection can be a sick person or a recovered carrier who has developed strong immunity. The infection is transmitted by airborne droplets.

The incubation period is 5-6 days. The virus, once on the nasopharyngeal mucosa, causes an inflammatory process, provoking meningococcal nasopharyngitis in 95% of cases. With a weakened immune system, microbes with lymph spread at lightning speed throughout the body. Purulent meningitis occurs, and if the patient is not urgently provided with qualified medical care, the pus will enter the brain and the person will die. If the patient survives, it may take a lot of time for rehabilitation and full recovery.

Manifestation of symptoms

Meningococcemia is a disease that is characterized by an acute course, sudden appearance and development of clinical symptoms. The first sign that a person will not even pay attention to is an increase in temperature. A few hours later, only for this disease, a characteristic skin rash. In a typical course, it is hemorrhagic, stellate with necrosis in the center. A severe course is accompanied by necrosis of the fingers and toes, continuous hemorrhages appear. The rash with meningococcemia is localized on any part of the skin, at first it is pink-red in color, gradually darkens and acquires a purple hue, almost black.

The first elements are more common on the buttocks and legs, then it spreads throughout the body. The tissues of internal organs and mucous membranes are also affected.

The patient's condition worsens very quickly, the body temperature can rise above 41 ° C, while there is a severe diffuse headache, the normal rhythm of the heartbeat is disturbed, pronounced muscular and joint ailments appear.

Severity

Meningococcemia in children occurs in moderate, severe and hypertoxic form. The latter manifests itself in babies with good immunity, with proper nutrition and in physically healthy, strong young people. Almost every case is fatal. The onset is acute: body temperature rises sharply, chills appear. Rash with meningococcemia from the first hours abundant reaches 10-15 cm in size, dry gangrene of the auricles, tip of the nose and fingers is formed. In the absence of qualified assistance, death will occur within 20-48 hours from the onset of the disease.

Complications and signs

Other common symptoms of meningococcemia include:

• extreme weakness;
• internal and external bleeding (nasal, gastrointestinal, uterine);
• tachypnea (frequent shallow breathing);
• tachycardia;
• damage to the central nervous system;
• meningitis - in 50-88% of cases;
• hypotension;
• irritation of the meninges;
• loss of consciousness;
• bacterial endocarditis;
• septic arthritis;
• purulent pericarditis;
• hemorrhages in the adrenal glands (Waterhouse-Frideriksen syndrome);
• repeated vomiting.

The neurological status of patients changes: they become extremely withdrawn, as in a coma, or, conversely, overexcited.

First aid for meningococcemia

Emergency first aid is provided in two stages: at home and in the hospital. Sometimes the pre-hospital stage is the most important. Therefore, it is necessary to know about the features of the course of the disease not only for medical specialists, but also for patients, as well as parents. With a generalized form of meningococcal infection at home, the patient is injected intramuscularly per 1 kg of body weight:

• levomycetin sodium succinate - in a single dose of 25 thousand units;
• benzylpenicillin - 200-400 thousand units per day;
• prednisolone - one-time 2-5 mg.

During transportation to the hospital with signs of infectious-toxic shock, infusion therapy is carried out for detoxification and dehydration.

Diagnosis of the disease

The final diagnosis that this is meningococcemia, even with pronounced symptoms, can only be made after laboratory testing. However, the pathology progresses at lightning speed and is characterized by high mortality, so it is reasonable to start treatment without waiting for the results of a laboratory test:

Basic diagnostic methods:

• clinical blood test;
• examination of the cerebrospinal fluid;
• bacteriological method;
• serological testing;
• PCR study - detection of meningococcal DNA.

The latter analysis is the most accurate, but it is not carried out in all clinics, and the disadvantage of this method is the impossibility of determining the sensitivity of bacteria to a particular group of antibiotics.

Emergency treatment and rehabilitation

Treatment of meningococcemia begins immediately at the first sign of suspected disease. A patient with a generalized form of meningococcal infection is subject to emergency hospitalization. Antibiotics are mandatory - chloramphenicol succinate. With an ultra-fast course of the disease, the drug is administered intravenously every 4 hours. After the blood pressure stabilizes, the drug is administered intramuscularly. The duration of therapy is 10 days or more.

Symptoms of intoxication of the body are removed by the following drugs:

• detoxification agents: Ringer's solution, 5% glucose solution;
• "Furosemide" - to prevent cerebral edema;
• drugs for seizures ("Sibazon");
• vitamins of group C, B;
• glutamic acid;
• glucocorticosteroids.

Medicines from the cephalosporin group are also used: Cefotaxime, Ceftriaxone.

Symptomatic antibiotic therapy:

• washing the nose with antiseptic agents;
• antipyretic drugs;
• glucose solution (intravenously);
• hormonal products;
• vitamin complexes;
• antihistamines and diuretics.

Treatment of meningococcemia in children is possible only in a hospital setting.

Important! In case of problems with the kidneys, the doses of drugs are selected individually. Levomycetin often provokes aplastic anemia.

chance of survival

Even with the lightning-fast development and severe course of meningococcemia, the patient has a chance to survive, provided that the diagnosis is established immediately without error, and treatment with hormones and antibiotics begins immediately. In order not to aggravate the state of shock, a bactericidal antibiotic is administered and intensive infusion therapy is carried out.

