Symptoms of meningococcal meningitis and methods of treatment. How the disease develops Treatment of meningococcal disease

Meningococcal meningitis is one of the generalized clinical forms meningococcal infection- is caused by meningococcus and is characterized by an acute onset, the appearance of cerebral and meningeal symptoms, as well as signs of toxemia and bacteremia.

The causative agent of the disease is an immobile gram-negative meningococcus, characterized by great variability. Meningococcus is very unstable in the external environment: it is sensitive to desiccation, sunlight, cold, and quickly dies when the temperature deviates from 37 ° C.

pathological anatomy

Morphological changes in purulent meningococcal meningitis are found in the pia mater, in the substance of the brain, the ependyma of the cerebral ventricles and the subependymal region. In the initial phase of inflammation, the pia mater is predominantly affected and the process is serous-purulent in nature, and later - purulent and purulent-fibrinous.

As the pathological process progresses, in addition to the pia mater, the substance of the brain is also affected as a result of exposure to the brain tissue of both the meningococci themselves and their toxins. The defeat of the ependyma of the ventricles, the presence of diffuse and focal hemorrhages, growth granulation tissue, obturation of the openings of Magendie and Luschka, sclerotic changes in the perivascular fissures, degeneration of the arachnoid membrane and obliteration of the subarachnoid spaces lead to impaired CSF outflow and the development of internal hydrocephalus

Incubation period meningococcal infection is on average 2-7 days.

The clinical picture of purulent meningococcal meningitis consists of 3 syndromes: infectious-toxic, meningeal and hypertensive. The leader is infectious toxic syndrome, since even before the development of meningitis, the patient may die from intoxication, and in children under the age of 1 year, all other syndromes may be absent altogether or be expressed slightly. Meningococcal meningitis often begins acutely, violently, suddenly (often the mother of the child can indicate the hour of the onset of the disease). Less commonly, meningitis develops following nasopharyngitis or meningococcemia. Body temperature reaches 38-40 ° C, chills appear, headache grows rapidly, becomes excruciating, "bursting" character. Disturbed by dizziness, pain in eyeballs ah, especially when they move. Appetite disappears, nausea occurs, repeated vomiting appears with a “fountain”, which does not bring relief to the patient, and is tormented by thirst. Severe hyperesthesia to all types of stimuli is expressed - touch, bright light, loud sounds. Tendon hyperreflexia, trembling, twitching, shuddering and other signs of convulsive readiness are characteristic, in some cases convulsions of a tonic-clonic nature develop. Seizures in children during the first year of life are often the first and early symptom meningitis, while other symptoms, including neck stiffness, do not have time to develop. Convulsive twitches at the onset of the disease in older children indicate the severity of the course and are considered a formidable symptom. In some patients, convulsions may occur as a grand tonic-clonic seizure. Some children have early disorder consciousness: adynamia, lethargy, stupor, sometimes - complete loss of consciousness. Most older patients are characterized by restlessness, hallucinations, delirium. Already from the first hours of the disease (after 10–12 hours), signs of damage to the meninges are noted: stiff neck muscles, symptoms of Brudzinsky, Kernig, and others. By the end of the first day, a characteristic posture of a "pointing dog" is observed. Often there is a general muscular hypotension. Tendon reflexes are increased, there may be anisoreflexia. In severe intoxication, tendon reflexes may be absent, skin reflexes (abdominal, cremasteric), as a rule, are reduced. At the same time, pathological Babinski's reflexes, clonus of the feet are quite often observed. On the 3-4th day of illness, many children develop herpetic eruptions on the face, less often on other areas of the skin, on the oral mucosa.

In severe forms of meningitis, involvement in the process is possible. cranial nerves. Damage to the oculomotor nerves (III, IV, VI pairs) is manifested by strabismus, ptosis of the upper eyelid, sometimes anisocoria; in defeat facial nerve(VII pair) there is asymmetry of the face. Close attention is required to identify hearing disorders, especially in young children, which can occur from the first days of the disease, and hearing impairments are possible on various levels and can lead to partial or complete deafness. Rarely, II, IX, X pairs of cranial nerves are affected. To severe manifestations meningococcal meningitis include the appearance of signs of edema-swelling of the brain, which are manifested by attacks of psychomotor agitation, followed by a soporous state, followed by a transition to a coma.

An essential role in clinical diagnostics meningococcal meningitis is often combined with a hemorrhagic-necrotic rash that appears on the skin and mucous membranes in 70–90% of children in the first hours of infection generalization.

Complications. The most formidable and common complications in young people are acute edema and swelling of the brain, infectious-toxic shock.

Acute edema and swelling of the brain occur more often at the end of the first - the beginning of the second day of illness. Against the background of the rapid course of meningitis with sharp signs of intoxication, cerebral disorders and psychomotor agitation, the patient loses consciousness. Patients do not respond to strong stimuli. General clonic-tonic convulsions appear and grow. Marked extinction of corneal reflexes, constriction of the pupils and their sluggish reaction to light. Bradycardia is quickly replaced by tachycardia. Arterial pressure is initially labile, with a tendency to significant reduction, in terminal stage- high, up to 150/90-180/110 mm Hg. Art. Dyspnea quickly increases to 50-60 breaths per minute, breathing becomes noisy, superficial, with the participation of auxiliary muscles, then arrhythmic. meningeal symptoms fade away, the increased liquor pressure decreases. Involuntary bowel movements and urination are noted. Pulmonary edema develops, hemiparesis occurs. Death occurs when breathing stops as a result of paralysis of the respiratory center, cardiac activity can continue for another 5-10 minutes.

