Meningococcal infection
Meningococcal infection is an acute infectious disease characterized by lesions of the nasopharyngeal mucosa, inflammation of the soft meninges, meningococcemia.
ETIOLOGY
Bacterial meningitis is caused by the gram-negative rod Neisseria meningitis in the form of coffee beans, there are 20 serotypes. Neyseria is not stable in the external environment. The incidence is seasonal – winter-spring time. Infection occurs indoors from a sick person or a bacterial carrier at a distance of no more than 0.5 meters. The mechanism is aerosol, the transmission path is airborne. The incubation period is from 2 to 10 days. After recovery, a long-term stable immunity develops. Bacterial carriers have a natural reservoir – the nasopharynx.
CLASSIFICATION OF MENINGOCOCCAL INFECTION
Localized – bacterial carrier, nasopharyngitis
Generalized – Meningitis, meningococcemia, meningoencephaly
symptoms
With bacterial carrier, the patient has no symptoms and develops long-term immunity.
Acute nasopharyngitis develops acutely with a sore throat, throat, accompanied by a cough. Nasal congestion, runny nose with mucopurulent discharge. Symptoms of general intoxication develop – headache, fever, pallor, hyperemia, tachycardia. Recovery occurs after 1-2 weeks. This form of meningococcal infection may be confused with acute respiratory illness. Nevertheless, another infected person can get over more dangerous forms.
Meningitis also begins acutely, with febrile fever. It is accompanied by a headache that is not stopped by analgesics, in young children a “brain cry” is characteristic. Vomiting occurs without nausea and does not bring relief (origin from the central nervous system). Severe weakness, dizziness develops, then lethargy and impaired consciousness, photophobia, tactile hypersthesia, muscle cramps. Then a rash appears on the upper and lower extremities, the trunk. The rash is hemorrhagic, “stellate”. The patient takes a forced pose – “cocked trigger” – the legs are brought to the stomach, the head is thrown back. In children, a large fontanel bulges out, a symptom of “hanging”. The muscles are tense, rigid – the patient cannot nod his head. Kernig’s symptom is positive – the inability to straighten the leg in the knee joint, having previously bent it in the hip joint. The upper symptom of Brudzinsky is positive. (the patient bends his legs and pulls his legs up to his stomach when trying to bend his head to his chest).
Meningococcemia – begins acutely with chills with the development of febrile and hyperpyretic fever. There is shortness of breath, tachycardia, hypotension, collapse. Bleeding – nasal, gastric, renal, affected joints. After a few hours, exanthema develops, hemorrhagic rash with necrosis. Meningeal symptoms, oliguria, anuria develop. Fatal outcome – after 6-48 hours. Upon recovery, keloid scars form at the site of necrosis.
COMPLICATIONS
OF ITSH
Syndrome of acute edema and swelling of the brain
Acute renal failure
Hydrocephalus
Paresis of the facial nerve
Strabismus
Blindness
Arthritis
Pericarditis
LABORATORY DIAGNOSTICS
Bacterial method – on an empty stomach or 2 hours after eating – nasopharyngeal smear, sowing
Microscopic method – taking cerebrospinal fluid for analysis
Serological method – ELISA, RPG
treatment
The patient is hospitalized in the position in which he lies himself. A mask mode is assigned. Etiotropic therapy – taking antibiotics 5 times more than the standard therapeutic dose (Penicillin – 200000-500000 units per day, I / m, IV). Before the cancellation of antibiotics, a second lumbar puncture is performed. A high-protein diet of up to 150 grams per day is prescribed. Along with antibiotics, diuretics (Lasix), hypnotics, sedatives (Relanium), anticonvulsants are prescribed, in severe cases – glucocorticosteroids.
Patients are discharged after 2 negative smears from the nasopharynx 3 days after the withdrawal of penicillin.