It has been proven and verified that the bacterial load during first aid determines the prognosis of meningococcemia by increasing the breakdown of meningococcus in the bloodstream. Therefore, even before hospitalization, benzylpenicillin, third-generation cephalosporins are administered. The chances of survival are increased if the clinic has the full range of drugs to provide emergency assistance patients with this diagnosis.

Prevention measures

Meningococcemia is an infection from which it is extremely difficult to insure. Preventive measures do not give a 100% guarantee of safety. However, the risk of infection is greatly reduced. The most effective preventive measures:

• timely vaccination;
• taking vitamins;
• general hardening of the body;
• compliance with the quarantine regime;
• exclusion of hypothermia.
• preventive antibiotic prophylaxis

Any form of meningococcemia – very serious illness. It requires qualified diagnosis and immediate comprehensive treatment. Thanks to the modern technical equipment of clinics and the availability of the required medicines, the mortality rate from this disease is decreasing.

Meningococcemia (meningococcal sepsis) is a generalized form of meningococcal infection. The disease is characterized by the entry of meningococci from the primary inflammatory focus into the bloodstream and their rapid multiplication. At mass death bacteria secrete endotoxins, the effect of which on the internal organs and systems of the body is determined by clinical picture diseases.

Most often, meningococcemia in children develops between the ages of 3 months and 1 year. Among all generalized forms of meningococcal infection, meningococcemia ranges from 35 to 43%.

Rice. 1. The photo shows meningococcemia (meningococcal sepsis).

How does meningococcemia develop?

From the lesion with macrophages, in which viable bacteria have survived, or through the lymphatic pathways, meningococci enter the bloodstream. Meningococcal sepsis or meningococcemia develops. The spread of infection is facilitated by many factors: the virulence of pathogens, the massiveness of the infectious dose, the state of the body's immune system, etc. During meningococcemia, foci are formed secondary lesions and immunological reactions. The disease proceeds rapidly, unpredictably and always very hard.

The mass death of meningococci and the release of endotoxin is accompanied by toxic reactions. The acid-base state, hemocoagulation, water-electrolyte balance, the function of external and tissue respiration, the activity of the sympathetic-adrenal system are disturbed.

Endotoxin of pathogens affects blood vessels, stasis and multiple hemorrhages are formed in the skin, mucous membranes and internal organs. Intravascular coagulation syndrome (DIC) develops. Hemorrhages in the adrenal glands lead to the development of the Waterhouse-Friderichsen syndrome and infectious-toxic shock. The internal organs are affected, the dysfunction of which leads to the death of the patient.

Rice. 2. The photo shows meningococcemia in children. Extensive hemorrhages are visible on the skin. The photo on the left shows skin necrosis.

The incubation period for meningococcemia is 5 to 6 days. Fluctuations are from 1 to 10 days. The onset of the disease is most often acute, sudden. The generalization of the process is indicated by the deteriorating general state patient, a significant increase in body temperature, increasing headache, increasing pallor of the skin, tachycardia and shortness of breath. Muscular and joint pain, rash on the skin and hemorrhages on the mucous membranes.

A rash with meningococcemia appears in the first hours of the disease. Hemorrhagic elements can be huge and accompanied by skin necrosis. Along with a hemorrhagic rash, hemorrhages are noted in the conjunctiva of the eyes and sclera, mucous membranes of the nose and pharynx, and internal organs. Sometimes there are gastric, nasal and uterine micro- and macrobleeds, subarachnoid hemorrhages.

An extremely severe form of meningococcemia is complicated by damage to the heart and its membranes, thrombosis of large vessels, infectious-toxic shock, hemorrhage in the adrenal glands (Waterhouse-Friderichsen syndromes). Violations of the functions of vital organs leads to the death of the patient.

In some cases, there is a milder course of the disease and atypical meningococcemia, which occurs without skin rashes. At the same time, symptoms of damage to one or another organ prevail in the clinical picture of the disease.

Very rarely, meningococcemia can acquire a chronic or recurrent course. The disease proceeds with subfebrile body temperature, often with a rash and joint damage. The disease lasts for months, and even years. Months after the onset of the disease, the patient may develop endocarditis and meningitis. The periods of remission are characterized by the disappearance of the rash and the normalization of body temperature. Chronic meningococcemia may develop erythema nodosum, subacute meningococcal endocarditis and nephritis.

Rice. 3. The photo shows a chronic form of meningococcemia.

Under the influence of endotoxin, which is released during the mass death of meningococci, the walls of arteries and arterioles are damaged, their permeability increases. Intravascular coagulation syndrome (DIC) develops. The blood clotting system starts. AT blood vessels blood clots form, which significantly impedes blood flow. As a compensatory mechanism, the body launches an anticoagulant system. The blood begins to thin, which is why blood clots form in the patient's body and bleeding develops.

The rash with meningococcal infection has the character of hemorrhages (hemorrhages), which appear on the skin and internal organs and have different sizes. Hemorrhages in the adrenal glands are especially dangerous. The developed Waterhouse-Frideriksen syndrome and dysfunction of vital organs lead to the death of the patient.

Rice. 4. In the photo, hemorrhages in the peritoneum (left) and the mucous membrane of the tongue (right).