Infectious-toxic shock occurs against the background of the rapid course of meningococcemia. In patients with high fever and severe hemorrhagic syndrome, body temperature drops critically to normal or subnormal numbers. In the first hours, patients are fully conscious. Characterized by severe hyperesthesia, general arousal. The skin is pale. The pulse is frequent, hardly perceptible. Blood pressure drops rapidly. Increasing cyanosis, shortness of breath. Stops urinating (renal failure). Excitation is replaced by prostration, convulsions occur. Without intensive treatment death can occur within 6-60 hours from the moment the first signs of shock appear. In conditions of environmental and professional stress in young people, infectious toxic shock occurs, as a rule, in combination with acute edema and swelling of the brain. Against the background of severe intoxication and cerebral disorders, a hemorrhagic rash and disorders of cardiovascular activity appear. Pale skin, cyanosis of the lips and nail phalanges. Tachycardia increases, blood pressure rapidly decreases. Signs of cerebral disorders sharply increase, breathing quickens to 40 or more in 1 minute, total loss consciousness, there are general clonic tonic convulsions, corneal reflexes fade, the pupils narrow and almost do not react to light. Anuria occurs. Lethal outcome occurs 18-22 hours after the first signs of combined complications appear.

Features of CNS damage in other forms of meningococcal infection

The clinical features of meningococcal meningitis include its combination with meningococcemia, the development of serous meningitis, purulent meningitis with cerebrospinal fluid hypotension, Waterhouse-Frideriksen syndrome, as well as the development of complications in the form of infectious-toxic shock, meningoencephalitis and ependymatitis.

Diagnosis and differential diagnosis. Diagnosis is based on clinical and epidemiological data. Among the most important clinical signs include: acute onset of the disease, severe symptoms general intoxication- high body temperature, chills, lack of appetite, sleep disturbances, pain in the eyeballs, muscles of the whole body, stupor or agitation: increasing meningeal syndrome - headache, general hyperesthesia, nausea, vomiting, changes in abdominal, tendon and periosteal reflexes, muscle rigidity neck, symptoms of Kernig, Brudzinsky. Given the fulminant course of meningococcal infection, optimal timing diagnosis should be considered the first 12 hours from the onset of the disease. Rational treatment, begun in these terms, leads to full recovery of patients. However, it should be borne in mind that in the first hours of the disease, some supporting meningeal symptoms (stiff neck muscles, Kernig's symptom, etc.) may be absent. Special in the hospital diagnostic value has a lumbar puncture.

CSF pressure increased. By the end of the first day of the disease, it is usually cloudy, cell-protein dissociation is observed, globulin reactions (Pandi, Nonne-Appelt) are sharply positive. The content of sugar and chlorides in the liquor decreases. In the peripheral blood - high leukocytosis with a shift of neutrophils to the left, from the second day - sharp rise ESR. Bacteriological studies of cerebrospinal fluid, blood, scrapings from hemorrhagic elements of the rash, mucus from the nasopharynx, as well as the detection of an increase in antimeningococcal antibodies in the blood serum are necessary. However, negative results of bacteriological studies for meningococcus in no way exclude the diagnosis of meningococcal infection if the disease proceeds clinically in a typical form. Against the background of an epidemic outbreak, a clinical and epidemiological diagnosis is also possible in the case of mild forms of meningitis.

In etiotropic therapy, the drug of choice is benzylpenicillin, which is prescribed at the rate of 200 thousand units / kg of the patient's body weight per day. The drug is administered intramuscularly at intervals of 4 hours (you can alternate intramuscular and intravenous administration of penicillin). A prerequisite for the use of benzylpenicillin in these doses is the simultaneous administration of agents that improve its penetration through the blood-brain barrier.

In the period of early convalescence, immediately after the abolition of etiotropic drugs, the following are prescribed:

Drugs that improve microcirculation in the vessels of the brain (trental or emoxipin 2 tablets 3 times a day or doxium up to 0.25 g 3 times a day for 3 weeks); - drugs of "nootropic" action, normalizing the processes of tissue metabolism of the brain (pantogam 1 tablet 3 times or piracetam 2 capsules 3 times or aminalon 2 tablets 3 times a day for 6 weeks); - after completion of treatment, drugs that improve microcirculation are prescribed (from the 4th week rehabilitation treatment) means of adaptogenic action: pantocrine 30-40 drops 2 times a day or Leuzea 30-40 drops 2 times a day or Eleutherococcus 30-40 drops 2 times a day for 3 weeks.

Meningococcal meningitis is an inflammatory process of the lining of the brain, which develops due to the penetration and activation of pathogenic microflora of the genus meningococci. It is distinguished by a fulminant course, a high percentage of mortality, as well as an extensive list of complications. Most often diagnosed in people with chronic diseases of inflammatory origin, which causes pathological low level immunity. transmitted by airborne droplets, therefore, can provoke the emergence of epidemics.

The main reason for the development of meningitis is the ingestion of meningococcus. Under favorable conditions (lowered immunity, the presence of chronic diseases) these bacteria begin to actively divide and spread along with the blood flow to all tissues and organs, settling in biological fluids. Penetrating into the brain, generalized foci are formed that provoke changes in the work of the whole organism.

The risk group includes people who often come into contact with potential carriers of the bacteria, as well as patients with pathologically weakened immunity. When a bacterium enters the body, defensive reactions do not work immediately or not in full, as it should be in a healthy person.

Pathogen and transmission routes

Meningitis is caused by the gram-negative bacterium meningococcus, which has the following characteristics:

• easily found in general analysis blood, because it provokes the development of leukocytosis;
• unable to live outside the body;
• sensitive to temperature changes;
• dies when exposed to direct sunlight;
• reproduces very quickly;
• easily passes placental and cellular barriers;
• has a protective capsule that protects the bacterium from phagocytosis;
• produces toxins in the form of lipopolysaccharides, which provoke extensive intoxication.

It is enough to talk with a sick person to become a carrier of meningococcus.

