Meningococcal infection - an infectious disease caused by meningococcus. Meningococcus is gram-negative, immobile, does not form a spore, is little resistant to external influences. Direct sunlight, temperatures below 22 ° C, drying lead to the rapid death of the microbe. Boiling kills him instantly. The source of the causative agent of infection is a sick person or a bacteria excreta. The most dangerous epidemic patient with meningococcal nasopharyngitis. The causative agent of infection is transmitted by airborne droplets with mucus when coughing, sneezing, talking. Infection is promoted by crowding of people, close contact between them. The duration of meningococcus formation usually does not exceed 2–3 weeks, sometimes it lasts up to 6 weeks or more, especially in the presence of chronic inflammation of the nasopharynx. The incidence is subject to seasonal fluctuations: in temperate countries, the annual rise in incidence begins in November-December and reaches a maximum in March — May. Children are ill more often.
Clinical picture . The incubation period lasts 3 - 7 days.
Acute nasopharyngitis is the most common form of the disease. The main symptoms of this form are headache , tickling and sore throat, nasal congestion, runny nose with scanty mucopurulent discharge, dry cough . The back wall of the pharynx is hyperemic, edematous, often with the imposition of mucus, lymphoid follicles are hyperplastic. Injection of vascular sclera and conjunctival hyperemia are noted. In severe cases, dizziness , sometimes vomiting , vegetative-vascular dystonia. Body temperature rises to 37.5 - 38 ° C, in more severe cases and higher, sometimes it can remain normal. The duration of the fever is usually 2 - 3 days. At the same time nasopharyngitis subsides. In some cases, meningococcemia or meningitis develops after 2-3 days from the onset of the disease.
Meningococcemia is characterized by a violent onset. Within a few hours, the temperature reaches 39 - 41 ° C, its rise is accompanied by chills, pain in muscles and joints, and headache. The skin is pale, dry, tongue lined with bloom. The most characteristic symptom is a hemorrhagic rash, which appears on the first day of the disease, sometimes after a few hours, less often after a day. Elements of the rash are irregular, often star-shaped, of various sizes (from small petechiae to large hemorrhages in severe disease). Large elements are dense to the touch and slightly rise above the surface of the skin. The rash is localized mainly in the distal extremities, with severe forms of the disease spread to the face and torso. Often hemorrhagic rash is combined with roseolous or roseolous-papular. Occasional uveitis, usually unilateral; in some cases, inflammation of the choroid of the eyeball, the development of meningococcal myocarditis, endocarditis and pericarditis are possible. In some patients with meningococcemia, arthritis and polyarthritis are observed.
The leading sign in the clinical picture of an extremely severe fulminant form of meningococcemia is infectious-toxic shock .
Meningococcal meningitis usually begins acutely with moderate chills, the temperature rises to 38 - 40 ° C. General condition is deteriorating. After a few hours or on the 2nd day, a headache of unusual intensity, nausea , and vomiting appears and progresses rapidly. Meningeal symptoms - stiff neck, Kernig, Brudzinski and others symptoms appear by the end of the day. In the elderly, the onset of the disease may be less acute, the temperature of the subfeb-
Ryly, meningeal symptoms appear on the 3-4th day. Disorders of consciousness and mental disorders (agitation, delirium , hallucinations , lethargy, weakness, stupor and coma) occur on the 2nd — 4th day of the disease. On the 3rd — 4th day of the disease, a herpetic infection often joins: rashes can be abundant and of different localization. Their appearance is accompanied by a new rise in temperature and deterioration of the general condition. When lumbar puncture cerebrospinal fluid flows under increased pressure, turbid. Cytosis - 1000–15,000 leukocytes and more in 1 μl of fluid, neutrophils predominate in the cytogram, protein — 0.66–16% 0. In some cases, bacterioscopy of cerebrospinal fluid causes pathogens located in neutrophils.
Meningococcal meningitis in infants has a number of features: it usually occurs with a weak severity or complete absence of meningeal syndrome in the background of general toxic symptoms. The bulging and tension of a large fontanelle, general hyperesthesia can be noted.
The diagnosis is made on the basis of the clinical picture, data of the epidemiological history and results of laboratory studies. Carry out bacteriological examination of cerebrospinal fluid, blood, mucus from the nasopharynx.
Patients have high leukocytosis in the blood (20,000–40,000 in 1 μl), neutrophilic shift to young forms, and sometimes to myelocytes, aneosinophilia, and an increase in ESR.
Treatment . When nasopharyngitis shows rinsing of the nasopharynx with warm solutions of boric acid (2%), furatsilina (0.02%), potassium permanganate (0.05-0.1%). In cases of severe fever and intoxication, chloramphenicol is prescribed (2 g per day for 5 days), sulfonamides or rifampicin (0.9 g for 5 days).
For generalized forms, emergency hospitalization is necessary. Apply antibiotics, hormones, to combat toxicosis injected a sufficient amount of liquid, polyionic solutions (kvtasol, Trisol), blood-substituting liquids (reopoliglyukin, hemodez). At the same time carry out dehydration through the use of diuretics (lasix, furosemide, diakarba). Required vitamin therapy. According to the testimony used cardiovascular agents.
The prognosis for timely and proper treatment in most cases favorable. However, in case of generalized forms with a severe course, fatal outcomes are frequent, especially in children of the first years of life.
Prevention. The main preventive measures are the identification and treatment of the source of the infectious agent (patient or meningococcus). In the outbreak, early detection of meningococcus carriers and patients with nasopharyngitis (especially in preschool institutions, schools, vocational schools, boarding schools) by means of examination and bacteriological examination for meningococcus carriage is necessary. Identified patients are isolated in a hospital or at home and admitted to teams after a double negative result of bacteriological examination.
In children's teams, convalescents are allowed after a single negative bacteriological examination, conducted no earlier than 10 days after discharge from the hospital.
For members of the family or children's team, where the patient is identified, and other persons who have come into contact with the patient, medical observation is established for 10 days with daily thermometry and examination of the nasopharynx. From families where the disease originated, children are not allowed into children's groups until a negative result of bacteriological research is obtained.
It is important to prevent the transmission of pathogens — reducing the density of children’s accommodation (placing beds in child care facilities at least 1 m away), using additional rooms for bedrooms, and children and teenagers for a long time to be outdoors. In case of outbreaks of infection, it is recommended to carry out wet cleaning with disinfecting solutions in rooms, current and final disinfection. Caregivers should wear gauze masks.
A pronounced preventive effect was established when gamma globulin in a dose of 3 ml was administered to children who had been in contact with patients with meningococcal infection, preferably as soon as possible, but not later than the 7th day after isolating the patient.
According to epidemiological indications vaccination is carried out.