Licensed books on medicine
<< Previous || Next >> |
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.
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.
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.
| << Previous || Next >> |
| = Skip to textbook content = |
Cerebrospinal epidemic meningitis
- Epidemic cerebrospinal meningitis
Etiology and pathogenesis. It is caused by a gram-negative diplococcus - Weixelbaum meningococcus. The disease is transmitted by drip and contact through objects that were in use by the patient. The entrance gate is the mucous membrane of the pharynx and nasopharynx. Meningococci penetrate the membranes of the brain and spinal cord by the hematogenous route. The source of infection is not only sick but also healthy
- Cerebrospinal fluid
Cerebrospinal fluid is located in the ventricles and cisterns of the brain, as well as in the sub-arachnoid space of the central nervous system. The main function of cerebrospinal fluid is to protect the brain from injury. Most of the cerebrospinal fluid is produced in the vascular plexuses of the ventricles of the brain (mainly in the lateral). A certain amount is formed directly in the ependymal cells of the ventricles,
- Cerebrospinal fluid
- Cerebrospinal fluid production and absorption
Inhaled anesthetics affect the production and absorption of cerebrospinal fluid. Enflurane increases the formation of fluid and prevents its absorption, which, with reduced extensibility of the intracranial system, causes an increase in ICP. Halotane interferes with the absorption of cerebrospinal fluid and slightly reduces its formation. Isoflurane promotes absorption and therefore is
- Primary meningitis
Meningococcal epidemic cerebrospinal meningitis is the primary purulent inflammation of the membranes of the brain and spinal cord and refers to acute infectious diseases with a tendency to epidemic spread and affecting mainly children under 5 years of age. Currently, this disease occurs in the form of sporadic cases, whereas earlier it took the character of large
Meningitis is an inflammation of the meninges. There are serous and purulent meningitis. According to the pathogenesis of meningitis is divided into primary and secondary. According to localization, meningitis is divided into generalized and limited, as well as basal and convexital) (on a convex surface). With the flow, lightning, acute, subacute and chronic meningitis are distinguished. In terms of severity, meningitis is divided into mild,
- Otogenic meningitis
Otogenic meningitis is the most common complication of chronic suppurative otitis media and much less often - acute purulent otitis media. All cases of otogenic meningitis can be divided into two groups: primary - developed as a result of the spread of infection from the ear to the meninges in various ways and secondary - arising as a result of other intracranial complications:
Training target: using diagnostic algorithms, be able to establish a diagnosis of mumps, determine the clinical form of the disease, complications and prescribe adequate treatment. Assignment for independent study of the topic. Using a textbook and lecture material to acquire the necessary basic knowledge, learn the following sections for practical training: 1.
- Changes in the composition of cerebrospinal fluid in vascular inflammatory and traumatic brain lesions
In cases of neurological pathology, changes in CSF pressure are possible (see chapter 20), its color and composition. Blood in the CSF and the corresponding changes in its color and composition are a constant sign of subarachnoid and a possible manifestation of intracerebral hemorrhage. However, with small parenchymal hemorrhages and with hemorrhagic heart attacks (more often arising after embolism of cerebral vessels), the composition
- Rhinogenic meningitis, arachnoiditis
Rhinogenic purulent meningitis usually develops with acute or exacerbation of chronic purulent inflammation in the upper group of the paranasal sinuses (frontal, ethmoid, sphenoid) due to the fact that the infection can penetrate through the contact into the cranial cavity and cause purulent diffuse inflammation of the cerebral membranes. Numerous cases of purulent meningitis in trauma are known.
- Question 28 The epidemic process
—A chain of continuous, consecutive, infectious conditions, from asymptomatic carriage to manifest diseases caused by a pathogen circulating in the collective. The epidemic process manifests itself in the form of epidemic foci, with one or more cases of illness or carriage. The epidemic process is determined by the continuity of the interaction of its three components
Meningitis is an inflammation of the meninges. The disease is caused by various bacterial forms, but most often by a group of cocci (meningococci, streptococci, pneumococci). One of the most common forms of meningitis is cerebrospinal meningitis, caused by a special group of meningococci. This disease often spreads in the form of epidemic outbreaks in winter and spring.
Meningitis is a disease characterized by damage to the membranes of the brain and spinal cord. Among its pathogens can be both bacterial and viral agents. Purulent inflammations are caused mainly by a small group of microbes: meningococci, pneumococci, Pfeiffer hemophilus bacillus, staphylococci, Pseudomonas aeruginosa, fungi; in newborns, E. coli, staphylococci predominate,
Bacterial meningitis should be suspected in all patients with impaired consciousness, fever and signs of irritation of the meninges. If neurological symptoms appear, they often progress rapidly, but in most patients with bacterial meningitis, symptoms appear several days before admission. In the ICU where tracheal intubation, sedation and / or muscle relaxant use
Mumps (mumps) - refers to acute contagious viral diseases, characterized by fever, general intoxication, an increase and soreness of the salivary glands, mainly the parotid. Etiology. The virus causative agent of mumps infection is unstable, is inactivated by heating (at a temperature of 70 ° C for 10 min), ultraviolet radiation, exposure to formalin solutions
- EPIDEMIC COUPLE
C. George Ray (C. George Ray) Definition. Mumps (mumps) is an acute highly contagious disease of viral etiology, characterized by an increase in the parotid salivary glands, and sometimes involvement in the process of the sex glands. meninges, pancreas, and other organs. Etiology. The causative agent of mumps belongs to the family