A rash in meningococcal sepsis appears already in the first hours of the disease. First on distal parts extremities and then spread throughout the body.

Her signs:

1. petechiae - petechial hemorrhages into the skin and mucous membranes.
2. Ecchymoses are small hemorrhages (from 3 mm to 1 cm in diameter).
3. Bruises are large hemorrhages.

With significant skin lesions, necrosis appears - ulcers that are difficult to heal, in place of which keloid scars remain during healing.

Rice. 5. Rash with meningococcal infection has a purple-red color and does not disappear with pressure.

The elements of the rash are dense to the touch, rise above the skin, have a star shape. Rash with meningococcemia sometimes appears on the face and ears. Eruption-free skin is pale in color. Often, before the appearance of a rash on the skin, hemorrhages appear on the mucous membranes of the oral cavity, conjunctiva and sclera. With inflammation of the choroid eyeball the iris becomes rusty.

The more severe the meningococcemia, the greater the area of ​​bruising. Enormous rashes are always accompanied by the development of infectious-toxic shock.

When the patient recovers, petechiae and ecchymosis become pigmented. A small rash disappears within 3 days, a large one - within 7-10 days. bruising large sizes necrotic and covered with crusts. After rejection of the crusts, tissue defects of different depths remain, healing with a scar. Damage to the skin of the tip of the nose, auricles and phalanges with a finger proceeds according to the type of dry gangrene.

In severe forms of meningococcemia, bleeding develops: uterine, nasal, gastrointestinal, hemorrhages appear in the fundus. With hemorrhages in the adrenal glands, the Waterhouse-Frideriksen syndrome develops.

Rice. 6. Rash with meningococcemia. Point and small hemorrhages in the skin.

Rice. 7. Large hemorrhages on the skin with meningococcal sepsis acquire a stellate shape.

Rice. 8. The photo shows the symptoms of meningococcemia: large hemorrhages on the skin of the extremities.

Rice. 9. Meningococcemia in children. Extensive hemorrhages in a child with a severe form of the disease (left) and small hemorrhages in the skin (right).

Rice. 10. The photo shows necrosis and crusts at the site of extensive hemorrhages in severe meningococcemia in children.

Rice. 11. The photo shows a severe form of meningococcemia in a child. The skin over the extensive bruising is necrotic.

Rice. 12. After healing of deep tissue defects after a meningococcal infection, keloid scars develop.

Meningococcal toxin contains an allergenic substance, which leads to a pronounced sensitization of the body from the moment the nasopharynx is settled. The formed immune complexes settle on the walls of blood vessels, enhancing the damaging effect (Schwartzmann-Sanarelli syndrome). Sensitization of the body underlies the development of arthritis, nephritis, pericarditis, episcleritis and vasculitis.

Meningococcal carditis accounts for half of all cases of damage to the internal organs with meningococcal infection. With toxic damage to the heart, the endocardium, pericardium and myocardium are affected. The contractility of the heart muscle decreases, the heartbeat quickens. Hemorrhages in the heart muscle, tricuspid valve and subendocardial space lead to the development of cardiac weakness, which is often the cause of death of the patient.

When the infection enters the pericardium, purulent pericarditis develops. On auscultation, a pericardial rub is heard.

Elderly people often develop myocardiosclerosis after a disease.

Rice. 13. In the photo, hemorrhages in the endocardium (left) and pericardium (right) with meningococcal sepsis.

With damage to the vessels of the lung tissue develops specific inflammation- meningococcal pneumonia. The disease develops against the background of severe intoxication.

The liquid sweats into the lumen of the alveoli, innervation is disturbed, the level of hemoglobin affinity for oxygen decreases, respiratory failure and pulmonary edema develop, and the pleura may be affected. Initially, there is a focal lesion, but over time, the infection spreads to the entire lobe of the lung. When coughing, a large amount of sputum is released.

Recovery from meningococcal pneumonia is slow. The patient is worried about coughing for a long time, asthenia develops.

Joint damage in meningococcal infection is recorded in 5-8% of cases. More often one joint is affected, less often two or more. The wrist, elbow, and hip joints are usually affected. Initially, there is pain and swelling. With belated treatment, inflammation becomes purulent, which leads to the development of contractures and ankylosis.

Rice. 14. Arthritis in meningococcal infection.

Damage to the paranasal sinuses

Inflammation paranasal sinuses nose occurs with meningococcal nasopharyngitis and with a generalized form of infection.

Urethral injury

Meningococcal nasopharyngitis can cause specific urethritis in homosexuals with orogenital contact.

Meningococcal iridocyclitis and uveitis

In meningococcal sepsis, the choroid of the eye (uveitis) can be affected. The lesion is often bilateral. Opacification of the vitreous body is noted. It detaches from the retina. Coarse adhesions are formed in places of exfoliation. Decreased visual acuity. Sometimes secondary glaucoma and cataracts develop.

With inflammation of the ciliary body and the iris (iridocyclitis), already in the first day appears strong pain sharply reduced visual acuity, up to blindness. The iris bulges forward and takes on a rusty hue. The intraocular pressure decreases.

Involvement in the inflammatory process of all tissues of the eyeball (panophthalmitis) can result in complete blindness.

Rice. 15. Meningococcal uveitis (left) and iridocyclitis (right).