After a bacterium enters the body, there are two ways the situation develops:

1. Meningitis develops rapidly with further negative consequences - possibly with weakened immunity, which is not able to counteract the pathogenic microflora.
2. Meningitis does not develop fully, and a person becomes a carrier - this situation is extremely dangerous for society for the reason that a person may not even suspect that he is a carrier of meningococcal infection, which is asymptomatic in his body. This is possible if the immune system worked instantly, preventing bacteria from multiplying and penetrating into biological fluids. The body's own reserves are sufficient to keep the bacteria in check, and the diagnosis is made by chance during a blood test.

In the latter case, a person himself, without suspecting it, can infect others, representing a serious danger.

The incubation period of the disease is from 2 to 10 days. Latent form in the absence favorable conditions can be kept for years.

The contact method of transmission of meningococcus is impossible due to its instability to environmental factors.

The risk group includes children under 5 years of age due to unformed immunity, as well as people who are forced to contact daily with large quantity potential carriers of the bacteria.

Classification

Given the clinical manifestations, etiology and pathogenesis of the disease, meningococcal meningitis is usually classified according to several parameters. According to the severity of the flow:

1. Mild form - characterized by minor lesions that are eliminated within a week with properly selected therapy.
2. Moderate form - characterized by the appearance of generalized foci, which are quite easily eliminated with minimal health consequences.
3. Severe form - complex therapy does not allow you to get the desired result, develop adverse reactions and complications.
4. Lightning form - characterized by a rapid course, in the absence of relief of which in 99% of cases a fatal outcome is diagnosed.

In terms of progression:

1. Generalized forms: purulent meningitis, meningococcemia, purulent meningoencephalitis, mixed form.
2. Localized forms: open carriage, nasopharyngitis.
3. Atypical forms: arthritis, pneumonia, myocarditis.

There are 11 types of meningococci that are considered in the diagnosis. Treatment is based on identifying the form and type of the disease.

Clinical manifestations

Meningococcal meningitis provokes the development of three groups of clinical manifestations: meningeal, infectious-toxic, hypertensive.

Infectious-toxic symptoms are the first to be activated, indicating the presence in the body pathological processes due to dehydration. In children, meningeal hypertension symptoms may be absent altogether. With a fulminant form of the disease, a person dies when initial signs meningitis, so it is important to control the process of intoxication by implementing detoxification therapy.

Infectious-toxic symptoms

This group includes such manifestations as:

• severe headache, the intensity of which increases with light and sound stimuli;
• increase in body temperature to critical levels;
• chills and fever, secretion of sticky sweat in the abdomen and forehead;
• pain when moving the eyeballs;
• reduced manifestations of reflexes;
• lack of appetite and the appearance of persistent nausea and vomiting;
• strong thirst, which ends with profuse vomiting "fountain";
• cramps and muscle pain.

The patient prefers to be in a horizontal position without a pillow, which relieves the headache. In the absence of assistance, an infectious-toxic shock develops, in which the patient is unconscious.

meningeal symptoms

They are a kind of clue in the diagnosis, since they are inherent only in this disease:

• neck stiffness;
• desire to throw the head back;
• reflex flexion of the second leg in the joints, with intentional flexion of the first;
• hemorrhagic-necrotic rash, characteristic of the first hours of progression of the generalized form of the disease.

Together with toxic symptoms the diagnosis can be made even before laboratory confirmation.

Hypertensive symptoms

With the accumulation of a large amount of fluid in the brain, cerebrospinal fluid-hypertension syndrome develops. The fluid provokes an increase in intracranial pressure, which in turn affects the functioning of the brain. This may present with symptoms such as:

• loss of consciousness;
• redness and sweating of the scalp;
• bulge skin occipital part of the skull;
• decreased vision and hearing.

In most cases, these symptoms are characteristic of the final stages of meningitis, after which the chances of survival tend to be zero.

Diagnostics

After examining the patient and identifying predisposing factors that cause the possibility of developing meningitis, the diagnosis is confirmed using:

1. Bacteriological examination of the puncture spinal cord- shows the presence of pathogens of meningitis and their type, as well as the degree of intoxication. In biological fluids, toxins accumulate faster than in tissues. Liquor in meningococcal meningitis is cloudy, comes out under pressure, and is prone to bubbling. Sometimes contains impurities of blood and pus.
2. MRI and CT of the head - helps to determine the generalized lesions of the meninges of the brain and the need for surgical intervention.
3. Electroneuromyography - assesses the degree of damage to nerve fibers.

It also requires a blood test for sterility and cultures from the nasopharynx and oral cavity. The expressed leukocytosis is found in urine and blood.

Methods of treatment

The key to diagnosis is bacteriological examination cerebrospinal fluid, therefore, treatment is carried out immediately, as soon as the results are ready, without waiting for the conclusion of MRI and CT. Drug therapy is carried out according to the scheme:

1. Antibiotics + caffeine - the latter substance enhances the passage of antibiotics through barriers, helping to quickly and fully fight pathogenic microorganisms. The type of antibiotic is chosen taking into account resistance to the causative agent of meningitis.
2. Detoxification therapy - saline solution and others are introduced lytic mixtures aimed at restoring the lytic and water balance in the body and reducing signs of dehydration. With a deterioration in kidney function, hemodialysis may be required if intoxication has acquired life-threatening forms.
3. Symptomatic treatment - the patient is prescribed antipsychotics and nootropic substances, as well as antispasmodics and painkillers that help eliminate pain syndrome and reduce stiffness of the whole body. Anticonvulsants, vitamin complexes and drugs that strengthen the immune system can be used.

Treatment begins with the maximum allowable dosages of antibiotics, which are calculated taking into account age and individual characteristics organism.

In the case of diagnosing localized foci of brain damage, it is indicated surgery for their removal and rehabilitation of nearby tissues.

