Epidemic cerebrospinal meningitis

The clinical picture and over. The incubation period for meningococcal meningitis lasts from 1 to 4 days, but sometimes it can be longer. The disease begins suddenly, with a temperature increase of up to 39-40°, chills, headache, vomiting, sometimes with loss of consciousness and seizures. Before the use of antibiotics period of high temperature continued 7-10 days. Only in abortifacient cases, the temperature remained 24-48 hours. If a timely started treatment, modern methods of febrile period is considerably reduced.


Fig. 3. Rigidity of muscles of the head and drooping head at epidemic cerebrospinal meningitis.

The most constant symptom of the disease is a headache, and sometimes painful. In the first days of the disease it is combined with vomiting, which disappear in a few days. The resumption of vomiting in the later stages of the disease is an unfavorable prognostic sign. Along with these symptoms in the early stages of the disease may occur sudden loss of consciousness and expressed delirium. Seizures in meningococcal meningitis occur more frequently in infants and have clonicotonic character. Simultaneously appear meningeal symptoms - muscle stiffness of the neck, the symptoms of Cernica and Brudzinskogo. They take a position on the side with head thrown back and brought to the stomach feet. Stiff neck (Fig. 3) can go to their persistent information (opistotonus), which is more common in untreated infants in the later stages of the disease. Stiff neck may be absent in children of the first months of life in patients with pronounced toxicosis and coma, and in agonistic condition. In young children, who have not closed a large fontanel, early in the disease appears bulging and tension. With frequent vomiting and symptoms of toxicity due to loss of body fluids large fontanel may not Vibhuti. In addition to the above symptoms with meningococcal meningitis there is a General hyperesthesia, which is expressed in strong anxiety child, aggravated by touching him, for different kinds of treatments. Often the General concern of the patient is associated with headache.
Cerebrospinal fluid in the beginning of the disease is derived under high pressure, mostly cloudy or purulent, but may be only opal. It contains a large number of polymorphonuclear leukocytes (5000 - 10 000 1 mm3 and more). Sometimes it happens so much that the liquid is hardly passes through needle puncture. In the vast majority of cases detected increased protein (0,66-1,32% respectively). Reactions Pandi and Nonna - apelt reaction (see Cerebrospinal fluid) strongly positive. The sugar content in the spinal fluid is reduced, but not very sharp.
In the blood of most patients with meningococcal meningitis occurs pronounced leukocytosis with the increase in the number of cells from 12 000 to 30 000 1 mm3, rarely less than 12 000. The number of neutrophilic leukocytes sharply increased in the early period of the disease. At the same time there are significant stab shift and acceleration ROHE 30-45 mm per hour.
The meningococtsemiya. The clinical picture of meningococcemia without meningitis quite variable. Sometimes the disease is easily without deterioration and intoxication, with high, but short-term (2-4 days) temperature, poor skin, joints and quickly disappear. This form of the disease is often not diagnosed. Often meningococtsemiya flows in moderate shape. In such cases, the patient's condition worsens significantly, there is quite pronounced toxicosis. The temperature is often the intermittent nature, the skin is manifested in the form of bleeding into the skin of various sizes. With the defeat of joints marked a noticeable swelling them, pain, redness and effusion with fluctuation. The defeat of the eye is expressed in the inflammatory process of the choroid with changing the color of the iris, which takes rusty, and conjunctivitis. In severe forms of meningococcemia observed pronounced symptoms of General intoxication and severe conditions, sometimes with meningeal symptoms, but no inflammation of the meninges. The temperature rises to high numbers, there is repeated vomiting and General concern. Hemorrhagic rash, reaching the big sizes, can cause necrosis of the skin and even the subcutaneous tissue. It is often located on the buttocks, external surfaces of the thighs and shins, very rarely on the face. The outcome of the affection of joints always favorable, despite the intensity of the process. Even purulent exudate in the joints dissipates, leaving behind any consequences. Eye damage, expressed in ovate or horioidit, leads to loss of vision.
When the most severe form of meningococcal infection occurring in the form of meningococcal septicemia, dominated by the common symptoms of severe intoxication with severe cerebral phenomena. Death in these cases, it may occur within a few hours. Meningeal symptoms are very mild or completely absent. The disease begins suddenly with fever, high temperature, seizures, vomiting, rapid loss of consciousness and extremely grave General condition. A characteristic feature is the rapid emergence of a widespread rash that consists of smaller and more" large hemorrhages in the skin, sometimes merged into extensive bleeding. At the same time there is a disorder of the heart's activity and peripheral blood circulation. Heart sounds become deaf, a faint flicker of pulse, a significant cyanosis, a fall in blood pressure, sometimes cold sweat. Often in such gipertoniceski forms of meningitis occurs bleeding into the adrenal glands, which may lead to significant destructive changes in them, followed by a rapid drop in blood pressure and collapse. Such bleeding into the adrenal glands may be the proximate cause of death.
Before applying modern methods of treatment gipertoniceski form of meningitis always ended fatally. Only in recent years sooner applied treatment in some cases leads to a favorable outcome.