Streptococcal meningitis - life-threatening condition. Meningitis in children and adults, symptoms and treatment of meningitis inflammation of cerebral shells after surgery

The date: 04.07.2020

Streptococcal meningitis is a frequent disease in breast and small children. Streptococcal infection of the group in treatless antibiotics, but information on the long-term consequences of this disease is very limited. Long term consequences are due to the rapid lesion of the brain in the development of infection, and even if the defeat is not detected immediately, it can manifest itself in the future.

A recently published study described 90 children. Five children from the group died in the acute stage of the disease. Five more - aged half a year to three years. From the remaining 43 people agreed to subsequent observation and surveys. It was discovered that 56% of children (24 of 43 participated in the study) are characterized by a normal level of development. In 25% there are disorders from weak to moderate, and in 19% - functional disorders were characterized as significant. Disturbances from small to temperate represented reduced performance in school, weakly pronounced neurological or functional disorders. Significant violations included blindness, hearing loss, paralysis and pronounced delays in development. The surveys included a physical inspection, a neurological assessment, broad audits of hearing and vision, as well as interviews with parents.

Vaccination against streptococcal infection of the group B had a significant impact on the prevalence of the disease and mortality caused to them. The authors of the study indicate that their data emphasizes the significance of the spread of vaccination, as well as require special follow-up to children who experienced streptococcal meningitis. Early identification of violations and correct work with them can further allow the child to adapt to school at school and overcome the possible remote consequences of meningitis.

Streptococcal meningitis - life threatening condition

Streptococcal meningitis - This is a disease in which the soft shells of the brain are affected. Streptococcal Meningitis Refers to secondary purulent meningitis, for which the pathogen is characterized: with blood flow (hematogenous), lymphs (lymphogenic), perioreural (in the course of nerves), contact (directly at contact with the focus of inflammation) into the space between cerebral shells, with possible penetration In the brain itself itself. Streptococcal Meningitis Arises against the background of various foci of infection caused by beta hemolytic streptococcus of various groups, including groups A and is distinguished by a rapid and severe course. Such foci of infection may be inflammation of the apparent sinuses of the nose, streptococcal lesions of the heart, the corrosive inflammation of various localities. Streptococcal Meningitis - is one of the most severe complications of the angina called beta hemolytic streptococcus group A. as a rule streptococcal Meningitis It develops due to a very launched thread of an angina, which has already complicated abscesses of various localization, or phlegmons of various localization. For development streptococcal Meningita, It is necessary to enter the purulent content of abscess or phlegmon with blood flow into the shell of the brain. Pushing in the bloodstream occurs due to damage to the pus wall of the vessels. And streptococcal Meningitisis just one of the manifestations of the so-called septicemia (sepsis) when the bacteria and the products of their livelihoods and decay are circteried in the peripheral blood, in the case of septicemia development against the background of angina, these bacteria is beta hemolytic streptococcus group A.

Streptococcal MeningitisFortunately, it is infrequent, however, in recent decades there is a tendency to increase the number of this disease. Streptococcal Meningitismay be observed at any age. Cause meningitis Bacteria, viruses, toxoplasms (simplest), as well as tuberculosis can serve. There are cases of occurrence meningita When exposed to (inhalation) of chemical poisons - acetone, dichloroethane and others. The most severe course has meningitiscaused by meningococcus, with this option meningitis It may flow lightning, in a few hours.

Streptococcal meningitis - clinical manifestations

Streptococcal Meningitis - Burly starts (when streptococcal MeningiteIt is possible a small incubation period), the general state is sharply deteriorating, there is a strong headache (sometimes such an intensity that patients are screaming ("meningial cry" or lose consciousness)), the body temperature is sharply. In patients S. streptococcal Meningitis Develop nonsense and hallucinations. Loud sounds and light cause pain. There is a multiple, severe vomiting (brain vomiting) that does not bring relief. Meningial symptoms are growing and growing - pathological symptoms arising from damage to the brain nerve and brain shells (symptoms of rigidity (stress) of cervical muscles, cunning, Burunzinsky, German, Guien, Mondonesees, Lesza). Also called the so-called reactive pain phenomena, in which when pressed in certain places of the head, pain is enhanced. These are the phenomena of Cerera, Bekhtereva, Pulatov, Flatau. In young children, meningitis can manifest only drowsiness, intensity or irritability. One of the first symptoms streptococcal Meningitawhich is audited at home, is a symptom of the cervical muscles - with it, the patient is involuntarily intensified the rear muscles of the neck, it cannot reach the chin to the chest. Diagnosis streptococcal Meningitiscannot be put without studying the liquid (spinal fluid). Only if there are characteristic changes in the liquor streptococcal Meningita, you can definitely diagnose. In such cases, a large number of neutrophils, protein are found in the liquor, and there is a high pressure of the liquor when taking it (spinal puncture). As a rule, the spinal points, not only diagnostic value, streptococcal MeningiteThis procedure brings a significant facilitation to the patient, due to the removal of intracranial pressure. Flow streptococcal Meningita Wears, as a rule, acute character, but may leak and lightly, as well as acquire a chronic course. Often, clinical manifestations streptococcal MeningitaMasked by a common septic state, in which a polyorgangan is observed (there are many internal organs with a pathological process) insufficiency.

