Transcript Meningeal syndrome

Meningococcal infection
(А 39)
Infectio meningococcica
Acute infection of respiratory tract,
which
is
caused
by
meningococcous
(Neisseria
meningitidis)
and
clinically
represents in the forms of
nasopharyngitis,
sepsis
or
meningitis
Etiology
Neisseria meningitidis
 Gramnegative diplococcus (0,6-1,0
mkm)
 Intracellular location in the blood smear,
combined in pairs, cofee-grains-like
 A, B, C, D, X, Y, Z serotypes of
infectious agents

Neisseria
meningitidis
The source of disease:
carriers (1 case per 2000 carriers)
 patients with meningococcal
nasopharyngitis
 patients with generalized forms of
infection
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Mechanism of transmission – air-drop
Seasonal occurrence – February-April
Most of the patients are children under 10
Morbidity is sporadic, sometimes epidemic
Immunity is type-specific, steady
Pathogenesis
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Entrance gate - upper respiratory routes
Local inflammatory process (nasopharyngitis)
Overcoming of a protective barrier (meningococcaemia)
Penetration of the agent through hematoencephalitic
barrier, irritation of receptors of soft cerebral membrane
of the brain and systems, forming cerebrospinal fluid
Hypersecretion of cerebrospinal fluid
Disorders of circulation of the blood in the brain vessels
and membranes, delay of resorbtion of cerebrospinal
fluid
Swelling-edema of the brain hyperirritation of the brain’s
membranes and radices of cerebrospinal nerves
Production of endotoxin, damage of endothelium of the
vessels (capillary toxicosis, hemorrhagic symptoms,
IDS, ITS)
Anatomic pathology changes
Classification:
I. Primarily localized forms:
- meningococcal carrier state;
- acute nasopharyngitis;
II. Hematogenic generalized forms:
- meningococcemia;
- meningitis;
- meningoencephalitis;
III. Mixed forms (meningococcemia+meningitis);
IV. Rare forms (endocarditis, arthritis, irideocyclitis,
pneumonia).
Complications: severe brain edema, infectious-toxic
shock
Rashes peculiarities:
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haemorrhagic;
localization on buttocks, thighs, shins, trunk;
a lot of elements;
different sizes of elements – from patechial to the spread
hemorrhages;
non correct form, often star-like;
different coloring and brightness of elements;
necrosis in place of considerable hemorrhages with
formation of defects;
often combination of hemorrhages with roseolla and
papules.
Haemorrhagic
scleritis in case
of
meningococce
mia
Typical position of patient
with meningococal infection
Symptom
Meningococal
meningitis
Second
festering
meningitis
Serous (viral) Toubercoulous
meningitis
meningitis
Beginning
Sudden
Acute
Acute, rarer
gradual
Gradual, rarer
subacute
Fever
High
High
High
Of Long Duration
It Is
Expressed
Severe at the
beginning of
illness
It is acute
expressed, attack
like in half of
patients
Rarely, gradually
becomes more
frequent
Grows gradually
Headache
Very severe
Vomits
Often, without
nausea
Often
Often, at the
beginning of
disease
Rigidity of
muscles of the
back of head
It Is Expressed
It Is
Expressed
Moderate
It Is
Expressed
Grows gradually,
It is expressed
expressed anymore
at the
than rigidity of
beginning of
muscles of the back
illness
Symptom
Kernic
It Is Expressed
Laboratory diagnostics
1. Revealing of infectious agent in smears
from pharynx, blood, liquor
- the material for stain should be taken without
touching of mucous membrane of cheeks and
tongue.
Microscopy: gram-negative diplococci with
intracellular localization
2. Serologic tests: in dynamic with interval 57 days
3. Express-diagnosis: immunofluorescent
method.
Liquor in case
of
meningococcal
meningitis
Treatment
Generalized forms:
- immediate hospitalization
- antibiotics in large doses (benzylpenicilline 200
000 – 500 000 U/kg, levomycetini succinatis)
- corticosteroids
- dehydratation therapy (in case of meningitis)
- desintoxication
- treatment of disseminated intravessel
coagulation (heparin, contrical, human plasma)
Sanation of meningococcus carriers:
- antibiotics in common doses (ampicillini,
levomycetini, rifampicini)
- local sanation (ultraviolet, ultrasonic)
- desensibilisation therapy
Antiepidemic measures against the source
of infection:
- revealing of patients with meningococcal
meningitis and sepsis and their hospitalization;
- patients with meningococcal nasopharyngitis
should be hospitalize in infectious hospital or
isolate at home;
- isolation of patients till their clinical
convalescence and negative bacteriological
investigation;
Ant epidemic measures
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contact persons should be observed
during 10 days with their thermometry
every day, skin and throat examination
and bacteriological test
persons with rash and inflammatory
changes in the throat should be isolated
and observed
in child's institutions apply 10-days
quarantine
sanation of carriers by antibiotics
(ampicillin, erythromycin) and discharging
after double bacteriological investigation.