Meningococcal infection

Meningococcal infection - caused by meningococcal disease, occurring in the form of acute nasopharyngitis, purulent meningitis and meningococcemia. Relate to airborne anthroponoses. A healthy carrier of meningococci is widespread.

Etiology, pathogenesis. Meningococcus - pairwise arranged gram-negative spherical formations; In the cerebroslinal fluid are localized intracellularly and have the form of coffee beans. In the environment quickly die. There are various serotypes of pathogens (A, B., etc.). Sensitive to penicillin, lavomycetin, tetracyclines. The gate of infection is the mucosa of the upper respiratory tract. In most cases, the presence of meningococci on the mucous membrane does not lead to the development of the disease (carriage). Some infected develop a picture of acute nasopharyngitis, and only in some individuals meningococcus enters the blood, hematogenously affecting various organs and systems (meningococcemia). Sometimes the changes are localized mainly in the meninges (cerebrospinal meningitis). Infectious-toxic shock can develop.

Symptoms, course. The incubation period lasts from 2 to 10 days (usually 4-6 days). Acute nasopharyngitis may be a prodromatic stage of purulent meningitis or an independent form of meningococcal infection. It is characterized by subfebrile body temperature, mild symptoms of intoxication (headache, weakness) and rhinopharyngitis. Meningococcal sepsis (meningococcemia) begins suddenly and proceeds violently. There is a chill and severe headache, the body temperature rises rapidly to 40 ° C and above 5 to 15 hours after the onset of the disease, a hemorrhagic rash appears.The elements of the rash may appear as irregularly shaped stars, along with which there may be petite petechiae and large Hemorrhages up to 2-4 cm in diameter.The latter are often combined with necrosis of skin areas, fingertips.The simultaneous hemorrhages may cause roseola and papular elements of the rash.Minigitis symptoms with this form are absent.Can development of arthritis, pneumonia, endocarditis.With hyperacute meningococcal sepsis A tremendous chill, an increase in body temperature to 40-41 "C in a few hours followed by the appearance of a profuse hemorrhagic rash with necrotic elements and a simultaneous drop in temperature to normal; BP decreases, tachycardia appears, shortness of breath, on the skin - large bluish spots reminiscent of cadaveric. Motor excitation, convulsions are replaced by coma. Meningococcemia is often combined with meningococcal meningitis.

Meningococcal meningitis also begins acutely. Only in individual patients for 1-5 days symptoms of nasopharyngitis are noted. The disease begins with chills, fever, excitement, motor anxiety, early there is a severe headache, vomiting without previous nausea, general hyperesthesia. By the end of the first day of the disease, meningeal symptoms (stiff neck, symptoms of Kernig-Brudzinsky) arise and grow. There may be delusions, blackouts, convulsions, tremors. Tendon reflexes are animated, pathological reflexes are sometimes noted (Babinsky, Rossolimo). In some patients, cranial nerves are affected (more often, visual, auditory, or abnormal). Half of patients on the 2nd-5th day of the disease have a profuse herpetic rash. In the blood - neutrophilic leukocytosis (up to 16-25 -10 (the ninth degree)), ESR is increased. Cerebrospinal fluid flows under increased pressure; At the beginning of the disease it opalescent, then becomes turbid, purulent (cytosis up to 10 â € "1000 in 1 μl). Against the background of meningitis, there may be encephalitic symptoms (nystagmus, mono- and hemiplegia, cerebellar symptoms, epilotipiform seizures).

Complications: infectious-toxic shock, acute adrenal insufficiency, swelling and swelling of the brain, leading to brain wilting. Differentiate necessary from other purulent meningitis. Proof of the disease is the allocation of meningococcus from cerebrospinal fluid or blood.

Treatment. The early-onset intensive penicillin therapy is most effective. Benzylpenicillin is prescribed immediately after diagnosis or if there is a suspicion of meningococcal meningitis. The drug is administered at a rate of 200,000 U / (kg-day). The minimum dose of penicillin for children under the age of 3 months is 1 200 000 units / day; From 4 to 6 months - 1 500 000 units / day; 7-11 months-2,000,000 units / day; 1-2 years - 2400 000 units / day; Z years-2 800 000 units / day; 4 years-3 200 000 units / day; 5-7 years-4,000,000 units / day, 8-10 years-6,000,000 units / day; 11-15 years - 9 000 000 units / day; For adults - 12 000 000 units / day. Intervals between penicillin administration should not exceed 4 h. Penicillin is administered intramuscularly. The dose of penicillin during treatment can not be reduced. The duration of antibiotic therapy is 5-8 days. Indication kot-me penicillin is the reduction of cytosis in the cerebrospinal fluid of the lower 100-150 cells in 1 μl. Semisynthetic penicillins (ampicillin, methicillin) are also effective, and they are administered at a dose of 200-300 mg / kg / day. If penicillin intolerances are prescribed, Levomi-Cetinum sodium succinate in a dose of 50-100 mg / (kg-day) in / m. With the development of seizures, phenobarbital, chloral hydrate in enemas are shown.

The prognosis for early and adequate treatment is favorable. In severe cases and untimely started treatment, lethal outcomes are possible. Reconvalvesent should be under the supervision of a local doctor and a district psychoneurologist for at least 2-3 years and should be inspected once every 3-6 months.

Prevention. Identification and isolation of patients. In the hospital, current disinfection is carried out. Final disinfection and chemoprophylaxis in the outbreaks are not carried out.