Streptococcal meningitis - forecast

Forecast for streptococcal Meningite - Heavy. For absence antibiotic therapy, 95% streptococcal meningitis, ends fatally. In the era of antibiotics, mortality from streptococcal MeningitaDespite the development of high medical technologies, continues to be at the level of 5-8%. Often, the patient simply do not have time to provide the necessary medical care, so it is very important in the early stages of the disease to provide the necessary medical care. When the first signs are found streptococcal MeningitaThe patient must urgently hospitalize. Patients with such a disease are treated in specialized resuscitation compartments. Streptococcal Meningitismay be complicated by hydrocephalus, hearing impairment, up to its loss, violation of vision, lag in development, epilepsy.

In no case cannot be engaged in self-medication.

Streptococcal Meningitis - Prevention

Early diagnosis of foci of primary infection, and their early reservation. Attentive attitude towards infections caused by beta hemolytic streptococcus Group A, detection of BGSA at the stage of catarrhal changes.

Streptococcal meningitis symptoms, reasons, diagnosis

Streptococcal meningitis causes

The causative agent is streptococcus. The source of streptococcal meningitis may be a sick person or carrier.

The virulence of pathogens is determined by the antigenic properties of the microbe, the spectrum of enzymes and toxins provoking and supporting the inflammatory reactions of the macroorganism. The defeat of the central nervous system is secondary. Ways of distribution: hematogenic, contact. The probability of developing streptococcal meningitis or meningo-encephalitis increases in the presence of three factors: a virulent strain, oppression of general or local resistance, violation of the integrity of the hematorecephalic barrier.

By severity of the flow and frequency of complications, this is one of the most adverse nosological forms of bacterial neurine-faces.

Streptococcal meningitis symptoms

Clinical symptoms of streptococcal meningitis do not differ from those outlined above inherent in bacterial meningitis. The general infective, meningial syndromes, an intracranial hypertension syndrome, encephalitic syndrome are determined; It is characterized by syndrome of inflammatory changes in the liquor (neutrophil profile), edema syndrome and brain swelling outlined above.

The most frequent complications with this form of meningoen-cefalitis are swelling and brain swelling, subdural effusion and hydrocephalus. Other complications, as a rule, characterize the manifestations of severe streptococcal sepsis. These include: DVS syndrome, polyorgan deficiency syndrome.

It is necessary to remember about one important pathology caused by streptococci. This is a rheumatic lesion of brain vessels or rheumatious cerebral vasculitis, having a peculiar anamnestic and clinical and lying-gheal picture, and its possible consequences, for example, chorea.

Streptococcal meningitis diagnostics

In the hemogram - the presence of leukocytosis, the acceleration of ESO. With a lumbal puncture - liquid lying, leaks under high pressure. It is characterized by neutrophilic Plequitosis (800-1200 cells in 1 μl), the protein content is increased to 2-4 g / l. Typical is to reduce the content of glucose in the liquor.

The etiology of streptococcal meningitis is established by the release of the culture of the pathogen in bacteriological crops of liquor and blood. Conduct steam serums. Apply setting (latex agglutination).

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Streptococcal infection of the group in newborn and infants

Clinical manifestations and outcomes of streptococcal infection of the group in (SGB) in newborns, methods of diagnosing SGB infection, approaches to treatment and provincialization are considered.

Clinical Manifestations and Clinical Outcome Of Streptococcosis Of B Group, Methods of Streptococcosis Of B GROUP Diagnostic, Approaches to Treatment and Prophylaxis Are Covered.

Streptococci Group B (S. Agalactiae) is the most common cause of morbidity and mortality of newborn children from meningitis, sepsis and pneumonia in developed countries. In the United States, the heavy streptococcal infection of the group in 8,000 newborn, about 800 of these children dies. In the UK, the frequency of early neonatal infections caused by Streptococcus Group B (SGB) is 3.6 cases per 1000 newborns. Registration and prevention of SGB infection in pregnant women and newborns is carried out in many countries (USA, Canada, Australia, Belgium, France, etc.), which made it possible to radically reduce the incidence frequency and mortality from this infection in newborns. With the introduction of NGB infection in the developed countries in genera, the frequency of development of meningitis in children from 1993 to 2008 decreased by 80 percent. In Russia, measures for registration and prevention of infections caused by the SGB are not conducted.

