Meningococcal infection - an infectious disease caused by meningococcus. Meningococcus is gram-negative, motionless, does not form a dispute, is not very resistant to external influences. Direct sunlight, temperatures below 22 ° C, drying out lead to rapid death of the microbe. Boiling kills him instantly. The source of the causative agent of the infection is a sick person or a bacterial excretory. The most dangerous epidemic patient with meningococcal nasopharyngitis. The causative agent of the infection is transmitted by airborne droplets with droplets of mucus when coughing, sneezing, talking. Crowding of people, close contact between them contribute to infection. The duration of meningococcal congestion 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 incidence is subject to seasonal variations: in temperate countries, the annual rise in incidence begins in November - December and reaches a maximum in March -May. Children are sick more often.
The clinical picture . The incubation period lasts 3 to 7 days.
Acute nasopharyngitis is the most common form of the disease. The main symptoms of this form are headache , sore feeling and sore throat, nasal congestion, runny nose with scanty mucopurulent discharge, dry cough . The back wall of the pharynx is hyperemic, edematous, often with mucus, the lymphoid follicles are hyperplastic. Vascular injection of sclera and conjunctival hyperemia are noted. In severe cases, dizziness , sometimes vomiting , and vegetative-vascular dystonia are observed. Body temperature rises to 37.5 - 38 ° C, in more severe cases and higher, sometimes it can remain normal. The duration of a fever is usually 2 to 3 days. At the same time, the phenomena of nasopharyngitis subside. In some cases, after 2-3 days from the onset of the disease, meningococcemia or meningitis develops.
Meningococcemia is characterized by a rapid onset. Within a few hours, the temperature reaches 39 - 41 ° C, its rise is accompanied by chills, pain in the muscles and joints, headache. The skin is pale, dry, tongue coated with plaque. 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 cases of the disease). Large elements are denser 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 spreads to the face and trunk. Often, a hemorrhagic rash is combined with roseola or roseola-papular. Uveitis is sometimes noted, usually unilateral; in some cases, inflammation of the choroid of the eyeball, the development of meningococcal myocarditis, endocarditis and pericarditis are possible. Some patients with meningococcemia have arthritis and polyarthritis.
The leading sign in the clinical picture of an extremely severe fulminant form of meningococcemia is an infectious toxic shock .
Meningococcal meningitis usually begins acutely with moderate chills, a rise in temperature to 38 - 40 ° C. General condition deteriorates sharply. After a few hours or on the 2nd day, a headache of unusual intensity, nausea , vomiting appears and progresses rapidly. Meningeal symptoms - stiff neck, symptoms of Kernig, Brudzinsky and others appear by the end of the day. In the elderly, the onset of the disease may be less acute, the temperature of subfeb-
rila, meningeal symptoms appear on the 3-4th day. Consciousness disorder and mental disorders (agitation, delirium , hallucinations , lethargy, adynamia, stupor and coma) occur on the 2nd – 4th day of illness. On the 3-4th day of the disease, a herpetic infection often joins: rashes can be plentiful and of various localization. Their appearance is accompanied by a new increase in temperature and a deterioration in the general condition. With lumbar puncture, cerebrospinal fluid flows under high pressure, cloudy. Cytosis - 1000 - 15 000 leukocytes and more in 1 μl of liquid, neutrophils predominate in the cytogram, protein - 0.66-16% 0. In some cases, bacterioscopy of cerebrospinal fluid shows pathogens located in neutrophils.
Meningococcal meningitis in infants has a number of features: it usually occurs with mild or complete absence of meningeal syndrome against the background of general toxic symptoms. Bulging and tension of the large fontanel, general hyperesthesia may be noted.
The diagnosis is established on the basis of the clinical picture, data of an epidemiological history and the results of laboratory tests. A bacteriological study of cerebrospinal fluid, blood, mucus from the nasopharynx is carried out.
High leukocytosis (20,000 - 40,000 in 1 μl), a neutrophilic shift to young forms, and sometimes to myelocytes, aneosinophilia, and an increase in ESR are noted in the blood of patients.
Treatment . With nasopharyngitis, rinsing of the nasopharynx is shown with warm solutions of boric acid (2%), furatsilina (0.02%), potassium permanganate (0.05-0.1%). In cases of severe fever and intoxication, chloramphenicol (2 g per day for 5 days), sulfonamides or rifampicin (0.9 g for 5 days) are prescribed.
With generalized forms, emergency hospitalization is necessary. Antibiotics, hormonal drugs are used, a sufficient amount of liquid, polyionic solutions (quartasol, trisol), blood-replacing fluids (reopoliglyukin, hemodesis) are administered to combat toxicosis. At the same time, dehydration is carried out using diuretics (lasix, furosemide, diacarb). Mandatory vitamin therapy. According to indications, cardiovascular agents are used.
The prognosis for timely and proper treatment in most cases is favorable. However, with generalized forms with a severe course, deaths are not uncommon, especially in children of the first years of life.
Prevention The main preventive measures are the identification and treatment of the source of the pathogen (patient or meningococcus). In the outbreak, early detection of meningococcus and patients with nasopharyngitis (especially in kindergartens, schools, vocational schools, boarding schools) is necessary by examination and bacteriological examination for carriage of meningococcus. Identified patients are isolated in a hospital or at home and admitted to teams after a double negative result of bacteriological examination.
Convalescents are allowed in children's groups after a single negative result of a bacteriological examination conducted no earlier than 10 days after discharge from the hospital.
Members of the family or children's team where the patient is identified, and other persons who have contacted the patient, are under medical supervision for 10 days with daily thermometry and an examination of the nasopharynx. From families where the disease arose, children are not allowed in children's groups until a negative bacteriological test is obtained.
Measures to prevent the transmission of pathogens are important - reducing the density of children (beds in child care facilities at a distance of at least 1 m), the use of additional rooms for bedrooms, and prolonged exposure of children and adolescents to the air. In case of outbreaks of infection, it is recommended to carry out 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 3 ml of gamma globulin was administered to children who were in contact with patients with meningococcal infection, preferably as early as possible, but no later than the 7th day after isolation of the patient.
According to epidemiological indications, vaccination is carried out.