The fulminant form of meningococcemia or Waterhouse-Frideriksen syndrome is an acute sepsis against the background of multiple hemorrhages in the adrenal glands. The disease occurs in 10-20% of cases of generalized meningococcal infection and is the most unfavorable form in terms of prognosis. Mortality ranges from 80 to 100%.

Signs and symptoms of fulminant meningococcemia

With the disease, there are multiple extensive hemorrhages in the skin and the rapid development bacterial shock. With hemorrhages in the adrenal glands, there is a deficiency of gluco and mineralocorticoids, as a result of which metabolic disorders and the functions of a number of organs and systems quickly occur in the patient's body. The developed crisis (acute adrenal insufficiency) proceeds according to the type of Addison's disease and often ends in death.

The fulminant form of meningococcemia occurs suddenly. Body temperature rises significantly - up to 40 ° C, severe headache and nausea appear. The patient becomes lethargic. Extensive areas of hemorrhages appear on the skin.

Arterial pressure drops, tachycardia appears, the pulse becomes thready, breathing quickens, diuresis decreases. The patient is immersed in deep sleep(sopor). Coma develops.

Rice. 16. A severe form of meningococcal infection in a child.

Diagnosis of the fulminant form of meningococcemia

In the blood of patients with a fulminant form of meningococcemia, there is a significant increase in leukocytes and residual nitrogen, reducing platelets, sodium, chloride and sugar.

With the development of meningitis with meningococcemia, a spinal puncture is performed.

Emergency care for fulminant meningococcemia

Treatment of the Waterhouse-Friderichsen syndrome is primarily aimed at combating the deficiency of corticosteroids, in parallel, correction of water and electrolyte metabolism is carried out, drugs are used to increase blood pressure and blood sugar, antibiotic treatment aimed at fighting infection.

To compensate for the lack of corticosteroids, hydrocortisone and prednisolone are administered.

In order to correct the water-electrolyte metabolism, a solution of sodium chloride with ascorbic acid is introduced. In order to increase blood pressure, mezaton or norepinephrine is administered. To support cardiac activity, strophanthin, camphor, cordiamine are introduced.

Rice. 17. In the photo of hemorrhage in the adrenal glands with Waterhouse-Frideriksen syndrome.

Infectious-toxic shock develops in fulminant forms of meningococcal infection and is its most formidable complication.

Infectious-toxic shock is based on bacterial intoxication. As a result of the mass death of meningococci, endotoxins are released, which damage the vessels and lead to paralysis of small vessels. They expand, the blood in the vascular bed is redistributed. A decrease in the volume of circulating blood leads to a violation of microcirculation and a decrease in its perfusion to organs and tissues. The syndrome of intravascular coagulation develops. Redox processes are disturbed. Decreased function of vital organs. Blood pressure drops rapidly.

The introduction of penicillin leads to the mass death of meningococci and the release of endotoxin, which aggravates the development of shock and accelerates the death of the patient. AT this case instead of penicillin, chloramphenicol should be administered. After removing the patient from shock, the introduction of penicillin can be continued.

The development of infectious shock can be judged by the following signs:

• the rapid spread of the rash and its appearance on the face and mucous membranes,
• decrease in blood pressure, increase in tachycardia and shortness of breath,
• the rapid increase in the disorder of consciousness,
• development of cyanosis and hyperhidrosis,
• decrease in peripheral blood of leukocytes and neutrophils, the appearance of eosinophilic granulocytes, slowing down the ESR,
• decrease in protein, severe acidosis, decrease in blood sugar.

The patient's body temperature drops rapidly to normal levels. There is excitement. Urine stops coming out. Prostration develops. Convulsions appear. The patient dies.

Rice. 18. The photo shows a meningococcal infection in an adult.

Without adequate treatment, the course of the disease is long and severe. A meningococcal infection usually lasts from one to one and a half months. There are cases of a longer course - up to 2 - 3 months.

Generalized forms of meningococcal infection in 10 - 20% of cases are fatal. The highest mortality is observed in children of the first year of life. Meningococcemia has a 100% mortality rate without treatment. The main cause of death in meningococcal sepsis is toxic shock. With the development of meningococcal meningitis, the cause of death of patients is respiratory paralysis caused by edema and swelling of the brain.

Rice. 19. The photo shows a severe form of meningococcemia in children.

With timely and adequate treatment, the prognosis for meningococcal infection is favorable.

Articles in the section "Meningococcal infection"Most popular

Meningococcal infection- acute infectious disease caused by meningococcus N. meningitidis), with an aerosol pathogen transmission mechanism; clinically characterized by damage to the mucous membrane of the nasopharynx (nasopharyngitis), generalization in the form of specific septicemia (meningococcemia) and inflammation of the meninges (meningitis).

Etiology: meningococcus - Gr-MB.

Epidemiology: anthroponosis; the source of infection is a sick person and a bacteria excretor; transmission route - airborne.

Pathogenesis: at the site of introduction of the pathogen (upper respiratory tract, nasopharynx), an inflammatory process develops; in case of overcoming the protective barrier of mucous membranes, meningococcus enters the bloodstream, bacteremia develops, which is accompanied by a massive death of pathogens and toxins in the blood, leads to the release of biologically active substances, damage to the vascular endothelium and the development of multiple hemorrhages in various tissues and internal organs; as a result of the penetration of meningococci and toxins through the blood-brain barrier, serous-purulent, and then purulent inflammation of the meninges occurs.