Clinical case. The child (girl) from the first pregnancy, which occurred against the background of gestosis with a 4-fold threat of interrupt. Mother during pregnancy was the aggravation of chronic pyelonephritis. Births premature on a period of 35-36 weeks by cesarean section. Body mass at birth of 2650 sick at the age of 24 days: lethargy, subfebilitation, rejection of food, jeeping, liquid chair 3-5 times a day. On the 4th day of the disease, the condition deteriorated sharply, and the girl was hospitalized into an infectious hospital. Upon admission, the state is extremely heavy: the average coma, swelling and ripple of large springs, frequent attacks of tonic convulsions, breathing aritimic, weakening breathing in the lower lungs, skin marble, acrocyanosis, tachycardia to 190 ° C. / min, "Coffee thickness" from the stomach, oliguria. In general blood test: LEY 21400, TR 36000, P - 4%, C - 56%, e - 0%, b - 6%, L - 24%, M - 13%, T coat. 9 min, ESP 23 mm / h. Faculture Research Results: Yellow, Muddy, PH \u003d 7.0, Pandi ++++ Reaction, Nonn-Apert /+++ Reaction, Cytosis 34 thousand cells in 1 μl (neutrophils 89%, lymphocytes 11%), protein 2.98 g / l, glucose 3.8 mmol / l. In biochemical analysis of blood, moderate hyperbilirubinemia and hyperfermenia, a decrease in the prothrombin index (PT) to 40%, decompensated metabolic acidosis (pH 6.8; ve - 27.3 mmol / l) was revealed. The results of bacteriological examination of blood and liquor negative. Positive Latex Test for Antigen S. Agalactia In Likvore. Studies of feces on Rotavirus, pathogenic and conditionally pathogenic microorganisms are negative. Final diagnosis: late neonatal sepsis caused S. Agalaactiae. (Meningoencephalitis, carditis, enterocolitis, pneumonia, hepatitis). Complications: polyorgan deficiency. Septic shock II-III stage. Swelling brain swelling. Disseminated intravascular coagulation (DVS syndrome) stage III. The child received 4 courses of antibacterial therapy (ampicillin, ceftriaxone, merronic, amikacin, vancomycin), imprint therapy. Disposable in satisfactory condition on the 27th day of the disease.

Source of SGB infection and risk of a child

SGB \u200b\u200bare representatives of the normal microflora of the urogenital, intestinal tract and the upper respiratory tract of a person. The SGB is found as part of the vagina microflora in 15-45% of women. Asymptomatic colonization (carriage) prevails, but the SGB may cause the development of urinary tract infections, sepsis, chorioamnionitis, endometritis, thrombophlebitis, and endocarditis. The highest level of colonization in women under 20 years old, leading active sexual life using NMS contraception. Pregnancy does not affect the frequency of NGB.

According to our data, the frequency of S. Agalactia's carriage in the urogenital tract in women of the reproductive age of Kazan is 12.7%. The results were obtained in a bacteriological study of smears from the cervical canal, the vaginal mucosa, urine 172 women using a polychromogenic medium, followed by the identification of microorganisms on the Vitek analyzer. It is not excluded that the carrier frequency of the SGB is higher, since a bacteriological study of rectal smears was carried out.

The main source of infection of newborn children of the SGB is a mother. Child infection can occur intrauterine, as well as in childbirth. Rhodework by caesarean section does not reduce the risk of child infection with the SGB. The vertical path of the SGB transmission mainly leads to the development of early streptococcal infection (development time before the 7th day of life). The main risk factors for the development of a SGB infection in newborns are: bacteriuria S. Agalaactiae. Mother during pregnancy, neonatal SGB infections from previously born children, prematurity (

I. V. Nikolaev, candidate of Medical Sciences, Associate Professor

Kazan State Medical University, Kazan.

Streptococcal Meningitis

What is streptococcal meningitis -

What provokes / reasons for streptococcal meningitis:

The causative agent of meningitis are streptococci, which are spherical or oval cells with a size of 0.5-2.0 μm, in strokes located with pairs or short chains, can acquire an elongated or lanceal form, reminding kokcobacillos. Mixless, disputes and capsules do not form, anaerobes or optional anaerobes, temperature optimum - 37 ° C. According to the presence of special carbohydrates in the cell wall, 17 serogroups denoted by capital letters of the Latin alphabet.

Hemolytic streptococci group A are the main causative agents of disease in humans. They are responsible for pharyngitis, scarletin, cellulites, corrosive inflammation, pyodermia, impetigo, streptococcal toxic shock syndrome, septic endocarditis, acute glomerulonephritis and other diseases.

Streptococci Group B. populate the nasophal, gastrointestinal tract and vagina. Serovas 1A and 111 trops to the tissues of the central nervous system and respiratory tract and most often cause meningitis and pneumonia in newborns, as well as lesions of skin cover, soft tissues, pneumonia, endocardits, meningitis and endometritis, urinary tract damage and complications of surgical wounds with cesarean sections.

The causative agent of meningitis is hemolytic or green streptococcus, which has pronounced toxic properties, which cause the virulence of the microbe and its aggressiveness. The main ones are: Fimbrial protein, capsule and C5A-peptidase.

Fimbrial protein is the main factor of virulence, which is a typical antigen. It prevents phagocytosis, binds fibrinogen, fibrin and their degradation products, adsorb them on its surface, masking receptors for complement components and opsonins, causes the activation of lymphocytes and the formation of an antibody with low affinity.

The capsule is the second most important factor of virulence. It protects streptocoki from the antimicrobial potential of phagocytes and contributes to adhesion to the epithelium.

The third factor of virulence is C5A-peptidase, which suppresses the activity of phagocytes. Also, streptokinase, hyaluronidase, erythrogenic (pyrogen) toxins, cardiohypatic toxin, streptolysin o and S are also played in pathogenesis.

