Infectious diseases. Meningococcal infections. Clinic. Diagnostics. Treatment (most important)

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Infectious diseases. Meningococcal infections. Clinic. Diagnostics. Treatment (most important)

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10. Meningococcal infections. Clinic. Diagnostics. Treatment

Clinical manifestations. The most common manifestation of meningococcal infection is acute respiratory infections of the upper respiratory tract with bacteremia, resembling common colds.

Acute meningococcemia can present as a flu-like illness with fever, malaise, and muscle and joint pain. Headaches and dysfunction of the gastrointestinal tract may occur. A few hours or days after the onset of the disease, morbilliform petechial or hemorrhagic skin rashes are detected.

Septicemia may be fulminant, accompanied by exceptionally rapid progression of purpura and shock.

Acute meningococcemia is usually not so violent, the severity of the patient's condition varies, and the ongoing therapy gives a good effect. Metastasis of the process to various organs is noted due to hematogenous dispersion of the pathogen. The development of meningitis against the background of acute meningococcemia is accompanied by the appearance of lethargy, vomiting, photophobia, convulsions and other symptoms of irritation of the meningeal membranes.

Chronic meningococcemia is rare in children and is characterized by loss of appetite, weight loss, chills, fever, arthralgia or arthritis, and maculopapular rash.

Diagnosis. In children of the first year of life, the diagnosis is established on the basis of pronounced symptoms of intoxication, anxiety, hyperesthesia, tremor of the hands, chin, convulsions, tension and bulging of the large fontanel, a symptom of suspension.

Lumbar puncture and the results of laboratory tests are of decisive importance in the diagnosis of meningitis: bacteriological examination of the sediment of the cerebrospinal fluid and blood smears, bacteriological cultures on nutrient media of the cerebrospinal fluid, blood, mucus from the nasopharynx, serological research methods that allow to detect a low content of antibodies (RPHA) and a minimum concentration in blood of patients with meningococcal toxin (VIEF), immunoenzymatic and radioimmune research methods.

Treatment. Penicillin G is prescribed for intravenous administration. If there are doubts about the etiology of the disease, ampicillin is used, with an allergy to penicillin - cefuroxime, cefotaxime and ceftriaxone, which give a good effect in the treatment of meningococcal meningitis and other localizations of this infection. In severe infection and threatening shock, immediate intravenous hydrocortisone is indicated. With the development of shock or disseminated intravascular coagulation, the introduction of a sufficient amount of osmotically active fluids is required in order to maintain an adequate level of blood pressure. In this case, patients are shown the introduction of fresh whole blood and heparin.

Author: Pavlova N.V.

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