Classification(Pokrovsky V.I.)

Localized Forms

carriage

acute nasopharyngitis

Generalized forms

meningococcemia

meningitis

meningoencephalitis

mixed

rare forms

endocarditis

polyarthritis

pneumonia

iridocyclitis

Clinic: incubation period from 4 to 10 days (usually 4-6 days).

Clinical forms:

a) carrier- there are no clinical manifestations. The time of a healthy carriage ranges from several days to several weeks, and sometimes months.

b) acute nasopharyngitis - diagnosed by bacteriological examination, especially during outbreaks. Characteristic: "dry runny nose", sore throat, nested hyperplasia of the follicles of the posterior pharyngeal wall. Intoxication is moderate, although there may be a short-term increase in temperature to high values.

c) purulent meningitis- begins acutely with a sharp chill and an increase in body temperature to 38 - 40 ° C, only about half of the patients develop prodromal symptoms of nasopharyngitis in 1-5 days. It is characterized by severe general weakness, pain in the eyeballs, especially when moving, severe headache, which is not relieved by conventional analgesics. Allocate meningeal triad:

1) headache - excruciating, acute, pressing or bursting in nature, localized mainly in the frontal or fronto-parietal regions.

2) vomiting - appears suddenly, without previous nausea and does not bring relief to the patient

3) temperature - rises suddenly, among full health, not prone to spontaneous decrease and keeps the entire period of the peak of the disease at high values.

As a result of increased intracranial pressure, the patient develops meningeal symptoms- rigidity of the occipital muscles, Kernig, Brudzinsky, etc. In infants, tension or bulging of the fontanel is noted. Patients with meningitis are characterized ”meningeal posture”- the patient lies on his side with his head thrown back and legs brought to the stomach, photophobia, hyperesthesia, hyperacusis are typical.

With the progression of the disease - increasing disorders of consciousness, inadequacy of the patient, stupor, cerebral coma, tonic-clonic convulsions, prone to recurrence, respiratory and cardiac disorders.

Within 3-4 days of illness, the lack of adequate therapy can lead to dislocation syndrome and death of the patient due to respiratory and cardiovascular disorders due to the development of the terminal stage of the syndrome of edema and swelling of the brain - the wedging phase.

In the acute period, there are often signs of damage to the substance of the brain (pyramidal symptoms, damage to III, IV, V, VI pairs of cranial nerves) caused by circulatory disorders of mixed origin (edema, including inflammatory origin, embolic ischemia, etc.) in the periothecal areas of the brain fabrics. However, these symptoms are reversible during therapy.

b) meningococcal meningoencephalitis- unlike meningitis, the substance of the brain is affected, while manifestations from the cranial nerves are noted: ptosis, anisocoria, strobism, decreased vision, deafness. In some cases, the course of the disease is complicated by ependymatitis, which is characterized by muscle rigidity, increasing swelling of the brain.

c) meningococcemia - characterized by a high degree of toxicity. The disease occurs acutely with a rise in temperature, as a rule, against the background of complete health. Fever is accompanied by severe chills, often arthralgia. A polymorphic hemorrhagic rash appears. At the beginning of the disease, the rash can be roseolous, and then an increasing hemorrhage appears in the central part of the element. Primary hemorrhagic large elements of the rash, prone to fusion, indicate the severity of the process. Most often, the rash appears on the lower half of the body, scrotum, buttocks. For severe cases meningococcemia is characterized by pallor of the skin with a cyanotic tinge. With untimely help, the elements of the rash acquire a stellate character, merge into large, sometimes continuous spots. Severe cases of meningococcemia are complicated by toxic shock (ITS).

d) combined the form - meningococcemia + meningitis - with this form, the patient has both signs of meningitis (headache, vomiting, meningeal symptoms) and signs of meningococcemia (high intoxication, hemorrhagic rash, hemodynamic disorders).

Diagnostics: epidemiological history, clinic, laboratory tests - KLA (hyperleukocytosis, stab shift, lymphopenia, accelerated ESR), lumbar puncture and examination of cerebrospinal fluid (“milky character”), bacteriological examination of mucus from the nasopharynx (taken on an empty stomach with a sterile swab before starting antibiotic therapy; sterile the tampon, fixed on a curved wire, is directed end up and brought under the soft palate into the nasopharynx.Be sure to press the spatula on the root of the tongue.When removing the tampon, it should not touch the teeth, cheeks and tongue), blood and cerebrospinal fluid (in generalized forms), serological methods of express identification (co-agglutination, latex agglutination reaction).

Treatment.

With localized forms- hospitalization according to epidemiological indications, treatment with average therapeutic doses of AB (penicillin, macrofoam, erythromycin), followed by bacteriological control. Patients with nasopharyngitis who are at home should be visited daily by a health worker.

With generalized forms- Mandatory hospitalization.

1. At the prehospital stage with suspected meningitis: prednisolone at a dose of 60-90 mg, lasix 40 mg, according to indications - anticonvulsants (relanium).

