Secondary purulent meningitis

Secondary purulent meningitis occur when the penetration of pathogens of any suppurative focus in meninges contact way (when the pathogen enters the Central nervous system from neighbouring purulent) and metastatic by (with the introduction of infection through the bloodstream or lymphatic system from a remote distance from meninges purulent focus or when the total infection of the body). Secondary purulent meningitis more likely to occur when purulent inflammation of the ear (otogenny purulent meningitis), and the children - and in inflammatory lesions in paranasal cavities of the nose (rhinogenic meningitis). In children, moreover, often developed pneumococcal meningitis as a complication of pneumonia. It is especially meningitis caused by Pseudomonas aeruginosa.
The clinical picture. The disease develops suddenly, sharply. Often there is rapid development of symptoms, a sharp rise of temperature up to 40 degrees, accompanied by chills. Appear severe headaches, vomiting, meningeal symptoms. There is a General hyperesthesia, sharply increased sensitivity to sound, visual and olfactory stimuli. The temperature is constant or remitting nature. The pulse is weak filling, often irregular. Breathing quickens. Patients become restless, irritable, consciousness can sometimes be oppressed; often delusions, hallucinations, agitation. In severe cases, there comes a coma. Can be epileptiform convulsions. In children, in addition to seizures, can develop paralysis of the limbs and marvel at the cranial nerves.
Changes in the spinal fluid is expressed very sharply. The turbid liquid, purulent, very dense and so with a puncture can flow out slowly, despite increased pressure. The number of cells in the cerebrospinal fluid can be so considerable that is beyond calculation. Dominated by neutrophils. The amount of protein sharply increased (up to 3% respectively). The content of sugar and chlorides reduced. In the blood was great leukocytosis with a significant shift to the left, ROE accelerated. Before applying modern methods of treatment for purulent meningitis was very fast, sometimes fast and death occurred within the first 2-3 days. Secondary purulent meningitis was considered certainly fatal disease. Currently, the course and prognosis of purulent meningitis has changed dramatically.
Treatment. Purulent meningitis autogennaja origin treated surgically and the conservative: it is necessary to eliminate the painful centre in the ear and active drug therapy. First of all you should remove the source of infection, septic processes in the ear, in paranasal cavities, the bones of the skull needs an urgent surgery. Essential started early and in large doses used antibiotics and sulfa drugs (see above treatment cerebrospinal meningococcal meningitis). When resistance to penicillin and streptomycin apply chloramphenicol and tetracycline in doses twice the normal therapeutic. As with meningitis caused by Bacillus Afanasyeva - Pfeifer, penicillin does not have a favorable impact, apply streptomycin and chloramphenicol in combination with sulfa drugs.
When Pseudomonas meningitis, it is recommended comprehensive treatment streptomycin (endolyumbalno - potassium chloride complex streptomycin once a day) with terramycin and biomitsin inside and vitamins b and C in large quantities. In all forms of purulent meningitis, it is recommended the appointment of dehydration (solution of magnesium sulfate, novoryt and others) and restorative means.