Complications

The most dangerous complication that can develop with meningitis is toxic-infectious shock, which affects all vital functions. Toxins violate metabolic processes from which all organs suffer. The kidneys and liver are the first to give up, after which problems with breathing and the cardiovascular system are noted. In the absence of resuscitation measures, a lethal outcome may develop.

No less dangerous phenomenon is cerebral edema, which provokes the development of coma. A person is on artificial life support devices for a long time, after which he dies.

With a favorable prognosis, the occurrence of complications is also possible:

• decreased quality of vision;
• deafness;
• paresis and complete paralysis of the body;
• disability.

With absence early diagnosis and timely treatment meningitis provokes disability and death, therefore, when detecting anxiety symptoms you should immediately seek help from a doctor.

Forecast

The initial stages of meningitis have a favorable prognosis. With timely treatment and a properly selected antibiotic, the disease is treated in 95% of cases without the development of concomitant complications.

A lethal outcome and poor prognosis are noted in the fulminant form of meningitis, as well as in untimely treatment. In this case, irreversible processes occur in the body that lead to death.

Meningococcal meningitis in children, especially the preschool group, is extremely difficult to diagnose on initial stage and causes the development mental retardation further.

Prevention

Prevention of meningococcal meningitis is to minimize the risk factors that predispose to its appearance:

1. Reduced contact with sick people who suffer from a runny nose and cough. Use personal protective equipment and flush mucous membranes after each contact.
2. Avoiding visiting places with large crowds of people (potential carriers of bacteria) during periods of activation of respiratory diseases.
3. Strengthen immunity with hardening, balanced nutrition and vitamin complexes.

In case of manifestation warning signs and acute pain in the back of the head, which is accompanied high temperature, chills and fever, you should immediately call a doctor. Delay can accelerate the process of intoxication and the development of pathogenic microflora, which will not do without consequences for later life.

Meningococcal meningitis is a disease with serious consequences.

Some infectious diseases able to hit the most important organs bodies - the spinal cord and brain, thus causing irreparable harm to the body. A type of such a dangerous infection is meningococcal meningitis.

What is meningococcal meningitis

Meningococcal meningitis is an acute infectious disease that has a generalized form (that is, it spreads throughout the body through the lymphohematogenous route), the causative agent of which is meningococcus. The infection affects only the human body.

There are different forms of the disease, one of which is the most dangerous because of the lightning speed of its course and possible complications. The incubation period can last from 12 hours to 4 days.

The pathogen is divided into 13 groups. In Russia and post-Soviet space group A meningococcus is the leader, group B bacteria are sometimes found.

Young children are most susceptible to infection, but newborns are more often protected by antibodies obtained from the mother, which last up to six months.

The disease is based on damage to the central nervous system (namely, blood vessels) by toxins that are released after the death of meningococci, as a result of which the brain swells. If bacteria penetrate the blood-brain barrier (BBB), it develops purulent inflammation, hemorrhage and blood clots are formed. Such a process, moreover, can cover the nerves located in the skull. With a lightning-fast course of the disease, an infectious-toxic shock develops.

Meningococcal meningitis can be of the following types:

• uncomplicated;
• complicated ONGM with dislocation (edema and swelling of the brain with displacement of its tissues inside the skull);
• meningoencephalitis (inflammation of both the tissues of the brain and its membranes).

Localized (nasopharyngitis) and generalized (damage to the whole body) forms can occur with or without the formation of metastases in the internal organs.

According to the severity of the course of the disease, the following conditions are distinguished:

• lung;
• moderate;
• heavy;
• very heavy.

According to the duration of the course, the disease is divided into:

• acute (up to 3 months);
• long-term (more than 3 months);
• chronic (more than six months).

The main danger of the disease lies in the possible swelling of the brain with dislocation syndrome and infringement of its trunk. The mortality rate for this reason is quite high.

The reasons

The disease is characterized by a certain seasonality, outbreaks of mass morbidity are recorded every 15-20 years in the spring season. Experts suggest that infection with meningitis at certain intervals is associated with a decrease in herd immunity, as well as with the ability of the infection to mutate, giving rise to new strains.

If a person has strong immunity, then the bacterium, once in the nasopharynx, will die, or, in some cases, will cause nasopharyngitis.

Otherwise, if the body is weakened by stress, poor diet, ecology and other diseases, the infection crosses the blood-brain barrier and affects the membranes of the brain and spinal cord, a severe form of the disease develops. A person can die from intoxication of the body before the onset of acute meningitis.

Ways of disease transmission

The coccal infection is transmitted only by airborne droplets. contact way is excluded, since meningococcus is extremely unstable in the external environment and dies from:

• drying;
• sun rays;
• cold;
• temperatures above 50 degrees Celsius.

Meningococcus is a bacterium that requires the presence of oxygen in the tissues.

The main sources of the disease:

1. carriers generalized form, such patients are most often immediately isolated in the infectious diseases department.
2. sick nasopharyngitis(a localized form of infectious meningitis, when inflammatory processes appear in the mucous membrane of the oropharynx or nasopharynx), the patient is contagious as long as meningococcus is found on his mucous membrane.
3. So called "healthy" carriers. A person can be a carrier of the infection for about 2-3 weeks, while being able to infect others by airborne droplets, but it the immune system eventually suppresses meningococcus.

Often, nasopharyngitis gives rise to a generalized form of the disease.

Children under 3 years of age cannot be carriers of the infection. In some cases, a meningococcal infection is carried by a child in utero, then the baby is already born with hydrocephalus.

Symptoms

In 25% of cases, meningococcal meningitis is characterized by an acute onset, in 50% with a mild degree of the disease, if the infection could not pass beyond the nasopharynx, nasopharyngitis occurs. At the same time, the patient experiences symptoms similar to those of influenza and SARS:

• difficult nasal breathing;
• cough, sore throat;
• discharge from the nose, as in a coryza;
• headache;
• fever up to 38.5-39 degrees Celsius;
• aches in muscles and joints;
• general weakness;
• mucous membrane rear wall swollen throat.

