Purulent meningitis

The etiology and pathogenesis. Purulent meningitis are common etiological form, as various pathogenic agents can cause suppurative process in mild cerebral membranes. Only meningococcal meningitis can be classified as primary purulent to meningitis, other purulent Meters belong to the secondary. The most common cause of purulent Meters are pneumococci, streptococci, staphylococci, different strains of E. coli. Recently described purulent M, caused by Candida albicans, Salmonella-meningitis. There are purulent M: 1) traumatic; 2) extending the contact by and 3) metastatic or hematogenous.
Traumatic meningitis occurs in fractures of the skull base, cracked bones of the code. Infection soft meninges may be coming from the nose, of the main sinus or ear canal. This purulent M may be early or late, sometimes may occur several years after the injury. According to the materials of the great Patriotic war M. developed, starting from the second day after the injury, usually after three days later. Purulent meningitis with open non-penetrating wounds develops due to infection by wounds of soft tissues of the skull or the development of osteoblastov. With traumatic M pus is localized in soft shells and partly on the inner surface of the hard shell, mainly on the convex surface of the cerebral hemispheres and is usually on the side of the wounded.
When meningitis, spreading contact way (transition of a purulent process with neighbouring regions on Pia mater), microorganisms correspond to those found mainly purulent lesion. First place in terms of frequency occupy otogenny meningitis who join chronic purulent inflammation of the middle ear (see below). Then follow M, developing as a result of sepsis in paranasal cavities nose spreads via bones in Dura, then Pia mater through venous anastomoses and lymphatic vessels.
Purulent M may also arise due to purulent processes in the skin and scalp. In children purulent Feet, may develop during tonsillar suppurations (tonsillar abscess) or retropharyngeal abscess.
Metastatic purulent meningitis occur in the presence in the body of purulent by generalization of the process by blood or lymph flow; purulent M. this is called septic or embolus is one of the manifestations of sepsis.
Metastatic M can occur with or purulent inflammatory processes in the lungs, abscesses of other bodies, erysipelas in any part of the body, septic endocarditis. Children are more common metastatic forms M.
Separate forms of purulent meningitis.
Pneumococcal meningitis is the most frequent form of purulent meningitis, usually occurs as a complication of a disease caused by pneumococcus in children is most often after pneumonia. It occurs more often in children than in adults; for children of younger age (up to 6 years) in half of the cases of pneumococcal M are observed in the age of 6 months. Cerebrospinal fluid usually purulent, polinucleari cover the whole field of view, in smears of liquid detected pneumococci. The disease was previously thought to be deadly, at present mortality decreased dramatically.
Streptococcal M almost always purulent nature; occurs secondary metastatic by at Roger, septic endocarditis. Runs very hard. Staphylococcal M usually autogennaja and traumatic origin. can also occur as a consequence of staphylococcal pneumonia or a staphylococcal sepsis. Gonococcal M. occurs metstaticski, the infection penetrates into the Pia mater hematogenous route, can spread and lymphogenous by, for example when gonorrheal conjunctivitis and blepharitis. This form of purulent meningitis is uncommon, in advanced cases of gonorrhea. Beginning of the disease is acute, in the spinal fluid pleoticus comes to 4000, found gonorrhea. Pseudomonas M currently meets more often. One reason for this increase is considered widespread use of antibiotics, resulting disappear unstable bacteria survive and sustainable types, including Pseudomonas aeruginosa (X. X. Planelles). Proceeds hardly, in the spinal fluid great Placitas - up to 10 000. Forecast serious, there are some cases of recovery. Purulent M. observed in the flu (mostly adults), is an independent form of purulent M (Doctor S. Footer, B. N. Mogilnitsky). According to rivers (I.e. Rivers), this form M is more common in October-December, in contrast to pneumococcal meningitis, which is observed in most cases, in March - April. Occurs M flu metstaticski, hematogenous route. Exciter (wand of Pfeifer-Afanasyeva) is found in blood and cerebrospinal fluid.