Despite the widespread streptococcal infection with extensive and diverse pathology, the purulent meningitis of streptococcal nature is rare. The pathogens are hemolytic and green streptococci (I. G. Weinstein, N. I. Postchenkov, 1962). Stressing the rarity of the disease, Noune and Herzen (1950) indicate that in world literature until 1948 they found only 63 cases of streptococcal meningitis. According to statistical data, streptococcal meningitis is observed predominantly in breast and small children, more often in the period of streptococcal septicemia with purulent otitis, feeling of the face, inflammation of the nasal cavities, endocarditis, thrombophlebitis of the brain sinuses and other purulent foci (Biedel, 1950; Baccheta, Digilio, 1960; Mannik, Baringer, Stokes, 1962). In a significant percentage of cases, the source of purulent meningitis remains unexplained (Hoyne, Herzen, 1950).

Recently, reports of a number of authors appeared, in which there is a noticeable increase in the specific gravity of streptococcal meningitis among other forms. Schneeweiss, Blaurock, Jungfer (1963) are written about this, which from 1956 to 1961 counted 2372 reports of purulent meningitis caused by Streptococcus in the literature. The clinical picture of streptococcal meningitis does not have specific features. In the overwhelming majority of cases, the disease is characterized by acute beginning, an increase in temperature to significant numbers, re-vomiting, lethargy or anxiety of a child.

Epidemiology
The reservoir is a sick person or a bacteria carrier. Main transmission paths: contact, air-drip and alimentary (through infected foods, such as milk). Children of all ages are sick, but more often newborn, in which meningitis develops as a manifestation of sepsis. In 50% of newborns, the most often infection occurs vertically - when the fetus is passing through the generic paths, infected with streptococci.

Significant colonization of the generic pathways of the mother streptococci leads to the early development of meningitis (for the first 5 days), and in children infected with a small dose, meningitis develops significantly later (from 6 days to 3 months). In 50% of patients with newborns who do not have a specific focus of infection, meningitis develops within 24 hours, while mortality reaches 37%. Of the total number of children with late manifestations of infection, development of meningitis and bacteremia die 10-20%, and 50% of the surviving children are observed coarse residual phenomena. In patients with septic endocarditis, meningitis may occur as the result of the embolism of vessels of brain shells.

Pathogenesis (what happens?) During streptococcal meningitis:

Symptoms of streptococcal meningitis:

Clinical manifestations of streptococcal meningitis do not have specific features that distinguish it from other secondary purulent meningitis.

The disease begins acutely, with an increase in body temperature, anorexia, chills, headaches, vomiting, sometimes re-expressed meningeal symptoms. It is possible to develop encephalic manifestations in the form of a violation of consciousness, clonic-tonic convulsion, tremor limbs. Characteristic of streptococcal meningitis are signs of severe septicemia: high-speed body temperature, hemorrhagic rash, increase in heart size, deafness of cardiac tones. The function of parenchymal organs is naturally affected, hepatolyenal syndrome, renal failure, the defeat of the adrenal glands arises. In the acute course of the disease, the signs of severe septicemia and encephalic manifestations may prevail over meningeal symptoms. Streptococcal meningitis with endocarditis is often accompanied by a lesion of brain vessels with hemorrhages in the subpautical space, an early occurrence of focal symptoms. The development of edema-swelling of the brain is characteristic, but the brain abscesses are rarely developed.

Staphylococcal and streptococcal meningitis are usually secondary. Mix contact and hematogenous forms. Contact purulent people are developing with osteomyelitis of the bones of the skull and spine, epidurite, brain abscess, chronic purulent middle otitis, sinusitis. Hematogenous meningitis occurs during sepsis, acute staphylococcal and streptococcal endocardite. The inflammatory process in the brain shell is characterized by a tendency to abscess.

The beginning of the disease is sharp. The main complaint is strong headaches of spilled or local character. From the 2-3rd day of the disease, meningeal symptoms are detected, total hyperesthesia of the skin, sometimes convulsive syndrome. The cranial nerves are often affected, the appearance of pathological reflexes is possible, in severe cases, there are disorders of consciousness and disruption of stem functions. Cerebrospinal fluid opalescent or muddy, its pressure is raised dramatically; Plequitosis is predominantly neutrophilic or mixed from several hundred to 3-3 thousand cells in 1 μl; Sugar and chloride content reduced, protein is increased. In the study of blood, neutrophilic leukocytosis is detected, an increase in ESP. The diagnosis is based on the data of the anamnesis, clinical manifestations and results of blood test and cerebrospinal fluid (detection of the pathogen).
An early active treatment of primary purulent focus is required against the background of antibacterial therapy by oxacillin, aminoglycosides, cephalosporins, bispetol, etc. (depending on the sensitivity of the dedicated strain of the pathogen). Antibacterial therapy is combined with the use of antistaphococcal gamma globulin, antistaphococcal plasma, bacteriophage, immunomodulators. The forecast is heavy, defined both by direct damage to the central nervous system and the flow of a common septic process.

Diagnosis of streptococcal meningitis:

The main diagnostic criteria of streptococcal meningitis:
1. Epidanamnez: The disease develops against the background of streptococcal sepsis, less often - other streptococcal disease, the pathogen spreads hematogenically or lymphogenically, children of any age are sick, but more often newborns.
2. The beginning of meningitis is acute, with the development of signs of severe septicemia: significant intelligence of the temperature reaction, the presence of hemorrhagic rash, hepatolyenal syndrome and pronounced meningeal symptoms.
3. Often quickly develops swelling of brain swelling, encephalic focal symptomatomy.
4. often proceeds with involvement in the infectious process of other vital organs and systems (liver, heart, lungs, adrenal glands).
5. Isolation of hemolytic streptococcus from the CSW, the blood confirms the etiological diagnosis.