The symptoms last for about a week, after which, thanks to a properly selected drug therapy pass.

If a generalized form of meningitis develops, completely different signs appear.

Primary symptoms:

• elevated body temperature (up to 40 degrees Celsius);
• loss of appetite;
• severe headache of aching and squeezing nature in the frontal and temporal regions;
• nausea, followed by vomiting, which does not alleviate the condition.

Symptoms at the height of the disease:

• pain in the eyeballs, inability to move them;
• painful light perception;
• intolerance to loud and sharp sounds;
• strong thirst;
• damage to the facial, hypoglossal nerves;
• convulsions;
• hallucinations;
• symptom of Lasegue (when bending the legs in hip joint, there are severe pains in the lumbosacral zone and along the sciatic nerve);
• Kernig's symptom (the leg does not straighten at the knee joint or the head cannot be pressed to the chest);
• the appearance of a rash first on the buttocks, shins and hands, and then on the whole body.

Symptoms in severe form:

• meningococcal posture: lying on your side with legs bent to the body and head thrown back;
• unbearable headache;
• strabismus;
• anisocoria (deviation in the size of the pupils and their deformation);
• increased sweating and sebum secretion;
• facial asymmetry;
• herpetic rash on the face and oral mucosa;
• meningococcal eruptions, ranging from small spots to extensive hemorrhages, which protrude somewhat above the skin and are quite dense to the touch;
• gastrointestinal and internal bleeding.

Symptoms of the fulminant form of the disease:

• failures in cardiovascular activity (arrhythmia, tachycardia, bariccardia);
• activity disruption respiratory system(shortness of breath, respiratory arrhythmia, tachypnea);
• overheating of the body, the onset of hyperthermia;
• convulsions;
• loss of consciousness;
• constriction of the pupils and almost no reaction to light.

With severe development of the disease, cerebral edema and the onset of coma are possible.

Diagnostics

Meningococcal meningitis is difficult to distinguish from other types of meningitis and diseases of the central nervous system by external signs, so laboratory studies play a key role.

The most informative in the diagnosis of meningococcus puncture of cerebrospinal fluid (CSF). In the first day of the disease, it flows out under pressure. The doctor selects a certain amount of cerebrospinal fluid between the vertebrae and sends the fluid for bacteriological, biochemical and cytological analysis.

Liquor, which in the normal state should have a transparent color, with meningococcus is cloudy and whitish. The protein content in it is increased, and glucose is reduced. CSF samples contain Gram-negative meningococcus bacteria. In the future, pus may form in the cerebrospinal fluid.

In addition, blood, urine, and the contents of the nasopharynx are examined. All samples are searched for Gram-negative cocci or diplococci. At the same time, an increase in leukocytes and ESR is observed in the blood (erythrocyte sedimentation rate is an indirect sign of the presence of an inflammatory process).

Laboratory studies include:

1. PCR method (polymerase chain reaction) is highly informative and exact method molecular genetic diagnostics, with the help of which it is possible to identify infectious diseases, both in the acute and chronic stages.
2. RLA method (Reaction of latex agglutination) - an express method for diagnosing infectious diseases.
3. immunological diagnosis of meningococcus.

A clear sign of meningococcus is a hemorrhagic rash that begins with small pinpoint subcutaneous hemorrhages. With the course of the disease, they are able to grow and combine into large spots.

If necessary, CT or MRI of the brain is performed (before puncture of the cerebrospinal fluid).

Treatment

Treatment usually begins with examining the cerebrospinal fluid to determine the type of causative agent of meningitis and administering glucocorticoid drugs (a type of hormone produced by the adrenal glands). Then, as needed, apply:

• antibiotics penicillin, tetracycline series (Cefotaxime, Ceftriaxone, Meropenem);
• solution crystalloids With high content sodium and glucose to replenish lost fluid;
• plasma and plasma substitutes;
• diuretics funds;
• at need drugs that increase blood pressure;
• preparations containing heparin for the prevention of intravascular coagulation syndrome;
• steroid hormones (hydrocortisone, prednisolone);
• anticonvulsants drugs;
• vitamins C, B1, B2, B6, glutamic acid;
• immunocorrective drugs (Viferon, Ergoferon).

Oxygen therapy is also carried out, and with kidney failure hemodialysis.

After the main medical measures when the condition is stabilized, the following medications are prescribed:

• drugs that improve microcirculation in vessels (Agapurin);
• nootropic drugs that improve cellular metabolism in brain tissues (Pantocalcin);
• funds adaptogenic actions (Pantea and Leuzea);
• multivitamins.

Rehabilitation after suffering meningitis plays a huge role, especially for children, so that their development does not lag behind. Recovery period includes physiotherapy exercises and various physiotherapy procedures:

• aerotherapy;
• mud treatment;
• electrophoresis;
• UHF therapy;
• massage;
• medicinal baths;
• magnetotherapy;
• therapeutic electrosleep.

In addition, it is necessary Spa treatment and special diet. Those who have recovered should eat 5-6 times a day in small portions. The menu should include: boiled lean meat, fish, steamed vegetables, fruits, cereals from various cereals, compotes and jelly.

Consequences and complications

In case of timely hospitalization and treatment, it is possible to avoid negative consequences for the body as a whole and for the brain in particular.

Effects organic damage brain:

• oligophrenia;
• hydrocephalus;
• defeat optic nerve and the retina of the eye;
• defeat auditory nerve, complete or partial deafness.

