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Cerebrospinal epidemic meningitis

Etiology and pathogenesis

The disease is caused by meningococcus Frankel-Vekselbaum. This is a gram-negative diplococcus, located most often intracellularly. 4 strains of the pathogen were isolated: A, B, C, D.

The disease is transmitted by airborne droplets and contact through objects that were in use of the patient. The entrance gate is the mucous membrane of the pharynx and nasopharynx. Mostly children are ill. Epidemic outbreaks occur in winter and spring. The hematogenous pathogen enters the central nervous system and first affects the vascular plexus and ventricles, and then the membranes of the brain and spinal cord.

Pathomorphology

Macroscopically, the brain of a person who has died from meningitis looks covered with a purulent cap of yellowish-gray or yellow color. Dilated vessels. There is a significant accumulation of pus along the vessels. The substance of the brain is swollen, full-blooded. The greatest amount of pus is noted on the dorsal-lateral surface of the brain and on the base.

Clinic

The incubation period of the disease lasts from 1 to 5 days. The disease develops acutely: severe chills appear, body temperature rises to 39 degrees. Headaches with vomiting appear and quickly increase. Delusions, hallucinations, convulsions, unconsciousness are possible. In the first hours, sheath symptoms appear (stiff neck, symptoms of Kernig, Brudzinsky, Lessage). Symptoms of defeat of III, VII, VIII pairs of cranial nerves appear. Pyramidal signs, general hyperesthesia are revealed.

Herpetic eruptions are often observed in the corners of the mouth and nose, less often on the mucous membrane of the tongue and on the skin of the auricle. Herpes appears on day 2-3 and lasts for several days.

Hyperleukocytosis is detected in the blood, reaching up to 15-30 lymphocytes, mainly neutrophils.

The most characteristic change in cerebrospinal fluid. Liquor, usually cloudy, flows under high pressure. Protein reactions are very pronounced. Pleocytosis is estimated at hundreds or thousands of neutrophils. With a bacterioscopic examination, pathogens - meningococci can be detected.

Cerebrospinal epidemic meningitis is often complicated by joint disease.

The duration of the disease is different. In a typical course, the meningitic symptom complex lasts 3-4 weeks. In some cases, it lasts longer or the disease takes a relapsing character. Long-lasting forms of the disease can be complicated later by head dropsy, a violation of the central type of fat metabolism.

The following clinical options for meningococcal meningitis are distinguished:

? Lightning fast. The stormy beginning is noted. The patient immediately loses consciousness, the temperature rises sharply, breathing is disturbed. Shell symptoms do not have time to develop. Without regaining consciousness, the patient dies within 24 hours. There can be no pathological changes in the cerebrospinal fluid. One of the possible causes of death of patients is the development of an infectious toxic shock. As a rule, meningococcal sepsis develops. A small point hemorrhagic rash appears on the body. With hemorrhage in the adrenal gland, acute adrenal insufficiency develops (Waterhouse-Friedericksen syndrome). Mortality in this form of meningitis reaches 100%.

? The ultra-sharp form lasts from 1 to 5 days. With this form, convulsions, bulbar disorders are observed, consciousness is lost, the activity of the sphincters is disturbed. With a puncture, a purulent muddy cerebrospinal fluid is found, in which many meningococci are found.
Mortality in this form is 50%.

? The acute form lasts about three weeks. This is a classic picture of meningococcal meningitis.

? A relapsing form of meningitis is characterized by the fact that the meningeal symptom complex lasts for some time and then passes, but after a while comes forward with renewed vigor. The intervals between relapses last from two weeks to many months.

? There is also meningitis with a protracted course. In this clinical form, neutrophilic pleocytosis is replaced by lymphocytic.

? Meningococcal meningoencephalitis

? Meningitis in old and old people. The severity of symptoms is noted, they last a long time. Characteristic changes are found in the cerebrospinal fluid.

Treatment of meningococcal meningitis

The patient should be isolated. From the very first days, specific or etiotropic therapy is prescribed. One of the effective drugs is penicillin at a dose of 300,000 units per 1 kg of patient body weight. The daily dose is 24,000,000 - 32,000,000 units, which is divided into 6-8 doses. The drug is administered intramuscularly. The duration of treatment is 7-10 days. They also focus on the cellular composition of the cerebrospinal fluid. With the effectiveness of the therapy with repeated lumbar punctures, the number of neutrophils decreases, and they are replaced by lymphocytes. In severe cases of the disease, the daily dose of penicillin increases to 48,000,000 units. In the case of a coma, intravenous administration of the drug is possible. For this, only the sodium salt of benzylpenicillin is used at a dose of 4,000,000 - 12,000,000 units per day. It is possible to administer penicillin endolumbally at the time of the spinal puncture. A maximum of 50,000 units of the drug is administered once, the maximum daily dose is 100,000-150,000 units.

As a specific therapy, the introduction of semi-synthetic penicillins - ampicillin - is possible. Effective drugs of the cephalosporin series - zeporin, cephaloridin. Sulfonamide drugs — sulfamonomethoxin, sulfapyridazine, sulfadimethoxin — are highly effective.

Conduct pathogenetic treatment.

Anti-inflammatory drugs are prescribed (reopirin, indomethacin, voltaren, brufen).

With hypovolemia, drip intravenous administration of glucose-salt solutions (sodium chloride, Ringer, disol) is prescribed.

To combat metabolic acidosis, intravenous administration of 4% soda (up to 800 ml per day) is used.

For the purpose of detoxification, intravenous administration of plasma-substituting toxin-binding solutions is used (hemodes).

No less important is dehydrating therapy. Furosemide, lasix in injections is prescribed.

Symptomatic treatment includes the relief of seizures (seduxen, relanium). To lower the temperature, lytic mixtures are used (diphenhydramine + analginum + promedol).

With the development of infectious toxic shock and Waterhouse-Friedericksen syndrome, intravenous fluids with the addition of glucocorticosteroids (125-500 mg of hydrocortisone) are used.

In the subacute period of the disease, glutamic acid, nootropics, multivitamins are prescribed.

With timely treatment, the prognosis in most cases is favorable. Perhaps the development of asthenic syndrome, less often there are focal neurological disorders, damage to individual cranial nerves and cerebrospinal fluid disorders.
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Cerebrospinal epidemic meningitis

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