Laboratory diagnostics
General blood analysis. In peripheral blood, leukocytosis, neutrophileese, the shear of the blood formula left, elevated ESO is found.
Research of liquor. In the cerebrospinal fluid, high neutrophily plea) (thousands of cells in 1 μl) are revealed, an increase in the protein content (1-10 g / l) and a decrease in glucose levels. During bacterioscopy, gram-negative coccoints are found.
Bacteriological research. The selection of the pathogen is the most reliable method. Produce it by sowing blood, mucus from the nose and zea, sputum, liquor on the blood agar. On the liquid media streptococci give the bottom, rising growth. For differentiation, the revealed microorganisms fall on a thioglycolic environment, a semi-liquid agar.
Bacterioscopic examination. With bacterioscopy in the smears, typical gram-positive coils forming short chains are detected, but polymorphic forms can be detected.
Serological examination. Serotyping is carried out in the reaction of latex agglutination or coagglutination using monoclonal antibodies labeled with fluorescins.

Treatment of streptococcal meningitis:

Secondary purulent meningitis leaks no less hard than meningococcal meningitis. Treatment should be started already in the pre-hospital stage with the introduction of penicillin. It is prescribed on 200,000 - 300,000 units / kg body weight per day intramuscularly.

With pneumococcal meningitis, Penicillin dose is 300,000-500,000 units / kg per day, with severe condition - 1,000,000 units / kg per day. With streptococcal meningitis, Penicillin is prescribed to 200,000 units / kg per day.

In staphylococcal and streptococcal meningitis, semi-synthetic penicillins (methisillalin, oxacillin, ampicillin) are also intramuscularly used at a dose of 200-300 mg / kg per day. Sodium succinate in a dose of 60-80 mg / kg per day, clafranoran - 50-80 mg / kg per day can be prescribed.

Under meningitis caused by PFFiffera-Afanasyev wand, an intestinal wand, a bacillus freedlander or salmonella, the maximum effect gives Levomycetin Sodium succinate, which is prescribed at a dose of 60-80 mg / kg per day intramuscularly with an interval of 6 to 8 hours. Effective neomycin sulfate is also effective. 50,000 units / kg 2 times a day.

Morphocyclin is also recommended - 150 mg 2 times a day intravenously drip.
In staphylococcal meningitis, staphylococcal animal in a dose of 0.1-0.3-0.5-0.7-1 ml intramuscularly, anti-staphylochemical gamma globulin - 1 - 2 doses intramuscularly for 6-10 days, immunized antistaphococcal plasma - 250 ml 1 time in 3 days.

Prevention of streptococcal meningitis:

What doctors should be pleased if you have streptococcal meningitis:

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What doctors should contact if you have streptococcal meningitis

What is streptococcal meningitis

Streptococcal Meningitis - (m. Streptococcica) purulent meningitis arising from the generalization of streptococcal infection or when penetrating pathogens into cerebral shells from nearby organs (middle ear, near-axis sinuses, etc.). It is characterized by a rapid beginning with the development of edema-swelling of the brain, encephalic focal symptoms, defeat other organs and systems.

What provokes streptococcal meningitis

The capsule is the second most important factor of virulence. It protects streptocoki from the antimicrobial potential of phagocytes and contributes to adhesion to the epithelium.

Pathogenesis (what is happening?) During streptococcal meningitis

Most often, the entrance gate of the infection is damaged skin cover (diarmity, materaction areas, burns, wounds), as well as the mucous membranes of the nasopharynk, the upper respiratory tract (streptodermia, phlegmon, abscess, purulent-necrotic rhinitis, nico-pharyngitis, otitis, tracheobronchitis, etc.) . However, in most cases, the source of the development of purulent meningitis cannot be identified. The outcome of the infection of the streptococcus of a newborn baby to directly depends on the state of its cellular and humoral protection factors and the value of the infecting dose.
In the place of implementation, Streptococcus causes not only catarrhal, but also purulent-necrotic inflammation, from where it is rapidly distributed throughout the body lymphogenically or hematogenous. Streptococcus, its toxins, enzymes, lead to activation and increase of biologically active substances, impaired hemostasis, metabolic processes with the development of acidosis, an increase in the permeability of cellular and vascular membranes, as well as the BC. This contributes to the penetration of streptococcus in the central nervous system, the damage to the brain shells and the brain substance.

Symptoms of streptococcal meningitis

Clinical manifestations of streptococcal meningitis do not have specific features that distinguish it from other secondary purulent meningitis.

Diagnosis of streptococcal meningitis

Treatment of streptococcal meningitis

Prevention of streptococcal meningitis

IN prevention of streptococcal meningitisan important role is to popularize information about the paths of the spread of infection, since the disease is more often transmitted by air-droplet, the patient and others should know that infection is possible when talking, cough, sneezing. An important role in the prevention of meningitis is played by hygienic skills, household conditions.