Functional Consequences:

• Delay mental development.
• Asthenic syndrome.
• Neuroses: surface, restless sleep, obsessive movements, hysteria.
• cerebrosthenic syndrome: hyperdynamic form: excessive excitability, lack of self-control, aggressiveness; hypodynamic form: lethargy, fearfulness, emotional sensitivity, sleep disturbance.
• Syndrome hypothalamic dysfunctions: rapid or vice versa slow pulse, impaired thermoregulation, dry mouth or vice versa increased salivation, hypertrichosis (increased hairiness of body parts) or, conversely, baldness.
• Focal violations of the central nervous system: paresis, epileptic seizures.

The severity of the consequences directly depends on how badly the brain was damaged.

Forecast

Meningococcal meningitis in children older than 2 years, with timely assistance, ends in complete recovery, without complications.

With a fulminant form of the disease, when an infectious-toxic shock occurs, and the brain swells, a rather high percentage of death. At the same time, 75% of children who died from this infection were under the age of 2 years.

The earlier the symptoms of the disease are detected and the onset adequate treatment the better the prognosis.

Prevention

There is a vaccine for meningococcal infection, however, it is not on the mandatory list. It is shown if:

1. AT close environment (at work, at school, kindergarten, in the family) someone fell ill with meningitis.
2. Planned the trip to countries where this infection is common (Saudi Arabia, UAE, Nepal, Kenya).

Vaccination can be made against meningococcus type A or C, there are no vaccines for type B, because immunity to it is poorly developed. In addition, you can make a vaccine simultaneously from 2 (A + C) or 4 (A + Y + C + W135) types. Immunity lasts for 2-3 years.

Patients with a generalized form in without fail should be isolated in separate boxes in the infectious diseases departments of the hospital. Patients with nasopharyngitis are also isolated at home. You can visit crowds only if at least 10 days after the start of taking an antibiotic, a nasopharyngeal examination for infection will give a negative result.

Family members of the sick person should preventive measures take immunoglobulin and antibacterial drugs(Sumamed, Ciprofloxacin).

Disease prevention includes:

1. strengthening immunity.
2. Rejection smoking(smokers are several times more likely to get infected).
3. Complete dream and rest.
4. avoiding the big clusters people during periods of acute respiratory infections.
5. Frequent the washing up hands
6. Use of personal hygiene accessories(e.g. towels).

For people who have never experienced meningococcal infection, it is quite difficult to self-diagnose this disease. For any unusual or incomprehensible symptoms, you should immediately call an ambulance, because in time Taken measures can save not only health, but also life.

Meningococcal meningitis is serious infection which affects the lining of the brain.

The cause of the disease is meningococcus, characterized by acute onset, cerebral and meningeal symptoms, with signs of toxemia and bacteremia.

What causes meningococcal meningitis

The virus is transmitted between people by airborne droplets (when sneezing, coughing). There is a risk of infection due to close contact with the patient - when living in the same living space, using the same things, utensils. The duration of the incubation period is approximately four days, but in general from two to ten days.

Meningococcal meningitis spreads exclusively between people, animals are not susceptible to this disease.

Bacteria are usually carried in the throat.

But there are cases where the infection spread through the blood stream to the brain.

The reasons for this action have not yet been identified.

There are statistics according to which about 20% of the world's people are carriers of meningococcal meningitis. But in an epidemic situation, the number of carriers increases dramatically.

Symptoms and signs of occurrence

Meningococcal meningitis is characterized by three syndromes:

• meningeal;
• hypertensive;
• infectious and toxic.

Infectious - toxic syndrome is considered the main one, because. a person may die even before the development of meningitis due to intoxication, and children of one year are characterized by the absence of any symptoms.

The onset of meningococcal meningitis is abrupt and unexpected. Cases have been recorded when meningitis began after nasopharyngitis.

The symptoms of meningitis are:

• chills and fever, it can reach 40 degrees;
• stiff neck muscles;
• severe headache and dizziness;
• Pain in the eyes;
• confusion;
• nausea and vomiting;
• constant feeling of thirst;
• increased sensitivity to bright lights, touch, and loud sounds;
• convulsions appear: trembling and twitching of the limbs.

In young children, seizures may be the only symptom for the reason that the others do not have time to develop.

In older children, seizures are serious symptom. In addition, there may be retardation. After a few days, a characteristic rash may appear on the skin and in the oral cavity. One of the main roles in determining this disease is played by the presence or absence of a rash, which can manifest itself from the very beginning of the disease. The early appearance of the rash means that the disease will be severe. The rash may be different shapes and sizes.

Elderly people may develop delusions and hallucinations. At the end of the day, the patient can take the position of "pointing dog". If intoxication is severe, then skin and tendon reflexes are significantly reduced, or absent altogether.

Previously, meningococcemia was characterized by joint damage in half of the cases of diseases. Nowadays, the joints are affected quite rarely, and mostly small ones are affected. Children usually spread their fingers, and if they are touched, the kids will react by crying.

Meningitis is an inflammation of the membranes of the brain, the disease is infectious. which lasts up to ten days, responds better to treatment with early diagnosis.

Did you know that meningitis can be fatal? What is purulent meningitis and how to treat it, read.

Since meningitis is a disease that is dangerous for its complications, it is necessary to diagnose it in time. Below you will find a description of the main symptoms of the disease.

Complications

The most serious complications that meningococcal meningitis can cause are:

• swelling of the brain;
• meningococcal sepsis;
• circulatory collapse.

Already on the second day of illness, cerebral edema may occur. Meningitis comes with acute intoxication, brain disorder, as well as psychomotor agitation. All this creates conditions for loss of consciousness.

cerebral edema

In patients, the reaction to any stimuli is dulled. The convulsions are getting stronger. The pupils become constricted, and the reaction to light is dulled. There is tachycardia and very frequent shortness of breath. The patient breathes noisily and not deeply. Involuntary urination and defecation may occur. Pulmonary edema passes into the stage of development.

Among 10-20% of people who have had meningococcal meningitis, complications occur, which are manifested by brain damage, hearing loss, and learning difficulties.