2. Indications for hospitalization in the ICU: clinical (rapid negative dynamics of the disease; coma level< 7 баллов по шкале Глазго; неадекватный моторный ответ на раздражения; нарушение функции черепных нервов; судорожный синдром; признаки отека-набухания головного мозга: АГ, брадикардия, нарушение самостоятельного дыхания или его патологический тип; шок; геморрагический синдром и др.) и лабораторные (ацидоз, гипоксемия, прогрессирующая тромбоцитопения, ДВС, гипонатриемия)

3. Etiotropic therapy - penicillin (200-300 thousand units per kg of body weight per day in 6 doses im) or ampicillin, ceftriaxone, in case of intolerance to beta-lactam AB - chloramphenicol. The reserve drug is meropenem.

4. Pathogenetic therapy: based on the principle of dehydration (administration of osmodiuretics - mannitol, concentrated glucose solutions). With severe cerebral edema, mechanical ventilation, detoxification therapy, anti-shock measures, and the fight against thrombohemorrhagic syndrome are indicated. Extracorporeal detox.

5. Symptomatic therapy: in the presence of convulsions and hyperthermia: chlorpromazine, sodium oxybuterate, droperidol, Relanium, lytic mixtures.

6.3 complication of meningococcal infection (toxic shock, cerebral edema, acute adrenal insufficiency).

Complications of generalized forms of meningococcal infection

1) Syndrome of edema and swelling of the brain (more often with meningitis)- manifested by the syndrome of cerebral hypertension - an increase in intracranial pressure as a result of hyperproduction of cerebrospinal fluid (with inflammation of the meninges), edema-swelling of the brain (encephalitis, meningoencephalitis) or its toxic damage due to infectious intoxication, acute insufficiency of the excretory organs.

Clinical symptoms of cerebral hypertension: increasing headache, hyperesthesia, repeated vomiting. Meningeal symptoms of Kernig, Brudzinsky, stiff neck are characteristic. Moderately increased blood pressure (reflex defensive reaction - Kocher-Cushing reflex). There is bradycardia, fever, flushing and "greasiness" of the face. The function of the central nervous system is impaired, which is manifested by symptoms of infectious-toxic encephalopathy.

The herniation of the medulla oblongata into the foramen magnum develops acutely against the background of progressive encephalopathy. At the same time, general cyanosis, bradypnea and bradycardia appear, blood pressure drops, fever is replaced by hypothermia. Muscle atony is noted, motor activity is absent. The pupils become as dilated as possible, their reaction to light disappears, and the movements of the eyeballs stop. Tendon reflexes are sharply reduced, up to their complete absence. Pyramidal symptoms cease to be caused. Involuntary defecation and urination are noted.

When the brain is wedged into the notch of the cerebellar tenon, sweeping erratic movements appear, more pronounced in the upper limbs. The pupils become uneven, their reaction to light weakens. Sharply increased tendon reflexes and pathological pyramidal symptoms. Against the background of increased sweating, the body temperature rises. The bradycardia characteristic of CG turns into tachycardia, arterial hypertension persists or appears. In the terminal stage, tachypnea turns into Biot or Cheyne-Stokes type of breathing. The symptom complex of herniation of the brain usually develops rapidly, and its threat classifies cerebral hypertension as a critical condition requiring urgent resuscitation.

Treatment: urgent dehydration - osmotic diuretics - concentrated 20% mannitol solution or 30% urea solution or reogluman IV at a rate of 120-140 drops / min in single doses of 1.0-1.5 g / kg. In case of inefficiency - combine with saluretics (lasix, furosemide). If signs of brain dislocation appear: transfer to mechanical ventilation, endolumbar 40-60 ml of isotonic sodium chloride solution, vigorous dehydration.

2) Infectious-toxic shock(more often with meningococcemia) - see question 6.3.

There is one infection that none of the doctors wants to deal with at all ever in their lives, and even more so patients. Its danger is that a serious illness can develop in a matter of hours and even minutes, and it is not always possible to save the patient. It's about about meningococcal infection.

Meningococcus (Neisseria meningitidis) refers to diplococci (“double cocci”), by the way, they also include gonococci - the causative agents of gonorrhea (Neisseria gonorrhoeae).

Meningococci "live" in the nasal cavity and are transmitted by airborne droplets (when sneezing, coughing, even just talking), but they are very "gentle" and die outside the human body within 30 minutes.

Meningococcal infection is an anthroponotic (that is, only a person is sick) disease transmitted by airborne droplets and is characterized by a wide range of clinical manifestations - from meningococcal disease to meningitis and severe meningococcal sepsis.

Causes of meningococcal infection.

Pathogen (Neisseria meningitidis) - gram-negative cocci, unstable in the environment, sensitive to many antibiotics and sulfanilamide drugs.

The source of infection is a person infected with meningococcus. The greatest epidemic danger is posed by people who do not have clinical signs of the disease - meningococcal carriers, and especially those with nasopharyngitis (manifested as a common ARVI).

The infection is transmitted by airborne droplets, occurs mainly in the winter-spring period. Children are more likely to get sick - 80% of all cases of generalized forms occur in children under 14 years of age.

Epidemic rises in incidence are observed every 10-12 years, which is associated with a change in the pathogen and a decrease in herd immunity.