These diseases are usually secondary origin and arise as a complication of inflammatory processes in the middle ear, the appointments of the nose, during the face of the face and other purulent foci. The most frequent pathogens are hemolytic and green streptococci, golden and white staphylococci. Cases of meningitis caused by green streptococcus began to be described relatively not so long ago. Goyn and Geong until 1948 in world literature found 63 cases of this meningitis (34 patients recovered and 29 died). According to statistical data, from all purulent meningitis, green streptococcus was determined in 0.3-2.4% of cases. The authors indicate that the source of meningitis caused by this pathogen, in 13% of cases (from 63) was a heart disease (Endocarditis Lenta), in 31% of ear disease, throat and nose, in 21% - diseases of other bodies and in 35% of cases Meningitis turned out to be "isolated".

Staphylococcal meningitis meets less often. Symptomatologically streptococcal and staphylococcal meningitis proceed mainly as other purulent meningitis, and are characterized by a pronounced clinical picture and a severe course of the disease. The latter is determined by the presence of a primary purulent focus in any organ and the fact that these purulent meningitis often represent only a particular manifestation of a common disease with localization in brain shears.

The disease develops acutely, from the first days there is a high temperature, vomiting, clearly protrude symptoms of Kerniga, Brudzinsky and the rigidity of the occipital muscles. When involving the brainstant, depending on the localization of the lesion, there are sometimes cramps and rarely focal draws. The latter are usually due to concomitant brain abscesses or thrombosis of cerebral vessels. With general sepsis or septicopemia, skin rashes appear, an increase in the liver and spleen, lesions of the joints, the inflammation of the lungs, purulent pleurisites, pericarditis, jade, etc.

With the spinal puncture, the liquid flows under high pressure; Sometimes in cases where it wears a pronounced purulent nature, the liquid can flow slowly and with reduced pressure. The protein content is sharply increased, cytosis is high, predominantly neutrophil. Bacterioscopically and bacteriologically, the pathogen is determined in the liquid. However, the liquid is often sterile. Case cases of purulent meningitis from their own observations. One patient in the blood was discovered golden staphylococcus, in the other in the spinal fluid - green streptococcus and the third pathogen was not found, although the source of meningitis should be considered a furunculese.

Clinic

1. Patient T., 39 years old. Received November 13th. From November 3 notes ailment, pain in the lumbar region and abdomen. From November 11, a strong headache appeared, a temperature of 38.9 °. The patient appealed to the doctor and with a diagnosis of abdominal typhoid was sent to the hospital. Upon admission, the condition is severe, the patient is sluggish, drone. Nausea and vomiting is not. Meningheal symptoms are expressed. Rash on the skin is not. Language is covered, in zea light hyperemia. The liver is palpable from the hypochondrium, the spleen is not palpable. Respiratory and blood circulation organs without features. Urination freely. The spinal puncture is made: the liquid is muddy, followed by frequent drops, protein 1.32% o, cells 1050 in 1 mm 3, of which 90% neutrophils, 10% lymphocytes. Blood test: l. 12 000, p. 9%, p. 74%. Lymph. 13%, MON. four%; Roe 37 mm per hour. Eye bottom normal. In liquid microflora was not found. Sowing blood- Golden Staphylococcus. Diagnosis: purulent meningitis. The treatment of penicillin (endoomumboral and intramuscularly) and sulfatiazole has begun. From 21 / XI, the temperature fell to normal numbers and kept at such a level until November 20, then rose again to 38.6 ° and lasted on such numbers 4 days. In the future, before the discharge of the patient, the temperature was normal. The meningeal syndrome by November 26 was flushed completely, but in the period of re-lifting the temperature revealed to a weak degree again and lasted 5 days. The spinal fluid on December 3 contained a protein of 0.26%, cells 46 in 1 mm 3, of which are 90 ° / oh lymphocytes, 10 ° / o neutrophils. In total, a total of 13,600,000 units of Penicillin and 30 g of sulfatiazole received the patient. Disposable in satisfactory condition.

2. Patient G., 56 years old. Received the hospital on November 19th. The condition is severe, consciousness is darkened. According to his daughter, the patient on November 18 complained to headache, runny nose, embedded in the ears. Temperature 37.6 °. I slept badly at night because of pain in the stomach and vomiting. In the afternoon, November 19 was taken to the hospital. The past two years in the patient noted an increased blood pressure (180/100 mm). Detected duodenal ulcer.

The patient of the right physique, the subcutaneous layer is expressed. The boundaries of the heart are expanded to the left, the tones of the heart are muffled. Pulse 120 beats per minute. Blood pressure 180/90 mm mercury post. Language is dry, covered, the stomach will be off. Light within the normal range. Exophthalm more on the right. Pupils are uniform, the reaction to the light is saved, a slight internal squint on the left. Language in the mouth of the middle line. Parares are not. Resists inspection. Tender reflexes are alive, pathological are not called. Rigidity of the nape, bilateral symptom of Kerniga. A more detailed examination cannot be made due to the severe state of the patient. A spinal puncture is made: liquid turbid, pressure 500 mm of water column, protein 2.31%, cytosis of 1600 cells in 1 mm 3, of which neutrophils are 95%, lymphocytes 3% and plasma cells 2%. Blood test: l. 12 500, p. 9%, p. 83%, lymph. 4%, MON. four%; Roe 10 mm per hour. According to the conclusion of the otolaryngologist, there are no inflammatory changes in the ears. Eye bottom normally. Diagnosis: purulent meningitis. Treatment with sulfanimide and penicillin intramuscularly and endoomumoral (100,000 units).

