INFECTIOUS DISEASES : THE EPIDEMIC CEREBROSPINAL MENINGITIS (MENINGITIS CEREBROSPINALIS EPIDEMICА) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Etiology. Pathogen - small polymorphic gram-negative diplococci - Diplococcus intraceilularis s. Meningococcus Of Weichselbaum (1887). Close morphological and biological properties to the gonococcus. Serologically divided into four types: a, b, C, D; the most common types a and B.
Epidemiology. Often found in sporadic cases, but the disease is usually dramatically grow in the spring months (put in the link catarray mucous membranes); sometimes epidemic with increased disease severity. The instability of the meningococcus in the external environment leaves only way of direct contact with infected droplets. However, the infection directly from the patient are very rare; they occur mainly from healthy baillonella, which are easily found in the environment of the patient, and during epidemics exceed the number of patients up to 20 times. The nasopharynx is the location of the original accumulation of germs from the patient and site of infection of baillonella, mainly adults. Ill more children. Observed family epidemics occur, apparently, from a family member carrier.
The pathogenesis. The disease often precedes katarr nasopharynx - the place of introduction of infection. The transition of meningococci in meninges may occur directly from the primary tumor through the lymph spaces around nerve trunks (especially often defeat of the front parts of the brain, the so-called "cap"), but more often the infection is spread by hematogenous, as evidenced by positive hemoculture. On the soft cerebral meninges of the anterior lobe, sometimes the base of the brain and rear parts of the spinal cord develops ceropegieae inflammation with a sharp increase of cerebrospinal fluid, rich in leukocytes, contain in their cytoplasm a large number of meningococci. In very severe cases, culminate in death within 1 - 2 days purulent inflammation does not have time to develop; sharply in protracted cases, the prevailing picture of hydrocephalus. Clinical manifestations associated with meningitis as such and with the poisoning of the body by endotoxin.
Symptoms. Acute onset, severe headache, vomiting, stiffness in the nape of the neck, cutaneous hyperesthesia, rigidity of the limbs (the symptom of Cernica), often herpes. Hyperleukocytosis.
For. Incubation lasts 2 to 4 days. Temperature increases; in spite of severe headaches, consciousness is preserved; these symptoms appear quickly, but not all are obvious, especially in young children with open fontanel (bulging fontanels reduces the pressure on the brain). Feeling much better in the morning, by the evening all the symptoms are more pronounced; nonsense. Gradually new symptoms: Brudzinskogo, Babinsky, strabismus, uneven pupils, the attack of the abdomen, skin WASAPI roseolous or hemorrhagic in nature (histological examination of the skin vessels of many leukocytes and meningococci). Lightning forms end in death within 1 to 2 days, fast current - a 5 - 6 days, but it is possible and relatively quick recovery. Sometimes the recovered remains deafness, less impaired vision.
Protracted forms occur in two types:
1) recurrent, in which periods of improvement are replaced by exacerbations; accompanied by a significant loss of weight, insomnia, bowel movements, depression, mental; or sudden fracture and recovery, or death during exacerbations;
2) education hуdrocephalus internus with clearings cerebrospinal fluid, reaching, however, under very high pressure, with a strong retraction of the abdomen, note the lower limbs, muscle atrophy and decay. The duration of the disease for several months. The recovery is still possible. Mortality before the introduction of sulfa therapy reached 50%.
On the basis of clinical symptoms is easy to establish the diagnosis of meningitis, but it is not always possible to establish etiology. In the absence of other diseases, complicated by meningitis (pneumonia, scarlet fever, typhoid fever, inflammation of the middle ear, and so on), may be suspected tuberculous meningitis. Finally the problem is solved spinal or suboccipital lymphadenopathy puncture. Transparent, reaching under high pressure, colored slightly yellow (xanthochromia)forming when standing delicate spider web fishnet fluid characteristic of tuberculous meningitis; in sediments predominantly lymphocytes, bakteriostaticheski - TB bacilli (not always). When epidemic meningitis pressure is increased (if there is no blockage of the foramen Magendie), highly liquid opalestiruet or turbidity; suspended numerous neutrophils, a lot of extra - and intracellular meningococci. With pneumococcal meningitis purulent fluid, secreted drops contains pneumococcus Frenkel.
Mandatory registration. Isolation of the patient. Examination of others in the carriage.
Specifically there are sulfa drugs group (alfasol, sulfathiazole and other) Schema therapy: the 1st and 2nd days of treatment for 6,0 pro die, day 3 - 5,0, day 4 - 4,0, 5-th day - 3.0 and 6-day - 2,0. Daily dose be split up based admission every 3 to 4 hours, abundant alkaline drink. Contraindicated sulfate saline laxatives. Sulfonylurea reduced mortality up to 5 - 7%. Successfully used penicillin intramuscularly and subarachnoid, only 200 000 - 250 000 units per day (6 injections) for 5 to 6 days. Both methods can be combined with serotherapy (see below). Other methods:
1) lumbar puncture every day or two; the liquid produced, depending on the pressure until you go drops;
2) introduction intraluminally 20 - 30 ml protivoanemicakimi serum (monovalent - type meningococcus or polyvalent) to 4 - 5 days in a row;
3) washing of the spinal canal is performed when you double puncture - suboccipital lymphadenopathy and lumbar; solution rivanol 1 : 500 is introduced into the upper trocar until the bottom yellow liquid:
4) the use of hexamine per os (0.5 to several times a day) or intravenously (3 - 5 ml of 40% solution);
5) white streptocide of 0.8% solution: 10 - 15 ml intralumbalno and 0.3 per os 6 - 8 times a day.