The causative agent has a tropism for the mucous membrane of the nasopharynx, on which, under certain conditions, it multiplies and is excreted with the nasopharyngeal mucus into the external environment, which corresponds to the most common form of infection - meningococcal carriage. With a decrease in the activity of local immunity, a violation of the microbiocenosis, meningococcus can penetrate deep into the mucous membrane, causing inflammation and symptoms of nasopharyngitis.

Only in 5% of patients with nasopharyngitis, meningococcus, overcoming local barriers, penetrates into the vessels of the submucosal layer, and then spreads hematogenously (that is, with blood), damaging various organs. Meningococci penetrate the skin, meninges, joints, retina, adrenal glands, lungs, myocardium and other organs.

The cause of death in the disease can be shock, acute heart failure, edema-swelling of the brain, pulmonary edema, acute adrenal insufficiency.

Mortality in meningococcal infection reaches 12.5%. After past illness strong immunity develops.

Symptoms of a meningococcal infection

There are 4 main forms of infection.

Asymptomatic carrier. Nothing is manifested, or small chronic inflammatory changes in the nasopharynx are possible. The number of asymptomatic carriers is 99.5% of all infected persons, then the three subsequent forms of infection cover no more than 0.5% of infected people.

Meningococcal nasopharyngitis (from nasis, nose and pharynx, pharynx), or inflammation of the nasopharynx. In other words, a common cold. According to the clinical picture, it is impossible to distinguish a runny nose caused by meningococcus from a runny nose with another pathogen. The diagnosis is made when looking at the mucus from the nasopharynx under a microscope and seeing the characteristic diplococci in large numbers.

Meningococcemia (“meningococci in the blood”), that is, meningococcal sepsis. More on this and the next form below.

Meningitis (inflammation of the meninges).

How Meningococcemia Develops.

In some patients, meningococcus overcomes local barriers of immunity and enters the bloodstream, where it dies and disintegrates. The massive breakdown of meningococci with the release of endotoxin (a strong vascular poison) leads to catastrophic consequences. Blood clotting starts throughout circulatory system microthrombi are formed, impeding blood flow. This is called DIC (Disseminated Intravascular Coagulation Syndrome, the word "disseminated" means "scattered, widespread"). As compensation, the body's anti-coagulation system is activated, the blood thins. By this time, both the coagulation system and the anti-coagulation system are depleted.

As a result, chaotic multidirectional changes occur in the hemocoagulation system - blood clots and bleeding. Extensive hemorrhages appear in various organs and tissues, including the adrenal glands. The adrenal glands normally produce hormones called corticosteroids, which increase blood pressure and suppress inflammation and the immune system. Hemorrhage into the adrenal glands leads to acute adrenal insufficiency with an additional drop in already reduced blood pressure. Rash with meningococcemia and there are multiple hemorrhages in the skin.

Meningococcemia begins suddenly or after a runny nose. When meningococci enter the bloodstream, chills occur, the temperature rises to 38-39 ° C, muscle and joint pains, headache, and often vomiting appear. At the end of the first - the beginning of the second day, the most characteristic symptom- hemorrhagic rash, which is called "star-shaped". Please note: the rash does not disappear with pressure. Elements of this rash with irregular contours, "star-shaped", "processed", on a pale background of the skin, they resemble a picture of the starry sky.

The rash is located mainly on sloping (lower) places - on the lateral surfaces and lower part of the body, on the hips. Necrosis appears in the center of hemorrhages, the rash darkens, becomes larger, its quantity increases, sometimes it becomes confluent, affecting large areas. More often these are the distal (remote) parts of the limbs, the tips of the toes, hands. Possible necrosis (necrosis) and dry gangrene of the auricles, nose, phalanges of the fingers. The appearance of a rash on the face, eyelids, sclera, auricles is also an unfavorable sign. If a rash occurs in the first hours from the onset of the disease, this is a prognostically unfavorable sign and is typical for very severe forms of the disease.

Acute adrenal insufficiency due to adrenal hemorrhage resembles the clinical picture of any shock: the patient is in serious condition, pale, wet, upper blood pressure 60-80 and below.

If you find signs of shock or a "star" rash in a patient, immediately call an intensive care team or resuscitation team. The principles of treatment for meningococcemia are as follows:

Large dose of glucocorticoid hormones intravenously. Purpose: to muffle the excessive reaction of the body's immune system to meningococcus and stop the decay of bacteria, maintain blood pressure levels.
- an antibiotic that stops the development of bacteria, but does not destroy them. Such antibiotics are called bacteriostatic (levomycetin, etc.). Objective: Bacteria should not be killed and destroyed with the release of endotoxin, but also they should not be allowed to multiply under conditions when the immune system is suppressed by the injected glucocorticoids.
-shock treatment: intravenous infusion saline, rheopolyglucin, etc.

Meningitis.

It is possible for meningococcus to enter various organs and tissues, but more often it enters the brain - meningitis develops. Meningitis is an inflammation of the meninges.

Inflammation of the substance of the brain is called encephalitis. Meningitis also begins acutely with chills and fever. Typical signs of meningitis:

Strong headache,

Hypersensitivity to everyone external stimuli(light, sounds, touch). Any sound, bright light hurts

Vomiting (due to increased intracranial pressure) that does not relieve. (Food poisoning gets better after vomiting.)