With repeated puncture (November 21) in the liquor cytosis of 6000 cells in 1 mm, of which are lymphocytes of 50%, neutrophils of 48%, 2% eosinophils, protein 0.9%.

From November 23, the condition improved, the patient came into consciousness. Sowing the spinal fluid gave an increase in green streptococcus. In the future, meningeal symptoms were gradually smoothed, the temperature decreased to the norm, giving the subfebrile lifts at times. During the disease there was a peptic stomatitis and an ulcer on the inner surface of the left hip below the inguinal bend. The affectionant was opened. By November 29, the spinal fluid was saved, and 15 Mayabolian was discharged from the hospital.

3. Patient M., 58 years old. He entered the hospital on December 28 in a state of moderate gravity with complaints of headache, weakness, chills and cough with a mocroid. The ailment felt from December 13, and on December 15, chills appeared, muscle pain and severe headache. From December 27, high temperature. He turned to the doctor and was hospitalized on December 28th. Upon arrival in the patient, abundant rash on the body, shortness of breath, shortening the percussion sound to the right in the field of the lower lobe of the lung, the presence of dry and wet wheezing on this site. From the side of the cardiovascular system, special changes are not marked. The liver was palpable at the edge of the rib, the spleen did not fit. Meningeal phenomena was not. On the right temple the traces of the former furuncule, on the lower back the furuncle at the stage of reverse development. From December 29, consciousness is darkened, the headache intensified, there were sharply pronounced meningeal symptoms (rigidity of the nape, symptoms of Kernig, Brudzinsky). In the spinal point of the puncture, a turbid fluid, containing 2.64% protein, cytosis of 1280 cells in 1 mm (neutrophils 55 ° / o, lymphocytes of 40%, microphages 1%, plasma cells 4%), sugar 83 mg% and chlorides of 561 mg%. Blood test: l. 9000, Yu. 1%, e. 1%, p. 8%, p. 73%, lymph. 16%, MON. 2%; Roe 40 mm per hour. Remained blood crops and liquids are sterile. Upon conclusion of the eyepiece, the neuroretinite of the left eye. ENT organs are normal. Diagnosis: purulent meningitis.

Penicillin (endolumboral and intramuscular) treatment was carried out, sulfanimides, glucose and urotropin. The meningeal syndrome by January 4 was smoothed, but the pathological changes in fluids were kept until November 20. Temperature from December 31 is normal. Disposable November 26th.

The course of the disease Usually acute, in part wears subacute, chronic, and sometimes remitting character. The differential diagnosis of streptococcal and staphylococcal meningitis is carried out mainly on the basis of the following factors:

detection in the spinal fluid of the appropriate pathogen;
detection of purulent focus in any organ.

Since the spinal fluid is often sterile, it is necessary to close primary foci more carefully (purulent inflammation of the middle ear, furuncular, osteomyelitis, panaria, etc.). It is necessary to conduct a detailed examination of the heart, lungs, kidney and other organs. Usually, the primary source of purulent meningitis can be found, but in cases where it is impossible. During the epidemic of meningococcal meningitis, the diagnosis is established without much difficulty; In sporadic cases of this disease, the differential diagnosis is very difficult, since the symptoms of meningococcal meningitis and other purulent meningitis is similar, especially in the first days of the disease. The course of the disease and the therapeutic effect of therapeutic drugs used can also help in a differential diagnosis. It should be borne in mind that during meningococcal meningitis, currently known treatment methods have a very beneficial effect on the course of the disease, while with purulent meningitis of other etiologies the treatment effect is relative. If with meningococcal meningitis, there are often abortive and light shapes of the flow, then with staphylococcal and streptococcal meningitis, this happens much less frequently. Finally, when meningococcal meningitis, in the overwhelming majority of cases, there is a favorable outcome (with the exception of young children), and with purulent meningitis, other etiology mortality is still significant.

Pathogenesis

Streptococcal and staphylococcal meningitis (Meningitis Streptococci et staphylococci) is usually secondary purulent meningitis. Streptococcal meningitis occurs less frequently pneumococcal. Streptococcal and staphylococcal meningitis can be an complication of purulent otitis, mastoiditis, inflammatory processes of the apparent cavities of the nose and other purulent and septic processes. With beaches of meningitis, more often than other microorganisms are encountered streptococcus. With the purulent meningitis complicating the furunculosis, the causative agent is usually golden staphylococcus.

Symptomatology

The clinical picture of streptococcal and staphylococcal meningitis is the same as with other purulent meningitis. The etiological diagnosis is possible only with bacteriological examination of the spinal fluid.

Treatment

The forecast of streptococcal meningitis before the use of sulfanimamides and antibiotics was unfavorable: mortality reached 97%. With the introduction of sulfonilamidotherapy, it decreased to 21%. Since the use of antibiotics, the forecast has improved significantly.

Hemolytic streptococcus is sensitive to sulfonamide, and green - to penicillin. Aswod believes that with purulent meningitis caused by hemolytic streptococcus, very effective treatment with large doses of penicillin (1,000,000 units after 2 hours) in combination with sulfanimamides. Hoan and Kherson, leading 9 cases of recovery (out of 12), noted that due to the treatment of sulfanimide and penicillin, the forecast of meningitis caused by the green streptococcus has improved. While until 1947, only 9 cases of recovery were published in world literature, in the following years 34 of 63 patients recovered.