Diagnostics

Meningitis is often first diagnosed in a person during a clinical examination. Next is a lumbar puncture. During the study of cerebrospinal fluid through a microscope, bacteria can be detected. Meningitis is confirmed in the process of growing bacteria from the cerebrospinal fluid.

In order to assign the correct methods to eliminate the infection, serogroups must be identified. Additionally, the patient is assigned to take an antibiotic tolerance test.

Treatment of meningococcal meningitis

The sooner help is provided to the patient and the sooner treatment begins, the greater the chance of getting rid of the disease. Complex treatment carried out in the acute phase. Such treatment includes the use of pathogenetic and etiotropic agents.

In etiotropic therapy, they prefer to use the drug Benzylpenicillin. It is administered intramuscularly every four hours.

Together with this drug, drugs are prescribed that improve access through the blood-brain barrier.

Caffeine, sodium benzoate, Lasix and isotonic sodium chloride solution are also prescribed.

These drugs are administered intravenously every eight hours. Treatment is usually carried out within a week.

If therapy is carried out in a hot climate, in the desert, and with a low body weight of the patient, then the treatment will have its own nuances, because. infection is most severe in these patients. Treatment is primarily aimed at ensuring sufficient tissue perfusion. The main drugs under such conditions are an oily solution of chloramphenicol or ceftriaxone. For the effectiveness of treatment, one dose is usually sufficient.

Meningococcal infection is considered potentially fatal. The patient is immediately hospitalized and antibiotics should be started as soon as possible!

Prevention

• The most important component in the prevention of meningococcal infection is the use of vaccination against meningococcal infection.
• If contact with the patient cannot be avoided, then prophylaxis with antibiotics, as well as antimeningococcal immunoglobulins, should be carried out.
• If an epidemic period is declared, then at this time it is recommended to avoid visiting various places with a large crowd of people. It can be cinemas, parks, shopping centers, etc.
• Health water hardening of the body is recommended.
• In autumn and winter it is necessary to take vitamins. Vitamin C is especially important.
• Avoid hypothermia.

Meningococcal disease is one of the most severe and potentially fatal diseases and should always be treated as a medical emergency.

Related video

Meningococcal meningitis is a form of meningococcal infection that occurs in a generalized manner or in the form of nasopharyngitis. It is called meningococcus, characterized by an acute onset, severe cerebral and meningeal symptoms, toxemia and bacteremia.

Meningococcal meningitis is bacterial form meningitis

Infectious meningitis is transmitted exclusively by airborne droplets, the source is a sick person and a healthy bacterial carrier. Even with proper diagnosis and timely treatment, 5-10% of patients die in the first 24-48 hours after the onset of symptoms. Meningococcal meningitis is a potentially fatal infection and should always be treated as a medical emergency.

Statistics

Statistics distribute the sources of infection as follows:

• 1–3% are patients with a generalized form;
• 10–30% are patients with meningococcal nasopharyngitis;
• 70-80% are carriers of meningococcus.

According to WHO, more than three hundred cases of meningococcal meningitis are registered annually in the world, of which 10% are fatal.

During the incidence, a cyclicity is observed: every 10–12 years, another epidemic occurs lasting up to 4–6 years (associated with a change in the strain of the pathogen and a decrease in collective immunity). Seasonality is characteristic: the main peak falls on March-February. This is explained by the unstable weather conditions and the maximum spread during this period of ARVI.

Young children are at risk for bacterial meningitis.

The most susceptible to meningococcus are children under three years- they make up to 70% of all cases.

In infants, severe hypertoxic forms with complications develop. The highest mortality in this age group (up to 50%) is associated precisely with complications of meningococcal meningitis.

Pathogen and transmission routes

The causative agent of meningococcal meningitis (Neisseria meningitinus) is a gram-negative meningococcus, immobile, very variable, unstable to environmental factors: it quickly dies in the cold, when dried, temperature fluctuations in any direction from 37 0, under the influence of sunlight. It has the appearance of a double coffee bean (diplococcus) in a capsule. The capsule is a factor of pathogenicity, toxic properties are due to endotoxin.

The route of transmission is airborne, this is due to the low resistance of meningococcus in the environment. The contact route of transmission is impossible due to the rapid death of the microbe. Infection can occur when talking, coughing, sneezing. The most dangerous distance is 50 cm. A healthy bacterial carrier plays a special role in the spread of infection, which is the source of the maximum spread of the disease. The highest contagiousness is represented by persons with nasopharyngitis. The incubation period is from 6 to 11 days.

The disease develops rapidly or does not receive further development due to the pathogenicity factor (this is a capsule that protects pathogen from phagocytes), and endotoxins, which cause toxic manifestation.

When meningococcus enters the mucous membrane of the nasopharynx, 90% become infected if the body is weakened by stress, lack of sleep, and concomitant diseases.

In the case of persistent immunity, the microbe dies due to the protective system of the nasopharynx, i.e., a healthy carriage occurs. Or catarrhal nasopharyngitis develops.

Mechanism of infection

When meningococcus enters a weakened body, bacteremia occurs - a short period, which is clinically manifested by herpetic eruptions, hemorrhagic exanthema. If an infectious agent overcomes the blood-brain barrier (BBB), then the next stage in the development of the disease is damage to the membranes of the brain and spinal cord with an expanded clinical picture. But even before the development of meningitis itself, the patient may die from severe intoxication that accompanies the disease.

Clinical picture and symptoms of the disease

Signs of meningitis

Meningococcal meningitis has a typical clinical picture, combining three syndromes:

1. Infectious - toxic.
2. Meningeal.
3. Hypertensive.

The main syndrome is infectious-toxic: the most acute onset with a high temperature above 40 0, chills, headaches when moving the eyeballs, extreme weakness, nausea, repeated vomiting of a “fountain” that does not bring relief and is not associated with food, lack of appetite, intense thirst. In the future (very quickly) develop hyperesthesia to all types of irritation (light, sounds, touch), hyperreflexia, often - tonic-clonic convulsions, hallucinations, delirium.

