Meningococcal Infection

Meningococcal Infection is an infectious disease caused by meningococcus. Meningococcus is gram-negative, immobile, does not form a spore, is not resistant to external influences. Direct sunlight, temperature below 22 ° C, drying lead to rapid death of the microbe. Boiling kills him instantly. The source of the causative agent of infection is a sick person or bacteriovirus. The most dangerous in the epidemic relation is a patient with meningococcal nasopharyngitis. The causative agent of the infection is transmitted by airborne droplets with mucus droplets when coughing, sneezing, talking. Infection is facilitated by crowding people, close contact between them. The duration of meningokokokositelstva usually does not exceed 2 to 3 weeks, sometimes lasts up to 6 weeks or more, especially in the presence of chronic inflammation of the nasopharynx. The morbidity is subject to seasonal fluctuations: in countries of temperate climate, the annual incidence of morbidity begins in November-December and reaches a maximum in March-May. Children are more often ill.

The 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 , sensation of perspiration and sore throat, nasal congestion, runny nose with lean mucopurulent discharge, dry cough . The posterior wall of the pharynx is hyperemic, edematic, often with mucus overlay, lymphoid follicles hyperplastic. There are injections of vessels of sclera and hyperemia conjunctiva. In severe cases, dizziness, sometimes vomiting , vegetative-vascular dystonia. Body temperature rises to 37.5 - 38 ° C, in more severe cases and higher, it can sometimes remain normal. The duration of the fever, as a rule, is 2 - 3 days. At the same time, the symptoms of nasopharyngitis subsided. In some cases, 2-3 days after the onset of the disease, meningococcemia or meningitis develops.

Meningococcemia is characterized by a violent onset. Within several hours the temperature reaches 39 - 41 ° C, its rise is accompanied by chills, pains in the muscles and joints, headache. The skin is pale, dry, the tongue is covered with plaque. The most characteristic symptom is hemorrhagic rash, which appears on the first day of the disease, sometimes in a few hours, less often - in a day. Elements of the rash have an irregular, often stellate shape, 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 parts of the extremities, with severe forms of the disease spreads to the face and trunk. Often, hemorrhagic rash is combined with rose-ooleiform or rose-leafy-papular. Occasionally, uveitis is noted, usually unilateral; In some cases, possible inflammation of the choroid of the eyeball, the development of meningococcal myocarditis, endocarditis and pericarditis. A part of patients with meningococcemia have arthritis and polyarthritis.

The leading sign in the clinical picture of an extremely severe lightning-fast form of meningococcemia is an infectious-toxic shock .

Meningococcal meningitis usually begins with acute chill, raising the temperature to 38 - 40 ° C. The general condition deteriorates sharply. A few hours later or on the second day, a headache of unusual intensity, nausea , vomiting appears and rapidly progresses. Meningeal symptoms - rigidity of the occipital muscles, symptoms of Kernig, Brudzinsky, etc. appear by the end of the day. In the elderly, the onset of the disease may be less acute, the temperature of the sub-

The meningeal symptoms appear on the 3rd-4th day. Disturbance of consciousness and mental disorders (excitement, delirium , hallucinations , inhibition, adynamia, sopor and coma) occur on the 2nd -4th day of the disease. On the 3rd -4th day of the disease, a herpetic infection is often associated: rashes can be abundant and of different localization. Their appearance is accompanied by a new increase in temperature and a worsening of the general condition. With lumbar puncture, the cerebrospinal fluid flows under increased pressure, turbid. Cytosis - 1000 - 15 000 leukocytes and more in 1 μl of liquid, neutrophils prevail in the cytogram, protein - 0,66-16% 0. In some cases, bacterioscopy of the cerebrospinal fluid shows pathogens located in neutrophils.

Meningococcal meningitis in infants has a number of peculiarities: it usually occurs with mild or no meningeal syndrome on the background of general toxic symptoms. Swelling and tension of the large fontanel, general hyperesthesia can be noted.

Diagnosis is established based on the clinical picture, the epidemiological history and the results of laboratory studies. Bacteriological examination of cerebrospinal fluid, blood, mucus from the nasopharynx is carried out.

In the blood, high leukocytosis (20,000 - 40,000 in 1 μl) is observed in the blood, neutrophilic shift to young forms, and sometimes to myelocytes, aneosinophilia, an increase in ESR.

Treatment. When nasopharyngitis is shown, rinsing of the nasopharynx with warm solutions of boric acid (2%), furacilin (0.02%), potassium permanganate (0.05-0.1%). In cases of severe fever and intoxication, levomycetin (2 g per day for 5 days), sulfonamides or rifampicin (0.9 g for 5 days) is prescribed.

Generalized forms require emergency hospitalization. Antibiotics, hormonal drugs are used, enough fluids, polyionic solutions (quartrel, trisol), blood-substituting fluids (rheopolyglucin, gemodez) are introduced to fight against toxicosis. At the same time, dehydration is carried out using diuretics (lasix, furosemide, diacarb). Vitaminotherapy is mandatory. According to the indications, cardiovascular drugs are used.

The prognosis with timely and correct treatment is favorable in most cases. However, in generalized forms with severe course, lethal 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 causative agent of the infection (patient or meningokokkoskositelja). In the focus, early detection of meningococcus carriers and patients with nasopharyngitis (especially in preschool institutions, schools, vocational schools, boarding schools) should be done by the method of examination and bacteriological examination for the carriage of meningococcus. Identified patients are isolated in the hospital or at home and admitted to the team after a double negative result of bacteriological examination.

In children's collectives, convalescents are allowed after a single negative result of 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 in contact with the patient, medical supervision is established for 10 days with daily thermometry and examination of the nasopharynx. From families where the disease occurred, children are not admitted to children's groups until a negative result of bacteriological research is obtained.

Measures to prevent the transmission of pathogens are important - reducing the density of children (placement of beds in children's institutions at a distance of not less than 1 m), the use of additional rooms for the bedrooms, and the prolonged stay of children and adolescents in the air. For outbreaks of infection, it is recommended that wet cleaning with disinfectant solutions in the premises, current and final disinfection. Persons caring for patients should wear gauze masks.

A pronounced prophylactic effect was established when administering to children who were in contact with patients with meningococcal infection, gamma globulin in a dose of 3 ml, preferably as soon as possible, but not later than the 7th day after isolation of the patient.

According to epidemiological indications, vaccination is carried out.