Epidemic cerebrospinal meningitis

Epidemiology. Currently, epidemic cerebrospinal meningitis in the Soviet Union it occurs only as a sporadic disease. The source of infection at epidemic cerebrospinal M is a sick person or healthy ballonhotel. The causative agent of the disease is on the mucous lining of the nasopharynx. Infecting others are airborne. Relatively few are recurring disease in the family, school or other group in connection with the first disease. However, around the patient epidemic cerebrospinal M. there is a considerable number of healthy baillonella. It is believed that the increase in the number of carriers is a sign of a possible epidemic of this disease. Carriage at epidemic cerebrospinal meningitis lasts from several days to 3 months, more often about 2 weeks.
To the epidemic cerebrospinal M. most susceptible children. Susceptibility to the disease does not exceed 0.5 to 1.0%. Mortality in modern medicine therapy has dramatically decreased. After the disease is formed strong immunity; re disease is extremely rare.
Pathogenesis. It is recognized that meningococcal disease spreads through the blood stream where it goes through the lymphatic vessels of the nasopharynx. In the period bacteremia often occurs septicaemia, when affects the skin, joints, vascular shell eyes, occasionally, and adrenal glands. Invades the Central nervous system, the first meningococcal disease affects the vascular plexus and ependyma ventricles, and then, according to some authors, is transferred by a current of cerebrospinal fluid in the subarachnoid space and meninges. According to M. A. Skvortsov, meningococcal disease firstly affects the blood vessels of the brain base, and then goes to the meninges.
Pathological anatomy. The main changes in meningococcal meningitis are localized in the soft brain membranes (printing. Fig. 4)where the inflammation goes on vagina cranial and spinal nerves. Much later involved in Dura. In subarachnoid spaces there was an accumulation of turbid liquid. In the beginning of the process exudate has sero-purulent and sometimes only serous. In the late stages of the disease exudate is beginning to acquire the character of a true green pus yellow color along the furrows in the course of the vessels. The most dense exudate usually occurs on the base of the brain, in the field of stem and cerebellum. The procedure consists of polymorphonuclear leukocytes and fibrin mixed with a small amount of red blood cells.
In the course of the vessels leukocyte infiltration penetrate into the brain substance. As a rule, the process involved membranes of the spinal cord, mainly in the thoracic and lumbar regions.

epidemic cerebrospinal meningitis
Fig. 4. Epidemic cerebrospinal meningitis. Purulent soaking the Pia mater.
epidemic cerebrospinal meningitis
Fig. 5. Epidemic cerebrospinal meningitis. The enlargement of the ventricles of the brain in the blocking their holes with pus.

In the substance of the brain there are disorders of blood circulation: hyperemia and edema of different degrees, small hemorrhages in containers stasis reaching the brain. Changes are detected in those areas of the brain that are adjacent to the inflamed meninges. They can be in the cerebral cortex, in the contiguous parts of the white matter and the basal ganglia. In nerve cells and fibers are observed secondary degenerative changes. When remitting inflammatory process, especially with the active treatment with antibiotics, fluid in the membranes undergo gradual resorption. However, there are such cases, often in the late start of treatment, when the process is delayed, the exudate not resolved, and organized. Mater in such cases become cloudy, thickened and sklerozirovanie. As a result of sclerosis of the meninges may occur zapustevanie subarachnoid space and the violation of circulation of cerebrospinal fluid with subsequent development of brain edema (printing. Fig. 5). In such cases, cerebral hemispheres are atrophy and become large blisters filled with fluid, the walls of which are dramatically thinned tropinovogo matter of the brain. Especially it is expressed in the head dropsy in infants. In the transition process of the meninges ependyma ventricular there is a purulent ependymoma; when passing on vaginal cranial nerves and directly on the nerve fibers of peripheral neuropathy. More often, and more usually affects the optic tract and auditory nerves with the development of blindness and deafness.
Sometimes meningococcal disease occurs as a General septic process, inflammatory changes on the part of the meninges fade into the background or even absent.