As for purulent meningitis due to golden staphylococcus, a good effect is observed in the treatment of penicillin. There are also indications of greater efficiency of streptomycin. However, it should be noted that staphylococcis relatively quickly acquire antibiotic resistance.

Streptococcal Meningitis- (m. Streptococcica) purulent meningitis arising from the generalization of streptococcal infection or when penetrating pathogens into cerebral shells from nearby organs (middle ear, near-axis sinuses, etc.). It is characterized by a rapid beginning with the development of edema-swelling of the brain, encephalic focal symptoms, defeat other organs and systems.

What provokes streptococcal meningitis:

Hemolytic streptococci group Aare the main causative agents of disease in humans. They are responsible for pharyngitis, scarletin, cellulites, corrosive inflammation, pyodermia, impetigo, streptococcal toxic shock syndrome, septic endocarditis, acute glomerulonephritis and other diseases.

Streptococci Group B.populate the nasophal, gastrointestinal tract and vagina. Serovas 1A and 111 trops to the tissues of the central nervous system and respiratory tract and most often cause meningitis and pneumonia in newborns, as well as lesions of skin cover, soft tissues, pneumonia, endocardits, meningitis and endometritis, urinary tract damage and complications of surgical wounds with cesarean sections.

The capsule is the second most important factor of virulence. It protects streptocoki from the antimicrobial potential of phagocytes and contributes to adhesion to the epithelium.

Pathogenesis (what happens?) During streptococcal meningitis:

Symptoms of streptococcal meningitis:

Clinical manifestations of streptococcal meningitis do not have specific features that distinguish it from other secondary purulent meningitis.

Staphylococcal and streptococcal meningitis are usually secondary. Mix contact and hematogenous forms. Contact purulent people are developing with osteomyelitis of the bones of the skull and spine, epidurite, brain abscess, chronic purulent middle otitis, sinusitis. Hematogenous meningitis occurs during sepsis, acute staphylococcal and streptococcal endocardite. The inflammatory n rozzes in the brain shell is characterized by a tendency to abscess.

Diagnosis of streptococcal meningitis:

Treatment of streptococcal meningitis:

Prevention of streptococcal meningitis:

Diseases

This is an inflammatory process that is localized in the shells of the spine and brain. With a timely and professional medical approach, the disease can be fully cured. For the first time, this ailment was officially recorded in 1805, although his signs are known since the time of the hippocrat. In our country, Meningit is diagnosed in 1863. By the end of the 20th century, cases of this ailment were recorded more and less. But in recent years, the increase in incidence is noted. Streptococcal meningitis is considered one of the most common species. It develops when a person infects the same microorganisms.

Symptoms of Disease

The clinical picture of streptococcal meningitis is similar to other forms of this illness and does not have specific signs. As a rule, the development of the disease is characterized by an acute flow. For streptococcal meningitis, such manifestations are characteristic:

Also, in some cases such symptoms may be observed:

rash on the skin, change its color (pallor);
increased excitability and concern;
mental disorders (loss of orientation in space).

Also, sometimes in patients with streptococcal meningitis are observed photophobia and characteristic signs of hyperactus (distorted perception of sounds). These manifestations are caused by irritation of receptors and nerve endings in cerebral shells. They are especially brightly expressed in children and adolescents. Less often appear opposite symptoms. For example, if the disease amazes the auditory and visual nerves, problems can arise with the relevant senses.

In the role of the causative agent of this disease, the Bacterium Streptococcus appears. The source of streptococcal meningitis can be its carrier or a sick man. The main routes of transmission of doctors include the following:

airborne drip;
hematogenic;
contact.

Also, infection can occur with an alimentary way, that is, with the use of unwashed food, infected water or insect bite. People of all ages are sick of streptococcal meningitis, but more innanyby children are more in this form of illness. In 50% of cases, infection of infants occurs when the fetus passes through the generic paths, which are infected with pathogenic microorganisms. Also, the baby can get sick already during the period of tooling.

Streptococcal meningitis is considered one of the most dangerous ailments of the brain. The success of treatment largely depends on its timely diagnosis. Therefore, at the very first uncharacteristic manifestations or changes in behavior, seek help from a specialist. Treatment of this disease, such doctors are engaged:

In some cases, it may be necessary to consult an immunologist. At the reception, the doctor must carefully listen to the patient's complaints and conduct a visual inspection. It will appreciate the condition of the skin and measure the body temperature. In addition, the doctor will ask:

How long have you started to disturb the unpleasant feeling?
Is the tremor of the limbs observed?
Do headaches and nausea torment?
What chronic diseases are in history?
Did the patient use the unwashed products?

One survey is usually not enough. The doctor must write down the direction on the hardware study and analyzes. Only the passage of these medical manipulations will allow to deliver the most accurate diagnosis. After the results will be prepared, the doctor, having familiarized themselves with them, will appoint an appropriate course of therapy, oriented to eliminate the cause and symptoms of illness. In compliance with all medical requirements, the likelihood of complete recovery, without complications, is quite large.