Epidemic cerebrospinal meningitis

Epidemic cerebrospinal meningitis - primary purulent inflammation of the soft brain membranes caused by meningococci of Weichselbaum. The disease can occur at any age, but mainly affects children. Meningococcal disease is on the mucous lining of the nasopharynx. In cases of meningitis almost always possible to find the meningococcus in the discharge of the nasopharynx within 3 weeks from the onset of the disease. A healthy person can also be a carrier of meningococcus in 2-3 weeks. The disease is transmitted by airborne droplets when talking, sneezing, coughing, kissing, and through dirty hands, linen, dishes, contaminated with secretions from the nose or saliva of the patient. The incubation period is usually from 1 to 4 days. From the nasopharynx meningococcal disease enters the bloodstream and from there through the blood-brain barrier into the cerebrospinal fluid and brain shell. In the period of circulation of meningococcus in the blood can develop septicaemia affecting the skin, joints, and eyes. Clinical symptoms of meningitis may not be.
Postmortem noted purulent inflammation of the soft meninges of the brain and spinal cord, the presence of purulent exudate on the surface and the base of the brain. In the process can involve the ventricles and the substance of the brain.
The clinical picture. The beginning of the sharp, rapid temperature increase up to 39-40°, sudden headache, repeated vomiting. It is often stated cold sores on the lips and around the ears, poor petechial rash on the legs and torso. Appear stiff neck, symptoms of Cernica and Brudzinskogo, hyperesthesia of the skin (see Sensitivity), pathologic reflexes. Patients are often excited, do not sleep at night, in severe cases, the mind is obscured or missing. Sometimes the symptoms of focal lesions of the Central nervous system. The pulse is usually much Ochsen, blood marked leukocytosis and left shift.
Critical to the diagnosis of epidemic meningitis have a data analysis of the cerebrospinal fluid (see), which in the first days of the disease becomes cloudy and acquires then purulent. The number of cells in the fluid sharply increased - from several hundreds to several thousands, sometimes tens of thousands of 1 mm3, where the vast majority of cells are neutrophils. The amount of protein also significantly increased - from 0.06 to 1,32 degrees per 0(). Globulin reaction strongly positive. The pressure of the cerebrospinal fluid sharply increased up to 400 mm of water. tbsp. sugar and chlorides is reduced. Bakteriostaticeski detected located intracellular gram-positive meningococci.
In the first days of the disease clinical symptoms usually grow, grow changes in the spinal fluid. Earlier in the absence of specific treatment of the disease has gained a protracted course, leading to a variety of complications and death.
At present timely initiation of therapy with penicillin and sulfa drugs, the disease usually ends with the recovery of the sick in 2-3 weeks.
Apart from the typical forms of cerebrospinal meningitis meet atypical: gipertoniceski and erased form. Gipertoniceski form differs stormy start, the rapid development of a coma with symptoms of edema and swelling of the brain or the syndrome of acute adrenal insufficiency. Erased form appears only by common cold. In recent years there are isolated skin manifestations.
In diagnostically complex cases (especially if you erased forms) the problem is solved after examination of the cerebrospinal fluid.
The forecast. Before the implementation in practice of treatment of sulfanilamidami and antibiotics forecast was always serious. We observed different complications: paralysis of cranial nerves, deafness, spastic paralysis of the extremities, the children hydrocephalus. Mortality ranged from 20%to 80%. Currently, when started early and properly administered treatment in most cases of meningococcal meningitis sick get well.
Diagnosis in typical cases of cerebrospinal meningitis is not difficult. Should be differentiated from tuberculous meningitis, secondary purulent meningitis, syphilitic meningitis, acute serous meningitis.
Treatment of spinal meningitis should start as early as possible with massive doses of penicillin intramuscularly and sulpha drugs inside. If necessary (in severe Cases) penicillin administered endolyumbalnoe.
Intramuscular penicillin administered dose of less than 200-400 thousand for 1 kg of weight per day, while large doses sulfadimezina. Such treatment pretty quickly there will be a noticeable improvement. In addition to the specific antibacterial therapy, symptomatic treatment. Upon the occurrence of heart failure administered epinephrine, strofantin, give oxygen. At occurrence of seizures designate 1% solution of chloral hydrate in enemas (from 20 to 50 ml depending on the age). To reduce swelling of the brain and reducing the pressure of the cerebrospinal fluid is injected hypertensive solutions: 40% solution of glucose in 10-20 ml; 10% solution of chloride calcium in 10 ml of 40% solution of hexamethylenetetramine (urotropine) to 10 ml; intramuscularly - 25% solution of magnesium sulfate adults id ml, and children in a dose of 1 ml per year, but not more than 7 ml is also Used diuretics (novoryt, lasix and others).
If a timely diagnosis and early treatment is ensured quick and full recovery.
Prevention. The primary means of prevention is compulsory hospitalization of patients and thorough disinfection of disease foci. You must also identify baillonella, compulsory treatment and removal from service teams.