Disturbances of consciousness (drowsiness, confusion).

Meningeal symptoms (they are determined by a health worker) are associated with the fact that muscle regulation is disturbed and extensor tone begins to predominate. The neck becomes rigid (that is, stiff, hard, and difficult to bend).

Kernig's sign.

In a patient with meningitis, lying on his back, it is impossible to straighten the leg at the knee joint, previously bent at a right angle at the knee and hip joints(normally this can be done). In newborns, Kernig's symptom is physiological and persists for up to 3 months.

The upper symptom of Brudzinsky consists of bending the legs and pulling them towards the stomach while trying to bend the head to the chest. Normally, the legs should not bend.

In advanced cases (which should not be!) the patient assumes a forced posture of "hound dog" or "cocked trigger".
Meningococcus becomes active during a flu epidemic

Cold and flu season is very auspicious time for the active spread of an infection such as meningitis. It is her pathogens that, when coughing and sneezing, fall from the carrier of meningococcus to healthy person. Moreover, most often the carriers are adults, without even suspecting it, and mostly children get sick.

Meningitis can be caused by a variety of pathogens: meningococcus, pneumococcus, Haemophilus influenzae, and even herpes simplex virus, which usually affects the mucous membrane of the lips. The insidiousness of this infection is that the initial clinical manifestations of the disease resemble a cold or flu. For example, this happens with such a clinical form of meningitis as nasopharyngitis, when it becomes inflamed back wall throats. Patients cough, they have a stuffy nose, itching in the throat. At this stage, patients are most often diagnosed with acute respiratory disease. However, incorrect and untimely diagnosis can further lead to inflammation of the meninges.

The most severe form of the disease is bacterial meningitis. In this case, the disease begins suddenly. For example, a child goes to bed perfectly healthy, and at night he suddenly becomes restless, feels muscle weakness; if verbal contact is possible with the child, he will complain of a severe headache. Within an hour, the temperature usually rises to 39-40 °, after 5-6 hours vomiting occurs. But the most formidable symptom that you should definitely pay attention to is the appearance of a rash. At first, these are pale pink stars, but it is during the first day that they appear in 80% of patients. The rash will increase. And it is precisely in the presence of it that it is necessary to re-call the doctor, because primary diagnosis before the rash can be exposed as an acute respiratory illness.

Rash in meningococcemia.

Why is this form of meningitis dangerous?
The fact that toxic-septic shock can develop due to hemorrhage in vital organs and, above all, in the adrenal glands. This shock causes death in 5-10 percent of patients. Therefore, the sooner parents seek medical help, and the sooner an appropriate diagnosis is made, the more likely we are to save a sick child. But in any case, hospitalization will be required and parents do not need to refuse it.

Are there vaccinations against meningitis and what preventive measures can be taken in general so as not to pick up this infection?
There are vaccinations. Vaccination is recommended in the case when the incidence of meningococcal infection is recorded in the region of residence, before traveling to regions that are unfavorable for meningococcal infection, travel. Mandatory vaccinations schoolchildren are subject if 2 or more cases of meningococcal infection are registered at the school, pilgrims traveling on the Hajj and tourists traveling to the countries of the so-called. meningitis belt of Africa.

The MENINGO A+C vaccine proved to be excellent during mass epidemics in Brazil, Senegal and other African countries. MENINGO A+C has been successfully used to combat outbreaks of meningococcal infection in England, France and other European countries. To date, more than 270 million doses have been applied worldwide.

The MENINGO A+C vaccine is prepared on the basis of meningococcal capsular polysaccharides and, due to the absence of whole bacteria in its composition, can be used in children from 18 months of age. After vaccination, there may be minor, spontaneously passing vaccination reactions (slight soreness at the injection site, a slight increase in body temperature).
Vaccination requires only one dose of the vaccine. The duration of immunity is 3-5 years. Immunity develops within 5 days, reaching a maximum by day 10.

Among other preventive measures, I would recommend to have fewer contacts during the epidemic, to attend social events less frequently. In order not to get sick, you need to get rid of chronic diseases nasopharynx - pharyngitis, tonsillitis, laryngitis.

I also want to draw the attention of parents to such a circumstance as holding family celebrations. Infection is most often associated with them. For example, the birthday of a one-year-old peanut is celebrated. Parents invite guests, they seek to nurse the baby, breathe on him, caress him, and someone among them may be a carrier of meningococcus. Young children, on the other hand, have a weak immune system and are very susceptible to such infections. As a result, the baby becomes infected and after 2-5 days he develops a clinic of the disease. The less contact a small person has with adults, the less likely it is that he will stumble upon a source of infection and get a serious illness.

An important preventive measure is the detection of carriage. When cases of meningitis appear, pediatricians examine the source of infection, epidemiologists identify contact people, they take smears from the nasopharynx, try to isolate meningococcus, and then treat them with antibiotics if meningococcus is present.

Prevention and measures in the outbreak. The main preventive measures are early detection and isolation of patients, sanitation of identified meningococcal carriers (benzylpenicillin 300 thousand units intramuscularly after 4 hours for 6 days or bicillin-5 1.5 million units intramuscularly once, or chloramphenicol 0.5 ml 4 times a day day for 6 days), promotion of the rules of personal and public hygiene, hardening, sanitary and educational work.