In the next 10-12 hours, meningeal syndrome develops - involved in the process meninges, there is stiffness of the occipital muscles. By the end of the first day, a characteristic “pointing dog” posture arises - lying on its side with its head thrown back (this is associated with severe headaches, when any movement causes an even greater attack of pain), muscle hypotension, in severe cases- areflexia. Subsequently, the cranial nerves are affected. And without that serious condition aggravated: facial asymmetry appears, hearing is impaired up to deafness, various violations oculomotor system: ptosis upper eyelids, anisocoria, strabismus.

meningeal symptoms

Hypertension syndrome due to the development of cerebral edema. Clinical manifestations: psychomotor agitation- stupor - coma.

Complications

Meningococcal meningitis is fatal.

• Cerebral edema is the most formidable complication this form of meningitis. Develops at the end of the first day. Around this time, meningococcemia manifests itself: a hemorrhagic rash occurs, which is a characteristic symptom. In some cases, a rash may occur in the first hours of illness. This is an extremely unfavorable sign in the course of the disease. Occurs on the lateral surfaces of the body, on the hips, may be on the face, ears. The rash has a patchy character, later it changes: necrosis occurs in the center of each element, the number of elements increases sharply, it becomes confluent, covers most of the body.

Hemorrhagic stellate rash on the skin

• At severe course meningococcemia, hemorrhages occur in the mucous membranes of all organs: toxic-infectious shock develops - another complication that, without urgent measures, leads to death. With the development of this complication, the temperature drops critically to normal numbers, blood pressure drops sharply, a thready pulse appears, cyanosis increases, shortness of breath up to 40–60 per minute, anuria occurs, corneal reflexes decrease, there is no reaction to light, complete loss of consciousness.
• Another complication is Waterhouse-Frideriksen syndrome (acute adrenal insufficiency). It complicates many infections, but only in meningococcal meningitis is characterized by specific lesions of the adrenal glands, leading to the death of the patient, although it is very rare in meningococcal meningitis. Acute adrenal insufficiency develops so rapidly that it is possible to name the time of its onset; characterized by a pronounced intoxication syndrome with cold sticky sweat, general cyanosis of the skin; blood pressure first rises, then rapidly drops to zero; breathing quickens, a rash appears, there is no urine, pulmonary edema occurs. Mortality is 80–100%.

Diagnostics

Diagnosis of meningococcal meningitis includes taking an anamnesis, a thorough examination, analysis of the data obtained laboratory research. In the general clinical analysis of blood, signs of acute inflammation are revealed. The main diagnostic criterion, which is guided by when making a diagnosis, is the state of the cerebrospinal fluid (cerebrospinal fluid). But the results of the CSF study are considered in conjunction with the clinical picture. In the cerebrospinal fluid, signs of severe inflammation are revealed. CSF is obtained under sterile conditions in three test tubes for biochemical, bacteriological and cytological studies.

Lumbar puncture

Microscopy, bacteriological examination, cytological and serological examination of all body fluids are carried out: blood, cerebrospinal fluid, contents of the rash discharged from the nasopharynx, cadaveric material.

With meningitis, cerebrospinal fluid is secreted when punctured with a needle under high pressure, cloudy, contains gram-negative diplococci located intracellularly, a large number of protein, the entire field of view of neutrophils, sugar.

This suggests the presence of meningococcal meningitis. Detection of meningococci in cerebrospinal fluid during bacteriological culture confirms the diagnosis. Also, the analysis of cerebrospinal fluid is used for differential diagnosis in establishing a diagnosis.

In a serological study, the serological groups of the pathogen and sensitivity to antibiotics are determined.

Treatment

Treatment begins immediately, immediately after the lumbar puncture. If meningococcal meningitis is suspected, CSF analysis is taken prior to antibiotic administration in order to determine the specific serotype of the pathogen. Antibiotics of the penicillin series are used in large doses simultaneously with the introduction of caffeine, which improves the penetration of the antibiotic through the BBB. Reserve antibiotics are chloramphenicol, kanamycin.

Antibiotics are used to treat meningococcal meningitis

Upon receipt of an analysis of cerebrospinal fluid with a specified serotype of the pathogen, it is possible to replace the antibiotic or add another one. Detoxification therapy, rehydration, resuscitation. At severe forms treatment begins with the introduction of chloramphenicol. The choice of antibiotic depends on the suspected pathogen and the age of the patient. In the course of treatment, symptomatic therapy.

What is the prognosis?

With timely diagnosis and timely treatment, the prognosis can be favorable. With developed complications of meningococcal meningitis, the prognosis is poor.

In children, the prognosis depends on the age and form of the disease: the smaller the child, the higher the likelihood of death.

The consequences of the transferred meningococcal meningitis with the missed time for treatment can be deafness, atrophy of the optic nerve, in children - hydrocephalus, epileptiform syndrome with short-term loss of consciousness, developmental delay. Asthenic syndrome persists for a long time.

Preventive actions

Introduction meningococcal vaccine

Vaccination plays a global role in the prevention of meningococcal meningitis. But immunization in planned is inappropriate. The vaccine against meningeal meningitis is used according to strict indications - before traveling to epidemically dangerous areas: Kenya, Nepal, Saudi Arabia. In the most unfavorable places in terms of the epidemiological situation, vaccination is carried out for certain categories of the population: children living in boarding schools, students living in hostels - if a case of the disease has been registered. In the US, all military personnel are vaccinated.

To preventive measures includes timely hospitalization of sick, suspicious and in contact with patients, examination of persons with nasopharyngitis from the focus of infection.